Outcomes of sarcomatoid carcinoma of the lung

http://www.ncbi.nlm.nih.gov/pubmed/22739072

Surgery. 2012 Jun 26. [Epub ahead of print]

Outcomes of sarcomatoid carcinoma of the lung: A Surveillance, Epidemiology, and End Results database analysis.

Yendamuri S, Caty L, Pine M, Adem S, Bogner P, Miller A, Demmy TL, Groman A, Reid M.

Source

Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY.

Abstract

BACKGROUND:

Sarcomatoid lung carcinomas are unusual, and reports from small single institution case series suggest poor survival rates. We sought to study the clinical characteristics of this form of non-small cell lung cancer using the Surveillance Epidemiology, End Results database.

METHODS:

The Surveillance, Epidemiology, and End Results database was queried for respiratory tract malignancies of sarcomatoid histology. The demographic information and oncologic characteristics of this population were examined. A propensity score-matched analysis of patients was performed to test the hypothesis that patients with sarcomatoid cancers undergoing lobectomies perform worse that those with other non-small celllung cancers.

RESULTS:

Of 878,810 patients with lung cancer, only 3,647 patients had a diagnosis of sarcomatoid cancer (0.4%). For the additional analyses of outcomes, only patients with lifetime incidence of a single cancer, known Surveillance, Epidemiology, and End Results historic stage and inpatient reporting were selected (n = 1,921). Demographics, tumor characteristics, and outcomes of these patients were described. Non-small cell lung cancer cohorts (with and without sarcomatoid cancer propensity-matched on age, gender, race, year of diagnosis, grade, and Surveillance, Epidemiology, and End Results historic stage) that underwent lobectomies or pneumonectomies were selected (n = 758). Univariate (hazard ratio, 1.60; 95% confidence interval, 1.31-1.97) and multivariate analysis (hazard ratio, 1.67; 95% confidence interval, 1.36-2.05) revealed a significantly worse overall survival for patients with sarcomatoid cancer compared to matched nonsarcomatoid lung cancer controls.

CONCLUSION:

Sarcomatoid cancer is a rare form of lung malignancy with outcomes significantly worse than other forms of non-small cell lung cancer. Novel multimodality treatment strategies are necessary to improve outcomes of this disease.

From U New South Wales: Distressed Partners and Caregivers Do Not Recover Easily: Adjustment Trajectories Among Partners and Caregivers of Cancer Survivors

http://www.ncbi.nlm.nih.gov/pubmed/22740365

Ann Behav Med. 2012 Jun 28. [Epub ahead of print]

Distressed Partners and Caregivers Do Not Recover Easily: Adjustment Trajectories Among Partners and Caregivers of Cancer Survivors.

Lambert SD, Jones BL, Girgis A, Lecathelinais C.

Source

Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia, sylvie.d.lambert@gmail.com.

Abstract

BACKGROUND:

Although a number of cross-sectional studies document the distress experienced by partners and caregivers of cancer survivors, few have considered their potential differential patterns of adjustment over time.

PURPOSE:

Identify distinct trajectories of anxiety and depression among partners and caregivers of cancer survivors and predictors of these trajectories.

METHODS:

Participants completed a survey to examine the impact of caring for, or living with, a cancer survivor at 6, 12, and 24 months post-survivor diagnosis. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (N (anxiety) = 510; N (depression) = 511).

RESULTS:

Anxiety trajectories included: no anxiety (15.1% scored <3; 37.8% scored 3-5); chronic, borderline anxiety (33.2%); and chronic, clinicalanxiety (13.9%). The depression trajectories were: no depression (38.9% scored <2; 31.5% scored around 3); a sustained score of 7 (25.5%); and chronic, clinical depression (4.1%). Variables associated with the trajectories included most of the psychosocial variables.

CONCLUSIONS:

Findings highlight that most caregivers maintained their baseline level of distress, which is particularly concerning for participants reporting chronic anxiety or depression.

