Second primary cancer risk - the impact of applying different definitions of multiple primaries: results from a retrospective population-based cancer registry study

Background: There is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks.<p></p> Methods: We examined the incidence of second primary cancer among adults in the West of Scotland, UK, diagnosed with cancer between 2000 and 2004 (n = 57,393). We used National Cancer Institute Surveillance Epidemiology and End Results and International Agency for Research on Cancer definitions of multiple primary cancers and estimated indirectly standardised incidence ratios (SIR) with 95% confidence intervals (CI).<p></p> Results: There was a high incidence of cancer during the first 60 days following diagnosis (SIR = 2.36, 95% CI = 2.12 to 2.63). When this period was excluded the risk was not raised, but it was high for some patient groups; in particular women aged <50 years with breast cancer (SIR = 2.13, 95% CI = 1.58 to 2.78), patients with bladder (SIR = 1.41, 95% CI = 1.19 to 1.67) and head & neck (SIR = 1.93, 95% CI = 1.67 to 2.21) cancer. Head & neck cancer patients had increased risks of lung cancer (SIR = 3.75, 95% CI = 3.01 to 4.62), oesophageal (SIR = 4.62, 95% CI = 2.73 to 7.29) and other head & neck tumours (SIR = 6.10, 95% CI = 4.17 to 8.61). Patients with bladder cancer had raised risks of lung (SIR = 2.18, 95% CI = 1.62 to 2.88) and prostate (SIR = 2.41, 95% CI = 1.72 to 3.30) cancer.<p></p> Conclusions: Relative risks of second primary cancers may be smaller than previously reported. Premenopausal women with breast cancer and patients with malignant melanomas, bladder and head & neck cancers may benefit from increased surveillance and advice to avoid known risk factors

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

OBJECTIVE: To characterize practices related to observation care and to examine the current models of pediatric observation medicine in US children's hospitals. DESIGN: We utilized 2 web‐based surveys to examine observation care in the 42 hospitals participating in the Pediatric Health Information System database. We obtained information regarding the designation of observation status, including the criteria used to admit patients into observation. From hospitals reporting the use of observation status, we requested specific details relating to the structures of observation care and the processes of care for observation patients following emergency department treatment. RESULTS: A total of 37 hospitals responded to Survey 1, and 20 hospitals responded to Survey 2. Designated observation units were present in only 12 of 31 (39%) hospitals that report observation patient data to the Pediatric Health Information System. Observation status was variably defined in terms of duration of treatment and prespecified criteria. Observation periods were limited to <48 hours in 24 of 31 (77%) hospitals. Hospitals reported that various standards were used by different payers to determine observation status reimbursement. Observation care was delivered in a variety of settings. Most hospitals indicated that there were no differences in the clinical care delivered to virtual observation status patients when compared with other inpatients. CONCLUSIONS: Observation is a variably applied patient status, defined differently by individual hospitals. Consistency in the designation of patients under observation status among hospitals and payers may be necessary to compare quality outcomes and costs, as well as optimize models of pediatric observation care. Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91108/1/949_ftp.pd

Like parents, like children... this is not always the case! A longitudinal study on the family transmission of intergroup contact

During adolescence, opportunities for interethnic interactions can shape future attitudes toward diversity. However, it is unclear how family can influence adolescents' quality of contact in different life contexts. This study aims to fill this gap. A sample of 702 Italian adolescents (M-age=15.61, SDage=1.11, 48.58% girls) and their parents (615 mothers, M-age=48.45, SDage=4.34; 487 fathers, M-age=51.22, SDage=4.92) completed questionnaires at two time points. Cross-lagged models indicated that adolescents' intergroup contact at T1 was associated with mothers' contact over time, mainly in structured (i.e., school and work) contexts. No significant associations were found regarding fathers' intergroup contact and unstructured contexts. These results shed new light on the process of family transmission during adolescence, particularly regarding intergroup dynamics

COVID-19 Disease and Viral Characteristics in a Long-Term Care Facility

Abstract Due to the combination of age, comorbidities, and close living quarters, residents at long-term care facilities (LTCFs) are at particularly high risk of severe symptoms and death due to COVID-19. This cross-sectional study examines the relationship between demographic characteristics, symptom severity, and length of viral shedding in 49 residents testing positive for SARS-CoV-2 at a LTCF in West Virginia (WV). Over half of the residents were asymptomatic while nearly a quarter experienced severe symptoms. Women were more likely to be asymptomatic and age was not associated with symptom severity. While no specific medical condition was associated with symptom severity, having more chronic illnesses was associated. The length of time from initial positive to PCR negative ranged from 2 to 63 days with an average of 29 days. Given the variability in PCR testing reliability, 30 days of isolation and 2 consecutive negative PCR tests are recommended before reintegrating residents

Lower incidence rates but thicker melanomas in Eastern Europe before 1992: A comparison with Western Europe

The objective of this study was to investigate the epidemiology of melanoma across Europe with regard to Breslow thickness and body-site distribution. Incidence data from Cancer Incidence in 5 Continents and the EUROCARE-melanoma database were used: 28 117 melanoma cases from 20 cancer registries in 12 European countries, diagnosed between 1978 and 1992. Regression analysis and general linear modelling were used to analyse the data. Melanomas in Eastern Europe were on average 1.4 mm thicker (P<0.05) than in Western Europe and appeared more often on the trunk. From 1978 to 1992, their Breslow thickness had decreased in Western but not Eastern Europe. There was a latitude gradient in incidence, with highest rates in southern regions in Eastern Europe and an inverse gradient in Western Europe, with highest rates in the North. Mortality:incidence ratios were less favourable in southern parts across Europe, especially in Eastern Europe. If Eastern European populations copy the sunbathing behaviour of the West it is likely that in the near future a higher melanoma incidence can be expected there

