The COVID-19 pandemic has not changed stage at presentation nor treatment patterns of head and neck cancer: A retrospective cohort study.

OBJECTIVES: To evaluate the impact of the COVID-19 lockdown measures on HNC, by comparing the stage at presentation and treatment of HNC before and after the most severe COVID-19 restrictions. DESIGN: A retrospective cohort study. SETTING: A regional cancer network serving a patient population of 2.4 million. PARTICIPANTS: Newly diagnosed patients with HNC between June and October 2019 (pre-pandemic) and June and October 2021 (post-pandemic). MAIN OUTCOME MEASURES: Symptom duration before diagnosis, stage at diagnosis, patient performance status (PS) and intent of treatment delivered (palliative vs. curative). RESULTS: Five hundred forty-five patients were evaluated-250 in the 2019 and 295 in the 2021 cohort. There were no significant differences in symptom duration between the cohorts (p = .359) or patient PS (p = .821). There were no increased odds of presenting with a late (Stage III or IV) AJCC cancer stage in 2021 compared with 2019 (odds ratio [OR] = 0.90; 95% confidence interval [CI]: 0.76-1.08); nor increased odds of receiving palliative rather than curative treatment in 2021 compared with 2019 (OR = 0.68; 95% CI: 0.45-1.03). CONCLUSION: The predicted stage shift to more advanced disease at the time of diagnosis of HNC due to the COVID-19 pandemic has not been realised in the longer term. In keeping with this, there was no difference in symptom duration, patient PS, or treatment patterns between the 2019 and 2021 cohorts.

Physiological stress reactivity in pediatric cancer survivors treated with chemotherapy.

Children who experience early life stress demonstrate changes to their stress responses, which may modulate long-term health. Childhood cancer presents significant stress during diagnosis, treatment, and survivorship. We hypothesized that children who have completed chemotherapy treatment for ALL will demonstrate altered hormone patterns in response to a stressor compared with healthy controls. Twelve pediatric ALL survivors and 12 healthy controls completed the Trier Social Stress Test. Salivary samples, heart rate, and self-report ratings of stress were collected at baseline, pretest, and posttest. Between group comparison showed baseline (interleukin [IL]-8) was significantly higher in the survivor group versus controls (survivors: 89.9, 40.1-544.9 pg ml-1 ; controls: 30.7, 5.6-241.9 pg ml-1 , p = .001) as was peak (IL-8) (survivors: 147.1, 71.6-1177.6 pg ml-1 ; controls: 75.5, 28.6-698.6 pg ml-1 ). Peak salivary alpha-amylase (sAA) concentration was significantly lower in the survivor group (survivors: 69.3, 19.4-195.5 U ml-1 ; controls: 91.2, 27.7-213.7 U ml-1 ; p = .04). Repeated measures ANOVA revealed significant main effects for time on cortisol (F(2.35, 50.81)  = 5.9, p < .01), sAA (F(1.56, 33.17)  = 6.6, p < .01), stress ratings (F(3.42, 88.14)  = 53.4, p < .001), and heart rate (F(8, 83)  = 16.8, p < .05). Significant main effects for group were observed for IL-8 (F(1, 23)  = 8.2, p < .01) and tumor necrosis factor-α (F(1, 23)  = 6.8, p < .05). Significant interaction effects for group × time were found for sAA (F(5, 106)  = 2.8, p < .05). Our results indicate that childhood ALL survivors have similar responses to stress as healthy controls, but lower sympatho-adrenal-medullary reactivity. Therefore, altered stress regulation may present a pathway modulating long-term health in this population.

Peripheral Skeletal Muscle Impairment in Children After Treatment for Leukemia and Lymphoma.

