RESUMEN
BACKGROUND: Cancer Research UK ran a mass-media campaign for 6 weeks from Sept 1, 2022, to Sept 13, 2022, targeted to people aged 50 years and older and from a lower social-grade (C2DE) in Northern Ireland. The campaign was developed to target barriers to help-seeking for the target audience. With this evaluation, we aimed to compare reported barriers and self-reported help-seeking before and after the campaign to assess changes potentially related to the campaign. METHODS: We ran cross-sectional surveys that collected data from independent participants before the campaign (wave 1; n=1262; July 18-Aug 31, 2022) and after the campaign (wave 2; n=1250; Oct 3-Nov 3, 2022; N=2512). A recruitment agency recruited participants to be representative of Northern Ireland by age, gender, and social grade (Office for National Statistics, 2011; quota sampling). After wave 2, age range was 16-94 years (mean 51 years) and gender breakdown was 46% male (n=1152), 54% female (n=1356), and <1% other (n=3). Participants gave written informed consent, and the survey was administered using Computer Assisted Personal Interviewing (CAPI) at waves 1 and 2, and Computer Assisted Telephone Interviewing (CATI) at wave 1. Ethics approval was given by Queens University Belfast. Data were analysed in SPSS. FINDINGS: 78% of the targeted audience (354/451) reported remembering the TV campaign. Of people who reported no symptoms, more reported "nothing would put them off or delay seeking medical attention" at wave 2 (447 [41%] of 1084 participants) than at wave 1 (221 [24%] of 936 participants), and this difference was significant (t(939.796)=2·243, p=0·025; 95% CI 0·083 to 1·244). Participants who reported experiencing a symptom (wave 1 n=186; wave 2 103) were less likely to report that they did not seek help from their GP or doctor in wave 2 (n=63 [61%]) than in wave 1 (n=157 [85%]); however, this difference was not significant (t(214.167)=1·133, p=0·258, 95% CI -0·051 to 0·188). INTERPRETATION: Decreases in barriers reported "nothing putting them off seeking help" and decreases in not seeking help from a GP or doctor to help seeking for actual symptoms experienced suggests this campaign might have resulted in some positive shifts in self-reported help-seeking behaviours for actual symptoms. However, these findings should be interpreted in light of the limitations of this research. Although this was a large sample, additional consideration should be given to the use of independent samples (rather than repeated surveys with the same population), self-reported data, and different data collection methods. FUNDING: Community Foundation for Northern Ireland through the Department of Health Cancer Charities Fund.
Asunto(s)
Detección Precoz del Cáncer , Neoplasias , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adolescente , Adulto Joven , Adulto , Anciano de 80 o más Años , Estudios Transversales , Irlanda del Norte , Neoplasias/diagnóstico , Encuestas y Cuestionarios , Medios de Comunicación de Masas , Aceptación de la Atención de SaludRESUMEN
BACKGROUND: Social (or physical) distancing is an important transmission-prevention behaviour that has been endorsed to minimize COVID-19 transmission. This qualitative study explores the facilitators of and barriers to social distancing for young people during the COVID-19 pandemic, with recognition that young people represent a unique demographic group, with differing psychosocial needs and experiences to other age cohorts. METHODS: Qualitative data was collected as part of a larger Qualtrics survey between July 28th 2020 and August 24th 2020. Eligible participants were young people living on the Island of Ireland, aged 16-25 years. The survey design was underpinned by the Capability, Opportunity, and Motivation model of behaviour change (COM-B). Semi-inductive thematic analysis was used to analyse comments collected via three free-text survey items. The COM-B model provided a thematic framework to organise subthemes extracted. RESULTS: A total of N = 477 young people completed the survey, of which N = 347 provided comments for at least one of three free-text survey items. The majority of respondents lived in Northern Ireland (96%), the average age was 21 years, and most respondents were female (73%) and were students (81%). Key barriers identified included lack of environmental support for social distancing (lack of physical Opportunity to social distance), observing other people not social distancing (lack of social Opportunities supporting social distancing), and missing physical interaction from others (relating to the dissuading influence of automatic Motivational factors i.e. the influence of loneliness). Key facilitators included presence of clear and consistent environmental cues and availability of space to support social distancing (increasing physical Opportunity to social distance), increasing awareness and perceived consequences of risk of transmission (enhancing reflective Motivational factors i.e. perceived benefits (versus costs) of social distancing), and increasing opportunities to observe others' adhering to guidelines (increasing social Opportunities supporting social distancing). CONCLUSIONS: These findings suggest that the actions and endorsement of peers and the physical design of environments have a key role in influencing social distancing behaviour among young people living in NI. The COM-B factors identified in this study can inform the development of tailored interventions using models such as the Behaviour Change Wheel. The findings of this study suggest that intervention functions based on peer modelling and physical environmental restructuring and enablement should be priortitised, however it is imperative that interventions are co-designed with young people to foster collaboration and empowerment.
