Prospective registration of symptoms and times to diagnosis in children and adolescents with central nervous system tumors: A study of the Swedish Childhood Cancer Registry

Background: The elapsed time taken to diagnose tumors of the central nervous system in children and adolescents varies widely. The aim of the present study was to investigate such diagnostic time intervals at a national level in Sweden as they correlate with clinical features. Methods: Data prospectively accumulated over a 4-year period in the Swedish Childhood Cancer Registry from patients aged 0-18 years were pooled, and diagnostic time intervals were analyzed considering tumor location, tumor type, patient age and sex, initial symptoms, and clinical timelines. All six pediatric oncology centers in Sweden contributed to collection of data. Time points for calculating the total diagnostic interval (TDI) defined as the time from symptom onset to diagnosis were reported in 257 of 319 patients (81%). Results: The time from symptom onset to the first healthcare consultation, median 2.6 weeks, did not vary significantly between patients categorized according to tumor type or location. The median TDI was 8.3 weeks for the 4-year study period. Patients with optic pathway glioma (TDI 26.6 weeks), those with tumors of the spinal cord (TDI 25.9 weeks), and those with midline tumors (TDI 24.6 weeks) had the longest lead times. Additionally, older age, too few initial symptoms, and seeking initial redress outside an emergency ward were factors associated with a longer time to diagnosis. Conclusion: This study identified several factors associated with delayed diagnosis of central nervous system tumors among Swedish children and adolescents. These novel data ought to help direct future efforts toward clinical improvement.</p

Hälsorisker vid saneringsarbete i bostadshus

Det här arbetet innehåller främst information om hälsorisker vid saneringsarbete samt hur det går att förhindra hälsoriskerna i samband med arbetet. Sjukdomar och symptom relaterade till saneringsarbete är fortfarande vanligt i Finland. Hus byggda från 1920 – talet till det sena 80 – talet har ofta material eller ämnen som kan klassas som en hälsorisk. Mögel, en följd av fuktskada, stöter man ofta på i såväl nya som gamla byggnader, det är därför på sin plats att säga att det ofta finns för hälsan skadliga ämnen i byggnader där det utförs saneringsarbeten. Detta är bra att ta i beaktande då stor del av byggnaderna i Finland nu är i behov av sanering. I texten framkommer de vanligaste för hälsan skadliga ämnen, var de kan förekomma, vilka hälsoriskerna är samt hur man skyddar sig från dessa. Vibrationer och buller är också en hälsorisk som inte är lika mycket omtalad men som tas upp, likaså vilken skyddsutrustning finns tillgänglig samt risker relaterade till denna. Slutligen framförs metoder använda för olika saneringsobjekt. Dessa beskrivs endast kort. Detta arbete går inte igenom utförandet av de olika momenten i saneringsarbeten utan redogör endast för metoder, hälsorisker samt förebyggandet av dessa. Som källor har jag använt Rakennustietos bibliotek, RT, branschböcker samt länkar från internet som t.ex. hometalkoot och Anvisining om boendehälsa. Detta är ett examensarbete för byggmästare (YH) -examen. Examensarbetet är till sin omfattning 10 studiepoäng.This work primarily contains information about the health risks associated with renovation work and how it is possible to prevent these risks. Diseases and symptoms related to renovation work is still common in Finland. Houses built from 1920 to the late 1980’s often have materials or substances which can be classified as health hazards. Mold, the result of water damage, is encountered in both new and old buildings so it is appropriate to say that there are very often health hazardous substances in buildings where renovation work is being done. This is good to take into consideration when many of the buildings in Finland are now in need of total renovation. The text introduces the most common harmful substances, wherever they may occur, what the health risks are and how to protect oneself from these. Vibration and noise are also a health risk that is not as much talked about but is mentioned in the text, as is the protective equipment available and the risks related to this. Finally methods used in various renovation projects are mentioned. These are described only briefly, this is not a text that thoroughly goes through the execution of the various parts of renovation work, only a description of methods, health risks and their prevention. As sources I have used online resources and books, such as hometalkoot and Anvisining om boendehälsa. This is the Degree Thesis of the Bachelor's degree in Construction Management. The extent of the Degree Thesis is in total 10 ECTS

Glioneuronal tumours in childhood : Clinical picture, long-term outcome and possible new treatments

