Risk Of Severe Symptoms Research Articles

Immunogenicity Parameters of Cancer Patients Receiving the mRNA Vaccine BNT162b2 While Obtaining Radiotherapy: A Longitudinal Cohort Evaluation.

Cancer patients are highly prone to infectious diseases. While undergoing antineoplastic treatment, the risk of severe symptoms upon infection increases, necessitating efficient protective measures, such as vaccination. For patients receiving radiotherapy, there is no specific information about humoral immunity. During the COVID-19 pandemic, serial antibody measurements were therefore offered to cancer patients, following SARS-CoV-2 vaccination while obtaining radiotherapy. Out of 74 enrolled patients, 46 met the inclusion criteria. Two cohorts were allocated, depending on an association with chemotherapy or pure radiotherapy. An additional healthy control cohort of 16 healthcare workers was enrolled. All participants followed a two-fold BNT162b2 vaccine schedule. SARS-CoV-2 binding antibodies were measured serially in a 7-day cycle for 35 days and over the long-term, using the Elecsys® Anti-SARS-CoV-2 immunoassay. Cancer patients under pure radiotherapy have a comparable humoral vaccination response and long-term persistency of antibodies to healthy controls. Patients receiving additional chemotherapy show a significantly delayed immune response and decreased antibody titers. The vaccine was well tolerated in all cohorts. Pure radiotherapy in cancer patients does not interfere with the vaccine-induced humoral immune response or other immunogenetic aspects, whereas previous or simultaneous chemotherapy does. Findings are of particular relevance for future epidemic or pandemic scenarios.

Prevalence of comorbid asthma in Tunisian patients with COVID-19: clinical features and outcomes.

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in around 1 million COVID-19 infection cases and over 29,000 deaths in Tunisia thus far. There is great variability in the prevalence of asthma among patients with COVID-19, but the impact of asthma on patients with COVID-19 is not clear. We sought to describe the clinical features of Tunisian patients with COVID-19 and to compare asthmatic and non-asthmatic patients. This retrospective study included 675 Tunisian patients who were hospitalized with COVID-19. Clinical characteristics were collected from medical records. Bivariate analyses and multivariate regression models were used to assess the associations between asthma and the risk of severe symptoms, including death/recovery. The prevalence of asthma in the sample was 14.5%. The results show that asthmatic patients with COVID-19 have significantly less severe symptoms and better outcomes than non-asthmatic patients. Asthma was not found to be associated with higher severity or worse prognosis among patients with COVID-19 in Tunisia.

Association between Vaccination Status for COVID-19 and the Risk of Severe Symptoms during the Endemic Phase of the Disease.

The global health emergency caused by COVID-19 concluded in May 2023, marking the beginning of an endemic phase. This study aimed to evaluate the association between vaccination status and other patient characteristics and the risk of severe disease during this new endemic period. A nationwide cohort study was conducted in Mexico, where we analyzed data from 646 adults who had received positive confirmation of COVID-19 through PCR testing from May to August 2023. The overall risk of severe symptoms in the study sample was 5.3%. The average time elapsed from the last vaccine shot to symptom onset was over six months in all the immunized groups (1, 2 or 3 vaccine doses). Compared to unvaccinated patients, those with three vaccine doses showed an elevated risk of severe symptoms. Advancing age and various chronic comorbidities (specifically cardiovascular, kidney, and obstructive pulmonary conditions) were associated with a heightened risk of severe COVID-19 manifestations. These findings underscore the ongoing seriousness of COVID-19, even in an endemic phase, underscoring the urgent need for tailored interventions aimed at high-risk patients.

Access to symptom screening and severe symptom risk among cancer patients with major mental illness.

