Incidence By Area-Based Socioeconomic Indicators

Objective: To examine the relationship between area-based socioeconomic (SES) measures and incidence of all laboratory-confirmed influenza, laboratory-confirmed non-hospitalized influenza, influenza-associated hospitalizations, and influenza-associated deaths, in Connecticut. Methods: Laboratory-confirmed influenza cases in Connecticut from October 1, 2006 to April 30, 2012 were geocoded, and in accordance with the methods of Harvard\u27s Public Health Disparities Geocoding Project, linked to census tract measures of SES. Total and seasonal incidence rates were determined for each of the four influenza-associated health outcomes by SES measure. For each outcome, a relative rate ratio was calculated between the highest and the lowest percent quantile of each SES measure. For the poverty and crowding variables, this relative rate was then calculated by season for each of the four influenza outcomes, and compared to overall seasonal incidence. Results: When laboratory-confirmed influenza incidence is examined by measures of SES, there is a positive linear relationship between the four percent quantiles of each SES measure and incidence of each outcome. For all laboratory-confirmed influenza, within each season the quantiles of each SES measure are significantly linearly related to total incidence. However, it is not clear whether or not the change in poverty or crowding high versus low incidence rate ratios correlates with the seasonal fluctuations in overall incidence rates. Conclusions: Laboratory-confirmed influenza incidence varies by area-based SES. Continued evaluation of the relationship between influenza-associated health outcomes and census tract SES allows for public health interventions to more effectively target vulnerable populations. In addition, routine use of these methods may help elucidate previously unrecognized disparities in public health surveillance data

Designing a broad-spectrum integrative approach for cancer prevention and treatment.

Targeted therapies and the consequent adoption of "personalized" oncology have achieved notable successes in some cancers; however, significant problems remain with this approach. Many targeted therapies are highly toxic, costs are extremely high, and most patients experience relapse after a few disease-free months. Relapses arise from genetic heterogeneity in tumors, which harbor therapy-resistant immortalized cells that have adopted alternate and compensatory pathways (i.e., pathways that are not reliant upon the same mechanisms as those which have been targeted). To address these limitations, an international task force of 180 scientists was assembled to explore the concept of a low-toxicity "broad-spectrum" therapeutic approach that could simultaneously target many key pathways and mechanisms. Using cancer hallmark phenotypes and the tumor microenvironment to account for the various aspects of relevant cancer biology, interdisciplinary teams reviewed each hallmark area and nominated a wide range of high-priority targets (74 in total) that could be modified to improve patient outcomes. For these targets, corresponding low-toxicity therapeutic approaches were then suggested, many of which were phytochemicals. Proposed actions on each target and all of the approaches were further reviewed for known effects on other hallmark areas and the tumor microenvironment. Potential contrary or procarcinogenic effects were found for 3.9% of the relationships between targets and hallmarks, and mixed evidence of complementary and contrary relationships was found for 7.1%. Approximately 67% of the relationships revealed potentially complementary effects, and the remainder had no known relationship. Among the approaches, 1.1% had contrary, 2.8% had mixed and 62.1% had complementary relationships. These results suggest that a broad-spectrum approach should be feasible from a safety standpoint. This novel approach has potential to be relatively inexpensive, it should help us address stages and types of cancer that lack conventional treatment, and it may reduce relapse risks. A proposed agenda for future research is offered.Multiple funders. See acknowledgments within article for details.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.semcancer.2015.09.00