Higher Proportion Of Survivors Research Articles

Testing the effectiveness of a sexual assault resistance programme in ‘real-world’ implementation

ABSTRACT Background: In a multi-site randomized controlled trial (RCT), the EAAA programme designed for first year university women (17–24 years old) was shown to reduce the likelihood of any (attempted and completed) rape in the next year by 50% (Senn, C. Y., Eliasziw, M., Barata, P. C., Thurston, W. E., Newby-Clark, I. R., Radtke, H. L., & Hobden, K. L. (2015). Efficacy of a sexual assault resistance program for university women. New England Journal of Medicine, 372(24), 2326–2335). Through a non-profit organization, EAAA has been available to universities globally since 2016 using a Train-the-Trainer model. Observations of the ‘real world’ implementation suggested that universities often altered eligibility criteria (especially year of study and age) in their recruitment. Objective: The current study (2017–2021) evaluated whether EAAA was effective when implemented by universities in Canada outside of the constraints of an RCT. Method: Five universities participated. Women students who signed up to take the EAAA programme on their campuses were recruited for the research. Participants completed surveys at 1-week pre-program and 1-week and 6-months post-programme. Compared to the RCT, participant eligibility was broader, the sample was more diverse in terms of race and sexual identity and had a higher proportion of survivors. Programme fidelity was adequate. Results: Comparisons in this quasi-experimental design, between students who took the programme and students in the control group (i.e. those who signed up but did not attend the programme), confirmed the effectiveness of the EAAA programme. Reduction of any rape exceeded the a priori benchmark of 37.5%. Completed rape was significantly reduced by 57.3% at 6-months. Reduction in attempted rape of 32.9% was lower than in the RCT likely due to the somewhat older (average age 22 vs 18) sample. Positive changes to previously established mediators of the programme effects were all replicated. Conclusions: These findings suggest that the EAAA is highly effective when implemented by universities even when eligibility for students in terms of year of study and age is broadened.

Early Tracheostomy May Reduce the Length of Hospital Stay.

There is evidence that prolonged invasive mechanical ventilation has negative consequences for critically ill patients and that performing tracheostomy (TQT) could help to reduce these consequences. The ideal period for performing TQT is still not clear in the literature since few studies have compared clinical aspects between patients undergoing early or late TQT. To compare the mortality rate, length of stay in the intensive care unit, length of hospital stay, and number of days free of mechanical ventilation in patients undergoing TQT before or after ten days of orotracheal intubation. A retrospective cohort study carried out by collecting data from patients admitted to an intensive care unit between January 2008 and December 2017. Patients who underwent TQT were divided into an early TQT group (i.e., time to TQT ≤ 10 days) or late TQT (i.e., time to TQT > 10 days) and the clinical outcomes of the two groups were compared. Patients in the early TQT group had a shorter ICU stay than the late TQT group (19 ± 16 vs. 32 ± 22 days, p < 0.001), a shorter stay in the hospital (42 ± 32 vs. 52 ± 50 days, p < 0.001), a shorter duration of mechanical ventilation (17 ± 14 vs. 30 ± 18 days, p < 0.001), and a higher proportion of survivors in the ICU outcome (57% vs. 46%, p < 0.001). Tracheostomy performed within 10 days of mechanical ventilation provides several benefits to the patient and should be considered by the multidisciplinary team as a part of their clinical practice.

HIV Disclosure to Infected Children Involving Peers: A New Take on HIV Disclosure in the Democratic Republic of Congo.

