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1.
Ann Surg Oncol ; 2020 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-32514804

RESUMEN

BACKGROUND: Neoadjuvant chemotherapy (NAC) has been proven to increase breast-conserving surgery (BCS) rates, but data are limited on conversion rates from BCS-ineligible (BCSi) to BCS-eligible (BCSe), specifically, in patients with large tumors. METHODS: Consecutive patients with stage I-III breast cancer treated with NAC from November 2013 to March 2019 were identified. BCS eligibility before and after NAC was prospectively determined. Patients deemed BCSi before NAC due to large tumor size were studied. Statistical analyses were conducted using Student's t-test, Wilcoxon rank sum test, Chi-square test, Fisher's test, and logistic regression. RESULTS: In this study, 600 of 1353 cancers were BCSi with large tumors; 69% were non-BCS candidates, 31% were borderline-BCS (bBCS) candidates. Of non-BCS candidates, 69% became BCSe after NAC; 66% chose BCS, and 90% were successful. Among bBCS candidates, 87% were BCSe after NAC, 73% chose BCS, and 96% were successful. On univariate analysis, bBCS candidacy, lower cT stage, cN0 status, absence of calcifications, human epidermal growth factor receptor 2 positive (HER2+)/triple negative (TN) receptor status, poor differentiation, ductal histology, and breast pCR were associated with conversion to BCS eligibility. On multivariable analysis, receptor status (hormone receptor positive [HR+]/HER2- ref; odds ratio [OR] HER2+ 1.63, P = 0.047; HR-/HER2- OR, 2.26, P = 0.003) and breast pCR (OR 2.62, P < 0.001) predicted successful downstaging, while larger clinical tumor size (OR 0.86, P = 0.003), non-BCS candidacy (OR 0.46, P = 0.003), cN+ status (OR 0.54, P = 0.008), and calcifications (OR 0.56, P = 0.007) predicted lower downstaging rates. CONCLUSION: In patients with large tumors precluding BCS, conversion to BCS eligibility was high with NAC, particularly in bBCS candidates. HER2+/TN receptor status predicted successful downstaging, while lower downstaging rates were observed with larger tumors, cN+ status, and calcifications. These factors should be considered when selecting patients for NAC.

2.
US Army Med Dep J ; (1-17): 23-33, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28511271

RESUMEN

Zika virus (ZIKV) was declared an international public health emergency by the World Health Organization on February 1, 2016. Due to the known and estimated range of the ZIKV mosquito vectors, southern and central US states faced increased risk of ZIKV transmission. With the state of Georgia hosting the world's busiest international airport, a climate that supports the ZIKV vectors, and limited surveillance (13 counties) and response capacity, the Department of Public Health (DPH) was challenged to respond and prevent ZIKV transmission. This case study describes and evaluates the state's surveillance capacity before and after the declaration of ZIKV as a public health emergency. METHOD: We analyzed surveillance data from the DPH to compare the geographical distribution of counties conducting surveillance, total number, and overall percentage of mosquito species trapped in 2015 to 2016. Counties conducting surveillance before and after the identification of the ZIKV risk were mapped using ArcMap 10.4.1. Using SAS (version 9.2) (SAS Institute, Inc, Cary, NC), we performed the independent 2 sample t test to test for differences in prevalence in both years, and a χ² analysis to test for differences between numbers of species across the 13 counties. In addition, weighted frequency counts of mosquitoes were used to test (χ²) an association between major mosquito vector species and 7 urban counties. Lastly, using data from 2012-2016, a time-trend analysis was conducted to evaluate temporal trends in species prevalence. RESULTS: From 2015 to 2016, surveillance increased from 13 to 57 (338% increase) counties geographically dispersed across Georgia. A total of 76,052 mosquitoes were trapped and identified in 2015 compared to 144,731 (90.3% increase) in 2016. Significant differences between species (P<.001) and significant associations (P<.0001) between 7 urban counties and major mosquito vectors were found. Significant differences in prevalence were found between several species and year highlighting species-year temporal trends. CONCLUSIONS: The DPH collaborative response to ZIKV allowed a rapid increase in its surveillance footprint. Existing and new partnerships were developed with the military and local health departments to expand and share data. This additional surveillance data allowed DPH to make sound public health decisions regarding mosquito-borne disease risks and close gaps in data related to vector distribution.


Asunto(s)
Culicidae , Monitoreo Epidemiológico , Control de Mosquitos/métodos , Mosquitos Vectores , Distribución Animal , Animales , Georgia , Humanos , Virus Zika
3.
PLoS One ; 12(2): e0170381, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28207744

RESUMEN

OBJECTIVE: To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes. METHODS: We used the linked National Health Interview Survey (survey years 1995, 1997-2005) and the Medicaid Analytic eXtract files (1999-2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding. RESULTS: In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization. CONCLUSIONS: Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid programs from excluding any FDA-approved cessation medications from coverage as of January 2014, monitoring Medicaid cessation medication claims may be beneficial for informing efforts to increase utilization and maximize smoking cessation.


