Suchergebnisse

ABSTRACT
ObjectivesTo determine whether cancer diagnostic pathways and survival are affected by access to GP practice, diagnostic centre and cancer treatment centre.
Cancer treatment in the UK is generally delivered in large cancer centres within major cities. This could have a detrimental effect on outcomes for people from rural areas who develop cancer. Historical UK studies suggest distance from services affects cancer outcomes. In recent years several developments, such as cancer networks and suspected cancer referral pathways, have occurred within the UK NHS, which may have reduced earlier inequalities. It is currently unknown whether a persons' geographical location within the UK has implications for the timeliness of their receipt of a diagnosis and treatment for cancer.
ApproachRoutine clinical data from Scottish Morbidity Record (SMR) 01, Scottish Cancer Registry SMR 06, and Geographical Information Systems (GIS) derived measures of road distances and travelling times from key healthcare facilities have been linked to a clinical tracking database, NHS Grampian Cancer Care Pathway to form the Northeast and Aberdeen Scotland Cancer and Residence (NASCAR) database. This linkage provided a retrospective cohort of 13 702 people diagnosed with cancer since 2007.
Logistic regression analyses have been conducted to determine the effect of distance from services on provider delays and survival at one year following diagnosis.
ResultsOf the 13 702 patients included in the analysis the mean age was 67.4 ± 13 years and 45% were male. The highest proportion of patients lived within one mile of their GP practice (35.5%), less than five miles from their diagnostic centre (39.6%) and less than five miles from their cancer treatment centre (39.6%).
Distance to GP practice or distance to diagnostic centre was not a significant predictor of timely treatment (treatment within 62 days of GP referral) or survival at one year following diagnosis.
Increased distance to cancer treatment centre predicted shorter timely treatment intervals (5-9 miles [OR 1.50; CI 1.18-1.90], 10-29 miles [OR 1.09; CI0.90-1.31], 30-59 miles [OR 1.26; CI 1.05-1.52], > 60 miles [OR 1.72; CI 1.41-2.09]. Increased distance to treatment centre > 60 miles was associated with quicker times between diagnosis and receipt of treatment [OR 1.26; CI 1.12-1.42).
ConclusionsIncreased distance to cancer treatment centre is associated with shorter treatment intervals. There was no association between likelihood of metastatic disease at diagnosis or survival at one year. Analysis is on-going into travelling times to services and may provide further insight.

Purpose. This study evaluated the consistency of cardiovascular health information in popular women's magazines against the American Heart Association's (AHA) guidelines for nutrition, physical activity, weight management, and smoking. Design. Six issues of four publications, Cosmopolitan, Glamour, Vogue, and Shape (24 total) were reviewed for inclusion. Setting. Content analysis was performed by two independent raters on 162 articles (283 instances of priority-related information). Measures. Articles were rated using a questionnaire developed from the AHA-recommended priorities. Analysis. Results are presented primarily in qualitative form, supplemented by analyses of variance and correlation significance tests when appropriate. Results. Physical activity was the most common topic, followed by nutrition, weight management, and cigarette smoking. Information about weight management was less consistent than other areas. Although publications varied widely in the frequency of coverage, there was no significant difference among them in overall consistency of the information. No articles gave information directly contrary to the AHA recommendations. Limitations include the subjective nature of the content analysis and the limited number of publications and time period for review. Conclusion. Women are receiving information related to diet, exercise, weight management, and cigarette smoking in popular magazines. However, the information is variable to the extent that it is consistent with evidence-based prevention guidelines.

Data from Northeast Scotland for 11,803 cancer patients (diagnosed 2007-13) were linked to UK Censuses to explore relationships between hospital travel-time, timely-treatment and one-year-mortality, adjusting for both area and individual-level socioeconomic status (SES). Adjusting for area-based SES, those living >60 minutes from hospital received timely-treatment more often than those living <15 minutes. Substituting individual-level SES changed little. Adjusting for area-based SES those living >60 minutes from hospital died within one year more often than those living <15 minutes. Again, substituting individual-level SES changed little. In Northeast Scotland distance to services, rather than individual SES, likely explains poorer rural cancer survival.
Background and objectiveThe Northeast and Aberdeen Scottish Cancer and Residence (NASCAR) study found rural-dwellers are treated quicker but more likely to die within a year of a cancer diagnosis. A potential confounder of the relationship between geography and cancer mortality is socioeconomic status (SES). We linked the original NASCAR cohort to the UK Censuses of 2001 and 2011, at an individual level, to explore the relationship between travel time to key healthcare facilities, timely cancer treatment and one-year mortality adjusting for both area and individual-level markers of socioeconomic status.
MethodsA data linkage study of 11803 patients examined the association between travel times, timely treatment and one-year mortality with adjustment for area, and for individual-level, markers of socioeconomic status.
ResultsFollowing adjustment for area-based SES measures those living more than 60 minutes from the cancer treatment centre were significantly more likely to be treated within 62 days of GP referral than those living within 15 minutes (Odds Ratio [OR]) 1.41; 95% (Confidence Interval [CI]) 1.23 , 1.60]. Replacing area-based with individual-level SES measures from UK Censuses made little impact on the results [OR 1.39; 95% CI 1.22, 1.57].
Following adjustment for area-based SES measures of socioeconomic status those living more than 60 minutes from the cancer treatment centre were significantly more likely to die within one year than those living closer by [OR 1.22; 95% CI 1.08, 1.38]. Again, replacing area-based with individual-level SES measures from UK Censuses made little impact on the result [OR 1.20; CI 1.06, 1.35].
ConclusionsDistribution of individual measures of socioeconomic status did not differ significantly between ruraland urban cancer patients. The relationship between distance to service, timely treatment and one-year survival were the same adjusting for both area-based and individual SES. Overall, it seems thatdistance to services, rather than personal characteristics, influences poorer rural cancer survival.

The current analysis was supported by a grant from Chest, Heart and Stroke Scotland. The main INTERSTROKE study was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Vastra Gotaland (Sweden), and through unrestricted grants from several pharmaceutical companies with major contributions from AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Swedish Heart and Lung Foundation, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network. The Department of Neurology at the University Duisburg-Essen received research grants awarded to H-CD from the German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, National Institutes of Health, Bertelsmann Foundation, and Heinz-Nixdorf Foundation. ; Peer reviewed ; Postprint ; Postprint ; Postprint ; Postprint

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited more than 8700 times in the literature (including citations of all annual versions). In 2009 alone, the various Statistical Updates were cited ≈1600 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year and added a new chapter detailing how family history and genetics play a role in cardiovascular disease (CVD) risk. Also, the 2011 Statistical Update is a major source for monitoring both cardiovascular health and disease in the population, with a focus on progress toward achievement of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update.