Trends in outpatient breast cancer surgery among Medicare fee-for-service patients in the United States from 1993 to 2002 / 癌症

The practice of outpatient breast cancer surgery has been controversial in the United States. This study aimed to update time trends and geographic variation in outpatient breast cancer surgery among elderly Medicare fee-for-service women in the United States. Using the 1993-2002 linked Surveillance, Epidemiology and End Results (SEER)-Medicare claims data and the Area Resource Files, we identified 2 study samples, including the women whose breast cancers were the first-ever-diagnosed cancer at age 65 years or older from 9 regions continuously covered by the SEER registries since 1993. The first sample included the women receiving unilateral mastectomy for stage 0-IV cancer; the second included the women receiving the breast-conserving surgery with lymph node dissection (BCS/LND) for stage 0-II cancer. The proportions of patients receiving outpatient surgery increased from 3.2% to 19.4% for mastectomy and from 48.9% to 77.8% for BCS/LND from 1993 to 2002. We observed substantial geographic variation in the average proportion of the patients receiving outpatient surgery in the studied areas across the 10-year period, ranging from 3.9% in Connecticut to 27.2% in Utah for mastectomy and from 54.7% in Hawaii to 78.1% in Seattle, Washington, for BCS/LND. As the popularity of outpatient breast cancer surgery continues to grow, more evidence-based analyses related to quality and outcomes of outpatient breast cancer surgery among various populations are needed in order to facilitate the public debates about state and federal mandated health benefit legislations.

Genetic population structure of an anchialine shrimp, Metabetaeus lohena (Crustacea: Alpheidae), in the Hawaiian Islands

Anchialine habitats in the Hawaiian Islands, characterized as coastal bodies of land-locked salt or brackish water that fluctuate with the tides due to subterranean connections, are the only ecosystems of this type found within the United States. These habitats are currently subject to anthropogenic impacts tha t threaten their future existence. Previous research has shown strong genetic population structure of an endemic atyid shrimp, Halocaridina rubra, in these habitats. The native alpheid shrimp, Metabetaeus lohena, whose known range entirely overlaps that of H. rubra, has feeding and reproductive behaviors that are biologically distinct from H. rubra. Its historic scarcity and status as a candidate for the US Fish and Wildlife Department’s Endangered Species List, make M. lohena an ideal species to compare against the known genetic structure of H. rubra. We investigated the population structure of this native anchialine shrimp to test the hypothesis that genetic population structure differs between the two shrimp species and that M. lohena is genetically unstructured across its range. A survey of 605 bp of the mitochondrial cytochrome c oxidase subunit I (COI) gene from 127 individuals collected at 7 sites spanning the islands of O’ahu, Maui and Hawaii revealed 43 haplotypes. The most common haplotype was represented in similar proportions from all sites sampled, accounting for 44% of the surveyed sequences. Analyses of molecular variation (AMOVA), pairwise ΦST values, Bayesian estimates of migration (M), Mantel tests and Nested Clade Analyses (NCAs) all failed to reveal evidence of major barriers to gene flow among most populations separated by inter-island channels. This lack of genetic structure in M. lohena is found to be in stark contrast with the highly structured population of H. rubra, and may be attributed to oceanic dispersal strategies and/or a recent introduction to the Hawaiian Islands. Rev. Biol. Trop. 58 (1): 159-170. Epub 2010 March 01.

