Gender-based disparities East/West: rethinking the burden of care in the United States and Taiwan

When feminist bioethicists express concerns about health-related gender disparities, they raise considerations about justice and gender that traditional bioethicists have either not raised or raised somewhat weakly. In this article, I first provide a feminist analysis of long-term healthcare by and for women in the United States and women in Taiwan. Next, I make the case that, on average, elderly US and Taiwanese women fare less well in long-term care contexts than do elderly US and Taiwanese men. Finally, I explore some suggested practical remedies to reduce gender disparities in long-term care contexts.     

Racial/ethnic disparities in infant mortality: the role of behavioral factors

Using the National Maternal and Infant Health Survey 1988 (NMIHS), a nationally representative sample of mothers, we investigate the role of behavioral factors in explaining racial/ethnic disparities in infant mortality. In particular, we focus on the following variables: weight gain during pregnancy, prenatal care utilization, exercise, vitamin use, and substance use during pregnancy. These analyses are conducted by modeling both time of death (neonatal vs. postneonatal) and cause of death (infections, perinatal complications, delivery complications, congenital malformations, SIDS, other causes) outcomes. Our results suggest that behavioral factors are partially responsible for observed race/ethnic differentials in infant mortality, but are not as important as sociostructural determinants such as SES.     

Population trends in emergency cancer diagnoses: The role of changing patient case-mix

BackgroundDiagnosis of cancer through an emergency presentation is associated with worse clinical and patient experience outcomes. The proportion of patients with cancer who are diagnosed through emergency presentations has consequently been introduced as a routine cancer surveillance measure in England. Welcome reductions in this metric have been reported over more than a decade but whether reductions reflect true changes in how patients are diagnosed rather than the changing case-mix of incident cohorts in unknown.MethodsWe analysed ‘Routes to Diagnosis’ data on cancer patients (2006–2015) and used logistic regression modelling to determine the contribution of changes in four case-mix variables (sex, age, deprivation, cancer site) to time-trends in emergency presentations.ResultsBetween 2006 and 2015 there was an absolute 4.7 percentage point reduction in emergency presentations (23.8%–19.2%). Changing distributions of the four case-mix variables explained 19.0% of this reduction, leaving 81.0% unexplained. Changes in cancer site case-mix alone explained 16.0% of the total reduction.ConclusionChanges in case-mix (particularly that of cancer sites) account for about a fifth of the overall reduction in emergency presentations. This would support the use of adjustment/standardisation of reported statistics to support their interpretation and help appreciate the influence of case-mix, particularly regarding cancer sites with changing incidence. However, most of the reduction in emergency presentations remains unaccounted for, and likely reflects genuine changes during the study period in how patients were being diagnosed.     

Socio-economic disparities in the burden of seasonal influenza: the effect of social and material deprivation on rates of influenza infection

Background

There is little empirical evidence in support of a relationship between rates of influenza infection and level of material deprivation (i.e., lack of access to goods and services) and social deprivation (i.e. lack of social cohesion and support).

Method

Using validated population-level indices of material and social deprivation and medical billing claims for outpatient clinic and emergency department visits for influenza from 1996 to 2006, we assessed the relationship between neighbourhood rates of influenza and neighbourhood levels of deprivation using Bayesian ecological regression models. Then, by pooling data from neighbourhoods in the top decile (i.e., most deprived) and the bottom decile, we compared rates in the most deprived populations to the least deprived populations using age- and sex-standardized rate ratios.

Results

Deprivation scores ranged from one to five with five representing the highest level of deprivation. We found a 21% reduction in rates for every 1 unit increase in social deprivation score (rate ratio [RR] 0.79, 95% Credible Interval [CrI] 0.66, 0.97). There was little evidence of a meaningful linear relationship with material deprivation (RR 1.06, 95% CrI 0.93, 1.24). However, relative to neighbourhoods with deprivation scores in the bottom decile, those in the top decile (i.e., most materially deprived) had substantially higher rates (RR 2.02, 95% Confidence Interval 1.99, 2.05).

