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1.
Ann Med Surg (Lond) ; 86(4): 2137-2142, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38576944

RESUMO

The causal relationship between physical activity and anti-cancer effect are not proved by the current studies. However, Ou MC decrescendo phenomenon treatment (OuDPt), a simple exercise treatment, has shown consistent anti-cancer effects, which evinces the consequent anti-cancer effect by physical activity. The anti-cancer effects through OuDPt in the context of physical activity and human body anatomical axes showed to induce apoptosis, restore apical-basal polarity of cancer cells and mitigate epithelial-mesenchymal transition (EMT) with concomitant clinical regression of uterine endometrial cancer, suppression of ovarian and pancreatic cancer growth, regression of early suspicious pancreatic cancer, enhancement of chemotherapy effect of pancreatic cancer and cessation of cancer-related bleeding, which underlines the most important anti-cancer mechanisms. Although such anti-cancer effects by OuDPt show insufficient efficacy for advanced cancer in long-term treatment, OuDPt may be availed as an Ou MC decrescendo phenomenon exercise for cancer prevention. Further study is warranted.

2.
Cancers (Basel) ; 16(6)2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38539552

RESUMO

PURPOSE: This retrospective cohort study aims to compare the quality of life (QoL) in patients with nasopharyngeal cancer (NPC) treated with intensity-modulated proton therapy (IMPT) versus volumetric modulated arc therapy (VMAT) at different time points. MATERIALS AND METHODS: We conducted a longitudinal assessment of QoL on 287 newly diagnosed NPC patients (IMPT: 41 and VMAT: 246). We collected outcomes of global QoL, functional QoL, C30 symptoms, and HN35 symptoms from EORTC QLQ-C30 and QLQ-HN35 questionnaires at pre-radiotherapy, during radiotherapy (around 40 Gy), 3 months post radiotherapy, and 12-months post radiotherapy (RT). The generalized estimating equation was utilized to interpret the group effect, originating from inherent group differences; time effect, attributed to RT effects over time; and interaction of the group and time effect. RESULTS: IMPT demonstrated superior mean dose reductions in 12 of the 16 organs at risk compared to VMAT, including a significant (>50%) reduction in the oral cavity and larynx. Both groups exhibited improved scores of global QoL, functional QoL, and C30 symptoms at 12 months post RT compared to the pre-RT status. Regarding global QoL and C30 symptoms, there was no interaction effect of group over time. In contrast, significant interaction effects were observed on functional QoL (p = 0.040) and HN35 symptoms (p = 0.004) during RT, where IMPT created an average of 7.5 points higher functional QoL and 10.7 points lower HN35 symptoms than VMAT. CONCLUSIONS: Compared to VMAT, dose reduction attributed to IMPT could translate into better functional QoL and HN35 symptoms, but the effect is time dependent and exclusively observed during the RT phase.

3.
Eur J Pediatr ; 183(4): 1891-1900, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38319404

RESUMO

Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment, and the increase in number and survival of premature infants may inflate its burden globally. We aimed to comprehensively assess the trends and inequalities in the burden of ROP-related visual impairment and to identify improvement gaps to facilitate appropriate actions in neonatal care systems. We obtained ROP data from the Global Burden of Disease 2019 study. We employed joinpoint regression analysis to assess the trends of the burden of ROP-related visual impairment, measured by age-standardised prevalence rates, health equity analysis methods to evaluate cross-country burden inequalities, and data envelopment and stochastic frontier analyses to identify improvement gaps based on the development status, i.e., sociodemographic index (SDI). Between 1990 and 2019, the age-standardised prevalence rates of ROP-related visual impairment significantly increased worldwide (average annual percentage change: 0.23 [95% confidence interval, 0.21-0.26] among males and 0.26 [0.25-0.27] among females), primarily in developed regions. Although significant SDI-related cross-country inequalities were identified, these reduced over time (slope index of inequality: -57.74 [-66.22 to -49.25] in 1990 to -29.68 [-38.39 to -20.97] in 2019; health concentration index: -0.11 [-0.13 to -0.09] in 1990 to -0.07 [-0.09 to -0.06] in 2019). Notably, some less-developed countries exhibited superior performance despite limited resources, whereas others with a higher SDI delivered lagging performance.  Conclusion: The global burden of ROP-related visual impairment has steadily increased between 1990 and 2019, with disproportionate burden concentration among less-developed countries, requiring appropriate preventive and intervention measures. What is Known: • Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment. • The prevalence of ROP is anticipated to increase due to the growing number of extremely premature infants. What is New: • The prevalence of ROP-related visual impairment has increased worldwide, primarily in developed regions, with declining but persisting cross-country inequalities. • The increasing burden of ROP-related visual impairment should be considered as part of global and national health agendas, requiring interventions with proven efficacy.