Los hábitats de los alfeidos de las islas de Hawaii, se caracterizan por ser zonas cerradas de aguas saladas o salobres, que fluctúan con las mareas, debido a las conexiones subterráneas, son los únicos ecosistemas de este tipo que se encuentran en Estados Unidos. Estos hábitats actualmente están sujetos a impactos antropogénicos que amenazan su existencia futura. La investigación anterior ha demostrado una fuerte estructura genética de una población de camarones atíidos endémicos, Halocaridina rubra, en estos hábitats. El camarón alfeido nativo, Metabetaeus lohena, cuya área de distribución conocida se superpone totalmente con la de H. rubra, tiene comportamientos alimenticios y reproductivos que son biológicamente diferentes a los de H. rubra. Su escasez histórica y su condición de candidato para aparecer en la Lista de Especies en Peligro del Departamento de Pesca y Vida Silvestre de Estados Unidos, hace de M. lohena una especie ideal para comparar su estructura genética con la de H. rubra. Se investigó la estructura de la población de este camarón alfeido nativo para probar la hipótesis que la estructura genética de la población difiere entre las dos especies y que la de M. lohena está genéticamente no estructurada en todo su ámbito. El análisis de 605 pb de la oxidasa mitocondrial citocromo c subunidad I (COI) de genes de 127 individuos recolectados en 7 sitios que abarcan las islas de Oahu, Maui y Hawaii reveló 43 haplotipos. El haplotipo más común fue representado en proporciones similares en todos los sitios incluidos en la muestra, de acuerdo al 44% de las secuencias estudiadas. El análisis de variación molecular (AMOVA), los valores de ΦST pareados, la estimación bayesiana de la migración (M), las pruebas de Mantel y los Análisis Cladísticos no pudieron revelar la existencia de importantes barreras al flujo genético entre las poblaciones más separadas por los canales entre las islas. La falta de estructura genética en M. lohena contrasta con la muy estructurada población de H. rubra, y puede ser atribuida a las estrategias de dispersión oceánica y/o una introducción reciente en las islas hawaianas.

Pulmonary blastomycosis diagnosed in Hawai'i.

Blastomycosis, a fungal infection caused by Blastomyces dermatitidis, was once thought to be endemic only to the Central and Great Lakes regions of the United States of America. We present the first reported case series of patients documenting the diagnosis of blastomycosis in the Pacific region. In both cases, exposure to endemic areas was retrospectively identified.

Defensive responses to threat scenarios in Brazilians reproduce the pattern of Hawaiian Americans and non-human mammals

A former study with scenarios conducted in Hawaii has suggested that humans share with non-human mammals the same basic defensive strategies - risk assessment, freezing, defensive threat, defensive attack, and flight. The selection of the most adaptive strategy is strongly influenced by features of the threat stimulus - magnitude, escapability, distance, ambiguity, and availability of a hiding place. Aiming at verifying if these strategies would be consistent in a different culture, 12 defensive scenarios were translated into Portuguese and adapted to the Brazilian culture. The sample consisted of male and female undergraduate students divided into two groups: 76 students, who evaluated the five dimensions of each scenario and 248 medical students, who chose the most likely response for each scenario. In agreement with the findings from studies of non-human mammal species, the scenarios were able to elicit different defensive behavioral responses, depending on features of the threat. "Flight" was chosen as the most likely response in scenarios evaluated as an unambiguous and intense threat, but with an available route of escape, whereas "attack" was chosen in an unambiguous, intense and close dangerous situation without an escape route. Less urgent behaviors, such as "check out", were chosen in scenarios evaluated as less intense, more distant and more ambiguous. Moreover, the results from the Brazilian sample were similar to the results obtained in the original study with Hawaiian students. These data suggest that a basic repertoire of defensive strategies is conserved along the mammalian evolution because they share similar functional benefits in maintaining fitness.

