Assessment of smoking/tobacco smoke exposure and provision of smoking cessation advice/assistance by healthcare professionals at a women´s and children´s hospital - practices and barriers

Background Children and pregnant women are vulnerable to the harms of tobacco smoke. All healthcare professionals (HCPs) have a responsibility to protect them from tobacco smoke. This study aims to identify the gaps between this knowledge and real world practice in a clinical setting. Methods Self administered questionnaires were distributed to 2436 HCPs at a women´s and children´s hospital. The HCPs were asked about their practice of smoking/tobacco smoke exposure (TSE) assessment and provision of smoking cessation advice/assistance in their clinical work, and the barriers they face in carrying out these activities. Results The response rate was 74.6% (1817 respondents), from 276 (15.2%) doctors, 1498 (82.4%) nurses and 43 pharmacists (2.4%). Only 20% of HCPs would always ask about smoking/TSE, while 19.5% do not at all. Only 15.1% of HCPs would always provide smoking cessation advice/assistance to patient smokers or smoker parents/caregivers, while 28.4% do not at all. Only 7.9% of Paediatrics HCPs would always ask about smoking/TSE, while 38.7% of O&G HCPs would always do so ( p = 0.000 ). The reasons/barriers for not always assessing smoking/TSE or providing smoking cessation advice/assistance are listed in Table 1. Not always assessing for smoking/TSE Not always providing smoking cessation advice/assistance Smoking/TSE is not a common/significant issue (35.6%) Smoking/TSE is not a common/significant issue (23.4%) Not my direct responsibility (21.7%) Not my direct responsibility (20.9%), Smoking/TSE is not related to the patient´s disease (19.4%) Smoking/TSE is not related to the patient´s disease (17.0%) Fear of negative reaction from smoker (14.5%) Lack of counseling skills (16.5%) Lack of time (7.5%) Fear of negative reaction from smoker (15.7%) Inadequate resource personnel to assist (3.2%) Lack of time (14.6%) [Table 1 - Reasons and Barriers] The most common interventions for patient smokers and smoker parents/caregivers are provision of general advice for the smoker to quit smoking (36.5%), assessment of smoker willingness to quit (15.7%), and provision of reading materials (9.9%). The suggestions from HCPs on how to overcome the barriers identified are relevant training courses for all HCPs (62.2%), setting up of smoking cessation clinics (42.4%), and training more smoking cessation counselors (30.6%). Conclusions There is room for improvement in the real world practice of HCPs in protecting children and women from tobacco smoke. Awareness and mindset issues are barriers to be addressed. Fear of negative reaction and lack of counseling skills limit HCPs´ confidence but the majority are receptive to receiving training

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries

Background: Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods: We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings: 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation: This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field