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Mandavia R, Parmar D, Ahmed MN, Berber V, Sanz D, Paulucci B, D'Souza AR. An Overview of Rhinoplasty Practices: European Academy of Facial Plastic Surgery, Collaborative Cross-Sectional Study. Facial Plast Surg 2024; 40:31-35. [PMID: 36787791 DOI: 10.1055/a-2034-8397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
This collaborative European Academy of Plastic Surgery (EAFPS) study aimed to provide an overview of rhinoplasty practices, informing clinician and patient decision making. It is a multicenter cross-sectional study, reported as per Strengthening the Reporting of Observational Studies in Epidemiology guidelines. All EAFPS members were contacted via email, inviting them to participate. Members expressing an interest to participate were asked to anonymously complete a questionnaire, related to rhinoplasties that they performed as first/supervising surgeon over a period from January 1, 2019 to January 1, 2022. A descriptive analysis was performed. One hundred and fifteen surgeons submitted data on 41,259 rhinoplasties from 33 countries. Eighty percent of rhinoplasties were primary, and 20% were secondary. Thirty five percent of primary rhinoplasties were closed and 65% were open. Thirty one percent of primary rhinoplasties were for cosmetic indications, 11% functional and 58% were for both. Of the 8147 secondary rhinoplasties, 44% were closed and 56% were open. Thirty percent were for cosmetic indications, 11% functional, and 59% for both cosmetic and functional. Ninety-one percent of rhinoplasties were performed by ENT surgeons, 3% by plastic surgeons, 5% by maxillofacial surgeons, and 1% were dual (maxillofacial and ENT) trained. One-thousand seven-hundred thirty primary rhinoplasties underwent revision surgery (5%) and 102 secondary rhinoplasties underwent revision surgery (1%). The most commonly reported indications for revision surgery were dorsal asymmetry, nasal blockage, and dissatisfaction with nasal tip. Three percent of rhinoplasties underwent preoperative psychological assessment. To the authors knowledge, this is the largest published rhinoplasty dataset. This study provides an overview of rhinoplasty practices that can be used for benchmarking and to guide clinician and patient decision making. Psychological assessment of prerhinoplasty appears insufficient with higher levels recommended to minimize unsuccessful outcomes. This study showcases the power of collaborative research and may serve as a catalyst for future collaborative facial plastic surgery research.
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Affiliation(s)
- R Mandavia
- Department of ENT, Head and Neck Surgery, University College London Hospitals, NHS Trust, London, United Kingdom
| | - D Parmar
- Bedfordshire Hospitals NHS Foundation Trust, Luton, United Kingdom
| | - M N Ahmed
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - V Berber
- Department of Otolaryngology, Ege University, Izmir, Turkey
| | - D Sanz
- Miguel Servet University Hospital, Zaragoza, Spain
| | - B Paulucci
- Royal Free NHS Trust, London, United Kingdom
| | - A R D'Souza
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust UK, London, United Kingdom
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Srivastava S, Bertone MP, Parmar D, Walsh C, De Allegri M. The genesis of the PM-JAY health insurance scheme in India: technical and political elements influencing a national reform towards universal health coverage. Health Policy Plan 2023:czad045. [PMID: 37436821 DOI: 10.1093/heapol/czad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
Many countries are using health insurance to advance progress towards universal health coverage (UHC). India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY) health insurance scheme in 2018. We examine the political economy context around PM-JAY policy formulation, by examining the perspectives of policy stakeholders shaping decisions around the reform. More specifically, we focus on early policy design at the central (national) level. We use a framework on the politics of UHC reform proposed by Fox and Reich (The politics of universal health coverage in low- and middle-income countries: A framework for evaluation and action. J. Health Polit. Policy Law 2015;40:1023-1060), to categorize the reform into phases and examine the interactions between actors, institutions, interests, ideas and ideology which shaped reform decisions. We interviewed 15 respondents in Delhi between February and April 2019, who were either closely associated with the reform process or subject experts. The ruling centre-right government introduced PM-JAY shortly before national elections, drawing upon policy legacies from prior and state insurance schemes. Empowered policy entrepreneurs within the government focused discourse around ideas of UHC and strategic purchasing, and engaged in institution building leading to the creation of the National Health Authority and State Health Agencies through policy directives, thereby expanding state infrastructural and institutional power for insurance implementation. Indian state inputs were incorporated in scheme design features like mode of implementation, benefit package and provider network, while features like the coverage amount, portability of benefits and branding strategy were more centrally driven. These balanced negotiations opened up political space for a cohesive, central narrative of the reform and facilitated adoption. Our analysis shows that the PM-JAY reform focused on bureaucratic rather than ideological elements and that technical compromises and adjustments accommodating the interests of states enabled the political success of policy formulation. Appreciating these politics, power and structural issues shaping PM-JAY institutional design will be important to understand how PM-JAY is implemented and how it advances UHC in India.
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Affiliation(s)
- S Srivastava
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
| | - M P Bertone
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland EH21 6UU, UK
| | - D Parmar
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, Strand, London WC2R 2LS, UK
| | - C Walsh
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
| | - M De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Baden-Württemberg 69120, Germany
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Blyuss O, Dibden A, Massat NJ, Parmar D, Cuzick J, Duffy SW, Sasieni P. A case-control study to evaluate the impact of the breast screening programme on breast cancer incidence in England. Cancer Med 2023; 12:1878-1887. [PMID: 35851849 PMCID: PMC9883434 DOI: 10.1002/cam4.5004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is uncertainty about overdiagnosis in mammography screening. METHODS We aimed to estimate the effect of screening on breast cancer incidence and overdiagnosis in the NHS Breast Screening Programme in England. The study included 57,493 cases and 105,653 controls, with cases defined as women diagnosed at ages 47-89 with primary breast cancer, invasive or ductal carcinoma in situ, in 2010 or 2011. Where possible, two controls were selected per case, matched on date of birth and screening area. Conditional logistic regression was used to estimate the effect of screening on breast cancer risk, with adjustment for potential self-selection bias. Results were combined with national incidence data to estimate absolute rates of overdiagnosis. Overdiagnosis was calculated as the cumulative excess of cancers diagnosed in the age group 50-77 in a woman attending three-yearly screening between ages 50 and 70 compared with a woman attending no screens. RESULTS The estimated number of cases overdiagnosed in women attending all screens in the programme was 679.3 per 100,000 without adjustment for self-selection bias and 261.2 per 100,000 with adjustment. These corresponded to an estimated 9.5% of screen-detected cancers overdiagnosed without adjustment and 3.7% with adjustment for self-selection. CONCLUSIONS The NHS Breast Screening Programme in England confers at worst modest levels of overdiagnosis.
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Affiliation(s)
- Oleg Blyuss
- Centre for Prevention, Detection, and Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Amanda Dibden
- Centre for Prevention, Detection, and Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Nathalie J. Massat
- Centre for Prevention, Detection, and Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Dharmishta Parmar
- Centre for Prevention, Detection, and Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Jack Cuzick
- Centre for Prevention, Detection, and Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Stephen W. Duffy
- Centre for Prevention, Detection, and Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Peter Sasieni
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
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Castanon A, Parmar D, Massat NJ, Sasieni P, Duffy SW. Benefit of Biennial Fecal Occult Blood Screening on Colorectal Cancer in England: A Population-Based Case-Control Study. J Natl Cancer Inst 2022; 114:1262-1269. [PMID: 35575409 PMCID: PMC9468279 DOI: 10.1093/jnci/djac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/23/2021] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The English national bowel cancer screening program offering a guaiac fecal occult blood test began in July 2006. In randomized controlled trials of guaiac fecal occult blood test screening, reductions in mortality were accompanied by reductions in advanced stage colorectal cancer (CRC). We aimed to evaluate the effect of participation in the national bowel cancer screening program on stage-specific CRC incidence as a likely precursor of a mortality effect. METHODS In this population-based case-control study, cases were individuals diagnosed with CRC aged 60-79 years between January 1, 2012, and December 31, 2013. Two controls per case were matched on geographic region, gender, date of birth, and year of first screening invitation. Screening histories were extracted from the screening database. Conditional logistic regression with correction for self-selection bias was used to estimate odds ratios (odds ratios corrected for self-selection bias [cOR]) and 95% confidence intervals (CIs) by Duke stage, sex, and age. RESULTS 14 636 individuals with CRC and 29 036 without were eligible for analysis. The odds of CRC (any stage) were increased within 30 days of a screening test and decreased thereafter. No reduction in CRC (any stage) among screened individuals compared with those not screened was observed (cOR = 1.00, 95% CI = 0.89 to 1.15). However, screened individuals had lower odds of Duke stage D CRC (cOR = 0.68, 95% CI = 0.50 to 0.93). We estimate 435 fewer Duke D CRC by age 80 years in 100 000 people screened biennially between ages 60 and 74 years compared with an unscreened cohort. CONCLUSION The impact of colorectal screening on advanced CRC incidence suggests that the program will meet its aim of reducing mortality.
