Bill Schu

 from researchers at Sweden’s Lund University is among the first to show that women may be at much greater risk of developing chronic obstructive pulmonary disease than men—perhaps as much as 50% more likely.

For a condition that affects as many patients as does COPD, with a high mortality rate, it is surprising that such a potentially strong correlation between female sex and disease susceptibility hasn’t been definitively made previously. While a few earlier studies did show a potential sex effect, the clinical evidence has been conflicting in some cases, and many of the studies before this one looked only at younger patients and more strongly at the clear correlation between smokers and non-smokers. “With regard to sex as a risk factor for developing COPD, the evidence is not clear-cut and seems to depend on the diagnostic criteria used,” the researchers note.

The current research incorporates a new modern measurement for defining airflow limitation in COPD: Lower Limit of Normal (LLN), which has recently been recommended by the American Thoracic Society and the European Respiratory Society, among others. The results of the study suggest that women’s airways may be more sensitive than men’s. Previous COPD measurement was done with spirometry.

“Other potential mechanisms behind the sex effect may include effects of sex hormones

 susceptibility due to dimensional differences, and morphological differences suggesting a difference in the natural history of COPD,” the authors suggest

The finding will need to be confirmed by further research. Limitations of the study include that it included only post-menopausal females; thus, the results may not translate to younger females

 “The observed sex effect could theoretically be affected by higher awareness of COPD in male patients, leading to better treatment and spirometry performance,” the authors noted. “With few incident subjects, the observed effect may possibly be an artefact of natural variability, measurement error and dichotomizing a continuous outcome to either obstructive or non-obstructive.”

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Researchers suggest that women may be at much greater risk of developing chronic obstructive pulmonary disease than menâ€”perhaps as much as 50% more likely.

Women May Be Twice as Likely to Develop COPD

 suggests that computer programs that use what’s called computer-adapted testing—or CAT&mdash;may be significantly more likely to lead to better outcomes patients who are at risk for skin cancer.

The finding is potentially important because online surveying and screening of patients with skin cancer is an emerging and important field, but it can be hindered by participation rates. Removing some of the obstacles to participation could be a significant boon to overall screening efforts.

The study is from Australia, a country with an incredibly high incidence of skin cancers. In the land down under, skin cancers account for approximately 80% of all newly diagnosed cancers. “From a population of only 23 million, more than 434,000 people are treated for one or more nonmelanoma skin cancers in Australia each year,” the study authors observe.

The researchers have been working with questionnaires that assess the underlying risk of potential cancer patients. The researchers posited that using responses to questions about attitudes toward sunblock usage, indoor and outdoor tanning, body freckles, eye color, and tendency to burn, among other questions, it should be possible to create a scale to measure these attributes and calculate an overall skin cancer risk score.

They compared the efficiency of non-adaptive (NAT) and CAT facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk, using a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). Using statistical models, including popular Rasch models, they found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision. The CAT test reduced response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively.

“A brief CAT such as the one we developed could be used to inform people quickly about their skin cancer risk and how to improve their sun protection behaviors,” the researchers concluded. “A mobile online CAT could be used for evaluating skin cancer risk and might reduce the item length in clinical settings.”

Strengths of the study include a very large sample size. Possible limitations include possible need to modify the CAT module for non-English speaking populations.

Computerized Patient Survey Can Aid in Skin Cancer Screening

Over the next few weeks, we’ll take a high-level look at the positions of the leading nominees for President when it comes to political issues potentially impacting physicians.

Is it possible to be an anti-establishment candidate when you’ve been part of the establishment for more than two decades? In the case of Vermont Senator Bernie Sanders, the answer is yes. His first term as a Congressman was as an independent, and as a politician, he has sacrificed friends and allies throughout his career by being critical of politicians on both sides of the aisle. In a political environment in which the word “socialist” is a label to avoid, Sanders embraces it, openly describing himself as a “democratic socialist.”

He voted for the Affordable Care Act, considering it an improvement over the old system, but stating loudly and often that it did not go far enough in improving access and care for all citizens. Should Sanders pull off a minor miracle and beat Hillary Clinton for the nomination and then go on to win the national election, what would his presidency look like for health care?