From Zurich U: Hedgehog Signaling in Pleural Mesothelioma

http://www.ncbi.nlm.nih.gov/pubmed/22733539

Clin Cancer Res. 2012 Jun 25. [Epub ahead of print]

ROLE OF HEDGEHOG SIGNALING IN MALIGNANT PLEURAL MESOTHELIOMA.

Shi Y, Moura U, Opitz I, Soltzermann A, Rehrauer H, Thies S, Weder W, Stahel RA, Felley-Bosco E.

Source

Laboratory of Molecular Oncology, Zürich University Hospital.

Abstract

PURPOSE:

The aim of this study was to assess the activity of hedgehog (HH) signaling pathway in malignant pleural mesothelioma (MPM).

EXPERIMENTAL DESIGN:

The expression of HH signaling components was assessed by q-PCR and in situ hybridization in 45 clinical samples. Primary MPM cultures were developed in serum-free condition in 3% oxygen and were used to investigate the effects of Smoothened (SMO) inhibitors or GLI1 silencing on cell growth and HH signaling. In vivo effects of SMO antagonists were determined in a MPM xenograft growing in nude mice.

RESULTS:

A significant increase in GLI1, sonic hedgehog, and human hedgehog interacting protein gene expression was observed in MPM tumors compared to non tumoral pleural tissue. SMO antagonists inhibited GLI1 expression and cell growth in sensitive primary cultures. This effect was mimicked by GLI1 silencing. Reduced survivin and YAP protein levels were also observed. Survivin protein levels were rescued by overexpression of GLI1 or constitutively active YAP1. Treatment of tumor-bearing mice with the SMO inhibitor HhAntag led to a significant inhibition of tumor growth in vivo accompanied by decreased Ki-67 and nuclear YAP immunostaining and a significant difference in selected gene expression profile in tumors.

CONCLUSIONS:

An aberrant HH signaling is present in MPM and inhibition of HH signaling decreases tumor growth indicating potential new therapeutic approach.

From BJ Wadia Hospital for Children-Mumbai: Clinical Profile of Drug Resistant Tuberculosis in Children

http://www.ncbi.nlm.nih.gov/pubmed/22728624

Indian Pediatr. 2011 Jun 10. pii: S097475591101060-2. [Epub ahead of print]

Clinical Profile of Drug Resistant Tuberculosis in Children.

Shah I, Chilkar S.

Abstract

This Cross-sectional observational study was conducted at Pediatric Tuberculosis Clinic, BJ Wadia Hospital for Children, Mumbai from July 2007- August 2010 to determine the clinical profile of Drug resistant tuberculosis in children. All children with active or latent TB with culture and drug susceptibility test proven drug resistant TB or in contact with a patient who had drug resistant TB were enrolled in the study. Patients were classified as monoresistant TB, polyresistant TB, multidrug resistant (MDR)-TB and extensively drug resistant (XDR) - TB as per the World Health Organization (WHO) definition and contact with DR-TB. We coined a term called as Partial XDR-TB when isolates of Mycobacterium TB were confirmed to beresistant in vitro to be MDR along with either a fluoroquinolone or an aminoglycoside resistance (apart from streptomycin). Clinical and biochemical features associated with drug resistance TB were analysed. Of 500 children analysed, 34 (6.8%) had drug resistant TB. Mean age of presentation was 6.8±3.2 years (Male: Female ratio 13:21). Eighteen (52.9%) children had been treated for tuberculosis in the past (1 defaulted), seven patients had been in contact with an adult suffering from drug resistant TB and 3 patients (10.3%) were HIV co-infected. Fourteen children (41.2 %) had MDR TB,11 (32.4%) had Partial XDR, 1 each (2.9%) had Polyresistant TB and XDR TB. Clinical features of DRTB are similar in all age groups. Past history of TB with treatment with antitubercular agents, and contact with adults suffering with drug resistant (DR-TB) are important risk factors in development of drug-resistant -TB in children.

From Aston U-UK: Video games and higher education: what can "call of duty" teach our students?

http://www.ncbi.nlm.nih.gov/pubmed/22737142

Front Psychol. 2012;3:210. Epub 2012 Jun 25.

