Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)

Several colorectal cancer (CRC) screening models have been developed describing the progression of adenomas to CRC. Currently, there is increasing evidence that serrated lesions can also develop into CRC. It is not clear whether screening tests have the same test characteristics for serrated lesions as for adenomas, but lower sensitivities have been suggested. Models that ignore this type of colorectal lesions may provide overly optimistic predictions of the screen‐induced reduction in CRC incidence. To address this issue, we have developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that includes the adenoma‐carcinoma pathway and the serrated pathway to CRC as well as characteristics of colorectal lesions. The model structure and the calibration procedure are described in detail. Calibration resulted in 19 parameter sets for the adenoma‐carcinoma pathway and 13 for the serrated pathway that match the age‐ and sex‐specific adenoma and serrated lesion prevalence in the COlonoscopy versus COlonography Screening (COCOS) trial, Dutch CRC incidence and mortality rates, and a number of other intermediate outcomes concerning characteristics of colorectal lesions. As an example, we simulated outcomes for a biennial fecal immunochemical test screening program and a hypothetical one‐time colonoscopy screening program. Inclusion of the serrated pathway influenced the predicted effectiveness of screening when serrated lesions are associated with lower screening test sensitivity or when they are not removed. To our knowledge, this is the first model that explicitly includes the serrated pathway and characteristics of colorectal lesions. It is suitable for the evaluation of the (cost)effectiveness of potential screening strategies for CRC.     

Healthy Barbs: Activism Confronts Mortality

Barbara Brenner, JD, was the Executive Director of Breast Cancer Action (BCA) from 1995–2010. Before that, she was a longtime activist in the anti-war movement and an attorney who, for most of her career, practiced public policy law. After she was diagnosed with breast cancer in 1993 at the age of 41, she took the helm of BCA. Under her leadership, the organization moved into a position of national advocacy—demanding research on the causes and prevention of breast cancer, including the role of industrial pollutants. Barbara started the “Think Before You Pink” campaign, encouraging people to question whether companies that display pink ribbons actually produce products that harm women's health or generate any funds to fight breast cancer. Her blog, “Healthy Barbs,” challenged readers to critique routine healthcare practices and policies. Barbara received numerous awards, including a Jefferson Award for Public Service in 2007, the Smith College Medal in 2012, and the ACLU-Northern California's Lola Hanzel Courageous Advocacy Award in 2012. Barbara had a recurrence of breast cancer in 1996. She died of complications associated with amyotrophic lateral sclerosis, ALS, on May 10, 2013.     

Computer-Assisted Screening and Intervention for Alcohol Problems in Primary Care

ABSTRACT

The effectiveness of a bilingual (English/Spanish) computer-assisted alcohol screening/intervention for hazardous and harmful alcohol use, the Health Habits Survey (HHS) was tested in primary care settings. Assessment-only patients were compared with patients exposed to the HHS. Of the 2053 recruited, 151 (7.4%) screened positive on the Alcohol Use Disorders Identification Test (AUDIT) and were re-contacted six months later for follow-up. Significant alcohol reduction was observed in both conditions. No between-group differences were observed. Computer-assisted screening and intervention are feasible in primary care settings and may be a realistic provider-extender when traditional screening is absent or inconsistently implemented.     

Social Work with the Osteoporotic Woman

A chronic, progressive, and potentially debilitating condition, osteoporosis has a multitude of currently untapped implications for effective social work practice. A working knowledge of the medical framework of the disease process itself is a prerequisite to informed practice. This article presents such information, along with the psychological and social components, in order to provide the social worker with the comprehensive biopsyehosaial knowledge base necessary for effective practice with the osteoporotic woman and her family.     

信息不对称下医药营销服务外包契约设计

为了缩减销售成本,一些制药企业将营销服务外包给合约销售公司(contract sales organization,CSO).由于CSO的营销努力不可合同化,制药企业需要基于市场销量来激励CSO的营销努力.然而,市场销量受制药企业定价决策的影响,因此CSO将面临制药企业提高定价的道德风险.此外,药品营销难度信息可能是CSO的私人信息,这使得制药企业面临逆向选择问题.当制药企业将营销服务外包给多个CSO时,由于制药企业针对同一药品在不同市场的售价相同,其定价决策对多个CSO所服务市场的销量具有共同的影响.相对绩效的激励契约能够消除共同不确定因素对代理人产出的影响,从而更有利于激励代理人付出高水平的努力.因此依据信息甄别的博弈模型,分析基于个体绩效与基于相对绩效的激励契约的有效性.研究发现:1)药品营销难度信息对称时,基于相对绩效的激励契约占优于基于个体绩效的激励契约,且可以获得全局最优的营销努力和期望利润;2)药品营销难度信息不对称时,两种激励契约均不能获得全局最优的营销努力和期望利润.数值分析表明,药品营销难度的先验概率,市场价格敏感性和高低类型药品营销难度差异的变化会影响制药企业的契约选择,较高的市场价格敏感性和较低的高低类型药品营销难度差异使得基于相对绩效的激励契约更有效.     

Factor screening in nonregular two-level designs based on projection-based variable selection

In this paper, we focus on the problem of factor screening in nonregular two-level designs through gradually reducing the number of possible sets of active factors. We are particularly concerned with situations when three or four factors are active. Our proposed method works through examining fits of projection models, where variable selection techniques are used to reduce the number of terms. To examine the reliability of the methods in combination with such techniques, a panel of models consisting of three or four active factors with data generated from the 12-run and the 20-run Plackett–Burman (PB) design is used. The dependence of the procedure on the amount of noise, the number of active factors and the number of experimental factors is also investigated. For designs with few runs such as the 12-run PB design, variable selection should be done with care and default procedures in computer software may not be reliable to which we suggest improvements. A real example is included to show how we propose factor screening can be done in practice.     

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.     

Family violence in gambling help-seeking populations

Elevated rates of family violence among treatment-seeking problem gamblers compared to general population estimates have been reported in Spain, Canada and Australia. This study examined the occurrence of family violence among 454 problem gambling help-seeking clients (370 gamblers, 84 affected others) recruited through 3 national gambling treatment services in New Zealand. Measures used were the Problem Gambling Severity Index, and a modified version of the HITS Scale which assessed physical, emotional, verbal and sexual abuse. Past-year family violence among gamblers in this sample was 46.8% for victimization, 41.2% for perpetration and 55.0% for any form of family violence. Among affected others the occurrence was 65.5% for victimization, 57.1% for perpetration and 71.4% for any form of violence. The most common type of violence was verbal intimate partner violence. Affected others and women gamblers reported higher rates of violence victimization and perpetration. These findings underscore the importance of screening gambling help-seeking clients for family violence, and the development of prevention and treatment programmes to address violence in this population, with particular attention to affected others and women gamblers. Future research should assess coercive control and the gendered nature of family violence among problem gambling help-seekers.     

The roller-coaster of experiences: becoming the parent of a deaf child

When early testing indicates a hearing loss, parents find themselves on a roller-coaster of experiences leaving little time or space for reflection. This study is based on interviews with families in the Flemish region of Belgium, one of the earliest in the world to introduce universal neonatal screening for hearing loss. Starting from a phenomenological approach, we explore parents’ accounts of their experiences in order to uncover the meanings of early parenting of a child identified with a label. Soon after birth, these parents encounter a different world in which intertwined discourses construct parenthood with a deaf child. During the process of becoming a parent, representations of deafness as impairment were omnipresent. In contrast to a medical and technological perspective that insists on the need to intervene as fast as possible, it is argued that the private and social implications of rapid intervention require explicit consideration.