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Affiliation(s)
- Alejandra Castanon
- Cancer Prevention Group, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Dharmishta Parmar
- Centre for Prevention, Detection and Diagnosis,Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nathalie J Massat
- Centre for Prevention, Detection and Diagnosis,Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Peter Sasieni
- Cancer Prevention Group, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis,Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Parmar D, Rodriguez-Gutierrez R, González-González J, Shaikh F, Cruz-López J. Efficacy and safety of saroglitazar 4 mg compared to fenofibrate 160 mg in latino adults with moderate to severe hypertriglyceridemia-a randomized clinical trial. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Laake JP, Vulkan D, Quaife SL, Hamilton WT, Martins T, Waller J, Parmar D, Sasieni P, Duffy SW. Targeted encouragement of GP consultations for possible cancer symptoms: a randomised controlled trial. Br J Gen Pract 2021; 71:e339-e346. [PMID: 33875418 PMCID: PMC8087296 DOI: 10.3399/bjgp20x713489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND For some common cancers, survival is lower in the UK than in comparable high-income countries. AIM To assess the effectiveness of a targeted postal intervention (to promote awareness of cancer symptoms and earlier help seeking) on patient consultation rates. DESIGN AND SETTING A two-arm randomised controlled trial was carried out on patients aged 50-84 years registered at 23 general practices in rural and urban areas of Greater London, Greater Manchester, and the North East of England. METHOD Patients who had not had a consultation at their general practice in the previous 12 months and had at least two other risk factors for late presentation with cancer were randomised to intervention and control arms. The intervention consisted of a posted letter and leaflet. Primary outcome was the number of consultations at the practice with patients randomised to each arm in the 6 months subsequent to posting the intervention. All patients with outcome data were included in the intention-to-treat analyses. RESULTS In total, 1513 patients were individually randomised to the intervention (n = 783) and control (n = 730) arms between Nov 2016 - May 2017; outcome data were available for 749 and 705 patients, respectively, with a statistically significantly higher rate of consultation in the intervention arm compared with the control arm: 436 versus 335 consultations (relative risk 1.40, 95% confidence interval = 1.11 to 1.77, P = 0.004). There was, however, no difference in the numbers of patients consulting. CONCLUSION Targeted interventions of this nature can change behaviour; there is a need to develop interventions that can be more effective at engaging patients with primary care. This study demonstrates that targeted interventions promoting both awareness of possible cancer symptoms and earlier health seeking, can change behaviour. There is a need to develop and test interventions that can be more effective at engaging the most at-risk patients.
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Affiliation(s)
- Jean-Pierre Laake
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; medical student, Warwick Medical School, University of Warwick, Coventry
| | - Daniel Vulkan
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London; senior research fellow, Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London
| | | | | | - Jo Waller
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London; reader in cancer behavioural science, School of Cancer & Pharmaceutical Sciences, King's College London, London
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
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Maroni R, Massat NJ, Parmar D, Dibden A, Cuzick J, Sasieni PD, Duffy SW. A case-control study to evaluate the impact of the breast screening programme on mortality in England. Br J Cancer 2021; 124:736-743. [PMID: 33223536 PMCID: PMC7884709 DOI: 10.1038/s41416-020-01163-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Over the past 30 years since the implementation of the National Health Service Breast Screening Programme, improvements in diagnostic techniques and treatments have led to the need for an up-to-date evaluation of its benefit on risk of death from breast cancer. An initial pilot case-control study in London indicated that attending mammography screening led to a mortality reduction of 39%. METHODS Based on the same study protocol, an England-wide study was set up. Women aged 47-89 years who died of primary breast cancer in 2010 or 2011 were selected as cases (8288 cases). When possible, two controls were selected per case (15,202 controls) and were matched by date of birth and screening area. RESULTS Conditional logistic regressions showed a 38% reduction in breast cancer mortality after correcting for self-selection bias (OR 0.62, 95% CI 0.56-0.69) for women being screened at least once. Secondary analyses by age group, and time between last screen and breast cancer diagnosis were also performed. CONCLUSIONS According to this England-wide case-control study, mammography screening still plays an important role in lowering the risk of dying from breast cancer. Women aged 65 or over see a stronger and longer lasting benefit of screening compared to younger women.
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Affiliation(s)
- Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Nathalie J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Amanda Dibden
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Peter D Sasieni
- Faculty of Life Sciences and Medicine, Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Campus, Great Maze Pond, London, SE1 9RT, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Duffy S, Vulkan D, Cuckle H, Parmar D, Sheikh S, Smith R, Evans A, Blyuss O, Johns L, Ellis I, Sasieni P, Wale C, Myles J, Moss S. Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: long-term follow-up of the UK Age RCT. Health Technol Assess 2020; 24:1-24. [PMID: 33141657 PMCID: PMC7681269 DOI: 10.3310/hta24550] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There remains disagreement on the long-term effect of mammographic screening in women aged 40-49 years. OBJECTIVES The long-term follow-up of a randomised controlled trial that offered annual mammography to women aged 40-49 years. The estimation of the effect of these mammograms on breast cancer and other-cause mortality, and the effect on incidence, with implications for overdiagnosis. DESIGN An individually randomised controlled trial comparing offering annual mammography with offering usual care in those aged 40-48 years, and thus evaluating the effect of annual screening entirely taking place before the age of 50 years. There was follow-up for an average of 23 years for breast cancer incidence, breast cancer death and death from other causes. We analysed the mortality and incidence data by Poisson regression and estimated overdiagnosis formally using Markov process models. SETTING Twenty-three screening units in England, Wales and Scotland within the NHS Breast Screening Programme. PARTICIPANTS Women aged 39-41 years were recruited between 1990 and 1997. After exclusions, a total of 53,883 women were randomised to undergo screening (the intervention group) and 106,953 women were randomised to have usual care (the control group). INTERVENTIONS The intervention group was invited to an annual breast screen with film mammography, two view at first screen and single view thereafter, up to and including the calendar year of their 48th birthday. The control group received no intervention. Both groups were invited to the National Programme from the age of 50 years, when screening is offered to all women in the UK. MAIN OUTCOME MEASURES The main outcome measures were mortality from breast cancers diagnosed during the intervention phase of the trial (i.e. before the first National Programme screen at 50 years), mortality from all breast cancers diagnosed after randomisation, all-cause mortality, mortality from causes other than breast cancer, and the incidence of breast cancer. RESULTS There was a statistically significant 25% reduction in mortality from breast cancers diagnosed during the intervention phase at 10 years' follow-up (relative rate 0.75, 95% confidence interval 0.58 to 0.97; p = 0.03). No reduction was observed thereafter (relative rate 0.98, 95% confidence interval 0.79 to 1.22). Overall, there was a statistically non-significant 12% reduction (relative rate 0.88, 95% confidence interval 0.74 to 1.03; p = 0.1). The absolute benefit remained approximately constant over time, at one death prevented per 1000 women screened. There was no effect of intervention on other-cause mortality (relative rate 1.02, 95% confidence interval 0.97 to 1.07; p = 0.4). The intervention group had a higher incidence of breast cancer than the control group during the intervention phase of the trial, but incidence equalised immediately on the first National Programme screen at the age of 50-52 years. LIMITATIONS There was 31% average non-compliance with screening and three centres had to cease screening for resource and capacity reasons. CONCLUSIONS Annual mammographic screening at the age of 40-49 years resulted in a relative reduction in mortality, which was attenuated after 10 years. It is likely that digital mammography with two views at all screens, as practised now, could improve this further. There was no evidence of overdiagnosis in addition to that which already results from the National Programme carried out at later ages. FUTURE WORK There is a need for research on the effects of modern mammographic protocols and additional imaging in this age group. TRIAL REGISTRATION Current Controlled Trials ISRCTN24647151. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 55. See the NIHR Journals Library website for further project information. Other funding in the past has been received from the Medical Research Council, Cancer Research UK, the Department of Health and Social Care, the US National Cancer Institute and the American Cancer Society.
