International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data.

BACKGROUND: Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries. METHODS: Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1,355,910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries. RESULTS: Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29-3.17) and being married rather than divorced (ORs 1.17-2.54) were most consistently associated with home death across countries. CONCLUSIONS: A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.

[Early Integration of Palliative Care into Standard Oncology Care -  Benefits, Limitations, Barriers and Types of Palliative Care]. / Casná integrace paliativní péce do standardní onkologické péce -  benefit, limitace, bariéry a druhy paliativní péce.

Patients with advanced cancer experience a significant number of physical symptoms and psychological distress, which worsen their quality of life (QOL). Palliative care is oriented to prevent and relieve suffering and promote QOL of patients with advanced cancer. In oncology, the role of palliative care is traditionally perceived to be the treatment after the antineoplastic therapy is finished. A concept of early integration of palliative care into standard oncology practice has been recently introduced. There is a lot of data supporting this concept of parallel application of both oncology care and palliative care. Early palliative care has been shown to provide benefits in QOL, mood, symptoms, health care utilization and survival. In this review, we summarize published data about benefits and difficulties of early palliative care. We also discuss the model of general and specialized palliative care integrated into oncological practice, their differences and consequences.

The effect of acclimatization and ambient temperature on heat withdrawal threshold in rats.

BACKGROUND: Nociception in rats is frequently measured in terms of latency of withdrawal reaction to radiant heat (thermal nociceptive threshold). The aim of this study was to determine how much housing acclimatization and ambient temperature affect the results of thermal pain threshold testing. METHODS: All experiments used adult male Wistar rats. Thermal pain thresholds were tested using the radiant heat withdrawal reaction at three different body sites: forepaws, hind paws and tail. Skin temperature was measured using an Infrared thermometer and ambient temperature was set at 18, 20, 24 or 26 °C. RESULTS: The results demonstrate that (1) thermal pain threshold was inversely related to both ambient and skin temperature; (2) housing acclimatization and repeated testing had no effect on nociceptive thresholds at any of the three body sites; (3) a resting, cranio-caudal distribution, of nociceptive sensitivity was observed; (4) hind paws and tail were more sensitive to changes of skin and ambient temperature than forepaws. CONCLUSION: These findings show the importance of recording laboratory conditions in experiments and their influence on results.

Quantitative ballistocardiography (Q-BCG) for measurement of cardiovascular dynamics.

In the seventies of the past century ballistocardiography had been thought to be obsolete in cardiology for impossibility of objective calibration. In the present work the quantitative ballistocardiography (Q-BCG) for measurement of systolic force (F) and minute cardiac force (MF) in sitting subject was described. The new principle of piezoelectric transducer enabled to register the force caused by the heart and blood movement, which was not measured before. The calibration proved that the action of the force on the transducer was expressed quantitatively without the amplitude-, time-, and phase deformation. The close relationship of skeletal muscle force and F was proved. The F and MF changed under different physiological conditions (age, partial pressure of oxygen, body weight, skeletal muscle force). It was shown that the systolic force (F) and minute cardiac force (MF) are the physiological parameters neurohumorally regulated similarly as the heart rate or systolic volume.

Long-term survival of patients treated for Hodgkin's disease in 1971-1996 depending on the clinical stage of the disease, patient's fertility after therapy and cause of death analysis.

The long-term survival in a group of 370 patients treated for Hodgkin's disease in the years 1971-1996 was retrospectively analyzed. Up to now 191 patients live. 179 patients have died. Since the year 1978 the uniform diagnostic and therapy protocol has been used. The therapy consisted in the combination of a radiation therapy (usual dose 40 Gy) with the COPP chemotherapy (6 cycles). Since the year 1988 the alternation of the ABVD and COPP chemotherapy has been used. According to the stage of the Hodgkin's disease and the patient's age the modification of the therapy was introduced. One chemotherapy cycle was removed for each 10 years above the 50 year age of the patient. The radiation therapy was not applied to the areas of the reproductive organs in young patients to preserve their fertility. The percentage of surviving patients for thirty years was 58.8% for Stage I and IIA,B and for Stage IIIA was 60.72%. In the group of surviving patients, we have registered 11 fathers and 34 females with up to 3 children. All together 75 children without health problems are monitored.

New clearance evaluation method for hepatological diagnostics.

