Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

PURPOSE: To evaluate the pathologic response of cervical carcinoma to external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDRB) and outcome. MATERIALS AND METHODS: Between 1992 and 2001, 67 patients with cervical carcinoma were submitted to preoperative radiotherapy. Sixty-five patients were stage IIb. Preoperative treatment included 45 Gy EBRT and 12 Gy HDRB. Patients were submitted to surgery after a mean time of 82 days. Lymphadenectomy was performed in 81% of patients. Eleven patients with residual cervix residual disease on pathological specimen were submitted to 2 additional insertions of HDRB. RESULTS: median follow up was 72 months. Five-year cause specific survival was 75%, overall survival 65%, local control 95%. Complete pelvic pathological response was seen in 40%. Surgery performed later than 80 days was associated with pathological response. Pelvic nodal involvement was found in 12%. Complete pelvic pathological response and negative lymphnodes were associated with better outcome (p = .03 and p = .005). Late grade 3 and 4 urinary and intestinal adverse effects were seen in 12 and 2% of patients. CONCLUSION: Time allowed between RT and surgery correlated with pathological response. Pelvic pathological response was associated with improved outcome. Postoperative additional HDRB did not improve therapeutic results. Treatment was well tolerated

Cardiovasc Diabetol

BACKGROUND: Advanced glycation end-products play a role in diabetic vascular complications. Their optical properties allow to estimate their accumulation in tissues by measuring the skin autofluorescence (SAF). We searched for an association between SAF and major adverse cardiovascular events (MACE) incidence in subjects with Type 1 Diabetes (T1D) during a 7 year follow-up. METHODS: During year 2009, 232 subjects with T1D were included. SAF measurement, clinical [age, sex, body mass index (BMI), comorbidities] and biological data (HbA1C, blood lipids, renal parameters) were recorded. MACE (myocardial infarction, stroke, lower extremity amputation or a revascularization procedure) were registered at visits in the center or by phone call to general practitioners until 2016. RESULTS: The participants were mainly men (59.5%), 51.5 +/- 16.7 years old, with BMI 25.0 +/- 4.1 kg/m(2), diabetes duration 21.5 +/- 13.6 years, HbA1C 7.6 +/- 1.1%. LDL cholesterol was 1.04 +/- 0.29 g/L, estimated Glomerular Filtration Rates (CKD-EPI): 86.3 +/- 26.6 ml/min/1.73 m(2). Among these subjects, 25.1% were smokers, 45.3% had arterial hypertension, 15.9% had elevated AER (>/= 30 mg/24 h), and 9.9% subjects had a history of previous MACE. From 2009 to 2016, 22 patients had at least one new MACE: 6 myocardial infarctions, 1 lower limb amputation, 15 revascularization procedures. Their SAF was 2.63 +/- 0.73 arbitrary units (AU) vs 2.08 +/- 0.54 for other patients (p = 0.002). Using Cox-model, after adjustment for age (as the scale time), sex, diabetes duration, BMI, hypertension, smoking status, albumin excretion rates, statin treatment and a previous history of MACE, higher baseline levels of SAF were significantly associated with an increased risk of MACE during follow-up (HR = 4.13 [1.30-13.07]; p = 0.02 for 1 AU of SAF) and Kaplan-Meier curve follow-up showed significantly more frequent MACE in group with SAF upper the median (p = 0.001). CONCLUSION: A high SAF predicts MACE in patients with T1D

Causal and associational language in observational health research: A systematic evaluation.

This is the final version. Available from Oxford University Press via the DOI in this record. Data, data analysis code, and materials are available on the Open Science Framework project https://osf.io/jtdaz/.We estimated the degree to which language used in the high profile medical/public health/epidemiology literature implied causality using language linking exposures to outcomes and action recommendations; examined disconnects between language and recommendations; identified the most common linking phrases; and estimated how strongly linking phrases imply causality. We searched and screened for 1,170 articles from 18 high-profile journals (65 per journal) published from 2010-2019. Based on written framing and systematic guidance, three reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as None (no causal implication) in 13.8%, Weak 34.2%, Moderate 33.2%, and Strong 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was "associate" (45.7%). Reviewers' ratings of linking word roots were highly heterogeneous; over half of reviewers rated "association" as having at least some causal implication. This research undercuts the assumption that avoiding "causal" words leads to clarity of interpretation in medical research.Marie Skłodowska-Curie grantAustralian Research CouncilNational Institute of Mental HealthNational Institute of Mental HealthNational Institute of Biomedical Imaging and BioengineeringNational Center for Advancing Translational Sciences UCLA Clinical Translational Science InstituteBloomberg American Health InitiativeKaren Toffler Charity Trus

Cervical cancer burden in Latin America and the Caribbean: where are we?