Video games and higher education: what can "call of duty" teach our students?

Tannahill N, Tissington P, Senior C.

Source

Aston Business School, Aston University Birmingham, UK.

Good article; unfortunately, no abstract.

Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London

http://www.ncbi.nlm.nih.gov/pubmed/22738286

Eur J Cancer Care (Engl). 2012 Jun 28. doi: 10.1111/j.1365-2354.2012.01373.x. [Epub ahead of print]

Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London, UK.

Nimako K, Gunapala R, Popat S, O'Brien ME.

Source

The Royal Marsden Hospital, NHS Foundation Trust, Sutton, Surrey, UK The Royal Marsden Hospital, NHS Foundation Trust, Sutton, Surrey, and Molecular Genetics and Genomics Group, Imperial College London, London.

Abstract

Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London, UK International and UK data suggest that there are ethnic differences in survival for some malignancies. The aim of the present study was to identify any health inequalities related to lung cancer and ethnicity. Data on 423 patients with a diagnosis of lung cancer treated at a large specialist cancer hospital in London UK were analysed. Data on stage of disease at diagnosis, co-morbidities, socio-economic status, treatments received and survival were collected and examined for differences by ethnic group. There was a significant difference between black and minority ethnic (BME) patients and White-European patients in socio-economic status (Chi-square test P-value < 0.001). BME patients were over-represented in the most deprived socio-economic groups and under-represented in the most affluent. There were no significant differences in histology, stage of disease, co-morbidities and performance status or treatments received between the different ethnic groups. Ethnicity was not associated with survival. Significant prognostic factors for overall survival were performance status (P < 0.001), stage of disease (P= 0.001) and gender (P= 0.003). Our findings suggest that patients from BME groups are over-represented in more deprived socio-economic groups; however, this did not impact on significant prognostic factors or the treatments that they received. Importantly ethnicity did not influence survival.

From U London: A paradigm for the study of paranoia in the general population: The Prisoner's Dilemma Game

http://www.ncbi.nlm.nih.gov/pubmed/22731988d

Cogn Emot. 2012 Jun 26. [Epub ahead of print]

A paradigm for the study of paranoia in the general population: The Prisoner's Dilemma Game.

Ellett L, Allen-Crooks R, Stevens A, Wildschut T, Chadwick P.

Source

a Department of Psychology, Royal Holloway , University of London , London , UK.

Abstract

A growing body of research shows that paranoia is common in the general population. We report three studies that examined the Prisoner's Dilemma Game (PDG) as a paradigm for evaluation of non-clinical paranoia. The PDG captures three key qualities that are at the heart of paranoia-it is interpersonal, it concerns threat, and it concerns the perception of others' intentions towards the self. Study 1 (n=175) found that state paranoia was positively associated with selection of the competitive PDG choice. Study 2 (n=111) found that this association was significant only when participants believed they were playing the PDG against another person, and not when playing against a computer. This finding underscores the interpersonal nature of paranoia and the concomitant necessity of studying paranoia in interpersonal context. In Study 3 (n=152), we assessed both trait and state paranoia, and differentiated between distrust- and greed-based competition. Both trait and state paranoia were positively associated with distrust-based competition (but not with greed-based competition). Crucially, we found that the association between trait paranoia and distrust-based competition was fully mediated by state paranoia. The PDG is a promising paradigm for the study of non-clinical paranoia.

http://www.ncbi.nlm.nih.gov/pubmed/22738086

Health Expect. 2012 Jun 28. doi: 10.1111/j.1369-7625.2012.00790.x. [Epub ahead of print]

Evidence-based disparities: examining the gap between health expectations and experiences.

Vashdi DR, Zalmanovitch Y.

Source

Lecturer Senior Lecturer, Division of Public Administration and Policy, School of political Sciences, University of Haifa, Haifa, Israel.

