Gynecologists are afraid of prescribing hormone replacement to endometrial/ovarian cancer survivors despite national guidelines-a survey in Sweden.

BACKGROUND: Prolonged survival in ovarian and endometrial cancer patients increases the importance of paying attention to quality of life. Hormone replacement therapy (HRT) after gynecologic cancer has been controversial. With this survey, we sought to describe Swedish gynecologists' and gynecologic oncologists' attitudes towards prescribing HRT to these cancer survivors and see if prescribing practice is consistent with the available evidence and national guidelines. MATERIAL AND METHODS: A web-based survey containing three hypothetical cases with a total of 15 questions was distributed to gynecologists and gynecologic oncologists in Sweden. Respondents were asked about their HRT prescription practices in endometrial/ovarian cancer patients with moderate to severe menopausal symptoms. RESULTS: In total 262 gynecologists and 24 gynecologic oncologists answered the survey. In the low-risk endometrial cancer case a majority of the gynecologists (55%) and gynecologic oncologists (66.7%) would prescribe local estrogen. A total of 30% of the gynecologists would prescribe estrogen replacement therapy (ERT) in the high-risk endometrial cancer case compared to 58.3% of the gynecologic oncologists. The gynecologic oncologists felt more comfortable treating patients with endometrial cancer than did gynecologists, and the gynecologists were more likely to read the national guidelines. In the ovarian cancer case, 63.7% of the gynecologists would prescribe HRT compared to 92% of the gynecologic oncologists. CONCLUSION: Swedish gynecologic oncologists have a more favorable attitude towards HRT for endometrial/ovarian cancer patients and feel more comfortable treating their patients than do gynecologists. This study illustrates a need for education in these matters in order not to withhold HRT from women due to doctors' sometimes unjustified anxiety.

Bacterial meningitis in children in Iceland, 1975-2010: a nationwide epidemiological study.

BACKGROUND: Bacterial meningitis is a serious and potentially rapid life-threatening disease. Therefore, to ensure appropriate treatment, early recognition of signs and symptoms is imperative, along with knowledge of the epidemiology and microbiology of the disease. METHODS: A long-term, nationwide epidemiological study of bacterial causes of meningitis in children (≤ 18 y) in Iceland during the period 1975-2010 was carried out. A detailed chart review was performed of all cases diagnosed in 1995-2010. RESULTS: A total of 477 children were diagnosed with bacterial meningitis during the period 1975-2010. Of these, 67% were aged under 5 y. The most common pathogens were Neisseria meningitidis (n = 265), Haemophilus influenzae (n = 132), Streptococcus pneumoniae (n = 47), and Streptococcus agalactiae (n = 19); their incidences varied according to age. The age-specific incidence (cases/100,000/y) dropped from 26 in 1975 to 1 in 2010 (p < 0.001). The most common symptoms during the period 1995-2010 were fever (92%), vomiting (67%), nuchal rigidity (60%), and rashes/petechiae (51%). H. influenzae type b disappeared following implementation of Hib vaccination in 1989, and, likewise, the incidence of meningococcal meningitis fell significantly after vaccination against meningococcus serogroup C was initiated in 2002 (p < 0.001). The overall 30-day case fatality rate of bacterial meningitis was 4.4% and remained unchanged during the study period. CONCLUSIONS: The incidence of childhood bacterial meningitis has been reduced significantly by successful vaccinations against H. influenzae type b and N. meningitidis serogroup C. Nevertheless, the case fatality rate has remained unchanged and thus the disease is still a serious threat to childhood health. Further prevention by novel vaccines and improved management of childhood meningitis is an exciting challenge.