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Affiliation(s)
- Stephen Duffy
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Daniel Vulkan
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Howard Cuckle
- Department of Obstetrics and Gynaecology, Tel Aviv University, Tel Aviv, Israel
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Shama Sheikh
- Cancer Prevention Group, King's College London, London, UK
| | - Robert Smith
- Cancer Screening, American Cancer Society, Atlanta, GA, USA
| | - Andrew Evans
- Division of Cancer Research, University of Dundee, Dundee, UK
| | - Oleg Blyuss
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Louise Johns
- Cancer Prevention Group, King's College London, London, UK
| | - Ian Ellis
- Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Peter Sasieni
- Cancer Prevention Group, King's College London, London, UK
| | - Chris Wale
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Sue Moss
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
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Duffy SW, Vulkan D, Cuckle H, Parmar D, Sheikh S, Smith RA, Evans A, Blyuss O, Johns L, Ellis IO, Myles J, Sasieni PD, Moss SM. Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial): final results of a randomised, controlled trial. Lancet Oncol 2020; 21:1165-1172. [PMID: 32800099 PMCID: PMC7491203 DOI: 10.1016/s1470-2045(20)30398-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40-48 years on breast cancer mortality. METHODS We did a randomised, controlled trial involving 23 breast screening units across Great Britain. We randomly assigned women aged 39-41 years, using individual randomisation, stratified by general practice, in a 1:2 ratio, to yearly mammographic screening from the year of inclusion in the trial up to and including the calendar year that they reached age 48 years (intervention group), or to standard care of no screening until the invitation to their first National Health Service Breast Screening Programme (NHSBSP) screen at approximately age 50 years (control group). Women in the intervention group were recruited by postal invitation. Women in the control group were unaware of the study. The primary endpoint was mortality from breast cancers (with breast cancer coded as the underlying cause of death) diagnosed during the intervention period, before the participant's first NHSBSP screen. To study the timing of the mortality effect, we analysed the results in different follow-up periods. Women were included in the primary comparison regardless of compliance with randomisation status (intention-to-treat analysis). This Article reports on long-term follow-up analysis. The trial is registered with the ISRCTN registry, ISRCTN24647151. FINDINGS 160 921 women were recruited between Oct 14, 1990, and Sept 24, 1997. 53 883 women (33·5%) were randomly assigned to the intervention group and 106 953 (66·5%) to the control group. Between randomisation and Feb 28, 2017, women were followed up for a median of 22·8 years (IQR 21·8-24·0). We observed a significant reduction in breast cancer mortality at 10 years of follow-up, with 83 breast cancer deaths in the intervention group versus 219 in the control group (relative rate [RR] 0·75 [95% CI 0·58-0·97]; p=0·029). No significant reduction was observed thereafter, with 126 deaths versus 255 deaths occurring after more than 10 years of follow-up (RR 0·98 [0·79-1·22]; p=0·86). INTERPRETATION Yearly mammography before age 50 years, commencing at age 40 or 41 years, was associated with a relative reduction in breast cancer mortality, which was attenuated after 10 years, although the absolute reduction remained constant. Reducing the lower age limit for screening from 50 to 40 years could potentially reduce breast cancer mortality. FUNDING National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Daniel Vulkan
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Howard Cuckle
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Shama Sheikh
- Cancer Prevention Group, King's College London, London, UK
| | | | - Andrew Evans
- Division of Cancer Research, University of Dundee, Dundee, UK
| | - Oleg Blyuss
- School of Physics, Astronomy, and Mathematics, University of Hertfordshire, Hatfield, UK; Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Louise Johns
- Cancer Prevention Group, King's College London, London, UK
| | - Ian O Ellis
- Division of Cancer and Stem Cells, University of Nottingham, Nottingham, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Sue M Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Abstract
Objectives To determine how many women participate in all three recommended cancer screening programmes (breast, cervical, and bowel). During their early 60s, English women receive an invitation from all the three programmes. Methods For 3060 women aged 60–65 included in an England-wide breast screening case–control study, we investigated the number of screening programmes they participated in during the last invitation round. Additionally, using the Fingertips database curated by Public Health England, we explored area-level correlations between participation in the three cancer screening programmes and various population characteristics for all 7014 English general practices with complete data. Results Of the 3060 women, 1086 (35%) participated in all three programmes, 1142 (37%) in two, 526 (17%) in one, and 306 (10%) in none. Participation in all three did not appear to be a random event (p < 0.001). General practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes. Conclusions Only a minority of English women is concurrently protected through all recommended cancer screening programmes. Future studies should consider why most women participate in some but not all recommended screening.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Oleg Blyuss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Paediatrics, Sechenov University, Moscow, Russia
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Sharma AC, Srivastava RN, Srivastava SR, Agrahari A, Singh A, Parmar D. Evaluation of the association between a single-nucleotide polymorphism of bone morphogenetic proteins 5 gene and risk of knee osteoarthritis. J Postgrad Med 2019; 63:151-156. [PMID: 28695869 PMCID: PMC5525478 DOI: 10.4103/jpgm.jpgm_450_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Osteoarthritis (OA) is a chronic degenerative disorder probably affected by both genetic and environmental causes. Bone morphogenetic proteins (BMPs) are bone-derived factors that can induce new bone formation. Single-nucleotide polymorphisms (SNPs) of BMP5 gene alters the transcriptional activity of the BMP5 promoter that has been involved in OA susceptibility. This case–control study investigated the association of rs1470527 and rs9382564 SNP of BMP5 gene with susceptibility to knee OA (KOA). Materials and Methods: A total of 499 cases with radiographic KOA and 458 age- and sex-matched healthy controls were enrolled. Venous blood samples were obtained from all the cases as well as controls for polymerase chain reaction-restriction fragment length polymorphism. Results: The genotype distribution for rs1470527 and rs9382564 SNP was significantly different in cases and controls (P < 0.0001). Within both the SNPs of BMP5 gene, genotype CT and TT were significantly (P < 0.0001) associated with KOA as compared to the CC genotype. T allele of both the studied SNP was significantly associated with KOA (P < 0.0001). The allele frequencies of rs1470527 were 0.56(T) and 0.44(C) in cases and 0.33(T) and 0.67(C) in controls and in rs9382564 were 0.57(C) and 0.43(T) in cases and 0.71(C) and 0.29(T) in controls. Further in relation with clinical severity of OA, we observed signification association of TT genotype with both visual analog scale (P < 0.0001) and Western Ontario and McMaster Universities score (P < 0.05). Conclusion: Our results indicate significant association of rs1470527 and rs9382564 polymorphism of BMP5 gene with KOA.
