Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer.

CONTEXT: Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. OBJECTIVES: We examined patterns of symptom management medication receipt at EOL for older adults who died of lung cancer. METHODS: This retrospective cohort used the Surveillance, Epidemiology, and End Results-Medicare database to identify decedents diagnosed with lung cancer at age 67 years and older between January 2008 and December 2013 who survived six months and greater after diagnosis. Using Medicare Part B and D claims, we identified monthly receipt of outpatient medications for symptomatic management of pain, emotional distress, fatigue, dyspnea, anorexia, and nausea/vomiting. Multivariable logistic regression estimated associations between medication receipt and patient demographic characteristics, comorbidity, and concurrent therapy. RESULTS: Of the 16,246 included patients, large proportions received medications for dyspnea (70.7%), pain (62.5%), and emotional distress (49.4%), with lower prevalence for other symptoms. Medication receipt increased from six months to one month before death. Women and dual Medicaid enrolled were more likely to receive medications for pain, emotional distress, dyspnea, and nausea/vomiting. Receipt of symptom management medications decreased with increasing age and racial/ethnical minorities. CONCLUSION: Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patient-provider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.

[Analysis on occupational health monitoring to workers in Zhoushan City].

Objective: To analyze the occupational health monitoring data of workers in Zhoushan City, and provide scientific basis for health monitoring and the formulation of occupational disease prevention measures. Methods: From January 2016 to November 2019, the occupational health examination data of 37826 workers in Zhoushan City were collected to analyze the change trend of the detection rate of suspected occupational diseases and occupational contraindications, and to compare the health monitoring status of workers with different social characteristics such as enterprise scale and economic type. Results: From 2016 to 2019, the detection rate of suspected occupational diseases showed a downward trend (χ(2)(trend)=21.09, P<0.05) . The occupational health examination of on-the-job workers in Zhoushan were mainly small enterprises (59.72%, 22591/37826) , private economic enterprises (65.32%, 24707/37826) , male (82.03%, 31028/37826) , 30-49 years old (59.11%, 22359/37826) , and exposed to noise (67.06%, 25365/37826) . The detection rates of occupational contraindications and suspected occupational diseases were higher in micro enterprise, male, over 60 years old, exposed to occupational hazards for more than 49 months, and exposed to chemical and physical hazards at the same time. The detection rates of occupational contraindications and suspected occupational diseases were significantly different among different enterprise scale, economic type, gender, age and occupational hazard factors (P<0.05) . Among benzene workers with occupational contraindications and suspected occupational diseases, the detection rate of A/G abnormality in female workers was higher than that in male workers (P=0.04) , and there was no significant difference in other genders (P>0.05) . Conclusion: It is necessary to pay more attention to the workers working in small and private enterprises in Zhoushan City, strengthen the occupational health supervision of male workers who are over 60 years old who are exposed to benzene, noise and other occupational hazards, standardize the occupational health inspection, and effectively protect the health of the occupational population.

Uterine microvascular sensitivity to nanomaterial inhalation: An in vivo assessment.

With the tremendous number and diverse applications of engineered nanomaterials incorporated in daily human activity, exposure can no longer be solely confined to occupational exposures of healthy male models. Cardiovascular and endothelial cell dysfunction have been established using in vitro and in situ preparations, but the translation to intact in vivo models is limited. Intravital microscopy has been used extensively to understand microvascular physiology while maintaining in vivo neurogenic, humoral, and myogenic control. However, a tissue specific model to assess the influences of nanomaterial exposure on female reproductive health has not been fully elucidated. Female Sprague Dawley (SD) rats were exposed to nano-TiO2 aerosols (171 ± 6 nm, 10.1 ± 0.39 mg/m(3), 5h) 24-hours prior to experimentation, leading to a calculated deposition of 42.0 ± 1.65 µg. After verifying estrus status, vital signs were monitored and the right horn of the uterus was exteriorized, gently secured over an optical pedestal, and enclosed in a warmed tissue bath using intravital microscopy techniques. After equilibration, significantly higher leukocyte-endothelium interactions were recorded in the exposed group. Arteriolar responsiveness was assessed using ionophoretically applied agents: muscarinic agonist acetylcholine (0.025 M; ACh; 20, 40, 100, and 200 nA), and nitric oxide donor sodium nitroprusside (0.05 M; SNP; 20, 40, and 100 nA), or adrenergic agonist phenylephrine (0.05 M; PE; 20, 40, and 100 nA) using glass micropipettes. Passive diameter was established by tissue superfusion with 10(-4)M adenosine. Similar to male counterparts, female SD rats present systemic microvascular dysfunction; however the ramifications associated with female health and reproduction have yet to be elucidated.