Abstract

Context  

In a time of economic austerity, one of the most daunting questions is who decides on healthcare rationing? In the current study, we sought to examine if the public can in fact provide meaningful information regarding healthcare policy issues. Based on theories of public policy, this paper tries to find out if patients behave akin to 'responsible citizens' and can provide differentiated expectations between three healthcare dimensions. 

Methods  

One thousand two-hundred eleven individuals participated in a telephone interview. Participants were asked two series of questions, one regarding their views on the primary care, prevention and promotion practices they experience with their healthcare provider and one regarding the importance of these practices to them. We calculated a difference score representing the gap in each healthcare dimension. 

Findings  

In all three healthcare dimensions, the mean gap is in the positive side of the axis indicating that the public does not receive what it expects to receive, or in policy terms there is 'a responsiveness deficit'. The mean gap in relation to primary care is significantly lower than the mean gap in both preventive care and health promotion. 

Conclusions  

The public can provide meaningful information even in areas of endless demand and can provide an addition point of view to be considered by policy makers in complicated healthcare rationing decisions.

"The upshot is that Congress cannot use the Commerce Clause to force you to eat broccoli, but it can tax you into doing so. Huzzah for liberty!"

http://townhall.com/columnists/jonahgoldberg/2012/06/29/roberts_ruling_took_guts

Roberts' Ruling Took Guts

Jonah Goldberg

"The upshot is that Congress cannot use the Commerce Clause to force you to eat broccoli, but it can tax you into doing so. Huzzah for liberty!"

(HT: LR)

Todd Henderson, U Chicago Law School Professor: Executive perks serve a useful function (HT:GB)

http://www.forbes.com/sites/danielfisher/2012/06/27/the-most-outrageous-executive-perks/

The Most Outrageous Executive Perks

"These perks may annoy investors and envious employees who don’t share in them, but they serve a useful purpose, says M. Todd Henderson, a professor at the University of Chicago Law School. Henderson penned an article that compared perks to “corporate heroin,” meaning they leave executives tied to the company and less likely to steal or slack off.  Henderson’s theory is that executives who amass enough savings to be independently wealthy are more likely to be disloyal to their employer. So perks like forgivable loans or free housing are better than cash since the company can take them away with little risk of being forced to give them back.

“If you pay him the cash, that cash is gone,” Henderson  says. “If you get him used to a lifestyle of largesse, he’s addicted and will have to continue to perform to get it.”"

http://www.ncbi.nlm.nih.gov/pubmed/22736421

Int J Epidemiol. 2012 Jun 25. [Epub ahead of print]

Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study.

Sacerdote C, Ricceri F, Rolandsson O, Baldi I, Chirlaque MD, Feskens E, Bendinelli B, Ardanaz E, Arriola L, Balkau B, Bergmann M, Beulens JW, Boeing H,Clavel-Chapelon F, Crowe F, de Lauzon-Guillain B, Forouhi N, Franks PW, Gallo V, Gonzalez C, Halkjær J, Illner AK, Kaaks R, Key T, Khaw KT, Navarro C,Nilsson PM, Dal Ton SO, Overvad K, Pala V, Palli D, Panico S, Polidoro S, Quirós JR, Romieu I, Sánchez MJ, Slimani N, Sluijs I, Spijkerman A, Teucher B,Tjønneland A, Tumino R, van der A D, Vergnaud AC, Wennberg P, Sharp S, Langenberg C, Riboli E, Vineis P, Wareham N.