Background: Glioneuronal tumours are a subgroup of low-grade tumours of the central nervous system (CNS), often causing epilepsy. Overall survival is excellent, but data regarding long-term seizure outcome and late effects are scarce. Aims: The overall aim was to gather data about pre- and postsurgical factors of importance and long-term outcomes to improve standards of care. Another aim was to explore the expression of somatostatin receptor (SSTR) subtypes and mTOR pathway markers. Methods: This thesis, based on four population-based studies with both retrospective and cross-sectional parts, was performed through a long-term follow-up of a Swedish cohort of children with glioneuronal tumours in the Uppsala-Örebro health region. Patients were identified from the National Brain Tumour Registry and the National Epilepsy Surgery Registry. Various methods were used: reviews of hospital medical records, patient interviews, health-related quality of life (HRQoL) assessments with generic (Short Form 36version2) and disease specific (Quality of Life in Epilepsy-31) questionnaires, neuropsychological evaluations with Wechsler Intelligence Scale for Children-IV or Wechsler Adult Intelligence Test-IV and Reys Complex Figure Test and evaluation for possible depression with Hospital Anxiety Depression Scale. Immunohistochemical analyses for SSTR subtypes 1, 2a, 3 and 5 and mTOR pathway components ezrin-radixin-moesin and pS6 were performed on tumour specimens. Results: Glioneuronal tumours seem to be more frequent than previously reported, accounting for 13.5% of all childhood CNS tumours. They often cause medically refractory epilepsy resulting in cognitive impairment. Neurosurgery was often delayed; mean time from symptom debut to lesionectomy was 4.6 years. Long-term seizure freedom was achieved in 84% of patients who had a gross total resection (GTR) and is important for long-term cognitive restitution, HRQoL, educational and vocational outcomes. SSTR2a and SSTR3 expression was a frequent finding in glioneuronal tumours. Signs of mTOR pathway activation were abundant in ganglioglioma. Conclusions: A safe GTR should be striven for and considered a first-line treatment. Long-term clinical follow-up should be offered to all patients and for those with an inoperable tumour/tumour remnant causing tumour growth and/or medically refractory epilepsy, somatostatin analogues and/or mTOR inhibitors might represent a therapeutic alternative worth exploring further

Glioneuronal tumours in childhood : Clinical picture, long-term outcome and possible new treatments

Background: Glioneuronal tumours are a subgroup of low-grade tumours of the central nervous system (CNS), often causing epilepsy. Overall survival is excellent, but data regarding long-term seizure outcome and late effects are scarce. Aims: The overall aim was to gather data about pre- and postsurgical factors of importance and long-term outcomes to improve standards of care. Another aim was to explore the expression of somatostatin receptor (SSTR) subtypes and mTOR pathway markers. Methods: This thesis, based on four population-based studies with both retrospective and cross-sectional parts, was performed through a long-term follow-up of a Swedish cohort of children with glioneuronal tumours in the Uppsala-Örebro health region. Patients were identified from the National Brain Tumour Registry and the National Epilepsy Surgery Registry. Various methods were used: reviews of hospital medical records, patient interviews, health-related quality of life (HRQoL) assessments with generic (Short Form 36version2) and disease specific (Quality of Life in Epilepsy-31) questionnaires, neuropsychological evaluations with Wechsler Intelligence Scale for Children-IV or Wechsler Adult Intelligence Test-IV and Reys Complex Figure Test and evaluation for possible depression with Hospital Anxiety Depression Scale. Immunohistochemical analyses for SSTR subtypes 1, 2a, 3 and 5 and mTOR pathway components ezrin-radixin-moesin and pS6 were performed on tumour specimens. Results: Glioneuronal tumours seem to be more frequent than previously reported, accounting for 13.5% of all childhood CNS tumours. They often cause medically refractory epilepsy resulting in cognitive impairment. Neurosurgery was often delayed; mean time from symptom debut to lesionectomy was 4.6 years. Long-term seizure freedom was achieved in 84% of patients who had a gross total resection (GTR) and is important for long-term cognitive restitution, HRQoL, educational and vocational outcomes. SSTR2a and SSTR3 expression was a frequent finding in glioneuronal tumours. Signs of mTOR pathway activation were abundant in ganglioglioma. Conclusions: A safe GTR should be striven for and considered a first-line treatment. Long-term clinical follow-up should be offered to all patients and for those with an inoperable tumour/tumour remnant causing tumour growth and/or medically refractory epilepsy, somatostatin analogues and/or mTOR inhibitors might represent a therapeutic alternative worth exploring further