Relevance of iodine intake as a reputed predisposing factor for thyroid cancer

Iodine is a trace element that is essential for the synthesis of thyroid hormone. Both chronic iodine deficiency and iodine excess have been associated with hypertrophy and hyperplasia of follicular cells, attributed to excessive secretion of TSH. This may be associated to thyroid cancer risk, particularly in women. Experimental studies have documented thyroid cancer induction by elevation of endogenous TSH, although in a small number of animals. Iodine deficiency associated with carcinogenic agents and chemical mutagens will result in a higher incidence of thyroid malignancy. Inadequate low iodine intake will result in increased TSH stimulation, increased thyroid cell responsiveness to TSH, increased thyroid cell EGF-induced proliferation, decreased TGFbeta 1 production and increased angiogenesis, all phenomena related to promotion of tumor growth. Epidemiological studies associating iodine intake and thyroid cancer led to controversial and conflicting results. There is no doubt that introduction of universal iodine prophylaxis in population previously in chronic iodine-deficiency leads to a changing pattern of more prevalent papillary thyroid cancer and declining of follicular thyroid cancer. Also anaplastic thyroid cancer is practically not seen after years of iodine supplementation. Iodine excess has also been indicated as a possible nutritional factor in the prevalence of differentiated thyroid cancer in Iceland, Hawaii and, more recently, in China. In conclusion: available evidence from animal experiments, epidemiological studies and iodine prophylaxis has demonstrated a shift towards a rise in papillary carcinoma, but no clear relationship between overall thyroid cancer incidence and iodine intake.

O iodo é essencial para a síntese de hormônios tireóideos e tanto a deficiência crônica deste halogeno como o excesso nutricional de iodo levam a hiperplasia e hipertrofia dos elementos foliculares (por excesso de TSH). Esse fenômeno pode se associar a maior risco de câncer de tireóide, especialmente no sexo feminino. Estudos experimentais documentam indução de câncer de tireóide após prolongado excesso circulante de TSH, o qual induz aumento da proliferação celular medida por fator de crescimento epidermal (EGF), decréscimo de síntese de fator de transformação do crescimento (TGFbeta 1) e aumento da angiogenese. Estudos epidemiológicos entre nutrição de iodo e câncer de tireóide são conflitantes. É, todavia, aceito que a correção de prévia deficiência de iodo com aporte nutricional adequado deste halogeno leva à maior prevalência de carcinoma papilífero (e decréscimo de carcinoma folicular). Em alguns países, o excesso de iodo foi apontado como causa aparente de maior prevalência de câncer de tireóide. Em conclusão: não existe uma relação causa-efeito entre iodo nutricional e prevalência de câncer de tireóide, e outros fatores intervenientes ambientais devem ser considerados.

Polymorphic and sex-limited phosphoglucomutase in Parastrongylus cantonensis (Nematoda: Angiostrongylidae)

Phosphoglucomutase was studied by polyacrylamide gel electrophoresis in the Thailand and Hawaii isolates of Parastrongylus cantonensis (also known as Angiostrongylus cantonensis). Two loci were present. The faster-moving locus (PGM-1) was polymorphic in the Hawaii isolate, represented by two alleles - the faster-moving, less common Pgm-1A and the slower-moving, more common Pgm-1B . It was monomorphic for the faster-moving allele Pgm-1A in the Thailand isolate. The slower-moving locus (PGM-2) was invariant, with a single band of enzyme activity, in the female worms of both the Thailand and Hawaii isolates. There was no detectable enzyme activity at this PGM-2 locus in the male worms of both isolates. The non-expression or 'null' PGM-2 phenotype in the male worms was presumed to be sex- limited. The present findings differ significantly in several aspects (polymorphic locus, proportion of polymorphic loci, heterozygosity, deviations from Hardy-Weinberg expectations, sex-limited expression) from the Japan isolate of P. cantonensis reported in the literature.

Comparison of bladder cancer survival among Japanese, Chinese, Filipino, Hawaiian and Caucasian populations in the United States.

