Early stage breast cancer and comorbidities: Their impact on breast cancer disease-free survival differences by ethnicity

The retrospective cohort study examined the association between the presence of comorbidities and breast cancer disease-free survival rates among racial/ethnic groups. The study population consisted of 2389 women with stage I and II invasive breast cancer who were diagnosed and treated at the M.D. Anderson Cancer Center between 1985 and 2000. It has been suggested that as the number of comorbidities increases, breast cancer mortality increases. It is known that African Americans and Hispanics are considered to be at a higher risk for comorbid conditions such as hypertension and diabetes compared to Caucasian women (23) (10). When compared to Caucasian women, African American women also have a higher breast cancer mortality rate (1). As a result, the study also examined whether comorbid conditions contribute to racial differences in breast cancer disease-free survival. Among the study population, 24% suffered from breast cancer recurrence, 6% died from breast cancer and 24% died from all causes. The mean age was 56 with 41% of the population being women between the ages of 40-55. One or more comorbidities were reported in 84 (36%) African Americans (OR 1.57; 95% CI 1.19-2.10), 58 (31%) Hispanics (OR 1.25; 95% CI 0.90-1.74) compared to the reference group of 531 (27%) Caucasians. Additionally, African American women were significantly more likely to suffer from either a breast cancer recurrence or breast cancer death (OR 1.5; 95% CI 0.70-1.41) when compared to Caucasian women. Multivariate analysis found hypertension (HR 1.22; 95% CI 0.99-1.49; p<0.05) to be statistically significant and a potential prognostic tool for disease-free survival with African American women (OR 2.96; 95% 2.25-3.90) more likely to suffer from hypertension when compared to Caucasian women. When compared to Caucasian women, Hispanics were also more likely to suffer from hypertension (OR 1.33; 95% CI 0.96-1.83). This suggests that comorbid conditions like hypertension could account for the racial disparities that exist when comparing breast cancer survival rates. Future studies should investigate this relationship further.^

Gender differences in colorectal cancer screening and incidence in large nationwide, population-based cohorts

Background. A few studies have reported gender differences along the colorectal cancer (CRC) continuum but none has done so longitudinally to compare a cancer and a non-cancer populations.^ Objectives and Methods. To examine gender differences in colorectal cancer screening (CRCS); to examine trends in gender differences in CRC screening among two groups of patients (Medicare beneficiaries with and without cancer); to examine gender differences in CRC incidence; and to examine for any differences over time. In Paper 1, the study population consisted of men and women, ages 67–89 years, with CRC (73,666) or without any cancer (39,006), residing in 12 U.S. Surveillance Epidemiology and End-Results (SEER) regions. Crude and age-adjusted percentages and odds ratios of receiving fecal occult blood test (FOBT), sigmoidoscopy (SIG), or colonoscopy (COL) were calculated. Multivariable logistic regression was used to assess gender on the odds of receiving CRC screening over time.^ In Paper 2, age-adjusted incidence rates and proportions over time were reported across race, CRC subsite, CRC stage and SEER region for 373,956 patients, ages 40+ years, residing in 9 SEER regions and diagnosed with malignant CRC. ^ Results. Overall, women had higher CRC screening rates than men and screening rates in general were higher in the SEER sample of persons with CRC diagnosis. Significant temporal divergence in FOBT screening was observed between men and women in both cohorts. Although the largest temporal increases in screening rates were found for COL, especially among the cohort with CRC, little change in the gender gap was observed over time. Receipt of FOBT was significantly associated with female gender especially in the period of full Medicare coverage. Receipt of COL was also significantly associated with male gender, especially in the period of limited Medicare coverage.^ Overall, approximately equal numbers of men (187,973) and women (185,983) were diagnosed with malignant CRC. Men had significantly higher age-adjusted CRC incidence rates than women across all categories of age, race, subsite, stage and SEER region even though rates declined in all categories over time. Significant moderate increases in rate difference occurred among 40-59 year olds; significant reductions occurred among patients age 70+, within subsite rectum, unstaged and distant stage CRC, and eastern and western SEER regions. ^ Conclusions. Persistent gender differences in CRC incidence across time may have implications for gender-based interventions that take age into consideration. A shift toward proximal cancer was observed over time for both genders, but the high proportion of men who develop rectal cancer suggests that a greater proportion of men may need to be targeted with newer screening methods such as fecal DNA or COL. Although previous reports have documented higher CRC screening among men, higher incidence of CRC observed among men suggests that higher risk categories of men are probably not being reached. FOBT utilization rates among women have increased over time and the gender gap has widened between 1998 and 2005. COL utilization is associated with male gender but the differences over time are small.^