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Affiliation(s)
- A C Sharma
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R N Srivastava
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S R Srivastava
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A Agrahari
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A Singh
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Parmar
- Developmental Toxicology Division, IITR, Lucknow, Uttar Pradesh, India
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Mudawal A, Srivastava A, Singh A, Shankar J, Yadav S, Mishra M, Singh PK, Khanna VK, Parmar D. Corrigendum to 'Proteomic approaches to investigate age related vulnerability to lindane induced neurodegenerative effects in rats' [Food Chem. Toxicol.] 115 (2018) 499-510. Food Chem Toxicol 2019; 133:110752. [PMID: 31431304 DOI: 10.1016/j.fct.2019.110752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Mudawal
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India; Academy of Scientific & Innovative Research (AcSIR), New Delhi, India
| | - A Srivastava
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - A Singh
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - J Shankar
- Microscopy Laboratory, CSIR-Indian Institute of Toxicology Research, Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - S Yadav
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - M Mishra
- Plant Molecular Biology Laboratory, CSIR-National Botanical Research Institute, Rana Pratap Marg, Lucknow, 226 001, India
| | - P K Singh
- Plant Molecular Biology Laboratory, CSIR-National Botanical Research Institute, Rana Pratap Marg, Lucknow, 226 001, India
| | - V K Khanna
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India
| | - D Parmar
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (IITR), Vishvigyan Bhavan, 31, M.G. Marg, Lucknow, 226 001, U.P., India.
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Parmar D, Krishnappa M, Arifahmed F, Mali N, Patel J, Shah M, Parmar K, Shah C, Faldu K. A Clinical Trial To Evaluate The Safety And Efficacy Of Saroglitazar Compared To Fenofibrate In Patients With Dyslipidemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Parmar D, Kansagra K. MON-318 A PHASE II TRIAL TO ASSESS SAFETY, TOLERABILITY AND EFFICACY OF PHD-2 INHIBITOR (DESIDUSTAT-ZYAN1) IN THE TREATMENT OF ANEMIA IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.
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Affiliation(s)
- N. Khan
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - D. Parmar
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - M. S. Ibrahim
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - B. Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - F. S. Haddad
- University College London Hospitals NHS Foundation Trust, The Princess Grace Hospital, and the NIHR Biomedical Research Centre at UCLH, London, UK
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Yadav S, Parmar D. Cys144Arg & Tyr358Cys variants (alleles *2 & *3) of CYP2C9 gene: Effect on chemotherapeutic outcomes in HNSCC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy438.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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He J, Fuelscher I, Coxon J, Barhoun P, Parmar D, Enticott P, Hyde C. Impaired motor inhibition in developmental coordination disorder. Brain Cogn 2018; 127:23-33. [DOI: 10.1016/j.bandc.2018.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/09/2018] [Accepted: 09/11/2018] [Indexed: 01/30/2023]
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18
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Rebolj M, Assi V, Brentnall A, Parmar D, Duffy SW. Addition of ultrasound to mammography in the case of dense breast tissue: systematic review and meta-analysis. Br J Cancer 2018; 118:1559-1570. [PMID: 29736009 PMCID: PMC6008336 DOI: 10.1038/s41416-018-0080-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mammography is less effective in detecting cancer in dense than in fatty breasts. METHODS We undertook a systematic search in PubMed to identify studies on women with dense breasts who underwent screening with mammography supplemented with ultrasound. A meta-analysis was undertaken on the proportion of cancers detected only by ultrasound, out of all screen-detected cancers, and the proportion of women with negative mammography who were referred for assessment following ultrasound screening. RESULTS Twenty-nine studies satisfied our inclusion criteria. The proportion of total cancers detected only by ultrasound was 0.29 (95% CI: 0.27-0.31), consistent with an approximately 40% increase in the detection of cancers compared to mammography. In the studied populations, this translated into an additional 3.8 (95% CI: 3.4-4.2) screen-detected cases per 1000 mammography-negative women. About 13% (32/248) of cancers were in situ from 17 studies with information on this subgroup. Ultrasound approximately doubled the referral for assessment in three studies with these data. CONCLUSIONS Studies have consistently shown an increased detection of breast cancer by supplementary ultrasound screening. An inclusion of supplementary ultrasound into routine screening will need to consider the availability of ultrasound and diagnostic assessment capacities.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Valentina Assi
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Adam Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Bandyopadhyay M, Chakraborty A, Rotti C, Joshi J, Patel H, Yadav A, Shah S, Tyagi H, Parmar D, Sudhir D, Gahlaut A, Bansal G, Soni J, Pandya K, Pandey R, Yadav R, Nagaraju MV, Mahesh V, Pillai S, Sharma D, Singh D, Bhuyan M, Mistry H, Parmar K, Patel M, Patel K, Prajapati B, Shishangiya H, Vishnudev M, Bhagora J. Indian Test Facility (INTF) and its updates. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/823/1/012001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Bhatia S, Parmar D. 364PD Head & neck cancer pharmacogenetics: case control study on 5- fluorouracil and cisplatin adjuvant treatment outcome. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw587.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Massat NJ, Dibden A, Parmar D, Cuzick J, Sasieni PD, Duffy SW. Impact of Screening on Breast Cancer Mortality-Response. Cancer Epidemiol Biomarkers Prev 2016; 25:873. [PMID: 27197146 DOI: 10.1158/1055-9965.epi-16-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nathalie J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Amanda Dibden
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Peter D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
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22
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Massat NJ, Dibden A, Parmar D, Cuzick J, Sasieni PD, Duffy SW. Impact of Screening on Breast Cancer Mortality: The UK Program 20 Years On. Cancer Epidemiol Biomarkers Prev 2016; 25:455-62. [PMID: 26646362 DOI: 10.1158/1055-9965.epi-15-0803] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND With changes in diagnosis, treatment, and management of breast cancer since the mammography screening trials, there is a need to evaluate contemporary breast screening programs. A case-control study was set up to assess the current impact of attendance in the English Breast Screening Program on breast cancer mortality. METHODS Cancer registry cases who died from primary breast cancer ages 47 to 89 years in London in 2008 to 2009 (869 women) were matched to 1 or 2 general population controls (1,642 women) with no diagnosis of breast cancer at the time of the case's diagnosis, who were alive at the case's death. Cases and controls were matched for date of birth and screening area, and had been invited to breast screening at least once prior to the case's diagnosis. ORs were estimated using conditional logistic regression. Self-selection bias was addressed using contemporaneous attendance at the cervical screening program. Sensitivity analyses were undertaken to assess the likely effect of lead time bias. RESULTS Attendance at breast screening resulted in a breast cancer mortality reduction of 39% [OR, 0.61; 95% confidence interval (CI), 0.44-0.85] after self-selection correction. Attendance in the last 3 years prior to diagnosis resulted in a 60% mortality reduction (OR, 0.40; 95% CI, 0.31-0.51). Lead time bias effects were negligible. CONCLUSION Our results suggest that community breast screening programs provide their expected benefit in terms of reducing the risk of breast cancer death among women participating. IMPACT Mammography is an important tool for reducing breast cancer mortality and its impact could be increased by encouraging regular attendance.
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Affiliation(s)
- Nathalie J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Amanda Dibden
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Peter D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, England.
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Massat NJ, Sasieni PD, Tataru D, Parmar D, Cuzick J, Duffy SW. Explaining the Better Prognosis of Screening-Exposed Breast Cancers: Influence of Tumor Characteristics and Treatment. Cancer Epidemiol Biomarkers Prev 2016; 25:479-87. [PMID: 26646361 DOI: 10.1158/1055-9965.epi-15-0804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/01/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In England, population mammographic screening has been offered to women for over 20 years. Overall decrease in breast cancer mortality rates and improvements in cancer awareness and organization of medical care over this period call for a more current evaluation of the mediators behind the better prognosis of screening-exposed breast cancers. METHODS A case-control study was conducted within the English National Breast Screening Program. Women who died from primary breast cancer in 2008 to 2009 were matched (by year of birth, screening invitation, and area) to controls that received a diagnosis of invasive breast cancer at the time of the case diagnosis but survived the case death. Data were analyzed by unconditional logistic regression with adjustment for matching factors. RESULTS The unadjusted OR for dying from breast cancer associated with ever having attended breast screening was 0.44 [95% confidence interval (CI), 0.33-0.58]. After adjustment for lead time, overdiagnosis, and self-selection, the OR increased to 0.69 (95% CI, 0.50-0.94). Adjusting for tumor size, lymph node status, stage, grade, histopathology, and laterality accounted for all the screening effect (OR, 1.00; 95% CI, 0.71-1.40). Further adjustment for treatment factors only had a minimal impact on the OR (OR, 1.02; 95% CI, 0.72-1.45). CONCLUSIONS Our results suggest that earlier diagnosis, as reflected by tumor characteristics, remains the major mediator of the improvement in breast cancer survival due to participation in mammographic screening. IMPACT Mammographic screening continues to prevent breast cancer-related deaths in the epoch of adjuvant systemic therapy.
