The impact of socioeconomic status (SES) on cognitive outcomes following radiotherapy for pediatric brain tumors: a prospective, longitudinal trial.

BACKGROUND: Socioeconomic status (SES) is a determinant of cognitive and academic functioning among healthy and ill children; however, few pediatric oncology studies examine SES and long-term cognitive functioning. The current study systematically investigated SES as a predictor of cognitive outcomes among children treated for localized brain tumors (BT) with photon radiation therapy (RT). METHODS: 248 children treated on a prospective, longitudinal, phase II trial of conformal RT (54-59.4 Gy) for ependymoma, low-grade glioma, or craniopharyngioma were monitored serially with cognitive assessments (intelligence quotient [IQ], reading, math, attention, adaptive function) for 10 years (2209 observations, median age at RT = 6.6 years, 48% male, 80% Caucasian). SES was derived from the Barratt Simplified Measure of Social Status, which incorporates parental occupation, education, and marital status. RESULTS: Overall, SES scores fell in the low range (Barratt median = 37). At pre-RT baseline, linear mixed models revealed significant associations between SES and IQ, reading, math, attention, and adaptive function, with higher SES associated with better performance (P < .005). SES predicted change over time in IQ, reading, and math; higher SES was associated with less decline (P < .001). Accounting for sex and age at RT, SES remained predictive of IQ, reading, and math. Analysis of variance revealed a greater relative contribution of SES than sex or age at RT to reading and math. CONCLUSIONS: SES represents a novel predictor of cognitive performance before and after RT for pediatric BT. These findings have broad implications as high SES represents a protective factor. Developing interventions to mitigate the effects of low SES is warranted.

Evaluation of the best compromise between the urban air quality monitoring resolution by diffusive sampling and resource requirements.

The need to collect data representative of overall urban pollution is all-important in order to monitor the population exposure. High spatial resolution monitoring using diffusive samplers allows studying of the urban pollutant distribution, thus enabling deeper investigation of their generation and diffusion mechanisms. Nevertheless, such a monitoring campaign has a certain cost. In this study we point out how to find the best compromise between the number of necessary measurements and the affordable costs for monitoring campaigns. We also describe an innovative method for the proper design of a fixed urban monitoring network by means of preliminary high spatial resolution campaigns using diffusive samplers. Four European capital cities (Dublin, Madrid, Paris and Rome) were monitored six times, each time for seven days. Benzene, toluene, ethylbenzene, xylenes (BTEX) and NO(2) concentrations were measured at 146 sites in Dublin, 293 in Madrid, 339 in Paris and 290 in Rome. Multiscale grids have been drawn which ranged in mesh size from 500 m to 2 km. The statistical processing of data produced a twofold result: the creation of isoconcentration maps with geostatistical procedures, and an algorithm aimed at locating the minimum number of sampling sites where the fixed monitoring stations should be placed. Average urban levels estimated on the basis of these selected sites differ by less than 8% from those calculated on the whole populations of the sampled points. The aim of this work is to investigate how far the resolution of a monitoring campaign of urban pollution by diffusive sampling can be reduced, thus making the monitoring less expensive in terms of human and financial resources, while preserving the same quality of the results that could be achieved with a higher resolution. We found that there is no significant loss of information when the resolution of the monitoring grid for BTEX is lowered to a mesh size of 1.85 km, that is a sampling site each 3.4 km(2), and that the minimum number of sampling sites to be used is N = 0.29 A, where A is the urban surface to be monitored (in km(2)). As the spatial distribution of NO(2) is less sensitive to the distance from the emission source than that of BTEX, this relationship could be retained as a valid lower limit for the mesh grid size also for NO(2) monitoring.

Client and community services satisfaction with an assertive community treatment subprogram for inner-city clients in Edmonton, Alberta.

OBJECTIVES: To evaluate client and agency satisfaction with a specific assertive community treatment subprogram, known as inner-city support, developed in Edmonton to target the inner-city population, and to determine the demographics and potential needs of this population. METHOD: Clients were administered questionnaires based on the Client Satisfaction Questionnaire and the Satisfaction With Life Scale. We also conducted a face-to-face interview. We contacted and similarly surveyed 18 community agencies. RESULTS: The program was well received, although areas for improvements included dissemination of information and hours of operation. Clients also requested more input regarding the development of activities. Clients were predominantly male with a diagnosis of schizophrenia comorbid with substance abuse and antisocial personality disorders, a history of forensic contact, homeless, and dependent on social assistance. CONCLUSION: Among the population with serious and persistent mental illness, inner-city clients represent a particularly disadvantaged subpopulation that may benefit from specialized community programs.