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BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited. METHODS: Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records. RESULTS: In the full cohort of 8465 patients, the mean ± SD age at diagnosis was 59.3 ± 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan. CONCLUSIONS: The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.
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Neoplasias Colorrectales , Utilización de Instalaciones y Servicios , Gastos en Salud , Anciano , China/epidemiología , Neoplasias Colorrectales/economía , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/terapia , Utilización de Instalaciones y Servicios/economía , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Femenino , Gastos en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The impact of participating in breast cancer screening programmes on health-related quality of life (HRQoL)is poorly understood. METHODS: Based on a national breast cancer screening programme in China, a multicentre cross-sectional survey was conducted covering 12 provinces from September 2013 to December 2014. HRQoL of participants in the screening population and general population was evaluated by the three-levelEuroQol-five-Dimensions (EQ-5D-3L) instrument, and utility scores were generated through the Chinese value set. Univariate and multivariate regression analyses were performed to explore determinants of utility scores and anxiety/depression problems. RESULTS: For screening group and general population (n = 4756, mean age = 51.6 year old), the corresponding utility scores were 0.937 (95% CI, 0.933-0.941) and 0.953 (0.949-0.957) (P < .001). Pain/discomfort and anxiety/depression were the most common reported in both groups (51.4% and 34.3%, P < .001). Utility scores at prescreening, in-screening, and postscreening interview timings were 0.928 (0.921-0.935), 0.958 (0.948-0.969), and 0.938 (0.933-0.943), respectively (P < .001); the corresponding proportions of anxiety/depression reporting were 25.9%, 16.3%, and 21.1%, respectively (P = .004). Interview timing, geographical region, and insurance status were associated with HRQoL and anxiety/depression in women at high-risk of breast cancer. CONCLUSIONS: Utility scores of screening participants were significantly lower than that of general population in China, but the difference may be clinically insignificant. Further cohort studies using HRQoL measurements are needed.
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Neoplasias de la Mama/psicología , Detección Precoz del Cáncer/estadística & datos numéricos , Calidad de Vida , Adulto , Anciano , Ansiedad/epidemiología , Neoplasias de la Mama/diagnóstico , China/epidemiología , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Medición de RiesgoRESUMEN
The aim of investigation is to explore the relationship between demands for lung cancer screening (LCS) and the constructs derived from the health belief model (HBM) in Hefei. The study collected data about socio-demographics, health beliefs in and demands for LCS during early June to later July 2015. By constructing a LCS demands HBM constructs, it calculated indices of demands for LCS (DSI) and HBM constructs, which include perceived risk (PR) and seriousness (PS) of the cancers; and perceived effectiveness (PE), benefits (PB) and difficulties (PD) of the screening. It also performed descriptive and multivariate regression analysis of the demands and the HBM constructs. The amount of 823 respondents participated and completed the survey. 6.4% of them had ever undertaken LCS, whereas 60.1% of them expressed willingness to accept the service of LCS if it is free. In multiple regression analysis which used weights in calculating the HBM construct indices, education displayed significant positive associations with DSI (p = .044), and most of HBM constructs indices (PSI, PRI, PBI, and PDI) were statistically significant with DSI (p < .05). HBM-based constructs regarding LCS have important effects on demands for the service, and may provide effective paths to cancer screening promotion.
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Actitud Frente a la Salud , Detección Precoz del Cáncer , Neoplasias Pulmonares/diagnóstico , Aceptación de la Atención de Salud , Adulto , Anciano , China , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Percepción , Análisis de Regresión , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To demonstrate that an enhanced sediment microbial fuel cell (SMFC) system can accelerate the degradation of cellulose in fresh water sediments as the accumulation of cellulose in lake sediments may aggravate the lake marsh, increase organic matter content and result in rapid deterioration of water quality and damage the ecosystem. RESULTS: After 330 days the highest cellulose removal efficiency (72.7 ± 2.1 %) was achieved in the presence of a SMFC with a carbon nanotube decorated cathode, followed by a SMFC without the cathode decoration (64.4 ± 2.8 %). The lowest cellulose removal efficiency (47.9 ± 2.1 %) was in the absence of SMFC. The sediment characterization analysis confirmed that the carbon nanotube decorated cathode enhances the electron transfer rate in the SMFC and improves the dissolved organic matter oxidation rate. CONCLUSION: This study offers a relatively simple and promising new method for cellulose degradation in sediment.
