Recruitment and Early Retention of Women with Advanced Breast Cancer in a Complementary and Alternative Medicine Trial

More than 80% of women with breast cancer are now reported to be using complementary and alternative medicine (CAM) therapies during conventional treatment. A randomized clinical trial (RCT) of reflexology with late stage breast cancer patients serves as the data source for this article. The purposes were to investigate: (i) reasons for refusal to participate in a RCT of reflexology; (ii) the differences between those who completed the baseline interview and those who dropped out before baseline; and (iii) the utility of the Palliative Prognostic Score (PPS) as a prognostic screening tool in minimizing early attrition (before baseline) from the trial. Eligible women (N = 400) approached at 12 cancer centers in the Midwest had advanced breast cancer, were on chemotherapy or hormonal therapy, and had a PPS of 11 or less. Comparisons of those who dropped out early (N = 33) to those who stayed in the trial (N = 240) were carried out using Wilcoxon rank, t-, chi-squared and Fisher's exact tests. The reasons of being “too sick” or “overwhelmed” were given by less than 12% of the women who refused to participate. There was a higher early dropout rate among black women compared to other (primarily white) women (P = .01). Cancer recurrence and metastasis, age, and the PPS were not predictive of early retention of women. Specialized techniques may be needed to ensure black women remain in the trial once consented. Women with advanced disease were likely to enter and remain in the trial despite deterioration in health

Meeting the Emerging Public Health Needs of Persons With Blood Disorders

In its decades-long history, the Division of Blood Disorders (DBD) at CDC has evolved from a patient-focused, services-supporting entity at inception, to one of the world leaders in the practice of public health to improve the lives of people at risk for or affected by nonmalignant blood disorders. The DBD’s earliest public health activities consisted of working with care providers in a network of hemophilia treatment centers to provide AIDS risk reduction services to people with hemophilia. Because this infectious disease threat has been reduced over time as a result of the development of safer treatment products, the DBD—under the auspices of congressional appropriations guidance—has expanded its core activities to encompass blood disorders other than hemophilia, including hemoglobinopathies such as thalassemia and sickle cell disease, and Diamond Blackfan anemia. Simultaneously, in transitioning to a greater public health role, the DBD has expanded its network of partners to new consumer and professional organizations, as well as state and other federal health agencies. The DBD has also developed and maintains many surveillance and registry activities beyond the Universal Data Collection system aimed at providing a better understanding of the health status, health needs, and health-related quality of life of people with nonmalignant blood disorders. The DBD has integrated applicable components of the Essential Services of Public Health successfully to promote and advance the agenda of blood disorders in public health

Testing the Differential Effects of Symptom Management Interventions in Cancer

Objective: The purpose of this study was to test for moderating effects of patient characteristics on self-management interventions developed to address symptoms during cancer treatment. Patient’s age, education and depressive symptomatology were considered as potential moderators. Methods: A secondary analysis of data of 782 patients from two randomized clinical trials was performed. Both trials enrolled patients with solid tumors undergoing chemotherapy. After completing baseline interviews, patients were randomized to a nurse-delivered intervention versus intervention delivered by a “coach” in trial I, and to a nurse-delivered intervention versus an intervention delivered by an automated voice response system in trial II. In each of the two trials, following a 6-contact 8-week intervention, patients were interviewed at week 10 to assess the primary outcome of symptom severity. Results: While nurse-delivered intervention proved no better than the “coach” or automated system in lowering symptom severity, important differences in the intervention by age were found in both trials. Patients“coach” or automated system; while those \u3e75 years favored the nurse. Education and depressive symptomatology did not modify the intervention effects in either of the two trials. Depressive symptomatology had a significant main effect on symptom severity at week 10 in both trials (p=.03 and p Conclusions: Clinicians need to carefully consider the age of the population when using or testing interventions to manage symptoms among cancer patients

Risk of development of clinical tuberculosis among infected individuals identified by a single blood PCR test