Gender differences in life circumstances, monthly income, risky sexual and drug behaviors among injection drug users in Dar es Salaam, Tanzania

This study investigated the gender difference between male and female injection drug users’ (IDUs) life circumstances, income and risky sexual and drug behaviors. The study sample comprised of 318 male and 249 female injection drug users in Dar es Salaam, Tanzania. There were gender differences between male and female IDUs in terms of life circumstances and sexual behaviors. There were no differences in the drug behaviors among the two sexes. Women were more likely to be 21-25 years of age, have had more sexual partners in the last 30 days, traded sex for money, and have been sexually abused as a child. On the other hand, the males were more likely to be 26-30 years of age and have never used a condom during sex in the last 30 days. Regardless of the differences in sexual risk behaviors by gender, both male and female injection drug users in Dar es Salaam are at risk of HIV/AIDS, blood borne and other sexually transmitted diseases associated with drug use.^

Gender differences in tuberculosis notification in Pakistan

Worldwide the male:female ratio of new smear-positive TB cases is estimated to be roughly 2:1. However in Pakistan this is not the case. Rates of notified TB cases are 20–30% higher in young females compared with males and female rates remain high regardless of increasing age. This is in stark contrast to neighboring India which is characterized by a huge excess of male TB cases. It is currently unknown why rates of notified TB are so high in females in Pakistan, but it is clear this epidemiology is a public health issue of great importance that impacts transmission dynamics and disease control initiatives.^

Differences in performance for quality of care indicators for acute myocardial infarction (AMI) across various hospital categories in Texas

The study analyzed Hospital Compare data for Medicare Fee-for-service patients at least 65 years of age to determine whether hospital performance for AMI outcome and processes of care measures differ amongst Texas hospitals with respect to ownership status (for profit vs. not-for-profit), academic status (teaching vs. non-teaching) and geographical setting (rural vs. urban). ^ The study found a statistically significant difference between for-profit and not-for-profit hospitals in four process-of-care measures (aspirin at discharge, P=0.028; ACE or ARB inhibitor for LSVD, P=0.048; Smoking cessation advice: P=0.034; outpatients who got aspirin with 24 hours of arrival in the ED, P=0.044). No significant difference in performance was found between COTH-member teaching and non-teaching hospitals for any of the eight process-of-care measures or the two outcome measures for AMI. The study was unable to compare performance based on geographic setting of hospitals due to lack of sufficient data for rural hospitals. ^ The results of the study suggest that for-profit Texas hospitals might be slightly better than not-for –profit hospitals at providing possible heart attack patients with certain processes of care.^

Age -period -cohort analysis: An extension of Cox's lifetable regression with time -dependent covariates

It is well known that an identification problem exists in the analysis of age-period-cohort data because of the relationship among the three factors (date of birth + age at death = date of death). There are numerous suggestions about how to analyze the data. No one solution has been satisfactory. The purpose of this study is to provide another analytic method by extending the Cox's lifetable regression model with time-dependent covariates. The new approach contains the following features: (1) It is based on the conditional maximum likelihood procedure using a proportional hazard function described by Cox (1972), treating the age factor as the underlying hazard to estimate the parameters for the cohort and period factors. (2) The model is flexible so that both the cohort and period factors can be treated as dummy or continuous variables, and the parameter estimations can be obtained for numerous combinations of variables as in a regression analysis. (3) The model is applicable even when the time period is unequally spaced.^ Two specific models are considered to illustrate the new approach and applied to the U.S. prostate cancer data. We find that there are significant differences between all cohorts and there is a significant period effect for both whites and nonwhites. The underlying hazard increases exponentially with age indicating that old people have much higher risk than young people. A log transformation of relative risk shows that the prostate cancer risk declined in recent cohorts for both models. However, prostate cancer risk declined 5 cohorts (25 years) earlier for whites than for nonwhites under the period factor model (0 0 0 1 1 1 1). These latter results are similar to the previous study by Holford (1983).^ The new approach offers a general method to analyze the age-period-cohort data without using any arbitrary constraint in the model. ^

