Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement.

Recent guidelines concerning exercise for people with cancer provide evidence-based direction for exercise assessment and prescription for clinicians and their patients. Although the guidelines promote exercise integration into clinical care for people with cancer, they do not support strategies for bridging the guidelines with related resources or programs. Exercise program accessibility remains a challenge in implementing the guidelines, but that challenge might be mitigated with conceptual frameworks ("pathways") that connect patients with exercise-related resources. In the present paper, we describe a pathway model and related resources that were developed by an expert panel of practitioners and researchers in the field of exercise and rehabilitation in oncology and that support the transition from health care practitioner to exercise programs or services for people with cancer. The model acknowledges the nuanced distinctions between research and exercise programming, as well as physical activity promotion, that, depending on the available programming in the local community or region, might influence practitioner use. Furthermore, the pathway identifies and provides examples of processes for referral, screening, medical clearance, and programming for people after a cancer diagnosis. The pathway supports the implementation of exercise guidelines and should serve as a model of enhanced care delivery to increase the health and well-being of people with cancer.

A turning point: Head and neck cancer patients' exercise preferences and barriers before and after participation in an exercise intervention.

This study examined the exercise barriers and preferences of head and neck cancer (HNC) survivors in relation to exercise experience. Participants (n = 22; 46.8% response rate) completed retrospective self-report questionnaires on demographic and medical information, exercise barriers and preferences. A subset of participants then completed semi-structured interviews (n = 18). Participants had previously engaged in the ENHANCE trial during, or immediately following, radiation treatment, an average of 22.1 ± 5.8 months before. Retrospective questionnaires revealed that before ENHANCE participation, lack of interest and time were the primary exercise barriers. After participation, there was a significant decrease in typical barriers including lack of interest (p = .008), exercise not a priority (p = .039) and exercise not in routine (p = .004). Number of barriers experienced after ENHANCE participation was negatively correlated with age, quality of life and minutes of resistance exercise training per week. After ENHANCE participation, significant increases were found in preference for exercising at a cancer centre (p = .031) and with other cancer survivors (p = .016). Four higher order themes emerged inductively from interview data analysis pertaining to preferences (i.e., class format) and three higher order themes regarding barriers (physical, psychological and external). By investigating participants' perspectives after ENHANCE participation, key factors for effective HNC exercise programme design were identified.

Iron deficiency screening in the first three years of life: a three-decade-long retrospective case study.

A three-decade-long retrospective study of iron status in a cohort of 1250 children aged 8-36 months was carried out at the Pediatric Department at the Second University Naples. Iron status was evaluated with independent variables such as family income, weight for height, introduction of cow's milk (CM), iron supplementation and weaning. Iron deficiency (ID) is prevalent in children with low income, early introduction of CM, delayed weaning, over-weight, and in those not receiving iron supplementation (P < 0.05). The first decade (1980-1990) was marked by low family income, while early introduction of CM characterized the first two decades (1980-1990, 1990-2000) (P < 0.05). ID depends on a variety of social and dietary factors. Hematological tests should be performed early to identify children at risk for ID.

Thrombophilia and varicella zoster in children.

From 2005 to 2011, 25 children of both sexes (13 boys and 12 girls, mean age 7.8 ± 2.5 years, 5-12.4 years) with acute varicella zoster virus (VZV) infection were selected. Five patients showed venous thromboembolism characterized by deep venous thrombosis (DVT). Comparison of activated partial thromboplastin time, antithrombin III, D-dimer, lupus anticoagulant, free S protein (PS), C protein, and antiphospholipid and PS antibodies was performed on children with acute VZV and DVT (group I), acute uncomplicated VZV (group II), and 30 healthy controls of both sexes (15 boys and 15 girls, mean age 7.5 ± 2.6 years, group III). Genetic thrombophilic mutations (Factor V Leiden, MTHFR C677T, and Prothrombin G20210A) were evaluated. Coagulation disorders and PS antibody were found in children with acute VZV (groups I and II). Significant differences were shown among the three groups (P < 0.05). Acute VZV infection could be associated with coagulation disorders and production of inhibitory PS antibodies in many uncomplicated cases.