Cancer symptom screening has the potential to improve cancer outcomes, including reducing symptom burden among patients with major mental illness (MMI). We determined rates of symptom screening with the Edmonton Symptom Assessment System (ESAS-r) and risk of severe symptoms in cancer patients with MMI. This retrospective cohort study used linked administrative health databases of adults diagnosed with cancer between 2007 and 2020. An MMI was measured in the 5years prior to cancer diagnosis and categorized as inpatient, outpatient, or no MMI. Outcomes were defined as time to first ESAS-r screening and time to first moderate-to-severe symptom score. Cause-specific and Fine and Gray competing events models were used for both outcomes, controlling for age, sex, rural residence, year of diagnosis and cancer site. Of 389,870 cancer patients, 4049 (1.0%) had an inpatient MMI and 9775 (2.5%) had an outpatient MMI. Individuals with inpatient MMI were least likely to complete an ESAS-r (67.5%) compared to those with outpatient MMI (72.3%) and without MMI (74.8%). Compared to those without MMI, individuals with an inpatient or outpatient MMI had a lower incidence of symptom screening records after accounting for the competing risk of death (subdistribution Hazard Ratio 0.77 (95% CI 0.74-0.80) and 0.88 (95% CI 0.86-0.90) respectively). Individuals with inpatient and outpatient MMI status consistently had a significantly higher risk of reporting high symptom scores across all symptoms. Understanding the disparity in ESAS-r screening and management for cancer patients with MMI is a vital step toward providing equitable cancer care.

Factors related to COVID-19 vaccination intention and uptake among childbearing women.

Pregnant women are a vulnerable population for coronavirus disease 2019 (COVID-19) due to their risk for severe symptoms and adverse perinatal outcomes. Our objective was to identify contributors to COVID-19 vaccine intention in pregnancy and subsequent uptake, informed by the Theory of Planned Behavior, the Health Belief Model, and paradigms implicating social determinants of health (SDoH). Total of 1,899 pregnant women across the United States completed questionnaires in December 2020 (T1) and April 2021 (T2). A structural equation model (SEM) was built from hypothesized contributors to vaccine intention (T1) and uptake (T2), including perceived threat of COVID-19, attitudes toward infection mitigation behaviors, and social determinants of health SDoH (i.e., socioeconomic status [SES], minoritized identity), controlling for maternal health, age, and county-level political orientation. In the SEM, SDoH variables, perceived threat and behavioral attitudes predicted vaccine intention. SDoH were directly associated with vaccine uptake and indirectly associated via vaccine intention (SES direct effect b = .17, total effect b = .38; identifying as Black/African American direct effect b = -.05, total effect b = -.09) The SEM demonstrated good fit and explained 38% of the variance in vaccine intention and 26% in vaccine uptake. COVID-19 vaccination for pregnant women is influenced by SDoH and perceptual factors. Particular attention should focus on persons with lower SES and Black/African American women who reported lower vaccination intention and uptake. Potential routes to increase vaccination in perinatal populations include reducing accessibility barriers and providing information about vaccine safety and efficacy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Volunteer Program Skrining Dan Percepatan Vaksinasi Covid-19 Pada Ibu Hamil Di Surabaya

The increasing number of Covid-19 cases, especially the presence of a new Delta variant which causes a risk of severe symptoms in pregnant women, the Indonesian government has established a screening program and implementation of the Covid-19 vaccination as stated in circular letter HK.02.01/I/2007/2021. Based on preliminary studies carried out on pregnant women in the city of Surabaya, there are 90% percent of pregnant women who are still hesitant and afraid to vaccinate. One form of effort being made is the development of an application that facilitates screening and accelerates vaccination of pregnant women, namely the VMil application. The purpose of this study was to find out how the Volunteer program through the V-MiL application affects pregnant women in carrying out Covid-19. This type of research is pre-experimental with one group pre-test and post test design. The dependent variable is the respondent's participation in the implementation of the Covid-19 vaccine, while the independent variable is intervention by volunteers using the V-MiL application. The research sample for pregnant women who had not been vaccinated was 40 people using a purposive sampling technique. Data collection with questionnaires and interviews. The results of the study the majority of respondents aged 21-30 years (58%), gestational age 13-27 weeks (78%). After the intervention the respondents had good knowledge 18 (45%), lack of knowledge 22 (55%), negative attitude positive attitude 16 (40%), negative attitude 24 (60%), strong motivation 15 (38%), weak motivation 25 (63%) to vaccinate. Respondents did the Covid-19 vaccine as many as 15 (38%) and 25 (63%) respondents did not do the vaccine. Analysis using the Paired sample T test obtained a value of λ of 0.001 <0.005 which indicated that there was a significant influence on the intervention given by volunteers to the respondents. Keywords : Volunteers, Covid-19 Vaccines, Pregnant Women