Exercise intolerance is a common adverse effect of childhood cancer, contributing to impaired health and well-being. While reduced aerobic fitness has been attributed to central cardiovascular deficiencies, the involvement of peripheral musculature has not been investigated. We studied peripheral muscle function in children following cancer treatment using noninvasive phosphorus-31 magnetic resonance spectroscopy. Ten acute lymphoblastic leukemia (ALL) and 1 lymphoma patient 8 to 18 years of age who completed treatment 6 to 36 months prior and 11 healthy controls participated in the study. Phosphorus-31 magnetic resonance spectroscopy was used to characterize muscle bioenergetics at rest and following an in-magnet knee-extension exercise. Exercise capacity was evaluated using a submaximal graded treadmill test. Both analysis of variance and Cohen d were used as statistical methods to determine the statistical significance and magnitude of differences, respectively, on these parameters between the patient and control groups. The patients treated for ALL and lymphoma exhibited lower anaerobic function ( P =0.14, d =0.72), slower metabolic recovery ( P =0.08, d =0.93), and lower mechanical muscle power ( d =1.09) during exercise compared with healthy controls. Patients demonstrated lower estimated VO 2peak (41.61±5.97 vs. 47.71±9.99 mL/min/kg, P =0.11, d =0.76), lower minutes of physical activity (58.3±35.3 vs. 114.8±79.3 min, P =0.12, d =0.99) and higher minutes of inactivity (107.3±74.0 vs. 43.5±48.3 min, d =1.04, P <0.05). Children treated for ALL and lymphoma exhibit altered peripheral skeletal muscle metabolism during exercise. Both deconditioning and direct effects of chemotherapy likely contribute to exercise intolerance in this population.

Study protocol for a 2-year longitudinal study of positive youth development at an urban sport for development facility.

BACKGROUND: Youth facing barriers created by social marginalization are at a greater risk of adverse health outcomes, lower educational and occupational attainment, and decreased overall quality of life as adults. The negative psychosocial and physiological consequences of significant barriers to positive development during youth may be mitigated by interventions promoting physical activity, psychosocial development, and healthy behaviours. Sport for Development programming is a possible opportunity for youth facing barriers to engage in activities that foster positive youth development, which may improve socioeconomic outcomes, quality of life and long-term health status in this population. This paper outlines the study protocol measuring impact of an urban Sport for Development facility on positive youth development in youth facing barriers. METHODS/DESIGN: Participants aged 6-29 will be recruited from programs at an urban Sport for Development facility to a 2-year prospective longitudinal mixed-methods study. Participants will be stratified by age into three cohorts with age-specific outcomes. Age-specific positive youth development outcomes will be assessed quantitatively by self-report and pedometer at baseline and after 6 months, 1-year, and 2-years of program participation. Focus groups will provide data regarding youth experience and the impact of facility and program components on youth outcomes. DISCUSSION: Our findings will inform best-practice and feasibility of a Sport for Development facility delivering programs in a socially and economically challenged urban setting in a high-income country. TRIAL REGISTRATION: ISRCTN67016999. Date of registration: October 22, 2019.

Physical activity for children with chronic disease; a narrative review and practical applications.

BACKGROUND: Physical activity (PA) is associated with a diverse range of health benefits. International guidelines suggest that children should be participating in a minimum of 60 min of moderate to vigorous intensity PA per day to achieve these benefits. However, current guidelines are intended for healthy children, and thus may not be applicable to children with a chronic disease. Specifically, the dose of PA and disease specific exercise considerations are not included in these guidelines, leaving such children with few, if any, evidence-based informed suggestions pertaining to PA. Thus, the purpose of this narrative review was to consider current literature in the area of exercise as medicine and provide practical applications for exercise in five prevalent pediatric chronic diseases: respiratory, congenital heart, metabolic, systemic inflammatory/autoimmune, and cancer. METHODS: For each disease, we present the pathophysiology of exercise intolerance, summarize the pediatric exercise intervention research, and provide PA suggestions. RESULTS: Overall, exercise intolerance is prevalent in pediatric chronic disease. PA is important and safe for most children with a chronic disease, however exercise prescription should involve the entire health care team to create an individualized program. CONCLUSIONS: Future research, including a systematic review to create evidence-based guidelines, is needed to better understand the safety and efficacy of exercise among children with chronic disease.

Exercise Intensity and Recovery: Biomarkers of Injury, Inflammation, and Oxidative Stress.