Assuntos
Doenças do Recém-Nascido , Retinopatia da Prematuridade , Recém-Nascido , Masculino , Lactente , Feminino , Humanos , Criança , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/epidemiologia , Países em Desenvolvimento , Lactente Extremamente Prematuro , Prevalência , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Idade Gestacional
4.
Cancer Manag Res ; 15: 719-728, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37485039

RESUMO

Background: Few instruments are available for assessing the otorhinologic-related quality of life (QOL) in nasopharyngeal carcinoma (NPC) patients. Therefore, we evaluated whether the 22-item Sinonasal Outcome Test (SNOT-22) could be applied to these patients. Methods: Patients diagnosed with NPC, who had been treated with standard protocol and followed up in our institute between 2019 and 2022, were invited to join the cross-sectional study during their clinic visits. All participants completed the SNOT-22 and Eustachian Tube Dysfunction Questionnaire-7 once they were recruited. Confirmatory factor analysis (CFA) was performed to decide the most suitable model for the underlying SNOT-22 subdomains, along with various validity and reliability tests. Results: We identified a total of 275 patients, with 84 (30.5%) women and 191 (69.5%) men. The mean age was 54.1 years (standard deviation: 11.2). Among these patients, 171 (62.1%) were in late stages, and 260 (94.5%) received chemoradiotherapy as treatment. The median interval between primary RT treatment and questionnaire completion was 50 months (interquartile range: 29-93). CFA supported a five-factor model for the SNOT-22 for NPC patients, including nasal, ear/facial, sleep, function, and emotion domains. The internal consistency and test-retest reliability of the SNOT-22 domain score were good. In addition, known-group validity was good for the SNOT-22 total score and domain scores according to the disease recurrence status. Conclusion: Psychometric analyses supported the reliability and validity of a five-domain SNOT-22 for assessing otorhinologic-related QOL in NPC patients.

5.
PLoS One ; 18(6): e0286534, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37390053

RESUMO

With the change of climate issues and the needs of economic development, the idea of practicing green and low-carbon behaviors sinks deeper and deeper into people's hearts. This paper based on the social cost of carbon (SCC) model, this paper constructs a new carbon social cost model by adding the impact of green low-carbon behavior. Classify climate states, based on Bayesian statistical knowledge, study the posterior probability distribution of climate state transitions, and discuss the optimal carbon policy for different climate states by balancing emission utility costs and utility weighted carbon marginal products. This article also discusses the damage caused by rising temperatures and explores their impact on carbon price policies. then, the paper calculates SCC under four kinds of climate states, which will be visually displayed with graphs. Finally, we compare SCC obtained in this paper with that in other researches. The results show that: (1) Climate status has a significant impact on carbon policy, and carbon price predictions will dynamically change with climate status. (2) Green low-carbon behavior has a positive impact on climate status. (3) There are differences in the impact of the three types of damage caused by rising temperatures on carbon price policies. (4) Green development is conducive to stabilizing the value of SCC. (5) Close monitoring of the climate state helps to update the probability of damage in time so that we can precisely adjust the corresponding policies on SCC. This study provides theoretical and empirical reference for the government to formulate carbon price policies and promote the development of social green behavior.


