Screening for distress in pediatric cancer survivors : a systematic comparison of one-step and two-step strategies to minimize detection errors

Background:Childhood cancer survivors should be routinelyscreened for psychological distress. However, existing screeningtools promoted by cancer care institutions, such as the DistressThermometer (DT) generate high rates of errors. The aim of thisstudy is to help refining strategies of screening psychologicaldistress in this population by exploring two-step methods com-bining the DT on step #1 with one question on step #2.Procedure:Data from 255 survivors of childhood acutelymphoblastic leukemia aged 13–40years were analyzed (38%13–18 years, 62% 19þyears, 53% females). We used the DTon step #1 and the individual emotion items from thePediatric Quality of Life Questionnaire (PedsQL) on step #2, todetect distress, depression and anxiety as measured by stand-ard instruments. We compared sensitivity, specificity, negativeand positive predictive values, Youden index, and clinical util-ity indices, in newly developed two-step strategies.Results:The best two-step strategies to screen anxious-depressive distress were DT 2 on step #1, with the item ofSadness on step #2, and DT 2 combined with the item ofConcerns. Two-step strategies outperformed the DT alone onthe correct identification of distressed survivors. However,two-step strategies did not outperform the DT used alone onthe correct detection of no distressed survivors. Results weresimilar when predicting depression or anxiety alone.Conclusion:Completing the DT with one single question onemotions from the PedsQL may minimize the number of par-ticipants falsely identified as distressed, which could be par-ticularly pertinent in resource-limited clinics

Psychological risk in long-term survivors of childhood acute lymphoblastic leukemia and its association with functional health status : A PETALE cohort study

Background: Recent research has suggested that long-term pediatric cancer survivors were at risk of important physical and psychological morbidities. To date, we do not know to what extent functional health status contributes to psychological risk and which domains are most important. The aim of this study was to systematically explore which functional domain could explain anxiety, depression, and distress symptoms. Procedure: We used data available for 105 adolescents and 182 adults successfully treated for childhood acute lymphoblastic leukemia at two Canadian sites part of the PETALE cohort. Participants were ≥5 years postdiagnosis, aged 22 ± 6 years, 52% female, and 49% acute lymphoblastic leukemia high-risk status. The contribution of health functional status (15D/16D questionnaires) to self-reported anxiety, depression, and distress (Beck scales and distress thermometer) was evaluated using adjusted logistic regression models. Results: Prevalence rates found for mild-severe anxiety, depression, and distress were 14%, 21%, and 30% among adolescents and 27%, 20%, and 19% among adults. Frequent health domains associated with psychological risk were sleeping and breathing in adolescents, and vitality/fatigue, discomfort/symptoms, mental function, and sleeping in adults. Mental function was systematically associated with psychological risk across age groups (median OR = 10.00, 95% CI 3.01-33.71). Exploratory mediation bootstrapping analyses suggested that the effect on psychological risk of overall health status and mental function problems was partly explained by social/work/school functioning. Conclusion: The results identified important functional health domains that could be targeted for interventions preventing psychological risk: vitality/fatigue, discomfort/symptoms, sleeping, and mental function issues. Health domains probably affect mood partly by limiting social/work/school functioning

Inconsistencies between measures of cognitive dysfunction in childhood acute lymphoblastic leukemia survivors : description and understanding