Tuberculosis is still a major health problem of most developing countries including Pakistan. It is also re-emerging as a significant cause of morbidity and mortality in the developed countries. Literature review indicates that despite availability of good anti-tuberculosis medicines, it is difficult to eradicate or control tuberculosis. One reason for this, among others, is the limitations of current laboratory tests widely used for its diagnosis. In recent past, polymerase chain reaction (PCR), for detection of Mycobacterium tuberculosis DNA has been gaining popularity, particularly because of its rapidity and its ability to detect TB infection much earlier then it becomes detectable by any other method. While PCR can be considered good at identifying TB infection, it can be considered a useful adjunct or replacement test for the current diagnostic methods only after its meaning in terms of the disease is better understood. If early identification of TB infection by PCR means, that a large proportion of such individuals will go on to develop clinical disease if left untreated, then PCR has good utility in terms of disease prevention and is a useful tool from public health aspect. We therefore performed a community based study to estimate the risk of development of clinical tuberculosis among PCR for MTB DNA positive individuals, with no or minimal symptoms, during July - September 1998. A total of sixty-five individuals who were diagnosed infected by a positive blood PCR for MTB DNA and were AFB sputum smear and culture negative, were identified from a study that started in June of 1996. We successfully retraced 42 of these individuals and interviewed them to determine the proportion of those among them who, in the course of two years developed tuberculosis and also to identify the factors associated with increased risk of development of tuberculosis disease. Results show that 38% of these individuals were diagnosed as tuberculosis patients by general practitioners at some time during the two years period. For various sub groups based on demographic characteristics, presence or absence of symptoms like fever, blood in sputum and weight loss and the Presence or absence of chronic illness; statistical analysis was done to determine the proportion of PCR positive individuals who developed clinical tuberculosis over the two years\u27 period. Risk in the sub groups with a characteristic, relative to those without the characteristic (relative risk) was also determined. We found that presence of blood in sputum, at the time of identification of infection was associated with a risk of 70% for the development of disease. Infected individuals with blood in their sputum were more likely to develop the disease than those infected individuals who did not have blood in their sputum at the time infection was identified (RR 3.69, 95% CI 1.65 - 6.13). Also, it was learnt that the risk increased with the increase in the duration for which a person have had cough. Each month\u27s increase in the duration of cough was associated with an increase of 1.3% in the risk of TB (RR 1.013, 95% CI 1.002 - 1.026). Our results show that identification of tuberculosis infection by blood PCR, even early in the disease process is associated with a fairly high probability of the development of disease in just two years time

Impact of viral suppression among persons with HIV upon estimated HIV incidence between 2010 and 2015 in the United States.

BackgroundThe suppression of viremia among persons with HIV (PWH) using antiretroviral therapy has been hypothesized to reduce HIV incidence at the population level. We investigated the impact of state level viral suppression among PWH in the United States on estimated HIV incidence between 2010 and 2015.MethodsViral suppression data and HIV incidence estimates from the National HIV Surveillance System were available from 29 states and the District of Columbia. We assumed a one year delay for viral suppression to impact incidence. Poisson regression models were used to calculate the estimated annual percent change (EAPC) in incidence rate. We employed a multivariable mixed-effects Poisson regression model to assess the effects of state level race/ethnicity, socioeconomic status, percent men who have sex with men (MSM) and hepatitis C virus prevalence as a proxy for injection drug use on HIV incidence.FindingsFitted HIV incidence for 30 jurisdictions declined from 11.5 in 2010 to 10.0 per 100,000 population by 2015 corresponding with an EAPC of -2.67 (95% confidence interval [95%CI] -2.95, -2.38). Southern states experienced the highest estimated incidence by far throughout this period but upon adjustment for viral suppression and demographics there was a 36% lower incidence rate than Northeast states (adjusted rate ratio [aRR] 0.64; 95%CI 0.42, 0.99). For every 10 percentage point (pp) increase in viral suppression there was an adjusted 4% decline in HIV incidence rate in the subsequent year (aRR 0.96; 95%CI 0.93, 0.99). While controlling for viral suppression, HIV incidence rate increased by 42% (aRR 1.42 95%CI 1.31, 1.54) for every 5 pp increase in percent Black race and by 27% (aRR 1.27 95%CI 1.10, 1.48) for every 1 pp increase in percent MSM in states.InterpretationA decline in estimated HIV incidence from 2010 to 2015 was associated with increasing viral suppression in the United States. Race and sexual orientation were important HIV acquisition risk factors

Burden of disease resulting from hemophilia in the U.S.

BACKGROUND: Hemophilia is a hereditary bleeding disorder. Its complications can result in substantial morbidity, but few efforts have been made to quantify the disease burden. PURPOSE: The objective of this analysis was to estimate the burden of disease due to hemophilia (A and B) in the U.S., using disability-adjusted life years (DALY). METHODS: The approach taken by the WHO in its Global Burden of Disease study was followed. Assumptions were drawn from published literature, and population estimates from the U.S. Census Bureau for the Year 2007 were used. Estimations of years of life lost resulting from mortality (YLL) and years of life lost resulting from morbidity (YLD) were done separately by gender, 5-year age intervals, and severity of disease (morbidity only) with their sum representing DALYs. Disability weights were derived from the quality-of-life tool EuroQol (EQ-5D). The stability of burden estimates was tested by performing sensitivity analyses, changing one assumption at a time. RESULTS: In the U.S. in 2007, hemophilia resulted in 110,095 DALYs, composed of 13,418 YLLs and 96,677 YLDs. Large differences between men/boys (107,346) and women/girls (2749) were observed, given that females are genetic carriers of the disorder and rarely present with disease. Sensitivity analyses revealed a relatively robust estimate with a maximum variation of 4.49%. CONCLUSIONS: This first estimate of hemophilia-related DALYs in the U.S. indicates that control of hemophilia can potentially result in a gain of 1 healthy year of life for every 2700 people in the population