NCCN Guidelines Insights: Palliative Care, Version 2.2017.

The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. These NCCN Guidelines Insights summarize and provide context for the updated guidelines recommendations regarding hospice and end-of-life (EOL) care. Updates for 2017 include revisions to and restructuring of the algorithms that address important EOL concerns. These recommendations were revised to provide clearer guidance for oncologists as they care for patients with cancer who are approaching the transition to EOL care. Recommendations for interventions and reassessment based on estimated life expectancy were streamlined and reprioritized to promote hospice referrals and improved EOL care.

Exposure to trihalomethanes in drinking water and small-for-gestational-age births.

BACKGROUND: Trihalomethanes in drinking water have been associated with higher occurrence of small-for-gestational-age (SGA) births, although results have been inconsistent. METHOD: We geocoded residential address for mother of live, singleton, term births to 33 water distribution systems in a large metropolitan area of New South Wales, Australia (314,982 births between 1998 and 2004) and classified births into <10th percentile and ≥ 10 percentile of weight for gestational age. Mean trihalomethane exposure was estimated by trimester and for the entire pregnancy based on monthly sampling in each of the 33 water distribution systems. We estimated the relative risk (RR) of SGA for exposure to trihalomethanes using log-binomial regression adjusting for confounding. RESULTS: SGA births increased with mother's third-trimester exposure to chloroform (RR = 1.04 [95% confidence interval = 1.02-1.06], across an interquartile range [IQR] = 25 µg/L) and bromodichloromethane (1.02 [1.01-1.04], 5 µg/L). Larger associations were found for SGA less than third percentile. Smoking modified the effects of trihalomethane exposure, with generally larger associations in births to nonsmoking mother and weaker or protective associations in births to smoking mothers. CONCLUSIONS: : Mothers' exposures during pregnancy to total trihalomethane as well as to chloroform and bromodichloromethane were associated with SGA. These associations were modified by maternal smoking during pregnancy.

The impact of childhood sexual abuse on psychological distress among women in New Zealand.

PROBLEMS: In order to better understand the long-term impact of child sex abuse, this study examined the association between women's experience of abuse, health symptoms, and psychological distress in adulthood. There is limited information about child abuse outside the United States. METHODS: Nine hundred sixty-one women participated in a structured interview. RESULTS: Participants who had experienced abuse (13%) were significantly more vulnerable to psychological distress in adulthood if they were younger, less satisfied with their standard of living, and resided in urban areas. CONCLUSION: Dissemination and evaluation of therapies for the treatment of sex abuse in the New Zealand context is warranted.

Spatio-temporal variation in trihalomethanes in New South Wales.

AIM: This paper describes the spatio-temporal variation of trihalomethanes in drinking water in New South Wales, Australia from 1997 to 2007 METHOD: We obtained data on trihalomethanes (THMs) from two metropolitan and 13 rural water utilities and conducted a descriptive analysis of the spatial and temporal trends in THMs and the influence of season and drought. RESULTS: Concetrations of monthly THMs in the two metropolitan water utilities of Sydney/Illawarra (mean 66.8 µg/L) and Hunter (mean 62.7 µg/L) were similar compared to the considerable variation between rural water utilities (range in mean THMs: 14.5-330.7 µg/L). Chloroform was the predominate THM in two-thirds of the rural water utilities. Higher concentrations of THMs were found in chlorinated water distribution systems compared to chloraminated systems, and in distribution systems sourced from surface water compared to ground water or mixed surface and ground water. Ground water sourced supplies had a greater proportion of brominated THMs than surface water sourced supplies. There was substantial variation in concentration of THMs between seasons and between periods of drought or no drought. There was a moderate correlation between heavy rainfall and elevated concentrations of THMs. CONCLUSION: There is considerable spatial and temporal variation in THMs amongst New South Wales water utilities and these variations are likely related to water source, treatment processes, catchments, drought and seasonal factors.

Sleep quality in borderline personality disorder: a cross-sectional study.

OBJECTIVE: In this study, relationships between sleep quality and borderline personality disorder were examined using 2 self-report measures. METHOD: Using a cross-sectional design in a sample of convenience of internal medicine outpatients, we surveyed men and women (N=76), aged 18 years or older, who were seeking nonemergent medical care during the period January 2009 to September 2009. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and borderline personality was assessed with 2 measures: the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). RESULTS: The global PSQI score was statistically significantly associated with scores on the PDQ-4 (P < .01), the SHI (P < .01), and the combination PDQ-4 and SHI (P < .01). With regard to the components of the PSQI, subjective sleep quality (P < .05), sleep duration (P < .05), and daytime dysfunction (P < .01) were all statistically significantly associated with scores on the PDQ-4, and sleep latency was statistically significantly associated with the combined PDQ-4 and SHI (P < .05). CONCLUSIONS: Individuals with borderline personality symptomatology demonstrate a poorer overall quality of sleep than those without these symptoms.

Mental healthcare utilization and sleep disturbance: a pilot study.

Disturbances in sleep are empirically associated with a number of different psychiatric disorders. In this pilot study, we examined whether four general queries about mental healthcare utilization ("Have you ever been seen by a psychiatrist?," "Have you ever been hospitalized in a psychiatric hospital?," "Have you ever been in counseling?," and "Have you ever been on medication for your nerves?") would evidence correlations with various aspects of sleep disturbance as measured by the Pittsburgh Sleep Quality Index. In a cross-sectional sample of convenience, we surveyed 75 internal medicine outpatients. We asked participants about the four preceding mental healthcare variables as well as sleep experiences using the Pittsburgh Sleep Quality Index. Prior to statistical analyses, we assigned one point to each mental healthcare utilization variable endorsed and developed a composite score (0-4). In analyses, while the mental-healthcare-utilization composite score was not related to overall sleep quality (i.e., the Global Pittsburgh Sleep Quality Index Score), it was statistically significantly related to the Pittsburgh Sleep Quality Index component of Sleep Disturbance (p<.01). This suggests that while individuals with greater mental healthcare utilization do not evidence differences in overall sleep quality compared to those with low utilization, they do report more disturbances in sleep.

The relationship between caretaking experiences in childhood and sleep disturbances in adulthood.

Studies on the relationship between childhood experiences with parents and sleep disturbances in adulthood are relatively few in number. Excluding studies on posttraumatic stress disorder, available studies on this relationship in adult participants is scant. In this study, we examined three caretaking variables (i.e., the number of different caretakers in childhood, whether caretakers were the biological parents or not, and the perceived quality of caretaking) and their relationship to self-reported sleep quality over the past month. Contrary to our expectations, only one of the childhood caretaking variables demonstrated a relationship with quality of sleep in adulthood-the perceived quality of caretaking. Lower ratings of parental caretaking quality were associated with poorer overall sleep quality. We discuss the potential implications of this finding.