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Biomedical subjects

Rachel Cooper

Publications and source records attributed to Rachel Cooper.

11 recordsLinked to original sources
PubMed2006

Cessation of hormone replacement therapy after reports of adverse findings from randomized controlled trials: evidence from a British Birth Cohort.

OBJECTIVES: We examined the cessation of hormone replacement therapy (HRT) among British women, by educational level, social class, and cardiovascular risk factors, at the time of publicity about 2 clinical trials of HRT that were halted after adverse findings. METHODS: A total of 1387 women aged 57 years reported their monthly HRT use between January 2002 and February 2003. A succession of regression-based time-series models were fitted to detect changes in the proportion of HRT users stratified by education level, social class, hypertension, and obesity. RESULTS: The overall percentage of HRT users declined from 31% in January 2002 to less than 26% by February 2003. Changes in trends of HRT use were first detected in June 2002 (for women with advanced secondary educational qualification or higher) and in July 2002 (for all other groups). The rate of decline was greatest for women with no formal educational qualifications, from the manual social class, or who were hypertensive or obese. CONCLUSIONS: These decreases coincided with the announced cessation of a large US clinical trial of HRT. This publicity may have had a differential influence on the immediate decline in HRT use by various groups of British women.

Educational Status↗
PubMed2005

Outcomes and patterns of failure in solitary plasmacytoma: a multicenter Rare Cancer Network study of 258 patients.

PURPOSE: To assess the outcomes and patterns of failure in solitary plasmacytoma (SP). METHODS AND MATERIALS: The data from 258 patients with bone (n = 206) or extramedullary (n = 52) SP without evidence of multiple myeloma (MM) were collected. A histopathologic diagnosis was obtained for all patients. Most (n = 214) of the patients received radiotherapy (RT) alone; 34 received chemotherapy and RT, and 8 surgery alone. The median radiation dose was 40 Gy. The median follow-up was 56 months (range 7-245). RESULTS: The median time to MM development was 21 months (range 2-135), with a 5-year probability of 45%. The 5-year overall survival, disease-free survival, and local control rate was 74%, 50%, and 86%, respectively. On multivariate analyses, the favorable factors were younger age and tumor size <4 cm for survival; younger age, extramedullary localization, and RT for disease-free survival; and small tumor and RT for local control. Bone localization was the only predictor of MM development. No dose-response relationship was found for doses >30 Gy, even for larger tumors. CONCLUSION: Progression to MM remains the main problem. Patients with extramedullary SP had the best outcomes, especially when treated with moderate-dose RT. Chemotherapy and/or novel therapies should be investigated for bone or bulky extramedullary SP.

Analysis of Variance↗
PubMed2005

Biological surrogate end-points in cancer trials: potential uses, benefits and pitfalls.

New technologies have led to the development of an increasing number of targeted therapies and interest in combining these with conventional therapy to provide individualised patient treatments. New drug or treatment regimens must, however, undergo rigorous testing under strictly controlled conditions before they can be adopted as standard. This can be expensive, time-consuming and inefficient. Surrogate end-points have been proposed as an alternative, which could be measured earlier or more conveniently than true end-points. The aim of this paper is to review the definition, advantages, disadvantages and potential pitfalls of biological surrogate end-points in the context of cancer treatment.

Biomarkers↗
PubMed2005

Socio-economic position across the life course and hysterectomy in three British cohorts: a cross-cohort comparative study.

OBJECTIVE: To examine the association between indicators of lifetime socio-economic position and rates of hysterectomy in three British cohorts. DESIGN: Cross-cohort comparative study. SETTING: Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland. POPULATION: Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio-economic position and hysterectomy status. METHODS: Relative indices of inequality were derived for markers of socio-economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy. MAIN OUTCOME MEASURE: Self-reported hysterectomy with or without oophorectomy. RESULTS: Adverse socio-economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio-economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio-economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance. CONCLUSIONS: Our results show that hysterectomy rates are influenced by childhood socio-economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.

Adult↗
PubMed2005

Meta-analysis of randomised trials of monetary incentives and response to mailed questionnaires.

STUDY OBJECTIVE: To quantify the increase in mailed questionnaire response attributable to a monetary incentive. DESIGN: A systematic search for randomised controlled trials of monetary incentives and mailed questionnaire response was conducted. For each trial identified, logistic regression was used to estimate the odds ratio for response per 0.01 dollars incentive increase. Odds ratios were pooled in a series of random effect meta-analyses stratified by the minimum and maximum amounts offered. Piecewise logistic regression was used to estimate the odds ratio for response per $0.01 increase given in each of five incentive ranges. SETTING: Populations in several developed countries, predominantly the USA. PARTICIPANTS: 85,671 randomised participants from 88 trials. MAIN RESULTS: The pooled odds ratios for response per 0.01 dollars incentive decreased monotonically as the maximum amount of incentive offered increased. The piecewise logistic regression model estimated that for incentive amounts up to 0.50 dollars, each additional 0.01 dollars increased the odds of response by about 1% (pooled OR = 1.012, 95%CI 1.007 to 1.016). The effects on response above 0.50 dollars were smaller and decreased monotonically in the ranges: 0.50-0.99 dollars, 1-1.99 dollars, 2-4.99 dollars, 5.00 dollars and over, but remained statistically significant up to 5 dollars. CONCLUSIONS: This meta-analysis of the best available evidence shows that monetary incentives increase mailed questionnaire response. Researchers should include small amounts of money with mailed questionnaires rather than give no incentive at all.

