Physical Activity Among Adolescent Cancer Survivors: The PACCS Study

OBJECTIVES Physical activity (PA) may modify risks of late effects after cancer. We aimed to examine levels of PA and sedentary time (ST) in a large, international sample of adolescent childhood cancer survivors in relation to sociodemographic and cancer-related factors and compare levels of PA and ST to reference cohorts. METHODS Survivors from any cancer diagnosis who had completed cancer treatment ≥1 year ago, aged 9 to 16 years, were eligible for the multicenter Physical Activity in Childhood Cancer Survivors study. PA and ST were measured by ActiGraph GT3X+ accelerometers. We performed linear regression analyses to assess factors associated with moderate-to-vigorous PA (MVPA) and ST, and compared marginal means of total PA, MVPA, and ST in 432 survivors to sex- and age-stratified references (2-year intervals) using immediate t-tests for aggregated data. RESULTS Among survivors, 34% fulfilled the World Health Organization's PA recommendation of ≥60 min of daily MVPA on average and their ST was 8.7 hours per day. Being female, older, overweight, a survivor of central nervous system tumor, or having experienced relapse were associated with lower MVPA and/or higher ST. Generally, male survivors spent less time in MVPA compared with references, whereas female survivors had similar levels. Both male and female survivors had higher ST than references in nearly all age groups. CONCLUSIONS The low PA and high ST in this large sample of adolescent childhood cancer survivors is worrisome. Combined, our results call for targeted interventions addressing both PA and ST in follow-up care after childhood cancer

Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis

Acute bronchiolitis in infants, which frequently leads to hospitalization and sometimes requires ventilatory support, is occasionally fatal; it is usually viral in origin, with respiratory syncytial virus being the most common cause. The clinical disease is characterized by nasal flaring, tachypnea, dyspnea, chest retractions, crepitations, and wheezing. Bronchodilators are not recommended but are often used in the treatment of bronchiolitis, as are saline inhalations. Adrenaline reduces mucosal swelling, giving it an edge over the β2-adrenergic agonists, and has led to the frequent use of inhaled adrenaline, which has improved symptoms and reduced the need for hospitalization in outpatients with acute bronchiolitis. Among inpatients, however, inhaled adrenaline has not been found to reduce the length of the hospital stay. Assessment of the possible influences of age, sex, and status with respect to an asthma predisposition on the effect of inhaled adrenaline requires large multicenter studies. Inhaled nebulized solutions can be prescribed for use on demand or on a fixed schedule. We were unable to find documentation on the comparative efficacy of these two strategies in children with acute bronchiolitis. We tested the hypothesis that inhaled racemic adrenaline is superior to inhaled saline in the treatment of acute bronchiolitis in infancy and that administration on a fixed schedule is superior to administration on demand. We also assessed whether age, sex, or status with respect to allergic diseases influenced treatment efficacy. Including: Letter to the Editor. Skjerven Håvard Ove, Carlsen Kai-Håkon og Carlsen Karin C Lødrup. Inhaled adrenaline in acute bronchiolitis. The New England Journal of Medicine 2013;369:1076-7. http://dx.doi.org/10.1056/NEJMc130896