Radiation therapy for the elderly-change of concepts in breast cancer?

The incidence of breast cancer in elderly patients has increased in the last years, perhaps due to better and earlier diagnostics and a longer life expectancy. Radiotherapy as a local adjuvant treatment after breast surgery, improves local control and overall survival. Due to frailty or comorbidity current guidelines cannot always be applied and the treatment decision-making process involving these older patients often remains the task of the treating physician rather than a fully established tumor board. The goal of this review is to summarize in short, the radiation therapy techniques available, and to outline the most important factors that could be relevant in the decision making for radiotherapy for elderly woman affected by invasive breast cancer.

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years.

CONTEXT: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization. RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma.

BACKGROUND: Image-guided intensity-modulated radiotherapy (IG-IMRT) is increasingly being used to treat patients with soft-tissue sarcoma (STS) of the head and neck. Although there is no comparison between IMRT and conventional radiation therapy (CRT) concerning their efficacy. In this analysis, we compared CRT and IMRT outcomes for head and neck STS. PATIENTS AND METHODS: Sixty-seven patients who underwent radiotherapy between 1994 and 2017 were identified. RESULTS: The median follow-up was 31 months. Of the 67 patients, 34% were treated with CRT technique and 66% with IG-IMRT. The locoregional relapse rate following IMRT was 21% versus 70% with CRT (p<0.001) and the 5-year locoregional control was 69% versus 28%, respectively (p=0.01). IG-IMRT was associated with non-significant, less acute, and chronic adverse events. In the multivariate analysis, a significant influence of radiation technique on locoregional control was confirmed (p=0.04). CONCLUSION: IG-IMRT seems to be associated both with higher locoregional control as well as lower acute and chronic toxicities.

The weight status of school-age children and its association with gross domestic product.

THE AIM: To examine the possible relationship between the prevalence of underweight, overweight and obesity of Polish children and adolescents and the gross domestic product per capita (GDP). MATERIAL AND METHODS: This report is based on the results of a nationwide, representative population study. An area of the country, the so-called Eastern Poland, where GDP per capita is less than 80% of the national average, was designated, based on the data from the Central Statistical Office of Poland (CSOP) and was compared with the rest of the country. The frequency of underweight, normal weight, overweight and obesity, as well as the odds ratio were calculated for gender and region of residence. The body mass index (BMI) for age and sex was standardized and expressed as z-score. The statistical significance of standardized mean differences of BMI depending on the area was examined using the t-test. RESULTS: There were significant differences in the prevalence of underweight, overweight and obesity between the regions analyzed. The region of Eastern Poland was characterized by a lower risk of overweight and obesity and an increased risk of underweight in comparison with the rest of the country. CONCLUSIONS: Identification of the diverse prevalence of overweight and underweight depending on the region and determined according to the economic status is an opportunity to modify and adapt the strategy of implementing programs aimed at promoting healthy behaviours.

The relationship between selected socioeconomic factors and thinness among Polish school-aged children and adolescents.

The analysis was performed on a database including 17,427 records of subjects aged 7-18 years, randomly sampled from a population of Polish students. Thinness was determined using international cut-off points, defined to pass through body mass index of 18.5 kg/m2 at the age of 18. The weighted prevalence of thinness and odds ratios with 95% confidence interval were estimated for gender, birth weight, level of schooling and school location, gross domestic product (GDP) per inhabitant, family income and maternal education. Body height was analysed according to body mass and birth weight categories. The prevalence of thinness was higher among children with low birth weight and among girls. The prevalence of thinness decreased with increasing GDP per inhabitant. In analysis by level of schooling: primary-middle-secondary, prevalence of thinness decreased among boys and increased among girls. Thin students were significantly shorter than other students, and thin girls less likely participated in physical education. CONCLUSION: Gender and socioeconomic factors are important determinants of thinness among Polish children and adolescents. Public health strategies should address family eating practices to prevent negative effects of weight deficit, especially among girls/children from low GDP regions. What is Known: • Socioeconomic factors and gender influence weight status of children and adolescents. What is New: • The first time the prevalence and determinants of thinness based on data from a nationally representative, weighted sample of Polish children aged 7-18 years were presented. • The analysis shows how gender and socioeconomics determinants influence the prevalence of thinness among children and adolescent in post-transformation country and can be used to international comparisons.