Asunto(s)
Planes de Aranceles por Servicios/economía , Cobertura del Seguro/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Cese del Hábito de Fumar/economía , Cese del Uso de Tabaco/métodos , Tabaquismo/tratamiento farmacológico , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act , Estados Unidos , Adulto Joven
4.
Trans R Soc Trop Med Hyg ; 110(11): 637-648, 2016 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-28115686

RESUMEN

BACKGROUND: Qualitative evidence suggests that inadequate water, sanitation and hygiene (WASH) may affect diarrheal and helminthic infection in women disproportionately. We systematically searched PubMed in June 2014 (updated 2016) and the WHO website, for relevant articles. METHODS: Articles dealing with the public health relevance of helminthic and diarrheal diseases, and highlighting the role of gender in WASH were included. Where possible, we carried out a meta-analysis. RESULTS: In studies of individuals 5 years or older, cholera showed lower prevalence in males (OR 0.56; 95% CI 0.34-0.94), while Schistosoma mansoni (1.38; 95% CI 1.14-1.67), Schistosoma japonicum (1.52; 95% CI 1.13-2.05), hookworm (1.43; 95% CI 1.07-1.89) and all forms of infectious diarrhea (1.21; 95% CI 1.06-1.38) showed a higher prevalence in males. When studies included all participants, S. mansoni and S. japonicum showed higher prevalence with males (OR 1.40; 95% CI 1.27-1.55 and 1.84; 95% CI 1.27-2.67, respectively). Prevalence of Trichiuris and hookworm infection showed effect modification with continent. CONCLUSIONS: Evidence of gender differences in infection may reflect differences in gender norms, suggesting that policy changes at the regional level may help ameliorate gender related disparities in helminthic and diarrheal disease prevalence.


Asunto(s)
Diarrea , Helmintiasis , Higiene , Abastecimiento de Agua , Diarrea/parasitología , Femenino , Humanos , Masculino , Factores Sexuales
6.
Tob Control ; 24(1): 94-9, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23864404

RESUMEN

PURPOSE: The news media plays an important role in agenda setting and framing of stories about tobacco control. The purpose of this study was to examine newspaper, newswire and television coverage of tobacco issues in the USA over a 7-year period. METHODS: Analyses of 2004-2010 news media surveillance system data from the US Centers for Disease Control and Prevention's Office on Smoking and Health, based on content analysis and quantitative methods. Information on extent of news coverage, and types of tobacco-related themes, were examined from articles in 10 newspapers and 2 major newswires, as well as transcripts from 6 national television networks. RESULTS: The overall extent of newspaper, newswire and television stories about tobacco, and level of coverage by specific media outlets, varied over time, especially for newspapers. Nevertheless, there was an average of 3 newspaper stories, 4 newswire stories, and 1 television tobacco-related story each day. Television stories were more likely to contain cessation/addiction or health effects/statistics themes and less likely to contain secondhand smoke or policy/regulation themes than newspaper/newswire stories. There was more variation in the choice of tobacco theme among individual newspapers/newswires than television media outlets. CONCLUSIONS: News coverage of tobacco in the USA was relatively constant from 2004 to 2010. Audiences were more likely to be exposed to different tobacco themes in newspapers/newswires than on television. Tracking information about tobacco news stories can be used by advocates, programs and others for planning and evaluation, and by researchers for hypothesis generation.


Asunto(s)
Periódicos como Asunto/tendencias , Cese del Hábito de Fumar , Fumar , Televisión/tendencias , Tabaco , Humanos , Estados Unidos
7.
Tob Control ; 24(1): 28-37, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23997070

RESUMEN

INTRODUCTION: Mentholated cigarettes are at least as dangerous to an individual's health as non-mentholated varieties. The addition of menthol to cigarettes reduces perceived harshness of smoke, which can facilitate initiation. Here, we examine correlates of menthol use, national trends in smoking menthol and non-menthol cigarettes, and brand preferences over time. METHODS: We estimated menthol cigarette use during 2004-2010 using annual data on persons ≥12 years old from the National Surveys on Drug Use and Health. We adjusted self-reported menthol status for selected brands that were either exclusively menthol or non-menthol, based on sales data. Data were weighted to provide national estimates. RESULTS: Among cigarette smokers, menthol cigarette use was more common among 12-17 year olds (56.7%) and 18-25 year olds (45.0%) than among older persons (range 30.5% to 34.7%). In a multivariable analysis, menthol use was associated with being younger, female and of non-Caucasian race/ethnicity. Among all adolescents, the percentage who smoked non-menthol cigarettes decreased from 2004-2010, while menthol smoking rates remained constant; among all young adults, the percentage who smoked non-menthol cigarettes also declined, while menthol smoking rates increased. The use of Camel menthol and Marlboro menthol increased among adolescent and young adult smokers, particularly non-Hispanic Caucasians, during the study period. CONCLUSIONS: Young people are heavy consumers of mentholated cigarettes. Progress in reducing youth smoking has likely been attenuated by the sale and marketing of mentholated cigarettes, including emerging varieties of established youth brands. This study should inform the Food and Drug Administration regarding the potential public health impact of a menthol ban.


Asunto(s)
Comportamiento del Consumidor , Mentol , Fumar/tendencias , Adolescente , Adulto , Factores de Edad , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto Joven
8.
Am J Public Health ; 102(7): 1310-2, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22594728

RESUMEN

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes; by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes.


Asunto(s)
Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Adolescente , Factores de Edad , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Mentol , Adulto Joven
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