Assuntos
Carbono , Comportamento Social , Humanos , Teorema de Bayes , Clima , Desenvolvimento Econômico
6.
Infect Dis Poverty ; 11(1): 57, 2022 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-35599310

RESUMO

BACKGROUND: A One Health approach has been increasingly mainstreamed by the international community, as it provides for holistic thinking in recognizing the close links and inter-dependence of the health of humans, animals and the environment. However, the dearth of real-world evidence has hampered application of a One Health approach in shaping policies and practice. This study proposes the development of a potential evaluation tool for One Health performance, in order to contribute to the scientific measurement of One Health approach and the identification of gaps where One Health capacity building is most urgently needed. METHODS: We describe five steps towards a global One Health index (GOHI), including (i) framework formulation; (ii) indicator selection; (iii) database building; (iv) weight determination; and (v) GOHI scores calculation. A cell-like framework for GOHI is proposed, which comprises an external drivers index (EDI), an intrinsic drivers index (IDI) and a core drivers index (CDI). We construct the indicator scheme for GOHI based on this framework after multiple rounds of panel discussions with our expert advisory committee. A fuzzy analytical hierarchy process is adopted to determine the weights for each of the indicators. RESULTS: The weighted indicator scheme of GOHI comprises three first-level indicators, 13 second-level indicators, and 57 third-level indicators. According to the pilot analysis based on the data from more than 200 countries/territories the GOHI scores overall are far from ideal (the highest score of 65.0 out of a maximum score of 100), and we found considerable variations among different countries/territories (31.8-65.0). The results from the pilot analysis are consistent with the results from a literature review, which suggests that a GOHI as a potential tool for the assessment of One Health performance might be feasible. CONCLUSIONS: GOHI-subject to rigorous validation-would represent the world's first evaluation tool that constructs the conceptual framework from a holistic perspective of One Health. Future application of GOHI might promote a common understanding of a strong One Health approach and provide reference for promoting effective measures to strengthen One Health capacity building. With further adaptations under various scenarios, GOHI, along with its technical protocols and databases, will be updated regularly to address current technical limitations, and capture new knowledge.


Assuntos
Saúde Única , Previsões , Saúde Global
7.
PLoS One ; 15(10): e0241400, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33125413

RESUMO

In view of the difficulty, high cost and complex technology of pharmaceutical logistics green transformation, based on the idea of green supply chain, three different government subsidy strategies for green logistics were proposed. Firstly, by constructing a Stackelberg game model with pharmaceutical logistics provider as the leader and manufacturer as the followers, the behavior selection and optimal decisions of the participants under the anarchic subsidy strategy, the single subsidy strategy of the pharmaceutical logistics provider, the single subsidy strategy of the pharmaceutical manufacturer and the coordinated subsidy strategy are analyzed respectively. Furthermore, the effects of different subsidy strategies on the green investment and strategy selection of logistics provider and manufacturer are compared. Finally, according to the research results, the paper provides reference and suggestions for the formulation of government subsidy strategy. The results show that the three subsidy strategies have different degrees of incentive effect on the green transformation of pharmaceutical logistics, and the single logistics provider subsidy strategy is the best.


Assuntos
Conservação dos Recursos Naturais , Indústria Farmacêutica , Algoritmos , Simulação por Computador , Conservação dos Recursos Naturais/economia , Tomada de Decisões , Indústria Farmacêutica/economia , Financiamento Governamental , Química Verde/economia , Humanos , Preparações Farmacêuticas/economia , Pesquisa
8.
PLoS One ; 15(7): e0236122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673371

RESUMO

OBJECTIVE: To determine the predictive factors of postoperative hospital stay and total hospital medical cost among patients who underwent total laryngectomy. METHODS: A total of 213 patients who underwent total laryngectomy in a tertiary referral center for tumor ablation were enrolled retrospectively between January 2009 and May 2018. Statistical analyses including Pearson's chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and outcomes. The outcomes of interest including postoperative length of hospital stay and inpatient total medical cost. Logistic regression analyses were performed to reveal the relationship between clinical factors and postoperative length of hospital stay or total inpatient medical cost. RESULTS: Preoperative radiotherapy (p = 0.007), method of wound closure (p < 0.001), postoperative serum albumin level (p = 0.025), and postoperative serum hemoglobin level (p = 0.04) were significantly associated with postoperative hospital stay in univariate analysis. Postoperative hypoalbuminemia (odds ratio [OR]: 2.477; 95% confidence interval [CI]: 1.189-5.163; p = 0.015) and previous radiotherapy history (OR 2.194; 95% CI: 1.228-3.917; p = 0.008) are independent predictors of a longer postoperative hospital stay in multiple regression analysis. With respect to total inpatient medical cost, method of wound closure (p < 0.001), preoperative serum albumin level (p = 0.04), postoperative serum albumin level (p < 0.001), and history of liver cirrhosis (p = 0.037) were significantly associated with total inpatient medical cost in univariate analysis. Postoperative hypoalbuminemia (OR: 6.671; 95% CI: 1.927-23.093; p = 0.003) and microvascular free flap reconstruction (OR: 5.011; 95% CI: 1.657-15.156; p = 0.004) were independent predictors of a higher total inpatient medical cost in multiple regression analysis. CONCLUSIONS: Postoperative albumin status is a significant factor in predicting prolonged postoperative hospital stay and higher inpatient medical cost among patients who undergo total laryngectomy. In this cohort, the inpatient medical cost was 48% higher and length of stay after surgery was 35% longer among hypoalbuminemia patients.