Thrombophilic gene mutations in children with migraine.

In 35 patients of both sexes (18 boys and 17 girls), mean age 8.9 ± 4.5 years, affected by migraine both with (45.2%) and without an aura (54.9%) (P > 0.05) who had no alteration of brain computerized tomography and/or magnetic resonance imaging, we evaluated possible thrombotic events in the pathogenesis of the disease. In all cases and in 50 random healthy controls clotting tests (prothrombin time, activated partial thromboplastin time, protein C activity (PC), antithrombin III (ATIII), protein S (PS), antiphospholipid antibodies (aPL), and Lupus anticoagulant (LA) were normal. FVIII and FIX activities were increased in seven and five migraine sufferers, respectively. Genetic thrombophilic risk factors - factor V Leiden (FVL) and MTHFR677T - resulted in a significantly increased prevalence in migraine patients when compared with controls but without significant differences for the F2 polymorphism. The examined polymorphisms were associated with an increased risk of developing migraine (odds ratio (OR) > 1). These findings could confirm the key role of a reduced cerebral flow in the pathogenesis of migraine and possible risk of ischaemic stroke (IS) but we feel that these observations need to be confirmed in larger multi-centre studies.

Effect on haematological and anthropometric parameters of iron supplementation in the first 2 years of life. Risks and benefits.

Effects of iron supplementation (IS) on haematological and anthropometric parameters in a cohort of 121 healthy children, followed from 6 to 24 months of life, in the Paediatric Department, Second University of Naples, were evaluated. Children were randomly segregated in four groups: (1) exclusively breast feeding (BF) weaned with non-iron fortified (NIF) foods, (2) BF and iron fortified formulas (IFF) and foods, (3) exclusively IFF and foods, (4) BF and oral iron supplementation (OIS). Haematological parameters (Hb, MCV, Serum ferritin and transferrin saturation) in addition to anthropometric measurements (length and weight) were obtained. Results from the study at 6, 12, 18 and 24 months showed significantly lower values of haematological parameters in BF infants than other groups and in IFF infants than in those with OIS. In contrast children with OIS showed significant lower length. It appears that IS may be of limited or no benefit for growth in non-iron deficient children.

Diet and iron deficiency in the first year of life: a retrospective study.

In an observational cohort of 385 infants, we have investigated the relationship between hemoglobin (Hb) levels and iron stores and the type of milk feeding [breast milk (BM), formula milk (FM), cow's milk (CM), age and type of weaning, and socioeconomic status] at 8 and 12 months of age. Levels of Hb<11 g/dl and iron stores <15 ng/ml were significantly more frequent in BM and CM groups than in FM group (P<0·05). Significant differences of Hb mean were observed among the three groups, while ferritin mean were lower in BM and CM groups than in FM group (P<0·05). Socioeconomic factors also influenced Hb levels and iron stores through differences in diet. Deprived infants were 23·1% of cohort and many of them received BM (43·5% at 8 months versus 38·5% at 12 months) or CM (42·6% at 8 months versus 47% at 12 months), while >50% were weaned before 6th month of age. FM feeding and weaning <6 months of age are related with better Hb levels and iron stores. Analysis of the impact of weaning on Hb levels and iron stores showed that infants weaned <6 months of life had, regardless of milk feeding, higher Hb and ferritin levels than weaned >6 months.

Reliability of red blood cell indices and formulas to discriminate between beta thalassemia trait and iron deficiency in children.