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Fuentes de Energía Bioeléctrica , Celulosa/metabolismo , Agua Dulce/microbiología , Sedimentos Geológicos/microbiología , Electrodos/microbiología , Transporte de Electrón , Hidrólisis , Lagos/microbiología , Nanotubos de Carbono/microbiología , Oxidación-ReducciónRESUMEN
A multi-walled, carbon nanotube (MWNT)-modified graphite felt (GF) cathode was fabricated to improve the performance of sediment microbial fuel cells (SMFC). Three types of MWNT-modified GF cathodes were prepared by different electrophoretic deposition (EPD) times. Maximum power density of SMFC with MWNT-GF*** cathode at 60 min EPD was 215 ± 9.9 mW m(-2). This was 1.6 times that of SMFC with a bare GF cathode. Cyclic voltammetry and the amount of biomass showed that biomass density and electrochemical activity increased as the electrophoretic deposition time extended. Therefore the electrode possesses the highest catalytic behavior toward O2 reduction reaction. This simple process of carbon nanotube modification of a cathode by EPD can serve as an effective technique to improve the performance of SMFC.
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Fuentes de Energía Bioeléctrica , Biotecnología/métodos , Nanotubos de Carbono/química , Electrodos , ElectroforesisRESUMEN
To perform a meta-analysis investigating the association of MTHFR C677T polymorphism and susceptibility of cervical cancer. All case-control studies published in English and Chinese with estimates of the relationship between MTHFR C677T polymorphism and risk of cervical cancer were analyzed using odds ratio (OR) with 95 % confidence interval (CI). A total of 10 studies (2,023 cases and 2,570 controls) were included in the meta-analysis. No significant association was observed between T allele and C allele (OR = 0.90; 95 %CI = 0.70-1.17; P = 0.43), and for genotype TT versus CC (OR = 1.09; 95 %CI = 0.74-1.61; P = 0.67), CT versus CC (OR = 0.95; 95 %CI = 0.75-1.20; P = 0.65), CT + TT versus CC (OR = 0.91; 95 %CI = 0.66-1.24; P = 0.55). The current meta-analysis results suggest that the MTHFR C677T polymorphism may not be associated with cervical cancer.
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Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo de Nucleótido Simple , Neoplasias del Cuello Uterino/genética , Alelos , Estudios de Casos y Controles , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Oportunidad Relativa , Sesgo de PublicaciónRESUMEN
PURPOSE: Although arachnoid granulations (AGs) were initially described by Pacchioni more than 300 years ago, they are still poorly described, especially those in middle cranial fossa. The aim of this study was to identify anatomical features of AGs in middle cranial fossa of cadaver and compare such features with that of 64-slice computed tomography. METHODS: The study involved anatomical dissection of 33 adult cadaveric heads and computed tomographic (CT) examinations of 40 patients with various intracranial diseases. The number, size, distribution, and morphology of the AGs in middle cranial fossa of the cadavers and patients were examined and compared. RESULTS: The number of AGs observed on the middle cranial fossa of the cadaveric specimens was greater than that of the patients (P < 0.05). While anatomic dissection revealed a total of 228 AGs in 24 of 33 cadaveric heads, CT scans demonstrated only 80 AGs in 23 of 40 patients. In cadavers, the AGs occurred in the following sites in order of frequency: the middle meningeal sinus (144 AGs, 63.2%), sphenoparietal sinus (47 AGs, 20.6%), lateral foramen rotundum (19 AGs, 8.3%), and cavernous sinus (18 AGs, 7.9%). In CT images, the AGs occurred in the following sites in order of frequency: the middle meningeal sinus (50 AGs, 62.5%), sphenoparietal sinus (23 AGs, 28.8%), and lateral foramen rotundum (7 AGs, 8.8%). The AGs of cavernous sinus and venous lacunae adjacent to the middle meningeal sinus were hardly identified on CT images. Most of the AGs were spherical or finger-like in shape. Histologically, the AGs can be divided into two types: single type and lobulated type. CONCLUSIONS: The study provides a detailed description of AGs in or near the middle meningeal sinus, sphenoparietal sinus, lateral foramen rotundum, and cavernous sinus. It also reveals a difference in the ability of detecting cranial AGs between microanatomy and CT scans.