Biomarkers of inflammation, muscle damage, and oxidative stress after high-intensity exercise have been described previously; however, further understanding of their role in the postexercise recovery period is necessary. Because these markers have been implicated in cell signaling, they may be specifically related to the training adaptations induced by high-intensity exercise. Thus, a clear model showing their responses to exercise may be useful in characterizing the relative recovery status of an athlete. The purpose of this study was twofold: (a) to investigate the time course of markers of muscle damage and inflammation in the blood from 3 to 72 hours after combined training exercises and (b) to investigate indicators of oxidative stress and damage associated with increased reactive oxygen species production during high-intensity exercise in elite athletes. Nineteen male athletes performed a combination of high-intensity aerobic and anaerobic training exercises. Samples were acquired immediately before and at 3, 6, 12, 24, 48, and 72 hours after exercise. The appearance and clearance of creatine kinase and lactate dehydrogenase in the blood occurred faster than previous studies have reported. The neutrophil/lymphocyte ratio summarizes the mobilization of 2 leukocyte subpopulations in a single marker and may be used to predict the end of the postexercise recovery period. Further analysis of the immune response using serum cytokines indicated that high-intensity exercise performed by highly trained athletes only generated inflammation that was localized to the skeletal muscle. Biomarkers are not a replacement for performance tests, but when used in conjunction, they may offer a better indication of metabolic recovery status. Therefore, the use of biomarkers can improve a coach's ability to assess the recovery period after an exercise session and to establish the intensity of subsequent training sessions.

The effect of on-hill active recovery performed between runs on blood lactate concentration and fatigue in alpine ski racers.

Alpine skiing is a high-intensity intermittent sport that results in lactate accumulation and muscle acidosis, which has been shown to contribute to peripheral neuromuscular fatigue. Active recovery influences the removal of lactate from the muscle and blood by maintaining blood flow to fatigued muscles and enhancing aerobic utilization of lactate by nonfatigued tissues. The purpose of this study was to investigate the effect of on-hill active recovery on blood lactate concentration in alpine skiers. Fourteen highly trained alpine skiers (7 women, 7 men) completed 8 training runs in a 45-gate slalom or a 25-gate giant slalom corridor at 2,600 m above sea level. Skiers were randomized to active (ACT) or static recovery (CON) performed at the top of each run. Blood lactate concentration and perceived fatigue were recorded at the top and bottom of each run. Performance was measured by time to complete each training run and rate of incomplete runs. A significant time (p < 0.01) and interaction (p = 0.001) effect was observed for blood lactate concentration measured at the top, with ACT being associated with significantly lower values. A significant time effect (p < 0.001) was observed for blood lactate concentration measured at the bottom. Training run completion time was longer (p ≤ 0.05), and higher rate of incomplete runs were observed in the CON group, despite no between-group differences in rating of perceived fatigue. On-hill active recovery performed between runs promotes blood lactate clearance in alpine skiers and is associated with delayed fatigue as indicated by faster training runs and fewer incomplete runs.

The effect of various cold-water immersion protocols on exercise-induced inflammatory response and functional recovery from high-intensity sprint exercise.

PURPOSE: The purpose of this study was to investigate the effects of different cold-water immersion (CWI) protocols on the inflammatory response to and functional recovery from high-intensity exercise. METHODS: Eight healthy recreationally active males completed five trials of a high-intensity intermittent sprint protocol followed by a randomly assigned recovery condition: 1 of 4 CWI protocols (CWI-10 min × 20 °C, CWI-30 min × 20 °C, CWI-10 min × 10 °C, or CWI-30 min × 10 °C) versus passive rest. Circulating mediators of the inflammatory response were measured from EDTA plasma taken pre-exercise (baseline), immediately post-exercise, and at 2, 24, and 48 h post-exercise. Ratings of perceived soreness and impairment were noted on a 10-pt Likert scale, and squat jump and drop jump were performed at these time points. RESULTS: IL-6, IL-8, and MPO increased significantly from baseline immediately post-exercise in all conditions. IL-6 remained elevated from baseline at 2 h in the CWI-30 min × 20 °C, CWI-10 min × 10 °C, and CWI-30 min × 10 °C conditions, while further increases were observed for IL-8 and MPO in the CWI-30 min × 20 °C and CWI-30 min × 10 °C conditions. Squat jump and drop jump height were significantly lower in all conditions immediately post-exercise and at 2 h. Drop jump remained below baseline at 24 and 48 h in the CON and CWI-10 min × 20 °C conditions only, while squat jump height returned to baseline in all conditions. CONCLUSIONS: Cold-water immersion appears to facilitate restoration of muscle performance in a stretch-shortening cycle, but not concentric power. These changes do not appear to be related to inflammatory modulation. CWI protocols of excessive duration may actually exacerbate the concentration of cytokines in circulation post-exercise; however, the origin of the circulating cytokines is not necessarily skeletal muscle.

The Psychoneuroimmunology of Stress Regulation in Pediatric Cancer Patients.

