Factors influencing the survival of patients with cancer of the prostate.

During the period 1969 through 1973, 777 new cases of cancer of the prostate in northern Alberta men were registered with the Alberta Cancer Registry. The overall survival rate after 5 years was 41.2%. As expected, the rates were higher for those aged less than 65 years than for those who were older at the time of diagnosis and higher for those without metastases than for those with metastases at that time. Urban residents had a higher survival rate than rural residents (45.3% v. 38.0%), and the survival ratio of the former, 1.31, was significant. Information on occupation, smoking and the interval between appearance of the first symptom and diagnosis was not always available. However, the differentials observed suggest that those in a professional occupation and nonsmokers live longer after the diagnosis of cancer of the prostate but that the interval before diagnosis does not affect the length of survival.     

Factors influencing early diagnosis of cancer of the oral cavity

Factors associated with stage at time of diagnosis and with interval between recognition of the first symptom and histologic diagnosis were assessed in a consecutive series of patients with primary epithelial tumours of the oral cavity. Of the 160 patients 55% had stage I or II disease. The proportion was significantly higher among patients with a high socioeconomic status, those with low levels of alcohol consumption and those who regularly received dental care. The interval between recognition of the first symptom and diagnosis was not significantly related to these factors, but it was shorter for the men. These relations were specific to the patients with cancer of the oral cavity, not being seen in those with other head and neck tumours. Dental practitioners are an important source of early diagnosis of oral cavity cancers. The impact of the disease might thus be lessened by more regular dental care.     

Survival with bladder cancer,evaluation of delay in treatment,type of surgeon,and modality of treatment.

OBJECTIVE--To determine whether length of delay before treatment; specialty and grade of the surgeon; and use made of surgery, radiotherapy, and chemotherapy influenced the survival of patients with cancer of the bladder, after adjusting for case severity. DESIGN--Retrospective cohort study. SETTING--South East and South West Thames health regions. PATIENTS--609 men aged under 75 resident in the South Thames regions who had been registered as new cases of bladder cancer in 1982, 35 of whom were excluded, leaving 574 eligible patients. Analysis was based on 75% retrieval rate for case notes. MAIN OUTCOME MEASURES--Duration of survival from date of diagnosis of the bladder tumour. RESULTS--10 prognostic variables were used to adjust for case severity. The median delay from referral to first treatment was 48 (interquartile range 27-84) days. Treatment after a short delay was associated with shorter survival because of the early treatment of more severe cases. Consultants treated 68% of patients, trainee surgeons treated less severe cases. Initial treatment was by a urologist in 67% of cases, but the specialty of the surgeon was not associated with prognosis. The associations of radiotherapy, cystectomy, and systemic chemotherapy with survival were interpreted in terms of selection bias as well as therapeutic effect. CONCLUSION--Case severity was the most important influence on survival and influenced length of delay before treatment, grade and specialty of the surgeon, and main treatment allocation. After adjusting for case severity variations in these processes of care were not strongly associated with variations in survival.     

Determinants of fecundity and reproductive success in captive vervet monkeys

Between 1975 and 1983, adult female vervet monkeys (Cercopithecus aethiops sabaeus) over 3.5 years of age, living in two undisturbed social groups in a captive colony in Sepulveda, California, have averaged 1.0 births per female year with a mean interbirth interval of 10.7 months. Increased fecundity did not result in decreased survival rates of offspring in this population. Fecundity was influenced by the mother's age and dominance rank. The primary factor in the age-fecundity relationship was the age at first birth, which varied from three to five years. High-ranking females contributed the most to the high rate of fecundity, with significantly shorter interbirth intervals, more births per female year, and more surviving infants compared to low-ranking females.     

Genetic demographic study of Shors in Tashtagolskiĭ district of the Kemerovo region: changes in the marriage migration structure

The changes in the marriage structure with respect to the age at marriage, ethnicity, and spouses' birthplaces during the period of time corresponding to two generations have been analyzed in the rural population of Shors of Tashtagolskii raion of Kemerovo oblast. In general, the Shor population had a high assortative marriage rate with respect to these parameters in the period studied, although there was a temporary tendency towards its decrease. The ages of marriage for both the male and the female Shor populations in the years 2000-2005 were significantly older than in 1940-1945 and 1970-1975. The age-assortative marriage rate was r = = 0.60 in 1940-1945, r = 0.73 in 1970-1975, and r = 0.66 in 2000-2005. The birthplace-assortative marriage rate decreased from 79.63% in 1970-1975 to 70.64% in 2000-2005. The ethnic assortative marriage rate of Shors steadily decreased during the time interval studied; it was 96.92, 89.95, and 80.98% in 1940-1945, 1970-1975, and 2000-2005, respectively, for the total rural population of Tashtagolskii raion.     

