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Underlying Reasons (underlying + reason)
Selected AbstractsA commentary on coastal research in New Zealand universitiesNEW ZEALAND GEOGRAPHER, Issue 2 2008Paul S. Kench Abstract: , University research in coastal geomorphology, processes and management has made a major contribution to the fundamental understanding of coastal systems in New Zealand over the past 43 years. This article examines the growth in university-based coastal research since 1964 and discusses the geographical pattern and themes of this research. Data indicate a significant geographical concentration of research effort and focus on a narrow range of research themes. Underlying reasons for these characteristics of New Zealand coastal research are explored and challenges facing university based research are discussed. Such challenges can be overcome through a more coordinated research effort to realize the huge potential to undertake coastal science of national relevance and international significance. [source] Neutralization of IL-17 by active vaccination inhibits IL-23-dependent autoimmune myocarditisEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 11 2006Ivo Sonderegger Abstract The most common reason for heart failure in young adults is dilated cardiomyopathy often resulting from myocarditis. Clinical studies and animal models provide evidence that an autoimmune response against heart myosin is the underlying reason for the disease. IL-12 has been suggested to play a key role in development of experimental autoimmune myocarditis (EAM), as IL-12p40 and IL-12R,1 knockouts are protected from disease. In this study, we have compared IL-12p40,/, mice, IL-12p35,/, mice and mice treated with a neutralizing IL-23 antibody in EAM and found that in fact IL-23, not IL-12, is responsible for inflammatory heart disease. However, these cytokines appear to have redundant activity for priming and expansion of autoreactive CD4 T cells, as specific T cell proliferation was only defective in the absence of both cytokines. IL-23 has been suggested to promote a pathogenic IL-17-producing T cell population. We targeted IL-17 by capitalizing on an active vaccination approach that effectively breaks B cell tolerance. Neutralization of IL-17 reduced myocarditis and heart autoantibody responses, suggesting that IL-17 is the critical effector cytokine responsible for EAM. Thus, targeting of IL-23 and IL-17 by passive and active vaccination strategies holds promise as a therapeutic approach to treat patients at risk for development of dilated cardiomyopathy. See accompanying commentary: http://dx.doi.org/10.1002/eji.200636760 [source] Serially concatenated continuous phase modulation with symbol interleavers: performance, properties and design principlesEUROPEAN TRANSACTIONS ON TELECOMMUNICATIONS, Issue 4 2006Ming Xiao Serially concatenated continuous phase modulation (SCCPM) systems with symbol interleavers are investigated. The transmitted signals are disturbed by additive white Gaussian noise (AWGN). Compared to bit interleaved SCCPM systems, this scheme shows a substantial improvement in the convergence threshold at the price of a higher error floor. In addition to showing this property, we also investigate the underlying reason by error event analysis. In order to estimate bit error rate (BER) performance, we generalise traditional union bounds for a bit interleaver to this non-binary interleaver. For the latter, both the order and the position of permuted non-zero symbols have to be considered. From the analysis, some principal properties are identified. Finally, some design principles are proposed. Our paper concentrates on SCCPM, but the proposed analysis methods and conclusions can be widely used in many other systems such as serially concatenated trellis coded modulation (SCTCM) et cetera. Copyright © 2006 AEIT [source] Presidents, Political Regimes, and Contentious Supreme Court Nominations: A Historical Institutional ModelLAW & SOCIAL INQUIRY, Issue 4 2007Kevin J. McMahon Before the nominations of John Roberts and Samuel Alito, scholars consistently pointed to the presence of divided government as an underlying reason for conflict in the confirmation process for U.S. Supreme Court nominees. However, the importance of party unity and coalition-building appointments,each of which highlights the role of the president in the process,should not be underestimated in these confirmation battles. Moreover, an examination of the sixty twentieth-century nominations reveals that a presidency-focused political regimes model provides