Stress is a ubiquitous experience that can be adaptive or maladaptive. Physiological stress regulation, or allostasis, can be disrupted at any point along the regulatory pathway resulting in adverse effects for the individual. Children with cancer exhibit significant changes to these pathways in line with stress dysregulation and long-term effects similar to those observed in other early-life stress populations, which are thought to be, in part, a result of cytotoxic cancer treatments. Children with cancer may have disruption to several steps in the stress-regulatory pathway including cognitive-affective function, neurological disruption to stress regulatory brain regions, altered adrenal and endocrine function, and disrupted tissue integrity, as well as lower engagement in positive coping behaviours such as physical activity and pro-social habits. To date, there has been minimal study of stress reactivity patterns in childhood illness populations. Nor has the role of stress regulation in long-term health and function been elucidated. We conclude that consideration of stress regulation in childhood cancer may be crucial in understanding and treating the disease.

Massage Therapy Modulates Inflammatory Mediators Following Sprint Exercise in Healthy Male Athletes.

Massage therapy is a common postexercise muscle recovery modality; however, its mechanisms of efficacy are uncertain. We evaluated the effects of massage on systemic inflammatory responses to exercise and postexercise muscle performance and soreness. In this crossover study, nine healthy male athletes completed a high-intensity intermittent sprint protocol, followed by massage therapy or control condition. Inflammatory markers were assessed pre-exercise; postexercise; and at 1, 2, and 24 h postexercise. Muscle performance was measured by squat and drop jump, and muscle soreness on a Likert scale. Significant time effects were observed for monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor alpha (TNFα), drop jump performance, squat jump performance, and soreness. No significant effects for condition were observed. However, compared with control, inflammatory marker concentrations (IL-8, TNFα, and MCP-1) returned to baseline levels earlier following the massage therapy condition (p < 0.05 for all). IL-6 returned to baseline levels earlier following the control versus massage therapy condition (p < 0.05). No differences were observed for performance or soreness variables. MCP-1 area under the curve (AUC) was negatively associated with squat and drop jump performance, while IL-10 AUC was positively associated with drop jump performance (p < 0.05 for all). In conclusion, massage therapy promotes resolution of systemic inflammatory signaling following exercise but does not appear to improve performance or soreness measurements.

Inherited understandings: the breast as object.

This paper discusses findings from a research study that investigated the experience of being a breastfeeding woman in New Zealand. The study was motivated by a desire to better understand why the majority of New Zealand women wean their infants before 6 months of age, despite the benefits of prolonged breastfeeding being well accepted. Nineteen women, who were breastfeeding or had recently breastfed, were engaged in unstructured interviews about their experience, and the results were examined using a reflective lifeworld research methodology. The findings presented here demonstrate that women often employ an interpretive framework that is aligned with the philosophical tradition of Descartes' mind-body split, also know as Cartesian dualism. This leads to a widely held perception of the breast as an object, which emerged in the participants' narratives and is explored using Heidegger's philosophical interpretation of equipment. We conclude that the objectification of the breast in our society fails to provide women with language that describes the breastfeeding experience in a meaningful way, thus undermining women's ability to articulate and reconcile their embodied breastfeeding experiences.

Skeletal Muscle Dysfunction and Exercise Intolerance in Children Treated with Haematopoietic Stem Cell Transplant-A Pilot Feasibility Study.

Haematopoietic stem cell transplant (HSCT) is an intensive therapy for some pediatric hematological illnesses. Survivors are at risk for adverse effects including exercise intolerance. Peripheral tissue dysfunction may contribute to exercise intolerance; therefore, we examined the feasibility of a magnetic resonance spectroscopy (MRS) protocol to evaluate skeletal muscle metabolism in children post-HSCT. We measured demographic characteristics, aerobic exercise capacity (YMCA protocol), and skeletal muscle function in response to exercise (MRS; Siemens 3T MRI) in five children post-allogeneic HSCT and five age/body mass index-matched healthy controls (HCs). The mean age (± standard deviation) of the HSCT group and HC group were 11 ± 1.2 and 12.8 ± 2.4 years, respectively. Children post-HSCT had a lower peak aerobic exercise capacity compared to HCs (27.8 ± 3.4 vs. 40.3 ± 8.1 mL kg-1 min-1, respectively; p = 0.015). Exercise MRS testing protocols were successfully completed by all HSCT and HC participants; however, MRS-derived skeletal muscle metabolism variables were not different between the two groups. In conclusion, the use of exercise protocols in conjunction with MRS to assess peripheral skeletal muscle metabolism was achievable in children post-HSCT. In the future, larger studies should determine if skeletal muscle function is associated with exercise capacity in children post-HSCT.