BACKGROUND: Racial differences for bladder cancer survival have been reported for Caucasians and African-Americans. However, the survival experience of bladder cancer patients in Asian and Pacific Islander ethnic groups in the United States have not been fully explored. The purpose of this study was to compare the bladder cancer survival rates of Japanese, Chinese, Filipinos, Hawaiians and Caucasians in the U.S. population. MATERIALS AND METHODS: The data was from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute between 1973 and 1998. Cox proportional hazard models and Kaplan-Meier's estimates were used to study differences in survival between the ethnic groups, adjusting for factors including age at diagnosis, gender, year of diagnosis, histological grade, stage, surgery type, and radiation therapy. RESULTS: The overall bladder cancer survival was 66% for Japanese patients, 64% for Chinese patients, 61% for Caucasians, 59% for Filipino patients and 52% for Hawaiian patients. Differences in bladder cancer survival rates between Japanese and Chinese populations in the United States were not observed. In the Asian population, higher relative risks and lower 5-year survival were observed with increasing age at diagnosis (p for trend<0.0001), grade (p for trend<0.0001), and stage (p for trend<0.0001). Asian women had lower survival and a higher risk of death due to bladder cancer than Asian men. CONCLUSIONS: Japanese and Chinese bladder cancer patients had higher overall survival rates than Caucasians, while Filipino and Hawaiian patients had lower survival than Caucasians.

Stomach cancer incidence in Metro Manila and Rizal province: 1980-1992

Incidence was derived from published data from 2 population-based registries - the Philippine Cancer Society - Manila Cancer Registry and the Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Civil Registry offices. Both registries are members of the International Association of Cancer Registries and received continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period 1988-1992 the combined age-standardized incidence rate (ASR) was 9.9 per 100,000 for male stomach cancer (ranked fifth, 4.5% of all male cancers), and 5.9 per 100,000 among females (ranked ninth, 2.8% of all female cancers). Stomach cancer among Philippine residents had lower ASRs and age-specific rates compared to Japanese, Korean, Chinese, Singaporean Chinese and Vietnamese populations. Age-specific rates among Filipinos reached 10 per 100,000 or higher at age-group 50-54 years among males, and 55-59 years among females. Significant differences in incidence were observed in only few cities and municipalities. There were little differences in ASRs between 2 populations during 3 time periods between 1980-1992, in both males and females with an indication of a slight decrease. Incidence of male Philippine migrants to Hawaii, San Francisco and Los Angeles were comparable to those of white residents covered by the Manila registry. Among females, stomach cancer incidence of Philippine residents and Filipina migrants to Hawaii were similar, and were slightly higher than those of white residents in Hawaii and both migrants and white residents in San Francisco and Los Angeles

Multiple Sclerosis in Korea: Its Clinical Features and Estimated Prevalence Rate

It is well-known that multiple sclerosis (MS) has a higher prevalence rate in occidental countries than in Asia and Africa. In addition to their lower prevalence rate of MS, oriental countries may have different clinical characteristics. It has been shown in the previous studies performed in Japan that there is more frequent involvement of optic nerve and spinal cord during the course of disease. These results were also confirmed by the study of MS in Hawaii which compared orientals with caucasians in their clinical features. In Korea, there has been no estimate for clinical features and prevalence rate of MS except two studies. We performed this study to evaluate the clinical features and estimated prevalence rate based on a series of 50 consecutive cases of MS seen over 8 and a half year-period in the Seoul National University Hospital.

A Comparative Study for Delinquents and Nondelinquents at Nanakuli Family Planning Clinic in Hawaii, U.S.A

Family planning is a very complex matter and has many ramifications so that one may expect a variety of problems besetting operation of family planning programs. One of the problems advocated so far is the drop-out rate or delinquent appointment rate of family planning clinics which is known to be as high as to deserve special attention. It is an urgent issue to be studied so that the family planning clinics could take measures to insure the continued optimal utilization of the services offered. Hence, the Nanakuli Family Planning Clinic was chosen as a sample to study and find out any differences and similarities between the "Delinquents" and "Non-delinquents" of the clinic, hoping that any meaningful facts brought out by this study could get the clinic to have the optimal utilization of the services by it's clients. Specific conclusions resulting from this study are the optimal utilization of family planning service by clients could not be expected without providing provisions for the biological, situational, and environmental problems of the clients as well as the administrative and managerial problems besetting the clinic operation itself.