Childhood cancer survivors report preferring lifestyle interventions delivered in person rather than online: An adolescent and parent perspective.

BACKGROUND: Maintaining a healthy lifestyle can protect adolescent survivors of pediatric cancer against chronic diseases such as obesity and cardiovascular disease. In this study, we examined the attitudes of adolescent survivors of pediatric cancer and their parents toward improving lifestyle behaviors after cancer treatment, including their preferences for intervention delivery and perceived barriers and benefits to healthy eating and exercise. METHODS: We recruited adolescent survivors of childhood cancer aged 11-19 years and their parents, from two hospitals. Participants completed a questionnaire via mail or at routine oncology clinic visits. RESULTS: Thirty-three adolescents (response rate 39%, mean age 15, 61% male) and 32 parents (representing 30 parent-child dyads) participated. Parents were significantly more interested in having their child participate in a lifestyle intervention than adolescents (41% of adolescents and 72% of parents, P = .012). Both groups preferred that the survivor receive lifestyle support face to face rather than online. Adolescents preferred to involve their friends (39% of adolescents and 19% of parents) whereas parents preferred to involve the family in a lifestyle intervention (15% of adolescents and 47% of parents, P = .006). Adolescents and their parents perceived a dislike of the taste of fruits and vegetables, fatigue, lack of motivation, and fear of injury as barriers to change. They perceived that keeping healthy and having more energy were benefits to participation. Participants indicated that interventions that provide face-to-face personal training and dietary education at a local gym would be well accepted. CONCLUSIONS: Adolescents who have had cancer in childhood have a preference for face-to-face contact with health professionals to overcome the barriers to participation in a lifestyle intervention.

A risk score including microdeletions improves relapse prediction for standard and medium risk precursor B-cell acute lymphoblastic leukaemia in children.

To prevent relapse, high risk paediatric acute lymphoblastic leukaemia (ALL) is treated very intensively. However, most patients who eventually relapse have standard or medium risk ALL with low minimal residual disease (MRD) levels. We analysed recurrent microdeletions and other clinical prognostic factors in a cohort of 475 uniformly treated non-high risk precursor B-cell ALL patients with the aim of better predicting relapse and refining risk stratification. Lower relapse-free survival at 7 years (RFS) was associated with IKZF1 intragenic deletions (P < 0·0001); P2RY8-CRLF2 gene fusion (P < 0·0004); Day 33 MRD>5 × 10-5 (P < 0·0001) and High National Cancer Institute (NCI) risk (P < 0·0001). We created a predictive model based on a risk score (RS) for deletions, MRD and NCI risk, extending from an RS of 0 (RS0) for patients with no unfavourable factors to RS2 +  for patients with 2 or 3 high risk factors. RS0, RS1, and RS2 +  groups had RFS of 93%, 78% and 49%, respectively, and overall survival (OS) of 99%, 91% and 71%. The RS provided greater discrimination than MRD-based risk stratification into standard (89% RFS, 96% OS) and medium risk groups (79% RFS, 91% OS). We conclude that this RS may enable better early therapeutic stratification and thus improve cure rates for childhood ALL.

Pineal cysts-A benign association with familial retinoblastoma.

Patients with familial/heritable retinoblastoma (RB) are at increased risk of developing second malignancies throughout life, including a pineoblastoma (trilateral RB [TRB]) in early childhood. Current guidelines recommend regular surveillance brain imaging for those with heritable RB until 5 years of age. The presence of pineal cysts has been reported in patients with RB. Pineal cysts are thought to arise due to focal degeneration of the pineal gland and can be found incidentally. The finding of pineal abnormalities including cysts in children with RB on imaging is disconcerting, as it raises the possibility of an underlying malignancy, specifically a pinealoblastoma. The authors reviewed the imaging findings and clinical significance of pineal cysts in 69 patients diagnosed with RB at our center between December 1999 and November 2015. Twenty-six patients had pineal cysts found on brain magnetic resonance imaging (MRI) scans performed either at diagnosis or follow-up. Thirty-eight of 69 patients had underlying heritable RB. Nineteen of 38 familial RB patients had a pineal cyst compared with 3 out of 26 with sporadic RB (P = .004). In the majority, the imaging characteristics and size of the cysts remained stable or resolved. In this cohort, pineal cysts were detected at significantly increased frequency in heritable RB. This may be a benign association or may reflect abnormal underlying biology of pineal tissue in individuals highly susceptible to malignancy. Imaging characteristics can be helpful in distinguishing between benign and malignant lesions. The presence of a pineal cyst in patients with unilateral disease may be a useful indicator of underlying heritable RB.

Association of practice size and pay-for-performance incentives with the quality of diabetes management in primary care.