Appropriately informing HIV-infected children of their diagnosis is a real challenge in sub-Saharan Africa. Until now, there is no consensus on who ought to disclose and how to disclose. This paper describes the model for HIV status disclosure in which HIV-positive children/adolescents are informed about their diagnosis in a process conducted by young peers under healthcare worker (HCW) supervision in a hospital in Kinshasa, the Democratic Republic of Congo. This new take on HIV status disclosure involving peers includes four stages that help the trained peer supporters to provide appropriate counseling, taking into account the age and level of maturity of the child/adolescent: the preliminary stage, the partial disclosure stage, the full disclosure stage, and the post-disclosure follow-up stage. Of all children/adolescents whose HIV status disclosure data were documented at Kalembelembe Pediatric Hospital (KLLPH) between 2004 and 2016, we found that disclosure by peers was highly accepted by parents, children/adolescents, and health workers. Compared to children/adolescents disclosed to by HCWs or parents, children/adolescents disclosed to by peers had (a) fewer depressive symptoms reported, (b) better drug adherence resulting in higher viral load suppression, and (c) a higher proportion of survivors on treatment. We found that involving peers in the disclosure process of HIV is an important approach to ensure adherence to treatment, resilience, and mental wellbeing of HIV-infected children/adolescents.

Late-onset Cognitive Impairment and Modifiable Risk Factors in Adult Childhood Cancer Survivors

Long-term survivors of childhood cancer may be at elevated risk for new neurocognitive impairment and decline as they age into adulthood. To determine whether aging adult childhood cancer survivors report more new-onset neurocognitive impairments compared with their siblings and to identify risk factors associated with such impairments. Participants of this cohort study included adult survivors of childhood cancer from the Childhood Cancer Survivor Study and their siblings as a control group. The original cohort included survivors who received a diagnosis between January 1, 1970, and December 31, 1986, for whom longitudinal neurocognitive assessment was available. This study examined the prevalence of new-onset neurocognitive impairment between baseline (23.4 years after diagnosis) and follow-up (35.0 years after diagnosis). The analysis was performed from January 2021 to May 2022. Cancer treatment exposures were abstracted from medical records. Chronic health conditions were graded using Common Terminology Criteria for Adverse Events version 4.03. The primary outcome was new-onset (present at follow-up, but not present at baseline) neurocognitive impairment (defined as a score in the worst 10% of the sibling cohort). Impairment was assessed using the Childhood Cancer Survivor Study Neurocognitive questionnaire. Relative risks (RRs) and 95% CIs were used to estimate associations of neurocognitive impairment with treatment and health behaviors and conditions using generalized linear models. The cohort comprised 2375 survivors (mean [SD] age at evaluation, 31.8 [7.5] years; 1298 women [54.6%]) of childhood cancer, including acute lymphoblastic leukemia (ALL; 1316 participants), central nervous system (CNS) tumors (488 participants), and Hodgkin lymphoma (HL; 571 participants). A total of 232 siblings (mean [SD] age at evaluation, 34.2 [8.4] years; 134 women [57.8%]) were included. Compared with siblings, a higher proportion of survivors with no impairment in memory at baseline had new-onset memory impairment at follow-up: siblings proportion, 7.8% (95% CI, 4.3%-11.4%); ALL survivors treated with chemotherapy only, 14.0% (95% CI, 10.7%-17.4%); ALL survivors treated with cranial radiation (CRT), 25.8% (95% CI, 22.6%-29.0%); CNS tumor survivors, 34.7% (95% CI, 30.0%-39.5%); and HL survivors, 16.6% (95% CI, 13.4%-19.8%). New-onset memory impairment was associated with CRT in CNS tumor survivors (RR, 1.97; 95% CI, 1.33-2.90) and alkylator chemotherapy greater than or equal to 8000 mg/m2 in ALL survivors treated without CRT (RR, 2.80; 95% CI, 1.28-6.12). Neurologic conditions mediated the impact of CRT on new-onset memory impairment in CNS survivors. Smoking, low educational attainment, and low physical activity were associated with elevated risk for new-onset memory impairment. These findings suggest that adult survivors of childhood cancer are at elevated risk for late-onset memory impairment related to modifiable risk factors identified early in survivorship.