significant explanatory force for understanding when and what types of nominees are likely to face the most resistance in the Senate. It does so by incorporating Stephen Skowronek's analytical framework for understanding presidential authority to explain how and why different periods of political time affect presidential attempts to shape the U.S. Supreme Court through appointments. In turn, the model places recent conflict in the confirmation process in historical context. [source] Liver transplantation for fulminant hepatic failure in infancy: A single center experiencePEDIATRIC TRANSPLANTATION, Issue 7 2009Annette Strauss Abstract:, FHF is characterized by a high percentage of unknown causes leading to acute liver failure and furthermore by an increased morbidity and mortality prior to and post-Ltx. In different transplant centers, the reasons leading to FHF differ significantly as well as outcome. We report our single center experience with 30 pediatric patients receiving a liver transplant for FHF, out of a total of 83 children presenting with FHF. The time to transfer patients to the transplant center after the diagnosis of FHF was long, with a median of 14 days (Ltx group) and 12 days (controls), respectively. In nearly half of the patients (n = 14) in the Ltx group, we were not able to establish an exact diagnosis prior to Ltx: 50% suffered from encephalopathy, and 13 patients were treated in the intensive care unit prior to transplant. Because of the availability of different surgical techniques, all children received a timely transplant [split (n = 18), living donor (n = 9), whole organ (n = 2), and reduced liver (n = 1)]. Patient survival was 93.4%, and graft survival was 83.4% for at least one yr follow-up. Severe complications following Ltx included three cases with aplastic anemia and one child suffering from systemic mitochondrial depletion syndrome. The survival of patients treated medically was 83%. We conclude that a strong focus should be made on early referral to a specialized center and on improvement of diagnostic tools to timely detect the underlying reason for FHF. Results following Ltx for FHF are good. [source] Testosterone and erectile function in hypogonadal men unresponsive to tadalafil: results from an open-label uncontrolled studyANDROLOGIA, Issue 2 2006A. A. Yassin Summary The study was aimed at investigating the efficacy of tadalafil (Cialis®) in combination with transdermal testosterone (Testogel®) for the treatment of tadalafil-refractory erectile dysfunction in hypogonadal patients. In an open-label, retrospective trial, 69 hypogonadal nonresponders to tadalafil monotherapy (mean age: 59 years, total testosterone ,3.4 ng ml,1) were randomly divided into two homogeneous groups. Group I (n = 35) received Testogel® (5 g containing 50 mg testosterone, daily) for 4 weeks, followed by concurrent therapy with tadalafil (20 mg, twice a week). Group II (n = 34) was assigned to treatment with Testogel® (5 g containing 50 mg testosterone, daily) for a duration of 10 weeks before adjunctive therapy with tadalafil was initiated. Total testosterone levels were measured at baseline, week 4 and week 10. Sexual function was assessed employing the International Index of Erectile Function (IIEF). As an additional measure of efficacy, a questionnaire completed by the patients' partner was used. Mean testosterone levels were observed to increase from baseline to study end. Following 4 weeks of therapy, an improvement in Erectile Function (EF) from baseline was observed, which was greater in group I than in group II. The assessment after week 10 showed that EF had further increased and was quite similar now in both groups. Partners found that erectile capacity had greatly improved from baseline to study end. No adverse effects have been observed. These data suggest that combination therapy with testosterone and tadalafil is an effective means in a subset of hypogonadal patients who did not respond to tadalafil alone. We assume that testosterone-induced remodelling of penile tissue structure is one underlying reason for the observed improvement of erectile function. The results imply that this process may require a longer period of testosterone administration than 4 weeks. [source] Changes in trimethylamine oxide and trimethylamine in muscle of wild and farmed cod (Gadus morhua) during iced storageAQUACULTURE RESEARCH, Issue 1 2009Hilde Herland Abstract Trimethylamine oxide (TMAO) is found at high levels in wild Atlantic cod. Trimethylamine oxide is reduced to trimethylamine (TMA) during iced storage. In this study, the