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Affiliation(s)
- Nathalie J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Peter D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Daniela Tataru
- National Cancer Intelligence Network (NCIN), Public Health England, London, United Kingdom
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
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Duffy SW, Dibden A, Michalopoulos D, Offman J, Parmar D, Jenkins J, Collins B, Robson T, Scorfield S, Green K, Hall C, Liao XH, Ryan M, Johnson F, Stevens G, Kearins O, Sellars S, Patnick J. Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol 2016; 17:109-14. [PMID: 26655422 PMCID: PMC4691349 DOI: 10.1016/s1470-2045(15)00446-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/29/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The value of screen detection and treatment of ductal carcinoma in situ (DCIS) is a matter of controversy. At present, the extent to which the diagnosis and treatment of DCIS could prevent the occurrence of invasive breast cancer in the future is not clear. We sought to estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen. METHODS We obtained aggregate data for screen-detected cancers from 84 local screening units within 11 regional Quality Assurance Reference Centres in England, Wales, and Northern Ireland from the National Health Service Breast Screening Programme. Data for DCIS diagnoses were obtained for women aged 50-64 years who were invited to and attended mammographic breast screening from April 1, 2003, to March 31, 2007 (4 screening years). Patient-level data for interval cancer arising in the 36 months after each of these were analysed by Poisson regression with invasive interval cancer screen detection rate as the outcome variable; DCIS detection frequencies were fitted first as a continuous and then as a categorical variable. We repeated this analysis after adjustment with both small size and high-grade invasive screen-detected cancers. FINDINGS We analysed data for 5,243,658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 0·54-3·56] [corrected to] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient -0·084 [95% CI -0·13 to -0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers. INTERPRETATION The association between screen-detected DCIS and subsequent invasive interval cancers suggests that detection and treatment of DCIS is worthwhile in prevention of future invasive disease. FUNDING UK Department of Health Policy Research Programme and NHS Cancer Screening Programmes.
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MESH Headings
- Aged
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Early Detection of Cancer
- Female
- Humans
- Incidence
- Mammography
- Middle Aged
- Retrospective Studies
- Time Factors
- United Kingdom/epidemiology
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Affiliation(s)
- Stephen W Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK.
| | - Amanda Dibden
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Dimitrios Michalopoulos
- Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Judith Offman
- Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Dharmishta Parmar
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Jacquie Jenkins
- East Midlands QARC, Nottingham University Hospital City Campus, Nottingham, UK
| | | | | | | | | | | | | | | | | | | | - Olive Kearins
- West Midlands QARC, Public Health Building, University of Birmingham, Birmingham, UK
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Yadav S, Parmar D, Chauhan V. 492P G681A & G636A variants (alleles *2 & *3) of CYP2C19 gene: Susceptibility to oral cancer and chemotherapeutic outcomes. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv533.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bhaskar B, Mullany D, Parmar D, Ziengenfuss M, Shekar K. Successful conservative management of an iatrogenic ECMO cannula--related inferior vena cava injury. Anaesth Intensive Care 2015; 43:418-419. [PMID: 25943619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Yadav S, Chauhan V, Parmar D. Pharmacogenetics & Treatment Outcome in Cancer Patients Receiving Radio-Chemotherapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv045.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sawke GK, Parmar D, Sawke N. Diagnostic application of computerised nuclear morphometric image analysis in fine needle aspirates of breast lesions. Saudi J Health Sci 2015. [DOI: 10.4103/2278-0521.151409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Massat NJ, Sasieni PD, Parmar D, Duffy SW. An ongoing case-control study to evaluate the NHS Bowel Cancer Screening Programme. BMC Cancer 2014; 14:945. [PMID: 25495609 PMCID: PMC4320602 DOI: 10.1186/1471-2407-14-945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Colorectal cancer is the third most common cause of cancer death in both males and females in England. A national bowel cancer screening programme was rolled out in England between 2006 and 2010. In the post-randomised controlled trials epoch, assessment of the impact of the programme using observational studies is needed. This study protocol was set up at the request of the UK Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis to evaluate the effect of the current bowel cancer screening programme on incidence of advanced primary colorectal cancer. METHODS/DESIGN All incident cases of primary colorectal cancer in England will be included. Cases will be matched to controls with respect to sex, age, area of registration and year of first invitation to screening. Each evaluation round will cover a 2-year period, starting from January 2012, and ongoing thereafter. In the first instance, a pilot will be carried out in a single region. Variables related to colorectal tumour pathology will be obtained to enable selection and matching of cases and controls, and to allow analyses stratification by anatomical subsite within the bowel. Cases at Duke's stage B or worse will be considered as "advanced stage". The influence of sex will also be investigated. The incidence ratio observed in randomised controlled trials between controls (not invited) and non-attender invitees will be used to correct for self-selection bias overall. Screening participation at other national screening programmes (cervical, breast) will also be collected to derive a more contemporaneous adjustment factor for self-selection bias and assess consistency in self-selection correction in female patients.Full ethical approval was obtained from the Health Research Authority. DISCUSSION The case-control design is potentially prone to a number of biases. The size of the planned study, the design specifications and the development of analytical strategies to cope with bias should enable us to obtain accurate estimates of reduction in incidence of advanced stage disease. The results of analyses by sex and anatomical subsite may highlight the potential need for sex-specific recommendations in the programme.
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Affiliation(s)
- Nathalie J Massat
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter D Sasieni
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dharmishta Parmar
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Stephen W Duffy
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts’ and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Shankleman J, Massat NJ, Khagram L, Ariyanayagam S, Garner A, Khatoon S, Rainbow S, Rangrez S, Colorado Z, Hu W, Parmar D, Duffy SW. Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas. Br J Cancer 2014; 111:1440-7. [PMID: 24983374 PMCID: PMC4183836 DOI: 10.1038/bjc.2014.363] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/08/2014] [Accepted: 06/09/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Uptake of bowel cancer screening is lowest in London, in populations of lower socio-economic status, and in particular ethnic or religious groups. METHODS We report on the evaluation of two interventions to improve uptake in an area including populations of low socio-economic status and considerable ethnic diversity. The interventions were face-to-face health promotion on bowel cancer screening at invitees' general practice and health promotion delivered by telephone only. Nine large general practices in East London were chosen at random to offer face-to-face health promotion, and nine other large practices to offer telephone health promotion, with 24 practices of similar size as comparators. Data at practice level were analysed by Mann-Whitney-Wilcoxon tests and grouped-logistic regression. RESULTS There were 2034 invitees in the telephone intervention practices, 1852 in the face-to-face intervention practices and 5227 in the comparison practices. Median gFOBt kit uptake in the target population (aged 59-70) was 46.7% in the telephone practices, 43.8% in the face-to-face practices and 39.1% in the comparison practices. Significant improvements in the odds of uptake were observed following telephone intervention in both males (OR=1.39, 95% CI=1.20-1.61, P<0.001) and females (OR=1.49, 95% CI=1.29-1.73, P<0.001), while the face-to-face intervention mainly impacted uptake in males (OR=1.23, 95% CI=1.10-1.36), P<0.001) but did not lead to a significant increase in females (OR=1.12, 95% CI=0.96-1.29, P=0.2). CONCLUSIONS Personally delivered health promotion improved uptake of bowel cancer screening in areas of low socio-economic status and high ethnic diversity. The intervention by telephone appears to be the most effective method.
