Non-attendance and utilization of a speech and language therapy service: a retrospective pilot study of school-aged referrals

BACKGROUND

Non-attendance and inappropriate referrals affect the effective and efficient running of healthcare services. Non-engagement with speech and language therapy (SLT) services may lead to negative long-term consequences for children in need of SLT intervention. Currently there is a dearth of research on non-attendance and non-engagement with SLT services.

AIMS

To identify factors associated with (1) non-attendance and (2) parents' non-engagement with SLT services.

METHODS & PROCEDURES

Demographic data were collected from 140 case files of children (aged 5;0-17;11 years) discharged from a public community SLT service (November 2011-October 2013) with no intervention provided. Logistic regression analyses explored relationships between demographic data and (1) non-attendance and (2) non-engagement with the SLT service.

OUTCOMES & RESULTS

There was an increased probability of non-attendance during winter (i.e. September-February inclusive; OR = 3.14; p = 0.028) relative to summer, and with each month a child waited for SLT assessment (OR = 1.19; p = 0.066). There was decreased probability of non-attendance with children referred for speech (OR = 0.08; p = 0.011) or language difficulties (OR = 0.15; p = 0.050) relative to dysfluency. The probability of non-engagement with the SLT service increased in each of the following conditions: with each month a child waited for assessment (OR = 1.27; p = 0.004); in urban (OR = 2.40; p = 0.066) relative to rural locations; during winter (OR = 2.65; p = 0.021) relative to summer; and with referrals made by occupational therapists, physiotherapists, psychologists and social workers (OR = 18.65; p = 0.016) relative to doctor referrals.

CONCLUSIONS & IMPLICATIONS

Non-attendance is influenced by wait times, season and the reason for referral. Location (urban versus rural), referral source, wait times and season are factors related to non-engagement with SLT services. Targeted policies to improve efficiency and effectiveness of SLT services could be designed around these study findings.

Les violences conjugales, familiales et structurelles : vers une perspective intégrative des savoirs

La violence conjugale est un problème social grave et persistant ; le tiers des femmes de la planète en a déjà été victime. Cet article vise à discuter des liens empiriques et théoriques entre les violences conjugales, familiales et structurelles. L’article débutera par une brève mise en contexte décrivant comment la violence conjugale s’est construite comme un problème socio-pénal au Québec. Les principales lacunes des connaissances actuelles dans le domaine seront ensuite identifiées, démontrant ainsi la nécessité de mieux comprendre les liens complexes entre les violences conjugales, familiales et structurelles, trois concepts dont les définitions pourraient s’enrichir et se compléter mutuellement. Cet article soulignera l’importance de prendre en considération les réalités diversifiées auxquelles sont confrontés les acteurs concernés par ces violences (femmes, hommes et enfants), en privilégiant une analyse globale qui intègre non seulement les facteurs individuels et interpersonnels, mais aussi les facteurs sociaux et structurels, notamment les oppressions liées au genre ou à d’autres marqueurs de l’identité sociale. La discussion sera enrichie par des modèles théoriques décrivant les différentes dynamiques de violences conjugales et familiales ainsi que par le féminisme intersectionnel, qui s’avère fort utile pour l’analyse des violences structurelles. La conclusion traitera des retombées potentielles d’une analyse des liens entre les violences conjugales, familiales et structurelles sur les politiques sociales et les programmes d’intervention pour les victimes, les agresseurs et les enfants exposés à la violence conjugale.

Analyse intersectionnelle de l’oppression de mères racisées en contexte de violence conjugale

En prenant appui sur la matrice du pouvoir de Collins (2000), le présent article rend compte des résultats d’une recherche portant sur les expériences de maternité de femmes autochtones et de femmes racisées en contexte de violence conjugale. Les résultats sont présentés et discutés à la lumière de la matrice du pouvoir de Collins.