HIV infection as a risk factor for COVID 19: A systematic review and meta-analysis

There are many questions about the behavior of coronavirus disease 2019 (COVID-19) in people living with human Immunodeficiency virus (PLHIV). It is not clear whether they have a higher risk of complications or higher mortality than the general population. The risk of infection of Severe acute respiratory sindrome coronavirus 2 (SARS CoV 2), risk of severe symptoms by COVID-19, and risk of mortality by COVID-19 of PLHIV were compared with people without human immunodeficiency virus (HIV) EMBASE, PubMed, Scopus, Cochrane Library, Web of Science, LILACS and SCIELO were searched from January 2020 to March 2021. 22 cohort / case-control studies were chosen. Software Review Manager 5.4 was used for the meta-analysis. An increased risk of mortality (2.07) due to COVID-19 was identified among people with human immudeficiency virus (HIV) compared to people without HIV. HIV infection is a risk factor for COVID-19; it should be given special to patients with high viral load, low count CD4 and who are not currently receiving antiviral therapy (ART).

A natural genetic variation screen identifies insulin signaling, neuronal communication, and innate immunity as modifiers of hyperglycemia in the absence of Sirt1.

Variation in the onset, progression, and severity of symptoms associated with metabolic disorders such as diabetes impairs the diagnosis and treatment of at-risk patients. Diabetes symptoms, and patient variation in these symptoms, are attributed to a combination of genetic and environmental factors, but identifying the genes and pathways that modify diabetes in humans has proven difficult. A greater understanding of genetic modifiers and the ways in which they interact with metabolic pathways could improve the ability to predict a patient’s risk for severe symptoms, as well as enhance the development of individualized therapeutic approaches. In this study, we use the Drosophila Genetic Reference Panel to identify genetic variation influencing hyperglycemia associated with loss of Sirt1 function. Through analysis of individual candidate functions, physical interaction networks, and gene set enrichment analysis, we identify not only modifiers involved in canonical glucose metabolism and insulin signaling, but also genes important for neuronal signaling and the innate immune response. Furthermore, reducing the expression of several of these candidates suppressed hyperglycemia, making them potential candidate therapeutic targets. These analyses showcase the diverse processes contributing to glucose homeostasis and open up several avenues of future investigation.

Indonesian Health Workers during COVID-19 Pandemic

Burnout in health workers causes physical and emotional fatigue; it is a condition of a long-term affective state and is an outcome of cumulative and chronic exposure to stress, particularly work stress. Burnout was especially evident in hospitals with limited availability of medical staff. Mental burdens are higher because they face more patients infected by the coronavirus, followed by the trauma of witnessing deaths among patients. These conditions may weaken the immune system, increasing vulnerability to COVID-19 and higher risk of severe symptoms that can cause death. When talking out of context of the pandemic, burnout can also be associated with various other diseases, including IBS.4 Burnout was associated with a 2.41-fold elevated prevalence of IBS after adjusting for potential confounding variables, including job strain.

587 PATIENT-REPORTED SYMPTOMS FOR ESOPHAGEAL CANCER PATIENTS UNDERGOING CURATIVE INTENT TREATMENT

Abstract Esophageal cancer (EC) patients experience considerable symptom burden from treatment. This study utilized population-level patient-reported Edmonton Symptom Assessment System (ESAS) scores collected as part of standard clinical care to describe symptom trajectories and characteristics associated with severe symptoms for patients undergoing curative intent EC treatment. Methods EC patients treated with curative intent at regional cancer centers and affiliates between 2009–2016 and assessed for symptoms in the 12 months following diagnosis were included. ESAS measures nine common patient-reported cancer symptoms. The outcome was reporting of severe (≥7/10) symptom scores. Multivariable analyses were used to identify characteristics associated with severe symptom scores. Results 1,751 patients reported a median of 7 (IQR 4–12) ESAS assessments in the year following diagnosis, for a total of 14,953 unique ESAS assessments included in the analysis. The most frequently reported severe symptoms were lack of appetite (n = 918, 52%), tiredness (n = 787, 45%) and poor wellbeing (713, 40.7%). The highest symptom burden is within the first five months following diagnosis, with moderate improvement in symptom burden in the second half of the first year. Characteristics associated with severe scores for all symptoms included female sex, high comorbidity, lower socioeconomic status, urban residence, and symptom assessment temporally close to diagnosis. Conclusion This study demonstrates a high symptom burden for EC patients undergoing curative intent therapy. Targeted treatment of common severe symptoms, and increased support for patients at risk for severe symptoms, may enhance patient quality of life.

COVID-19: The Effect of Host Genetic Variations on Host-Virus Interactions.

Spurred into action by the COVID-19 pandemic, the global scientific community has, in a short of period of time, made astonishing progress in understanding and combating COVID-19. Given the known human protein machinery for (a) SARS-CoV-2 entry, (b) the host innate immune response, and (c) virus–host interactions (protein–protein and RNA–protein), the potential effects of human genetic variation in this machinery, which may contribute to clinical differences in SARS-CoV-2 pathogenesis and help determine individual risk for COVID-19 infection, are explored. The Genome Aggregation Database (gnomAD) was used to show that several rare germline exome variants of proteins in these pathways occur in the human population, suggesting that carriers of these rare variants (especially for proteins of innate immunity pathways) are at risk for severe symptoms (like the severe symptoms in patients who are known to be rare variant carriers), whereas carriers of other variants could have a protective advantage against infection. The occurrence of genetic variation is thus expected to motivate the experimental probing of natural variants to understand the mechanistic differences in SARS-CoV-2 pathogenesis from one individual to another.

Abstract PO-050: Computational modeling of immunologic response to immune checkpoint inhibitors in COVID-19 patients with and without cancer

Abstract Cancer patients have an increased risk of severe COVID-19 infection due to the suppression of the immune system and the development of cytokine release syndrome (CRS) that favor respiratory syndromes and interstitial pneumonia. However, substantial differences exist between patients treated with chemotherapy and patients treated with immune checkpoint inhibitors (ICIs), for which the risk of COVID-19 infection and the immunologic and cytokine profile in case of infection have not yet been well characterized. The administration of ICIs for the treatment of severe COVID-19 infection has been recently suggested. However, no conclusive data have been generated on this matter. To recognize the therapeutic potential of ICIs administration in COVID-19 patients with or without cancer, the Universal Immune System Simulator (UISS) prediction model was used to simulate the immunologic response of COVID-19 patients after ICIs administration. Briefly, UISS represents an appropriate computational modeling infrastructure able to simulate the dynamics of every single entity of the immune system after a stimulus or a therapeutic intervention by using an agent-based methodology. Therefore, the UISS platform, already used for the prediction of the efficacy of specific SARS-CoV-2 candidate vaccines, was here adopted to characterize the immunologic behavior in both COVID-19 and cancer patients and to predict the effects of ICIs in these patients. The computational results allowed us to identify key inflammatory and immune-related factors responsible for severe respiratory syndromes in COVID-19 infected patients with and without cancer. UISS results suggest that the administration of ICIs modulates the immune system and the inflammatory status in both groups of patients with COVID-19 infection, reducing the risk of severe symptoms. Although the results of the present study are still under validation in peripheral blood samples obtained from COVID-19 patients and from cancer patients after two cycles of treatment with ICIs, we can speculate that ICIs may be a good therapeutic approach for the treatment of COVID-19 severe respiratory syndrome even with a concomitant cancer diagnosis. If this is the case, the lower expression levels of inflammatory biomarkers can result in the drop-down of the viral load, assessed by droplet digital PCR in COVID-19 patients. Citation Format: Giulia Russo, Luca Falzone, Bruno Cacopardo, Giuseppe Nunnari, Francesco Torino, Giuseppa Scandurra, Stefania Stefani, Francesco Pappalardo, Massimo Libra. Computational modeling of immunologic response to immune checkpoint inhibitors in COVID-19 patients with and without cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-050.