Trends in external causes of child and adolescent mortality in Poland, 1999-2012.

OBJECTIVES: To examine the pattern and trend of deaths due to external causes among Polish children and adolescents in 1999-2012, and to compare trends in Poland's neighboring countries. METHODS: Death records were obtained from the Central Statistical Office of Poland. External causes mortality rates (MR) with 95 % confidence interval were calculated. The annual percentage change of MR was examined using linear regression. To compare MR with Belarus, Ukraine, Czech Republic and Germany, data from the European Mortality Database were used. RESULTS: MR were the highest in the age 15-19 years (33.7/100,000) and among boys (22.7/100,000). Unintentional injuries including transport accidents, drowning, and suicides (especially in children over 10 years old), were the main cause of death in the analyzed groups. Between 1999 and 2012 annual MR for unintentional injuries declined substantially. MR due to injuries and poisoning in Poland were higher compared with Czech Republic and Germany and lower in comparison with Belarus and Ukraine. CONCLUSIONS: Deaths due to unintentional injuries are still the leading cause of death among Polish children and adolescents. There are differences in death rates between Poland and neighboring countries.

The prevalence of overweight and obesity among Polish pre-school-aged children.

UNLABELLED: The aim of this study is to estimate the prevalence of overweight and obesity in a current, nationally representative, random sample of pre-school-aged children in Poland and to compare their overweight and obesity rates with their peers from the US and Norway. MATERIAL AND METHODS: The height and weight were measured in a total of 5026 randomly sampled children aged 2-6 years and their Body Mass Index was calculated. The prevalence of overweight including obesity was determined using three definitions, i.e. those formulated by the International Obesity Task Force (IOTF), the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). RESULTS: The overall prevalence of overweight including obesity in boys was 12.2%, 12.2%, 17.2% and in girls 15.0%, 10.0%, 19.1% according to the IOTF, WHO, CDC definition, respectively, and did not significantly differ in comparison with their US and Norwegian peers. The overall prevalence of obesity in boys was: 4.4%, 4.9%, 8.9% and in girls: 3.8%, 3.4%, 7.6%, according to the IOTF, WHO, CDC definition, respectively. Among Polish girls the obesity rate was higher compared to the female US peers. The obesity rate was higher in Polish boys compared to their Norwegian peers. CONCLUSION: The estimates of the prevalence of overweight and obesity varied substantially by age group, gender and depending on the definition used. Obesity rates among Polish girls and boys were higher compared to their American and Norwegian peers. The influence of overweight definitions should be taken into account when studying childhood overweight and obesity. Overweight and obesity preventive programs should be implemented at preschool age.

The prevalence of overweight and obesity among Polish school- aged children and adolescents / Czestosc wystepowania nadwagi i otylosci wsród polskich dzieci i mlodziezy w wieku szkolnym

THE AIM: The aim was to estimate the prevalence of overweight and obesity among Polish school-aged children and adolescents in a population-based, random sample. MATERIAL AND METHODS: A total of 17 427 children and adolescents aged 7−18 years (8 327 boys) from a nationally representative random sample were examined from 2007 to 2009 in 416 schools in all regions of Poland. Height and weight were measured and body mass index was calculated. The prevalence of overweight and obesity was determined using three childhood obesity definitions: the Centers for Disease Control, the International Obesity Task Force, and the World Health Organization. RESULTS: According to the definitions used, the prevalence of excess weight among children aged 7−12 years was in the range 21.7−30.4% and 18.4−23.2%, boys and girls, respectively. The prevalence of overweight and obesity among adolescents aged 13−18 years was in the range 14.6−19.4% and 10.3−13.0%, boys and girls, respectively, using international definitions of childhood overweight. The prevalence of obesity among children aged 7−12 years was in the range 5.5−13.1% and 3.6−6.4%, in boys and girls, respectively. The prevalence of obesity among adolescents aged 13−18 years was in the range3.4−5.0% and 2.0−2.6%, boys and girls, respectively. CONCLUSIONS: The estimates of overweight and obesity prevalence varied substantially by age group, gender and the definition used. Comparing to the European countries, Poland had medium to high level of childhood and youth overweight and obesity prevalence. High prevalence of overweight and obesity among Polish children and adolescents requires implementation of public health approach to the problem.

The relationship between selected socioeconomic factors and basic anthropometric parameters of school-aged children and adolescents in Poland.

UNLABELLED: The aim of the present paper was to examine the associations between anthropometric parameters, overweight, obesity, and socioeconomic status (SES) of children and adolescents in Poland. Data were collected in the "Elaboration of reference blood pressure ranges for children and adolescents in Poland" OLAF-PL0080 (OLAF) study, a nationally representative survey on growth and blood pressure references for children and adolescents aged 7-18 years. Body height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Anthropometric parameters were standardized for age and gender and expressed as z-scores. Statistical analyses were conducted on 10,950 children and adolescents whose parents provided socioeconomic questionnaires. The associations between anthropometric parameters, overweight (including obesity), and SES were analyzed using multiple regression and multiple logistic regression. The height was positively associated with higher levels of maternal education and, in the case of girls, also with paternal education. Higher level of income per capita, but not the highest, was associated with higher weight, BMI, and WC and, in the case of boys, also tall stature. The height, weight, BMI, and waist were significantly inversely associated with number of children in the family. Lower number of children in the family and higher level of income, but not the highest, increased odds of overweight and obesity. In the case of girls, the odds of obesity decreased with paternal higher level of education. CONCLUSION: The social position associated with parents' education, better environment, and SES correlate with body height and weight of a child. However, it is associated with higher risk of overweight and abdominal obesity.

Polish 2012 growth references for preschool children.

UNLABELLED: Growth references are useful in monitoring a child's growth, which is an essential part of child care. The aim of this paper is to provide updated growth references for Polish preschool children and to assess how well children in Poland match or diverge from the World Health Organization (WHO) growth standards/references and recent German height-for-age references. The height-, weight-, body mass index-for-age, and weight-for-height references were constructed with the LMS method using data from a recent, large, population-representative sample of 4,941 preschool children aged 3 to 6 years (the OLA study). In the case of boys, the third, 50th, and 97th height percentiles of new Polish and German references overlap almost completely, whereas the WHO growth standards/references percentiles are systematically lower. In the case of girls, comparison between the new Polish and German height references showed conformity on the third and 50th percentile, whereas body height values of the WHO standards/references are shorter. Polish children aged 3 to 6 years from for the nation representative sample, had significantly greater than zero mean z scores of height-, weight-, and BMI-for-age and weight-for-height, relative to the WHO growth standards/references. The number of children in the sample with height-for-age below -2 SD was significantly lower than expected and number of children with height-for-age above +2 SD was significantly higher than expected. CONCLUSION: The OLA study growth references can be recommended as national references for preschool children in Poland.

Oscillometric blood pressure percentiles for Polish normal-weight school-aged children and adolescents.

OBJECTIVE: The objective of this study was to construct blood pressure (BP) references with the use of a validated oscillometric device for normal-weight, school-aged children and adolescents and to study BP predictors. METHODS: BP was measured in 14 266 randomly selected, normal-weight Polish children and adolescents aged 7-18 years, who were free of chronic disease, using a validated oscillometric device (Datascope Accutor Plus). Height, weight and waist circumference were measured. BP percentiles were constructed for age and height simultaneously with the use of a polynomial regression model. The normative values of BP were compared with the US normal-weight reference, German oscillometric reference, and Polish auscultatory reference. RESULTS: Reference BP percentiles by sex, age and height are presented. At median height, the age-specific differences in the 90th BP percentiles compared with German oscillometric reference ranged in the case of boys from -3 to 2  mmHg and from -5 to -1  mmHg, SBP and DBP, respectively, and in the case of girls from 0 to 3  mmHg and from -5 to -1  mmHg, SBP and DBP, respectively. As compared to weight, waist circumference was stronger SBP predictor in low birth weight boys. CONCLUSION: The study provides BP references for oscillmetric device, based on a current, nationally representative sample of normal-weight Polish children and adolescents. The normative values of BP were compared taking into consideration the height and BMI differences, the pubertal spurt, the methods of BP measurement and percentile construction.

Population-based centile curves for triceps, subscapular, and abdominal skinfold thicknesses in Polish children and adolescents--the OLAF study.