Health Services Research↗
PubMed2004

An examination of enrollment of children in public health insurance in New York City through facilitated enrollment.

A cohort of families was followed through the enrollment process for Medicaid and Child Health Plus in New York City to determine success in enrollment and the time it takes to enroll. Families were recruited into the study by enrollers in community-based organizations and managed-care organizations. In our sample, three of four families were successful in enrolling. On average, it took 60 days to attain insurance. Most applicants (76%) received some sort of assistance from enrollers, most frequently in determining which documents were needed (74%). In a multivariable analysis, some of the factors associated with success in enrollment included being assisted by a community-based facilitated enroller, knowledge of required documents, and having lost a child's other health insurance.

Child↗
PubMed2003

Positive and negative changes following vicarious exposure to the September 11 terrorist attacks.

The negative effects of vicarious traumatic exposure are well known. However, less is known about potential positive changes following vicarious exposure. Respondents living in Britain (n = 108) were surveyed about their vicarious exposure to the terrorist attacks of September 11. They also completed measures of their perceptions of the events of September 11, and positive (valuing friends and family more) and negative changes (loss of meaning, greater anxiety). Results revealed that respondents who perceived the terrorist attacks to be an attack on their own values and beliefs, or the work of religious fanatics, were more likely to report positive changes. Negative and positive psychological changes were positively associated.

Adult↗
PubMed2002

Prediction of radiotherapy outcome using dynamic contrast enhanced MRI of carcinoma of the cervix.

PURPOSE: To investigate whether analysis of MRI enhancement data using a pharmacokinetic model improved a previously found correlation between contrast enhancement and tumor oxygenation measured using PO2 histograph. To evaluate the prognostic value of gadolinium enhancement data for radiotherapy outcome, and to study the efficacy of combined enhancement and MRI volume data. METHODS AND MATERIALS: Fifty patients underwent dynamic gadolinium-enhanced MRI as part of their initial staging investigations before treatment. Gadolinium enhancement was analyzed using the Brix pharmacokinetic model to obtain the parameters amplitude and rate of contrast enhancement. Pretreatment tumor oxygen measurements (Eppendorf PO2 histograph) were available for 35 patients. RESULTS: Both standard and pharmacokinetic-derived enhancement data correlated with tumor oxygenation measurements, and poorly enhancing tumors had low tumor oxygen levels. However, only the pharmacokinetic-analyzed data correlated with patient outcome and patients with poorly (amplitude less than median) vs. well-enhancing tumors had significantly worse disease-specific survival (p = 0.024). For the 50 patients studied, no relationship was found between enhancement and volume data. Combining MRI volume and enhancement information highlighted large differences in outcome (p = 0.0054). At the time of analysis, only 55% of patients with large, poorly enhanced tumors were alive compared with 92% of patients with small, well-enhanced tumors. CONCLUSION: These preliminary results suggest that pharmacokinetic modeling of dynamic contrast-enhanced MRI provides data that reflect tumor oxygenation and yields useful prognostic information in patients with locally advanced carcinoma of the cervix. Combining MRI-derived enhancement and volume data delineates large differences in radiotherapy outcome.

Adenocarcinoma↗
PubMedDate not supplied

Cognitive function across the life course and the menopausal transition in a British birth cohort.

OBJECTIVE: Despite biological plausibility, relationships between menopause and cognitive function are inconsistent. We investigated whether menopause status and menopause age were associated with general cognitive ability, verbal memory, and visual search speed and concentration in a large cohort of women while considering vasomotor and psychological symptoms, previous childhood and adult measures of cognitive function, lifetime socioeconomic circumstances, educational attainment, lifestyle factors, and chronic diseases. DESIGN: A nationally representative British cohort of 1261 women born in March 1946 and all aged 53 years at cognitive testing, with prospective information on previous cognitive function, menopausal characteristics, and potential confounders. RESULTS: There was only weak evidence of the effect of natural menopause on cognitive function and no evidence of any effects of hormone therapy use or hysterectomy status. There was a trend across the phases of the natural menopausal transition (pre-, peri-, and postmenopause) for the National Adult Reading Test (P = 0.005) and search speed and concentration (P = 0.042), with postmenopausal women having the lowest cognitive function, but there was no trend in verbal memory. Variation in vasomotor and psychological symptoms did not explain these trends. In postmenopausal women, there was a positive trend across menopause age for verbal memory (P = 0.004) and a weak positive trend for the National Adult Reading Test (P = 0.052), with women who reached menopause later having higher cognitive function. Previous cognitive function generally explained the associations, which were further weakened by adjusting for socioeconomic and educational confounders. One exception was the association between the natural menopause transition and search speed and concentration, which remained after adjustment for these factors. CONCLUSION: Menopause adversely affects cognitive function, but this effect may be largely explained by premenopausal cognitive function. These findings suggest that common environmental or genetic factors, operating through long-term or lifelong hormonal mechanisms, may influence the timing of natural menopause and lifetime cognitive function.

Age Factors↗
PubMedDate not supplied

Costs of enrolling children in Medicaid and SCHIP.

As a way of saving Medicaid dollars, many states are reintroducing administrative hurdles into the enrollment process to deter people from enrolling. This study finds that administrative tasks associated with enrollment absorb sizable amounts of funds. We estimate that it costs approximately dollars 280 to enroll a child in Medicaid or the State Children's Health Insurance Program (SCHIP) in the New York City area. This amount could be reduced by approximately 40 percent if documentation requirements were simplified. In an era of scarce resources, the case for simplification is more compelling than ever.

Budgets↗