In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age‐standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0–29, 30–49, 50–64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population‐based cancer registries are critical in monitoring the elimination initiative

Self-rated health, and frailty in older adults from the population-based Three-City Bordeaux cohort

Introduction: To investigate the association between self-rated health (SRH) and frailty and its components among community-dwellers aged 75 years and older. Methods: We ran a cross-sectional and prospective analysis from 643 and 379 participants of the Bordeaux center (France) of the Three-City Study, respectively. We assessed SRH using a single question with five response options. We defined frailty as having at least three out of the following five criteria: weight loss; exhaustion; slowness; weakness, and low energy expenditure. We used multivariate logistic regression and Cox proportional hazard models. Results: At baseline, poor SRH was significantly associated with frailty (Odds Ratio= 5.2; 95% Confidence Interval (CI): 2.9 – 9.5), and its components except for weakness. In the prospective analysis on non-frail participants, poor SRH was associated with the 4-year risk of slowness (Hazard Ratio (HR)= 1.7; 95% CI: 1.1-2.6) but not with that of frailty (HR = 1.6; 95% CI:0.9-2.9) or the other components. Conclusions: In a French cohort of community-dwellers aged 75 years or older, poorer SRH was associated with concomitant frailty and 70% higher risk of slowness over four years.</p

Age disparities in lung cancer survival in New Zealand: the role of patient and clinical factors

Objective Age is an important prognostic factor for lung cancer. However, no studies have investigated the age difference in lung cancer survival per se. We, therefore, described the role of patient-related and clinical factors on the age pattern in lung cancer excess mortality hazard by stage at diagnosis in New Zealand. Materials and Methods We extracted 22 487 new lung cancer cases aged 50-99 (median age = 71, 47.1% females) diagnosed between 1 January 2006 and 31 July 2017 from the New Zealand population-based cancer registry and followed up to December 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on the excess mortality hazard by stage at diagnosis, and we derived corresponding lung cancer net survival. Results The age difference in net survival was particularly marked for localised and regional lung cancers, with a sharp decline in survival from the age of 70. No identified factors influenced age disparities in patients with localised cancer. However, for other stages, females had a greater difference in survival between middle-age and older-age than males. Comorbidity and emergency presentation played a minor role. Ethnicity and deprivation did not influence age disparities in lung cancer survival. Conclusion Sex and stage at diagnosis were the most important factors of age disparities in lung cancer survival in New Zealand

How we use noncancer-specific survival prediction in geriatric oncology: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative

An important aspect of the assessment of the health status of an older adult with cancer is estimating noncancer-specific survival, since this can be used to weigh the potential benefits and risks of treatment against the patient's all-cause mortality. Geriatric oncology guidelines issued by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend the use of validated tools to predict noncancer-specific survival, also labeled “life expectancy calculators”, in all patients aged 65 years and older before starting oncological treatment [1,2]. In addition, the estimation of noncancer-specific survival can also be integrated into the decision-making process for other medical interventions relevant for geriatric oncology, such as the decision of stopping screening in an older individual, or for determining the appropriateness of interventions related to the management of comorbidities in older adults with a cancer diagnosis. In this brief report, we outline some of the existing resources for estimating noncancer-specific survival and provide practical information as to how to use them in clinical practice

Dietary patterns and 12-year risk of frailty: Results from the three-city Bordeaux study