Study protocol for a multicenter randomized controlled pilot study on decompressive laparotomy vs. decompressive craniectomy for intractable intracranial pressure after traumatic brain injury: The SCALPEL study

IntroductionDecompressive craniectomy (DC) is the ultimate intervention to lower intracranial pressure (ICP) following severe traumatic brain injury (TBI). However, this intervention is associated with considerable adverse events and a higher proportion of survivors with poor functional outcomes. Research questionIn a multicompartment system ICP is associated with intraabdominal pressure (IAP) due to cerebral venous outflow from the brain. This is the rationale for decompressive laparotomy (DL) to control ICP after TBI as reported by experimental and retrospective clinical data. The safety profile of DL is superior to DC. This study aims to randomly assign patients with intractable high ICP after severe TBI to DL or DC. Material and methodsAmong other inclusion criteria, ICP must be above 20 mmHg (1–12 h) despite sedation and all other measures according to current guidelines. The primary outcome is the Extended Glasgow Outcome Scale assessed after twelve months. Further secondary outcome measures are compartmental pressure values, complications, etc. After 20 initial patients, results will be reviewed by the ethics committees and safety monitoring board to decide on the enrolment of 80 additional patients. ResultsThe study is designed to provide not only high-quality prospective data for the first time on this treatment approach, its two-stage design (20 + 80 pts) also provides maximum patient safety. This protocol conforms with the SPIRIT 2013 Statement. Ethics approval was granted by our but also 5 other university ethics committees (registration 473/18S). ConclusionRegistration was performed prior to study initiation in November 2021 (registration number NCT 05115929).

COVID-19 Risk Stratification and Mortality Prediction in Hospitalized Indian Patients: Harnessing clinical data for public health benefits.

The variability of clinical course and prognosis of COVID-19 highlights the necessity of patient sub-group risk stratification based on clinical data. In this study, clinical data from a cohort of Indian COVID-19 hospitalized patients is used to develop risk stratification and mortality prediction models. We analyzed a set of 70 clinical parameters including physiological and hematological for developing machine learning models to identify biomarkers. We also compared the Indian and Wuhan cohort, and analyzed the role of steroids. A bootstrap averaged ensemble of Bayesian networks was also learned to construct an explainable model for discovering actionable influences on mortality and days to outcome. We discovered blood parameters, diabetes, co-morbidity and SpO2 levels as important risk stratification features, whereas mortality prediction is dependent only on blood parameters. XGboost and logistic regression model yielded the best performance on risk stratification and mortality prediction, respectively (AUC score 0.83, AUC score 0.92). Blood coagulation parameters (ferritin, D-Dimer and INR), immune and inflammation parameters IL6, LDH and Neutrophil (%) are common features for both risk and mortality prediction. Compared with Wuhan patients, Indian patients with extreme blood parameters indicated higher survival rate. Analyses of medications suggest that a higher proportion of survivors and mild patients who were administered steroids had extreme neutrophil and lymphocyte percentages. The ensemble averaged Bayesian network structure revealed serum ferritin to be the most important predictor for mortality and Vitamin D to influence severity independent of days to outcome. The findings are important for effective triage during strains on healthcare infrastructure.

Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors.

Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUDs) among pediatric cancer survivors during the first year posttherapy. Using MarketScan Commercial Database, we identified 8969 survivors (aged 21 years or younger at diagnosis) who completed cancer therapy in 2009-2018 and remained continuously enrolled for at least 1 year posttherapy and 44 845 age-, sex-, and region-matched enrollees without cancer as a comparison group. Outcomes included opioid prescriptions, any indicator of potential prescription opioid misuse, and SUDs within 1 year posttherapy. Outcomes were compared between survivors and noncancer peers in bivariate and adjusted analyses, stratified by off-therapy age (children: 0-11 years; adolescents: 12-17 years; young adults: 18-28 years). All statistical tests were 2-sided. A higher proportion of survivors than noncancer peers filled opioid prescriptions (children: 12.7% vs 2.0%; adolescents: 22.9% vs 7.7%; young adults: 26.0% vs 11.9%). In models adjusting for sociodemographic factors and health status, survivors remained 74.4%-404.8% more likely than noncancer peer to fill opioid prescriptions (P < .001). The prevalence of potential misuse or SUDs was low, with 1.4% of child, 4.7% of adolescent, and 9.4% of young adult survivors fulfilling at least 1 criterion; however, it was higher than noncancer peers (0.1%, 1.4%, and 4.3%, respectively). In adjusted models, the likelihood of potential misuse among survivors remained at least 2 times higher than that among noncancer peers (P < .001), and the difference in SUDs became nonstatistically significant. Statistically significantly higher rates of opioid prescriptions and potential misuse were found among pediatric cancer survivors within 1 year posttherapy as compared with peers without cancer.