levels of TMAO and TMA in wild and farmed cod and the impact of storage, gender and season on these levels were investigated. Wild cod had higher levels of TMAO than farmed cod. Wild cod also had higher levels of TMA after 15 days of iced storage. Farmed cod were found to have levels of TMA-N <5 mg/100 g after 15 days of iced storage, which is below the maximum permitted level for fresh fish. Therefore, TMA appears to be an unsuitable measure of freshness in farmed cod. Female farmed cod had higher levels of TMAO than male farmed cod; no such difference between genders was found in wild cod. Female and male farmed cod had similar levels of TMA after post-mortem iced storage. The hepatosomatic index (HSI) of female farmed cod was higher than that seen in male cod and this may be the underlying reason for the differences in muscle TMAO. Levels of TMAO in male farmed cod were higher during the autumn and were correlated with a larger HSI during the same period. [source] The prognostic value of peritumoral regulatory T cells and its correlation with intratumoral cyclooxygenase-2 expression in clear cell renal cell carcinomaBJU INTERNATIONAL, Issue 3 2009Jin F. Li OBJECTIVE To investigate the prognostic value of regulatory T cells (Tregs) and its correlation with cyclooxygenase-2 (COX-2) expression in clear cell renal cell carcinoma (RCC). PATIENTS AND METHODS CD4+, Foxp3+ tumour-infiltrating lymphocytes and tumour COX-2 expression were assessed by immunohistochemistry in tissue microarrays containing RCC from 125 patients. Prognostic effects of low and high expression were evaluated by Cox regression and Kaplan,Meier analysis using the median values as thresholds. The expression of Tregs and COX-2 were compared with the clinicopathological variables. In addition, Tregs and its correlation with COX-2 expression was also analysed. RESULTS Peritumoral Tregs were positively correlated with intratumoral COX-2 expression (Spearman rank correlation 0.336, P < 0.001). Peritumoral Tregs were associated with TNM stage (P = 0.001) and tumour size (P = 0.002), while intratumoral COX-2 expression was associated with TNM stage (P = 0.018) and grade (P = 0.013). Using multivariate analysis, increased peritumoral Tregs, higher TNM stage (III + IV), larger tumour size (,7 cm) and higher nuclear grade (III + IV) were independent predictors for significantly shorter overall survival and disease-free survival. CONCLUSIONS Increased peritumoral Tregs are associated with worse prognosis in clear cell RCC. The high intratumoral COX-2 expression may be the underlying reason for the aberrant gathering of Tregs. These results suggest that clinical application of COX-2 inhibitors may benefit those patients with higher intratumoral COX-2 immunostaining by reducing the transformation of Tregs in RCC. [source] From Policy to Practice: Challenges in Infant Feeding in Emergencies During the Balkan CrisisDISASTERS, Issue 2 2001Annalies Borrel The preparation and dissemination of policy statements are necessary but insufficient to prevent the inappropriate use of infant-feeding products in emergencies. The widespread failure of humanitarian agencies operating in the Balkan crisis to act in accordance with international policies and recommendations provides a recent example of the failure to translate infant-feeding policies into practice. This article explores the underlying reasons behind the failures which include: (1) the weak institutionalisation of policies; (2) the massive quantities of unsolicited donations of infant-feeding products; (3) the absence of monitoring systems; (4) inadequate co-ordination mechanisms; (5) the high costs of correcting mistakes; and (6) the cumulative effects of poor practice. Efforts to uphold best practice during the crisis are also documented. Finally, the article identifies actions that could be undertaken in advance of and during future emergencies to enhance the application of infant feeding policies in emergencies. [source] Follow-up of an exercise-based treatment for children with reading difficultiesDYSLEXIA, Issue 2 2007David Reynolds Abstract This study reports the results of a long-term follow-up of an exercise-based approach to dyslexia-related disorders (Reynolds, Nicolson, & Hambly, Dyslexia, 2003; 9(1): 48,71). In the initial study, children at risk of dyslexia were identified in 3 years of a junior school. One half then undertook a 6 month, home-based exercise programme. Evaluation after 6 months indicated that the exercise group improved significantly more than the controls on a range of cognitive and motor skills. Critics