Abstract PO-071: Collaborating to share evidence-based COVID-19 information across lung cancer patient advocacy groups

Abstract Background: The COVID-19 pandemic has presented an urgent and serious threat to multiple at-risk populations, including those with lung cancer (LC). This rapidly evolving crisis has seen a growing onslaught of information and guidance from multiple sources, much of which is confusing and conflicting. Thus, LC patient advocacy groups (PAGs) in the USA collaborated to share carefully vetted COVID-19 information for LC patients and caregivers online. Our goals were to gather evidence-based information that addressed concerns of LC patients and caregivers, translate it in a manner understandable for the general public, and share it with one voice across all LC nonprofits. This retrospective study examined whether the online LC community found this collaboration valuable and whether the weekly updates addressed useful topics in a trustworthy manner. Methods: The first “Joint Statement on Coronavirus COVID-19 from Lung Cancer Advocacy Groups” was published on March 3, 2020. Updates were published most Mondays thereafter. We also produced an IASLC podcast. An online survey (conducted over a 5-day period in early June) asked USA LC patients and caregivers (1) if they were aware of the updates, (2) whether they found the updates useful, (3) which topic areas they found most helpful, and (4) what value they saw in the collaboration across LC advocacy groups. We also collected web statistics for each PAGs posts of this content. Results: Cumulatively, online posts of the weekly updates received over 34,000 views between March 3 and the end of May and reached over 71,000 on Facebook. The podcast received twice the number of listens compared to the average of pre-COVID-19 podcasts on the IASLC and Soundcloud sites. Of the 83 LC patients and caregivers who responded to the online survey, three quarters were dealing with stage III or IV non-small cell LC, and half were older than 60. About 2/3 were aware of the weekly updates, and of those, over 80% found the statements helpful. The five most helpful topics were (1) effect of the pandemic on LC diagnosis, treatment, and clinical trials; (2) effect of the pandemic on LC research; (3) COVID-19 treatments and vaccines; (4) who is likely to have a severe case of COVID-19; and (5) what we know about developing immunity to COVID-19. Based on coding responses from an open-ended question, the majority of respondents found the collaboration valuable and trustworthy (for example, “Increased trust and credibility knowing all orgs are behind it”). The updates were found so valuable that they are also translated into Spanish by a pan-cancer Latin American PAG for their communities. Conclusions: Lung cancer patients and caregivers, particularly those considered to be at higher risk for severe symptoms or death from COVID-19, found evidence-based, patient-focused collaborative updates about COVID-19 from major lung cancer PAGs informative, helpful, and trustworthy. Citation Format: Amy C. Moore, Janet Freeman-Daily, Kim Norris, Becky Bunn, Jan Baranski, Cristina Chin, Upal Basu Roy. Collaborating to share evidence-based COVID-19 information across lung cancer patient advocacy groups [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-071.

Colorectal adenocarcinoma patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases: A propensity score matching analysis.

BACKGROUNDSurgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer (CRC). The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery unless there is a risk of severe symptoms. However, accumulating evidence has shown that palliative surgery is associated with more favorable outcomes for patients with metastatic CRC.AIMTo investigate the separate role of palliative primary tumor resection for patients with stage IVA (M1a diseases) and stage IVB (M1b diseases) colorectal adenocarcinoma (CRA).METHODSCRA patients diagnosed from 2010 to 2015 with definite M1a and M1b categories according to the 8th edition of American Joint Committee on Cancer staging system were selected from the Surveillance Epidemiology and End Results (SEER) database. To minimize potential selection bias, the data were adjusted by propensity score matching (PSM). Baseline characteristics, including gender, year of diagnosis, age, marital status, primary site, surgical information, race, grade, chemotherapy, and radiotherapy, were recorded and analyzed. Univariate and multivariate analyses were performed to explore the separate role of palliative surgery for patients with M1a and M1b diseases.RESULTSA total of 19680 patients with metastatic CRA were collected from the SEER database, including 10399 cases of M1a diseases and 9281 cases of M1b diseases. Common independent prognostic factors for both M1a and M1b patients included year of diagnosis, age, race, marital status, primary site, grade, surgery, and chemotherapy. After PSM adjustment, 3732 and 3568 matched patients in the M1a and M1b groups were included, respectively. Patients receiving palliative primary tumor resection had longer survival time than those without surgery (P < 0.001). For patients with M1a diseases, palliative resection could increase the median survival time by 9 mo; for patients with M1b diseases, palliative resection could prolong the median survival time by 7 mo. For M1a diseases, patients with lung metastasis had more clinical benefit from palliative resection than those with liver metastasis (15 mo for lung metastasis vs 8 mo for liver metastasis, P < 0.001).CONCLUSIONCRA patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases. Those patients with M1a (lung metastasis) have superior long-term outcomes after palliative primary tumor resection.

Single-Center Noninferiority Randomized Trial on the Efficacy and Safety of Low- and High-Dose Rush Oral Milk Immunotherapy for Severe Milk Allergy

Introduction: Oral immunotherapy (OIT) has been reported to be effective but associated with a risk of severe symptoms. Thus, an OIT method with decreased risk is required. Objectives: We aimed to evaluate the efficacy and safety of low- and high-dose OIT regimens in children with severe milk allergy. Methods: Overall, 33 participants (median age, 9 years; median final dose of the milk oral food challenge [OFC], 2 mL) were included. The participants were randomly assigned to groups that received either a low (20 mL; n = 19) or high (100 mL; n = 14) maintenance target dose of OIT. The dose was gradually increased to the target dose in the rush escalation phase and was then maintained daily at home. The primary endpoint was the final OFC dose at 6 months of OIT. Adverse events during OIT were evaluated. Results: The final OFC dose after OIT was significantly higher than that before OIT in both groups (low-dose, p = 0.000; high-dose, p = 0.006), but there was no significant difference in the final OFC dose between the 2 groups (p = 0.767). In the maintenance phase, the high-dose group had significantly more severe symptoms than did the low-dose group (0.5%, 11/2,355 total intake events vs. 0.1%, 4/3,230 total intake events; p = 0.018). Conclusions: An equally increased dose effect was observed for maintenance OIT doses of 20 and 100 mL in children with severe milk allergy. The risk of severe symptoms in the maintenance phase was lower in the low-dose group. A low-dose OIT regimen is recommended for severe milk allergy.

COVID-19 and cancer: The bad and the ugly

Patients with cancer are more vulnerable to COVID-19 infection with higher risk of severe symptoms and death.

Patient-Reported Symptoms for Esophageal Cancer Patients Undergoing Curative Intent Treatment