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Aracnoides/patología , Enfermedades del Sistema Nervioso Central/patología , Fosa Craneal Media/patología , Adulto , Anciano , Aracnoides/diagnóstico por imagen , Cadáver , Enfermedades del Sistema Nervioso Central/diagnóstico por imagen , Fosa Craneal Media/diagnóstico por imagen , Femenino , Humanos , Masculino , Microdisección , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
There are two mol-ecules in the asymmetric unit of the title compound, C(17)H(20)O(4)S(2). There are slight differences in the twist of the two rings relative to the S-C-S chain [dihedral angles of 48.41â (18) and 87.58â (16)° in the first mol-ecule and 45.98â (18) and 87.02â (18)° in the second] and the difference in the C-S-C-S torsion angles [176.68â (17) and -77.6â (2)° for the two independent mol-ecules].
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BACKGROUND: The study was conducted to examine changes in diagnostic and staging imaging methods for lung cancer in China over a 10-year period and to determine the relationships between such changes and socioeconomic development. METHODS: This was a hospital-based, nationwide, multicenter retrospective study of primary lung cancer cases. The data were extracted from the 10-year primary lung cancer databases at eight tertiary hospitals from various geographic areas in China. The chi-squared test was used to assess the differences and the Cochran-Armitage trend test was used to estimate the trends of changes. RESULTS: A total of 7184 lung cancer cases were analyzed. Over the 10-year period, the utilization ratio of diagnostic imaging methods, such as chest computed tomography (CT) and chest magnetic resonance imaging (MRI), increased from 65.79% to 81.42% and from 0.73% to 1.96%, respectively, while the utilization ratio of chest X-ray declined from 50.15% to 30.93%. Staging imaging methods, such as positron emission tomography-CT, neck ultrasound, brain MRI, bone scintigraphy, and bone MRI increased from 0.73% to 9.29%, 22.95% to 47.92%, 8.77% to 40.71%, 42.40% to 62.22%, and 0.88% to 4.65%, respectively; abdominal ultrasound declined from 83.33% to 59.9%. These trends were more notable in less developed areas than in areas with substantial economic development. CONCLUSION: Overall, chest CT was the most common radiological diagnostic method for lung cancer in China. Imaging methods for lung cancer tend to be used in a diverse, rational, and regionally balanced manner.
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Huesos/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Diagnóstico por Imagen/tendencias , Neoplasias Pulmonares/diagnóstico por imagen , Huesos/patología , Encéfalo/patología , China , Diagnóstico por Imagen/métodos , Femenino , Humanos , Neoplasias Pulmonares/patología , Imagen por Resonancia Magnética , Masculino , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Estudios Retrospectivos , Centros de Atención Terciaria , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: This study aimed to explore the clinical profile and its trajectory of lung cancer on clinicopathological characteristics and medical service utilization in China. METHODS: Patients diagnosed with primary lung cancer in tertiary hospitals during 2005-14 were selected from seven geographic regions of China. Data on clinical characteristics and medical service utilization was extracted from medical record, and the ten-year trends were explored. RESULTS: A total of 7184 patients were included, the mean age was 58.3 years and the male-to-female-ratio was 2.7. From 2005 to 2014, the proportion of ≥60 year-old patients increased from 41.2% to 56.2% (p < 0.001). The smoking rate decreased from 62.9% to 51.1% (p < 0.001) and the proportion of females increased from 23.5% to 31.9% (p < 0.001). The proportion of advanced stage increased from 41.9% to 47.4% (p < 0.001). Adenocarcinoma's proportion increased from 36.4% to 53.5% (p < 0.001) while that of squamous carcinoma decreased from 45.4% to 34.4% (p < 0.001). The application of chest X-ray dropped from 50.2% to 31.0% (p < 0.001) but that of chest CT increased from 65.8% to 81.4% (p < 0.001). As two main treatment options, chemotherapy (p = 0.290) and surgery (p = 0.497) remained stable. The medical expenditure per patient increased from 40,508 to 66,020 Chinese Yuan (p < 0.001). CONCLUSIONS: The sustaining high smoking exposure, increasing proportion of female patients, advancing clinical stage, shifting of predominant pathology and increasing medical expenditure demonstrate potential challenges and directions on lung cancer prevention and control in China. Despite substantial changes of clinical characteristics, main treatment options remained unchanged, which needs further investigation.