had suggested that the improvement might be attributable to artifactual issues including Hawthorne effects; an initial literacy imbalance between the groups; and inclusion of non-dyslexic participants. The present study evaluated the issue of whether the gains were maintained over the following 18 months, and whether they were in some sense artifactual as postulated by critics of the original study. Comparison of (age-adjusted) initial and follow-up performance indicated significant gains in motor skill, speech/language fluency, phonology, and working memory. Both dyslexic and non-dyslexic low achieving children benefited. There was also a highly significant reduction in the incidence of symptoms of inattention. Interestingly there were no significant changes in speeded tests of reading and spelling, but there was a significant improvement in (age-adjusted) reading (NFER). It is concluded that the gains were indeed long-lasting, and that the alternative hypotheses based on potential artifacts were untenable, and that the exercise treatment therefore achieved its applied purpose. Further research is needed to determine the underlying reasons for the benefits. Possible (and potentially synergistic) explanations include: improved cerebellar function (neural level); improved learning ability and/or attentional ability (cognitive level); improved self-esteem and self-efficacy (affective level); and improved parental/familial support (social level). Copyright © 2006 John Wiley & Sons, Ltd. [source] Hospital ownership and quality of care: what explains the different results in the literature?HEALTH ECONOMICS, Issue 12 2008Karen Eggleston Abstract This systematic review examines what factors explain the diversity of findings regarding hospital ownership and quality. We identified 31 observational studies written in English since 1990 that used multivariate analysis to examine quality of care at nonfederal general acute, short-stay US hospitals. We find that pooled estimates of ownership effects are sensitive to the subset of studies included and the extent of overlap among hospitals analyzed in the underlying studies. Ownership does appear to be systematically related to differences in quality among hospitals in several contexts. Whether studies find for-profit and government-controlled hospitals to have higher mortality rates or rates of adverse events than their nonprofit counterparts depends on data sources, time period, and region covered. Policymakers should be aware of the underlying reasons for conflicting evidence in this literature, and the strengths and weaknesses of meta-analytic synthesis. The ,true' effect of ownership appears to depend on institutional context, including differences across regions, markets, and over time. Copyright © 2008 John Wiley & Sons, Ltd. [source] The reduced scalar potential in regions with permeable materials: Reasons for loss of accuracy and cancellationINTERNATIONAL JOURNAL OF NUMERICAL MODELLING: ELECTRONIC NETWORKS, DEVICES AND FIELDS, Issue 4 2007S. Balac Abstract Practical three-dimensional magnetic field problems usually involve regions containing current sources as well as regions with magnetic materials. For computational purposes, the use of the reduced scalar potential (RSP) as unknown has the advantage to transform a problem for a vector field throughout the space into a problem for a scalar function, thus reducing the number of degrees of freedom in the discretization. However, in regions with high magnetic permeability the use of the RSP alone usually results in severe loss in accuracy and it is recommended to use both the RSP and the total scalar potential. Using an asymptotic expansion, we investigate theoretically the underlying reasons for this lack of accuracy in permeable regions when using the RSP as a unique potential. Moreover, this investigation leads to an efficient numerical method to compute the magnetic field in regions with high magnetic permeability. Copyright © 2007 John Wiley & Sons, Ltd. [source] Emotional and informational support for families during their child's illnessINTERNATIONAL NURSING REVIEW, Issue 3 2006A. Sarajärvi rn Purpose:, To describe and compare the support provided by nursing staff to families during their child's illness from the viewpoint of families and nurses. Method:, A survey method was used. Data were collected by questionnaires planned for families and staff separately. The study population consisted of families who visited paediatric outpatient clinics, families with hospitalized children (n = 344) and the paediatric nursing staff (n = 