Diagnostic Intervals and Its Association with Breast,Prostate, Lung and Colorectal Cancer Survival in England: Historical Cohort Study Using the Clinical Practice Research Datalink

Rapid diagnostic pathways for cancer have been implemented, but evidence whether shorter diagnostic intervals (time from primary care presentation to diagnosis) improves survival is lacking. Using the Clinical Practice Research Datalink, we identified patients diagnosed with female breast (8,639), colorectal (5,912), lung (5,737) and prostate (1,763) cancers between 1998 and 2009, and aged >15 years. Presenting symptoms were classified as alert or non-alert, according to National Institute for Health and Care Excellence guidance. We used relative survival and excess risk modeling to determine associations between diagnostic intervals and five-year survival. The survival of patients with colorectal, lung and prostate cancer was greater in those with alert, compared with non-alert, symptoms, but findings were opposite for breast cancer. Longer diagnostic intervals were associated with lower mortality for colorectal and lung cancer patients with non-alert symptoms, (colorectal cancer: Excess Hazards Ratio, EHR >6 months vs <1 month: 0.85; 95% CI: 0.72-1.00; Lung cancer: EHR 3-6 months vs <1 month: 0.87; 95% CI: 0.80-0.95; EHR >6 months vs <1 month: 0.81; 95% CI: 0.74-0.89). Prostate cancer mortality was lower in patients with longer diagnostic intervals, regardless of type of presenting symptom. The association between diagnostic intervals and cancer survival is complex, and should take into account cancer site, tumour biology and clinical practice. Nevertheless, unnecessary delay causes patient anxiety and general practitioners should continue to refer patients with alert symptoms via the cancer pathways, and actively follow-up patients with non-alert symptoms in the community.     

The leading sequence of caulimovirus large RNA can be folded into a large stem-loop structure.

The 600 nt long sequences preceeding the first large ORFs (ORF VII) of three caulimoviruses, although varying in primary sequence, can be folded into a large stem/loop structure centered around a conserved stretch of 36 nucleotides. Deletions of the conserved sequence delay symptom appearance considerably, but do not affect expression of a reporter gene in plant protoplasts. Another striking similarity between the leaders concerns the number and distribution of small open reading frames (sORF) they carry. Expression of two of these sORFs was tested by fusion of a reporter gene: both were expressed in plant protoplasts.     

Time intervals from first symptom to diagnosis for head and neck cancers: An analysis of linked patient reports and medical records from the UK

BackgroundEngland has significantly higher mortality risks due to Head and Neck Cancer (HNC) compared with other European countries. Early diagnosis is important as it is likely to increase early-stage diagnosis and improve survival and better quality of life. This study sought to improve understanding of the intervals from first symptom recognition to diagnosis for HNC and investigate associations between patient-reported symptoms and socio-demographic factors.MethodsPeople within 3 months of diagnosis, completed a researcher-administered questionnaire and data were extracted from primary and secondary care clinical records.ResultsEighty (mean age 62.9 [SD 11.7] years; 66% men) were interviewed. The appraisal interval was longer than a month for 39% of participants and the help-seeking interval was longer than a week for 44%. The median diagnostic interval was 92 (IQR; 34-172) days. Appraisal intervals of > 1 month were associated with male gender, ulceration and persistent throat pain. The only symptom that associated with a help-seeking interval of > 1 week was ulceration. Participants who reported red/white patches in the mouth and ulceration were associated with a reduced likelihood of a diagnostic interval of > 3 months. A higher proportion of participants with a diagnostic interval of > 3 months were diagnosed with advanced disease (78%) than those with an interval < 3 months (68%).ConclusionThese data improve understanding of the intervals from first symptom recognition to HNC diagnosis and provide preliminary evidence to identify targets to reduce overall time to diagnosis.     

