Patient understanding and acceptability of an early lung cancer diagnosis trial: a qualitative study

Background The ELCID (Early Lung Cancer Investigation and Diagnosis) trial was a feasibility randomised controlled trial examining the effect on lung cancer diagnosis of lowering the threshold for referral for urgent chest x-ray for smokers and recent ex-smokers, aged over 60 years with new chest symptoms. The qualitative component aimed to explore the feasibility of individually randomising patients to an urgent chest x-ray or not and to investigate any barriers to patient recruitment and participation. We integrated this within the feasibility trial to inform the design of any future definitive trial, particularly in view of the lack of research exploring symptomatic patients’ experiences of participating in diagnostic trials for possible/suspected lung cancer. Although previous studies contributed valuable information concerning screening for lung cancer and patient participation in trials, this paper is the first to explore issues relating to this specific patient group. Methods Qualitative interviews were conducted with 21 patients, comprising 9 who had been randomised to receive an immediate chest x-ray, 10 who were randomised to receive the standard treatment according to the National Institute for Health and Care Excellence guidelines, and 2 who chose not to participate in the trial. Interviews were analysed using a framework approach. Results The findings of this analysis showed that altruism, personal benefit and the reassurance of not having lung cancer were important factors in patient participation. However, patients largely believed that being in the intervention arm was more beneficial, highlighting a lack of understanding of clinical equipoise. Disincentives to participation in the trial included the stigmatisation of patients who smoked (given the inclusion criteria). Although the majority of patients reported that they were happy with the trial design, there was evidence of poor understanding. Last, for several patients, placing trust in health professionals was preferred to understanding the trial processes. Conclusions The integration of a qualitative study focusing on participant experience as a secondary outcome of a feasibility trial enabled exploration of patient response to participation and recruitment. The study demonstrated that although it is feasible to recruit patients to the ELCID trial, more work needs to be done to ensure an understanding of study principles and also of smoking stigmatisation

Theorems on existence and global dynamics for the Einstein equations

This article is a guide to theorems on existence and global dynamics of solutions of the Einstein equations. It draws attention to open questions in the field. The local-in-time Cauchy problem, which is relatively well understood, is surveyed. Global results for solutions with various types of symmetry are discussed. A selection of results from Newtonian theory and special relativity that offer useful comparisons is presented. Treatments of global results in the case of small data and results on constructing spacetimes with prescribed singularity structure or late-time asymptotics are given. A conjectural picture of the asymptotic behaviour of general cosmological solutions of the Einstein equations is built up. Some miscellaneous topics connected with the main theme are collected in a separate section.Comment: Submitted to Living Reviews in Relativity, major update of Living Rev. Rel. 5 (2002)

Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial

Background: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation. Methods: We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer. Patients over 60, with a smoking history, presenting with new chest symptoms to primary care, were eligible to be randomised to intervention (urgent chest X-ray) or usual care. Results: The trial design and materials were acceptable to GPs and patients. We randomised 255 patients from 22 practices, although the proportion of eligible patients who participated was lower than expected. Survey responses (89%), and the fidelity of the intervention (82% patients X-rayed within 3 weeks) were good. There was slightly higher anxiety and depression in the control arm in participants aged >75. Three patients (1.2%) were diagnosed with lung cancer. Conclusions: We have demonstrated the feasibility of individually randomising patients at higher risk of lung cancer, to a trial offering urgent investigation or usual care

Multiplatform Analysis of 12 Cancer Types Reveals Molecular Classification within and across Tissues of Origin

Recent genomic analyses of pathologically-defined tumor types identify “within-a-tissue” disease subtypes. However, the extent to which genomic signatures are shared across tissues is still unclear. We performed an integrative analysis using five genome-wide platforms and one proteomic platform on 3,527 specimens from 12 cancer types, revealing a unified classification into 11 major subtypes. Five subtypes were nearly identical to their tissue-of-origin counterparts, but several distinct cancer types were found to converge into common subtypes. Lung squamous, head & neck, and a subset of bladder cancers coalesced into one subtype typified by TP53 alterations, TP63 amplifications, and high expression of immune and proliferation pathway genes. Of note, bladder cancers split into three pan-cancer subtypes. The multi-platform classification, while correlated with tissue-of-origin, provides independent information for predicting clinical outcomes. All datasets are available for data-mining from a unified resource to support further biological discoveries and insights into novel therapeutic strategies

Selection, Language Heritage, and the Earnings Trajectories of Black Immigrants in the United States

