Why Skipping Vaccines Is A Public, Not Personal, Health Choice
(Reuters Health) - Too many U.S. adults are not getting vaccinated, putting themselves and others at risk, immunization experts say. According to the latest available data, about 44 percent of adults over age 19 had a flu shot; 20 percent had a TDAP vaccine, which protects against tetanus, diphtheria and pertussis; and 20 percent of 19-to-64-year-olds at risk of pneumonia had that vaccine (compared to 60 percent of those over 65). Just 27 percent of those over age 60 were vaccinated against herpes zoster, which cuts the risk of shingles in half, according to new guidelines from the Advisory Committee on Immunization Practices (ACIP) published in Annals of Internal Medicine. “Vaccinations not only protect you. They also protect those around you,” ACIP liaison Dr. Sandra Fryhofer said by email, yet, “vaccination coverage rates for adults are abysmal.” Fryhofer, an Atlanta physician and adjunct associate professor at Emory University School of Medicine, also pointed to racial and ethnic disparities in vaccination rates, with whites more likely than all other groups to be vaccinated. And she noted that adults with health insurance are two to five times more likely to be appropriately vaccinated. “It’s a double whammy for those without insurance. They don’t have insurance coverage if they get sick and they don’t have insurance coverage to pay for vaccinations that can help them stay well,” said Fryhofer, who was also a mem...
“The tide of time flow’d back with me,The forward-flowing tide of time;And many a sheeny summer-morn,A down the Tigris I was borne,By Baghdad’s shrines of fretted gold,High-walled gardens green and old;”From “Recollections of the Arabian Nights”Alfred Lord Tennyson
Every few years, a new staging system is published, and we have survived many in the past 30 years. Each succeeding one is more complex and difficult to memorize. At the end of our careers, we have to admit giving up to some extent on learning the nuances of our most recent version. Additionally, we have witnessed our residents wasting countless hours trying to memorize this cobweb of minutia. Would their time not be more productively spent learning about patient care and outcomes?
First, and perhaps most importantly, Dinh et al are to be applauded for presenting their prospective series of men treated with proton therapy at the University of Washington and their carefully reported rectal toxicity outcomes in the context of dose-volume histogram analysis as well as differing rectal immobilization devices.1 These result s provide strong evidence suggesting that without the use of a rectal spacer, there is increased rectal toxicity with proton therapy compared with intensity modulated radiation therapy (IMRT).
Concurrent chemoradiation, the mainstay of treatment in locally advanced head and neck cancer, is a challenging endeavor even for the fittest of individuals. On one hand, it confers superior therapeutic outcomes compared with either chemotherapy or radiation alone; on the other hand, the high-intensity treatment is associated with substantial treatment toxicity that in turn leads to treatment schedule interruption or incompletion, hospitalization, or even death.1-4
The recent meta-analysis of the dose-response rate of prostate cancer biochemical control during hypofractionated radiation therapy by Vogelius and Bentzen1 showed that the standard linear-quadratic model was insufficient to model the observed clinical response. They proposed 2 possible corrections: either (1) the slope of the α/β ratio increases by 0.6 for every Gray of increase in the dose per fraction or (2) there is an arbitrary limit to the dose-response curve at 80 Gy.
We thank Drs. Alfonso and Berk for their interest1 in our meta-analysis of outcome data from randomized controlled trials of hypofractionated radiation therapy for low-risk prostate cancer.2 Specifically, we showed how the recently published study of ultrahypofractionated radiation therapy by Widmark et al3 provides further evidence for a diminishing benefit from radiation therapy intensified by increasing the dose per fraction.2 This is a purely empirical observation and does not rely on any mechanistic assumptions.
We appreciate the authors for their letter1 highlighting the complex issues of predicting survival and treatment toxicity in patients with head and neck cancer (HNC) before definitive chemoradiation therapy.
This study concluded that vulnerability, as measured by comprehensive geriatric assessment (CGA), was independently associated with poorer survival and hig her treatment-related toxicities.1
Condition: Breast Cancer Interventions: Drug: Metformin; Drug: Chemotherapy Sponsors: Beni-Suef University; Ahram Canadian University Recruiting
Conditions: Influenza, Human; Pneumonia, Pneumococcal Interventions: Biological: IIV4 and PPV23; Biological: IIV4; Biological: PPV23 Sponsors: China National Biotec Group Company Limited; Fujian Provincial Center for Disease Control and Prevention; Chengdu Institute of Biological Products Co.,Ltd.; Changchun Institute of Biological Products Co., Ltd.; National Institutes for Food and Drug Control, China; Guizho u Center for Disease Control ...
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