Iron deficiency (ID) and beta thalassemia trait (betaTT) are the most common causes of hypochromia and microcytosis. This study evaluates the reliability of some of the red blood cell (RBC) indices and the formulas used in the differentiation between betaTT and ID in a cohort of 458 children aged between 1.8 and 7.5 years (mean age 5.6+/-1.7 years) with mild hypochromic microcytic anemia. Within this group, 243 were confirmed with ID and 215 with betaTT. Red cell indices derived from automated red cell analyzers were used to evaluate the following discriminant indices and formulas: Mentzer Index (MI), Green and King Index (G&K), England and Fraser Index (E&F), RBC Distribution Width Index (RDWI), RBC distribution width (RDW) and RBC count. Sensitivity (SENS), specificity (SPEC), positive and negative prognostic value, efficiency (EFF) and Youden's Index (YI) were evaluated. For each index or formula Gauss curves were constructed. The highest SENS was obtained with RDWI (78.9%), while the highest SPEC and YI with E&F (99.1 and 64.2% respectively), the highest EFF (80.2%) with G&K. Gauss curves obtained from betaTT and ID children showed a different degree of overlap for each formula or index. In conclusion, none of RBC indices or formulas appears reliable to discriminate between betaTT and ID subjects.

Effect of Helicobacter pylori eradication on platelet count in children with chronic idiopathic thrombocytopenic purpura.

Recent reports have suggested, particularly in adults, an association between Helicobacter pylori infection (HPI) and chronic idiopatic thrombocytopenic purpura (cITP) with improvement of platelet count after eradication therapy. We investigated the association of HPI and cITP and the effect of HP eradication therapy on thrombocytopenia in a population of 24 children of both sexes mean age 8.0+/-0.28 years (range 5.4-10.7 years), affected by cITP (PLT 0.05). Non-significant differences were found in platelet count between infected and uninfected patients before eradication treatment (PLT 33.0+/-2.8 x 10(9)/l versus 34.0+/-5.75 x 10(9)/l) (P>0.05), while significant differences were observed after eradication therapy (PLT 315.0+/-7.07 x 10(9)/l versus 43.5+/-2.12 x 10(9)/l) (P<0.05). HP assessment should be performed in all cITP patients and eradication therapy should be attempted in positive cases.

Influence of Helicobacter pylori infection associated with iron deficiency anaemia on growth in pre-adolescent children.

In 102 children of both genders aged between 10 and 12 years affected by iron deficiency anaemia (IDA) from various causes, a retrospective study from 1999 to 2007 has been performed to investigate possible relationships between IDA and physical growth. Patients were divided into two groups according to gender. Hb, MCV, ferritin levels, HSDS and body mass index (BMI) were recorded to confirm the diagnosis and the height standard deviation scores were also evaluated. The causes of IDA were investigated. At study entry, both groups of patients, regardless of IDA etiology, had microcytic hypochromic anaemia with low ferritin level. Anthropometric parameters were also reduced. Significant differences of anthropometric parameters were found in both groups in relationship to various causes of IDA (p<0.05) (ANOVA). We conclude that IDA may influence physical growth and etiological factors play an important role on growth delay.

Prophylactic platelet transfusion in children with thrombocytopenic disorders: a retrospective review.

The safety of low platelet thresholds for prophylactic transfusions was retrospectively evaluated in 673 children with various thrombocytopenic disorders. In patients with idiopathic thrombocytopenic purpura and X linked thrombocytopenia the threshold for the use of platelet transfusion was based on bleeding events rather than platelet count. In children with hypoproliferative thrombocytopenia and Wiskott-Aldrich syndrome, prophylactic platelet transfusions were used when the platelet count was 10,000/microl in cases of bleeding or infections. The restrictive policy of platelet transfusions was shown to be proved safe in many thrombocytopenic disorders.

Iron deficiency in childhood and adolescence: retrospective review.