Research suggests that immigrants from the English-speaking Caribbean surpass the earnings of U.S.-born blacks approximately one decade after arriving in the United States. Using data from the 1980–2000 U.S. censuses and the 2005–2007 American Community Surveys on U.S.-born black and non-Hispanic white men as well as black immigrant men from all the major sending regions of the world, I evaluate whether selective migration and language heritage of immigrants’ birth countries account for the documented earnings crossover. I validate the earnings pattern of black immigrants documented in previous studies, but I also find that the earnings of most arrival cohorts of immigrants from the English-speaking Caribbean, after residing in the United States for more than 20 years, are projected to converge with or slightly overtake those of U.S.-born black internal migrants. The findings also show three arrival cohorts of black immigrants from English-speaking African countries are projected to surpass the earnings of U.S.-born black internal migrants. No arrival cohort of black immigrants is projected to surpass the earnings of U.S.-born non-Hispanic whites. Birth-region analysis shows that black immigrants from English-speaking countries experience more rapid earnings growth than immigrants from non-English-speaking countries. The arrival-cohort and birth-region variation in earnings documented in this study suggest that selective migration and language heritage of black immigrants’ birth countries are important determinants of their initial earnings and earnings trajectories in the United States

The Healthy Immigrant (Migrant) Effect: In Search of a Better Native-Born Comparison Group

This paper evaluates whether immigrants’ initial health advantage over their U.S.-born counterparts results primarily from characteristics correlated with their birth countries (e.g., immigrant culture) or from selective migration (e.g., unobserved characteristics such as motivation and ambition) by comparing recent immigrants’ health to that of recent U.S.-born interstate migrants (“U.S.-born movers”). Using data from the 1999–2013 waves of the March Current Population Survey, I find that, relative to U.S.-born adults (collectively), recent immigrants have a 6.1 percentage point lower probability of reporting their health as fair or poor. Changing the reference group to U.S.-born movers, however, reduces the recent immigrant health advantage by 28%. Similar reductions in the immigrant health advantage occurs in models estimated separately by either race/ethnicity or education level. Models that examine health differences between recent immigrants and U.S-born movers who both moved for a new job—a primary motivation behind moving for both immigrants and the U.S.-born—show that such immigrants have only a 1.9 percentage point lower probability of reporting their health as fair or poor. Together, the findings suggest that changing the reference group from U.S.-born adults collectively to U.S.-born movers reduces the identified immigrant health advantage, indicating that selective migration plays a significant role in explaining the initial health advantage of immigrants in the United States

Insights into the health and labor market experience of black immigrants in the United States : three essays on the labor market and health outcomes of black immigrants

textAbstract: Black immigrants are a demographically and socially important group in the United States. Between 1960 and 2005 the foreign-born share of the entire black population increased twenty-two fold. Furthermore, this group also accounted for more than 20% of the growth in the black population in the 2000s. In spite of the rapid growth of the black immigrant population, few studies have evaluated their health and labor market outcomes. The existing literature on black immigrants demonstrates that this group has health outcomes that are substantially different from those of other immigrant populations. Research illustrates that most black immigrants arrive in the United States with better health than black Americans and maintain this health advantage after more than two decades in the United States. This phenomenon is particularly pronounced among African immigrants. Research in this area also demonstrates that certain subgroups of black immigrants, such as West Indians, have superior labor market outcomes compared to black Americans. Because of the phenotypic similarities between these two groups, these findings have led some scholars and policymakers to question the salience of discrimination and racism in determining the labor market outcomes of black Americans. This dissertation expands the literature on the health and labor market outcomes of black immigrants by evaluating the salience of the major sociological theories, including immigrant versus native culture, bias of whites toward black immigrants over black Americans, and selective migration in explaining differences in labor market outcomes between black immigrants and black Americans. In an effort to better understand the unique health patterns among black immigrants, this dissertation also advances and tests a conceptual model that evaluates whether social, economic, and health conditions within the sending countries of black immigrants explain variations in health and disability among these immigrants. This dissertation uses data on males from the 1980-2000 U.S. Censuses and the 2001-2007 American Community Survey to estimate wage, employment, and self-employment models to determine if black immigrants have outcomes that resemble those of native blacks (collectively) or native black internal migrants. The results suggest that migration selectivity is important in explaining wage and employment differences between black immigrants and black natives. However, migration selectivity plays a limited role in explaining self-employment differences between black immigrants and black natives. This general finding is produced when black immigrants are evaluated collectively and when they are separated by both region and country of birth. This result suggests that differences that exist between black immigrants and black natives are the result of selective migration rather than culture. This work is the first to provide a comprehensive analysis of the importance of selective migration in explaining labor market differences between black Americans and black immigrants from all the major sending regions and countries of the world. This work also uses data on black immigrants from the 1996, 1998, 2000, 2002, 2004, 2006, and 2008 March Current Population Survey to evaluate the role that conditions in immigrants’ countries of origin play in explaining variation in health and disability among black immigrants in the United States. Estimates from reduced form health and disability models show that these outcomes are more favorable for immigrants who migrate from countries with high combined enrollment ratios, low income inequality, and high life expectancy. The results also demonstrate that country of origin conditions explain some portion of differences in health among immigrants.Sociolog