Source

Center for Cancer Prevention (CPO-Piemonte), Torino, Italy, Human Genetics Foundation (HuGeF), Torino, Italy, Department of Public Health and Clinical Medicine, Umea University, Sweden, Department of Environmental Medicine and Public Health, University of Padova, Italy, Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Spain, Murcia Regional Health Authority, Murcia, Spain, Division of Human Nutrition, Section of Nutrition and Epidemiology, University of Wageningen, The Netherlands, Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy, Navarre Public Health Institute, Pamplona, Spain, Public Health Department of Gipuzkoa, Basque Government, San Sebastián, Spain, Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), France, Paris-South University, Villejuif Cedex, France, Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands, Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, UK, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK, Lund University Diabetes Center, Malmö, Sweden, Department of Public Health and Clinical Medicine, Umea University, Sweden, Harvard School of Public Health, Boston, MA, USA, School of Public Health, Imperial College London, London, UK, Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, UK, Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Barcelona, Spain, Danish Cancer Society Research Center, Copenhagen, Denmark, Department of Epidemiology, German Institute of Human Nutrition, Bergholz-Rehbrücke, Germany, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany, Department of Clinical Gerontology, Addenbrooke's Hospital, Cambridge, UK, Unit of Preventive Medicine and Public Health School of Medicine, Murcia, Spain, Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark, Department of Epidemiology, School of Public Health, Aarhus University, Aaarhus, Denmark, Nutritional Epidemiology Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy, Asturias Health & Health Care Council, Oviedo, Spain, Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France, Andalusian School of Public Health, Granada, Spain, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands, Cancer Registry and Histopathology Unit, Civile M.P. Arezzo Hospital, Ragusa, Italy, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK, Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK and MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.

Abstract

BACKGROUND:

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. In high-income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship.Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed.

RESULTS:

Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women).

CONCLUSION:

This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.

http://www.ncbi.nlm.nih.gov/pubmed/22725728

Alcohol Clin Exp Res. 2012 Jun 22. doi: 10.1111/j.1530-0277.2012.01862.x. [Epub ahead of print]

Drinking History Associations with Regional White Matter Volumes in Alcoholic Men and Women.

Ruiz SM, Oscar-Berman M, Sawyer KS, Valmas MM, Urban T, Harris GJ.

Source

Graduate Program in Neuroscience, Boston University, Boston, Massachusetts; Psychology Research Service, VA Healthcare System, Boston, Massachusetts.

Abstract

BACKGROUND:

Alcoholism has been repeatedly associated with gray and white matter pathology. Although neuroimaging has shown alcoholism-related brain volume reductions and axonal compromise, the integrity of white matter volumes in chronic alcoholism has been challenging to measure on a regional level.

METHODS:

We first examined the effects of alcoholism on cerebral white matter volumes by lobar and gyral subdivisions in 42 abstinent alcoholics and 42 control participants (split evenly by gender). We also examined cerebellar white matter and regions of the corpus callosum, as well as ventricular volumes. Next, relationships between white matter and ventricular volumes with measures of drinking patterns were assessed. Finally, an examination of early versus late abstinence was conducted. Within each examination, gender effects were explored.

RESULTS:

Differences in regional white matter volumes between alcoholics and controls were observed primarily in the corpus callosum, with a stronger group difference among men than women. Years of heavy drinking had a strong negative impact on frontal and temporal white matter among alcoholic women, and on the corpus callosum among alcoholic men. Quantity of alcohol consumption was associated with smaller corpus callosum and larger ventricular volumes among alcoholic women, whereas abstinence duration was associated with larger corpus callosum volume among alcoholic men. Preliminary data indicated that alcoholic women showed stronger positive associations between sobriety duration and white matter volume than men within the first year of abstinence, whereas men showed this association more so than women after 1 year of abstinence.

CONCLUSIONS:

Effects of drinking history on white matter and ventricular volumes vary by gender, with alcoholic women showing greatest sensitivity in frontal, temporal, ventricular, and corpus callosum regions, and alcoholic men showing effects mainly in the corpus callosum. Preliminary results indicate that recovery of white matter volume may occur sooner for women than for men.

Body composition and military performance-many things to many people (or relaxing military standards?)

http://www.ncbi.nlm.nih.gov/pubmed/22643136

J Strength Cond Res. 2012 Jul;26 Suppl 2:S87-S100.

Body composition and military performance-many things to many people.

Friedl KE.

Source

Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland.

