265 research outputs found
Statistical Analysis of Proposed Pediatric Asthma Screening Survey
No full textBACKGROUND: Poor asthma control is responsible for considerable morbidity and mortality among children (1). Current pharmacotherapy can suppress exacerbations of asthma symptoms. Thus, proper treatment of asthma is imperative in limiting the toll of this disease process on individuals as well as society. Treatment protocols tend to be based on measurement of asthma severity (3), but there are currently no widely accepted guidelines defining efficacy of treatment (i.e.- asthma control).
OBJECTIVE: This study aimed to assess the construct validity and reliability of an asthma survey among a group of known asthmatics. Furthermore, we intended to determine the level of correlation between survey responses and asthma severity amongst survey participants as well as to discern the ability of the survey to discriminate between mild persistent, moderate persistent and severe persistent asthma.
METHODS: Surveys from 207 parents/guardians of children aged 5-17 with physician-diagnosed asthma were evaluated for construct validity using Principal Components Factor Analysis. Reliability was assessed via Cronbach's alpha coefficient scale. Severity/response correlations were tested by Chi-square exact tests and the strength of each relationship was assessed using Spearman's correlation. Discriminating ability was analyzed by ROC curve, sensitivity, specificity and odds ratio.
RESULTS: Construct validity testing showed that the scale is unidimensional with a Cronbach's alpha coefficient of 0.8076, indicating a high degree of reliability. Significant associations between asthma severity and each question were found, indicating that more severe asthmatics reported significantly greater symptom frequency (p-value range <0.001 - 0.019, Spearman's range = 0.152 - 0.396). ROC analysis yielded an area under the curve of 0.728. Analysis of the ROC curve indicated an optimal cutoff score of =6 to indicate moderate-to-severe asthma. This cutoff yielded a sensitivity and specificity of 65.2% and 70.2%, respectively. Odds ratio was 4.407 (95% CI of 2.366 - 8.207).
CONCLUSION: Our results indicate that, among asthmatics, the survey is valid and reliable. We also noted more frequent symptoms as severity increased, indicating sub-optimal control among more severe asthmatics. Finally, the ability of the survey to predict asthma severity is not supported as the survey seems to assess asthma control, with higher scores indicating poorer control
Incidence and Clinical Relevance of Abnormal Complete Blood Counts in Survivors of Childhood Cancer
No full textBACKGROUND: The purpose of this study was to determine the incidence and clinical significance of abnormal complete blood counts (CBCs) obtained during follow-up of childhood cancer survivors.
METHODS: A retrospective cohort study was conducted on 193 survivors, diagnosed between 1970-1986, who have been followed in our center's After Cancer Experience Program and are participants in the Childhood Cancer Survivor Study. Of these patients, 49% were female and 25% were racial/ethnic minorities. The primary outcome was determination of the cumulative percentage of patients having an abnormal CBC by 2 or 3 standard deviations (SDs). Four components of the CBC were examined and employed to define an abnormal CBC: low white blood cell count (WBC), high mean corpuscular volume (MCV), low platelet count, and low hemoglobin concentration. Association of treatment exposures to abnormal values was assessed with a multi-level logistic model.
RESULTS: There were 1,376 patient visits during 1,437 person-years of follow-up. The mean number of visits per survivor was 7.2 (SD 4.5). The cumulative percentage of subjects with at least one abnormal CBC was 70%. The cumulative percent of subjects with a value abnormal by 2 SD was WBC=23%, MCV=33%, platelets=9%, hemoglobin=49%. For values abnormal by 3 SD, the frequencies were WBC=3%, MCV=18%, platelets=1%, hemoglobin=27%. None of the patients developed myelodysplastic syndrome or a secondary leukemia during the follow-up period. Exposure to epipodophyllotoxins was associated with an increased risk of having abnormally high MCV values.
CONCLUSIONS: Mildly abnormal CBC values are common in survivors of childhood cancer. Abnormal values are often of questionable significance but seem to persist over time. Epipodophyllotoxin therapy was found to be associated with increased frequency of high MCV levels
Abstract ED02-02: Second cancers among cancer survivors: High-risk populations to target for prevention
No full textPredicting Adverse Health Outcomes in Long-Term Survivors of a Childhood Cancer
No full textMore than 80% of children and young adults diagnosed with invasive cancer will survive five or more years beyond their cancer diagnosis. This population has an increased risk for serious illness- and treatment-related morbidity and premature mortality. A number of these adverse health outcomes, such as cardiovascular disease and some second primary neoplasms, either have modifiable risk factors or can be successfully treated if detected early. Absolute risk models that project a personalized risk of developing a health outcome can be useful in patient counseling, in designing intervention studies, in forming prevention strategies, and in deciding upon surveillance programs. Here, we review existing absolute risk prediction models that are directly applicable to survivors of a childhood cancer, discuss the concepts and interpretation of absolute risk models, and examine ways in which these models can be used applied in clinical practice and public health
Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort
No full textBACKGROUND
Treatment of patients with paediatric acute lymphoblastic leukaemia has evolved such that the risk of late effects in survivors treated in accordance with contemporary protocols could be different from that noted in those treated decades ago. We aimed to estimate the risk of late effects in children with standard-risk acute lymphoblastic leukaemia treated with contemporary protocols.
METHODS
We used data from similarly treated members of the Childhood Cancer Survivor Study cohort. The Childhood Cancer Survivor Study is a multicentre, North American study of 5-year survivors of childhood cancer diagnosed between 1970 and 1986. We included cohort members if they were aged 1·0-9·9 years at the time of diagnosis of acute lymphoblastic leukaemia and had received treatment consistent with contemporary standard-risk protocols for acute lymphoblastic leukaemia. We calculated mortality rates and standardised mortality ratios, stratified by sex and survival time, after diagnosis of acute lymphoblastic leukaemia. We calculated standardised incidence ratios and absolute excess risk for subsequent neoplasms with age-specific, sex-specific, and calendar-year-specific rates from the Surveillance, Epidemiology and End Results Program. Outcomes were compared with a sibling cohort and the general US population.
FINDINGS
We included 556 (13%) of 4329 cohort members treated for acute lymphoblastic leukaemia. Median follow-up of the survivors from 5 years after diagnosis was 18·4 years (range 0·0-33·0). 28 (5%) of 556 participants had died (standardised mortality ratio 3·5, 95% CI 2·3-5·0). 16 (57%) deaths were due to causes other than recurrence of acute lymphoblastic leukaemia. Six (1%) survivors developed a subsequent malignant neoplasm (standardised incidence ratio 2·6, 95% CI 1·0-5·7). 107 participants (95% CI 81-193) in each group would need to be followed-up for 1 year to observe one extra chronic health disorder in the survivor group compared with the sibling group. 415 participants (376-939) in each group would need to be followed-up for 1 year to observe one extra severe, life-threatening, or fatal disorder in the group of survivors. Survivors did not differ from siblings in their educational attainment, rate of marriage, or independent living.
INTERPRETATION
The prevalence of adverse long-term outcomes in children treated for standard risk acute lymphoblastic leukaemia according to contemporary protocols is low, but regular care from a knowledgeable primary-care practitioner is warranted.
FUNDING
National Cancer Institute, American Lebanese-Syrian Associated Charities, Swiss Cancer Research
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