163 research outputs found
SOCIAL DETERMINANTS OF HEALTH IN UTERINE CANCER PATIENTS IN ONTARIO: ASSOCIATION WITH DISEASE PRESENTATION AND OUTCOME
Get PDFObjective: Delay in diagnosis and treatment of endometrial cancer may be associated with disease progression and impact management and outcomes. Social and cultural barriers influence recognition of symptoms and self-advocacy in seeking and complying with care. Associations between social determinants of health (SDH) and disease presentation, treatment and outcomes has been shown in some healthcare systems. Our objective was to investigate these in Ontario’s universal access system.
Methods: Endometrial cancer patients in Ontario diagnosed 2009-2017 were identified, and clinical, social and demographic information extracted from administrative databases. SDH were quantified using previously validated marginalization quintiles (material deprivation, residential instability and ethnic concentration). Associations between SDH, disease stage, treatment and outcome were explored using chi-square, log-rank and logistic regression.
Results: 19530 patients were identified. 73% of cancers were confined to the uterus. Stage distribution differed across marginalization quintiles (p<0.001) with advanced disease found more frequently in highly marginalized patients (highest vs lowest quintile): OR=1.28 (95% CI 1.14-1.45) for deprivation, OR=1.2 (95% CI 1.06-1.35) for residential instability and OR=1.3 (95% CI 1.15-1.46) for ethnic concentration (<0.0001)). Highly marginalized patients also had less timely surgery (p<0.0001). Overall survival was shorter in patients in high deprivation and residential instability quintiles (log rank p-value<0.0001) but not in high ethnic concentration quintiles, with HR=1.4 for deprivation (p<0.0001) and HR=1.53 for instability (p<0.0001) for the highest marginalization quintile. Survival differences persisted in more uniform cohorts of early (stage I) disease and endometrioid tumors and on multivariable analysis.
Conclusions: Marginalized populations diagnosed with uterine cancer present at more advanced stages, wait longer for surgery and have shorter overall survival. Associations of SDH with uterine cancer presentation and management in Ontario could shed light on the impact of these factors on disease trajectory, drive policies for patient advocacy and redistribution of resources and promote health equity in this population.ThesisMaster of Public Health (MPH)Conditions in the social environment in which people are born, live and work are powerful influencers of health and well-being. In fact, these circumstances have also been called Social Determinants of Health (SDH). Cancer outcomes are one of the domains impacted by SDH.
In this study, we set out to investigate the association between SDH and uterine cancer outcomes in Ontario, Canada. We guessed that SDH may influence how soon patients with symptoms seek help from their doctors, how quickly their problem is investigated and how well they are able to undergo treatment.
We used a tool called the Ontario Marginalization Index to break down Ontario’s uterine cancer patient population into groups according to degree of social, financial and ethnic marginalization. We found that more marginalized patients tended to present to care with more advanced cancers, that they took longer to have surgery for their cancer and that their survival was worse. These findings suggest there is more work to be done to promote health equity in cancer care
Hysterosalpingography (HSG) versus Hysterosalpingo-Contrast Sonography (HyCoSy) in Infertility Management
No full textThe Effects of Endogenous Protection on the Economic Landscape
Get PDFThe author studies the impact of political economy variables on the spatial distribution of industry. The political game between a single lobby and a partial opportunistic incumbent may alter the economic landscape of a small economy. The trade policy endogenously determined becomes the channel to understand how the players’ behaviour impacts on the long run spatial distribution of industry. When the rest of the world is a free trader and the spending share of an economy is relatively small, the marginal change in the trade policy has a relevant impact on the industry share. Amazingly, if a small economy is characterised by a government that is not very much concerned about general welfare and there is a lobby of few capital owners that play actively, the possible outcome will be a relocation of industry that favours such an economy. Capital owners might make capital flow to look for protection. Political variables may act as a dispersion force.
Abstract 721: Minimally invasive test and composite biomarker for early detection of serous ovarian carcinoma
No full textAbstract
Background: Current screening programs for early detection of high grade epithelial ovarian cancer (HGOvC) among high-risk populations have failed to show improvement in HGOvC mortality, therefore these women are offered risk-reducing bilateral salpingo-oophorectomy (RRBSO) at 35- 40 years. Stratification of high-risk population, especially BRCA mutation carriers, may enable personalized risk counseling and individualization of timing of RRBSO. In most cases, the precursor lesions of HGOvC arise in the epithelium of the fallopian tube (FT) fimbriae rather than intra-peritoneally. It is therefore plausible that proteins, RNA or DNA from early-stage tumor cells may be identifiable in fluid samples obtained from the lumen of the gynecological tract, thus making it possible to identify curable, early stage lesions.
Aims: (1) Test the feasibility of uterine lavage as a minimally invasive test for early detection of ovarian cancer, and (2) Identify novel early-detection biomarkers in the uterine lavage fluid (UtLF).
Methods: We developed a method for sampling of gynecologic tract fluid termed uterine lavage fluid (UtLF), which is a simple, reproducible, low-cost office procedure that can be performed routinely during gynecologic follow-up visits. We have already collected UtLF from 140 HGOvC patients and control women undergoing gynecologic surgical procedures for non-malignant indications. Deep proteomic profiling of UtLF is performed by isolation of microparticles from body fluids, followed by solubilization, trypsin digestion and high resolution mass spectrometric (MS) analysis (on the Q-Exactive MS). Machine learning algorithms have been used to extract a classifier that can predict the diagnosis of ovarian cancer.