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Affiliation(s)
- J Shankleman
- Public Health, London Borough of Tower Hamlets, 4th Floor Mulberry Place, 5 Clove Crescent, London E14 1BY, UK
| | - N J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - L Khagram
- NHS Bowel Cancer Screening Programme Newham, Tower Hamlets and City & Hackney Strategic Commissioning and Community Public Health Partnerships, 4th Floor Westside, Newham Dockside, 1000 Dockside Road, London E16 2QU, UK
| | - S Ariyanayagam
- NHS England, London Region, Southside, 105 Victoria Street, London SW1E 6QT, UK
| | - A Garner
- NHS City & Hackney Clinical Commissioning Group, Lawson practice, Nuttal Street, London N1 5HZ, UK
| | - S Khatoon
- NHS Newham Clinical Commissioning Group, Warehouse K, 2 Western Gateway, London E16 1DR, UK
| | - S Rainbow
- Bowel Cancer Screening Programme London Hub, North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK
| | - S Rangrez
- North East London Bowel Cancer Screening Programme, Homerton University Hospital Trust, Homerton Row, London E9 6SR, UK
| | - Z Colorado
- Community Links Trust, 105 Barking Road, London E16 4HQ, UK
| | - W Hu
- Community Links Trust, 105 Barking Road, London E16 4HQ, UK
| | - D Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - S W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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Yadav S, Pant M, Parmar D. Association of Cytochrome P450 2D6 (Cyp2D6) Polymorphisms with Susceptibility to Head & Neck Squamous Cell Carcinoma & Treatment Response. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Massat N, Tataru D, Parmar D, Sasieni P, Duffy S. Case Fatality in Breast Cancer: Relative Effect of Attendance at Breast Screening and Cancer Treatment. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Paul S, Chaudhuri T, Pant MC, Parmar D, Srivastava K. Association of cytochrome P450 2C9 polymorphism with locally advanced head and neck squamous cell carcinoma and response to concurrent cisplatin-based radical chemoradiation. South Asian J Cancer 2014; 3:154-8. [PMID: 25136521 PMCID: PMC4134605 DOI: 10.4103/2278-330x.136771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims: The aim of the present study is to investigate the association between polymorphism of cytochrome P450 2C9 (CYP2C9) enzyme with head and neck squamous cell carcinoma (HNSCC) and response in patients receiving cisplatin-based radical chemoradiation (CT-RT). Materials and Methods: Four hundred and sixty patients suffering from locally advanced HNSCC and an equal number of healthy controls were genotyped for CYP2C9*2 and CYP2C9*013, leading to poor metabolizers (PMs) by polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP). Each case was assessed thoroughly for treatment response as per the World Health Organization (WHO) criteria. Results and Analysis: The frequency of heterozygous genotypes of both CYP2C9*2 (27.8%) and CYP2C9*3 (25%) were found to be significantly higher in the HNSCC cases as compared to the healthy controls. Tobacco intake in the form of chewing or smoking and alcohol intake resulted in several folds increase in the risk to HNSCC in the cases carrying variant genotypes of CYP2C9*2 or CYP2C9*013. Further, majority of the cases assessed for response (n = 436) carrying variant alleles of CYP2C9*2 (69.6%) or CYP2C9*3 (65.2%) were found to respond poorly to cisplatin-based radical CT-RT. Conclusion: The data suggests a significant association of the CYP2C9 polymorphism with HNSCC and treatment outcome underlining the importance of pretherapeutic genotyping in determining the treatment protocol.
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Affiliation(s)
- Sayan Paul
- Department of Radiotherapy, Chhatrapati Shahuji Maharaj Medical University, Formerly, King George's Medical University, Lucknow, India
| | - Tamojit Chaudhuri
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - M C Pant
- Department of Radiotherapy, Chhatrapati Shahuji Maharaj Medical University, Formerly, King George's Medical University, Lucknow, India
| | - D Parmar
- Department of Developmental Toxicology and Environmental Epidemiology, Indian Institute of Toxicology and Research, Lucknow, Uttar Pradesh, India
| | - Kirti Srivastava
- Department of Radiotherapy, Chhatrapati Shahuji Maharaj Medical University, Formerly, King George's Medical University, Lucknow, India
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Shukla A, Mohapatra TM, Parmar D, Seth K. Neuroprotective potentials of neurotrophin rich olfactory ensheathing cell's conditioned media against 6OHDA-induced oxidative damage. Free Radic Res 2014; 48:560-71. [PMID: 24528157 DOI: 10.3109/10715762.2014.894636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
On the basis of recent reports, we propose that impaired neurotrophin signaling (PI3k/Akt), low antioxidant levels, and generation of reactive oxygen species (ROS) conjointly participate in the progressive events responsible for the dopaminergic cell loss in Parkinson's disease (PD). In the present study we tried to target these deficits collectively through multiple neurotrophic factors (NTFs) support in the form of Olfactory Ensheathing Cell's Conditioned Media (OEC CM) using human SH-SY5Y neuroblastoma cell line exposed to 6 hydroxydopamine (6OHDA). 6OHDA exposure induced, oxidative stress-mediated apoptotic cell death viz. enhanced ROS generation, diffused cytosolic cytochrome c (cyt c), impaired Bcl-2: Bax levels along with decrease in GSH content. These changes were accompanied by loss in Akt phosphorylation and TH levels in SH-SY5Y cells. OEC CM significantly checked apoptotic cell death by preserving pAkt levels which coincided with enhanced GSH and suppressed oxidative injury. Functional integrity of OEC CM supported cells was evident by maintained tyrosine hydroxylase (TH) expression. Intercepting Akt signaling by specific inhibitor LY294002 blocked the protective effect. Taken together our findings provide important evidence that the key to protective effect of multiple NTF support via OEC CM is enhanced Akt survival signaling which promotes antioxidant defense leading to suppression of oxidative damage.
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Affiliation(s)
- A Shukla
- Indian Institute of Toxicology Research (CSIR), Developmental Toxicology Division , Lucknow , India
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Dibden A, Offman J, Parmar D, Jenkins J, Slater J, Binysh K, McSorley J, Scorfield S, Cumming P, Liao XH, Ryan M, Harker D, Stevens G, Rogers N, Blanks R, Sellars S, Patnick J, Duffy SW. Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme. Br J Cancer 2014; 110:560-4. [PMID: 24366303 PMCID: PMC3915134 DOI: 10.1038/bjc.2013.778] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/13/2013] [Accepted: 11/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of two-view mammography at incident (subsequent) screens in the National Health Service Breast Screening Programme (NHSBSP) has led to an increased number of cancers detected at screen. However, the effect of two-view mammography on interval cancer rates has yet to be assessed. METHODS Routine screening and interval cancer data were collated from all screening programmes in the United Kingdom for women aged 50-64, screened between 1 April 2003 and 31 March 2005. Interval cancer rates were compared based on whether two-view mammography was in use at the last routine screen. RESULTS The reduction in interval cancers following screening using two-view mammography compared with one view was 0.68 per 1,000 women screened. Overall, this suggests the introduction of two-view mammography at incident screen was accompanied by a 15-20% reduction in interval cancer rates in the NHSBSP. CONCLUSION The introduction of two-view mammography at incident screens is associated with a reduction in incidence of interval cancers. This is consistent with previous publications on a contemporaneous increase in screen-detected cancers. The results provide further evidence of the benefit of the use of two-view mammography at incident screens.