UNLABELLED: Skinfold thicknesses are used as valid anthropometric indicators of regional body fatness. Actual population-based values for skinfold thicknesses for Polish children are not available. The purpose of this study was to provide population-based values for triceps, subscapular, and abdominal skinfold thicknesses in healthy children and adolescents. A total number of 17,416 boys and girls aged 6.5-18.5 years, randomly selected from whole Polish population of children and adolescents, were enrolled in the study. Skinfold thicknesses (triceps, subscapular, and abdominal) were measured using Harpenden skinfold caliper. All measurements were taken after the training of participating investigators. The LMS method was used to fit percentile curves across age for each skinfold. Q tests for fit were used to assess the global goodness of fit of our final models. The study shows for the first time smoothed population-based values of body fat distribution indices for Polish children and adolescents 7-18 years of age. Reported skinfold centiles are higher compared to previously established for Warsaw children and very close to the actual US data. CONCLUSION: Our study provided for the first time population-based values for skinfold thicknesses evaluation in a way allowing to calculate reliable Z scores. The early detection of abnormal fat stores, using our population-based values and respective Z scores, may be now implemented for practice.

Regional differences in the prevalence of overweight, obesity and underweight among polish children and adolescents.

AIM: The aim of the study was to compare the prevalence of overweight, obesity, and underweight in children and adolescents from different provinces in Poland. MATERIALS AND METHODS: Data from the recent, large, population-representative sample of school-aged children and adolescents (N=17573) OLAF study: "Elaboration of the reference range of arterial blood pressure for the population of children and adolescents in Poland" - PL0080 OLAF were used in the analysis. The survey was conducted in all provinces of Poland (N=16). Data were analyzed using SAS 9.2, EpiInfo 3.5.1 and LMSgrowth software packages. The frequency of overweight, obesity, and underweight were determined. For overweight and obesity (jointly) and underweight the odds ratio (OR) was calculated for gender and voivodship of residence. The body mass index (BMI) was standardized and expressed as a z-score. The statistical significance of differences between BMI z-scores depending on voivodship of residence was assessed by the t-test. RESULTS: Significant differences were found in the occurrence of overweight and obesity among the analysed regions, and voivodships with a lower (malopolskie, swietokrzyskie, lubelskie, and podkarpackie) and higher (mazowieckie) risk of overweight and obesity were identified. In case of underweight, lódzkie and podkarpackie (<0.040) provinces were higher risk areas, while mazowieckie (<0.001) had lower risk. The prevalence of overweight (including obesity) was higher compared to the prevalence of underweight in the majority of provinces (15 out of 16). CONCLUSIONS: Analysis of regional differences in the prevalence of obesity, overweight and underweight in children and adolescents may point to the direction in which nationwide and local efforts should be made to reduce the inequalities stemming from nutritional status.

Distribution of body mass index categories among Polish children and adolescents from rural and urban areas.

AIM: To demonstrate differences in nutritional status of school-aged children and adolescents depending on school localization (urban/rural), school level (elementary/middle) and gender. MATERIALS AND METHODS: Results of current health survey 'Elaboration of the reference range of arterial blood pressure for the population of children and adolescents in Poland' - PL0080 OLAF were used in the analysis. Data were analysed by SAS. 9.2 for Windows, EpiInfo 3.5.1 and LMSgrowth. The frequency and the Odds Ratio of underweight, overweight, obesity and normal weight were calculated by school localization, school level and gender. RESULTS: Data from 13 129 pupils were used in the analysis: 5 118 from elementary schools in urban areas, 3638 from elementary schools in rural areas, 2792 from middle schools in urban areas and 1581 from middle schools in rural areas. The frequency of normal weight was lower in urban compared with rural elementary schools (67.2% vs 70.0%; OR=0.88; p=0.005). The frequency of underweight, overweight and obesity was higher in urban compared with rural elementary schools, both boys and girls. The frequency of obesity was higher in urban middle schools than rural (3.0% vs 1.6%; OR=1.88; p=0.006). In the case of boys, statistically significant difference in frequency of overweight and obesity (together) was noted in urban middle schools compared to rural middle schools (16.7% vs 11.9%; OR=1.48; p=0.003). In the case of girls, the frequency of underweight was lower in urban compared with rural middle schools (12.7% vs 15.9%; OR= 0.77; p=0.032). CONCLUSIONS: Knowing differences in the nutritional status between pupils in urban and rural areas gives the opportunity to modify nutritional education programmes depending on needs identified in the particular type of area and target groups. In urban regions, in both elementary and middle schools, boys are a risk group for excess body weight, and require more attention in preventive undertakings. In rural areas, girls in middle schools should be targeted for preventive measures dealing with underweight.