Conclusion

Though it is hypothesized that social and material deprivation increase risk of acute respiratory infection, we found decreasing healthcare utilization rates for influenza with increasing social deprivation. This finding may be explained by the fewer social contacts and, thus, fewer influenza exposure opportunities of the socially deprived. Though there was no evidence of a linear relationship with material deprivation, when comparing the least to the most materially deprived populations, we observed higher rates in the most materially deprived populations.     

The burden of cervical cancer in Vietnam: Synthesis of the evidence

There is currently no national cervical screening or HPV immunization program in Vietnam. This study aims to synthesize available data on the burden of disease and to project the burden of cervical cancer to 2049 if no major interventions are implemented. We reviewed published data sources on risk factors for HPV prevalence, high-grade lesions, cervical cancer incidence and mortality in Vietnam from 1990 to 2017. We then used the available data to project the number of new cervical cancer cases for the period 2013–2049. Data on cervical cancer incidence and mortality in Vietnam are limited; two Vietnamese cancer registries have been reported on by the International Agency for Research on Cancer, which cover urban populations representing ∼20% of the national population. The reported age-standardized cervical cancer incidence in Hanoi was 6.7 (1993–1997), compared to 28.8 and 14.1 per 100,000 women in Ho Chi Minh City (1995–1998 and 2009–2012, respectively). Cancer mortality data are not uniformly available from cancer registries or mortality surveys in Vietnam because cause of death has not been routinely ascertained. Based on available urban population registry data, estimated rates in the rural population, and forward projection of existing trends, we estimate that without any further intervention, the number of new cases will increase from 6930 (range 5671–8493) in 2012 to 8562 (range 5775–12,762) in 2049, giving a total of 379,617 (range 276,879–542,941) new cases over the period 2013–2049. These findings help underpin the case for the delivery of HPV vaccination and cervical screening in Vietnam, and support similar initiatives in other low- and middle-income countries.     

Non-redundancy within the RAS oncogene family: Insights into mutational disparities in cancer

The RAS family of oncoproteins has been studied extensively for almost three decades. While we know that activation of RAS represents a key feature of malignant transformation for many cancers, we are only now beginning to understand the complex underpinnings of RAS biology. Here, we will discuss emerging cancer genome sequencing data in the context of what is currently known about RAS function. Taken together, retrospective studies of primary human tissues and prospective studies of experimental models support the notion that the variable mutation frequencies exhibited by the RAS oncogenes reflect unique functions of the RAS oncoproteins.     

The burden of rare cancer in Japan: Application of the RARECARE definition

BackgroundDespite the fact that rare cancer is a new target of cancer control in Japan, the incidence of rare cancers is unknown and there is no generally accepted definition of rare cancers in this country. With the aim of calculating incidences of rare cancers in Japan, we therefore adopted a definition and classification of rare cancers that had been published in the European Union (EU) in 2011.MethodsUsing incidence data between 1998 and 2007 submitted by 12 of population based cancer registries in Japan that met our quality criteria and drawing on the EU definition (incidence <6 per 100,000 per year), we estimated the incidences of 845 combinations of tumor sites and histological groups and thus identified the cancers that are rare in Japan.ResultsAfter identifying 193 combinations of tumor sites and histological groups that fit our criteria for rare cancers, we estimated their incidence to be about 75 per 100,000, which corresponds to about 94,800 new diagnoses in 2012 or approximately 15% of all cancer diagnoses. The categorization of rare and common cancers was almost the same in Japan as in EU.ConclusionsThe present study provides an indication of the size of the rare cancer burden in Japan and epidemiological information to explore this. We are expecting further discussion based on our results with stakeholders in order to construct a Japanese definition of rare cancers.     

Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008

MiR-141 has gradually demonstrated its value in the diagnosis of prostate cancer. However, the diagnostic parameters applied in previous studies were different. This systematic review was conducted to explore the diagnostic value of miR-141 in prostate cancer. A comprehensive search of related literature in PubMed, Medline, the Cochrane Library and Embase databases was performed. Seven studies were included which assessed the diagnostic value of miR-141 in patients with prostate cancer up to October 31, 2019. Meta-disc version 1.4 and STATA software version 12.0 were used to analyze the data. The pooled sensitivity and specificity were 0.70 (95% CI 0.64~0.75) and 0.73 (95% CI 0.64~0.80), respectively. The positive likelihood ratio (PLR) was 2.88 (95% CI 1.40~5.93), and negative likelihood ratio (NLR) was 0.38 (95% CI 0.20~0.71). The pooled diagnostic odds ratio (DOR) of miR-141 for prostate cancer was observed to be 9.94 (95% CI: 2.55~38.80). The summary area under the receiver operating characteristic (ROC) curve was 0.83 (95% CI: 0.79~0.86). The results of meta-regression suggested that heterogeneity was mainly derived from patient age. The Fagan nomogram results showed a significant increase when correlating miR-141 with the diagnosis of prostate cancer. This meta-analysis suggests that miR-141 has a high diagnostic value for prostate cancer. In future, large-scale prospective studies will be done to verify and evaluate this result.     

MAPs: cellular navigators for microtubule array orientations in Arabidopsis

Microtubules are subcellular nanotubes composed of α- and β-tubulin that arise from microtubule nucleation sites and are mainly composed of γ-tubulin complexes. Cell wall encased plant cells have evolved four distinct microtubule arrays that regulate cell division and expansion. Microtubule-associated proteins, the so called MAPs, construct, destruct and reorganize microtubule arrays thus regulating their spatiotemporal transitions during the cell cycle. By physically binding to microtubules and/or modulating their functions, MAPs control microtubule dynamic instability and/or interfilament cross talk. We survey the recent analyses of Arabidopsis MAPs such as MAP65, MOR1, CLASP, katanin, TON1, FASS, TRM, TAN1 and kinesins in terms of their effects on microtubule array organizations and plant development.     

A novel approach to reducing disparities in health outcomes by enhancing interpretation of cancer clinical trials for underrepresented patient groups

There has been a growing realization, based on emerging evidence from the point of care, that real-world outcomes of patients with cancer are often inferior to those reported in conventional clinical trials. This phenomenon can be attributed in part to deficits in external validity that are present in many studies. Several factors contribute to external validity deficits, including: narrow eligibility criteria; differences between protocol-specified procedures and routine care; and inadequate access to clinical trial participation among underrepresented and socioeconomically disadvantaged groups. As a result, the current body of clinical evidence derived from conventional clinical trials can be inadequate to inform patient-specific treatment decisions at the point of care. Furthermore, lack of practical guidance on how to evaluate the impact of external validity deficits can impede both the design of more generalizable clinical trials and efforts to personalize treatment decisions for individual patients. In this methodological review, we suggest an approach to aid clinicians in such evaluations, providing visual and quantitative methods for assessing the magnitude of, and adjusting for, the impact of external validity deficits in conventional clinical trials. Our methods and visualizations have broad applicability across important areas of real-world medical decision-making and research, providing opportunities to design clinical studies that are more reflective of the diverse needs of patients with cancer, including those excluded from traditional clinical trials due to narrow eligibility criteria, socioeconomic disadvantages, and other systemic barriers to equitable access to healthcare resources.     

Financial burden of childhood cancer.

Fifty-nine of 73 families of children referred for treatment of cancer during 1980 co-operated in a study of the financial consequences of the illness. Except for two social class I families who declined to take part, the sample was representative of the childhood cancer population and families were of similar socioeconomic status to the general population. During the first, inpatient, week week of treatment the sum of income lost plus additional expenditure exceeded 50% of total income in over 45% of families. During a subsequent week of outpatient treatment, loss of income plus additional expenditure amounted to more than 20% of income in over half the families. These problems affected all the groups studied and were not confined to lower paid or those living furthest from the centre. Financial help was available from charitable sources and the DHSS towards travel, extra nourishment, and heating costs but could not be obtained to compensate for loss of earnings. The families of children who died had difficulty in meeting the cost of funerals. Families of children with cancer need more help than is at present available, especially to offset loss of income and the cost of funerals.