Intracranial Pressure Monitoring in the Intensive Care Unit for Patients with Severe Traumatic Brain Injury: Analysis of the CENTER-TBI China Registry.

Although the current guidelines recommend the use of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI), the evidence indicating benefit is limited. The present study aims to evaluate the impact of ICP monitoring on patients with sTBI in the intensive care unit (ICU). The patient data were obtained from the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury China Registry, a prospective, multicenter, longitudinal, observational, cohort study. Patients with sTBI who were admitted to 52 ICUs across China, managed with ICP monitoring or without, were analyzed in this study. Patients with missing information on discharge survival status, Glasgow Coma Scale score on admission to hospital, and record of ICP monitoring application were excluded from the analysis. Data on demographic characteristics, injury, clinical features, treatments, survival at discharge, discharge destination, and length of stay were collected and assessed. The primary end point was survival state at discharge, and death from any cause was considered the event of interest. A total of 2029 patients with sTBI were admitted to the ICU; 737 patients (36.32%) underwent ICP monitoring, and 1292 (63.68%) were managed without ICP monitoring. There was a difference between management with and without ICP monitoring on in-hospital mortality in the unmatched cohort (18.86% vs. 26.63%, p < 0.001) and the propensity-score-matched cohort (19.82% vs. 26.83%, p = 0.003). Multivariate logistic regressions also indicated that increasing age, higher injury severity score, lower Glasgow Coma Scale score, unilateral and bilateral pupillary abnormalities, systemic hypotension (SBP ≤ 90mm Hg), hypoxia (SpO2 < 95%) on arrival at the hospital, and management without ICP monitoring were associated with higher in-hospital mortality. However, the patients without ICP monitoring had a lower length of stay in the ICU (11.79 vs. 7.95days, p < 0.001) and hospital (25.96 vs. 21.71days, p < 0.001), and a higher proportion of survivors were discharged to the home with better recovery in self-care. Although ICP monitoring was not widely used by all of the centers participating in this study, patients with sTBI managed with ICP monitoring show a better outcome in overall survival. Nevertheless, the use of ICP monitoring makes the management of sTBI more complex and increases the costs of medical care by prolonging the patient's stay in the ICU or hospital.

National estimates of mental health service use and unmet needs among adult cancer survivors

Cancer survivors are at elevated risk for developing mental health (MH) disorders. This study assessed MH service use and unmet service needs among a nationally representative sample of cancer survivors. Respondents aged 18 to 64years were identified from the 2015-2018 National Survey of Drug Use and Health data. Outcomes assessed past-year MH service use and self-reported unmet MH needs. Outcomes were compared between respondents who reported a cancer history (survivors) and those who did not (controls), descriptively and in adjusted analyses controlling for sociodemographic factors and health status. Analyses were stratified by age groups (18-34, 35-49, and 50-64years). Comparing 3540 survivors with 149,843 controls, within each age group, a higher proportion of survivors than controls received any MH service (P values<.05); this difference persisted among those aged 35 to 49years (P=.004) in fully adjusted models. Moreover, a higher proportion of survivors than controls reported an unmet need for MH care; this difference was larger among young adults aged 18 to 34years (20.8% vs 9.0%; P<.001) than those aged 35 to 49years (9.4% vs 5.3%; P<.001) and 50 to 64years (4.8% vs 3.4%; P=.029). In fully adjusted models, the survivor-control difference in self-reported unmet MH needs persisted among young adults (24% relative increase; P=.023). Among cancer survivors, young adult survivors had the highest likelihood of reporting unmet MH needs. This nationally representative study found an increased perception of unmet needs for MH care among cancer survivors, particularly among young adult survivors, compared with the general population without cancer.