Psychometric properties of the Italian Tinnitus Functional Index (TFI)

Diversi questionari sono utilizzati per valutare l\u2019impatto dell\u2019acufene sulla qualit\ue0 della vita. Il Tinnitus Functional Index (TFI) proposto da Meikle et al, nel 2012, ha dimostrato propriet\ue0 eccellenti per misurare la gravit\ue0 e le modificazioni indotte dal trattamento degli acufeni, sia in ambito clinico che di ricerca. Lo scopo di questo studio \ue8 stato valutare le propriet\ue0 psicometriche della versione italiana del TFI, in particolare, l\u2019analisi fattoriale, la consistenza interna, l\u2019affidabilit\ue0 e la validit\ue0. La versione originale inglese del TFI \ue8 stata tradotta in italiano secondo la procedura translation - back translation; 137 partecipanti con acufeni da almeno 3 mesi (39,4% femmine, et\ue0: 18-80 anni, et\ue0 media: 48,26, SD: 14,08), reclutati presso la Tinnitus Clinic di Milano, hanno completato la versione italiana del TFI, il Tinnitus Handicap Inventory, la Beck Depression Inventory - Versione Primary Care e la scala di valutazione numerica per il fastidio. Una parte del campione, 57 pazienti, ha completato la versione italiana del TFI in una seconda visita, dopo 7-14 giorni, prima di ricevere qualsiasi tipo di trattamen- to, per ricavare i dati per la valutazione della riproducibilit\ue0. Le propriet\ue0 psicometriche sono state studiate attraverso un\u2019analisi fattoriale esplorativa ed il calcolo di misure di consistenza interna e affidabilit\ue0 test-retest. La validit\ue0 convergente \ue8 stata valutata mediante i coefficienti di correlazione con le restanti misure. La versione italiana del TFI ha mostrato una struttura a quattro fattori, parzialmente diversa dalla struttura originale a otto fattori. L\u2019adattamento italiano del TFI ha rivelato buoni livelli di consistenza interna (0,92 64 \u3b1 64 0,96) e affidabilit\ue0 test-retest (0,79 64 \u3b1 64 0,85). In termini di validit\ue0 convergente, ha mostrato buone correlazioni con i punteggi del THI (r = 0,77) e della scala del fastidio (r = 0,70) e correlazioni medie con i punteggi del BDI (r = 0,46). Le difficolt\ue0 nel riprodurre la struttura originale a otto fattori sono coerenti con altri studi di validazione del TFI nelle lingue europee. Nonostante tali discrepanze, la versione italiana del TFI ha mostrato una struttura fattoriale caratterizzata da alti livelli di affidabilit\ue0 e validit\ue0. Nel complesso, l\u2019adattamento italiano di TFI si \ue8 rivelato idoneo a misurare l\u2019impatto degli acufeni sulla vita quotidiana degli individui.Various questionnaires are used to assess the impact of tinnitus on the quality of life. The Tinnitus Functional Index (TFI) has excellent properties for scaling the severity of tinnitus and treatment-related changes in both clinical and research settings. The aim of this study was to evaluate the psychometric properties of the Italian version of the TFI with particular emphasis on factor analysis, internal consistency, reliability and validity. The original English version of the TFI was translated into Italian using the translation/back - translation process; 137 participants who were re- cruited at the Tinnitus Clinic in Milan and had suffered from tinnitus for at least three months (39.4% females, age: 18-80 years, mean age: 48.26, SD: 14.08) completed the Italian version of the TFI, the Tinnitus Handicap Inventory (THI), the Beck Depression Inventory - Primary Care Version (BDI-PC) and the Numeric Rating Scale of annoyance (NRS-A). Of these patients, 57 completed the TFI again at a second visit 7-14 days later, before undergoing any intervention, in order to provide data for reproducibility assessment. The psychometric properties were investigated using exploratory factor analysis and internal consistency and test-retest reliability instruments. The convergent validity of the TFI was evalu- ated using correlation coefficients obtained from the remaining measurements. The Italian TFI has a four-factor structure that was somewhat different from the original. The internal consistency proved to be good (0.92 64 \u3b1 64 0.96) as did the test-retest reliability (0.79 64 \u3b1 64 0.85). In terms of convergent validity, the TFI showed high correlations with the THI (r = 0.77) and the NRS-A (r = 0.70) scores, and moderate correlations with the BDI-PC scores (r = 0.46). The difficulties encountered when attempting to reproduce the original eight-factor structure were consistent with other studies in which the TFI was translated into European languages. In spite of this, the factorial structure of the Italian version of the TFI was characterised by high levels of reliability and validity. Overall, the Italian adaptation of the TFI was shown to be suitable to measure the impact of tinnitus on the daily lives of individuals

Fracture and migration in right atrium of a permanent venous central access system in a elderly patient: case report and literature review

Catheter dislocation and fracture with migration of central venous lines have been reported in the International literature. Catheter fracture with consequent migration has been observed in 0.5-3.0% and may either be consequent to catheter removal or it can occur spontane-ously. Our case report concerns the migration of a Hickman catheter connected to a venous port to the right atrium in a 61-year old patient. A literature up-to-date has been performed to assess the risk of port-a-cath positioning. The position of catheter tip is considered critical for the risk of migration, that is greater as higher the tip localization respect to the carina. The aim of our study is to underline the critical role of X-ray to visualize the exact location of the catheter tip, regard-less of the approach used for catheter positioning

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems