Statistics for weighing benefits and harms in a proposed genetic substudy of a randomized cancer prevention trial

Summary.  When evaluating potential interventions for cancer prevention, it is necessary to compare benefits and harms. With new study designs, new statistical approaches may be needed to facilitate this comparison. A case in point arose in a proposed genetic substudy of a randomized trial of tamoxifen versus placebo in asymptomatic women who were at high risk for breast cancer. Although the randomized trial showed that tamoxifen substantially reduced the risk of breast cancer, the harms from tamoxifen were serious and some were life threaten-ing. In hopes of finding a subset of women with inherited risk genes who derive greater bene-fits from tamoxifen, we proposed a nested case–control study to test some trial subjects for various genes and new statistical methods to extrapolate benefits and harms to the general population. An important design question is whether or not the study should target common low penetrance genes. Our calculations show that useful results are only likely with rare high penetrance genes.     

The Role of Cancer Risk in the Regulation of Industrial Pollution

The extent of carcinogen regulation under existing U.S. environmental statutes is assessed by developing measures of the scope and stringency of regulation. While concern about cancer risk has played an important political role in obtaining support for pollution control programs, it has not provided the predominant rationale for most regulatory actions taken to date. Less than 20% of all standards established to limit concentrations of chemicals in various media address carcinogens. Restrictions on chemical use are more frequently based on concerns about noncancer human health or ecological effects. Of the chemicals in commercial use which have been identified as potential human carcinogens on the basis of rodent bioassays, only a small proportion are regulated. There is an inverse relationship between the scope of regulatory coverage and the stringency of regulatory requirements: the largest percentages of identified carcinogens are affected by the least stringent requirements, such as information disclosure. Standards based on de minimis cancer risk levels have been established for only 10% of identified carcinogens and are restricted to one medium: water. Complete bans on use have affected very few chemicals. The general role that carcinogenicity now plays in the regulatory process is not dramatically different from that of other adverse human health effects: if a substance is identified as a hazard, it may eventually be subject to economically achievable and technically feasible restrictions.     

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.     

医患关系现状及基于EAP视角的改进对策研究

医生的天职是治病救人,医生同患者之间彼此信任、和谐友好的关系是取得良好治疗效果的前提。但是近些年来医患之间矛盾不断,医患纠纷事件频发。这个问题已经不仅仅是牵涉到医疗方面的问题,而是已经上升至整个社会层面的问题。引起医患矛盾产生的因素有很多,对这些因素进行总结分析,并对建立和谐的医患关系的方法进行探讨和分析,能够基于EAP视角对构建和谐的医患关系提供一些参考和思路。     

东晋南朝医学知识的新发展:以医家、病者为中心的研究

本文以医家、病者为中心,结合医籍的相关叙述,来探讨东晋南朝医学知识的新发展。文中分析指出,此时期医家与病者多数都是出自社会地位较高的士大夫阶层。作为病者,他们世代内部通婚,过度优逸,嗜好饮酒,易受精神刺激,早婚多妾侍,多种因素导致了体貌柔弱,不堪劳作。显现于医学典籍,则是许多医方以体质偏虚之人为预设目标。而又作为医家的他们,传习家学,博通医术,或由信仰之故,兼修岐黄,这促使医界病源学理盛行以及佛道知识常被引入医书。综合诸历史迹象,作者认为东晋南朝医学知识有显著的贵胜特点。     

当代医患沟通的意义与技巧

良好的医患关系是保证医疗服务高质量的基础,而医患沟通是建立良好医患关系的前提。医患沟通是贯穿于整个医疗活动过程中并在较大程度上决定了医院服务质量的特殊的人际交往过程。探讨当代医患沟通的意义与技巧,力图使医务工作者以良好的心态从事医疗事业,推动医院科学的发展。     

Theoretical Factors Influencing Adolescent Sexual Behavior: Evidence from a Rural Sample Living in Poverty

ABSTRACT

This study of 414 adolescents who resided in rural Arkansas families receiving AFDC was designed to investigate what theoretical factors predicted frequency of sexual intercourse in the past year prior to the study and number of lifetime sexual partners among males and females. Multivariate analyses indicated that elements of bonding were important to the sexual behavior of females, but not males. On the other hand, feelings of frustration influenced male sexual behavior only. The number of sex partners was increased by associations with sexually active peers for both genders while only females made excuses. The only factor which was associated with both sexual behaviors among both genders was having sex to have a baby to love or to draw a partner closer. The family social work implications of these findings were discussed.     

Book Reviews

Books reviewed:
Office International Des Epizooties (World Organization for Animal Health) World Animal Health in 1998, Part 1: Reports on the Animal Health Status and Disease Control Methods and Tables on Incidence of List A Diseases and Part 2: Tables on the Animal Health Status and Disease Control Methods
Peter Sedlmeier. Lawrence Erlbaum Associates, Mahwah Improving Statistical Reasoning: Theoretical Models and Practical Implications
Andrew Ford. Island Press Modeling the Environment. An Introduction to System Dynamics Modeling of Environmental Systems
Jacob I. Bregman. Lewis Publishers, Boca Raton Environmental Impact Statements, Second Edition     

Forecasting the Incidence of Cancer in Regional Victoria,Australia

Loddon Mallee Integrated Cancer Service plays a key role in planning the delivery of cancer services in the Loddon Mallee Region of Victoria, Australia. Forecasting the incidence of cancer is an important part of planning for these services. This article is written from an industry perspective. We describe the context of our work, review the literature on forecasting the incidence of cancer, discuss contemporary approaches, describe our experience with forecasting models, and list issues associated with applying these models. An extensive bibliography illustrates the world-wide interest in this forecasting problem. We hope that it is useful to researchers.