Assuntos
Análise Custo-Benefício , Hospitais/estatística & dados numéricos , Laringectomia/economia , Tempo de Internação/economia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Prev Med ; 139: 106170, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32610059

RESUMO

The objective of the reported research was to assess the impact of text message (SMS) reminders and their content on cervical screening rates. Women invited for cervical screening in Northwest London from February-October 2015 were eligible. 3133 women aged 24-29 (Study 1) were randomized (1, 1) to 'no SMS' (control), or a primary care physician (PCP) endorsed SMS (SMS-PCP). 11,405 women aged 30-64 (Study 2), were randomized (1, 1:1:1:1:1:1) to either: no SMS, an SMS without manipulation (SMS), the SMS-PCP, an SMS with a total or proportionate social norm (SMS-SNT or SMS-SNP), or an SMS with a gain-framed or loss-framed message (SMS-GF and SMS-LF). The primary outcome was participation at 18 weeks. In Study 1 participation was significantly higher in the SMS-PCP arm (31.4%) compared to control (26.4%, aOR, 1.29, 95%CI: 1.09-1·51; p = 0.002). In Study 2 participation was highest in the SMS-PCP (38.4%) and SMS (38.1%) arms compared to control (34.4%), (aOR: 1.19, 95%CI: 1.03-1.38; p = 0.02 and aOR: 1.18, 95%CI: 1.02-1.37; p = 0.03, respectively). The results demonstrate that behavioral SMSs improve cervical screening participation. The message content plays an important role in the impact of SMS. The results from this trial have already been used to designing effective policy for cervical cancer screening. The NHS Cervical Screening Programme started running a London-wide screening SMS campaign which was based on the cervical screening trial described here. According to figures published by Public Health England, after six months attendance increased by 4.8%, which is the equivalent of 13,400 more women being screened at 18 weeks.


Assuntos
Telefone Celular , Envio de Mensagens de Texto , Neoplasias do Colo do Útero , Detecção Precoce de Câncer , Economia Comportamental , Inglaterra , Feminino , Humanos , Londres , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistemas de Alerta , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle
10.
BMC Gastroenterol ; 20(1): 164, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460705

RESUMO

BACKGROUND: Patients with acute pancreatitis usually exhibit dyslipidemia and oxidative stress. However, the significance of high-density lipoprotein cholesterol (HDL-C) level, low-density lipoprotein cholesterol (LDL-C) level and the HDL-C/LDL-C ratio (H/L ratio) as markers for disease progression remain unknown. AIM: The aim of this study was to evaluate the role of HDL-C levels, LDL-C levels and the H/L ratio as markers of disease progression in patients admitted to the intensive cate unit with acute pancreatitis. METHODS: This retrospective study was conducted at a tertiary critical care center in China. Plasma HDL-C and LDL-C levels were measured in 166 patients with acute pancreatitis. The associations between HDL-C, LDL-C, H/L ratio, as well as other inflammatory index and mortality, were analyzed. Multivariate cox analysis based on two models was used to determine the independent prognostic factor. Predictive ability of in-hospital mortality for variables was determined using the receiver operating characteristics curves. RESULTS: Significantly higher H/L ratios at admission were observed in patients with acute pancreatitis who died compared with survivors (0.93 vs. 0.64, p < 0.001). The area under the ROC curve for H/L ratio-based prediction of mortality was 0.658. When clinical confounders were included in multivariable cox regression analysis, the association was preserved (Model A HR = 1.587, p = 0.011; Model B HR = 1.332, p = 0.032). The mortality risk in different groups defined by an H/L ratio cutoff value was significantly different, based on survival curve analysis. CONCLUSION: The H/L ratio at the time of admission to the ICU appears to be a biomarker of disease progression in patients with acute pancreatitis.


