Risk-Adjusted Cancer Screening and Prevention (RiskAP): Complementing Screening for Early Disease Detection by a Learning Screening Based on Risk Factors

Background: Risk-adjusted cancer screening and prevention is a promising and continuously emerging option for improving cancer prevention. It is driven by increasing knowledge of risk factors and the ability to determine them for individual risk prediction. However, there is a knowledge gap between evidence of increased risk and evidence of the effectiveness and efficiency of clinical preventive interventions based on increased risk. This gap is, in particular, aggravated by the extensive availability of genetic risk factor diagnostics, since the question of appropriate preventive measures immediately arises when an increased risk is identified. However, collecting proof of effective preventive measures, ideally by prospective randomized preventive studies, typically requires very long periods of time, while the knowledge about an increased risk immediately creates a high demand for action. Summary: Therefore, we propose a risk-adjusted prevention concept that is based on the best current evidence making needed and appropriate preventive measures available, and which is constantly evaluated through outcome evaluation, and continuously improved based on these results. We further discuss the structural and procedural requirements as well as legal and socioeconomical aspects relevant for the implementation of this concept

RETRACTED ARTICLE: Age-dependent Increase in Desmosterol Restores DRM Formation and Membrane-related Functions in Cholesterol-free DHCR24−/− Mice

Cholesterol is a prominent modulator of the integrity and functional activity of physiological membranes and the most abundant sterol in the mammalian brain. DHCR24-knock-out mice lack cholesterol and accumulate desmosterol with age. Here we demonstrate that brain cholesterol deficiency in 3-week-old DHCR24−/− mice was associated with altered membrane composition including disrupted detergent-resistant membrane domain (DRM) structure. Furthermore, membrane-related functions differed extensively in the brains of these mice, resulting in lower plasmin activity, decreased β-secretase activity and diminished Aβ generation. Age-dependent accumulation and integration of desmosterol in brain membranes of 16-week-old DHCR24−/− mice led to the formation of desmosterol-containing DRMs and rescued the observed membrane-related functional deficits. Our data provide evidence that an alternate sterol, desmosterol, can facilitate processes that are normally cholesterol-dependent including formation of DRMs from mouse brain extracts, membrane receptor ligand binding and activation, and regulation of membrane protein proteolytic activity. These data indicate that desmosterol can replace cholesterol in membrane-related functions in the DHCR24−/− mouse

Caesarean section rates among the Syrian refugee population in Lebanon: possible causes, implications and recommendations going forward

Thesis (Master's)--University of Washington, 2013As of September, 2013, the conflict in the Syrian Arab Republic is far from abating, and this country of over 22 million citizens has now over 2 million of its people (three quarters of them women and children) have sought refuge in neighboring countries. With a surface area of 10,452 km2, Lebanon is by far the smallest of all hosting countries, yet it is hosting the highest number of refugees. Today, over 769,000 refugees are living in Lebanon (registered and awaiting registration) - over 1 million according to government sources--mostly concentrated in the Bekaa and the North of the country, settling in mainly economically stressed areas where services were severely strained to begin with. With a 2012 population of 4.425 million, Syrian refugees now account for about a quarter of Lebanon's total population, undoubtedly placing a very heavy strain on this small country's resources. In response to this refugee crisis, UNHCR has been assuming the role of leading and coordinating agency. On the health front of the response, the demand from refugees has been great. Hospitalizations have accounted for a proportionally large part of UNHCR's health budget expenses, with 14,546 hospital admissions from Jan-June 2013 alone. But it has especially been so in the request for maternal health services (deliveries), with 6,375 births recorded in that 2013 timeframe, and accounting for over 47% of our largest implementing partner's (IP) recorded requests for hospital admissions in 2013 (up from 23% in 2012). Of note, 5.6% of the overall hospital admissions requests were for "neonatal conditions". Combined, this constitutes over 53% of all hospital admissions. Overall, deliveries account for almost 50% of hospitalizations in our contracted hospitals, and are an important part of UNHCR's health expenses. From those hospital admissions for deliveries, the data collected for 2013 indicated an overall c-section (CS) rate of 35% in the Syrian refugee population , much higher than the recommended threshold of 15% given by the WHO, and also more elevated than Syria's reported CS rates of 12-23%. Since CS cost on average two times more than a natural delivery, it was important for UNHCR to try and understand what impetus was behind the CS rates that were being observed. Indeed, from Jan-June 2013, out of 6,375 births covered by UNHCR, an estimated minimum of $1.4 million would have been spent on CS (2,244 CS between Jan-June 2013) and$1.4 million for Natural Vaginal Deliveries (NVDs) (4,131 NVDs between Jan-June 2013). Taking into account that many of those CS actually cost much more because they are often linked to birth complications and neonatal ICU admissions, the total bill is most likely much higher than the simple delivery act. From this limited mixed methods study which looked at our IPs' 2013 hospital admissions data, as well as from our limited interviews with hospital administrators, medical providers and women having undergone c-sections, we tried to better understand the factors driving the CS rate among the Syrian refugee population

Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

Early detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. This study evaluated outcomes of MoPoTsyo's diabetes program in Takeo Province by assessing glycemic and blood pressure outcomes for individuals diagnosed with diabetes over a 24-month follow-up period between 2007-2013.This is a retrospective cohort analysis of records without a comparison group. We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow-up. The proportion of patients reaching recommended treatment targets for FBG and BP was assessed.Of the 3411 patients enrolled in the program, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow-up time in the program was 16 months (4.9-38.4 months). Mean FBG decreased 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow-up (p<0.001). After one year, 45% (321/708) of patients achieved goal FBG < 126. Of the 41.6% (927/2230) with elevated BP at enrollment, systolic and diastolic BP levels significantly decreased (p<0.001) by 16.9 mmHg (95% CI 1.2 to 22.9) and 10 mm Hg (95% CI 0.7 to 12.9) respectively between enrollment and one year of follow-up. At one year of follow-up, 51.1%% (183/355) of these patients reached the BP goal < 140/90.The improved outcome indicators of diabetes care for MoPoTsyo's Takeo program evaluation showed promise. The program demonstrated a reasonable and practical approach to delivering effective diabetes care in a rural area and may serve as a model for other low-income communities. Future prospective evaluations with more complete data are necessary for longer-term outcomes

Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial

Objective Executive functions (EFs) play a key role in emotion regulation and, related to this, depression. Cognitive remediation (CR) targeting EFs, such as Goal Management Training (GMT) and computerized cognitive training (CCT), may reduce maladaptive emotion regulation. However, the clinical potential of GMT in the context of depression and emotion regulation remains to be tested. Hence, the primary aim of the present study was to compare effects of GMT with CCT on symptoms of emotion dysregulation. Method The paper reports the effects of a preregistered randomized controlled trial. Sixty-three participants (18–60yrs) with active or remitted depression and EF complaints were randomized to nine sessions of GMT (n = 35) or CCT (n = 28). All were assessed at baseline, post-intervention, and at 6-month follow-up. The Ruminative Response Scale and the Difficulties in Emotion Regulation Scale were employed to assess emotion regulation. Results Both groups improved following the intervention on emotion regulation domains after controlling for intention-to-treat, including brooding rumination and on items reflecting non-accepting reactions to distress. Relative to CCT, the GMT-group demonstrated increased clarity of emotional responses in the per protocol analysis. Conclusions Our findings demonstrate the potential of GMT and CCT in reducing maladaptive emotion regulation in depression

Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial

Objective Executive functions (EFs) play a key role in emotion regulation and, related to this, depression. Cognitive remediation (CR) targeting EFs, such as Goal Management Training (GMT) and computerized cognitive training (CCT), may reduce maladaptive emotion regulation. However, the clinical potential of GMT in the context of depression and emotion regulation remains to be tested. Hence, the primary aim of the present study was to compare effects of GMT with CCT on symptoms of emotion dysregulation. Method The paper reports the effects of a preregistered randomized controlled trial. Sixty-three participants (18–60yrs) with active or remitted depression and EF complaints were randomized to nine sessions of GMT (n = 35) or CCT (n = 28). All were assessed at baseline, post-intervention, and at 6-month follow-up. The Ruminative Response Scale and the Difficulties in Emotion Regulation Scale were employed to assess emotion regulation. Results Both groups improved following the intervention on emotion regulation domains after controlling for intention-to-treat, including brooding rumination and on items reflecting non-accepting reactions to distress. Relative to CCT, the GMT-group demonstrated increased clarity of emotional responses in the per protocol analysis. Conclusions Our findings demonstrate the potential of GMT and CCT in reducing maladaptive emotion regulation in depression

Correction: Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013.

[This corrects the article DOI: 10.1371/journal.pone.0181582.]

Mean fasting blood glucose level over time.

<p>Mean fasting blood glucose level over time.</p

Evaluation of a multi-faceted diabetes care program including community-based peer educators in Takeo province, Cambodia, 2007-2013

<div><p>Introduction</p><p>Early detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. This study evaluated outcomes of MoPoTsyo’s diabetes program in Takeo Province by assessing glycemic and blood pressure outcomes for individuals diagnosed with diabetes over a 24-month follow-up period between 2007–2013.</p><p>Methods</p><p>This is a retrospective cohort analysis of records without a comparison group. We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow-up. The proportion of patients reaching recommended treatment targets for FBG and BP was assessed.</p><p>Results</p><p>Of the 3411 patients enrolled in the program, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow-up time in the program was 16 months (4.9–38.4 months). Mean FBG decreased 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow-up (p<0.001). After one year, 45% (321/708) of patients achieved goal FBG < 126. Of the 41.6% (927/2230) with elevated BP at enrollment, systolic and diastolic BP levels significantly decreased (p<0.001) by 16.9 mmHg (95% CI 1.2 to 22.9) and 10 mm Hg (95% CI 0.7 to 12.9) respectively between enrollment and one year of follow-up. At one year of follow-up, 51.1%% (183/355) of these patients reached the BP goal < 140/90.</p><p>Conclusion</p><p>The improved outcome indicators of diabetes care for MoPoTsyo’s Takeo program evaluation showed promise. The program demonstrated a reasonable and practical approach to delivering effective diabetes care in a rural area and may serve as a model for other low-income communities. Future prospective evaluations with more complete data are necessary for longer-term outcomes.</p></div

Characteristics of included and excluded DM patients.

<p>Characteristics of included and excluded DM patients.</p