This article describes a small-scale study which examined the views of both users and providers of primary healthcare services for the Chinese minority in Manchester. Thirty Chinese mothers of pre-school children were selected from immunization records and interviewed face-to-face at their homes using structured questionnaires and unstructured discussions. Thirty-eight GPs who had the largest number of Chinese patients (n = 10) registered with them, and 26 health visitors who worked with these GPs were also interviewed, using semi-structured questionnaires. The findings indicate that a discrepancy exists between the views of GPs, health visitors and Chinese mothers on the use of primary healthcare services. The health professionals' awareness of the effects of socio-economic characteristics, demographic profile and indigenous health beliefs and attitudes on the quality of primary healthcare services for Chinese families in Manchester is discussed.

Delayed sexual maturation and a possible defect in growth unrelated to the GH-IGF-1 axis may be responsible for the growth failure in adolescent children with thalassaemia major.

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We found a racial/ethnic disparity in HCV diagnosis rates and an association between HCV and syphilis, which is consistent with sexual transmission of HCV. With curative HCV treatment available, emphasis should be placed on adherence to guidelines recommending annual HCV screening for HIV-infected MSM, and education and outreach to MSM to prevent sexually transmitted HCV infections.

HCV-infected adults were at increased risk of dying and of dying prematurely, particularly from conditions associated with HCV, such as HIV/AIDS or drug use. The short interval between HCV report and death suggests a need for earlier testing and improved treatment.

Using surveillance data, we describe the prevalence and characteristics of individuals in New York City (NYC) co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and/or hepatitis C virus (HCV). Surveillance databases including persons reported to the NYC Department of Health and Mental Hygiene with HIV, HBV, and HCV by 31 December 2010 and not known to be dead as of 1 January 2000, were matched with 2000-2011 vital statistics mortality data. Of 140 606 persons reported with HIV, 4% were co-infected with HBV only, 15% were co-infected with HCV only, and 1% were co-infected with HBV and HCV. In all groups, 70-80% were male. The most common race/ethnicity and HIV transmission risk groups were non-Hispanic blacks and men who have sex with men (MSM) for HIV/HBV infection, and non-Hispanic blacks, Hispanics, and injection drug users for HIV/HCV and HIV/HBV/HCV infections. The overall age-adjusted 2000-2011 mortality was higher in co-infected than HIV mono-infected individuals. Use of population-based surveillance data provided a comprehensive characterization of HIV co-infection with HBV and HCV. Our findings emphasize the importance of targeting HIV and viral hepatitis testing and prevention efforts to populations at risk for co-infection, and of integrating HIV and viral hepatitis care and testing services.

BACKGROUND: This study evaluated the activity of 2 schedules of erlotinib in combination with chemotherapy, and the prognostic significance of serum amphiregulin (AREG) and transforming growth factor alpha (TGFa) in metastatic colorectal cancer. METHODS: A total of 60 untreated patients were randomized to a "continuous" (CON; erlotinib 100 mg daily) or an "intermittent" (INT; erlotinib 150 mg on alternate day on day 2 to 14, then 150 mg daily on days 15 to 21) schedule of erlotinib with a modified XELOX (capecitabine plus oxaliplatin) regimen. Serum levels of AREG and TGFa were determined serially. RESULTS: Baseline characteristics were similar between the 2 arms. Of the 58 patients evaluated for response, there was a nonsignificant trend toward a slightly higher overall response rate in the INT arm (66.7%) versus the CON arm (56.7%). At a median follow-up of 2.8 years, the median overall survival was 18.8 months (95% confidence interval 5 11.3-22.9 months) and 20.7 months (95% confidence interval 5 12.5-31 months, P 5.19) for the CON and INT arm, respectively. KRAS mutation did not predict drug response. The 2 arms did not differ significantly in toxicity. Baseline serum TGFa was an independent predictor of progression-free survival, whereas a drop in serum TGFa and AREG levels following 3 to 4 cycles of treatment were associated with shorter progression-free survival and overall survival, respectively. CONCLUSIONS: The intermittent erlotinib schedule was associated with a higher response rate, although this is not statistically significant. Serum TGFa and AREG levels have prognostic significance in erlotinib-treated patients with colorectal cancer, and further studies are warranted. Cancer 2013;119:4145-53. V C 2013 American Cancer Society.KEYWORDS: erlotinib, oxaliplatin, capecitabine, amphiregulin, transforming growth factor alpha. INTRODUCTIONThe development of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) in the treatment of metastatic colorectal cancer (mCRC) has taken a new turn with the recent reports on the DREAM 1 and the DUX studies, 2 which showed that erlotinib may play a role when combined with either bevacizumab 1 or cetuximab 2 in the palliative treatment of mCRC. Studies in preclinical models of CRC have demonstrated an additive to synergistic effect on growth inhibition when an EGFR TKI is combined with chemotherapy. 3 Furthermore, this inhibitory effect could be scheduledependent in CRC cells, such that synergism could be better observed when chemotherapy was administered before the EGFR TKI rather than concomitantly, whereas antagonism maybe observed if EGFR TKI is given before the cytotoxic agent. 4,5 Drug scheduling may also be important when combining EGFR TKI and cytotoxic agents, as shown in lung cancer models, where an intermittent schedule of EGFR TKI was more effective in controlling tumor growth than a continuous schedule. 6 Despite the number of clinical reports on the activity of combining EGFR TKI and chemotherapy in mCRC, none of them have evaluated the ...

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