D. Michal Freedman
Some previous epidemiologic studies have suggested that having Parkinson’s disease decreases your risk of developing cancer, and vice versa. If true, this finding could provide insight into underlying biologic mechanisms for the two diseases.
How we set out to answer the question
In a study published in the International Journal of Epidemiology we used data from Medicare, a U.S. federal health insurance programme for those aged ≥65 years, linked to U.S. cancer registry data to examine the relationship between Parkinson’s disease and cancer. Because we used Medicare data, we were limited to people aged 65 years and older. However, as the Medicare database is very large, we were able to examine relationships in whites and non-whites, in men and women, and in different age groups (all above 65 years).
We hypothesized that previous studies may have found a lower risk of cancer after Parkinson’s disease because cancer screening or medical work-ups were less frequent in people with a debilitating condition such as Parkinson’s than in people without such a condition. Continue reading “Parkinson’s disease and cancer risk: is there a relationship?”
A puzzling similarity
Researchers have long noted puzzling similarities between Hodgkin lymphoma and multiple sclerosis. Although the first is a cancer and the second is an autoimmune disease, risk for both diseases appears to increase due to the Epstein–Barr virus and a lack of sunlight. In fact having a family member with multiple sclerosis may place you at increased risk for Hodgkin lymphoma and vice versa. Now, a recent study, on which I am a co-author, has identified genetic similarities. Continue reading “Genome-wide association study gives rise to a new breed of disease network”
Elina Dale, Anubhav Agarwal, Cyrus Engineer
Significant resources in global health are spent on pay-for-performance (P4P), also known under a more general term as results-based financing (RBF). Originating in the UK and USA, P4P has now become – to borrow a phrase from Cheryl Cashin – the new “it-girl” in health financing. However, as recent experience from Afghanistan shows, implementation is not always easy and P4P interventions must be better designed if they are to achieve real population health gains.
From 2010 to 2012 a P4P programme in Afghanistan provided quarterly bonus payments to health-care providers for increases in the use of maternal and child health (MCH) services, adjusted by a quality of care score. Our study, a large-scale cluster randomized trial, demonstrates that the programme did not produce the intended results. There were no observable improvements in any of the five key MCH coverage indicators measuring contraceptive prevalence, skilled birth attendances, vaccinations, and antenatal and postnatal check-ups. No changes were observed in the equity of care. While the programme appeared to increase time spent with patients, resulting in more complete histories and physical examinations, and improved patient counselling, other measures of quality, such as availability of medicines and supplies, did not substantially change. Continue reading “Lessons from the recent trial of a pay-for-performance programme in Afghanistan”