BACKGROUND: Not enough is known about the association between practice size and clinical outcomes in primary care. We examined this association between 1997 and 2005, in addition to the impact of the Quality and Outcomes Framework, a pay-for-performance incentive scheme introduced in the United Kingdom in 2004, on diabetes management. METHODS: We conducted a retrospective open-cohort study using data from the General Practice Research Database. We enrolled 422 general practices providing care for 154,945 patients with diabetes. Our primary outcome measures were the achievement of national treatment targets for blood pressure, glycated hemoglobin (HbA(1c)) levels and total cholesterol. RESULTS: We saw improvements in the recording of process of care measures, prescribing and achieving intermediate outcomes in all practice sizes during the study period. We saw improvement in reaching national targets after the introduction of the Quality and Outcomes Framework. These improvements significantly exceeded the underlying trends in all practice sizes for achieving targets for cholesterol level and blood pressure, but not for HbA(1c) level. In 1997 and 2005, there were no significant differences between the smallest and largest practices in achieving targets for blood pressure (1997 odds ratio [OR] 0.98, 95% confidence interval [CI] 0.82 to 1.16; 2005 OR 0.92, 95% CI 0.80 to 1.06 in 2005), cholesterol level (1997 OR 0.94, 95% CI 0.76 to 1.16; 2005 OR 1.1, 95% CI 0.97 to 1.40) and glycated hemoglobin level (1997 OR 0.79, 95% CI 0.55 to 1.14; 2005 OR 1.05, 95% CI 0.93 to 1.19). INTERPRETATION: We found no evidence that size of practice is associated with the quality of diabetes management in primary care. Pay-for-performance programs appear to benefit both large and small practices to a similar extent.

MRI-based Alzheimer's disease-resemblance atrophy index in the detection of preclinical and prodromal Alzheimer's disease.

Alzheimer's Disease-resemblance atrophy index (AD-RAI) is an MRI-based machine learning derived biomarker that was developed to reflect the characteristic brain atrophy associated with AD. Recent study showed that AD-RAI (≥0.5) had the best performance in predicting conversion from mild cognitive impairment (MCI) to dementia and from cognitively unimpaired (CU) to MCI. We aimed to validate the performance of AD-RAI in detecting preclinical and prodromal AD. We recruited 128 subjects (MCI=50, CU=78) from two cohorts: CU-SEEDS and ADNI. Amyloid (A+) and tau (T+) status were confirmed by PET (11C-PIB, 18F-T807) or CSF analysis. We investigated the performance of AD-RAI in detecting preclinical and prodromal AD (i.e. A+T+) among MCI and CU subjects and compared its performance with that of hippocampal measures. AD-RAI achieved the best metrics among all subjects (sensitivity 0.74, specificity 0.91, accuracy 85.94%) and among MCI subjects (sensitivity 0.92, specificity 0.81, accuracy 86.00%) in detecting A+T+ subjects over other measures. Among CU subjects, AD-RAI yielded the best specificity (0.95) and accuracy (85.90%) over other measures, while hippocampal volume achieved a higher sensitivity (0.73) than AD-RAI (0.47) in detecting preclinical AD. These results showed the potential of AD-RAI in the detection of early AD, in particular at the prodromal stage.

Long-term morbidity of respiratory viral infections during chemotherapy in children with leukaemia.

BACKGROUND: Respiratory viruses are a common cause of infection in immunosuppressed children undergoing cancer therapy. Pulmonary sequelae have been documented following respiratory viral infections (RVIs) in hematopoietic stem cell transplant (HSCT) recipients; however potential late effects in children undergoing nonmyeloablative chemotherapy have not been investigated. AIM: To evaluate the long-term pulmonary morbidity of respiratory viral infections during chemotherapy in children with acute lymphoblastic leukemia (ALL). METHODS: Childhood ALL survivors, aged 7 to 18 years, greater than 6 months posttreatment were recruited. Exclusion criteria included HSCT or proven bacterial/fungal respiratory infection during treatment. Subjects were classified into "viral" or "control" groups according to retrospective medical records that documented the presence of laboratory-proven RVIs during chemotherapy. Symptom questionnaires (Liverpool, ISAAC) and lung function testing (spirometry, plethysmography, diffusing capacity, forced oscillation technique to ATS/ERS standards) were then performed cross-sectionally at the time of recruitment. RESULTS: Fifty-four patients (31 viral, 23 control) were recruited: median (range) age 11.2 (7.2-18.1) years, and at 4.9 (0.5-13) years posttherapy. Abnormalities were detected in 17 (31%) individuals (8 viral, 9 control), with the most common being DLCO impairment (3 viral, 4 control) and reduced respiratory reactance at 5 Hz (5 viral, 6 control). Children with RVIs during chemotherapy reported more current respiratory symptoms, particularly wheeze (odds ratio [OR], 3.0; 95% confidence interval [CI]: 0.9-10.0; P = .09) and cough (OR, 2.7; 95% CI: 0.8-9.5; P = .11). No differences in lung function tests were observed between the two groups. CONCLUSIONS: Our study found children with RVIs during chemotherapy developed more long-term respiratory symptoms than controls; however, differences did not reach statistical significance. No differences in static lung function were found between the two groups. Overall, pulmonary abnormalities and/or significant ongoing respiratory symptoms were detected in nearly a third of ALL survivors treated without HSCT. Larger, prospective studies are warranted to evaluate the etiology and clinical significance of these findings.

