Weekly cisplatin and daily oral etoposide is highly effective in platinum pretreated ovarian cancer

We investigated the potential of weekly cisplatin and daily oral etoposide followed by oral etoposide maintenance therapy in patients with platinum-refractory ovarium cancer. One hundred and seven patients were entered on the study, 98 patients completed the induction therapy consisting of cisplatin at either 50 or 70 mg m−2 weekly for six administrations plus oral etoposide at a dose of 50 mg daily. Of these 98 patients, 38 had a platinum treatment-free interval of more than 12 months, 32 had an interval between 4 and 12 months, and 28 had progressed during or within 4 months after last platinum therapy. We assessed response rates and time to progression, and also response duration and survival. Analyses were done on the 98 evaluable patients. All 107 patients were considered evaluable for toxicity. Of the 38 patients with a treatment-free interval of more than 12 months, 92% responded, with 63% complete responses. The median progression-free survival in these patients was 14 months, and the median survival was 26 months. Of the 32 patients with an interval of 4–12 months, 91% responded, with 31% complete responses, a median progression-free interval of 8 and a median overall survival of 16 months. Of the 28 patients with platinum-refractory disease, 46% as yet responded, with 29% complete responses, median progression-free interval of 5 and an overall survival of 13 months. Haematologic and non-haematologic, particularly renal toxicity and neurotoxicity, were notably mild. We conclude that this intensive regimen of weekly cisplatin plus daily etoposide is highly effective and well tolerated in patients with ovarian cancer relapsing after conventional platinum-based combination chemotherapy, including patients who have progressed during or within 4 months after platinum treatment

Consequences of obtaining a driving licence for transport mode choice and attitudes towards public transport

Analysis show that when an individual passes the driving exam, the pattern of travel and attitudes towards public transport changes. He or she will statistically travel less by public transport. Access to car is significant for choice of transport mode as well. What happens in this transition from being a captive public transport user to becoming a car user? Young people who recently have obtained a driving licence are in an important phase when it comes to travel mode choice. Analysis of panel surveys carried through in 10 Norwegian urban areas over a 2 year period indicates that the travel activity in general increases when you get your driving licence. Journeys by car constitute the increase. While journey made by bike, as a pedestrian or as a car passenger do not change significantly, our research shows that journeys made by public transport are reduced among those who have obtained their driving licence in this period. In other words, it is first and foremost public transport that looses market shares when youth obtain their driving licences. Youth often do have a lot of experience with using public transport, but is in danger of becoming a lost customer group for public transport when driving licences – and later car ownership – is within reach. We find that it is very important to learn more about the changes in driving licence holding, and throw light on possible causes for change. More knowledge about these mechanisms is essential for the public transport sectors capability to adjust the supply to the needs of this group. In this way only can the sector contribute in keeping youth as customers when the car becomes a possible alternative for travel

A Comparative Analysis of Mandated Benefit Laws, 1949–2002

OBJECTIVE: To understand and compare the trends in mandated benefits laws in the United States. DATA SOURCES/STUDY SETTING: Mandated benefit laws enacted in 50 states and the District of Columbia for the period 1949–2002 were compiled from multiple published compendia. STUDY DESIGN: Laws that require private insurers and health plans to cover particular services, types of diseases, or care by specific providers in 50 states and the District of Columbia are compared for the period 1949–2002. Legislation is compared by year, by average and total frequency, by state, by type (provider, health care service, or preventive), and according to whether it requires coverage or an offer of coverage. DATA COLLECTION/EXTRACTION METHOD: Data from published tables were entered into a spreadsheet and analyzed using statistical software. PRINCIPAL FINDINGS: A total of 1,471 laws mandated coverage for 76 types of providers and services. The most common type of mandated coverage is for specific health care services (670 laws for 34 different services), followed by laws for services offered by specific professionals and other providers (507 mandated benefits laws for 25 types of providers), and coverage for specific preventive services (295 laws for 17 benefits). On average, a mandated benefit law has been adopted or significantly revised by 19 states, and each state has approximately 29 mandates. Only two benefits (minimum maternity stay and breast reconstruction) are mandated in all 51 jurisdictions and these were also federally mandated benefits. The mean number of total mandated benefit laws adopted or significantly revised per year was 17 per year in the 1970s, 36 per year in the 1980s, 59 per year in the 1990s, and 76 per year between 2000 and 2002. Since 1990, mandate adoption increased substantially, with around 55 percent of all mandated benefit laws enacted between 1990 and 2002. CONCLUSIONS: There was a large increase in the number of mandated benefits laws during the managed care “backlash” of the 1990s. Many states now use mandated benefits to prescribe not only what services and benefits would be provided but how, where, and when services will be provided