High-quality care for all children with cancer.

BACKGROUND: Providing high-quality care for children with cancer could improve treatment outcomes, survival and quality of life of the children and parents. The aim of this study is to select high-quality care recommendations for all children with cancer based on literature and consensus for future development of quality indicators. MATERIALS AND METHODS: We performed an extensive search in databases for scientific literature and in websites of international health care and guideline development organizations to create an inventory of recommendations for the care for all children with cancer. The RAND modified Delphi method was used to grade and select recommendations for high-quality care. RESULTS: Our search resulted in a list of 131 recommendations on care for all children with cancer. The expert panel graded, discussed and prioritized these recommendations. Analysis of these ratings resulted ultimately in a list of 109 high-quality care recommendations for all children with cancer, including 31 prioritized recommendations. CONCLUSIONS: This study defines a set of high-quality care recommendations based on literature and consensus. These recommendations provide a basis for the development of a comprehensive set of quality indicators to evaluate care in paediatric oncology.

Development of lymphocyte subpopulations in preterm infants.

In preterm neonates the immune system is thought to be less developed at birth, but very little is known about the actual size of lymphocyte subpopulations, and even less about the maturation of these subpopulations during the first months after a premature birth. To evaluate the development of lymphocyte subpopulations in preterm infants during the first 3 months after birth, we performed a prospective longitudinal study in two hospitals in the Netherlands. Preterm neonates (n = 38) of all post-menstrual ages were included and blood samples were taken from cord blood, and at 1 week, 6 weeks, and 3 months. Lymphocyte subpopulations were measured by four-colour flow cytometry. The data were compared with follow-up data obtained in healthy term neonates (n = 8), and with single samples from school age children (n = 5) and adults (n = 5). Overall, we found a similar pattern of post-natal development of lymphocyte subpopulations in the term and preterm infants. Both B lymphocytes and helper and cytotoxic T lymphocytes mainly consist of naive cells at birth and during the 3 months of follow-up in all neonatal age groups. So, the preterm immune system seems to be able to generate an outburst of naive T and B lymphocytes from the thymus and bone marrow within the same time span after the start of post-natal antigenic stimulation from the environment as the term immune system, but, with lower post-menstrual age, the absolute counts of naive helper T lymphocytes are lower.

Comparison of the parasitologic efficacy of amodiaquine and sulfadoxine-pyrimethamine in the treatment of Plasmodium falciparum malaria in the Bungoma District of western Kenya.

The efficacy of amodiaquine (AQ) and sulfadoxine-pyrimethamine (SP) was assessed in 310 symptomatic children from western Kenya with uncomplicated Plasmodium falciparum malaria. A non-blinded, randomized, 14-day study was performed and parasitologic criteria were used. Of 310 patients included, 238 (77%) completed the study: 120 received AQ and 118 received SP. In those treated with AQ, there were sensitive (S) infections in 107 patients (89.2%, 95% confidence interval [CI] = 82.2, 94.1%), RI resistance in 10 (8.3%, 95% CI = 4.1, 14.8%), RII resistance in 1 (0.8%, 95% CI = 0, 4.6%), and RIII resistance in 2 (1.7%, 95% CI = 0.2, 5.9%). In those treated with SP, there were S infections in 74 patients (62.7%, 95% CI = 53.3, 71.4%), RI resistance in 21 (17.8%, 95% CI = 11.4, 25.9%), RII resistance in 11 (9.3%, 95% CI = 4.7, 16.1%), and RIII resistance in 12 (10.2%, 95% CI = 5.4, 17.1%). Resistance rates were consistently higher in the SP-treated patients (P < 0.001). Resistance to SP in this area has reached such levels that it should no longer be the first-line treatment. Alternative treatment, such as SP plus AQ combination treatment or artemisinin combination treatment, is urgently needed.

Exophthalmos in obesity.

AIMS: To establish the relationship between exophthalmos and obesity. METHODS: A group of 19 obese patients (body mass index, BMI >/=30 kg/m(2)) was compared with a control group of 45 nonobese individuals (26 > BMI >/= 20 kg/m(2)). Both groups underwent Hertel's exophthalmometry, Goldmann applanation tonometry and measurement of the medial rectus muscle by echography. RESULTS: Obese patients had higher Hertel values and enlarged medial rectus muscle diameter (p < 0.05). Indeed, bilateral exophthalmos was observed in 33% of obese subjects. However, this did not cause any ocular morbidity. In some cases the difference in intraocular pressure was enlarged but together with the exophthalmos not statistically significant. CONCLUSIONS: Standard values for exophthalmometry and orbital echography may have to be adapted for obese individuals. In several cases the eye signs had a remarkable resemblance to patients with Graves' orbitopathy. So in each patient with bilateral exophthalmos and eye signs suspicious of Graves' orbitopathy obesity should be considered as a possible cause.

Background zinc concentrations in soil affect the zinc sensitivity of soil microbial processes--a rationale for a metalloregion approach to risk assessments.

Soil microbial processes are particularly sensitive to Zn, but great difficulty exists in deriving soil standards based on laboratory toxicity tests. Zinc toxicity data for soil microbial processes were collated from the literature, and their variability with soil properties was assessed. Data were screened for quality and reliability, and analysis was based on the highest metal dose at which no adverse effect was found (HNOAED). The HNOAED values were expressed on a pore-water basis and were found to be positively related to background concentrations of Zn in soil, also expressed on a pore-water basis. This suggests that soil microorganisms acclimate to indigenous concentrations of Zn in soil pore water, and this acclimation affects the subsequent response to Zn added as a pollutant. Thus, regions having low background Zn concentrations in soil pore water will be much more sensitive to Zn pollution than others having high background concentrations. A method to account for effects of background Zn on assessments of Zn toxicity is suggested where metalloregions are defined having common sets of abiotic and biotic factors that affect the toxicity of Zn. This approach could markedly improve regional or continental risk assessments for metals in the environment.