Cost-effectiveness of the Danish smoking cessation interventions

The cost-effectiveness of smoking cessation interventions is well documented. However, most studies are based on randomized controlled trials (RCTs) and provide little information on the differences between subgroups. This study assessed the relative cost-effectiveness of smoking cessation interventions offered to various subgroups of smokers, based on real-life data. Regression analyses provided information on the factors determining abstinence and costs and led to the formation of relevant subgroups of smokers. Probabilistic Markov modeling was then used to estimate the relative cost-effectiveness of smoking cessation interventions for the entire database population and for the subgroups compared to a no-intervention case. The ICER for the base case population was estimated at €1,358. This is consistent with results from the existing literature. Group simulations showed lower ICERs for men, hospitals, and light smokers and falling ICERs with increasing age. Despite differences in the cost-effectiveness ratios between subgroups our results do not justify any kind of subgroup differentiation in a smoking prevention policy.     

Do clinical databases render population-based cancer registers obsolete? The example of breast cancer in Denmark

Objective: Clinical databases have been invented to monitor treatment outcomes, therapies or diseases, often in great detail. The traditional population-based cancer registry has been invented to collect a minimum of information about all incident cancers. Do clinical databases render population-based cancer registers obsolete as sources of cancer cases for epidemiological study? Methods: We compared the study base of first incident breast cancer cases in Denmark in 1978–1994 known from the national cancer register and from the national clinical database on breast cancer patients. The clinical database is used for monitoring protocoled treatment. Results: Combining the two data sources we found 48,522 first primary breast cancers in Denmark 1978–1994. Of these, 37,640 were included in both data sources, 2151 were included only in the clinical database, and 8731 were included only in the cancer register. A major part of the difference between the two data sources was due to treatment-focused data collection in the clinical database, and a minor part due to differences in the registration of second primaries, date of diagnosis and invasiveness. Conclusions: Cancer incidence data are sensitive to registration procedures and definitions. Clinical cancer databases cannot generally replace the traditional cancer register as a reliable data source for incident cancer cases in a national population.     

Dual stimulation using corifollitropin alfa in 54 Bologna criteria poor ovarian responders – a case series

Research question

What are the reproductive outcomes of Bologna criteria poor responders undergoing dual stimulation (DuoStim) and subsequent cryopreserved embryo transfer?

Hydrogels for Site-Specific Drug Delivery to the Colon: In Vitro and in Vivo Degradation

Novel hydrogels based on N,N-dimethylacrylamide, N-t-butylacrylamide, and acrylic acid cross-linked with azoaromatic compounds of varying length and electron density of the azo bond were synthesized. The cross-links are degradable by microbial azoreductases present predominantly in the colon, and the gels appear to be suitable for colon-specific drug delivery. The degradability in vitro and in vivo was found to be related to the degree of swelling of the gels. The higher the degree of swelling, the higher the degradability. However, structural and electronic factors were also shown to influence reduction of azo bonds.     

Formation,bioavailability and organoleptic properties of an inclusion complex of femoxetine with β-cyclodextrin

Femoxetine, a new selective serotonin uptake inhibitor with antidepressant properties, possesses a very bitter taste which hinders the development of oral liquid formulations. The present study has shown that it is possible to improve the organoleptic properties by inclusion complexation of the drug with β-cyclodextrin. Phase solubility diagrams and UV-spectroscopic studies revealed the formation of 1 :1 and 1: 2 inclusion complexes, the strongest complex being obtained for femoxetine in free-base form. A microcrystalline inclusion complex was isolated and shown to have the stoichiometric composition of 1: 2 (femoxetine: β-cyclodextrin). In a single dose cross-over study in 5 volunteers, the bioavailability of the solid complex formulated as an aqueous suspension was found to be similar to that observed for a sugar-coated tablet of femoxetine hydrochloride.     

Oestrogen receptor content and cancer cell/stroma ratio in mammary carcinoma

In a study of 86 human breast cancers the volume fraction of the neoplastic epithelium was estimated semiquantitatively and a significant association was found between the oestrogen receptor (ER) content and volume fraction of cancer cells of tumours (p less than 0.00001). Tumours with very low cellularity could thus be falsely ER negative. When quantitative ER concentration is used to predict the response of tumours to hormonal therapy the cellularity of tumours should be taken in consideration. The cellularity was not related to ER positivity. Although a correlation was seen between the contents of oestrogen and progesterone (PR) receptors, no correlation between PR content and volume fraction of the neoplastic epithelium was observed.     

Prognostic and predictive value of changes in tumour cell proliferation in locally advanced breast cancer primarily treated with doxorubicin

We previously reported that high tumour cell proliferation evaluated by Ki-67 expression, high mitotic frequency and high histological grade were associated with resistance to primary doxorubicin monotherapy in locally advanced breast cancer harbouring wild-type (wt) TP53. The aim of our present study was to evaluate the predictive and prognostic impact of proliferation parameters assessed in tumour tissue obtained after chemotherapy, and alterations induced in tumour cell proliferation. While we found a significant reduction in Ki-67 expression and mitotic frequency in tumours with wtTP53 (p=0.001 and p=0.008, respectively), no significant change was recorded in tumours expressing mutant TP53. For histological grade there was no significant change in either group. There was a direct correlation between pre- and post-treatment values for Ki-67 and mitotic frequency in tumours harbouring wtTP53 (p=0.0001 for both), but no correlation in tumours harbouring mutated TP53. High post-treatment Ki-67 expression and mitotic frequency were found to predict doxorubicin resistance only in patients with wtTP53 (p=0.04 and p=0.03, respectively). The prognostic importance of proliferation markers and histological grade was found to be similar whether they were determined in the pre- or post-treatment samples (Ki-67; pre: p=0.02; post: p=0.03; mitotic frequency; p=0.002 and p=0.01, respectively; histological grade; p=0.0001 and p=0.002, respectively). While the reduction in mitotic frequency was associated with improved survival (p=0.03), no significant associations between changes in other parameters and outcome were recorded.     

Impact of rapid socio-economic changes on teenage pregnancies in Estonia during 1992-2001

BACKGROUND: Major socio-economic changes, including health care reforms and changes in the school curriculum, took place in Estonia after the country regained its independence in 1991. These changes affected people's reproductive behavior in many ways. In this article, the impact of the changes on the reproductive behavior of teenage girls, measured by adolescent fertility and abortion rates between 1992 and 2001, is analyzed. METHODS: National data on abortions and births were obtained from official medical statistics, particularly from the Estonian Abortion Registry and the Estonian Medical Birth Registry. Female population denominators for the age group 15-19 were obtained from the Statistical Office of Estonia. RESULTS: In teenagers, the birth rate decreased more than two times, from 49.7 per 1000 in 1992 to 23.8 per 1000 in 2001. The abortion rate per 1000 decreased from 55.5 in 1992 to 30.4 in 2001. Compared with all women of fertile age (15-49 years), at the beginning of the decade, teenagers decided more often to have a baby, and, at the end of the decade, they decided more often to terminate the pregnancy. Two-thirds of all pregnancies in teenagers end in abortion--either legally induced abortion (legal abortion and therapeutic abortion) or spontaneous abortion. In 2001, the abortion ratio was 116.4 among ethnic Estonians and 147.9 among non-Estonians. CONCLUSIONS: The case in Estonia again proves that the availability of information, contraceptives, services and education, and the existence of other goals in life besides childbearing, have an impact on teenage birth and abortion rates. Successful health promotion activities should take into consideration the differences in the reproductive behavior of different ethnic groups.