Suchergebnisse

The relationship between humans and their environment is a heavily debated, multi-disciplinary discussion that has raised awareness about urgent issues, such as climate change. Earth's booming population encourages globalization, greed, and over-consumption and has changed the basic composition of the planet, causing humans to continually possess a distorted view of their relationship to nature. This idea can be applied to the Classic Maya, as their success as a thriving civilization rested on their access to the resources around them. Around 900 CE, many of the heavily populated Maya cities were abandoned suddenly and the reason for this collapse is still heavily disputed to this day. The theory that has gained the most momentum in this debate is the drought theory. The Maya suffered a series of droughts during the Classic Maya era and the most significant was a megadrought that lasted from 800CE to 1000 CE. This particular drought had a catastrophic impact on the political stability, economic success, and societal prosperity of many of the great Maya cities. Through lake core sediment analysis, Curtis, Hodell, and Brenner observed that drought periods coincided with periods of Maya recession; a drought period at 862 ± 50 cal, yr. corresponded with the Classic Maya collapse and a drought period at 585 CE occurred during the Maya Hiatus. Both of these drought periods were times of monument decline, city abandonment, and social cataclysm (Curtis, 1996, p. 45). The megadrought that the Maya were faced with produced complete social upheaval, resulting in their eventual fall. As with any diminishing civilization, all aspects of society were under threat; the political nature of many Maya cities was ominous, economic stability disintegrated, health, happiness, and personal faith were dejected, and social contentment vanished completely. The megadrought and its fatal impact had been the driving force behind the Classic Maya collapse.

We examined the risk perception that is derived from hypothetical physician risk communications. Subjects (n= 217) completed a questionnaire on the Web for $3. Subjects were presented with four hypothetical cancer risk scenarios that included a physician risk communication in one of three risk communication formats: verbal only, verbal plus numeric probability as a percent, and verbal plus numeric probability as a fraction. In each scenario, subjects were asked to imagine themselves as the patient described and to state their perceived personal susceptibility to the cancer (i.e., risk perception) on a 0 to 100 scale, as well as responses to other measures. Subjects' risk perceptions were highly variable, spanning nearly the entire probability scale for each scenario, and the degree of variation was only slightly less in the risk communication formats in which a numeric statement of risk was provided. Subjects were more likely to overestimate than underestimate their risk relative to the stated risk in the numeric versions, and overestimation was associated with the belief that the physician minimized the risk so they wouldn't worry, innumeracy, and worry, as well as decisions about testing for the cancer. These results demonstrate significant gaps between the intended message and the message received in physician risk communications. Implications for medical decisions, patient distress, and future research are discussed.

<i>Objective:</i> To describe awareness, knowledge, and attitudes about genetic testing for cancer risk among the general public. <i>Results:</i> Thirty-eight adults participated in focus groups in West Philadelphia, Pennsylvania. Participants' beliefs about what genetic testing is ranged from 'dianetics' to an accurate description of DNA analysis. Themes included misconceptions about genetic tests, the ability to gain control of one's life through genetic testing, anxiety that might be caused by testing, risk of insurance and employment discrimination, use of genetic information for racial or ethnic discrimination, concerns about medical information confidentiality and lack of informed consent. <i>Conclusions:</i> Although there was some accurate understanding of what genetic testing is and how the results could be used, there also exist significant misconceptions. In many cases, misconceptions may be barriers to uptake of genetic testing. Dispelling these misconceptions is an important step in the translation of advances in human genomics into improvements in health.

This study investigates differences in the effects of comorbidities on survival in Medicare beneficiaries with prostate cancer. Medicare data were used to assemble a cohort of 65- to 76-year-old Black ( n = 6,402) and White ( n = 47,458) men with incident localized prostate cancer in 1999 who survived ≥1 year postdiagnosis. Comorbidities were more prevalent among Blacks than among Whites. For both races, greater comorbidity was associated with decreasing survival rates; however, the effect among Blacks was smaller than in Whites. After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comorbidities. Differential effects of comorbidities on survival were also evident when examining different classes of comorbid conditions. Adjusting for treatment had little impact on these results, despite variation in the racial difference in receipt of prostatectomy with differing comorbidity levels.

<i>Background:</i> In recent decades, extensive resources have been invested to develop cellular, molecular and genomic technologies with clinical applications that span the continuum of cancer care. <i>Methods:</i> In December 2006, the National Cancer Institute sponsored the first workshop to uniquely examine the state of health services research on cancer-related cellular, molecular and genomic technologies and identify challenges and priorities for expanding the evidence base on their effectiveness in routine care. <i>Results:</i> This article summarizes the workshop outcomes, which included development of a comprehensive research agenda that incorporates health and safety endpoints, utilization patterns, patient and provider preferences, quality of care and access, disparities, economics and decision modeling, trends in cancer outcomes, and health-related quality of life among target populations. <i>Conclusions:</i> Ultimately, the successful adoption of useful technologies will depend on understanding and influencing the patient, provider, health care system and societal factors that contribute to their uptake and effectiveness in 'real-world' settings.