 Sanders is on record that “Obamacare” was a “small victory” for the uninsured, and a big part of his campaign is based on the idea of creating a “Medicare for all” (ie, a single-payer system for every American). “The United States must join the rest of the industrialized world and recognize that healthcare is a right of all, and not a privilege. Despite the fact that more than 40 million Americans have no health insurance, we spend almost twice as much per capita on healthcare as any other nation,” Sanders wrote in his 

. Under his system, health care would be publicly funded but privately delivered.

Where would that public funding come from? Sanders financing via various tax revenues, credits and subsidies. His draft plan includes a new healthcare income tax, an employer payroll tax, a surcharge on high-income individuals, and a tax on securities transactions, a funding structure that seems vague at best. Sanders is counting on universal health care to control health costs, an area of disagreement with many on the other side of the aisle.

 Alongside fervent beliefs on equal pay for women and extensions of paid family leave, Sanders is strongly pro-choice. “The decision about abortion must remain a decision for the woman and her doctor to make, not the government.” While Planned Parenthood has been in the GOP crosshairs, Sanders vows to expand funding for the organization.

 Sanders has strong positions on expanding mental health services to all, expanding Medicaid coverage, and curbing prescription drug prices through controls on generic pricing and drug reimportation. Sanders is also a big supporter of community health cancers, which provide affordable primary care and mental health counseling.

Part of an ongoing series that takes a high-level look at the positions of the leading nominees for President when it comes to political issues potentially impacting physicians, this installment focuses on Bernie Sanders.

Presidential Candidates on Health Care Issues: Bernie Sanders

Florida Senator Marco Rubio is currently running third in the Republican race, behind Donald Trump and Ted Cruz, but his campaign is picking up steam thanks to polished performances in the debates and a consistency of message the other candidates sometimes lack. Rubio was running well ahead of his former mentor, Jeb Bush, when the latter dropped out of the race following yet another dismal showing in a state primary. Rubio is one of the few Republican candidates to push beyond simply decrying the Affordable Care Act (ACA) and suggest an actual alternative. But how fleshed out is that alternative, and what does it look like?

 Rubio’s main issue with the ACA, besides the general party line that it increases the role of government, is that it potentially limits access to physicians and insurance plans and puts a strain on the economy at largeâ€‘â€‘and, in particular, on small businesses. “ObamaCare is fatally flawed not just because it is poorly constructed, but because it relies on the outdated philosophy that the federal government can solve our problems through more spending, more taxes, more regulations, and more bureaucrats,” Rubio wrote for 

. “...When I am president, repealing and replacing ObamaCare will be an urgent priority of my administration. Instead of relying on an outdated, big-government approach, I will utilize modern, consumer-centered reforms that lower costs, embrace innovation in healthcare and actually increase choices and improve quality of care.”

Those proposed changes take the form of refundable tax credits that would be used to purchase health insurance; reformed insurance regulations to lower costs, encourage innovation, and protect the vulnerable; and strengthening Medicare and Medicaid by placing them on fiscally-sustainable paths. Those are worthy ideas, but cutting costs while expanding access has proven a difficult challenge for every politician who has tried to tackle the US health care system. For the moment, they remain more core concepts than a specific action plan, although Rubio has provided some detail around how he would invigorate Medicare.

Rubio is staunchly pro-life, even in cases in which conception resulted from rape, or in cases in which the mother’s life could be in danger. “I personally and deeply believe that all human life is worthy of the protection of our laws,” he told NBC’s 

 “And I believe that irrespective of the conditions by which that life was conceived, or anything else, and for me to be consistent on that belief.” He did, however, support the Pain-Capable Unborn Child Protection Act in 2013, which aimed to ban late-stage abortions but would allow it under some circumstances. He denies inconsistency here, saying while he doesn’t support exceptions, he does support legislation that would lead to the overall result of fewer abortions.

Regarding Medicare and Social Security, Rubio differs from some of the GOP candidates in that he believes strongly that both programs should be maintained and strengthened. He does not believe in any changes for those in or near retirement. He has suggested transitioning Medicare to a premium support system that would give seniors a generous but fixed amount with which to purchase health insurance. Seniors would have the option of either Medicare or a private provider.

Part of an ongoing series that takes a high-level look at the positions of the leading nominees for President when it comes to political issues potentially impacting physicians, this installment focuses on Marco Rubio.