Abstract

Soldiers are expected to maintain the highest possible level of physical readiness because they must be ready to mobilize and perform their duties anywhere in the world at any time. The objective of Army body composition standards is to motivate physical training and good nutrition habits to ensure a high state of readiness. Establishment of enforceable and rational standards to support this objective has been challenging even at extremes of body size. Morbidly obese individuals are clearly not suited to military service, but very large muscular individuals may be superbly qualified for soldier performance demands. For this reason, large individuals are measured for body fat using a waist circumference-based equation (female soldiers are also measured for hip circumference). The main challenge comes in setting appropriate fat standards to support the full range of Army requirements. Military appearance ideals dictate the most stringent body fat standards, whereas health risk thresholds anchor the most liberalstandards, and physical performance associations fall on a spectrum between these 2 poles. Standards should not exclude or penalize specialized performance capabilities such as endurance running or power lifting across a spectrum of body sizes and fat. The full integration of women into the military further complicates the issue because of sexually dimorphic characteristics that make gender-appropriate standards essential and where inappropriately stringent standards can compromise both health and performance of this segment of the force. Other associations with body composition such as stress effects on intraabdominal fat distribution patterns and metabolic implications of a fat reserve for survival in extreme environments are also relevant considerations. This is a review of the science that underpins the U.S. Army body composition standards.

From Monash U: Social welfare and the Affordable Care Act: Is it ever optimal to set aside comparative cost?

http://www.ncbi.nlm.nih.gov/pubmed/22739260

Soc Sci Med. 2012 Jun 16. [Epub ahead of print]

Social welfare and the Affordable Care Act: Is it ever optimal to set aside comparative cost?

Mortimer D, Peacock S.

Source

Centre for Health Economics, Faculty of Business & Economics, Monash University, Building 75, Melbourne, Victoria 3800, Australia.

Abstract

The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that - to set aside comparative cost even after accounting for ethical and distributional constraints - would be truly to act as if money is no object.

From the Cleveland Clinic: UV protection and sunscreens: What to tell patients

http://www.ncbi.nlm.nih.gov/pubmed/22660875

Cleve Clin J Med. 2012 Jun;79(6):427-36.

UV protection and sunscreens: What to tell patients.

Jou PC, Feldman RJ, Tomecki KJ.

Source

Department of Dermatology, A61, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; tomeckk@ccf.org.

Abstract

Ultraviolet (UV) radiation is the major environmental risk factor for nonmelanoma skin cancer and is a suspected risk factor for melanoma. Avoiding overexposure to direct sunlight during the peak daylight hours, wearing protective clothing, and applying sunscreen are ways to protect the skin. To provide clinicians with the tools to advise patients and to answer their inquiries, including which sunscreen to use, we review UV radiation's effect on the skin, how sunscreens block UV light, current recommendations on sunscreen use, and new sunscreen labeling requirements.

From Emory U: The Concrete Jungle: City Stress and Substance Abuse among Young Adult African American Men

http://www.ncbi.nlm.nih.gov/pubmed/22739803

J Urban Health. 2012 Jun 28. [Epub ahead of print]

The Concrete Jungle: City Stress and Substance Abuse among Young Adult African American Men.

Seth P, Murray CC, Braxton ND, Diclemente RJ.

Source

Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA, pseth@cdc.gov.

Abstract

Substance use is prevalent among African American men living in urban communities. The impact of substance use on the social, psychological, and physical health of African American men has important public health implications for families, communities, and society. Given the adverse consequences of alcohol and drug abuse within communities of color, this study evaluated the relationship between city stress, alcohol consumption, and drug use among African American men. Eighty heterosexual, African American men, 18 to 29 years old, completed psychosocial risk assessments that assessed substance use and city stress. Multiple logistic regression analyses, controlling for age, indicated that participants reporting high levels of urban stress, relative to low levels of urban stress, were more likely to report a history of marijuana use (AOR = 5.19, p = .05), history of ecstasy and/or GHB use (AOR = 3.34, p = .04), having family/friends expressing strong concerns about their illicit drug use (AOR = 4.06, p = .02), and being unable to remember what happened the night before due to drinking (AOR = 4.98, p = .01). African American men living within the confines of a stressful urban environment are at increased risk for exposure to and utilization of illicit substances. Culturally competent public health interventions for substance use/abuse should address psychological factors, such as stress and neighborhood violence.