Abstract PR04: Engaging in physical activity after a cancer diagnosis: A Detroit ROCS study

Abstract Background: The benefit of regular exercise in improving cancer outcomes is well established. In 2012, the American Cancer Society (ACS) released a recommendation statement that cancer survivors should engage in regular physical activity (PA) as soon as possible after a cancer diagnosis with the goal of engaging in at least 150 minutes per week of moderate to vigorous PA (1). However, few cancer survivors report meeting this recommendation (2). Using data from the Detroit Research on Cancer Survivors (ROCS) study, we examined the patterns of PA and its association with health-related quality of life (HRQOL) in a cohort of African American cancer survivors. Methods: Detroit ROCS participants complete baseline and yearly follow-up surveys to update their health and provide information on health behaviors including PA, using the International Physical Activity Questionnaire-short form. We assessed the number of survivors who reported participating in regular PA and those who reported ≥150 minutes of moderate to vigorous PA per week by select characteristics and reported HRQOL measured using the Functional Assessment in Cancer Therapy (FACT) and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments. Results: Among the first 1,000 ROCS participants, 58% reported participating in regular PA with just 22% reporting engaging in ≥150 minutes of PA per week. While there were no differences by sex, prostate cancer survivors were the most likely to report participating in regular PA while lung cancer survivors were the least likely (p=0.009). There was a positive relationship between self-reported education and area-level affluence based on US census data with PA (p&amp;lt;0.001 and p=0.019, respectively). Survivors who reported participating in regular PA also reported higher HRQOL (p&amp;lt;0.001) and lower depression (p=0.036). The same patterns were observed among those reporting ≥150 minutes of PA per week, and additionally we found lower reported anxiety among survivors who report meeting ACS guidelines (PROMIS-Cancer anxiety score, p&amp;lt;0.001). Among survivors who completed their first follow-up survey (N=389), a higher proportion of survivors reported participating in regular PA (71%, p&amp;lt;0.001) and getting ≥150 minutes of PA per week (32%, p&amp;lt;0.001). Conclusions: Fewer than 25% of African American cancer survivors reported meeting the ACS guidelines for PA at baseline recruitment; however, it was encouraging to see significant increases in PA engagement over time. Given the established benefits associated with regular exercise and cancer outcomes, and the positive correlation on HRQOL and inverse relationship with depression observed in this study, identifying, understanding, and eliminating barriers to regular moderate to vigorous PA among African American cancer survivors is critical. Future study of ROCS subjects will attempt to establish the temporality of these relationships. This abstract is also being presented as Poster C048. Citation Format: Julie J. Ruterbusch, Ann G. Schwartz, Terrance Albrecht, Tara Baird, Dave Finlay, Felicity Harper, Stephanie Pandolfi, Julia Mantey, Andrew G. Rundle, Jennifer L. Beebe-Dimmer. Engaging in physical activity after a cancer diagnosis: A Detroit ROCS study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR04.

Provider-survivor communication: Identifying and addressing unmet needs.

81 Background: The Georgia Cancer Control Consortium’s Survivorship Working Group conducted a needs assessment to understand physical, psychological, practical, and spiritual needs of adult survivors. Results were used to assess survivors’ level of distress and how effectively their needs were being met. Methods: Cross-sectional online and paper-based surveys developed using NCCN and Commission on Cancer (CoC) guidelines. Surveys were distributed through survivorship programs of CoC hospitals (n = 40) and cancer organizations via email, social media and mail. 740 responses received September-December 2014. Results: Respondents were primarily female (78%) married (65%), college-educated (55%) and insured (97%). 83% were White,16% were African American and 3% were Hispanic. 36% of respondents were within 1 year of treatment; 45% were 1 - 5 years post treatment. Survivors reported positive experiences with provider communication. Responses of ‘often’ or ‘very often’ were: provider gave them a chance to ask questions (90.6%); provider involved them in healthcare decisions (84.7%), provider spent enough time with them (78.5%) and provider helped with feelings of uncertainty about health issues or treatment (75.7%). Physical and emotional needs were not as effectively met as spiritual or practical needs. A higher proportion of survivors reported moderate to extreme levels of emotional distress with: depression (32.7%), anxiety (32.1%), stress (30.2%), fear of recurrence (28.2%) and defining a “new normal” (25.9%). 81% of survivors found information and assistance online (56%), in print materials (41%) and from providers/cancer centers (41%). 37% received a survivorship care plan (SCP); 98% reported the SCP was helpful. Conclusions: Results demonstrate the need for providers in Georgia to be educated about and responsive to survivors’ unmet needs and levels of distress. Survivors report positive communication with providers but lower levels of having physical and emotional needs addressed. Survivors actively seek resources and benefit from SCPs. Providers can contribute to addressing needs and reducing distress by maintaining strong communication, guiding survivors to evidence-based resources and implementing SCPs.

