CRP values, 0-30d.

<p>CRP values within the 0-30d period for all patients with available measurements for both CRP and s-albumin within this period.</p

S-albumin values, 0-30d.

<p>S-albumin values within the 0-30d period for all patients with available measurements for both CRP and s-albumin within this period.</p

Median laboratory values (ICR).

<p>Median laboratory values (ICR).</p

Flow of selection process.

<p>Flow of selection process.</p

The prevalence of deranged C-reactive protein and albumin in patients with incurable cancer approaching death

<div><p>Introduction</p><p>Amongst patients with incurable cancer approaching death, cachexia is common and associated with adverse outcomes. The term cachexia lacks a universally accepted definition and there is no consensus regarding which variables are to be measured. Furthermore, an elevated C-reactive protein is a common clinical challenge in this patient group. This study aims to add to the ongoing discussion regarding the definition of cancer cachexia and to study the role of C-reactive protein and s-albumin in this context.</p><p>Material and methods</p><p>A 1-year cohort, consisting of 155 cancer patients enrolled in a specialized palliative home care team in the city of Östersund, Sweden, that were deceased during the year of 2015 was studied. Laboratory measures were studied within 0–30 and 31–60 days prior to death. C-reactive protein >10 mg/L and coinciding s-albumin <30 g/L was referred to as “laboratory cachexia”. Also, the number of days from the first found “laboratory cachexia” until death was noted.</p><p>Results</p><p>The prevalence of “laboratory cachexia” was 85% 0–30 days prior to death compared to 66% 31–60 days prior to death <i>(p<0</i>.<i>01)</i>. The majority of patients (75%) had an onset of “laboratory cachexia” within 0–120 days prior to death, with a median of 47 days. The median values for C-reactive protein and s-albumin within 0–30 days prior to death were 84mg/L and 23g/L respectively.</p><p>Discussion</p><p>Could markedly deranged values of C-reactive protein and s-albumin, such as found in this study, signal a relatively short remaining survival time in patients with incurable cancer and no clinical signs of ongoing infection? The role of “laboratory cachexia” in this context as well as the cut off values for the laboratory measures included may be further discussed.</p></div

“Laboratory cachexia”.

<p>“Laboratory cachexia”.</p

Laboratory cachexia.

<p>Number of days prior to death that the criteria for “laboratory cachexia” was first fulfilled for the 120 patients who at some point fulfilled the criteria.</p

Reducing child mental health inequities through parental mental health and preschool attendance

Background Prevention is key to reducing socioeconomic inequities in children’s mental health problems, especially given limited availability and accessibility of services supporting treatment. We investigated the potential to reduce these inequities for disadvantaged children by improving parental mental health and preschool attendance in early childhood. Methods Data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N=5107, commencing in 2004) were used to examine the impact of socioeconomic disadvantage (0-1 year) on children’s mental health problems (10-11 years). Using an interventional effects approach, we estimated the extent to which inequities in children’s mental health problems could be reduced by improving disadvantaged children’s parental mental health (4-5 years) and their preschool attendance (4-5 years). Results Disadvantaged children had a higher prevalence of elevated mental health symptoms (32.8%) compared with their non-disadvantaged peers (18.7%): confounder-adjusted difference in prevalence=11.6% (95% CI: 7.7%-15.4%). Improving disadvantaged children’s parental mental health and their preschool attendance to the level of their non-disadvantaged peers could reduce 6.5% and 0.3% of socioeconomic differences in child mental health problems, respectively (equivalent to 0.8% and 0.04% absolute reductions). If these interventions were delivered in combination, a 10.8% (95% CI: 6.9% to 14.7%) higher prevalence of elevated symptoms would remain for disadvantaged children. Conclusions Targeted policy interventions that improve parent mental health and preschool attendance for disadvantaged children are potential opportunities to reduce socioeconomic inequities in children’s mental health problems. Such interventions should be considered within a broader, sustained, and multipronged approach that includes addressing socioeconomic disadvantage itself.</p

Reducing child mental health inequities through parental mental health and preschool attendance

Background Prevention is key to reducing socioeconomic inequities in children’s mental health problems, especially given limited availability and accessibility of services supporting treatment. We investigated the potential to reduce these inequities for disadvantaged children by improving parental mental health and preschool attendance in early childhood. Methods Data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N=5107, commencing in 2004) were used to examine the impact of socioeconomic disadvantage (0-1 year) on children’s mental health problems (10-11 years). Using an interventional effects approach, we estimated the extent to which inequities in children’s mental health problems could be reduced by improving disadvantaged children’s parental mental health (4-5 years) and their preschool attendance (4-5 years). Results Disadvantaged children had a higher prevalence of elevated mental health symptoms (32.8%) compared with their non-disadvantaged peers (18.7%): confounder-adjusted difference in prevalence=11.6% (95% CI: 7.7%-15.4%). Improving disadvantaged children’s parental mental health and their preschool attendance to the level of their non-disadvantaged peers could reduce 6.5% and 0.3% of socioeconomic differences in child mental health problems, respectively (equivalent to 0.8% and 0.04% absolute reductions). If these interventions were delivered in combination, a 10.8% (95% CI: 6.9% to 14.7%) higher prevalence of elevated symptoms would remain for disadvantaged children. Conclusions Targeted policy interventions that improve parent mental health and preschool attendance for disadvantaged children are potential opportunities to reduce socioeconomic inequities in children’s mental health problems. Such interventions should be considered within a broader, sustained, and multipronged approach that includes addressing socioeconomic disadvantage itself.</p

Supplementary information files for article Addressing child mental health inequities through parental mental health and preschool attendance

Supplementary information files for article Addressing child mental health inequities through parental mental health and preschool attendance   Background Prevention is key to reducing socioeconomic inequities in children’s mental health problems, especially given limited availability and accessibility of services supporting treatment. We investigated the potential to reduce these inequities for disadvantaged children by improving parental mental health and preschool attendance in early childhood. Methods Data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N=5107, commencing in 2004) were used to examine the impact of socioeconomic disadvantage (0-1 year) on children’s mental health problems (10-11 years). Using an interventional effects approach, we estimated the extent to which inequities in children’s mental health problems could be reduced by improving disadvantaged children’s parental mental health (4-5 years) and their preschool attendance (4-5 years). Results Disadvantaged children had a higher prevalence of elevated mental health symptoms (32.8%) compared with their non-disadvantaged peers (18.7%): confounder-adjusted difference in prevalence=11.6% (95% CI: 7.7%-15.4%). Improving disadvantaged children’s parental mental health and their preschool attendance to the level of their non-disadvantaged peers could reduce 6.5% and 0.3% of socioeconomic differences in child mental health problems, respectively (equivalent to 0.8% and 0.04% absolute reductions). If these interventions were delivered in combination, a 10.8% (95% CI: 6.9% to 14.7%) higher prevalence of elevated symptoms would remain for disadvantaged children. Conclusions Targeted policy interventions that improve parent mental health and preschool attendance for disadvantaged children are potential opportunities to reduce socioeconomic inequities in children’s mental health problems. Such interventions should be considered within a broader, sustained, and multipronged approach that includes addressing socioeconomic disadvantage itself.</p