Asunto(s)
COVID-19 , Distanciamiento Físico , Adolescente , Adulto , COVID-19/prevención & control , Femenino , Humanos , Masculino , Motivación , Pandemias/prevención & control , Investigación Cualitativa , Adulto JovenRESUMEN
OBJECTIVES: Research on the needs of family caregivers of people living with cancer remains disproportionately focused in high income contexts. This research gap adds to the critical challenge on global equitable delivery of cancer care. This study describes the roles of family caregivers of people living with cancer in Vietnam and possible implications for intervention development. METHODS: Semi-structured interviews and focus groups with family caregivers (n = 20) and health care providers (n = 22) were conducted in two national oncology hospitals. Findings were verified via workshops with carers (n = 11) and health care professionals (n = 28) in five oncology hospitals representing different regions of Vietnam. Data was analyzed collaboratively by an international team of researchers according to thematic analysis. RESULTS: Family caregivers in Vietnam provide an integral role in the delivery of inpatient cancer care. In the hospital environment families are responsible for multiple roles including feeding, hydration, changing, washing, moving, wound care and security of personal belongings. Central to this role is primary decision making in terms of treatment and end-of-life care; relaying information, providing nutritional, emotional and financial support. Families are forced to manage severe complications and health care needs with minimal health literacy and limited health care professional input. CONCLUSIONS: Understanding context and the unique roles of family caregivers of people living with cancer is critical in the development of supportive services. As psycho-oncology develops in low and middle income contexts, it is essential that family caregiver roles are of significant importance.
Asunto(s)
Cuidados Paliativos al Final de la Vida , Neoplasias , Cuidado Terminal , Cuidadores , Familia , Humanos , Neoplasias/terapia , Investigación Cualitativa , VietnamRESUMEN
Oceanic uptake of anthropogenic CO2 leads to decreased pH, carbonate ion concentration, and saturation state with respect to CaCO3 minerals, causing increased dissolution of these minerals at the deep seafloor. This additional dissolution will figure prominently in the neutralization of man-made CO2 However, there has been no concerted assessment of the current extent of anthropogenic CaCO3 dissolution at the deep seafloor. Here, recent databases of bottom-water chemistry, benthic currents, and CaCO3 content of deep-sea sediments are combined with a rate model to derive the global distribution of benthic calcite dissolution rates and obtain primary confirmation of an anthropogenic component. By comparing preindustrial with present-day rates, we determine that significant anthropogenic dissolution now occurs in the western North Atlantic, amounting to 40-100% of the total seafloor dissolution at its most intense locations. At these locations, the calcite compensation depth has risen â¼300 m. Increased benthic dissolution was also revealed at various hot spots in the southern extent of the Atlantic, Indian, and Pacific Oceans. Our findings place constraints on future predictions of ocean acidification, are consequential to the fate of benthic calcifiers, and indicate that a by-product of human activities is currently altering the geological record of the deep sea.
