Contribution of insurance status to the association between marital status and cancer-specific survival: a mediation analysis.

OBJECTIVES: To evaluate the extent to which marriage influences cancer-specific survival (CSS) by influencing the insurance status among patients with common solid cancers and the feasibility of reducing the survival gap caused by marriage by increasing private insurance coverage for unmarried patients. SETTING: A retrospective cohort study with patients retrieved from the Surveillance, Epidemiology and End Results programme. PARTICIPANTS: Patients with nine common solid cancers diagnosed between 2007 and 2016 were included. Patients were excluded if their marital status, insurance status, socioeconomical status, stage or cause of death was unavailable, if survival time was less than 1 month, or if they were younger than 18 years at the time of diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was CSS, which was compared between married and unmarried individuals. Mediation analyses were conducted to determine the contribution of insurance status to the association between marriage and CSS. RESULTS: Married patients had better CSS than those unmarried (time ratio 1.778; 95% CI 1.758 to 1.797). Private health insurance was a key factor mediating the association between marital status and CSS (proportion mediated (PM), 17%; 95% CI 17% to 17.1%). The PM ranges from 10.7% in prostate cancer to 20% in kidney cancer. The contribution of private insurance to the association between marital status and CSS was greater among women than among men (PM 18.5% vs 16.7%). The mediating effect of private insurance was the greatest for the comparison between married and separated individuals (PM 25.6%; 95% CI 25.3% to 25.8%) and smallest for the comparison between married and widowed individuals (PM 11.0%; 95% CI 10.9% to 11.1%). CONCLUSIONS: 17% of the marital disparities in CSS are mediated by private insurance coverage. Increasing private insurance coverage for unmarried patients may reduce the survival gap related to marital status and sex. However, it is unclear whether better publicly funded insurance would have the same effect.

Liquid biopsy posttreatment surveillance in endemic nasopharyngeal carcinoma: a cost-effective strategy to integrate circulating cell-free Epstein-Barr virus DNA.

BACKGROUND: The optimal posttreatment surveillance strategy for nasopharyngeal carcinoma (NPC) remains unclear. Circulating cell-free Epstein-Barr virus (cfEBV) DNA has been recognized as a promising biomarker to facilitate early detection of NPC recurrence. Therefore, we aim to determine whether integrating circulating cfEBV DNA into NPC follow-up is cost-effective. METHODS: For each stage of asymptomatic nonmetastatic NPC patients after complete remission to primary NPC treatment, we developed a Markov model to compare the cost-effectiveness of the following surveillance strategies: routine follow-up strategy, i.e., (1) routine clinical physical examination; routine imaging strategies, including (2) routine magnetic resonance imaging plus computed tomography plus bone scintigraphy (MRI + CT + BS); and (3) routine 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT); cfEBV DNA-guided imaging strategies, including (4) cfEBV DNA-guided MRI + CT + BS and (5) cfEBV DNA-guided PET/CT. Clinical probabilities, utilities, and costs were derived from published studies or databases. Sensitivity analyses were performed. RESULTS: For all disease stages, cfEBV DNA-guided imaging strategies demonstrated similar survival benefits but were considerably more economical than routine imaging strategies. They only required approximately one quarter of the number of imaging studies compared with routine imaging strategies to detect one recurrence. Specifically, cfEBV DNA-guided MRI + CT + BS was most cost-effective for stage II (incremental cost-effectiveness ratio [ICER] $57,308/quality-adjusted life-year [QALY]) and stage III ($46,860/QALY) patients, while cfEBV DNA-guided PET/CT was most cost-effective for stage IV patients ($62,269/QALY). However, routine follow-up was adequate for stage I patients due to their low recurrence risk. CONCLUSIONS: The cfEBV DNA-guided imaging strategies are effective and cost-effective follow-up methods in NPC. These liquid biopsy-based strategies offer evidence-based, stage-specific surveillance modalities for clinicians and reduce disease burden for patients.

[Effects of temperature and photoperiod on body mass, energy budget and digestive tract morphology in Pycnonotus sinensis.] / æ¸©åº¦ä¸Žå ‰å‘¨æœŸå¯¹ç™½å¤´é¹Žä½“è´¨é‡ã€èƒ½é‡æ”¶æ”¯å’Œæ¶ˆåŒ–é“å½¢æ€çš„å½±å“.

Temperature and photoperiod are proximate environmental factors that have an important influence on the morphological, physiological and behavioral adjustments animals performance du-ring seasonal acclimatization. In this study, the effects of temperature and photoperiod on phenotypic flexibility in body mass, energy budget and digestive tract morphology in the Chinese bulbul (Pycnonotus sinensis) were examined, and the relationship between energy budget and digestive tract morphology was analyzed. Twelve male and sixteen female Chinese bulbuls were randomly assigned into 4 experimental groups so that each group was comprised of three males and four females. The groups were: 1) a warm and long photoperiod (30 ℃, 16 light: 8 dark) group, 2) a warm and short photoperiod (30 ℃, 8 light: 16 dark) group, 3) a cold and long photoperiod (10 ℃, 16 light:8 dark) group, and 4) a cold and short photoperiod (10 ℃, 8 light: 16 dark) group. Each group was acclimated to its respective temperature and photoperiod for 4 weeks. Birds in the cold temperature and short photoperiod group underwent a significant increase in body mass, gross energy intake (GEI) and digestible energy intake (DEI) compared to the other three groups, and there was a significant interaction between temperature and photoperiod on gross energy intake and diges-tible energy intake. The mass of the stomach, small intestine, rectum, and total digestive tract, all increased significantly in cold temperature treatment groups compared to those acclimated to a relatively warm temperature. There was a significant, positive correlation between GEI and DEI resi-duals and those of the length and dry mass of the small intestine and total digestive tract. These results suggested that the Chinese bulbul met the increased energy demands of winter (colder tempe-ratures and reduced foraging time due to shorter day-length) by increasing its body mass, digestible energy intake and digestive tract size.