The impact of health insurance affiliation and socioeconomic status on cervical cancer survival in Bucaramanga,Colombia

Cervical cancer is still an important cause of death in countries like Colombia. We aimed to determine whether socioeconomic status of residential address (SES) and type of health insurance affiliation (HIA) might be associated with cervical cancer survival among women in Bucaramanga, Colombia. All patients residing in the Bucaramanga Metropolitan Area diagnosed with invasive cervical cancer (ICD-0–3 codes C53.X) between 2008 and 2016 (n = 725) were identified through the population-based cancer registry, with 700 women having follow-up data for >5 years (date of study closure: Dec 31, 2021), yielding an overall 5-year survival estimate (95 % CI) of 56.4 % (52.7 – 60.0 %). KM estimates of 5-year overall survival were obtained to assess differences in cervical cancer survival by SES and HIA. Multivariable Cox-proportional hazards modeling was also conducted, including interaction effects between SES and HIA. Five-year overall survival was lower when comparing low vs. high SES (41.9 % vs 57.9 %, p < 0.0001) and subsidized vs. contributive HIA (45.1 % vs 63.0 %, p < 0.0001). Multivariable Cox modeling showed increased hazard ratios (HR) of death for low vs. high SES (HR = 1.78; 95 % CI = 1.18–2.70) and subsidized vs. contributive HIA (HR = 1.44; 95 % CI = 1.13–1.83). The greatest disparity in HR was among women of low SES affiliated to subsidized HIA (vs. contributive HIA and high SES) (HR=2.53; 95 % CI = 1.62–3.97). Despite Colombia’s universal healthcare system, important disparities in cervical cancer survival by health insurance affiliation and socioeconomic status remain.     

Substance use disorders: a comprehensive update of classification,epidemiology, neurobiology,clinical aspects,treatment and prevention

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.     

The ecosystem approach to environmental assessment: moving from theory to practice

The ecosystem approach to environmental management is viewed by many as being fundamental to the development of appropriate management strategies. While this approach represents a major advance in the way researchers view environmental assessment, the approach in itself does not provide practical information as to what questions to ask and what tools to use in assessing and managing ecosystems. Similarly, the concept of ecosystem health, as it is usually defined, has little practical value for ecosystem managers. We suggest the next stage in environmental assessment will be the development of specific frameworks designed to assess individual ecosystems. Of primary importance is the need to consider the basic structure and function of the ecosystem itself. Such consideration, together with explicit identification of anthropogenic stresses particular to the system, serves to identify those components most at risk and those issues most deserving of attention. Researchers should explore critical linkages between environmental stressors and their observable, measurable and predictable effects on ecological parameters and use this understanding to develop a management strategy that incorporates appropriate ecological indicators. The importance of these considerations will be illustrated using examples from the Northern River Basins Study.     

Perception of residential crowding,classroom experiences,and student health

The present research is based on a typology of crowding experiences incorporating two main dimensions: neutral-personal thwartings and primary-secondary environments. The thwarting dimension concerns the degree to which crowding experiences are associated with spatial inconveniences, alone, or with spatial as well as social constraints. The environmental dimension relates to the type of setting in which crowding experiences occur. A major assumption of this typology is that crowding experiences involving social conflict will be more intense and disruptive to the individual than those in which interpersonal conflict is minimal. The reported study examined the relationship between college students' evaluations of the physical amenity, social climate, and crowdedness of their residential environments, on the one hand, and their sensitivity to crowding in a classroom situation, their academic performance, and the frequency of their visits to the campus health center, on the other. Results indicated that perceived residential crowding and negative perceptions of residential social climate were strongly associated with increased sensitivity to crowding in a classroom situation, impaired course performance, and visits to the student health center. The implications of these correlational findings for future field-experimental research are discussed.     

The role of DNA polymerase I-associated 5'-exonuclease in replication of coliphage M13 replicative-form DNA.