Assuntos
HDL-Colesterol/sangue , LDL-Colesterol/sangue , Pancreatite/mortalidade , Admissão do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Doença Aguda , Biomarcadores/sangue , China , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pancreatite/sangue , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Curva ROC , Valores de Referência , Estudos Retrospectivos , Fatores de Risco
11.
Artigo em Inglês | MEDLINE | ID: mdl-31906010

RESUMO

Based on the panel data of the 11 provinces along the Yangtze River Economic Belt from 1997 to 2015, the super slack-based model (Super-SBM) model is adopted to calculate the provincial-level eco-efficiency of industrial energy. While bringing in time series analysis and spatial differentiation feature analysis, the traditional and spatial Markov probability transition matrix is established. This study delves into the spatial-temporal dynamic evolution traits of the eco-efficiency of industrial energy along the Yangtze River Economic Belt. According to the results: the eco-efficiency of industrial energy of the Yangtze River Economic Belt manifests "single crest" evolution and distribution traits from left to right and top to bottom, indicating that the eco-efficiency of industrial energy of the Yangtze River Economic Belt is steadily improving gradually. However, the overall level is still low and there is still ample room for the improvement of the eco-efficiency of industrial energy. Furthermore, the eco-efficiency of industrial energy along the Yangtze River Economic Belt is elevating. The geographical spatial pattern plays a pivotal role in the spatial and temporal evolution of eco-efficiency of industrial energy, and the spatial agglomeration traits are noticeable.


Assuntos
Conservação de Recursos Energéticos , Indústrias , Rios , China , Eficiência , Análise Espacial , Fatores de Tempo
12.
J Periodontol ; 88(6): 593-601, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28398151

RESUMO

BACKGROUND: The aim of the study is to determine if bone quality evaluation of surgically obtained bone core specimens using a stereomicroscope is reliable for determining bone quality at implant recipient sites. METHODS: Bone quality was presurgically assessed in 122 edentulous ridges obtained from 62 patients using periapical radiographs and categorized according to the Lekholm and Zarb classification. During surgery, bone specimens were trephined, and bone types were immediately classified using a stereomicroscope. Microarchitectural characteristics of bone cores were evaluated after being scanned using microcomputed tomography (micro-CT). RESULTS: Bone types of implant sites categorized from radiography and stereomicroscope had statistically similar distribution but poor interrater agreement. Using micro-CT, maxillae and mandibles showed significant differences in microarchitectural characteristics of bone cores. Bone volume (BV), total volume (TV), and trabecular thickness (Tb.Th) increased, whereas bone surface density (BS/BV) and open porosity (Po.[Op]) decreased in mandibular bone cores compared with those in maxillary bone cores. Moreover, micro-CT values of BV/TV and Po.(Op) statistically correlated with bone types assessed by stereomicroscopy, particularly in mandibles (adjusted means of BV/TV of Type 2 to 4 versus Type 1 decreasing from -9.88%, -15.09%, -29.31%; those of Po.(Op) ranged from 9.77%, 15.06%, 29.52% in an upward trend). However, such correlations were not found in maxillae or when bone types were classified using periapical radiographs. CONCLUSIONS: Caution is needed when using presurgical periapical radiographs to predict bone quality at implant recipient sites. Surgically preserved bone core specimens, whenever obtainable, might offer additional information to accurately assess bone quality, particularly at mandibular implant sites.