Results: Uterine lavage appears to be a feasible, low burden procedure. The MS approach has identified thousands of proteins in each UtLF specimen, in a high throughput manner. The label-free quantification algorithm (MaxQuant) enables a quantitative comparison between samples from cases and controls. We have derived a 20-protein classifier with an area under the curve (AUC) of Receiver Operating Characteristics (ROC) curve of 0.91 at 20% error. The composite biomarker has been applied to an independent validation set with a negative predictive value (NPV) of 92% and positive predictive value (PPV) of 45%.
Conclusions: A minimally invasive technique of uterine lavage to collect unique diagnostic samples, coupled with state-of-the-art proteomics methods, results in a highly sensitive and specific composite biomarker which may be developed in to a screening tool for early detection of serous ovarian cancer in high-risk populations.
Citation Format: Keren Bahar-Shany, Georgina D. Barnabas, Limor Helpman, Ariella Yakobson-Siton, Tamar Perri, Ram Eitan, Jacob Korach, Tamar Geiger, Keren Levanon. Minimally invasive test and composite biomarker for early detection of serous ovarian carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 721. doi:10.1158/1538-7445.AM2017-721</jats:p
The Structure of Foreign Trade
Get PDFDuring the last two decades, new research has greatly advanced the understanding of the structure of world trade. While research in the 1960s and 1970s provided mostly theoretical insights, major empirical innovations concerning the study of factor content of net trade flows appeared in the 1980s. Important improvements in this line of research were added in the 1990s. The author also discusses the literature that emphasizes economies of scale and product differentiation. This work was done mostly in the 1980s and 1990s, yielding important theoretical and empirical findings. An emphasis on the interplay between theoretical and empirical research characterizes the entire presentation.
An empirical assessment of co-activity among German professors
Get PDFThe growing importance of technology relevant non-publication output of university research has come into the focus of policy-makers? interest. A fierce debate arose on possible negative consequences of the increasing commercialization of science, as it may come along with a reduction in research performance. This paper investigates the relationship between publishing as a measure of scientific output and patenting for German professors active in a range of science fields. We combine bibliometric/technometric indicators and econometric techniques to show that patenting positively correlates with, first, the publication output and, second, with publication quality of patenting researchers. --academic inventors,patents,publications
An empirical assessment of co-activity among German professors.
Get PDFThe growing importance of technology relevant non-publication output of university research has come into the focus of policy-makers' interest. A fierce debate arose on possible negative consequences of the increasing commercialization of science, as it may come along with a reduction in research performance. This paper investigates the relationship between publishing as a measure of scientific output and patenting for German professors active in a range of science fields. We combine bibliometric/technometric indicators and econometric techniques to show that patenting positively correlates with, first, the publication output and, second, with publication quality of patenting researchers.Academic inventors; Patents; Publications; Technology; Indicators; Quality;
Elasticity of trade flow to trade barriers: A comparison among emerging estimation techniques
Get PDFThe objective of this study has been to analyze the sensitivity of trade flow to trade barriers from gravity equations, using different econometric techniques recently highlighted in the literature. Specifically, we compare a benchmark OLS fixed effects specification a la Feenstra (2002), with three emerging estimation methods: the standard Heckman correction for selection bias, to account for zero trade flow; its extension, recently proposed by Helpman et al. (2008), to control for firm heterogeneity; and, finally, the Poisson pseudo-maximum-likelihood (PPML) technique to correct for the presence of heteroskedasticity, first proposed by Santos Silva and Tenreyro (2006). Our gravity model includes trade among 211 exporter and 104 importer countries, in 18 food industry sectors.Gravity model, Trade Elasticity, Food trade, International Relations/Trade,
Why Legislators are Protectionists: the Role of Majoritarian Voting in Setting Tariffs
Get PDFBased on the observation that industries are often geographically concentrated, this paper proposes a new political economy model of trade protection. We associate the sectors of a specific factors model with electoral districts populated by continua of heterogeneous voters who differ in their relative factor endowments. We show how strategic delegation leads each district to elect a representative who is more protectionist than the median voter. The legislature formed by these representatives then sets tariffs that are strictly positive. Introducing additional policy instruments reveals a trade-off between efficiency and regional targetability. --trade policy,political economy,representative democracy
Inflationary rigidities and stabilization policies
Get PDFLatin American countries provide the best living laboratory to study inflationary processes and stabilization programs. The purpose of this paper is to analyze the experience with orthodox stabilization policies, which are based on a tight fiscal stance and not supported by a system of price controls. The analysis of these policies is structured as follows. Part I analyzes in detail the question of why purely orthodox policies were especially effective in stopping hyperinflation as opposed to chronic inflation processes. Part II turns to chronic inflation countries and analyzes three basic types of stabilization. The first type is based almost exclusively on fiscal adjustment. The second considers programs which employ nominal anchors in conjunction with fiscal adjustments. The third type examines the exchange rate based stabilizations which often evolve out of a monetary-fiscal package. In the final part of the paper, the authors consider the long run view which extends beyond specific programs and emphasizes the importance of persistence in fiscal discipline and in adherence to nominal anchors.Environmental Economics&Policies,Inflation,Banks&Banking Reform,Economic Stabilization,Economic Theory&Research
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