Interstitial deletion of the short arm of chromosome 2 in a mother and child, with facial dysmorphism and mild learning difficulties.

We report a mother and son with an interstitial deletion of chromosome 2: del(2)(p21p22.2). Both have mildly dysmorphic facial features and learning difficulties. This phenotype contrasts with two previously described cases with a similar deletion that presented with cyclopia and alobar holoprosencephaly.

Ultrasonographic appearance of the major duodenal papilla in dogs without evidence of hepatobiliary, pancreatic, or gastrointestinal tract disease.

OBJECTIVE To determine the ultrasonographic appearance of the major duodenal papilla (MDP) in dogs without evidence of hepatobiliary, pancreatic, or gastrointestinal tract disease. ANIMALS 40 adult client-owned dogs examined because of conditions that did not include hepatobiliary, pancreatic, or gastrointestinal tract disease. PROCEDURES Ultrasonographic examination of the MDP was performed. Each MDP was measured in 3 planes. Intraobserver reliability of measurements was determined, and associations between MDP dimensions and characteristics of the dogs were investigated. Histologic examination of longitudinal sections of the MDP was performed for 1 dog to compare the ultrasonographic and histologic appearance. RESULTS The MDP appeared as a layered structure with a hyperechoic outer layer, hypoechoic middle layer, and hyperechoic inner layer that corresponded to the duodenal serosa, duodenal muscularis, and duodenal submucosa, respectively. Layers visible during ultrasonographic examinations were consistent with layers identified histologically. Intraobserver reliability was substantial for each plane of measurement. Mean ± SD length, width, and height of the MDP were 15.2 ± 3.5 mm, 6.3 ± 1.6 mm, and 4.3 ± 1.0 mm, respectively. An increase in body weight of dogs was significantly associated with increased values for all measurements. CONCLUSIONS AND CLINICAL RELEVANCE The ultrasonographic appearance and approximate dimensions of the MDP of dogs without evidence of hepatobiliary, pancreatic, or gastrointestinal tract disease were determined. Additional studies are needed to evaluate possible ultrasonographic lesions of the MDP in dogs with hepatobiliary, pancreatic, or intestinal diseases and to investigate clinical implications of these lesions with regard to diagnosis and prognosis.

Death certification and doctors' dilemmas: a qualitative study of GPs' perspectives.

BACKGROUND: Death certificate inaccuracies have implications for funding and planning public health services, health research and family settlements. Improved training has been identified as a way of reducing inaccuracies. Understanding the influences on certifying doctors should inform that training. AIM: To explore what factors influence GPs as they complete death certificates. DESIGN: Focus groups held by teleconference with 16 GPs. SETTING: New Zealand general practice. METHOD: Four teleconferenced focus groups were taped and transcribed. Transcripts were examined for emerging themes. Credibility, transferability and confirmability were underwritten by a clear audit trail. RESULTS: Participants identified two factors that influenced death certification: clinical uncertainty and the family. Other themes provided an understanding of the personal and professional concerns for GPs. CONCLUSION: Improving death certification accuracy is a complex issue and needs to take into consideration factors that influence certifiers.

Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise.

High-intensity exercise is associated with mechanical and/or metabolic stresses that lead to reduced performance capacity of skeletal muscle, soreness and inflammation. Cold-water immersion and other forms of cryotherapy are commonly used following a high-intensity bout of exercise to speed recovery. Cryotherapy in its various forms has been used in this capacity for a number of years; however, the mechanisms underlying its recovery effects post-exercise remain elusive. The fundamental change induced by cold therapy is a reduction in tissue temperature, which subsequently exerts local effects on blood flow, cell swelling and metabolism and neural conductance velocity. Systemically, cold therapy causes core temperature reduction and cardiovascular and endocrine changes. A major hindrance to defining guidelines for best practice for the use of the various forms of cryotherapy is an incongruity between mechanistic studies investigating these physiological changes induced by cold and applied studies investigating the functional effects of cold for recovery from high-intensity exercise. When possible, studies investigating the functional recovery effects of cold therapy for recovery from exercise should concomitantly measure intramuscular temperature and relevant temperature-dependent physiological changes induced by this type of recovery strategy. This review will discuss the acute physiological changes induced by various cryotherapy modalities that may affect recovery in the hours to days (<5 days) that follow high-intensity exercise.