Clinical activity of overseas-trained doctors practising in general practice in Australia.

INTRODUCTION: Medical workforce shortages in Australia have led to increasing reliance on overseas-trained doctors (OTDs) to work in general practice in areas of need, particularly in rural areas. These OTDs do not have Australian postgraduate training in general practice, and we know little about how they practise. OBJECTIVE: To determine differences in practice style between a self-selected group of overseas-trained general practitioners undertaking the Alternative Pathways Program and GPs who are Fellows of the Royal Australian College of General Practitioners (FRACGP), and whether such differences can be explained by other practitioner, practice and patient characteristics. METHOD: A self-selected sample of 89 OTDs from the Alternative Pathways Program were compared with FRACGPs in a continuous national study of GP activity (n=1032). Each GP provided details about themselves and their practice and recorded data about patients, morbidity and treatments for 100 encounters. RESULTS: OTDs were younger, less experienced, worked more sessions per week, in smaller practices. OTDs saw fewer children and elderly patients, more new patients, health concession card holders and Indigenous people. OTDs managed less general, urological, social, skin and pregnancy problems, and more cardiovascular problems, urinary tract infections, tonsillitis and conjunctivitis. They provided more medications, other treatments and referrals, and ordered more pathology and imaging tests. CONCLUSION: This study suggests that OTDs see a different patient mix and range of morbidity and provide different management to that of FRACGPs, generating higher costs of care. Regular study of the clinical activities of a representative sample of overseas-trained GPs is needed.

Management of psychosis in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations involving the management of psychoses. In this analysis we have included schizophrenia, affective disorders/bipolar, organic psychoses, and senile psychoses, with undefined psychosis and chronic brain syndrome grouped as 'other'. This synopsis provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.

Management of type 2 diabetes in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of type 2 diabetes management in Australian general practice. Terms used by the general practitioner participants included in this analysis were: type 2 diabetes, noninsulin dependent diabetes, diabetes mellitus, adult onset diabetes, and insulin treated type 2 diabetes. This provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.

GI malignancies in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations involving the management of gastrointestinal (GI) malignancy. In this analysis we have included all bowel cancers; upper GI malignancies (stomach, oesophagus); and 'other' which include carcinomas of the liver, gall bladder, pancreas, tongue and parotid gland. This synopsis provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.

EPC encounters in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of the content of Enhanced Primary Care (EPC) encounters in Australian general practice. The EPC program was introduced on 1 November 1999, and contained three major aspects of care--health assessments, care plans and case conferences.

Management of cardiovascular conditions in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an analysis of the management of cardiovascular conditions in general practice. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.

Management of renal problems in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations involving the management of renal problems. In this analysis, we have included renal failure, glomerulonephritis/nephrosis (all forms of nephritis and nephrotic syndrome), renal insufficiency, nephropathy (including diabetic and analgesic), and uraemia and nephrosclerosis grouped as 'other'. This synopsis provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.

Presentations of shortness of breath in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of the consultations in general practice involving a patient presentation of shortness of breath. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.

Presentations of headache in Australian general practice.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of the consultations in general practice involving a patient presentation of "headache". Patient reasons for encounter specified as migraine, cluster, vascular or tension headaches were not included in the analysis. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.

Management of growth delay in patients aged less than 6 years.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations in general practice involving the management of growth delay. "Growth delay" encompasses physical problems such as "failure to thrive" and "delayed physical development" in infants and children. Over 80% of encounters at which growth delay was managed were with patients aged less than 6 years, so we have concentrated our analysis on this early childhood group. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.

Management of epilepsy in general practice patients.

The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations in general practice involving the management of epilepsy. Participating general practitioners recorded the problem as 'epilepsy' in 90% of cases, while 'grand mal' was specified at about 4% of encounters and 'temporal lobe' and 'petit mal' were each specified at about 1% of encounters.

Current status of hormone therapy in general practice in Australia.

The BEACH program is a continuous national study of general practice activity in Australia. The subject of this analysis was all problems for which a hormone therapy years (HT) medication was prescribed or supplied at HT encounters with women aged 40 and over between March 2002 and April 2004. This provides a backdrop against which the theme articles in this issue of Australian Family Physician can be further considered.