Genetic demographic study of Shors in Tashtagolskii raion of Kemerovo oblast: Changes in the marriage migration structure

The changes in the marriage structure with respect to the age at marriage, ethnicity, and spouses’ birthplaces during the period of time corresponding to two generations have been analyzed in the rural population of Shors of Tashtagolskii raion of Kemerovo oblast. In general, the Shor population had a high assortative marriage rate with respect to these parameters in the period studied, although there was a temporary tendency to wards its decrease. The ages of marriage for both the male and the female Shor populations in the years 2000–2005 were significantly older than in 1940–1945 and 1970–1975. The age-assortative marriage rate was r = 0.60 in 1940-1945, r = 0.73 in 1970–1975, and r = 0.66 in 2000–2005. The birthplace-assortative marriage rate decreased from 79.63% in 1970–1975 to 70.64% in 2000–2005. The ethnic assortative marriage rate of Shors steadily decreased during the time interval studied; it was 96.92, 89.95, and 80.98% in 1940–1945, 1970–1975, and 2000–2005, respectively, for the total rural population of Tashtagolskii raion.     

A Statistical Review of Malignant Testicular Tumours Based on the Experience of the Ontario Cancer Foundation Clinics, 1938-1961

For the 827 patients with malignant testicular tumours registered at the Ontario Cancer Foundation''s regional clinics in the period 1938-1961, the probability of surviving for five years after treatment was 59.8%; for the 731 patients who received all or part of their initial treatment at the clinics or were not treated anywhere, five-year survival probability was 62.7%. Most deaths from testicular cancer took place in the first two years after treatment, and 90% of recorded recurrences were diagnosed before the third anniversary. Survival rates were strongly influenced by histological type and extent of disease, and to some degree by age. Survival did not seem to be closely correlated with delay after first symptom, site or size of primary lesion, ectopia, surgical treatment of the abdominal nodes, site or dosage of radiation, or chemotherapy. The survival rates in this series of cases compare favourably with those of other large series.     

The 1975 Japanese diet has a stress reduction effect in mice: search for physiological effects using metabolome analysis

Abstract

We aimed to find new physiological effects of the Japanese diet. First, to determine the key components in serum from mice fed the 1975 diet, serum from mice fed the 1960, 1975, 1990 or 2005 Japanese diet was analyzed using CE-TOFMS and LC-TOFMS. Based on these results, the key components were determined by principal component analysis. Among the identified compounds, GABA was included. Therefore, a stress reduction effect was inferred as a novel physiological effect of this diet. Next, we tested whether the 1975 diet had an actual stress reduction effect in mice. Mice were given the 1975 diet or a control diet for 4 weeks, after which they were divided into restraint stress and non-stress groups. Mice fed the 1975 diet had significantly decreased stress parameters compared with those fed the control diet. These results provide the first evidence that the 1975 Japanese diet has a stress reduction effect.     

Height at diagnosis of diabetes in children: a study in identical twins.

The height at diagnosis of 16 insulin dependent diabetics aged under 19 was compared with that of their unaffected identical cotwins measured at the same time. In eight pairs the diabetic was shorter, and in the remainder the cotwins were the same height. In those diabetics who were shorter than their cotwins at diagnosis the average period of growth delay before diagnosis was at least 35 weeks; by contrast, the mean duration of symptoms was only six weeks. No cause for the growth delay other than the diabetes was known in any of the twins. These findings show that the onset of insulin dependent diabetes may be a slow process, with growth delay occurring several months before symptoms appear.     

In Memoríam

A study was made of all cases of transitional cell cancer of the anus or rectum in the records of the University of California Medical Center, San Francisco. None was listed until 1945, then an additional seven between 1954 and 1960. During the latter period there were 192 cases of adenocarcinoma of the rectum, six cases of squamous cell or epidermoid rectal cancer and 12 cases of squamous cell cancer of the anus.Distinctive and highly malignant anal and rectal epithelial tumors will occasionally arise at or near the anorectal junction from inconstant embryologic entodermal cloacal vestiges. These atypical nonkeratinizing lesions are very similar microscopically to transitional cell tumors found in the cloacogenic portions of the lower genitourinary tract.Review of the literature indicates that the prognosis of cloacogenic anal and rectal lesions appears to be relatively graver than that for the more common adenocarcinomas and keratinizing squamous cell epitheliomas. Early diagnosis and prompt, radical excision seem to offer the only hope for survival.     

Comparison of breast carcinomas diagnosed in the 1980s with those diagnosed in the 1940s to 1960s.