Broadcasting health programmes among audience and professionals in Korea: perceptions and needs.

Mass media has become an essential part of modern society, and it should be noted that mass media plays an important role in delivering information even in the area of health. This study was intended to investigate the perceptions of and needs for broadcasting health programmes among audience and related professionals in Korea, which will serve to help in the development of valuable health programmes. Data were collected through a series of self-administered questionnaire surveys conducted on two types of subjects sampled from residents in the areas around Seoul, Korea, and health or broadcasting professionals working on health programmes. There were some discrepancies in the perceptions of and needs for health programmes between audience and professionals, especially the main audience age group and image, needs for topics and mode of health programme. In conclusion, in order to enhance current health programmes which focus on aspects of diagnosis and treatment of diseases, the range of health programmes should be expanded to fulfill various needs.

Clinical improvement and immunohistochemical findings in severe atopic dermatitis treated with interferon gamma.

BACKGROUND: Several clinical studies have focused on the therapeutic effects of interferon gamma (IFN-gamma) in patients with severe atopic dermatitis (AD), although the dosage of recombinant IFN-gamma (rIFN-gamma), therapeutic schedule, and the degree of clinical improvement were different among studies. Although the exact mechanism of action of IFN-gamma therapy in AD is not clear, the beneficial effects of IFN-gamma have been attributed mainly to an immunomodulating effect on the expression of certain immunologic markers. OBJECTIVE: Our purpose was to study the therapeutic effect of two different dosages of rIFN-gamma on AD and to investigate the change of lesional expression of infiltrating inflammatory cell markers associated with rIFN-gamma therapeutic efficacy. METHODS: Fifty-one patients with severe recalcitrant AD were treated with rIFN-gamma. Twenty patients were treated with 0.5 x 10(6) IU/m(2) of rIFN-gamma (low-dose [LD] group); 21 patients received 1.5 x 10(6) IU/m(2) of rIFN-gamma (high-dose [HD] group); and 10 patients received placebo. The patients were injected subcutaneously 3 times a week for 12 weeks. Immunohistochemical study was performed in 20 patients of the HD group in the initial visit and after completion of rIFN-gamma therapy with a panel of 14 monoclonal antibodies as markers of inflammatory cells and cytokines. RESULTS: The disease severity of the 2 groups treated with rIFN-gamma was reduced significantly at the end of treatment compared with that of the placebo group (P<.05). More rapid clinical improvement and more effective treatment outcome were seen in the HD group than in the LD group for the initial 6-week treatment period; however, the clinical improvement in both of the treated groups was stable and maintained after week 8 of treatment. Immunohistochemical findings showed statistically significant reduction in the lesional expression of CD25 and EG2 cells that infiltrated into skin after rIFN-gamma therapy. CONCLUSION: This study demonstrated that rIFN-gamma therapy for AD is safe and effective. In the early phase of therapy, a higher dosage of rIFN-gamma is more effective; and for the maintenance of clinical improvement, a lower dosage of rIFN-gamma is recommended when high cost and effectiveness of rIFN-gamma are considered. The therapeutic efficacy of rIFN-gamma in AD might be in part related to the decreased number of CD25(+) and EG2(+) inflammatory cells infiltrated into skin.

A new classification scheme for hypertension based on relative and absolute risk with implications for treatment and reimbursement.

Classification schemes for hypertension are necessary. They provide us with definitions for when hypertension begins and help us to assess risk, determine prognosis, and guide management. Systems in current use rely on either the level of blood pressure (diastolic, systolic, or both) and classify patients based on the level of relative risk (the proportional likelihood of cardiovascular events occurring as blood pressure rises), absolute risk (the actual odds that a patient or a population will develop an event), or both. Absolute risk reflects the sum of all the factors that contribute to the likelihood that a patient will experience cardiovascular disease. The system we propose stages hypertensive individuals on the basis of blood pressure level (as does the Fifth Joint National Committee report on the detection, evaluation, and treatment of high blood pressure [JNC-V] and the World Health Organization/International Society of Hypertension guidelines) but uses different levels for each stage than do the previous systems and then modifies the numerical stage with the subscript "c" for complicated (when target-organ damage and/or other cardiovascular risk factors are present) or "u" for uncomplicated (when they are absent). The data obtained from a complete medical history and physical examination and a few inexpensive laboratory tests provide the information a provider needs to classify an individual as being complicated or uncomplicated. This system also provides a guide to treatment, as drug therapy would be used sooner in individuals with complicated hypertension, and we propose that compensation for providers be higher when they are caring for a patient with complicated rather than uncomplicated hypertension.