60). Findings:, Almost half of the families had received adequate emotional and informational support from the nursing staff for their physical and psychological reactions. One-fifth of the families reported that they had not been supported at all during the child's hospitalization. According to families and nurses, the support was provided in the forms of discussion, listening and giving time. Implications for practice:, Families' and nurses' suggestions for development of support were related to the time resources of the staff, to the flow of information, to more client-centred attitudes, to being appreciated and listened to and to home care guidance. However, the pervasiveness of this problem in the international literature suggests that deeper consideration of possible underlying reasons for this phenomenon is called for. [source] Spatial regression techniques for inter-population data: studying the relationships between morphological and environmental variationJOURNAL OF EVOLUTIONARY BIOLOGY, Issue 2 2010S. I. PEREZ Abstract Understanding the importance of environmental dimensions behind the morphological variation among populations has long been a central goal of evolutionary biology. The main objective of this study was to review the spatial regression techniques employed to test the association between morphological and environmental variables. In addition, we show empirically how spatial regression techniques can be used to test the association of cranial form variation among worldwide human populations with a set of ecological variables, taking into account the spatial autocorrelation in data. We suggest that spatial autocorrelation must be studied to explore the spatial structure underlying morphological variation and incorporated in regression models to provide more accurate statistical estimates of the relationships between morphological and ecological variables. Finally, we discuss the statistical properties of these techniques and the underlying reasons for using the spatial approach in population studies. [source] A solid-state NMR study of phase structure, molecular interactions, and mobility in blends of citric acid and paracetamolJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 5 2009S. Schantz Abstract Citric acid anhydrate (CAA) and paracetamol (PARA), prepared as crystalline physical mixtures and as amorphous blends, were studied using 13C solid-state cross polarization magic angle spinning (CPMAS) NMR. Amorphous blends showed significant line broadening from the conformational distribution as compared to the crystalline samples. Also, chemical shift variations were observed between crystalline and amorphous blends, which were attributed to differences in intermolecular interactions. Averaging of proton rotating-frame spin-lattice relaxation times (T1,) probed via different 13C sites in the amorphous blends confirmed molecular level mixing. For some, initially amorphous, sample compositions the onset of crystallization was evident directly from spectra and from the significantly longer T1, relaxations. Thus, crystallization caused phase separation with properties of the two phases resembling those of pure CAA and PARA, respectively. 13C spectra of amorphous 50/50 (w/w, %) CAA/PARA recorded from above the glass transition temperature broadened as the temperature increased to a maximum at T,,,Tg,+,33 K. This was the result of a dynamic interference between the line narrowing techniques being applied and the time scale of molecular reorientation in the miscible melt. The derived average correlation time was found to correspond well with previous results from melt rheology. We conclude that the underlying reasons for physical instability (i.e., crystallization from the miscible melt, including molecular interactions and dynamics) of this class of amorphous binary mixtures can be effectively evaluated using NMR spectroscopy. © 2008 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 98:1862,1870, 2009 [source] Gender and parents' reactions to children's emotion during the preschool yearsNEW DIRECTIONS FOR CHILD & ADOLESCENT DEVELOPMENT, Issue 128 2010Amy Kennedy Root In this chapter, the authors examine the differences between mothers and fathers in the socialization of specific emotions in preschool-aged boys and girls. They argue that mothers and fathers play both distinct and complementary roles in the development of children's emotional competence; these roles are influenced both by parents' own gender, as well as the child's gender and the type of emotion being socialized. Through analyses of descriptive data, it