Presentation of childhood cancers to a paediatric shared care unit.

OBJECTIVE: To describe the pathways by which children with cancer present to a shared care oncology unit. DESIGN: A population-based retrospective cohort study of children diagnosed with cancer between the years 2004 and 2014. SETTING: District General Hospital with a level 2 Paediatric Oncology Shared Care Unit. PATIENTS: 93 children aged 0-15 years . OUTCOME MEASURES: Time to presentation (TTP) was defined as time from initial symptoms to time seen by secondary paediatrics. Time to diagnosis (TTD) was defined as time from initial symptoms to diagnosis at a Principal Treatment Centre. Patient pathways to diagnosis were mapped and routes for different cancers were compared. RESULTS: Only 2/93 cases (2.1%) in 10 years were referred via the 2-week pathway. Most presentations were acute via immediate general practitioner (GP) referral or self-referral to the emergency department 62/93 (67%). Leukaemia presented acutely and via the GP more often than via self-presentation to the emergency department 21/28 (75% vs 25%), while solid tumours were self-referred to the emergency department 21/34 (62% vs 38%) more often than via the GP. TTP and TTD were calculated for 87 patients. Wilms' tumour demonstrated the shortest median TTP of 7 days and TTD of 16 days. Lymphoma had the longest TTD, with TTP 107 days and TTD 120 days. Pathways to diagnosis via other specialties were longer. CONCLUSION: The majority of children diagnosed with cancer present via acute services, with the route varying between tumour types. Only two cases in 10 years were referred via the 2-week pathway, thus challenging its relevance in the paediatric population.

Canadian and English students' beliefs about waterpipe smoking: a qualitative study.

BACKGROUND: Waterpipe smoking is becoming popular among western students. The aim was to understand the appeal to students of this form of smoking when other forms of smoking are becoming less common. METHODS: Waterpipe smokers were identified by snowball sampling and interviewed following a semi-structured schedule in waterpipe cafes and in their homes. Constant comparative analysis was used to derive themes for the analysis. RESULTS: Waterpipe smokers saw smoking as an alternative to more expensive nights out in bars. The appeal was related to the communal activity and the novelty of the experience. Respondents had not thought deeply about the health risks and reasoned that if no warnings about waterpipe smoking were apparent (unlike cigarette smoking) then it was probably safe. These observations were reinforced by observations about the mildness of the smoke, the fruit flavours, and beliefs about the filtering of the water. Waterpipe smokers felt no pressure to stop smoking and therefore had not tried to do so, but felt it might be something they did not continue after university. Waterpipe smoking was not linked in students' minds to other forms of smoking except in one individual who was using waterpipe smoking to help quit cigarettes. CONCLUSION: In the absence of public health information, students have fallen back on superficial experiences to form views that waterpipe smoking is less harmful than other forms of smoking and it is currently much more acceptable in student society than other forms of smoking.