Survival from teenage and young adult cancer in Northern England, 1968-2008.

BACKGROUND: Although cancer is relatively rare in teenagers and young adults (TYAs) aged 15-24 years, it is a major cause of death in this age group. This study investigated survival trends in TYA cancer diagnosed in Northern England, 1968-2008. METHODS: Five-year survival was analyzed using Kaplan-Meier estimation for four successive time periods. Cox regression analysis was used to investigate associations with demographic factors. RESULTS: The study included 2,987 cases (1,634 males, 1,353 females). Five-year survival for all patients with cancer improved greatly from 46% in 1968-1977 to 84% in 1998-2008 (P < 0.001), for patients with leukemia from 2% to 71% (P < 0.001), lymphoma from 66% to 86% (P < 0.001), central nervous system tumors from 53% to 84% (P < 0.001), bone tumors from 29% to 72% (P < 0.001), germ cell tumors from 39% to 94% (P < 0.001), melanoma and skin cancer from 64% to 100% (P < 0.001), and carcinomas from 48% to 80% (P < 0.001). Cox analysis showed that for all patients with cancer, survival was better for females than males (HR = 0.83; 95% CI 0.74-0.94, P < 0.001), for patients aged 20-24 years compared with those aged 15-19 years (HR = 0.84; 95% CI 0.75-0.94, P = 0.002), but survival was worse for patients who resided in more deprived areas (HR = 1.06; 95% CI 1.01-1.11, P = 0.025). CONCLUSION: There have been large improvements in TYA cancer survival in Northern England over the last four decades. Future work should determine factors that could lead to even better survival, including possible links with delayed diagnosis.

Survival from childhood cancer in northern England, 1968-2005.

BACKGROUND: Cancer is the second most common cause of death in children in the developed world. The study investigated patterns and trends in survival from childhood cancer in patients from northern England diagnosed 1968-2005. METHODS: Five-year survival was analysed using Kaplan-Meier estimation for four successive time periods. Cox regression analysis was used to explore associations with age and demographic factors. RESULTS: The study included 2958 cases (1659 males and 1299 females). Five-year survival for all cancers improved significantly from 39% in 1968-1977 to 79% in 1998-2005 (P<0.001). Five-year survival for leukaemia increased from 24% to 81% (P<0.001), lymphoma from 46% to 87% (P<0.001), central nervous system tumours from 43% to 73% (P<0.001), bone tumours from 21% to 75% (P<0.001), soft tissue sarcoma from 30% to 58% (P<0.001) and germ cell tumours from 59% to 97% (P<0.001). Survival was worse for cases of acute lymphoblastic leukaemia (P<0.001) and astrocytoma (P<0.001) aged 10-14 years compared with 0-4-year olds. CONCLUSION: There were marked improvements in survival over a 38-year time span. Future work should examine factors that could influence further improvement in survival such as diagnosis delays.

[Use of anamnesis and immunological techniques in the diagnosis of anisakidosis in patients with acute abdomen]. / Utilidad de la anamnesis y de las técnicas inmunológicas en el diagnóstico de la anisakidosis en pacientes con abdomen agudo.

INTRODUCTION: Anisakis simplex can be a cause of digestive symptoms. Our aim was to evaluate the epidemiological antecedents and immunological data available for a differentiation between patients with anisakidosis and those with other acute abdominal problems. PATIENTS AND METHODS: this is a prospective cohort study involving 134 patients with acute abdominal problems: 52 patients were diagnosed with anisakidosis by means of surgical and pathological findings and/or specific IgE seroconversion against Anisakis simplex (group A), and in 82 patients anisakidosis had been ruled out (group NA: non-anisakidosis). We evaluated the antecedent of raw fish ingestion, the skin prick test, and IgE immunoblotting as diagnostic tools. RESULTS: patients in groups A and NA differ in terms of prior raw fish ingestion (p < 0.0001) and positive SPT (p < 0.0001), with their respective negative predictive values (NPV) being 98.39% (95%CI: 90.17-99.92) and 95.56% (95%CI: 83.64-99.23). Regarding immunoblotting, in 86.2% of patients in group A a band of 60 kDa was detected, which was also detected in 19.2% of patients in group NA. CONCLUSIONS: a negative answer to the question about raw or undercooked fish ingestion has very high sensitivity and NPV (98.39%), and is thus reasonably reliable to rule out anisakidosis. The absence of cutaneous sensitization to crude A. simplex extract gives a high probability (95.56%) that the illness is absent. The presence of a band of about 60 kDa in immunoblotting would be useful for diagnosis.

[Exposure to Mycobacterium tuberculosis during a bus travel]. / Exposición a Mycobacterium tuberculosis durante un viaje en autobús.

BACKGROUND: In an outbreak of tuberculosis that occurred in a school, we evaluated the possible transmission during a trip in a school bus as the cause of infection. SUBJECTS, PATIENTS AND METHODS: Contact tracing of the driver, 3 teachers and 49 students from different grades who were travelling from Málaga to Sierra Nevada (Spain) in March 1998. All the students from the ten grades where any case of tuberculosis appeared from April to December 1998 and all the teachers of the school were included. RESULTS: At the school, 232 students were studied. The prevalence of the infection was 35%. A total of 12 new cases among the students were found. No teachers out of the 127 examined became ill. Out of the people who travelled by school bus, 2 teachers and 19 students were infected, prevalence among students 46%; five of those become ill. The odds ratio of infection for those having a class mate with positive smears was 5,5. On the other hand, the trip by bus (compared with those who did not take it) meant a odds ratio of 3,4. Most of the infected travellers were sitting in the bus close to the index case. CONCLUSIONS: In this tuberculosis outbreak some of the students who became ill or infected were not near the index case nor friendly with him at class. Therefore is possible that in some cases tuberculosis was transmitted inside the bus.