appears that mothers and fathers respond to their children's emotions differently. The authors provide a discussion of the potential underlying reasons and potential implications for distinct emotion socialization by mothers and fathers. © Wiley Periodicals, Inc. [source] Racial/ethnic variations in non-steroidal anti-inflammatory drug (NSAID) use among patients with osteoarthritis,,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2004Kelli L. Dominick PhD Abstract Purpose Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs for the treatment of osteoarthritis (OA). While there are documented racial differences in the use of opioid analgesics, little is known about racial differences in the use of NSAIDs. Methods This was a retrospective cohort study among a national sample of 6038 veterans with OA. Patients were new NSAID users, followed for approximately 6 months. Primary outcomes included: type of NSAID prescribed (COX-2 selective or preferentially COX-2 selective NSAIDs vs other NSAIDs), days' supply of initial prescription and time to discontinuation of the index NSAID. Results In an analysis adjusted for demographic and gastrointestinal (GI) bleeding risk factors (age, sex, geographic region, history of GI bleeding, comorbid illnesses, use of anti-coagulants and glucocorticoids), Hispanics were less likely than whites to be prescribed an NSAID with some degree of COX-2 selectivity (odds ratio (OR): 0.47, p,<,0.01). The days' supply of the initial prescription was lower for both blacks and Hispanics compared to whites (mean: 38, 31 and 43 days respectively, p,<,0.01). In an analysis adjusted for demographics, GI bleeding risk factors and type of NSAID prescribed, blacks discontinued use of the index NSAID earlier than whites (hazard ratio,=,1.19, p,<,0.001) and there was a similar trend for Hispanics. Conclusion Minorities with OA were prescribed NSAIDs with less COX-2 selectivity and lower days' supply than whites. Further research should address underlying reasons and whether these differences impact outcomes such as pain control, side effects and cost-effectiveness of care. Published in 2003 by John Wiley & Sons, Ltd. [source] Effects of additives on surfactant phase behavior relevant to bacteriorhodopsin crystallizationPROTEIN SCIENCE, Issue 12 2006Bryan W. Berger Abstract The interactions leading to crystallization of the integral membrane protein bacteriorhodopsin solubilized in n-octyl-,-D-glucoside were investigated. Osmotic second virial coefficients (B22) were measured by self-interaction chromatography using a wide range of additives and precipitants, including polyethylene glycol (PEG) and heptane-1,2,3-triol (HT). In all cases, attractive protein,detergent complex (PDC) interactions were observed near the surfactant cloud point temperature, and there is a correlation between the surfactant cloud point temperatures and PDC B22 values. Light scattering, isothermal titration calorimetry, and tensiometry reveal that although the underlying reasons for the patterns of interaction may be different for various combinations of precipitants and additives, surfactant phase behavior plays an important role in promoting crystallization. In most cases, solution conditions that led to crystallization fell within a similar range of slightly negative B22 values, suggesting that weakly attractive interactions are important as they are for soluble proteins. However, the sensitivity of the cloud point temperatures and resultant coexistence curves varied significantly as a function of precipitant type, which suggests that different types of forces are involved in driving phase separation depending on the precipitant used. [source] HP23 USE OF ANTI-REFLUX MEDICATION AFTER ANTI-REFLUX SURGERYANZ JOURNAL OF SURGERY, Issue 2007B. P. L. Wijnhoven Purpose It is thought that a substantial number of patients who undergo anti-reflux surgery use anti-reflux medication post operatively, despite no objective evidence of reflux. This study aims to determine the prevalence and underlying reasons for anti-reflux medication usage in patients after anti-reflux surgery. Methodology A questionnaire (13 questions) on the usage of anti-reflux medication was sent to 1016 patients from a prospective database of anti-reflux surgery patients. Results 852 patients (84%), (437 males & 415 females with a mean age 58 yrs) returned the questionnaire. Mean follow up was 5.9 yrs after surgery. A single or combination of medications was being taken by 319 patients (37%): 82% proton pump inhibitors, 9% H2-blockers and 34% antacids. 