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Neoplasias Pulmonares/epidemiología , Aceptación de la Atención de Salud , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Diseño de Investigaciones Epidemiológicas , Femenino , Gastos en Salud , Historia del Siglo XXI , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/historia , Neoplasias Pulmonares/terapia , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Estudios Retrospectivos , Factores de Riesgo , Clase Social , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
BACKGROUND: Most lung cancer patients are diagnosed after the onset of symptoms. However, whether the symptoms of lung cancer were independently associated with the diagnosis of lung cancer is unknown, especially in the Chinese population. METHODS: We conducted a 10 years (2005-2014) nationwide multicenter retrospective clinical epidemiology study of lung cancer patients diagnosed in China. As such, this study focused on nonsmall cell lung cancer (NSCLC). We calculated the odds ratios (ORs) for variables associated with the symptoms and physical signs using multivariate unconditional logistic regressions. RESULTS: A total of 7184 lung cancer patients were surveyed; finally, 6398 NSCLC patients with available information about their symptoms and physical signs were included in this analysis. The most common initial symptom and physical sign was chronic cough (4156, 65.0%), followed by sputum with blood (2110, 33.0%), chest pain (1146, 17.9%), shortness of breath (1090, 17.0%), neck and supraclavicular lymphadenectasis (629, 9.8%), weight loss (529, 8.3%), metastases pain (378, 5.9%), fatigue (307, 4.8%), fever (272, 4.3%), and dyspnea (270, 4.2%). Patients with squamous carcinoma and stage III disease were more likely to present with chronic cough (P < 0.0001) and sputum with blood (P < 0.0001) than patients with other pathological types and clinical stages, respectively. Metastases pain (P < 0.0001) and neck and supraclavicular lymphadenectasis (P = 0.0006) were more likely to occur in patients with nonsquamous carcinoma than in patients with other carcinomas. Additionally, patients with stage IV disease had a higher percentage of chest pain, shortness of breath, dyspnea, weight loss, and fatigue than patients with other stages of disease. In multivariable logistic analyses, compared with patients with adenocarcinoma, patients with squamous carcinoma were more likely to experience symptoms (OR = 2.885, 95% confidence interval [CI] 2.477-3.359) but were less likely to present physical signs (OR = 0.844, 95% CI 0.721-0.989). The odds of having both symptoms and physical signs were higher in patients with late-stage disease than in those with early-stage disease (P < 0.0001). CONCLUSIONS: The symptoms and physical signs of lung cancer were associated with the stage and pathological diagnosis of NSCLC. Patients with squamous carcinoma were more likely to develop symptoms, but not signs, than patients with adenocarcinoma. The more advanced the stage at diagnosis, the more likely that symptoms or physical signs are to develop. Further prospective cohort studies are needed to explore these results.
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Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Neoplasias Pulmonares/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , China/epidemiología , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Evaluación del Resultado de la Atención al Paciente , Vigilancia de la Población , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Evaluación de SíntomasRESUMEN
BACKGROUND: Lymphedema (LE) is recognized as a common complication after axillary lymph node dissection (ALND). Numerous studies have attempted to identify risk factors for LE. However, it is difficult to predict the probability of LE for an individual patient. The purpose of this study was to construct a scoring system for predicting the probability of LE after ALND for Chinese breast cancer patients. PATIENTS AND METHODS: 358 breast cancer patients were surveyed and followed for 12 months. LE was defined by circumferential measurement. Univariate and multivariate logistic regression analyses were used to screen risk factors of LE. Based on this, ß-coefficient of each risk factor was translated into a prognostic score and the scoring system was constructed. The area under the receiver operating characteristic curve (AUC) and calibration were calculated as an index for the predictive value of the scoring system. The model was internally validated using bootstrapping techniques. RESULTS: The incidence rate of LE was 31.84%. Variables associated with LE and their corresponding score in the scoring system were: the level of ALND (level I = 0, level II = 1, level III = 2), history of hypertension (yes = 1, no = 0), surgery on dominant arm (yes = 1, no = 0), radiotherapy (yes = 2, no = 0), and surgical infection/seroma/early edema (yes = 2, no = 0). The probability of LE was predicted according to the total risk scores. The system had good discrimination, with an AUC at 0.877. If a cut-off value of 3 was used, the sensitivity was 81.20% and the specificity was 80.90%. An individual whose total risk score was higher than 3 was recognized as being at risk for LE. On internal validation, the bootstrap-corrected predictive accuracy was 0.798. The model demonstrated excellent calibration in the development set and internal validation. CONCLUSIONS: Our scoring system could be a simple and easy tool for physicians to estimate the risk of LE.