Pulse dye densitometry (PDD) enables the evaluation of hemodynamic state as well as liver function. A repeated examination, even after a short pause (or under stress condition), enables to follow safely the dynamics of liver pathology. From presented parameters we have evaluated as reliable the C5-clearance, an expression of equilibrium state in the two compartment liver system. Furthermore, T-index expresses ratio of C5 value to cardiac output, it is a sensitive indicator of the blood pole, i.e. sinusoidal uptake, which is in very good correlation with staging of hepatopathies. The isolated h constant in correlation to T-index is valuable For functional grading. The Japanese automatic analyzer of indocyanine green (ICG) dilution and elimination curves, after incorporation of a two compartment mathematical model, becomes more useful for complex hepatological diagnostics. Non-invasive PDD is becoming of uppermost importance to clinical interest, yielding comparable results as other complicated and invasive examinations and may be, therefore, repeated in short time intervals for different indications with minimal stress of examined patient.

[Results of the monitoring the group of patients treated for the Hodgkin disease in the period of 1971 to 1996. Part 1: long-time survival in dependence of the clinical stage of the disease]. / Výsledky sledování souboru pacientu lécených pro Hodgkinovu nemoc v létech 1971 az 1996. I. cást: Dlouhodobé prezití pacientu v záivislosti na klinickém stádiu onemocnení.

BACKGROUND: This authors team has been dealing with the Hodgkin disease problems since 1971. The MORHO study started at eight working places in 1978 according to unified diagnostic and medical protocol. PATIENTS AND METHODS: 370 patients were treated. The treatment consisted in the combination of radiation and chemotherapy COPP and since 1988 in alternance of COPP and ABVD. Therapy was modificated with accordance to clinical stages and patient's histological type and age. Treatment of the patients over 50 was reduced in decades of one chemotherapy cycle less. RESULTS: Results from the clinical study are--patients with the stage IIA, IIB and IIIA survive 30 years in 59.29%, 57.86% and 60.72%. Patients diagnosed as stage IIIB survive after 30 years 36.78%, while patients in stages IVA and IVB survived 10 years 24.51% and 23.32% and 20 years 8.61% in stage IVB. Women survived longer than men. Histological types had no influence to the lenght of survival. The total number of relapses in the group was 55. There were 39 men and 16 women from that. 64% was in stage III and IV and in 73% mediastinal nodules were affected. 42% of relapses was till 1 year after the treatment. After the treatment 75 children were born to the patients from the group. 60 children from that were born to the women under treatment. CONCLUSION: The success of therapy of Hodgkin's disease according to protocol created by expert group of study MORHO is comparable with results of similar studies in the world. The most important contribution of this study was unification of treatment protocol in Czechoslovakia. This study changed the formerly paliative therapy to real curative treatment.

[Results of the monitoring the group of patients treated for the Hodgkin disease in the period of 1971 to 1996. Part 2: fertility after therapy]. / Výsledky sledování souboru pacientu lécených pro hodgkinovu nemoc v letech 1971-1996. II: fertilita po terapii.

BACKGROUND: This authors team has been dealing with the Hodgkin disease problems since 1971. The MORHO study started at eight working places in 1978 according to unified diagnostic and medical protocol. The aim of this study is evaluation of influence of Hodgkin disease therapy on the fertility in young patients. PATIENTS AND METHODS: Group of patients treated for Hodgkin disease in years 1971-1996 at workplaces using the same treatment protocol has been analyzed and the results have been compared with results of other medical centers in the world. Some of the young patients in fertile age became parents after the treatment. RESULTS: Information of number of pregnancies and of children born, long term surveillance and complications of treatment has been collected and discussed. Many patients stayed fertile also after therapy of numerous relapses. There was 75 children born to 34 women and 11 men previously treated for Hodgkin disease. CONCLUSION: The results of our study are comparable with results of statistial evaluation of similar studies in the world cancer research centers.

The new clearance method for hepatic diagnostics.

New multiparametric analysis and method of their evaluation were derived. The bolus dye injection is used for evaluation of ICG (indicyaningreen) and BSP (bromsulphophtalein) kinetics. This arrangement is a form of spectrophotometric measurement of BSP in plasma and/or pulse dye densitometry of ICG. Clearance values enable to differentiate liver diseases and to add their clinical staging. Pathophysiology of dye kinetics is discussed from two points of view i.e. sinusoidal and canalicular membrane transfer.

[Homocysteinemia--its significance in gynecology and obstetrics]. / Homocysteinemie--její význam v gynekologii a porodnictví.