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Affiliation(s)
- A Dibden
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - J Offman
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - D Parmar
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - J Jenkins
- East Midlands Quality Assurance Reference Centre (QARC), Nottingham University Hospital City Campus, Hucknall Road, Nottingham NG5 1PB, UK
| | - J Slater
- East of England QARC, 2nd Floor, Compass House, Chivers Way, Vision Park, Histon, Cambridge CB24 9AD, UK
| | - K Binysh
- London QARC, 1st Floor, 51/53 Bartholomew Close, London EC1A 7BE, UK
| | - J McSorley
- Northern Ireland QARC, 18 Ormeau Avenue, Belfast BT2 8HS, UK
| | - S Scorfield
- North East, Yorkshire and the Humber QARC, Waterfront 4, Goldcrest Way, Newburn Riverside Newcastle upon Tyne, NE15 8NY, UK
| | - P Cumming
- North West QARC, Hollinwood Business Centre, Albert Street, Oldham OL8 3QL, UK
| | - X-H Liao
- South Central QARC, 4150 Chancellor Court, Oxford Business Park South, Oxford OX4 2GX, UK
| | - M Ryan
- South East Coast QARC, 77a High Street, Battle, East Sussex TN33 0AG, UK
| | - D Harker
- South West QARC, 1st Floor, Grosvenor House, 149 Whiteladies Road, Clifton, Bristol BS8 2RA, UK
| | - G Stevens
- Public Health Wales, 18 Cathedral Road, Cardiff CF11 9LJ, UK
| | - N Rogers
- West Midlands Breast Screening QARC, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - R Blanks
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - S Sellars
- NHS Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
| | - J Patnick
- NHS Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
| | - S W Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
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Massat NJ, Sasieni PD, Parmar D, Duffy SW. An ongoing case-control study to evaluate the NHS breast screening programme. BMC Cancer 2013; 13:596. [PMID: 24330588 PMCID: PMC3866937 DOI: 10.1186/1471-2407-13-596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/04/2013] [Indexed: 11/22/2022] Open
Abstract
Background In England, a national breast screening programme (NHSBSP) has been in place since 1988, and assessment of its impact on breast cancer incidence and mortality is essential to ensure that the programme is indeed doing more good than harm. This article describes large observation studies designed to estimate the effects of the current programme in terms of the benefits on breast cancer incidence and mortality and detrimental effect in terms of overdiagnosis. The case-control design of the cervical screening programme evaluation was highly effective in informing policy on screening intervals and age ranges. We propose innovative selection of cases and controls and gathering of additional variables to address new outcomes of interest and develop new methodologies to control for potential sources of bias. Methods/Design Traditional case-control evaluation of breast screening uses women who have died from breast cancer as cases, and women known to be alive at the time of case death as controls. Breast screening histories prior to the cases’ date of first diagnosis are compared. If breast screening is preventing mortality from breast cancer, cases will be characterised by a lesser screening history than controls. All deaths and incident cases of primary breast cancer in England within each 2-year study period will be included in this ongoing evaluation. Cases will be age- and area-matched to controls and variables related to cancer treatment and breast tumour pathology will be obtained to investigate the interplay between screening and treatment, and the effect of screening on incidence of advanced stage disease. Screening attendance at other national screening programmes will also be collected to derive superior adjustment for self-selection bias. The study is registered and has received full ethics approval.
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Affiliation(s)
| | | | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine - Room 009, Queen Mary University of London, London EC1M 6BQ, UK.
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Umranikar A, Parmar D, Davies S, Fountain S. Multiple births following in vitro fertilization treatment: redefining success. Eur J Obstet Gynecol Reprod Biol 2013; 170:299-304. [DOI: 10.1016/j.ejogrb.2013.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/13/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
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Sturgess DJ, Parmar D, Dulhunty JM, Hedge R, Jarrett P, Udy A. A preliminary evaluation of plasma b-type natriuretic peptide as a screening test for left ventricular diastolic dysfunction in non-cardiac intensive care. Anaesth Intensive Care 2013; 41:591-5. [PMID: 23977909 DOI: 10.1177/0310057x1304100503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Left ventricular filling and thus diastolic function are frequently monitored and managed in critical care. However, scant data exist regarding possible screening tests for diastolic dysfunction in the intensive care unit (ICU). The present study aimed to evaluate plasma b-type natriuretic peptide (BNP) as a marker of diastolic dysfunction in a single-centre cohort of 'non-cardiac' ICU patients. The ICU is non-cardiac in that it provides mixed medical/surgical services with the exception of cardiology, cardiac surgery and solid organ transplantation. Clinical data were recorded over the first 24 hours of ICU stay for 32 consecutive patients. Transthoracic echocardiogram and blood collection for BNP assay were then performed. Diastolic dysfunction was demonstrated in 34% (n=11). Mean ± standard deviation BNP values were higher with diastolic dysfunction (238 ± 195 vs 72 ± 78 pg/ml; P=0.003). A BNP threshold of >43 pg/ml yielded a sensitivity of 80% and a specificity of 59%; area under the receiver operating characteristic curve was 0.82. BNP correlated independently with E/e' (R=0.425; P=0.015) (E/e': peak early transmitral velocity [E]/early diastolic mitral annular velocity [e']) but not left ventricular ejection fraction (P=0.8), illness severity (Acute Physiological and Chronic Health Evaluation II; P=0.3) or fluid balance (P=0.4). Diastolic dysfunction was common in this cohort of non-cardiac ICU patients and was independently associated with a significantly higher BNP. The potential application as a screening test for diastolic dysfunction is likely to require a threshold lower than previously proposed for heart failure.
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Affiliation(s)
- D J Sturgess
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Offman J, Wilson M, Lamont M, Birke H, Kutt E, Marriage S, Loughrey Y, Hudson S, Hartley A, Smith J, Eckersley B, Dungey F, Parmar D, Patnick J, Duffy SW. A randomised trial of weekend and evening breast screening appointments. Br J Cancer 2013; 109:597-602. [PMID: 23867998 PMCID: PMC3738129 DOI: 10.1038/bjc.2013.377] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/19/2013] [Accepted: 06/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: There is a need to research interventions that improve access to and convenience of breast cancer screening services. Methods: We conducted a randomised trial comparing invitations to out-of-hours appointments with standard office hour appointments. Women who were to be invited for routine breast screening were randomised (3 : 1 : 1 : 1) to one of these screening invitations: standard office hour appointment, office hour appointment with the option to change to an out-of-hours appointment, weekday evening appointment, or weekend appointment. Results: A total of 9410 women were invited to an office hour, 3519 to an office hour with the option to change, 3271 to a weekday evening, and 3162 to a weekend appointment. The offer of an initial out-of-hours appointment was associated with a non-significant decrease in attendance rates (73.7% vs 74.1%). The highest attendance was observed in the group offered an initial office hour appointment with the option to change to out-of-hours (76.1% vs 73.3% for standard office hour, P=0.001), with 7% of invitees exercising the option to change. Conclusion: The optimum strategy for improving attendance at breast screening is to offer a traditional office hour appointment and including in the letter of invitation an option to change to an evening or weekend appointment if wished.
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Affiliation(s)
- J Offman
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London EC1M 6BQ, UK
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Duffy SW, Parmar D. Overdiagnosis in breast cancer screening: the importance of length of observation period and lead time. Breast Cancer Res 2013; 15:R41. [PMID: 23680223 PMCID: PMC3706885 DOI: 10.1186/bcr3427] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/15/2013] [Accepted: 05/16/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Overdiagnosis in breast cancer screening is a controversial topic. One difficulty in estimation of overdiagnosis is the separation of overdiagnosis from lead time that is the advance in the time of diagnosis of cancers, which confers an artificial increase in incidence when a screening programme is introduced. METHODS We postulated a female population aged 50-79 with a similar age structure and age-specific breast cancer incidence as in England and Wales before the screening programme. We then imposed a two-yearly screening programme; screening women aged 50-69, to run for twenty years, with exponentially distributed lead time with an average of 40 months in screen-detected cancers. We imposed no effect of the screening on incidence other than lead time. RESULTS Comparison of age- and time-specific incidence between the screened and unscreened populations showed a major effect of lead time, which could only be adjusted for by follow-up for more than two decades and including ten years after the last screen. From lead time alone, twenty-year observation at ages 50-69 would confer an observed excess incidence of 37%. The excess would only fall below 10% with 25 years or more follow-up. For the excess to be nullified, we would require 30 year follow-up including observation up to 10 years above the upper age limit for screening. CONCLUSION Studies using shorter observation periods will overestimate overdiagnosis by inclusion of cancers diagnosed early due to lead time among the nominally overdiagnosed tumours.