Changes in income inequality and the health of immigrants

Research suggests that income inequality is inversely associated with health. This association has been documented in studies that utilize variation in income inequality across countries or across time from a single country. The primary criticism of these approaches is their inability to account for potential confounders that are associated with income inequality. This paper uses variation in individual experiences of income inequality among immigrants within the United States (U.S.) to evaluate whether individuals who moved from countries with greater income inequality than the U.S. have better health than those who migrated from countries with less income in equality than the U.S. Utilizing individual-level (March Current Population Survey) and country-level data (the United Nations Human Development Reports), we show that among immigrants who have resided in the U.S. between 6 and 20 years, self-reported health is more favorable for the immigrants in the former category (i.e., greater income inequality) than those in the latter (i.e., lower income inequality). Results also show that self-reported health is better among immigrants from more developed countries and those who have more years of education, are male, and are married

Maternal educational attainment and infant mortality in the United States: Does the gradient vary by race/ethnicity and nativity?

BACKGROUND Maternal education-infant health gradients are flatter among foreign-born mothers than U.S.-born mothers; However, because common metrics of infant health are less predictive of infant mortality for some racial/ethnic and nativity groups, further study of maternal education-infant mortality gradients is necessary. OBJECTIVE We investigate whether maternal education–infant mortality gradients vary by race/ethnicity and nativity among infants born to mothers in the United States. METHODS We use data from the 1998‒2002 National Vital Statistics Birth Cohort Linked Birth/Infant Death Data published by the National Center for Health Statistics (N = 17,520,140) to estimate logistic regression models predicting infant, neonatal, and post neonatal mortality by race/ethnicity and nativity. RESULTS The negative associations between maternal education and infant mortality are stronger for US-born mothers than foreign-born mothers. Among both groups, non-Hispanic whites have the highest returns to education and Non-Hispanic blacks have the lowest returns. While foreign-born mothers are less likely to have an infant die than their native-born counterparts, this advantage is largest at the lowest levels of education and converges at the highest levels of education. For most racial/ethnic groups, the maternal education–infant mortality gradient is steeper during the postneonatal period than during the neonatal period

Intergenerational differences in smoking among West Indian, Haitian, Latin American, and African blacks in the United States

Due in large part to increased migration from Africa and the Caribbean, black immigrants and their descendants are drastically changing the contours of health disparities among blacks in the United States. While prior studies have examined health variation among black immigrants by region of birth, few have explored the degree of variation in health behaviors, particularly smoking patterns, among first- and second- generation black immigrants by ancestral heritage. Using data from the 1995–2011 waves of the Tobacco Use Supplements of the Current Population Survey (TUS-CPS), we examine variation in current smoking status among first-, second-,and third/higher- generation black immigrants. Specifically, we investigate these differences among all black immigrants and then provide separate analyses for individuals with ancestry from the English-speaking Caribbean (West Indies), Haiti, Latin America, and Africa—the primary sending regions of black immigrants to the United States. We also explore differences in smoking behavior by gender. The results show that, relative to third/higher generation blacks,first-generation black immigrants are less likely to report being current smokers. Within the first-generation, immigrants who migrated after age 13 have a lower probability of smoking relative to those who migrated at or under age 13. Disparities in smoking prevalence among the first-generation by age at migration are largest among black immigrants from Latin America. The results also suggest that second-generation immigrants with two foreign-born parents are generally less likely to smoke than the third/higher generation. We find no statistically significant difference in smoking between second-generation immigrants with mixed nativity parents and the third or higher generation. Among individuals with West Indian, Haitian, Latin American, and African ancestry, the probability of being a current smoker increases with each successive generation. The intergenerational increase in smoking, however, is slower among individuals with African ancestry. Finally, with few exceptions, our results suggest that intergenerational gaps in smoking behavior are larger among women compared to men. As additional sources of data for this population become available, researchers should investigate which ancestral subgroups are driving the favorable smoking patterns for the African origin population