A case-control study of psychological distress in survivors of farmers' suicides in Wardha District in central India.

Context:Lack of literature on psychological aspects of survivors of farmers' suicides is hurdle in devising effective helping strategies for rising number of survivors across the country.Aims and Objectives:To assess the psychological distress and its correlates in survivors of farmers' suicides.Settings and Design:Case–control study design was used in Wardha District of Vidarbha region in the central India.Materials and Methods:A predesigned and pretested semistructured questionnaire was used to assess sociodemographic variables. Self-Reporting Questionnaire-20 was used to evaluate psychological distress in 98 survivors of farmers' suicides and 98 age, sex, and occupation-matched controls.Statistical Analysis:Significance of differences between case and control groups were assessed using Chi-square test or Fisher's two-tailed exact test for class variables. For continuous variables, Student's t-test was used P < 0.05 was considered significant.Results:Significantly higher proportion of survivors had psychological distress than controls. Female survivors, spouse and parents of suicide victims had a high risk of distress. Psychological distress was commonly expressed by depressive and somatic symptoms.Conclusions:Survivors of farmers' suicides are suffering from significant psychological distress.

Palaeobiogeographical constraints on the distribution of foraminifers and rugose corals in the Carboniferous Tindouf Basin, South Morocco

The northern flank of the Tindouf Syncline in southern Morocco exhibits a continuous, well exposed Carboniferous succession with limestones of Late Asbian to Early Bashkirian age containing rich and diverse foraminiferal and rugose coral assemblages. Analysis of these assemblages provides new data on the relatively poorly known Saharan basins. The palaeobiogeographical relationship of the Tindouf Basin with other Palaeotethyan basins is complex. Although there is a predominance of cosmopolitan taxa for the Palaeotethys, it is recognized that there was an influence of basins from NW Europe, such as the UK and Ireland. Some taxa are recorded in both NW Europe and Tindouf without any characteristic contributions from intermediate basins in northern Morocco. The neighbouring Béchar Basin in Algeria presents distinct assemblages. The bulk of the data analyzed suggest that this sector of the western Palaeotethys can be subdivided into four palaeobiogeographical subprovinces: the Atlantic Subprovince (UK, Ireland, N France and Belgium), the Mediterranean Subprovince (Pyrenees, Montagne Noire, Betic Cordillera, Rif (N Morocco) and Balearic Islands), and the Saharan Subprovince (Béchar, Reggan, Ahnet-Mouydir and Tindouf). In between, mobile belts of mixed faunal assemblage characteristics are observed (e.g., SW Spain and Central Meseta) forming the West peri-Gondwanan Subprovince. Analysis of the Tindouf Basin faunas shows that, as in other Saharan basins, there is a high diversity and abundance of foraminiferal taxa, with a higher proportion of survivors and longer stratigraphic ranges; these features also are mirrored by rugose corals. This emphasizes the longevity of the carbonate platform in a tropical setting, where periodic transgressions introduced new assemblages, and oceanic currents are interpreted as one of the main controlling factors for the distribution of the taxa in these subprovinces. Moreover, not only were water temperatures on the platform higher, but also tectonic stability greater. It is considered that the effects of the first phases of the Gondwanan glaciation were minimal on the Tindouf faunas.