Objectives The frequency of cognitive difficulties in childhood cancer survivors varies according to the measurement strategy. The goal of this research is to (a) describe agreements and differences between measures of working memory and attention (b) identify contributors of these differences, such as emotional distress, affects, and fatigue. Methods We used data available for 138 adults successfully treated for childhood acute lymphoblastic leukemia (ALL) (PETALE cohort). Working memory and attention were assessed using subtests from the WAIS‐IV and self‐reported questionnaires (BRIEF‐SR and CAARS‐S:L). Potential contributors included emotional distress, anxiety, depression (BSI‐18), affects (PANAS), and fatigue (PedsQL‐MFS). We explored measurement agreements and differences using diagnostic indices and multivariate regression models. Results The frequencies of working memory and attention deficits were higher when using cognitive tests (15%‐21%) than with self‐reports (10%‐11%). Self‐reported questionnaires showed high specificity (median 0.87) and low sensitivity (median 0.10), suggesting they did not reliably identify positive cases on cognitive tests. We identified negative affectivity as a possible contributor to inconsistencies between self‐report and test results. Conclusions When measuring working memory and attention in childhood ALL survivors, cognitive test results and self‐reports should not be considered equivalent. At best, self‐report may be used for screening (high specificity), but not to assess prevalence in large samples. Self‐reported difficulties are also probably influenced by the negative mood in this population

Genetic alterations of ALK in high-risk neuroblastoma patients: a SIOPEN study

Background: In neuroblastoma (NB), the ALK receptor tyrosine kinase can be constitutively activated either through genomic amplification or activating point mutations. We studied ALK genetic alterations in high-risk NB patients to determine their frequency and prognostic impact.N/

Low Cognitive Awareness, but Not Complaint, is a Good Marker of Preclinical Alzheimer's Disease

Subjective cognitive decline (SCD) may result from many conditions, including Alzheimer's disease (AD)

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Les étudiantes et étudiants et le mouvement indien des femmes à New Delhi : Entre continuité et renouveau générationnel

L’étude des étudiantes et étudiants engagés dans les luttes féministes et/ou pour l’égalité au sein de deux campus de la ville de New Delhi laisse entrevoir les débats actuels qui traversent le mouvement indien des femmes. Ce mouvement historique, composé de femmes et d’hommes luttant pour l’égalité en Inde, a éclos à la fin du XIXe siècle et a connu plusieurs périodes et générations de militantes portant des problématiques propres. Les étudiantes et étudiants sont des acteurs centraux des luttes du fait de leurs revendications et des débats qu’elles et ils suscitent. L’institutionnalisation du genre, la reproduction des inégalités et l’invisibilité de certaines problématiques qui sont au coeur des luttes sur les campus font écho aux luttes internes du mouvement. Tout en étant les héritiers des luttes passées, les étudiantes et étudiants semblent appartenir à une nouvelle génération de féministes naviguant entre idéologie intersectionnelle, demande d’autonomie et reproduction sociale.The study of students engaged in feminist and/or equality struggles on two campuses in the city of New Delhi provides a glimpse of the current debates going on in the Indian women’s movement. This historical Movement composed of women and men fighting for equality in India, which emerged at the end of the 19th century, has known several periods and generations of activists with their own issues. Students are central actors of the Movement because of their claims, and the debates they raise. The gender institutionalization, the reproduction of inequalities and the invisibility of certain issues, which are at the core of struggles on campus, reflect the internal conflicts of the Movement. While being the inheritors of past struggles, students seem to belong to a new generation of feminists navigating between an intersectional ideology, demand for autonomy and social reproduction.El estudio de los y las estudiantes comprometidas con las luchas feministas o por la igualdad en el seno de los dos campus de la ciudad de Nueva Delhi, deja entrever los debates actuales que atraviesan al movimiento Indú de las mujeres. Este movimiento histórico, iniciado a fines del siglo XIX por mujeres y hombres que luchaban por la igualdad en la India, ha conocido varios períodos y generaciones de militantes con problemáticas propias. Los y las estudiantes son actores centrales en las luchas debido a las reivindicaciones y debates que han suscitado. La institucionalización del género, la reproducción de desigualdades y la invisibilidad de ciertas problemáticas que están en el centro de las luchas en los campus, reflejan las luchas internas del movimiento. Al ser herederos de luchas pasadas, los y las estudiantes parecen pertenecer a una nueva generación de feministas que navegan entre ideología interseccional, exigencia de autonomía y reproducción social