Asunto(s)
Carbonato de Calcio/química , Dióxido de Carbono/efectos adversos , Agua de Mar/química , Carbonato de Calcio/análisis , Dióxido de Carbono/análisis , Ecosistema , Actividades Humanas , Concentración de Iones de Hidrógeno , Océanos y Mares , Océano Pacífico , Agua de Mar/análisis , Solubilidad , AguaRESUMEN
Bottom trawlers land around 19 million tons of fish and invertebrates annually, almost one-quarter of wild marine landings. The extent of bottom trawling footprint (seabed area trawled at least once in a specified region and time period) is often contested but poorly described. We quantify footprints using high-resolution satellite vessel monitoring system (VMS) and logbook data on 24 continental shelves and slopes to 1,000-m depth over at least 2 years. Trawling footprint varied markedly among regions: from <10% of seabed area in Australian and New Zealand waters, the Aleutian Islands, East Bering Sea, South Chile, and Gulf of Alaska to >50% in some European seas. Overall, 14% of the 7.8 million-km2 study area was trawled, and 86% was not trawled. Trawling activity was aggregated; the most intensively trawled areas accounting for 90% of activity comprised 77% of footprint on average. Regional swept area ratio (SAR; ratio of total swept area trawled annually to total area of region, a metric of trawling intensity) and footprint area were related, providing an approach to estimate regional trawling footprints when high-resolution spatial data are unavailable. If SAR was ≤0.1, as in 8 of 24 regions, there was >95% probability that >90% of seabed was not trawled. If SAR was 7.9, equal to the highest SAR recorded, there was >95% probability that >70% of seabed was trawled. Footprints were smaller and SAR was ≤0.25 in regions where fishing rates consistently met international sustainability benchmarks for fish stocks, implying collateral environmental benefits from sustainable fishing.
Asunto(s)
Explotaciones Pesqueras/estadística & datos numéricos , Alaska , Animales , Australia , Biodiversidad , Chile , Ecosistema , Invertebrados/fisiología , Nueva Zelanda , Océanos y Mares , Alimentos Marinos/estadística & datos numéricosRESUMEN
OBJECTIVE: Vietnam, like many low/middle income countries, lacks the infrastructure to provide information and psychosocial support to cancer patients and their carers. We undertook a codesign process to develop a web resource to inform and support carers. METHODS: Cancer carers and health care professionals' perspectives regarding information and support needs and the content and delivery of web-based supports, were explored via five focus groups (n = 39) and semistructured interviews (n = 4) in Vietnam in 2018. Focus groups and interviews were transcribed verbatim and analyzed using thematic analysis. Resource components were verified at two joint stakeholder workshops attended by 40 participants. RESULTS: The development of a web-based resource was identified as an urgent need. A web-based resource was viewed as a suitable interface to provide support across regions in a sustainable way. The structure of the resource should include peer-led videoed advice, signposting to services and include official endorsement. The potential resource components identified includes (a) cancer causes and consequences; (b) hospital administration, treatment processes, and prices; (c) daily living; (d) emotional and supportive information; (e) skills training; and (f) nutrition and traditional medicine. CONCLUSION: The development of a web-based resource to deliver information and psychosocial supports to cancer carers and by-proxy patients is an urgent requirement in Vietnam. Next steps will include resource development and testing the resources ability to address the unmet needs of cancer carers and patients. A web-based resource to support cancer carers has the potential for application to other developing countries.
Asunto(s)
Actitud Frente a la Salud , Cuidadores/psicología , Promoción de la Salud/métodos , Neoplasias/psicología , Relaciones Profesional-Familia , Adulto , Instrucción por Computador/métodos , Femenino , Grupos Focales , Humanos , Internet , Masculino , Persona de Mediana Edad , Neoplasias/rehabilitación , Apoyo Social , VietnamRESUMEN
BACKGROUND: Breast cancer incidence is increasing in Vietnam with studies indicating low levels of knowledge and awareness and late presentation. While there is a growing body of literature on challenges faced by women in accessing breast cancer services, and for delivering care, no studies have sought to analyse breast cancer messaging in the Vietnamese popular media. The aim of this study was to investigate and understand the content of messages concerning breast cancer in online Vietnamese newspapers in order to inform future health promotional content. METHODS: This study describes a mixed-methods media content analysis that counted and ranked frequencies for media content (article text, themes and images) related to breast cancer in six Vietnamese online news publications over a twelve month period. RESULTS: Media content (n = 129 articles & n = 237 images) sampled showed that although information is largely accurate, there is a marked lack of stories about Vietnamese women's personal experiences. Such stories could help bridge the gap between what information about breast cancer is presented in the Vietnamese media, and what women in Vietnam understand about breast cancer risk factors, symptoms, screening and treatment. CONCLUSIONS: Given findings from other studies indicating low levels of knowledge and women with breast cancer experiencing stigma and prejudice, more nuanced and in-depth narrative-focused messaging may be required.