Objective: To analyze the association between dietary patterns and the 12-year risk of frailty and its components in community-dwelling elderly French adults. Design: A prospective cohort study. Setting: The Bordeaux sample of the Three-City Study. Participants: A total of 972 initially nonfrail nondemented participants (336 men and 636 women) aged 73 years on average, re-examined at least once over 12 years. Measurements: Five sex-specific dietary clusters were previously derived at baseline. Frailty incident to the baseline visit was defined as having at least three out of the following 5 criteria: unintentional weight loss, exhaustion, low energy expenditure, slowness, and muscle weakness. Multivariate Cox proportional hazard models were used to assess the association between dietary clusters and the risk of frailty and its components. Results: In total, 78 men for 3719 person-years and 221 women for 7027 person-years became frail over the follow-up. In multivariate analyses, men in the “pasta” pattern and women in the “biscuits and snacking” pattern had a significantly higher risk of frailty compared with those in the “healthy” pattern [hazard ratio (HR) 2.2; 95% confidence interval (CI) 1.1–4.4 and HR 1.8; 95% CI 1.2–2.8, respectively; P = .09 and P = .13 for the global test of significance of risk difference across clusters, respectively]. In men, “biscuits and snacking” and “pasta” patterns were significantly associated with higher risk for muscle weakness (HR 3.3; 95% CI 1.6–7.0 and HR 2.1; 95% CI 1.2–3.7, respectively; P = .003 for global test). Conclusions: This 12-year prospective population-based study suggests that some particular unhealthy dietary patterns may increase the risk of frailty in older adults.</p

Participative decentralization of diabetes care in Davao City (Philippines) according to the Chronic Care Model : a program evaluation

Aim: To assess the effectiveness of the Diabetes Project in Davao City, Philippines, regarding diabetes care access, diabetes management and cardiovascular risk factors. The project was developed in accordance with the Chronic Care Model (CCM) framework. Methods: A non-randomized cross-sectional survey was conducted in nine intervention and five control Barangays (villages). People with diabetes aged >= 20 years were interviewed using a structured questionnaire; height, weight, waist circumference, and blood pressure were measured; HbA1c was tested with a NSGP-certified point-of-care device. Logistic regression models were used to compare the two groups. Results: The intervention group (n = 503) scored better than the controls (n = 136) on the following (OR, 95% CI): percentage of patients taking metformin (1.5, 1.0-2.2); and in the last 12 months: laboratory test for fasting blood sugar (1.6, 1.1-2.3), HbA1c (6.0, 2.4-15.1), lipid profile (1.7, 1.1-2.5), nutritionist visit (1.6, 1.0-2.5) and therapeutic education session (2.7, 1.8-4.0). Glycemic control (HbA1c < 7%) was also better in the intervention Barangays (1.6, 1.0-2.4). There were no statistical differences between the two groups for number of visits, and levels of other cardiovascular risk factors. Conclusions: Our findings support the effectiveness of implementing the CCM framework in a low-to-middle income country on glycemic control and diabetes management

Current and projected number of years of life lost due to prostate cancer: A global study

BACKGROUND: Prostate cancer is an important cause of death worldwide. The number of years of life lost (YLL) due to prostate cancer is a metric of the toll of prostate cancer and using projections of demographic changes, can be used to measure future burden. METHODS: Prostate cancer mortality data by country and world region was retrieved from the Global Cancer Observatory and the World Health Organization mortality data set, and life expectancy was from the United Nations Department of Economic and Social Affairs. We estimated YLL as the difference between age at death in people with prostate cancer and remaining life expectancy for people of the same age in the general population. We also estimated the age-standardized YLL rates per 100,000 males over 50 and the average annual percentage change in YLL rates over the period 2000-2019 and the number of YLL for the year 2040 by applying population projections to the 2020 YLL rates. RESULTS: In 2020, 3.5 million person-years of life were lost due to prostate cancer in males over 50, and 40% of YLL were in those aged over 75. Age-standardized rates varied greatly between and within regions. Over the last two decades, rates of YLL have increased in many Asian and African countries while they have decreased in northern American and European countries. Globally, YLL are anticipated to double by 2040 to reach 7.5 million, with the greatest increases in Africa, Asia, and Latin America and the Caribbean. CONCLUSION: There are wide variations in the burden of prostate cancer globally as measured by YLL. The burden of prostate cancer is projected to increase over time and appears to be highest in Sub-Saharan Africa, Eastern Europe, and Latin America and the Caribbean. It will be critical to plan and implement programs to reduce the burden of prostate cancer globally