OBJECTIVE--To find out if breast carcinomas diagnosed in the 1980s differ from those diagnosed a few decades ago. DESIGN--Retrospective comparative cohort study. SETTING--City of Turku, south western Finland. PATIENTS--439 patients with breast carcinoma diagnosed in 1945-65 with a median follow up of 27 years (95% of all those histologically diagnosed in Turku); and 370 patients with breast carcinoma diagnosed in 1980-4 with a median follow up of 6 years (94% of all those histologically diagnosed in Turku). MAIN OUTCOME MEASURES--Breast cancer incidence, mortality from breast cancer, age at diagnosis, stage of cancer, seven histological factors, DNA ploidy. RESULTS--Age adjusted incidence of breast cancer increased from 30.8/100,000 person years in 1953-7 to 62.2/100,000 in 1983-7; mortality in breast cancer increased from 16.7 to 17.2/100,000 person years. Survival of patients with stages II to IV (but not with stage I) improved. The mean age at diagnosis increased from 55.5 years in 1945-55 to 62.5 years in 1980-4 (p less than 0.0001); the proportion of patients with T0-1 carcinomas increased from 13% to 41% (p less than 0.0001) and with pN0 carcinomas from 43% to 55% (p = 0.003) from 1945-65 to 1980-4. There was no change in histological type or DNA ploidy of breast cancer, but in the 1980-4 cohort carcinomas were more often well differentiated, had lower mitotic counts and less nuclear pleomorphism, more often had a well defined tumour margin, and had less tumour necrosis. There was, however, no difference between the two cohorts in these histological characteristics except for tumour necrosis when they were compared in a multivariate log linear model at a given size of primary tumour. CONCLUSION--Improved survival with breast cancer can at least partially be explained by detection of increased numbers of small carcinomas with favourable histological characteristics.     

Pheromone-trap catch in relation to the phenology of codling moth (Cydia pomonella)

Relationships between a pheromone-trap catch, adult emergence and penetration of fruit by first-instar larvae of Cydia pomonella were investigated from 1975 to 1977 in an orchard in South West England. For the first generation the times of moth emergence and catch in the pheromone trap were not significantly different; nor were male and female emergence times. The catch of moths of the first generation in the pheromone trap anticipated the appearance of their larvae in the fruit by 140–169 day-degrees > 10 °C. Eggs hatched after 94 day-degrees in the laboratory but in the orchard, wind and sunshine modified the microclimate so that the number of day-degrees required for egg development, as measured by standard meteorological instruments, was affected by wind and sunshine but development lasted on average about 90 day-degrees. This indicated a lag of 50–80 day-degrees between the curves for trap catch and oviposition: the pre-oviposition period in the orchard was shorter than expected from laboratory studies. In 1975 and 1976, some larvae developed to produce a second generation of moths which gave rise to a second generation of eggs and larvae, after an interval of 161 day-degrees in 1975, but only 41 day-degrees in 1976, indicating that in 1976 some eggs were laid before moths of the second generation were trapped. These results indicate that the first insecticidal spray against first-generation larvae should be applied about 140 day-degrees after the start of the reference week in which five moths of the spring brood are caught per trap. A second spray, if required to maintain insecticidal cover, should be applied about 100 day-degrees later. A spray should be applied against second-generation larvae immediately after the reference week for second-generation moths.     

The course of diagnosis in autistic patients: the delay between recognition of the first symptoms by parents and correct diagnosis

The primary aim of the research was to find the delay between the first symptoms of an autistic disorder being recognized by parents and diagnosis in our centre. A secondary objective was to evaluate the number of contacts with professionals (physicians, teachers, and speech therapists) in which parents pointed out special manifestations seen in children and, in spite of that, the children were not referred to a specialist. A retrospective study assessed 204 children (59 girls, 145 boys) in total; 126 children (39 girls, 87 boys) with childhood autism (CHA), 57 (17 girls, 40 boys) with atypical autism (AA), and 21 (3 girls, 18 boys) with Asperger's syndrome (AS). The mean age at appearance of the first signs was 29.7 months (range 0-70, median 30+/-17.0) in N=201, and the average age at diagnosis was 81.5 months (range 13-276, median 69.5+/-45.2) in N=204. The mean delay in making a diagnosis was 51.3 months (range 0-246, median 39+/-40.9) in N=201. The delay in diagnosis is shortest in patients with AA (a mean period of 44.4 months = 3 years and 8 months), longer in CHA patients (49.5 months = 4 years and 2 months), and longest in patients with AS (80.8 months = 6 years and 9 months). A statistically significant difference in the period to diagnosis was found between CHA and AS patients (p=0.023) and between AA and AS patients (p=0.019). The mean number of visits to physicians and other specialists before referring to a specialized centre for diagnosis in N=133 was 2.4 (range 1-5, median 2+/-0.9). The diagnosis of autism is made late and early educational and behavioural interventions cannot be initiated.     