The conversion of both parental- and progeny-nascent open circular M13 RF DNA into covalently closed RF I is drastically reduced in an $\text{E. coli}$ mutant deficient in the 5′ → 3′ exonuclease associated with DNA polymerase I. The nascent progeny RF DNA also contains a significant proportion of fragments of smaller than unit length.     

DNA sequence analysis of the defective interfering particles of bacteriophage f1.

Restriction mapping and nucleotide sequence analysis of several defective, interfering particles of bacteriophage f1 are described. These particles contain the nucleotide sequences corresponding to the carboxyl terminus of gene IV and the amino-terminus of gene II and the intergenic space between them. Tandem duplication of a portion of this intergenic space generates defective particles with novel nucleotide sequences not found in wild-type f1. This duplication is shown to contain the origin of complementary strand synthesis. Our results suggest that the duplication occurs at the site of gene II protein action, i.e. the origin of viral strand synthesis. A model is presented for the generation of these duplications in defective particles.     

Rat and human embryo and post-natal sera contain a potent endogenous competitor of estrogen-rat alpha-fetoprotein interactions

A highly active inhibitor of the binding of estrone and estradiol-17β to rat alpha-fetoprotein is demonstrated for the first time in embryo, immature and adult rat sera as well as in fetal and adult human sera. The competitive character and the narrow specificity of this inhibition effect is shown. The major compound responsible for this activity is isolated by successive column Sephadex LH₂₀ and thin layer chromatography : it is characterized as a nonpolar, nonphenolic, dialysable and thermostable substance, unreactive towards anti-estrone and anti-estradiol-17β anti-bodies. The possible biological role of an endogenous non-estrogen ligand of rodent fetoproteins is discussed.     

Discontinuous DNA replication: accumulation of Simian virus 40 DNA at specific stages in its replication.

The number of proline residues in a protein should have very marked consequences for the rates of protein unfolding and refolding according to the model proposed by Brandts et al. (1975). Kinetic simulations of this model indicate that the half-time for refolding of a polypeptide chain with 20 proline residues should be greater than 10 minutes and should increase by about an order of magnitude for each additional 10 proline residues. Various means are considered by which the rate of protein folding in vivo and in vitro might be increased.     

Toxicological evaluation of methyl tertiary butyl ether (MTBE): Testing performed under TSCA consent agreement

MTBE is a colorless, relatively volatile liquid that has found widespread use as an octane‐enhancing gasoline additive. In 1987, the Environmental Protection Agency's (EPA) Interagency Testing Committee identified MTBE for priority testing consideration based on large production volume, potential widespread exposure, and limited data on chronic health effects. In response, the industry formed the MTBE Health Effects Testing Task Force, which in 1988 signed a Consent Agreement with the EPA requiring the task force member companies to perform toxicological testing on MTBE.

The testing program, which began in the second quarter of 1988, consists of a full complement of short‐ and long‐term tests. The testing completed to date includes genotoxicity (in vivo bone marrow cytogenetics and Drosophila sex‐linked recessive lethal assays), developmental toxicity, acute and subchronic neurotoxicity (motor activity, functional observation battery, and neuropathology), subchronic toxicity, reproductive/fertility effects, and pharmacokinetic studies. There is also an ongoing oncogenicity study in rats and mice. The final report for this chronic study is expected at the end of 1992. The total cost for the program is approximately $3.75 million, which is funded by the 11 Task Force member companies based on market share.

These studies were sponsored by the MTBE Health Effects Testing Task Force, Oxygenated Fuels Association, Washington, D.C.     

The structural simplification of an epidemiological compartment model

It is shown how a multicompartmental infectious disease model can be systematically examined for reduction of structural complexity. For steadystate situations, four basic rules are proposed for eliminating components of flow-lines, whole flow-lines, and compartments, plus combining compartments. An application to a typhoid fever model allows calculations to be done on a pocket calculator. The approach could be particularly important in developing countries.