Polish 2010 growth references for school-aged children and adolescents.

Growth references are useful in monitoring a child's growth, which is an essential part of child care. The aim of this paper was to provide updated growth references for Polish school-aged children and adolescents and show the prevalence of overweight and obesity among them. Growth references for height, weight, and body mass index (BMI) were constructed with the lambda, mu, sigma (LMS) method using data from a recent, large, population-representative sample of school-aged children and adolescents in Poland (n = 17,573). The prevalence of overweight and obesity according to the International Obesity Taskforce definition was determined with the use of LMSGrowth software. Updated growth references for Polish school-aged children and adolescents were compared with Polish growth references from the 1980s, the Warsaw 1996-1999 reference, German, and 2000 CDC references. A positive secular trend in height was observed in children and adolescents from 7 to 15 years of age. A significant shift of the upper tail of the BMI distribution occurred, especially in Polish boys at younger ages. The prevalence of overweight or obesity was 18.7% and 14.1% in school-aged boys and girls, respectively. The presented height, weight, and BMI references are based on a current, nationally representative sample of Polish children and adolescents without known disorders affecting growth. Changes in the body size of children and adolescents over the last three decades suggest an influence of the changing economical situation on anthropometric indices.

The height-, weight-, and BMI-for-age of Polish school-aged children and adolescents relative to international and local growth references.

BACKGROUND: The growth of children is an indicator of health and society's wellbeing. Growth references are useful in monitoring a child's growth, which is a very important part of child care. Poland's growth references are not updated regularly. Although several growth reference ranges have been developed in Poland over recent years, sampling was restricted to urban populations of major cities. The aim of this study was to assess how well Polish children match with, or diverge from, regional charts and to compare them with international growth references. METHODS: Four Polish and two international (WHO 2007 and USCDC2000) growth references were used to calculate the height, weight and BMI z-scores in a recent, large, population-representative sample of school-aged children and adolescents in Poland. The distributions of z-scores were analysed with descriptive and inferential statistical methods. RESULTS: Mean height z-scores calculated with the use of the WHO 2007 and USCDC2000 references were positive and significantly different from zero over the entire age range. The mean height z-score was closest to zero in the Poznan reference for boys (0.05) and Warszawa reference for girls (0.01). Median weight z-scores were positive under all weight references over the entire age range with only the exception of 18-year-old girls' weight z-score calculated relative to USCDC2000. Median BMI z-scores were positive in males in early childhood, decreasing with age. In the case of girls, the median BMI z-score calculated using WHO 2007 and USCDC2000 was close to zero in early childhood, decreased in adolescents and reached minimum values at age 18 years. Median BMI z-scores calculated with the use of the Lodz reference fluctuated between 0.05 and 0.2 over the studied age range. CONCLUSIONS: In this contemporary sample of Polish school-aged children, distributions of height, weight and BMI differed from those of children from the international growth references. These differences should be considered when using the references. There exist certain limitations to the analysis of height, weight, and BMI z-scores when Polish regional references are used.

[Trends in children and adolescents deaths due to suicide, event of undetermined intent and poisoning in Poland in the years 1999-2007]. / Tendencje zgonów dzieci i mlodziezy z powodu samobójstw, zdarzen o zamiarze nieokreslonym i zatruc w Polsce w latach 1999-2007.

AIM: The purpose of the study was to examine children and adolescents sex- and age-specific trends in mortality due to suicide, undetermined death and poisoning from 1999 to 2007 in Poland. METHODS: Anonymous deaths records were obtained from the Central Statistical Office and grouped according to the cause of death, age and sex. For each year and separately for 3-Year Moving Averages suicide and poisoning+undetermined death mortality rates were calculated. Time trends were analyzed by linear regression estimating annual percent change (APC) of the rates. Correlation between suicide and grouped poisoning and undetermined death was examined. RESULTS: A significant increase was observed in girls aged 10-14 years suicide mortality (APC=17,0; p<0,05). Mortality due to suicide did not change significantly from 1999 to 2007 in boys aged 10-14 and 15-19 years, and girls 15-19 years of age. In these groups negative correlation between suicides and grouped poisoning and undetermined death was observed which may indicate hidden suicide in this category of death causes. CONCLUSIONS: Monitoring suicide mortality should include observation of trends in undetermined death.