Asunto(s)
Neoplasias de la Mama/psicología , Medios de Comunicación , Información de Salud al Consumidor/normas , Detección Precoz del Cáncer/psicología , Neoplasias de la Mama/diagnóstico , Información de Salud al Consumidor/métodos , Femenino , Humanos , Prejuicio , Estigma Social , VietnamRESUMEN
We discuss three important cases that the Competition and Markets Authority (CMA) has completed over the past year: First, the coronavirus pandemic has had implications for a wide range of the CMA's work; we describe the work on price gouging conducted by the CMA's Covid-19 taskforce and respond to the argument that competition authorities should not be concerned about such behaviour. Second, a number of high-profile studies have considered the appropriate application of competition policy in digital industries. The second two cases-the Online Platforms and Digital Advertising market study, and the Google/Looker merger-show the work the CMA has continued to do in this area.
RESUMEN
We reviewed and analyzed published research concerning efforts to increase regular use of HIV testing services in Thailand. Separate studies suggested that the creation of participatory and creative online spaces for information sharing and promoting community-based testing positively influence levels of HIV testing, including repeat-testing in some cases. Population targeted approaches, using same-day rapid tests, and using diverse locations for testing (medical and non-medical) may improve rates of testing. Thailand shows an example of successful HIV management and reduction. The challenge is to continue towards zero new infections and end an epidemic that is increasingly associated among people with specific risk behaviors. These characteristics make Thailand a case study for consideration by other national HIV programs.
Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Humanos , Tamizaje Masivo/métodos , TailandiaRESUMEN
Breast cancer is the most frequently diagnosed cancer among Vietnamese women. This qualitative study describes and discusses the mental health challenges of women with breast cancer in Vietnam. Two-rounds of semi-structured in-depth interviews were conducted among thirteen women with breast cancer and four caregivers from northern and southern Vietnam. Participants were recruited using purposive sampling technique. Data was collaboratively analyzed by qualitative content analysis using the Open Code Software version 4.02 and discussed among a team of local and international researchers. Women in the study experienced significant mental health challenges associated with their breast cancer diagnosis. Both psychological and emotional health were adversely affected. Women with breast cancer had profound concerns about how the diagnosis impacted their families. They experienced challenges in spousal relationships as well as facing social stigma and discrimination. Appropriate public health interventions should be implemented to raise society's awareness and help improve the mental health of women with breast cancer.
Asunto(s)
Neoplasias de la Mama , Salud Mental , Humanos , Femenino , Vietnam , Neoplasias de la Mama/diagnóstico , Investigación Cualitativa , Estigma SocialRESUMEN
This study assesses the perceived impact and benefits of Project ECHO (Extension for Community Healthcare Outcomes), a tele-mentoring intervention for health and social care providers, patients and the health system in Northern Ireland. Having access to a specialist, a space to share experiences, and being able to disseminate up-to-date best practice were all cited as improving provider knowledge as well as improving quality of care for patients. Healthcare providers reported being more confident in managing patients and that relationships had been improved between different levels of the health system. ECHO was described as improving access to education and training by removing geographic and time barriers. This is one of the first studies to qualitatively analyse impact across a number of different clinical and social care ECHO networks. The results strongly indicate the perceived benefit of ECHO in improving provider, patient and health system outcomes such as increased healthcare provider knowledge and confidence to manage patients at primary levels of the health system. This has implications for future service design, particularly within the context of COVID-19 in which virtual and online training is necessitated by social distancing requirements.