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Affiliation(s)
- Stephen W Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Dharmishta Parmar
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London, EC1M 6BQ, UK
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Shukla A, Mohapatra TM, Agrawal AK, Parmar D, Seth K. Salsolinol induced apoptotic changes in neural stem cells: amelioration by neurotrophin support. Neurotoxicology 2013; 35:50-61. [PMID: 23261589 DOI: 10.1016/j.neuro.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/14/2012] [Accepted: 12/14/2012] [Indexed: 11/20/2022]
Abstract
Salsolinol (SAL), a catechol isoquinoline has invited considerable attention due to its structural similarity with dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Its high endogenous presence in Parkinsonian brain implicated its possible association with the disease process. SAL is also present in alcohol beverages and certain food materials and can get access to brain especially in conditions of immature or impaired BBB. Besides this, the effect of SAL on neural stem cells (NSCs) which are potential candidates for adult neurogenesis and transplantation mediated rejuvenating attempts for Parkinson's disease (PD) brain has not been known so far. NSCs in both the cases have to overcome suppressive cues of diseased brain for their survival and function. In this study we explored the toxicity of SAL toward NSCs focusing on apoptosis and status of PI3K survival signaling. NSCs cultured from embryonic day 11 rat fetal brain including those differentiated to TH(+ve) colonies, when challenged with SAL (1-100μM), elicited a concentration and time dependent cell death/loss of mitochondrial viability. 10μM SAL on which significant mitochondrial impairment initiated was further used to study mechanism of toxicity. Morphological impairment, enhanced TUNEL positivity, cleaved caspase-3 and decreased Bcl-2:Bax suggested apoptosis. Sal toxicity coincided with reduced pAkt level and its downstream effectors: pCREB, pGSK-3β, Bcl-2 and neurotrophins GDNF, BDNF suggesting repressed PI3K/Akt signaling. Multiple neurotrophic factor support in the form of Olfactory Ensheathing Cell's Conditioned Media (OEC CM) potentially protected NSCs against SAL through activating PI3K/Akt pathway. This was confirmed on adding LY294002 the PI3K inhibitor which abolished the protection. We inferred that SAL exerts substantial toxicity toward NSCs. These findings will lead to better understanding of endogenous threats that might affect the fate of transplanted NSCs and their probable antidotes.
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Affiliation(s)
- A Shukla
- Indian Institute of Toxicology Research (CSIR), Developmental Toxicology Division, Mahatma Gandhi Marg, Post Box 80, Lucknow 226 001, India; Department of Microbiology, IMS, Banaras Hindu University, Varanasi 221 005, India
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Parmar D, De Allegri M, Savadogo G, Sauerborn R. Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso. Health Policy Plan 2013; 29:76-84. [DOI: 10.1093/heapol/czs136] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- J. Kumar
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
| | - A. Kumar
- School of BiochemistryDevi Ahilya VishwavidyalayaIndoreIndia
| | - S.P. Singh
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
| | - J.K. Roy
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
| | - A. Lalit
- Department of Biochemistry and GeneticsBarkatullah UniversityBhopalIndia
| | - D. Parmar
- Department of Biochemistry and GeneticsBarkatullah UniversityBhopalIndia
| | - N.C. Sharma
- Department of Biochemistry and GeneticsBarkatullah UniversityBhopalIndia
| | - R. Tuli
- National Agri‐Food Biotechnology InstituteMohali160071PunjabIndia
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Gassmann T, Arambhadiya B, Beaumont B, Baruah U, Bonicelli T, Darbos C, Purohit D, Decamps H, Albajar F, Gandini F, Henderson M, Kazarian F, Lamalle P, Omori T, Parmar D, Patel A, Rathi D, Singh N. High voltage power supplies for ITER RF heating and current drive systems. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 Suppl 1:1-203. [PMID: 21356004 DOI: 10.1111/j.1471-0528.2010.02847.x] [Citation(s) in RCA: 624] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.
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Parmar D, Hauman CHJ, Leichter JW, McNaughton A, Tompkins GR. Bacterial localization and viability assessment in human ex vivo dentinal tubules by fluorescence confocal laser scanning microscopy. Int Endod J 2011; 44:644-51. [PMID: 21352240 DOI: 10.1111/j.1365-2591.2011.01867.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To develop a convenient method for the localization and quantification of live and dead bacteria in human ex vivo mineralized dentinal tubules. METHODOLOGY The roots from human single-rooted teeth (n = 12) were infected with Enterococcus faecalis V583 and either treated with calcium hydroxide paste or left untreated; six control roots were uninoculated and untreated. Following further incubation, roots were stained with fluorescent DNA-binding reagents, washed thoroughly, sectioned and examined by confocal laser scanning microscopy. Computer-assisted determinations of fluorescence (bacterial viability) were compared statistically. RESULTS Bacteria were distributed in the tubules throughout the length of the roots but tubule penetration distance was slightly reduced in the apical sections. There was no significant difference in bacterial tubule penetration between roots from different teeth and small standard deviations indicated reproducibility appropriate for experimental application. Following treatment with calcium hydroxide paste, live and dead bacteria were readily distinguishable by contrasting green and red fluorescence. Bacterial viability determinations amongst roots treated in the same way were not significantly different, and the small standard deviation is commensurate with experimental application. CONCLUSIONS Fluorescent viability staining is a convenient, accurate and reproducible method for localizing and quantifying live and dead bacteria in human ex vivo mineralized dentinal tubules.
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Affiliation(s)
- D Parmar
- Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand
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Paul S, Parmar D, Pant MC, Verma J. Association and treatment response to capecitabine-based chemoradiotherapy with CYP2C9 polymorphism in head and neck cancer. Indian J Cancer 2011; 48:223-9. [DOI: 10.4103/0019-509x.82899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Souares A, Savadogo G, Dong H, Parmar D, Sié A, Sauerborn R. Using community wealth ranking to identify the poor for subsidies: a case study of community-based health insurance in Nouna, Burkina Faso. Health Soc Care Community 2010; 18:363-368. [PMID: 20180867 DOI: 10.1111/j.1365-2524.2009.00905.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Access to health-care is low in developing countries. Poor people are less likely to seek care than those who are better off. Community-based health insurance (CBI) aims to improve healthcare utilisation by removing financial barriers, unfortunately CBI has been less effective in securing equity than expected. Poor people, who probably require greater protection from catastrophic health expenses, are less likely to enrol in such schemes. Therefore, it is important to implement targeted interventions so that the most in need are not left out. CBI has been offered to a district in Burkina Faso, comprising 7762 households in 41 villages and the district capital of Nouna since 2004. Community wealth ranking (CWR) was used in 2007 to identify the poorest quintile of households who were subsequently offered insurance at half the usual premium rate. The CWR is easy to implement and requires minimal resources such as interviews with local informants. As used in this study, the agreement between the key informants was more (37.5%) in the villages than in Nouna town (27.3%). CBI management unit only received nine complaints from villagers who considered that some households had been wrongly identified. Among the poorest, the annual enrolment increased from 18 households (1.1%) in 2006 to 186 (11.1%) in 2007 after subsidies. CWR is an alternative methodology to identify poor households and was found to be more cost and time efficient compared to other methods. It could be successfully replicated in low-income countries with similar contexts. Moreover, targeted subsidies had a positive impact on enrolment.
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Affiliation(s)
- A Souares
- Department of Tropical Hygiene and Public Health, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, Germany.
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Singh M, Shukla R, Khanna V, Parmar D. Genetic polymorphism in susceptibility genes for PD. Neurosci Res 2007. [DOI: 10.1016/j.neures.2007.06.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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