OBJECTIVE: Metabolic study on plasmatic levels of homocysteine (Hcy) in healthy women during normal or pathological pregnancy accompanied with corresponding levels of Hcy in amniotic fluid and foetal sera. Increased levels of Hcy--hyperhomocysteinaemia is respected as an independent risk factor accelerating the early development of vessel damage and causing the neural tube defects (NTD). DESIGN: Basic study to get our own data about Hcy in Czech healthy and population at risk of pregnant and non-pregnant women. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague. METHODS: Total homocysteine in plasma, amniotic fluid and foetal sera was estimated by chromatographic method with use of fluorescence detection. RESULTS: Normal homocysteine in preclimacteric healthy nonpregnant women is: 9.7 +/- 1.6 mumol/l with evident age-dependence. In healthy climacteric women are higher levels of Hcy (corresponding to the men values): 11.8 +/- 2.6 mumol/l. After use of hormonal contraceptives the plasmatic levels of Hcy decrease: 7.2 +/- 2.0 mumol/l. In physiological pregnancies Hcy reachs the lowest values: 4.4 +/- 1.7 mumol/l with any evident oscillations during pregnancy. In women in childbed period was Hcy 8.4 +/- 2.1 mumol/l observed. In pathological pregnanciesare its levels slightly elevated: 6.3 +/- 2.1 mumol/l, most evident in placental abruptions: 7.5 +/- 1.7 mumol/l. In pregnant women with susp. results of screening on M. Down only unsignificant increase of Hcy was observed: 6.12 +/- 2.4 mumol/l. In amnial fluids of healthy pregnant women are levels of Hcy are quite low: 4.1 +/- 1.2 mumol/l with any oscillations during pregnancy. In foetal sera of pregnancies at risk (NTD, susp., trisomy, inborn errors of metabolism): 3.6 +/- 1.4 mumol/l of Hcy was detected. The foetoplacental quotient for Hcy is 0.62. CONCLUSION: Average values for Hcy were established in physiological as well as in pathological pregnancies and till now only limited diagnostic significance has been observed. The hyperhomocysteinaemia mentioned in previous papers was not in NTD observed because our pregnant patients were regularly supplemented with all critical vitamins (folate, B6, B12).

[Diagnostic significance of mild hyperhomocysteinemia in a population of children with parents or grandparents who have peripheral or coronary artery disease]. / Diagnostický význam mírné hyperhomocysteinémie v populaci detí narozených z rodicu ci prarodicu trpících onemocnením periferních ci koronárních tepen.

BACKGROUND: A rise of the homocysteine plasma level--mild hyperhomocysteinaemia--is considered an independent risk factor for the development of vascular damage. It is due to hereditary deficiency of 5,10-methylene-tetrahydrofolate reductase with accentuation of vitamin deficiency (folic acid, vitamin B6 and B12). In previous studies the authors confirmed this fact in the population of patients with aortocoronary or peripheral arterial bypasses. The assumed autosomal recessive transmission of this deficiency should make it possible to detect carriers of this metabolic deviation already in childhood. By selective screening of the child population at risk it would thus be possible to detect affected subjects in time and prevent the development of vascular disease by preventive folate administration. METHODS AND RESULTS: In a group of 38 children and grandchildren from risk families where at least one of the parents or grandparents was operated on account of vascular obliterating disease the total homocysteine plasma level was examined by the chromatographic method. An increase of total homocystein (8.7 +/- 2.7 mumol/l) was found as compared with children from the non-risk population (5.4 +/- 1.8 mumol/l), (p < 0.001). The total homocysteine values however were dependent on the child's age and were more marked in children above 12 years of age. In the parental population mild hyperhomocysteinaemia was present in 38% of those with aortocoronary bypasses and in 43% of those with peripheral arterial bypasses. CONCLUSIONS: The authors found significantly elevated total homocysteine levels in the child population from risk families with obliterating vascular disease. The total homocysteine level depends on the child's age and is more markedly expressed in children above 12 years of age.

[Hyperhomocysteinemia. A risk factor for the development of vascular diseases not associated with lipid levels]. / Hyperhomocysteinémie. Rizikový faktor pro vznik cévních onemocnení nezávislý na hladinách lipidu.

BACKGROUND: Elevated total homocysteine plasma levels are considered a significant factor of vascular damage. As they are encountered in more than half the patients with atherosclerotic vascular damage the importance as a lipid-dependent or lipid-independent risk factor in the promotion of pathophysiological processes is discussed. METHODS AND RESULTS: In a group of 100 healthy subjects and 529 patients with indication for an aortocoronary or peripheral arterial bypass and in patients from the lipid clinic the mutual relation between total plasma homocysteine levels and selected indicators of the lipid metabolism was investigated. The following results more obtained: for total cholesterol a correlation coefficient of r = 0.26, for HDL-cholesterol r = 0.20, for LDL-cholesterol r = 0.21, for triacylglycerols r = 0.29, apolipoprotein A-I r = 0.06, apolipoprotein B r = -0.12 and for Lp(a) r = -0.03. To ensure correct evaluation of the homocysteine levels simultaneously also folate levels were examined (correlation coefficient r = 0.28), vitamin B12 r = (0.03) and fibrinogen r = (0.09). CONCLUSIONS: The authors did not detect an unequovical relationship between the total homocysteine level and selected lipid indicators in any of the patient groups (p < 0.05).