Assuntos
Densidade Óssea/fisiologia , Tomografia Computadorizada de Feixe Cônico/métodos , Implantação Dentária Endóssea , Mandíbula/patologia , Maxila/patologia , Radiografia Dentária/métodos , Microtomografia por Raio-X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Implantes Dentários , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Arcada Edêntula/diagnóstico por imagem , Arcada Edêntula/patologia , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Maxila/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia Dentária/estatística & dados numéricos , Cirurgia Assistida por Computador/métodos , Cirurgia Assistida por Computador/estatística & dados numéricos , Taiwan , Microtomografia por Raio-X/estatística & dados numéricos
13.
Biomed Res Int ; 2015: 769806, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26351638

RESUMO

OBJECTIVES: This study analyzed the long-term hearing loss after treatment of primary nasopharyngeal carcinoma to elucidate its causal factors. METHODS: Ninety-two nasopharyngeal carcinoma patients were treated with radiotherapy or chemoradiotherapy. Pure tone audiometry was performed before the therapy and annually up to 9 years after completing treatment. The hearing thresholds were corrected for age-related deterioration and compared to the results without adjusting for age. RESULTS: The mean air and bone conduction threshold with and without correction for age-related deterioration differed significantly 2-9 years after completing radiotherapy (p < 0.05). The audiometry results with age correction showed a flattened configuration compared to the results without age correction. The total radiation dose and radiation modality showed a causal relationship with a greater incidence of hearing loss after therapy (p < 0.05). There was more deterioration in the air and bone hearing thresholds with conformal radiotherapy than intensity-modulated radiotherapy (p < 0.001). A radiation dose >72 cGy resulted in more severe hearing loss than <72 cGy (p < 0.05). CONCLUSION: Hearing loss after completing therapy should be corrected for age-related hearing deterioration to reveal the true extent to which the loss is a therapeutic complication. Both the radiation modality used and the dose were significantly associated with hearing loss.


Assuntos
Perda Auditiva/etiologia , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/etiologia , Radioterapia Conformacional/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos , Adulto , Idoso , Audiometria de Tons Puros/métodos , Condução Óssea/efeitos dos fármacos , Carcinoma , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo , Dosagem Radioterapêutica , Adulto Jovem
14.
Death Stud ; 39(1-5): 151-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25255790

RESUMO

Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.


Assuntos
Luto , Emprego , Atenção Primária à Saúde , Cônjuges , Adulto , Idoso , Custos e Análise de Custo , Emprego/economia , Emprego/psicologia , Feminino , Mau Uso de Serviços de Saúde/economia , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Escócia , Fatores Socioeconômicos , Cônjuges/psicologia , Cônjuges/estatística & dados numéricos , Fatores de Tempo
15.
Qual Life Res ; 22(4): 715-23, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22669472

RESUMO

PURPOSE: Pretreatment quality of life (QoL) has been used to predict survival in cancer patients. In this study, we examined the prognostic value of QoL measured after treatment on subsequent survival in patients with nasopharyngeal carcinoma (NPC). METHODS: We enrolled 273 patients with NPC who had been curatively treated for more than 1 year. The EORTC QLQ-C30 and H&N35 questionnaires were completed 1 year after radiotherapy. The predictability of QoL variables on disease-specific survival (DSS) and overall survival (OS) was analyzed using Cox's proportional hazards models. RESULTS: Twenty-nine (10.6%) patients developed locoregional relapse and 27 (9.9%) had distant metastasis after the QoL survey with subsequent 5-year DSS and OS rates of 87.9% and 84.0 %, respectively. Based on the QLQ-C30, scales of physical functioning, fatigue, and appetite loss significantly predicted DSS and OS (p < 0.05). In the H&N35, only sexuality was significantly correlated with DSS and OS (p < 0.05). An increment of 10 points in physical functioning (HR: 0.69; 95% CI: 0.48-0.90; p = 0.004) or a decline of 10 points in fatigue problems (HR: 1.40; 95% CI: 1.19-1.61; p = 0.0002), appetite loss (HR: 1.21; 95% CI: 1.03-1.40; p = 0.02), and sexuality (HR: 1.14; 95% CI: 1.02-1.25; p = 0.019) was associated with better OS. CONCLUSION: Some QoL variables measured after the treatment provide prognostic value on subsequent survival in patients with NPC.