Asunto(s)
COVID-19 , Humanos , Irlanda del Norte , Servicios de Salud Comunitaria , Apoyo Social , Personal de Salud/educaciónRESUMEN
BACKGROUND: This study examined current breast cancer (BC) screening practices among Vietnamese women and the factors associated with the uptake of clinical breast examination (CBE). METHODS: A total of 508 women aged 30-74 years in Hanoi completed a knowledge-attitude-practice (KAP) survey in 2019 including validated measures of breast cancer awareness (Breast-CAM) and health beliefs (Champion's Health Belief Model Scale). Descriptive statistics, χ2, and ANOVA tests were used to analyse KAP responses across groups with different sociodemographic characteristics. A logistic regression model assessed the associations of knowledge, beliefs, and sociodemographic characteristics with CBE uptake. RESULTS: Only 18% of respondents were aware of BC signs, risk factors, and screening modalities although 63% had previously received BC screening. CBE was the most common screening modality with an uptake of 51%. A significantly higher proportion of urban residents compared with rural residents (32% vs 18%, Chi-square test, p = 0.04) received mammography. Unlike mammography, CBE uptake was not associated with sociodemographic characteristics (i.e., residence area/education level/occupation/household monthly income/possession of health insurance). CBE uptake was associated with BC knowledge (OR = 2.44, 95%CI: 1.37-4.32), perceived susceptibility to BC (OR = 1.15, 95%CI: 1.05-1.25), and perceived barriers to accessing CBE (OR = 0.88, 95%CI: 0.84-0.92). CONCLUSION: The study points to the need for public health education and promotion interventions to address low levels of awareness about BC and to increase uptake of BC screening in Vietnam in advance of screening programme planning and implementation. It also suggests that screening programmes using CBE are promising given current engagement and the absence of socio-demographic disparities.
Asunto(s)
Neoplasias de la Mama , Detección Precoz del Cáncer , Pueblo Asiatico , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/prevención & control , Autoexamen de Mamas , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Vietnam/epidemiologíaRESUMEN
The COVID-19 pandemic has greatly affected the delivery of cancer care. Due to social restrictions and reductions in health service contact, it is expected that the burdens experienced by informal carers have risen. This study provides an analysis of cancer carer's experiences and needs as a consequence of the pandemic. An online mixed method design was used. The survey included open-ended responses to explore carer's experiences and measures of health status (EQ-5D-5L), Quality of Life (WHOQoL-BREF) and impact of COVID-19. Open-ended responses were analysed thematically according to Miles and Huberman techniques and quantitative data were analysed descriptively. One hundred and ninety-six cancer carers participated in the online survey. Mixed method analysis demonstrated that carers were experiencing major difficulties. Of these n = 142/72.4% experienced challenges related to anxiety and depression; 35.2% rated these problems as slight with 25% rating these as moderate and 11.2% as severe. Qualitative analysis identified significant and sustained negative impacts of the pandemic on psychological health, social isolation, finance and access to health services with carers requiring urgent information and support. Carer's challenges have deepened throughout the COVID-19 pandemic. There is an urgent need to develop innovative ways to provide support for carers to provide palliative and supportive care at home now and during recovery from the pandemic. Due to the need for infection control meaningful development and integration of urgent digital technology might be the most feasible solution.
Asunto(s)
COVID-19 , Neoplasias , COVID-19/epidemiología , Cuidadores/psicología , Humanos , Neoplasias/epidemiología , Neoplasias/terapia , Pandemias , Calidad de VidaRESUMEN
BACKGROUND: Vietnam has experienced a rapid increase in cancer incidence with many cancers (70%) being diagnosed at a late stage. The majority of physical and psychosocial care is provided by caregivers with minimal professional input. Due to limited resources in hospitals and social and cultural norms regarding caregiving in Vietnam, caregivers provide a range of supportive functions for family members diagnosed with cancer. OBJECTIVES: This study sought to provide empirical evidence on the self-identified unmet needs of caregivers of inpatients in national oncology hospitals in Vietnam. METHODS: Focus groups and in-depth interviews were conducted with caregivers (n = 20) and health care providers (n = 22) in national oncology hospitals in Hanoi and Ho Chi Minh City. Data was collaboratively analysed using thematic analysis. Findings were validated through key stakeholder group discussions with both caregivers and healthcare providers across multiple regions in Vietnam. RESULTS: Analysis demonstrated that the burden of informal care is high with many caregivers managing patient's severe and complex health needs with minimal support. Caregivers highlighted four main areas of critical need: (i) challenges in providing long term care, particularly in hospital and in-patient settings, such as accessing comfortable facilities, accommodation and finance; (ii) information needs about cancer, treatment, and nutrition; (iii) support for the emotional impact of cancer; and (iv) training about how to provide care to their family members during treatment and recovery phases. CONCLUSIONS: Caregivers provide invaluable support in supporting people with a cancer diagnosis, particularly given wider systemic challenges in delivering cancer services in Vietnam. Increasing visibility and formal support is likely to have both a positive impact upon the health and wellbeing of caregivers, as well as for cancer patients under their care. Given its absence, it is critical that comprehensive psychosocial care is developed for caregivers in Vietnam.