Age determination and n-Alkane concentration of Arctic Ocean sediment cores

We have reconstructed the surface water environment of the Arctic Ocean over the last ? 50,000 years using measurements of the organic nitrogen and carbon isotope ratios, carbonate and total organic carbon concentrations (TOC), and terrestrial biomarkers (lignin and long-chain n-alkanes) in four multicores. Variations in nitrogen isotope ratios that are concordant with TOC and carbonate concentrations (representing foraminifera and excluding ice-rafted-debris) reflect differences in relative nutrient utilization of phytoplankton in the surface waters. However, d15N variations also appear to be dependent on the stratification of the water column and therefore potentially track the exchange of nutrients between deep and surface waters. Low Last Glacial Maximum (LGM) d15N values and higher Holocene values are opposite to those recorded in the Southern Ocean. The Arctic Ocean with higher nutrient utilization today compared to the LGM therefore acts as a counterpart to the Southern Ocean, although the global impact on carbon dioxide variations compared to the Southern Ocean is probably low.

(Table 2) Actual and synthetic mass accumulation rate data and their absolute differences for ODP Site 115-707

Synthetic mass accumulation rates have been calculated for ODP Site 707 using depth-density and depth-porosity functions to estimate values for these parameters with increasing sediment thickness, at 1 Ma time intervals determined on the basis of published microfossil datums. These datums were the basis of the age model used by Peterson and Backman (1990, doi:10.2973/odp.proc.sr.115.163.1990) to calculate actual mass accumulation rate data using density and porosity measurements. A comparison is made between the synthetic and actual mass accumulation rate values for the time interval 37 Ma to the Recent for 1 Myr time intervals. There is a correlation coefficient of 0.993 between the two data sets, with an absolute difference generally less than 0.1 g/cm**2/kyr. We have used the method to extend the mass accumulation rate analysis back to the Late Paleocene (60 Ma) for Site 707. Providing age datums (e.g. fossil or magnetic anomaly data) are available the generation of synthetic mass accumulation rates can be calculated for any sediment sequence.

Should differences be included? On a wrongly framed problem and an unbearable reality

Este texto se plantea una relectura ética acerca del derecho a la educación de las personas con discapacidades, con un énfasis prioritario de la situación en América Latina. A partir de considerar los sistemas jurídicos, los modos de financiamiento políticos, los porcentajes de inclusión y los programas de seguimiento de la población con discapacidad en edad escolar, se deriva toda una serie de discusiones sobre la idea de formación educativa, el estar junto a otros y las responsabilidades éticas en la tarea de educar.

Should differences be included? On a wrongly framed problem and an unbearable reality

Este texto se plantea una relectura ética acerca del derecho a la educación de las personas con discapacidades, con un énfasis prioritario de la situación en América Latina. A partir de considerar los sistemas jurídicos, los modos de financiamiento políticos, los porcentajes de inclusión y los programas de seguimiento de la población con discapacidad en edad escolar, se deriva toda una serie de discusiones sobre la idea de formación educativa, el estar junto a otros y las responsabilidades éticas en la tarea de educar.

Should differences be included? On a wrongly framed problem and an unbearable reality

Este texto se plantea una relectura ética acerca del derecho a la educación de las personas con discapacidades, con un énfasis prioritario de la situación en América Latina. A partir de considerar los sistemas jurídicos, los modos de financiamiento políticos, los porcentajes de inclusión y los programas de seguimiento de la población con discapacidad en edad escolar, se deriva toda una serie de discusiones sobre la idea de formación educativa, el estar junto a otros y las responsabilidades éticas en la tarea de educar.

Radiocarbon age of bottom sediments from the Atlantic and Pacific Oceans

Procedures for radiocarbon dating of ocean sediments on board the ship using the benzene variant of the method are described. The main features of the benzene synthesis scheme, together with its differences from the method usually used onshore laboratories, are discussed briefly. Parameters of radiometric installation, in which activity of synthesized benzenes is determined are cited. The method was used successfully during Cruise 14 of R/V Dmitry Mendeleev (45 datings) and Cruise 24 of R/V Akademik Kurchatov (81 datings).