A propósito de una auditoría de ingresos hospitalarios prevenibles por insuficiencia cardiaca en un distrito de atención primaria / An audit of preventable hospital admissions due to heart failure in a primary care district

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[Referrals from primary care to pneumology: influence of attendance patterns and specialisation]. / Derivaciones desde atención primaria a neumología: influencia del modelo asistencial y especialización.

OBJECTIVE: To study the number and quality of the referrals from primary care to pneumology. To analyse their relationship to specialist medical training and the attendance pattern. DESIGN: A descriptive, retrospective study. SETTING: A Pneumology Clinic at the Peripheral Specialities Centre at Cartuja (Granada). PATIENTS AND OTHER PARTICIPANTS: 597 referrals were gathered. These were for all the patients referred from primary care to this clinic from may to december 1992. MEASUREMENTS AND MAIN RESULTS: The overall population referral rate per 100,000 inhabitants and month of study was 39.73. The out-clinic doctors referred twice as many patients as health centre (HC) doctors, with OR = 2.01 (1.70 < OR < 2.36). Taken together, general physicians referred three times more than family doctors, with OR = 3.04 (2.54 < OR < 3.78). Regarding the quality of the referral documents, HC doctors accompanied a referral with sufficient information eleven times more often than out-clinic doctors, with OR = 11.38 (6.13 < OR < 21.47). Family doctors contributed this "correct" information thirteen times more often than general physicians without specialist training: OR = 13.50 (8.06 < OR < 22.67). CONCLUSIONS: The number and quality of referrals appear to be closely related to the attendance pattern and in particular to the specialist training of health professionals.

Utilidad de la anamnesis y de las técnicas inmunológicas en el diagnóstico de la anisakidosis en pacientes con abdomen agudo / No disponible

Introducción: Anisakis simplex puede producir síntomas digestivosy alérgicos. En este trabajo se evalúan los antecedentesepidemiológicos y los resultados inmunológicos para diferenciarentre pacientes con anisakidosis y aquellos con otras patologíasdigestivas que cursan con dolor abdominal.Pacientes y método: estudio de cohortes realizado con 134pacientes: 52 fueron diagnosticados de anisakidosis por los hallazgosquirúrgicos y anatomopatológicos y/o seroconversión específicafrente a A. simplex (grupo A) y en 82 pacientes la anisakidosisfue excluida como diagnóstico (grupo NA: no-anisakidosis). Sehan evaluado el antecedente de ingesta de pescado crudo, laprueba cutánea en prick (PC) y el inmunoblot IgE como elementosde diagnóstico.Resultados: los pacientes de los grupos A y NA mostraron resultadosdiferentes respecto a la de ingesta de pescado crudo (p <0,0001) y la PC (p < 0,0001), con valores predictivos negativos(VPN) del 98,39 y 95,56% y positivos (VPP) del 70,83 y 87,50%,respectivamente. En el inmunoblot, se halló una banda de aproximadamente60 kDa en el 86,2 y 19,2% de los pacientes del grupoA y NA, respectivamente (VPP: 62,50%; VPN: 94,03%).Conclusiones: en pacientes con dolor abdominal, la ingesta depescado crudo o poco cocinado tiene elevada sensibilidad y VPN(98,39%) pero menor VPP (70,83%), por lo que nos ayuda principalmentea descartar la anisakidosis. La ausencia de sensibilizacióncutánea al extracto crudo de A. simplex apoya la ausencia de anisakidosiscon una probabilidad alta (95,56%). La presencia de una bandade 60 kDa en el inmunoblot podría ser útil para su diagnóstico

Introduction: Anisakis simplex can be a cause of digestivesymptoms. Our aim was to evaluate the epidemiological antecedentsand immunological data available for a differentiationbetween patients with anisakidosis and those with other acute abdominalproblems.Patients and methods: this is a prospective cohort study involving134 patients with acute abdominal problems: 52 patientswere diagnosed with anisakidosis by means of surgical and pathologicalfindings and/or specific IgE seroconversion againstAnisakis simplex (group A), and in 82 patients anisakidosis hadbeen ruled out (group NA: non-anisakidosis). We evaluated theantecedent of raw fish ingestion, the skin prick test, and IgE immunoblottingas diagnostic tools.Results: patients in groups A and NA differ in terms of priorraw fish ingestion (p < 0.0001) and positive SPT (p < 0.0001),with their respective negative predictive values (NPV) being98.39% (95%CI: 90.17-99.92) and 95.56% (95%CI: 83.64-99.23). Regarding immunoblotting, in 86.2% of patients in groupA a band of 60 kDa was detected, which was also detected in19.2% of patients in group NA.Conclusions: a negative answer to the question about raw orundercooked fish ingestion has very high sensitivity and NPV(98.39%), and is thus reasonably reliable to rule out anisakidosis.The absence of cutaneous sensitization to crude A. simplex extractgives a high probability (95.56%) that the illness is absent.The presence of a band of about 60 kDa in immunoblotting would be useful for diagnosis (AU)