Asunto(s)
Cuidadores , Neoplasias , Familia , Humanos , Neoplasias/terapia , Investigación Cualitativa , Vietnam/epidemiologíaRESUMEN
In this study, we characterized nuclear factor kappaB (NF-kappaB) subunit DNA binding in chronic lymphocytic leukemia (CLL) samples and demonstrated heterogeneity in basal and inducible NF-kappaB. However, all cases showed higher basal NF-kappaB than normal B cells. Subunit analysis revealed DNA binding of p50, Rel A, and c-Rel in primary CLL cells, and Rel A DNA binding was associated with in vitro survival (P = .01) with high white cell count (P = .01) and shorter lymphocyte doubling time (P = .01). NF-kappaB induction after in vitro stimulation with anti-IgM was associated with increased in vitro survival (P < .001) and expression of the signaling molecule ZAP-70 (P = .003). Prompted by these data, we evaluated the novel parthenolide analog, LC-1, in 54 CLL patient samples. LC-1 induced apoptosis in all the samples tested with a mean LD(50) of 2.8 microM after 24 hours; normal B and T cells were significantly more resistant to its apoptotic effects (P < .001). Apoptosis was preceded by a marked loss of NF-kappaB DNA binding and sensitivity to LC-1 correlated with basal Rel A DNA binding (P = .03, r(2) = 0.15). Furthermore, Rel A DNA binding was inversely correlated with sensitivity to fludarabine (P = .001, r(2) = 0.3), implicating Rel A in fludarabine resistance. Taken together, these data indicate that Rel A represents an excellent therapeutic target for this incurable disease.
Asunto(s)
Leucemia Linfocítica Crónica de Células B/patología , Factor de Transcripción ReIA/metabolismo , Apoptosis , ADN/metabolismo , Progresión de la Enfermedad , Humanos , Unión Proteica , Factor de Transcripción ReIA/análisis , Células Tumorales CultivadasRESUMEN
PURPOSE: Comprehensive review of gene replacement therapy with guidance and expert opinion on handling and administration for pharmacists. SUMMARY: There are currently â¼2600 gene therapy clinical trials worldwide and 4 Food and Drug Administration (FDA)-approved gene therapy products available in the United States. Gene therapy and its handling are different from other drugs; however, there is a lack of guidance from the National Institutes of Health (NIH), FDA, Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and professional associations regarding their pharmaceutical application. Although the NIH stratifies the backbone biologicals of viral vectors in gene therapies into risk groups, incomplete information regarding minimization of exposure and reduction of risk exists. In the absence of defined guidance, individual institutions develop their own policies and procedures, which often differ and are often outdated. This review provides expert opinion on the role of pharmacists in institutional preparedness, as well as gene therapy handling and administration. A suggested infrastructural model for gene replacement therapy handling is described, including requisite equipment acquisition and standard operating procedure development. Personnel, patient, and caregiver education and training are discussed. CONCLUSION: Pharmacists have a key role in the proper handling and general management of gene replacement therapies, identifying risk level, establishing infrastructure, and developing adequate policies and protocols, particularly in the absence of consensus guidelines for the handling and transport of gene replacement therapies.
Asunto(s)
Farmacéuticos , Terapia Genética , Humanos , Preparaciones Farmacéuticas , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Introduction: National Institutes of Health (NIH) defines gene therapy as an experimental technique that uses genes to treat or prevent disease. Although gene therapy is a promising treatment option for a number of diseases (including inherited disorders, some types of cancer, and certain viral infections), the technique remains risky and is still under study to make sure that it will be effective and safe. Methods: Applications of viral vectors and nonviral gene delivery systems have found an encouraging new beginning in gene therapy in recent years. Although several viral vectors and nonviral gene delivery systems have been developed in the past 3 decades, no one delivery system can be applied in gene therapy to all cell types in vitro and in vivo. Furthermore, the use of viral vector systems (both in vitro and in vivo) present unique occupational health and safety challenges. In this review article, we discuss the biosafety challenges and the current framework of risk assessment for working with the viral vector systems. Discussion: The recent advances in the field of gene therapy is exciting, but it is important for scientists, institutional biosafety committees, and biosafety officers to safeguard public trust in the use of this technology in clinical trials and make conscious efforts to engage the public through ongoing forums and discussions.