54 patients (18%) had never stopped taking medication, whereas 261 patients (82%) re-started medication at a mean of 2.4 yrs after surgery. Persistent or return of the same or different symptoms was the reason for taking medication by the vast majority (85%), whereas 15% were asymptomatic or had other reasons for medication use. A response of symptoms to the medication occurred for 30% of the patients, whereas 64% noticed some improvement. Postoperative 24-hour pH studies (while off medication) were abnormal in 17/62 patients (27%) on medication and in 5/73 patients (6%) not taking medication. Conclusions Anti-reflux medication is frequently taken by patients for symptoms after surgery, despite normal pH profiles in the majority. Strategies need to be employed to lower the inappropriate use of medications after surgery and to further evaluate the mechanisms underlying postoperative symptoms, which are non-responsive to anti-reflux medication. [source] Sharing Ecological Knowledge: Opportunities and Barriers to UptakeBIOTROPICA, Issue 5 2009Virginie Boreux ABSTRACT Conserving tropical ecosystems is one of the foremost challenges of the 21st century. Lately, conservation efforts have focused on advancing conservation through dialogue and interaction with and among diverse stakeholders. Knowledge sharing, and specifically the transfer of scientific knowledge, can raise ecological awareness among stakeholders and is necessary to facilitate dialogue, yet the communication of tropical scientific research to local stakeholders is rarely effectively implemented. Such a communication gap potentially undermines the conservation and management of natural resources. The papers in this special section highlight the difficulties and benefits of sharing ecological knowledge, as well as the underlying reasons for why a research,implementation gap has arisen. [source] Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinomaCANCER, Issue 9 2003Evidence from a tertiary care cohort of chemotherapy-eligible patients Abstract BACKGROUND The appropriate use of adjuvant chemotherapy for elderly women with breast carcinoma remains controversial. Efficacy data in women age , 70 years are scarce, resulting in a lack of clear guidelines for patients in this age group. Although several studies have demonstrated decreasing use of chemotherapy with age, none specifically examined its use in an elderly cohort of patients who were deemed eligible for such therapy based on consensus guidelines, simultaneously examining the impact of comorbidity and previous history of malignant disease on these recommendations. METHODS The authors examined adjuvant chemotherapy use among chemotherapy-eligible patients age , 50 years who were evaluated in a tertiary care cancer center. Associations between patient age and 1) physician recommendation for adjuvant chemotherapy, 2) recommended treatment regimen, and 3) patient acceptance of the treatment plan recommended were examined, adjusting for the impact of aggressive tumor characteristics, medical comorbidity, previous history of malignant disease, and features of the treatment setting. RESULTS Of the 208 chemotherapy-eligible patients who were studied, 74% overall were recommended chemotherapy. Chemotherapy was recommended to 92% of women age 50,59 years compared with 77% of women age 60,69 years and 23% of women age , 70 years. Increasing age was associated strongly with a decreasing likelihood of receiving a recommendation in favor of chemotherapy. After adjusting for estrogen receptor status, previous history of malignant disease, comorbidity score, and prognostic group, the odds of receiving a recommendation in favor of chemotherapy fell by 22% per year or 91% per 10-year interval, and the rate of decline did not change significantly at age , 70 years. We found no age-related differences in either the drug regimens recommended or patient acceptance rates for adjuvant therapy. CONCLUSIONS Age was associated strongly and independently with physician recommendation for adjuvant chemotherapy among a group of older women who were eligible specifically for such therapy. Medical comorbidity and a history of previous malignant disease did not alter this correlation significantly, although the latter was a significant predictor of chemotherapy use. Further studies clearly are needed to determine the underlying reasons for this strong age effect and to explore strategies that will optimize the utilization of this potentially curative therapy in the elderly. Cancer 2003;97:2150,9. © 2003 American Cancer Society. DOI 10.1002/cncr.11338 [source] | |||||||||||||||||||||||||