Health care administration concepts and practices

Organ transplant recipients are more susceptible to cancer due to oncogenic viral infections and immunosuppression. What is the overall pattern of cancer following an organ transplantation?

Cancer is a major adverse outcome of solid organ transplantation.2 Previous studies have demonstrated an overall 2- to 4-fold elevated risk of cancer.3- 11 Excess risk is largely due to immunosuppression, with a spectrum of cancer resembling that seen with human immunodeficiency virus (HIV) infection, another immunosuppressing condition.11 Risks are especially high for malignancies caused by viral infections, including non-Hodgkin lymphoma and Hodgkin lymphoma (both due to Epstein-Barr virus [EBV]), Kaposi sarcoma (human herpesvirus 8), anogenital cancers (human papillomavirus), and liver cancer (hepatitis C and B viruses). Certain other malignancies such as cancers of the lung, kidney, skin, and thyroid also are increased in transplant recipients. Linkage of population-based transplant and cancer registries from the same geographic region can allow for systematic ascertainment of cancer outcomes in a large representative population of recipients. Except for a recent study from the United Kingdom with 37-616 transplant recipients,4 prior linkage studies of cancer following transplantation included 2000 to 11-000 recipients,3,5- 9 which is not large enough to accurately estimate risk for less common cancers. Also, these previous studies have been limited mostly to kidney recipients. As a result, it is unclear how cancer risk varies according to the transplanted organ (Engels et al., 2011, p. 1891).

Topic # 2

Alzheimer's is a terrible disease that affects the minds of millions of elderly worldwide. What can be done to detect preclinical phase of Alzheimer's disease in order to stop the disease from advancing and prolong the brain function of a person potentially suffering from it?

The pathophysiological process of Alzheimer's disease (AD) is thought to begin many years before the diagnosis of AD dementia. This long "preclinical" phase of AD would provide a critical opportunity for therapeutic intervention; however, we need to further elucidate the link between the pathological cascade of AD and the emergence of clinical symptoms. The National Institute on Aging and the Alzheimer's Association convened an international workgroup to review the biomarker, epidemiological, and neuropsychological evidence, and to develop recommendations to determine the factors which best predict the risk of progression from "normal" cognition to mild cognitive impairment and AD dementia. We propose a conceptual framework and operational research criteria, based on the prevailing scientific evidence to date, to test and refine these models with longitudinal clinical research studies. These recommendations are solely intended for research purposes and do not have any clinical implications at this time. It is hoped that these recommendations will provide a common rubric to advance the study of preclinical AD, and ultimately, aid the field in moving toward earlier intervention at a stage of AD when some disease-modifying therapies may be most efficacious (Sperling et al., 2011, p. 280).

Topic # 3

Can a healthy lifestyle stop or prevent diabetes type 2?

OBJECTIVE to investigate 1-year outcomes of a national diabetes prevention program in Finland.

RESEARCH DESIGN AND METHODS Altogether 10,149 individuals at high risk for diabetes were identified with the Finnish Diabetes Risk Score (FINDRISC; scoring ?, by a history of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), cardiovascular disease, or gestational diabetes mellitus in 400 primary health care centers. One-year follow-up data were available for 2,798 participants who were nondiabetic at baseline (919 men and 1,879 women, aged 56.0 ± 9.9 and 54.0 ± 10.7 years [mean ± SD] with BMI 30.9 ± 4.6 and 31.6 ± 5.4 kg/m2).