Inflammation and cardiovascular events in individuals with and without chronic kidney disease.

Inflammation and chronic kidney disease predict cardiovascular events. Here we evaluated markers of inflammation including fibrinogen, albumin and white blood cell count in individuals with and without stages 3-4 chronic kidney disease to assess inflammation as a risk factor for adverse events, the synergy between inflammation and chronic kidney disease, and the prognostic ability of these inflammatory markers relative to that of C-reactive protein. Using Atherosclerosis Risk in Communities and Cardiovascular Health Study data, inflammation was defined by worst quartile of at least 2 of these 3 markers. In Cox regression models, inflammation was assessed as a risk factor for a composite of cardiac events, stroke and mortality as well as components of this composite. Among 20 413 patients, inflammation was identified in 3594 and chronic kidney disease in 1649. In multivariable analyses, both inflammation and chronic kidney disease predicted all outcomes, but their interaction was non-significant. In 5597 patients with C-reactive protein levels, inflammation and elevated C-reactive protein had similar hazard ratios. When focusing only on individuals with the worst quartile of white cell count and albumin, results remained consistent.

School re-entry after a cancer diagnosis: physician attitudes about truth telling and information sharing.

BACKGROUND: School re-entry for children with cancer hallmarks a return to age-appropriate activities; a process fraught with adjustment challenges. The paediatric oncologist is in a pivotal role of setting the tone and providing direction to the child, family, and other members of the health care and school team about this process. Understanding physicians' attitudes and behaviours regarding school re-entry will provide insight into these practices. METHODS: A four-part survey (general attitudes, patient factors, work cultures and respondent characteristics) was developed and mailed to the members of US and Japanese paediatric oncology professional societies. Japanese (n=362) and US (n=350) paediatric oncologists comprised the study sample; the average respondent was a male in his mid-forties providing clinical care>or=5 hours/week practising for about 15 years. Responses to a hypothetical scenario reflecting the range of how school re-entry issues for a child on treatment may be handled was the outcome variable in this report. RESULTS: US physicians (284/350, 84.5%) endorsed telling everyone (the school officials and classmates) about a child's diagnosis and treatment to facilitate the transition back to school. In contrast, only 93/359 (25.9%) of the Japanese respondents endorsed telling everyone. Japanese physicians were more likely to endorse telling everyone if they believed it was the physician's responsibility to tell children the truth at diagnosis (P<0.001), if they did not believe that awareness of cancer dashes hope (P=0.002), and were not influenced by type of cancer the child had (P=0.003). CONCLUSIONS: Differences in US and Japanese paediatric oncologist responses in return to school issues may reflect larger cultural issues such as: benefits and disadvantages to telling the child that he/she has cancer; hospitalization practices; and the availability of school re-entry programs. More needs to be learned about how children, their families and schools prefer to have re-entry issues handled during and after treatment and how these approaches affect the child's re-entry into school.