Diagnosis delay in Libyan female breast cancer

ABSTRACT: BACKGROUND: To study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya METHODS: 200 women, aged 22 to 75 years with breast cancer diagnosed during 2008--2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3--6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records. RESULTS: The median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3--6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001). CONCLUSIONS: Diagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.     

The family physician and oncologic screening

The time of delay from the first symptoms experienced, to visiting a doctor and to the determination of the diagnosis may depend on several factors. One hundred and ten cancer patients were compared regarding gender, age, social status, qualifications, economic status, participation in organized screening programs, regular attendance by family physicians and delay in the diagnostic procedures. According to the results, 67% of the patients visited the doctor only in case of symptoms occurring. After recognizing the first symptoms, 44% of the men and 53% of the women turned to the doctor within one month. The longest time of delay was observed in case of patients over 60 and some patients with university degree, while usually shorter periods were reported in case of patients with secondary education and in case of most patients with a university degree. Low income people were over-represented in all delay categories. Twenty-five percent of female and 33% of male patients with lung cancer were diagnosed with routine x-ray screening. In the age cohort recommended for participation in organized screening programs, 66% of women took part on mammography and 69% on pap-screen. This ratio was the highest (88%) for women with secondary education and the lowest (50%) for women with university education. The awareness of cancer has a high importance in primary care, and family physicians have to motivate their patients to participate in organized screening programs.     

APPENDICITIS AND PREGNANCY

In 74,000 obstetrical patients at Los Angeles County Hospital the incidence of acute appendicitis in pregnancy was 0.05 per cent. In a study of 36 cases of clinically diagnosed appendicitis in pregnancy between 1956 and 1960, it was shown that the fetal and maternal morbidity and mortality were decreased when a definite operative procedure was done early. The difficulty in diagnosis is increased by the necessary consideration of pyelonephritis and twisted ovarian cyst. Rupture of the appendix increased hazards to maternal and fetal survival. It was noted also that threatened premature labor may indicate a ruptured appendix. Emergency operation with the use of antibiotics in such cases was effective therapy. The incidence of premature delivery was proportionate to the delay in operating. If operation was performed in less than eight hours after admission to the hospital, there was no maternal or fetal loss. A delay greater than eight hours resulted in a 17 per cent fetal loss in premature delivery and 4 per cent fetal loss of infants at term.     

The Cost of Autism Spectrum Disorders

Objective

A diagnosis of an autism spectrum disorders is usually associated with substantial lifetime costs to an individual, their family and the community. However, there remains an elusive factor in any cost-benefit analysis of ASD diagnosis, namely the cost of not obtaining a diagnosis. Given the infeasibility of estimating the costs of a population that, by its nature, is inaccessible, the current study compares expenses between families whose children received a formal ASD diagnosis immediately upon suspecting developmental atypicality and seeking advice, with families that experienced a delay between first suspicion and formal diagnosis.

Design

A register based questionnaire study covering all families with a child with ASD in Western Australia.

Participants

Families with one or more children diagnosed with an ASD, totalling 521 children diagnosed with an ASD; 317 records were able to be included in the final analysis.

Results

The median family cost of ASD was estimated to be AUD $34,900 per annum with almost 90% of the sum ($29,200) due to loss of income from employment. For each additional symptom reported, approximately $1,400 cost for the family per annum was added. While there was little direct influence on costs associated with a delay in the diagnosis, the delay was associated with a modest increase in the number of ASD symptoms, indirectly impacting the cost of ASD.

Conclusions

A delay in diagnosis was associated with an indirect increased financial burden to families. Early and appropriate access to early intervention is known to improve a child''s long-term outcomes and reduce lifetime costs to the individual, family and society. Consequently, a per symptom dollar value may assist in allocation of individualised funding amounts for interventions rather than a nominal amount allocated to all children below a certain age, regardless of symptom presentation, as is the case in Western Australia.