Assuntos
Neoplasias Nasofaríngeas/psicologia , Neoplasias Nasofaríngeas/radioterapia , Qualidade de Vida/psicologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Carcinoma , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/mortalidade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Análise de Regressão , Fatores Socioeconômicos , Inquéritos e Questionários , Análise de Sobrevida , Resultado do Tratamento
16.
Health Policy ; 99(1): 23-36, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20675011

RESUMO

There is a very large literature that examines the relationship between health and income. Two main hypotheses have been investigated: the income inequality hypothesis and the absolute income hypothesis. Most of previous studies that used mortality data have been criticized for estimating an aggregate model that does not account for non-linear links between health and income at the individual level. In this paper we follow a novel approach to avoid this bias, combining aggregate mortality data with individual-level data on socio-economic characteristics. We test the income inequality and absolute income hypotheses using county-level mortality data from Life Statistic of Department of Health and individual-level data from Taiwan census Family Income and Expenditure Survey (FIES) for 1976-2004. We find the evidence to support the absolute income hypothesis but not income inequality hypothesis in the case of the general population. We also find strong evidence that education does have significant effects on individuals' health and the estimates are not sensitive to income equivalent scales.


Assuntos
Mortalidade/tendências , Classe Social , Coleta de Dados , Humanos , Masculino , Modelos Econométricos , Modelos Teóricos , Estatística como Assunto , Taiwan/epidemiologia
17.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 45(2): 105-8, 2010 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-20368006

RESUMO

OBJECTIVE: To assess the quality of orthodontic clinical trials published in 4 major dental journals in the past 10 years and establish the reference standard for orthodontic clinical trials and quality control of dental journals. METHODS: All the clinical trials published in Chinese Journal of Stomatology, West China Journal of Stomatology, Journal of Practice Stomatology and Chinese Journal of Orthodontics from 1999 to 2008 were searched. The demographic information of the papers was extracted and the quality of the clinical trials according to the consolidated standards of reporting trials (CONSORT) was assessed. RESULTS: Four hundred and ninety-four clinical trials were retrieved, and 21.3% (105/494) of them were supported by grants. For the study design, only 26.1% (129/494) were prospective studies, and 3.8% (19/494) were randomized clinical trials. It was hard to evaluate precisely due to the lack of information about the details of the study designs. For the randomized clinical trials, the lack of details for randomization, allocation concealment, blinding and intention to treat compromised the quality. CONCLUSIONS: The general quality of clinical trials in orthodontics is poor. It needs to be improved both in the clinical study design and the paper writing.


Assuntos
Ensaios Clínicos como Assunto/normas , Odontologia Baseada em Evidências , Ortodontia/normas , Humanos , Publicações Periódicas como Assunto , Controle de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
18.
Environ Health Perspect ; 115(7): 1059-65, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17637923

RESUMO

BACKGROUND: C(60) is a highly insoluble nanoparticle that can form colloidal suspended aggregates in water, which may lead to environmental exposure in aquatic organisms. Previous research has indicated toxicity from C(60) aggregate; however, effects could be because of tetrahydrofuran (THF) vehicle used to prepare aggregates. OBJECTIVE: Our goal was to investigate changes in survival and gene expression in larval zebrafish Danio rerio after exposure to aggregates of C(60) prepared by two methods: a) stirring and sonication of C(60) in water (C(60)-water); and b) suspension of C(60) in THF followed by rotovaping, resuspension in water, and sparging with nitrogen gas (THF-C(60)). RESULTS: Survival of larval zebrafish was reduced in THF-C(60) and THF-water but not in C(60)-water. The greatest differences in gene expression were observed in fish exposed to THF-C(60) and most (182) of these genes were similarly expressed in fish exposed to THF-water. Significant up-regulation (3- to 7-fold) of genes involved in controlling oxidative damage was observed after exposure to THF-C(60) and THF-water. Analyses of THF-C(60) and THF-water by gas chromatography-mass spectrometry did not detect THF but found THF oxidation products gamma-butyrolactone and tetrahydro-2-furanol. Toxicity of gamma-butyrolactone (72-hr lethal concentration predicted to kill 50% was 47 ppm) indicated effects in THF treatments can result from gamma-butyrolactone toxicity. CONCLUSION: This research is the first to link toxic effects directly to a THF degradation product (gamma-butyrolactone) rather than to C(60) and may explain toxicity attributed to C(60) in other investigations. The present work was first presented at the meeting "Overcoming Obstacles to Effective Research Design in Nanotoxicology" held 24-26 April 2006 in Cambridge, Massachusetts, USA.


