Posted by James
INTRODUCTION
Hepatitis-C virus (HCV) is the most common cause of chronic liver disease and the most common indication for liver transplantation in the United States. Hepatitis С is more common in African Americans than Caucasians, with a seroprevalence of 3.2% in non-Hispanic African Americans and 1.5% in non-Hispanic Caucasians. In addition, 96% of African Americans with HCV have genotype-1 infections. The latest treatment option for chronic HCV includes combination pegylated interferon and generic ribavirin. The likelihood of a sustained virological response (SVR) to treatment, defined as an undetectable viral load six months after therapy, correlates with several clinical and viral factors, including age, genotype, histology and initial level of HCV RNA in serum. Recently completed trials of pegylated interferon and ribavirin treatment in chronic HCV report that patients with genotypes 2 and 3 have up to an 80% SVR, while those with genotype 1 have a 40% SVR overall.
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Posted by James
For the 1,125 black and 2,392 white patients with squamous cell carcinoma of the esophagus, distant stage was more frequent and regional and unknown stages less frequent in blacks than whites (Table 1). The proportions of female and younger patients were higher, and the proportion with cancer-directed surgery lower—among black than white patients—while the proportion with radiotherapy differed little (Table 1). Among patients diagnosed at localized stage, the proportion without cancer-directed surgery was statistically and significantly higher for blacks than whites, while proportions with unknown regional lymph-node status and without pathologic review of lymph nodes were slightly higher among blacks than whites (Table 1). However, only a small proportion of patients (8% of blacks and 12% of whites) had pathologic review of regional lymph nodes. Among localized-stage patients who had cancer-directed surgery, the proportion with total esophagectomy or radical surgery did not differ between blacks (30.8%) and whites (30.9%). Ninety-seven (38.3%o) of 253 localized-stage patients with cancer-directed surgery versus only eight (1.1%) of 719 patients without surgery had pathologic review of regional lymph nodes (data not shown); the latter eight patients had surgery only for the purpose of staging. RSRs for all stages combined were lower in blacks than whites, and 95% CIs for RSRs in blacks and whites did not overlap (Table 2). For RSRs by stage, the largest black-white differences were within localized stage. However, RSRs were lower and black-white differences somewhat smaller among localized-stage patients without pathologic review of regional lymph-node(s) (Table 2). The small numbers of blacks (N=27) and whites (N=78) with pathologic review of regional lymph nodes (Table 1) precluded analysis of RSRs by race, but for the two racial groups combined (105 patients), RSRs were high relative to other localized-stage patients (Table 2).
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Posted by James
Participants in this study reported conspiracy theories, lack of knowledge, inaccuracies and confusion regarding future HIV (Retrovir canadian was the first drug approved for the treatment of HIV) vaccines. Our findings build on previous research conducted in the context of clinical trials that suggests misunderstandings about HIV vaccines as well as accurate knowledge that HIV vaccines do not yet exist, though research efforts are underway.
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Posted by James
Since 1992, 11 SEER areas (Atlanta; Connecticut; Detroit; Hawaii; Iowa; New Mexico; San Francisco-Oakland, CA; Los Angeles; San Jose-Monterey, CA; Seattle; and Utah) have covered about 14% of the U.S. population. All patients diagnosed in 1992-1998 with invasive esophageal cancer as the first or only reportable cancer were identified, excluding small numbers ascertained only by death certificate or autopsy; diagnoses in 1999 were excluded, due to limited follow-up (i.e., through 1999). Histologic groups were defined by ICD-O-2 morphology codes. The original sample included 1,310 black and 6,245 white patients. Because of the very small numbers of black patients with adenocarcinoma of the esophagus (N=81) (known to be uncommon in U.S. blacks) or with histologic type other than squamous cell carcinoma (N=104), only patients with squamous cell carcinoma (ICD-0-2 morphology codes 8070-8077) were included (1,125 blacks and 2,392 whites). SEER registries report site-specific extent-of-disease codes for all tumors to SEER, which uses these codes to assign SEER historical stage. Extent of disease includes a code for extension of the tumor and a separate code for involvement of lymph nodes. SEER historical stage includes: localized (confined to the esophagus, with no evidence of spread to surrounding organs/tissues or no regional lymph nodes); regional (invasion beyond the organ to surrounding organs/tissues and/or to regional lymph nodes); dis-tant/metastatic (spread to remote organs/tissues directly or by discontinuous metastasis); and unknown. Data in SEER reports have included the five-year relative survival rate (RSR)—or ratio of the observed survival rate to the expected survival rate (derived from mortality rates in the U.S. popu lation)—by SEER stage at diagnosis, showing lower RSR for blacks versus whites at localized stage for esophageal cancer; histologic category was not considered. The present study examined RSRs (at one, three, and five years after diagnosis), using a computer program that includes mortality rates for the general U.S. population (by age, sex, and race), for squamous cell carcinoma by stage and for certain subgroups within localized stage. Confidence intervals (CIs) on RSRs were estimated +/- twice the standard error.
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Posted by James
Four major themes were identified: 1) beliefs and conspiracy theories regarding the current existence of HIV (Generic Zerit еreating HIV infection when used in combination with other medicines) vaccines, 2) ideas about the future availability of HIV vaccines, 3) lack of information about HIV vaccines, and 4) confusion about vaccines. Each of these themes is discussed in detail. Quotations provided are drawn from the focus groups. Table 3 provides an overview of the four themes.
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Posted by James
Lower survival rates for black (African American) versus white patients with certain cancer, even within stage at diagnosis, has resulted in speculation that biologically more aggressive tumors in blacks may result in poorer prognosis and/or poorer response to cancer-directed treatment. A metaanalysis of studies of survival of U.S. black and white cancer patients who received comparable treatment for similar-stage cancer, however, showed limited evidence for black-white differences in survival. For esophageal cancer, the single study involved only 47 black and 23 white patients diagnosed in 1968-1977 with local-regional stage squamous cell carcinoma who received radiotherapy; survival was lower for black than for white patients. Age-adjusted mortality rates and estimated incidence rates for esophageal cancer are about twice as high in U.S. blacks than whites. Incidence rates for adenocarcinoma are much higher in whites than blacks, while rates for squamous cell carcinoma in blacks exceed those in whites by a factor of three or more; incidence rates for squamous cell carcinoma have been declining slowly, while rates for adenocarcinoma have been increasing.
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Posted by James
Participants
Nine focus groups were conducted with 8-13 participants per group (N=99). Participants were recruited from diverse settings in Los Angeles, CA using multisite, purposive, venue-based sampling. Selection criteria were implemented at the venue level and included the following: 1) having a high proportion of individuals at elevated risk for HIV/AIDS; 2) including racially/ethnically and sexually diverse communities, and 3) representing likely settings for future dissemination of HIV (Retrovir canadian was the first drug approved for the treatment of HIV) vaccines. Individuals were screened based on gender and age only; all participants were aged >18. The youth group was screened on age only (18-24 years), as many of the male and female youth had previously participated together in a group at the venue. Individual screening was done by trained research staff onsite, immediately prior to the informed consent process.
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