Age and strontium isotope composition for Cretaceous in DSDP Hole 74-525

Firm stratigraphic correlations are needed to evaluate the global significance of unconformity bounded units (sequences). We correlate the well-developed uppermost Campanian and Maestrichtian sequences of the New Jersey Coastal Plain to the geomagnetic polarity time scale (GPTS) by integrating Sr-isotopic stratigraphy and biostratigraphy. To do this, we developed a Maestrichtian (ca. 73-65 Ma) Sr-isotopic reference section at Deep Sea Drilling Project Hole 525A in the southeastern Atlantic Ocean. Maestrichtian strata can then be dated by measuring their 87Sr/86Sr composition, calibrating to the GPTS of S. C. Cande and D. V. Kent (1993, personal commun.), and using the equation Age (Ma) = 37326.894-52639.89 (87Sr/86Sr). Sr-stratigraphic resolution for the Maestrichtian is estimated as +-1.2 to +-2 m.y. At least two unconformity-bounded units comprise the uppermost Campanian to Maestrichtian strata in New Jersey. The lower one, the Marshalltown sequence, is assigned to calcareous nannofossil Zones CC20/21 (~NC19) and CC22b (~NC20). It ranges in age from ~74.1 to 69.9 Ma based on Sr-isotope age estimates. The overlying Navesink sequence is assigned to calcareous nannoplankton Zones CC25-26 (~NC21-23); it ranges in age from 69.3 to 65 Ma based on Sr-isotope age estimates. The upper part of this sequence, the Tinton Formation, has no calcareous planktonic control; Sr-isotopes provide an age estimate of 66 +- 1.2 Ma (latest Maestrichtian). Sequence boundaries at the base and the top of the Marshalltown sequence match boundaries elsewhere in the Atlantic Coastal Plain (Owens and Gohn, 1985) and the inferred global sea-level record of Haq et al. (1987); they support eustatic changes as the mechanism controlling depositional history of this sequence. However, the latest Maestrichtian record in New Jersey does not agree with Haq et al. (1987); we attribute this to correlation and time-scale differences near the Cretaceous/Paleogene boundary. High sedimentation rates in the latest Maestrichtian of New Jersey (Shrewsbury Member of the Red Bank Formation and the Tinton Formation) suggest tectonic uplift and/or rapid progradation during deposition of the highstand systems tract.

Age determination and radiometric dates of cores from Okarito Pakihi in Australia

In agreement with the Milankovitch orbital forcing hypothesis (Imbrie et al., 1993) it is often assumed that glacial-interglacial climate transitions occurred synchronously in the Northern and Southern hemispheres of the Earth. It is difficult to test this assumption, because of the paucity of long, continuous climate records from the Southern Hemisphere that have not been dated by tuning them to the presumed Northern Hemisphere signals (Lynch-Stieglitz, 2004). Here we present an independently dated terrestrial pollen record from a peat bog on South Island, New Zealand, to investigate global and local factors in Southern Hemisphere climate changes during the last two glacial-interglacial cycles. Our record largely corroborates the Milankovitch model of orbital forcing but also exhibits some differences: in particular, an earlier onset and longer duration of the Last Glacial Maximum. Our results suggest that Southern Hemisphere insolation may have been responsible for these differences in timing. Our findings question the validity of applying orbital tuning to Southern Hemisphere records and suggest an alternative mechanism to the bipolar seesaw for generating interhemispheric asynchrony in climate change.

Age determination and sea surface temperature reconstruction from marine and lake records, Iberian Peninsula

Selected multi-proxy and accurately dated marine and terrestrial records covering the past 2000 years in the Iberian Peninsula (IP) facilitated a comprehensive regional paleoclimate reconstruction for the Medieval Climate Anomaly (MCA: 900-1300 AD). The sequences enabled an integrated approach to land-sea comparisons and, despite local differences and some minor chronological inconsistencies, presented clear evidence that the MCA was a dry period in the Mediterranean IP. It was a period characterized by decreased lake levels, more xerophytic and heliophytic vegetation, a low frequency of floods, major Saharan eolian fluxes, and less fluvial input to marine basins. In contrast, reconstruction based on sequences from the Atlantic Ocean side of the peninsula indicated increased humidity. The data highlight the unique characteristics of the MCA relative to earlier (the Dark Ages, DA: ca. 500-900 years AD) and subsequent (the Little Ice Age, LIA: 1300-1850 years AD) colder periods. The reconstruction supports the hypothesis of Trouet et al. (2009, doi:10.1126/science.1166349), that a persistent positive mode of the North Atlantic Oscillation (NAO) dominated the MCA.