Educational and vocational achievement among long‐term survivors of adolescent cancer in Germany

Adolescence involves graduating from school and preparing one's professional career. The accomplishment of these tasks may be hampered by the experience of cancer. This study investigates the educational and professional achievements of German long-term survivors of adolescent cancer. Adult survivors of cancer during adolescence (n = 820, age at onset between 15 and 18 years; M = 15.8, SD = 0.9 years; age at follow-up: M = 30.4, SD = 6.0 years) were recruited through the German Childhood Cancer Registry. They completed self-reports with standard items on their educational and vocational level and their current occupational situation. Outcomes were compared to an age-matched sample from the general population (German Socio-Economic Panel, n = 820, age: M = 30.4, SD = 6.7). Risk factors for educational and vocational underachievement were identified by subgroup analyses. Compared to peers from the general population, survivors of cancer during adolescence achieved higher educational and vocational levels. A higher proportion of survivors was employed; however, survivors were significantly older when starting their first occupation. Subgroup analyses revealed that neuropsychological late effects were associated with reduced rates of graduation from university and of employment among the survivors. No such effect of neuro-cognitive late effects occurred for high school graduation. Most German survivors of cancer during adolescence participate in school and vocational life without major difficulties. Problems particularly arise for survivors with neuropsychological sequelae. Further research should investigate whether these results can be attributed to the German support system for pediatric cancer patients or to sample effects.

Relation of prenephrectomy CD profiles and serum cytokines to the disease outcome and response to IFN-α/IL-2 therapy in renal cell carcinoma patients

Immune parameters, including cytokine levels and CD profiles were determined in 78 renal cell carcinoma patients (RCC) prior to nephrectomy. The values were correlated with the outcome of disease and response to cytokine-based treatment during a 3-year follow-up. Significantly lower frequency of progressions and higher proportion of survivors were recorded in 24 treated patients compared to 43 untreated ones (22.9% vs. 53.5% and 82.9% vs. 55.8%) illustrating the beneficial effect of immunotherapy on the course of RCC at localized stage. RCC-related immune changes are demonstrated by reduced proportion of CD19+, CD28+, HLA-DR+, CD19+/80+ and CD8+/28+ subsets, by increased serum levels of IL-6, sIL-2R, CRP and by impaired production of IL-2 and TNF-alpha released by in vitro stimulated PBMC. Only increased CRP, IL-6 serum values, decreased CD8+ and increased CD122+ were significantly related to patients' prognosis. Comparisons of preoperative CD profiles and cytokine values with the response to IL-2/IFN-alpha based therapy disclosed significant correlation in only CD80+ and CD19+/80+ subsets. Treated patients who relapsed during the 3-year follow-up exhibited at the diagnosis significantly reduced proportion of CD80+ and CD19+/80+ cells (CD80+ means - 0.79 vs. 1.69 and CD19+/80+ means - 0.32 vs. 0.61) comparing to those surviving disease-free. In addition initial proportion of CD3+, CD8+ and CD19+ cells was reduced in treated patients who manifested progression but statistical difference from those remaining disease-free was not proved.

Relative Survival of Calves in a University Herd in Zaria, Nigeria

SUMMARY A follow-up life-table approach was used to study mortality in 1105 calves horn alive in a University herd in Zaria, Nigeria for the period January 1975 to June 1980. The proportion of calves in the herd surviving for the first 12 weeks was 91·3 ± 0·8%. The probability of dying was greatest during the third week of life and decreased with age after the fourth week. Suckling calves survived better than bucket-fed calves. Except for 1978, the proportion of calves surviving in the herd has been decreasing since 1975. Calves from the indigenous breeds of cattle (Ndama, White Fulani, Sokoto Gudali) had a higher proportion of survivors than their crosses with imported breeds which in turn had a higher proportion of survivors than imported pure breeds (Friesians, Charollais). It is recommended that more attention than is given now be given to the management of bucket-fed calves and calves from imported breeds during the first five weeks of life, especially during the third and fourth weeks, to reduce mortality.