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National cancer registration reports provide a huge potential for identifying patterns and trends of important policy, research, prevention and treatment significance. As summary reports written on an annual basis, the China Cancer Registry Annual Reports (CCRARs) fall short from fully addressing their potential. This paper attempts to explore part of the patterns and trends hidden behind published CCRARs. It extracted data for cancer incidence rates (IRs) and mortality rates (MRs) for 2004, 2006 and 2009 from relevant CCRARs and portrayed 4 kinds of indicators in line graphs. The study showed that: a) all of the line graphs of age-specific IRs and MRs characterized typical "growth curves or histogram"; b) graphs of IRs and MRs for males and urban areas had higher peaks than that for females and rural regions; c) most of the line graphs of IR/MR ratios comprised a starting peak, a secondary peak and a decreasing tail and the secondary peaks for females and urban areas were higher than those for males and rural areas; d) most of the urban versus rural IR ratios valued above one, but most the urban versus rural MR ratios, below one; e) the accumulative IRs and MRs showed a stable increasing trend from 2004 to 2009 for urban areas, but mixed for rural regions.
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Mortalidad/tendencias , Neoplasias/epidemiología , Neoplasias/mortalidad , Sistema de Registros/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pronóstico , Población Rural , Tasa de Supervivencia , Población Urbana , Adulto JovenRESUMEN
Large scale secular registry or surveillance systems have been accumulating vast data that allow mathematical modeling of cancer incidence and mortality rates. Most contemporary models in this regard use time series and APC (age-period-cohort) methods and focus primarily on predicting or analyzing cancer epidemiology with little attention being paid to implications for designing cancer registry, surveillance or evaluation initiatives. This research models age-specific cancer incidence rates using logistic growth equations and explores their performance under different scenarios of data completeness in the hope of deriving clues for reshaping relevant data collection. The study used China Cancer Registry Report 2012 as the data source. It employed 3-parameter logistic growth equations and modeled the age-specific incidence rates of all and the top 10 cancers presented in the registry report. The study performed 3 types of modeling, namely full age-span by fitting, multiple 5-year- segment fitting and single-segment fitting. Measurement of model performance adopted adjusted goodness of fit that combines sum of squred residuals and relative errors. Both model simulation and performance evalation utilized self-developed algorithms programed using C# languade and MS Visual Studio 2008. For models built upon full age-span data, predicted age-specific cancer incidence rates fitted very well with observed values for most (except cervical and breast) cancers with estimated goodness of fit (Rs) being over 0.96. When a given cancer is concerned, the R valuae of the logistic growth model derived using observed data from urban residents was greater than or at least equal to that of the same model built on data from rural people. For models based on multiple-5-year-segment data, the Rs remained fairly high (over 0.89) until 3-fourths of the data segments were excluded. For models using a fixed length single-segment of observed data, the older the age covered by the corresponding data segment, the higher the resulting Rs. Logistic growth models describe age-specific incidence rates perfectly for most cancers and may be used to inform data collection for purposes of monitoring and analyzing cancer epidemic. Helped by appropriate logistic growth equations, the work vomume of contemporary data collection, e.g., cancer registry and surveilance systems, may be reduced substantially.
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Algoritmos , Recolección de Datos/métodos , Modelos Estadísticos , Neoplasias/epidemiología , Sistema de Registros , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China/epidemiología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
This study aimed at summarizing published study findings on the diagnostic value of rectal bleeding (RB) and informing clinical practice, preventive interventions and future research areas. We searched Medline and Embase for studies published by September 13, 2013 examining the risk of colorectal cancer in patients with RB using highly inclusive algorithms. Data for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive predictive value (PPV) of RB were extracted by two researchers and analyzed applying Meta-Disc (version 1.4) and Stata (version 11.0). Methodological quality of studies was assessed according to QUADAS. A total of 38 studies containing 5,626 colorectal cancer patients and 73,174 participants with RB were included. The pooled sensitivity and specificity were 0.47 (95% CI: 0.45-0.48) and 0.96 (95% CI: 0.96-0.96) respectively. The overall PPVs ranged from 0.01 to 0.21 with a pooled value of 0.06 (95% CI: 0.05-0.08). Being over the age of 60 years, change in bowel habit, weight loss, anaemia, colorectal cancer among first-degree relatives and feeling of incomplete evacuation of rectum appeared to increase the predictive value of RB. Although RB greatly increases the probability of diagnosing colorectal cancer, it alone may not be sufficient for proposing further sophisticated investigations. However, given the high specificity, subjects without RB may be ruled out of further investigations. Future studies should focus on strategies using RB as an "alarm" symptom and finding additional indications to justify whether there is a need for further investigations.