Esophageal cancer (EC) patients experience considerable symptom burden from treatment. This study utilized population-level patient-reported Edmonton Symptom Assessment System (ESAS) scores collected as part of standard clinical care to describe symptom trajectories and characteristics associated with severe symptoms for patients undergoing curative intent EC treatment. EC patients treated with curative intent at regional cancer centers and affiliates between 2009 and 2016 and assessed for symptoms in the 12 months after diagnosis were included. The ESAS measures 9 common patient-reported cancer symptoms. The outcome was report of a severe symptom score (score ≥7 our of 10). Multivariable analyses were used to identify characteristics associated with severe symptom scores. A total of 1751 patients reported a median of 7 (interquartile range, 4-12) ESAS assessments in the year after diagnosis, for a total of 14,953 unique ESAS assessments included in the analysis. The most frequently reported severe symptoms were lack of appetite (n= 918, 52%), tiredness (n= 787, 45%), and poor well-being (n= 713, 41%). The highest symptom burden was within the first 5 months after diagnosis, with moderate improvement in symptom burden in the second half of the first year. Characteristics associated with severe scores for all symptoms included female sex, high comorbidity, lower socioeconomic status, urban residence, and symptom assessment temporally close to diagnosis. This study demonstrates a high symptom burden for EC patients undergoing curative intent therapy. Targeted treatment of common severe symptoms and increased support for patients at risk for severe symptoms may enhance patient quality of life.

Influence of Inflammatory and Oxidative Stress Pathways on Longitudinal Symptom Experiences in Children With Leukemia.

The purpose of this study was to explore the influence of oxidative stress (F2-isoprostanes) and inflammatory (interleukin [IL]-8) biomarkers on symptom trajectories during the first 18 months of childhood leukemia treatment. A repeated-measures design was used to evaluate symptoms experienced by 218 children during treatment. A symptom cluster (fatigue, pain, and nausea) was explored over four time periods: initiation of post-induction therapy, 4 and 8 months into post-induction therapy, and the beginning of maintenance therapy (12 months postinduction). F2-isoprostanes and IL-8 were evaluated in cerebrospinal fluid (CSF) samples collected at baseline (diagnosis) and then at the four time periods. The longitudinal relationships of these biomarkers with the symptom cluster were examined using the longitudinal parallel process. Pain and fatigue levels were highest during the post-induction phases of treatment and decreased slightly during maintenance therapy, while nausea scores were relatively stable. Even in the later phases of treatment, children continued to experience symptoms. CSF levels of the biomarkers increased during the post-induction phases of treatment. Early increases in the biomarkers were associated with more severe symptoms during the same period; patients who had increased biomarkers over time also experienced more severe symptoms over time. Findings reveal that children experienced symptoms throughout the course of leukemia treatment and support hypothesized longitudinal relationships of oxidative stress and inflammatory biomarkers with symptom severity. Activation of the biomarker pathways during treatment may explain underlying mechanisms of symptom experiences and identify which children are at risk for severe symptoms.

Overactive bladder symptoms, stress urinary incontinence and associated bother in women aged 40 and above; a Belgian epidemiological survey

This Belgian epidemiological study aimed to assess the prevalence of overactive bladder (OAB) and stress urinary incontinence (SUI) and associated bother in a female primary care population. Data on OAB and SUI were prospectively collected among women ≥ 40 years by general practitioners (GP) during a regular visit for any reason. The validated Bladder Control Self-Assessment Questionnaire (B-SAQ) was used and complemented with a question on SUI and bladder bother. The presence of mild bladder control symptoms (BCS) was defined as an overall B-SAQ symptom score (OSS) ≥ 4 and an overall bother score (OBS) ≥ 1. Descriptive statistics were performed. Data from 7139 women were analysed. About 33.9% had mild BCS. Most women reported overall mild OAB symptoms (46.9%) and 34.9% had moderate-to-(very) severe symptoms. The prevalence of moderate-severe urgency, frequency or nocturia was higher than that of moderate-severe incontinence. Urgency and nocturia were considered the most bothersome symptoms. Moderate-severe SUI affected 17.7% of women. About 16.4% of women reported to be moderately-severely bothered by their bladder in everyday life. The risk of severe symptoms and bother increased with age. About 10% of women had clinically significant BCS (OSS ≥ 7 and OBS ≥ 4). In Belgian women ≥ 40 years visiting a GP for any reason, one in three had mild BCS and might benefit from further evaluation. Up to 10% of these women had clinically significant BCS for which medical therapy might be necessary. This warrants awareness for early diagnosis and intervention.