Assuntos
Fulerenos/toxicidade , Furanos/toxicidade , Expressão Gênica/efeitos dos fármacos , Larva/efeitos dos fármacos , Peixe-Zebra/crescimento & desenvolvimento , Animais , Furanos/metabolismo , Larva/metabolismo , Nanopartículas , Análise de Sequência com Séries de Oligonucleotídeos , Água
19.
Laryngoscope ; 115(8): 1458-60, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16094124

RESUMO

OBJECTIVES/HYPOTHESIS: The objectives were to measure the degree of trismus induced after radiation therapy for nasopharyngeal cancer and assess its progress over time. STUDY DESIGN: A prospective, single-armed measurement study with long-term follow-up. METHODS: Seventeen patients with nasopharyngeal cancer treated between 1997 and 1999 were studied. Patients were given radiation therapy with bilateral parallel-opposing ports of 45 Gy, 25 fractions, then with a reduced volume to 68.4 to 70.2 Gy. The end point was the degree of trismus, which was measured by serial changes of the maximal interincisal distance (MID) at various specified time points before, during, and after radiation therapy. RESULTS: During the 9 weeks of radiation therapy there was no significant change of MID (normalized MID ranged from 99.8% to 97%). The rate of decrease during this period was 1.3% per month. After radiation therapy there was a rapid decrease of MID between 1 and 9 months (normalized MID values at 1 and 9 mo were 95.5% +/- 3.1% and 74.2% +/- 5.7%, respectively). The rate of decrease during this period was dramatic (2.4%/mo). One year after radiation therapy, the rate of decrease became slower but was still measurable (0.2%/mo for the period from 12 to 24 mo). For the period from 24 to 48 months. the rate dropped to 0.1% per month. By the end of 48 months, normalized MID was 67.8% +/- 7.6%. CONCLUSION: By means of measurement over a period of time, it was found that patients with nasopharyngeal cancer had a mean decrease in initial interincisal distance of 32% at 4 years after radiotherapy. The trismus process evolved at different rates. It was rapid at 1 to 9 months after radiation therapy, then became slower and protracted over later years.


Assuntos
Braquiterapia/efeitos adversos , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/diagnóstico , Trismo/etiologia , Adulto , Distribuição por Idade , Idoso , Braquiterapia/métodos , Criança , Estudos de Coortes , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/mortalidade , Estadiamento de Neoplasias , Lesões por Radiação/epidemiologia , Medição de Risco , Distribuição por Sexo , Análise de Sobrevida , Trismo/epidemiologia , Trismo/fisiopatologia
20.
Mol Ecol ; 14(6): 1767-81, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15836648

RESUMO

Most phylogeographical studies of postglacial colonization focus on high latitude locations in the Northern Hemisphere. Here, we studied the phylogeographical structure of the red-necked snow finch Pyrgilauda ruficollis, an endemic species of the Tibetan plateau. We analysed 879 base pairs (bp) of the mitochondrial cytochrome b gene and 529 bp of the control region in 41 birds from four regional groups separated by mountain ranges. We detected 34 haplotypes, 31 of which occurred in a single individual and only three of which were shared among sampling sites within regional groups or among regional groups. Haplotype diversity was high (h = 0.94); nucleotide diversity was low (eth = 0.00415) and genetic differentiation was virtually non-existent. Analyses of mismatch distributions and geographically nested clades yielded results consistent with contiguous range expansion, and the expansion times were estimated as 0.07-0.19 million years ago (Ma). Our results suggest that P. ruficollis colonized the Tibetan plateau after the extensive glacial period (0.5-0.175 Ma), expanding from the eastern margin towards the inner plateau. Thus, in contrast to many of the post-glacial phylogeographical structures known at high latitudes, this colonization occurred without matrilineal population structuring. This might be due to the short glacial cycles typical of the Tibetan plateau, adaptation of P. ruficollis to cold conditions, or refugia and colonized habitat being semicontinuous and thus promoting population mixing.


Assuntos
Demografia , Tentilhões/genética , Variação Genética , Genética Populacional , Filogenia , Animais , Sequência de Bases , Primers do DNA , DNA Mitocondrial/genética , Evolução Molecular , Tentilhões/fisiologia , Geografia , Haplótipos/genética , Funções Verossimilhança , Cadeias de Markov , Dados de Sequência Molecular , Método de Monte Carlo , Dinâmica Populacional , Análise de Sequência de DNA , Tibet
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