Two hundred and thirty-eight subjects of both sexes, age range 7.5 months-16 years, with iron deficiency (ID), were included in a retrospective review of ID causes, to determine the best treatment. Inadequate iron intake was the cause of ID or iron deficiency anemia (IDA) in 59 subjects from the first months of life to adolescence. Blood loss linked to cow's milk intolerance was the cause of ID or IDA in 37 younger children. Meckel's diverticulum (MD) (6 cases), reflux esophagitis (RE) (10 cases), some drugs such as acetyl salicylic acid (11 cases) induced bleeding with ID or IDA in children and adolescents. In pubertal females with ID or IDA, polymenorrhea was observed in 16 cases. Coelic disease (CD) (37 cases), Helicobacter pylori infection (HPI) (39 cases), association of HPI and CD (8 cases), enteromonas infection (15 cases), determining particularly malabsorption, were causes of ID or IDA in patients of a wide age range, unresponsive to iron therapy. Our findings show that iron replacement therapy was not always required and should not be prescribed until the diagnosis is certain.

Side effects of corticosteroid therapy in children with chronic idiopathic thrombocytopenic purpura.

In 29 symptomatic children of both sexes with chronic idiopathic thrombocytopenic purpura (CITP) with platelet counts < or = 30,000/mm3, of mean age 7.2 +/- 1.3 years, the side effects of long-term glucocorticoid therapy were evaluated. Patients were divided into three groups based on the different glucocorticoid protocols they were receiving. Baseline measurements (t0) of height (H) as standard deviation score (SDS), body mass index (BMI) as kg/m2 and bone mineral density (BMD) at the femoral neck (FBMD) and lumbar spine L2-L4 (LBMD) by a dual energy X-ray absorption technique, expressed as Z score, with follow-up measurements at 1 (t1) and 2 (t2) years were assessed. Group I patients (10 pts) treated with oral prednisone (2 mg/kg/die-for one month for 2 cycles) showed significantly different HSDS, BMI, FBMD and LBMD at t1 and t2 (P < 0.005) than other groups treated respectively with pulsed high doses of dexamethasone (24 mg/m2 over 4 days/months for 6 cycles) and methylprednisolone (9 mg/kg/die for 5 days for 3-4 months). These findings suggest that pulsed high doses of glucocorticoid lead to fewer side effects than oral prednisone therapy.

Impact of excess weight and estrogen receptor gene polymorphisms on clinical course of homozygous beta thalassemia.

In homozygous beta thalassemic patients we examined the role played by the interaction of ER gene polymorphisms with adverse environmental factors. A total of 108 homozygous beta thalassemic patients, 60 prepubertal mean age 9,5 +/- 3,7 years (27 M, 33 F) and 48 pubertal mean age 22,2 +/- 5,4 years (21 M, 27 F), regularly treated with red cell transfusion and iron chelation therapy were segregated on the basis of their XbaI and PvuII ER gene polymorphisms. Body mass index (BMI), lipidic pattern and blood pressure values were evaluated in each group. No significant differences were observed between patients segregated by their PvuII ER genotypes. Prepubertal and pubertal patients of both sexes lacking XbaI site showed BMI, HDL, LDL cholesterol significantly different than the other patients. In addition, triglyceride levels and blood pressure values were significantly higher in pubertal patients of both sexes lacking XbaI site than in other patients. ER XbaI polymorphism appear to influence nutritional factors, metabolic status and blood pressure and could be considered additional risk factors for later cardiac involvement in beta thalassemic patients.

Relationship of recollections of first death experience to current death attitudes.

Previous research (Dickinson, 1992) has investigated adults' memories of their first childhood experience with death. The present study extended this work to examine the relationship of various qualitative aspects of the first experience with death to current death attitudes. College students (196 females, 101 males) described their first childhood death experience and provided memories of: (a) who died; (b) whether parental discussion of death had occurred; (c) whether they had unanswered questions at the time; and (d) whether they had cried at the time. They then completed the Death Attitude Profile-Revised (DAP-R; Wong, Reker, & Gesser, 1994). Results indicated that although boys and girls did not respond differently to the first death experience, gender did appear to moderate the relationship between the qualities of this experience and current death attitudes.