RESUMEN
OBJECTIVES: To understand, describe and analyse the experiences of women with breast cancer in Vietnam when accessing and using breast cancer services. DESIGN: Descriptive qualitative study. Women were interviewed about their experiences from the first time they became aware of symptoms or changes to their body through treatment and post-treatment. This study is the first descriptive study on breast cancer in Vietnam from the perspective of women with a breast cancer diagnosis. PARTICIPANTS: Women (n=13) who had completed or were still receiving treatment for breast cancer, purposively recruited from the north and south of Vietnam. RESULTS: An analysis of the experiences of women with breast cancer in Vietnam revealed a lack of awareness and knowledge about breast cancer and symptoms. Family and social support were described as key factors influencing whether a woman accesses and uses breast cancer services. Cost of treatment and out-of-pocket expenditures limited access to services and resulted in significant financial challenges for women and their families. CONCLUSIONS: Vietnam has made huge strides in improving cancer care, and is tackling a complex and expanding public health challenge, however, there are a number of areas requiring strengthening and future research. While Vietnam has successfully expanded social health insurance coverage, changes that increase the percentage of costs covered for specific treatments, such as chemotherapy or radiotherapy, could benefit women and their families.
Asunto(s)
Neoplasias de la Mama , Accesibilidad a los Servicios de Salud , Investigación sobre Servicios de Salud , Neoplasias de la Mama/terapia , Femenino , Humanos , Investigación Cualitativa , Apoyo Social , VietnamRESUMEN
PURPOSE: We have recently shown that the novel nuclear factor-kappaB (NF-kappaB) inhibitor LC-1 is effective in primary chronic lymphocytic leukemia (CLL) cells. Here we elucidated the mechanism of action of LC-1, evaluated its relative cytotoxicity in prognostic subsets, and investigated its potential synergistic interaction with fludarabine. EXPERIMENTAL DESIGN: Ninety-six fully characterized CLL cases were assessed for in vitro sensitivity to LC-1 and fludarabine. In selected cases, caspase activation, inhibition of Rel A DNA binding, and the transcription of CFLAR, BIRC5, and BCL2 were measured before and after exposure to LC-1. In addition, the efficacy of LC-1 was assessed in the presence of the survival factors CD154 and interleukin-4, and the potential synergistic interaction between LC-1 and fludarabine was evaluated. RESULTS: Cell death was associated with caspase-3 activation mediated via activation of both caspase-8 and caspase-9. Apoptosis was preceded by a reduction of nuclear Rel A DNA binding and inhibition of CFLAR, BIRC5, and BCL2 transcription. Importantly, LC-1 overcame the cytoprotective effects by interleukin-4 and CD40 ligand and was equipotent in CLL cells derived from good and bad prognostic subsets. LC-1 exhibited strong synergy with fludarabine, and the combination produced a highly significant mean dose reduction index for fludarabine of > 1,000. CONCLUSIONS: In view of imminent first-in-man study of LC-1 in Cardiff, these data show an important mechanistic rationale for the use of LC-1 in this disease. Furthermore, it validates the concept of targeting nuclear factor-kappaB in CLL and identifies the therapeutic potential of LC-1 in combination with fludarabine even in patients with fludarabine resistance.
Asunto(s)
Antineoplásicos/farmacología , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , FN-kappa B/antagonistas & inhibidores , Sesquiterpenos/farmacología , Vidarabina/análogos & derivados , Ligando de CD40/farmacología , Citoprotección , ADN/metabolismo , Sinergismo Farmacológico , Humanos , Interleucina-4/farmacología , Leucemia Linfocítica Crónica de Células B/mortalidad , Leucemia Linfocítica Crónica de Células B/patología , Pronóstico , Vidarabina/farmacologíaRESUMEN
Following the required review period initiated in August 2018, the Department of Health and Human Services, National Institutes of Health (NIH), published the final changes to the Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules (NIH Guidelines) in April 2019. This amendment focused on the review, registration, and reporting requirements for human gene transfer studies. In addition, the Recombinant DNA Advisory Committee (RAC) was renamed the Novel and Exceptional Technology and Research Advisory Committee (NeXTRAC) to serve as an advisory body on emerging technologies.