Childhood cancer and factors related to prolonged diagnostic intervals: a Danish population-based study.

BACKGROUND: Early diagnosis of childhood cancer provides hope for better prognoses. Shorter diagnostic intervals (DI) in primary care require better knowledge of the association between presenting symptoms, interpretation of symptoms and the wording of the referral letter. METHODS: A Danish nationwide population-based study. Data on 550 children aged <15 years with an incident cancer diagnosis (January 2007-December 2010) were collected through questionnaires to parents (response rate=69%) and general practitioners (GPs) (response rate=87%). The DI from the first presentation in general practice until diagnosis was categorised as short or long based on quartiles. Associations between variables and long DIs were assessed using logistic regression. RESULTS: The GPs interpreted symptoms as 'vague' in 25.4%, 'serious' in 50.0% and 'alarm' in 19.0% of cases. Symptom interpretation varied by cancer type (P<0.001) and was associated with the DI (P<0.001). Vomiting was associated with a shorter DI for central nervous system (CNS) tumours, and pain with a longer DI for leukaemia. Referral letter wording was associated with DI (P<0.001); the shortest DIs were observed when cancer suspicion was raised in the letter. CONCLUSION: The GPs play an important role in recognising early signs of childhood cancer as their symptom interpretation and referral wording have a profound impact on the diagnostic process.

Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care.

BACKGROUND: The relationship between the diagnostic interval and mortality from colorectal cancer (CRC) is unclear. This association was examined by taking account of important confounding factors at the time of first presentation of symptoms in primary care. METHODS: A total of 268 patients with CRC were included in a prospective, population-based study in a Danish county. The diagnostic interval was defined as the time from first presentation of symptoms until diagnosis. We analysed patients separately according to the general practitioner's interpretation of symptoms. Logistic regression was used to estimate 3-year mortality odds ratios as a function of the diagnostic interval using restricted cubic splines and adjusting for tumour site, comorbidity, age, and sex. RESULTS: In patients presenting with symptoms suggestive of cancer or any other serious illness, the risk of dying within 3 years decreased with diagnostic intervals up to 5 weeks and then increased (P=0.002). In patients presenting with vague symptoms, the association was reverse, although not statistically significant. CONCLUSION: Detecting cancer in primary care is two sided: aimed at expediting ill patients while preventing healthy people from going to hospital. This likely explains the counterintuitive findings; but it does not explain the increasing mortality with longer diagnostic intervals. Thus, this study provides evidence for the hypothesis that the length of the diagnostic interval affects mortality in CRC patients.

Social support, gender and patient delay.

BACKGROUND: The purpose of this study was to examine the relationship between perceived social support and patient delay (PD) among female and male cancer patients. METHODS: A population-based study with register-sampled cancer patients was designed. Patient delay was defined as the time interval between the patient's experience of the first symptom and the first contact with a health-care professional. Both dates were provided by the patients (n=910). The patients completed a purpose-designed questionnaire, which assessed the patient's perceptions of how the partner reacted ('Partner Avoidance' and 'Partner Support') and how others in the social network responded ('Other Avoidance' and 'Other Support') to the patient's worries about the symptoms. The associations between the social support subscales and PD were analysed separately for men and women. RESULTS: In female patients, Partner Support and Other Support were associated with shorter PD, whereas Other Avoidance was associated with longer PD. In the multivariate analysis, Other Avoidance remained associated with longer PD. Moreover, disclosure of symptoms to someone reduced the likelihood of a long PD in female patients. In male patients, none of the social support scales significantly increased or decreased the risk of a long PD in the univariate analysis, but Partner Support significantly decreased risk of a long PD in the multivariate analysis. CONCLUSIONS: The results of this study suggest that social support and avoidance from network members influence length of PD differently in male and female cancer patients. This gender difference may explain previous mixed findings obtained in this field.

Delay in diagnosis: the experience in Denmark.

BACKGROUND: Denmark has poorer 5-year survival rates than many other Western European countries, and cancer patients tend to have more advanced stages at diagnosis than those in other Scandinavian countries. Part of this may be due to delay in diagnosis. The aim of this paper is to give an overview of the initiatives currently underway to reduce delays. METHODS: Description of Danish actions to reduce delay. RESULTS: Results of surveys of patient-, doctor- and system-related delays are presented and so are the political initiatives to ensure that cancer is seen as an acute disease. CONCLUSION: In future, fast-track diagnosis and treatment will be provided for suspected cancers and access to general diagnostic investigations will be improved. A large national experiment with cancer seen as an acute disease is currently being implemented, and as yet the results are unknown.

The occurrence of diastereomers of phytanic and pristanic acids and their determination by gas-liquid chromatography.

The methyl esters of phytanic (3,7,11,15-tetramethylhexadecanoic) and pristanic (2,6,10,14-tetramethylpentadecanoic) acids derived from phytol each can be resolved into two diastereomers by gas-liquid chromatography on an efficient open-tubular, gas-liquid chromatographic column with a polyester coating. Authentic D,D,D isomers prepared from the lipids of bacteriumH. cutirubrum gave only one peak. In mammals the D,D,D isomers usually predominate, but in marine life the L,D,D isomers apparently are the principal forms. The origin and metabolic roles of the diastercomers are discussed.

The occurrence of methyl methoxystearate isomers in the methyl esters prepared from sheep perinephric fat.

A fraction has been isolated from sheep perinephric fat and identified by techniques which included mass and infrared spectrometry, as a mixture of the 8 to 14-methoxyoctadecanoic acid isomers. It is postulated that these isomers are artifacts produced by rigorous esterification with methanol and concentrated H(2)SO(4) of a large sample of sheep perinephric fatty acids which are presumed to have contained trace amounts of constituent hydroxy fatty acids. It is estimated that these methoxystearic acid isomers represented approximately 0.08% of the total weight of fatty acids.

2-ethylthio-9-methyl-1,4-dihydroacridine-1,4-dione and 9-methyl-2-(4-tolylthio)-1,4-dihydroacridine-1,4-dione.

The title compounds, C16H13NO2S, (I), and C21H15NO2S, (II), have similar molecular structures that differ only in the side groups attached to the S atom. The crystal packing is dominated by pi-pi stacking interactions, involving acridinedione-acridinedione overlap in (I) and both acridinedione-acridinedione and acridinedione-tolyl overlap in (II).

Polyclonal antibodies to domoic acid, and their use in immunoassays for domoic acid in sea water and shellfish.

Ovine antibodies raised against conjugates linked through the secondary amino group of domoic acid (1) were used, together with activated-ester-derived conjugates of domoic acid (DA) as the plate coater, to develop a robust indirect competitive enzyme-linked immunosorbent assay (cELISA) for DA in shellfish and seawater. The ELISA was used to analyze shellfish samples for DA, and was compatible with several extraction procedures. The ELISA had a detection limit below 0.01 ng ml(-1), a limit of quantitation (LOQ) of 0.15 ng ml(-1) and a working range of 0.15-15 ng ml(-1) DA. The LOQ is equivalent to 38 ng g(-1) DA in shellfish flesh, assuming a 250-fold dilution during extraction. This is more than 500 times lower than the maximum permitted level (20 microg g(-1) flesh). The ELISA is designed for use alongside regulatory analyses, and, following formal validation, should be available for pre-screening of regulatory shellfish flesh samples. The ELISA was also shown to be appropriate for analysis of DA in algal cultures and in samples of seawater, and thus has the potential to provide early warning of developing algal blooms.