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Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etiología , Hemorragia Gastrointestinal/complicaciones , Recto/patología , Humanos , PronósticoRESUMEN
PURPOSE: This study aimed at exploring treatment delay (TD) among cancer patients in China with an attempt to develop a practical methodology facilitating frontline Chinese clinicians in promoting earlier cancer diagnosis and treatment. MATERIALS AND METHODS: The study comprised framework development, qualitative interviews and paired factor rating. Framework development utilized systematic literature review, soft systems thinking and consensus groups. Qualitative interviews employed a checklist of open questions soliciting information about all the domains included the framework from cancer patients drawn via stratified randomized sampling of inpatients at 10 hospitals in Hefei, China. Paired factor rating used a self-developed computer aid and the interviewed patients as referring cases to weigh the relative importance of the factors listed in the framework in terms of their contributions to specific components of total delay (TD). RESULTS: a) A conceptual framework was proposed consisting of a 6-step path to TD and 36 category determinants. b) A total of 227 patients were interviewed; their TD was 267.3 mean or 108 median days ranging from 0 to 2475 days; average appraisal, illness, behavioral, preparation and treatment delay accounted for 52.1%, 9.4%, 0.30%, 8.8% and 29.4% of the TD respectively. Individual side factors were rated substantially more important than environmental side factors (60% vs. 40%); most influential TD factors included cancer symptoms, overall health, family relations and knowledge about cancer and health. CONCLUSIONS: The framework proposed together with the interviewing and rating approaches used provide a potential new methodology for understanding cancer patients' TD and promoting earlier cancer treatment.
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Conocimientos, Actitudes y Práctica en Salud , Cumplimiento de la Medicación , Neoplasias/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , China , Recolección de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes , Distribución AleatoriaRESUMEN
This study aimed at summarizing epidemiological research findings on associations between tobacco, alcohol and tea consumption and risk of gastric cancer (GC) in the Chinese population. The review searched PubMed, Embase, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases and reference lists of review papers for all studies published in English or Chinese languages. Information extracted, via two independent researchers, from retrieved articles included first author, year of publication, study design, sample size, source of controls and adjusted odds ratio (OR) or relative risk (RR) with the corresponding 95% confidence intervals (CIs) for each category. Statistical analyses used software STATA version 12.0. The systematic search found 89 articles containing 25,821 GC cases and 135,298 non-cases. The overall random effects in terms of pooled OR and 95%CI for tobacco, alcohol and tea consumption were 1.62 (95%CI: 1.50-1.74), 1.57 (95%CI: 1.41-1.76) and 0.67 (95%CI: 0.59-0.76) respectively; while the heterogeneity among included studies ranged from 80.1% to 87.5%. The majority of subgroup analyses revealed consistent results with the overall analyses. All three behavioral factors showed statistically significant dose-dependent effects on GC (P<0.05). The study revealed that tobacco smoking and alcohol drinking were associated with over 1/2 added risk of GC, while tea drinking conferred about 1/3 lower risk of GC in the Chinese population. However, these results should be interpreted with caution given the fact that most of the included studies were based on a retrospective design and heterogeneity among studies was relatively high.
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Consumo de Bebidas Alcohólicas/efectos adversos , Fumar/efectos adversos , Neoplasias Gástricas/etiología , Té/efectos adversos , China/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metaanálisis como Asunto , Estadificación de Neoplasias , Pronóstico , Factores de Riesgo , Neoplasias Gástricas/epidemiologíaRESUMEN
PURPOSE: This study aimed at summarizing epidemiological evidence of the association between gestational diabetes mellitus (GDM) and subsequent risk of cancer. MATERIALS AND METHODS: We searched Medline, Embase, Cancer Lit and CINAHL for epidemiological studies published by February 1, 2014 examining the risk of cancer in patients with history of GDM using highly inclusive algorithms. Information about first author, year of publication, country of study, study design, cancer sites, sample sizes, attained age of subjects and methods used for determining GDM status were extracted by two researchers and Stata version 11.0 was used to perform the meta-analysis and estimate the pooled effects. RESULTS: A total of 9 articles documented 5 cohort and 4 case- control studies containing 10,630 cancer cases and 14,608 women with a history of GDM were included in this review. Taken together, the pooled odds ratio (OR) between GDM and breast cancer risk was 1.01 (0.87-1.17); yet the same pooled ORs of case-control and cohort studies were 0.87 (0.71-1.06) and 1.25 (1.00-1.56) respectively. There are indications that GDM is strongly associated with higher risk of pancreatic cancer (HR=8.68) and hematologic malignancies (HR=4.53), but no relationships were detected between GDM and other types of cancer. CONCLUSIONS: Although GDM increases the risk of certain types of cancer, these results should be interpreted with caution becuase of some methodological flaws. The issue merits added investigation and coordinated efforts between researchers, antenatal clinics and cancer treatment and registration agencies to help attain better understanding.
Asunto(s)
Complicaciones de la Diabetes/epidemiología , Diabetes Gestacional/epidemiología , Neoplasias/epidemiología , Neoplasias de la Mama/epidemiología , Femenino , Neoplasias Hematológicas/epidemiología , Humanos , Neoplasias Pancreáticas/epidemiología , Embarazo , RiesgoRESUMEN
This study aimed to summarize published epidemiological evidence for the relationship between pancreatitis and subsequent risk of pancreatic cancer (PC). We searched Medline and Embase for epidemiological studies published by February 5th, 2014 examining the risk of PC in pancreatitis patients using highly inclusive algorithms. Information about first author, year of publication, country of study, recruitment period, type of pancreatitis, study design, sample size, source of controls and attained age of subjects were extracted by two researchers and Stata 11.0 was used to perform the statistical analyses and examine publication bias. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with the random effects model. A total of 17 articles documenting 3 cohort and 14 case-control studies containing 14,667 PC cases and 17,587 pancreatitis cases were included in this study. The pooled OR between pancreatitis and PC risk was 7.05 (95%CI: 6.42-7.75). However, the pooled ORs of case-control and cohort studies were 4.62 (95%CI: 4.08-5.22) and 16.3 (95%CI: 14.3-18.6) respectively. The risk of PC was the highest in patients with chronic pancreatitis (pooled OR=10.35; 95%CI: 9.13-11.75), followed by unspecified type of pancreatitis (pooled OR=6.41; 95%CI: 4.93-8.34), both acute and chronic pancreatitis (pooled OR=6.13; 95%CI: 5.00-7.52), and acute pancreatitis (pooled OR=2.12; 95%CI: 1.59-2.83). The pooled OR of PC in pancreatitis cases diagnosed within 1 year was the highest (pooled OR=23.3; 95%CI: 14.0-38.9); and the risk in subjects diagnosed with pancreatitis for no less than 2, 5 and 10 years were 3.03 (95%CI: 2.41-3.81), 2.82 (95%CI: 2.12-3.76) and 2.25 (95%CI: 1.59-3.19) respectively. Pancreatitis, especially chronic pancreatitis, was associated with a significantly increased risk of PC; and the risk decreased with increasing duration since diagnosis of pancreatitis.
Asunto(s)
Neoplasias Pancreáticas/etiología , Pancreatitis/complicaciones , China/epidemiología , Estudios Epidemiológicos , Humanos , Neoplasias Pancreáticas/epidemiología , Pronóstico , Factores de RiesgoRESUMEN
The big gap between efficacy of population level prevention and expectations due to heterogeneity and complexity of cancer etiologic factors calls for selective yet personalized interventions based on effective risk assessment. This paper documents our research protocol aimed at refining and validating a two-stage and web- based cancer risk assessment tool, from a tentative one in use by an ongoing project, capable of identifying individuals at elevated risk for one or more types of the 80% leading cancers in rural China with adequate sensitivity and specificity and featuring low cost, easy application and cultural and technical sensitivity for farmers and village doctors. The protocol adopted a modified population-based case control design using 72, 000 non-patients as controls, 2, 200 cancer patients as cases, and another 600 patients as cases for external validation. Factors taken into account comprised 8 domains including diet and nutrition, risk behaviors, family history, precancerous diseases, related medical procedures, exposure to environment hazards, mood and feelings, physical activities and anthropologic and biologic factors. Modeling stresses explored various methodologies like empirical analysis, logistic regression, neuro-network analysis, decision theory and both internal and external validation using concordance statistics, predictive values, etc..