A review of the volatiles from the healthy human body

A compendium of all the volatile organic compounds (VOCs) emanating from the human body (the volatolome) is for the first time reported. 1840 VOCs have been assigned from breath (872), saliva (359), blood (154), milk (256), skin secretions (532) urine (279), and faeces (381) in apparently healthy individuals. Compounds were assigned CAS registry numbers and named according to a common convention where possible. The compounds have been grouped into tables according to their chemical class or functionality to permit easy comparison. Some clear differences are observed, for instance, a lack of esters in urine with a high number in faeces. Careful use of the database is needed. The numbers may not be a true reflection of the actual VOCs present from each bodily excretion. The lack of a compound could be due to the techniques used or reflect the intensity of effort e.g. there are few publications on VOCs from blood compared to a large number on VOCs in breath. The large number of volatiles reported from skin is partly due to the methodologies used, e.g. collecting excretions on glass beads and then heating to desorb VOCs. All compounds have been included as reported (unless there was a clear discrepancy between name and chemical structure), but there may be some mistaken assignations arising from the original publications, particularly for isomers. It is the authors' intention that this database will not only be a useful database of VOCs listed in the literature, but will stimulate further study of VOCs from healthy individuals. Establishing a list of volatiles emanating from healthy individuals and increased understanding of VOC metabolic pathways is an important step for differentiating between diseases using VOCs.

Integrating molecular diagnostics into histopathology training: the Belfast model

Molecular medicine is transforming modern clinical practice, from diagnostics to therapeutics. Discoveries in research are being incorporated into the clinical setting with increasing rapidity. This transformation is also deeply changing the way we practise pathology. The great advances in cell and molecular biology which have accelerated our understanding of the pathogenesis of solid tumours have been embraced with variable degrees of enthusiasm by diverse medical professional specialties. While histopathologists have not been prompt to adopt molecular diagnostics to date, the need to incorporate molecular pathology into the training of future histopathologists is imperative. Our goal is to create, within an existing 5-year histopathology training curriculum, the structure for formal substantial teaching of molecular diagnostics. This specialist training has two main goals: (1) to equip future practising histopathologists with basic knowledge of molecular diagnostics and (2) to create the option for those interested in a subspecialty experience in tissue molecular diagnostics to pursue this training. It is our belief that this training will help to maintain in future the role of the pathologist at the centre of patient care as the integrator of clinical, morphological and molecular information.

A review of the volatiles from the healthy human body

A compendium of all the volatile organic compounds (VOCs) emanating from the human body (the volatolome) is for the first time reported. 1840 VOCs have been assigned from breath (872), saliva (359), blood (154), milk (256), skin secretions (532) urine (279), and faeces (381) in apparently healthy individuals. Compounds were assigned CAS registry numbers and named according to a common convention where possible. The compounds have been grouped into tables according to their chemical class or functionality to permit easy comparison. Some clear differences are observed, for instance, a lack of esters in urine with a high number in faeces. Careful use of the database is needed. The numbers may not be a true reflection of the actual VOCs present from each bodily excretion. The lack of a compound could be due to the techniques used or reflect the intensity of effort e.g. there are few publications on VOCs from blood compared to a large number on VOCs in breath. The large number of volatiles reported from skin is partly due to the methodologies used, e.g. collecting excretions on glass beads and then heating to desorb VOCs. All compounds have been included as reported (unless there was a clear discrepancy between name and chemical structure), but there may be some mistaken assignations arising from the original publications, particularly for isomers. It is the authors' intention that this database will not only be a useful database of VOCs listed in the literature, but will stimulate further study of VOCs from healthy individuals. Establishing a list of volatiles emanating from healthy individuals and increased understanding of VOC metabolic pathways is an important step for differentiating between diseases using VOCs.

Imaging findings in recurrent extramedullary leukaemias

Acute leukaemias are relatively common malignancies. Treatment has advanced significantly in the recent past and there has been improved patient survival. This improved initial response is leading to an increasing number of cases of relapse. Extramedullary relapse occurs in a wide variety of locations with varying presentations, imaging findings and differentials. The pathophysiology and clinical course of recurrent extramedullary myeloid and lymphocytic leukaemias are reviewed in this article. The wide variety of imaging findings associated with many important sites of recurrence and the associated differential diagnosis are discussed and illustrated.

Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome

BACKGROUND

Growing pains (GP) is a prevalent familial childhood disorder of unknown aetiology. Familial occurrence of GP, and individual and familial association of GP with restless legs syndrome (RLS) has been reported.

METHODS

We applied a twin family design to search for evidence of genetic susceptibility to GP, and for a genetic relationship between GP and RLS. The parents of 1843 twin pairs aged 3-16 years were administered a questionnaire, which identified 88 pairs with at least one twin individual fulfilling criteria for GP. Standard questionnaires for history of GP and RLS were completed for these twin pairs, their siblings and parents.

RESULTS

Twenty-five of 34 monozygotic (MZ) pairs were concordant for GP, compared with 12 of the 54 dizygotic (DZ) pairs. The casewise concordance was 0.85 and 0.36 for MZ and DZ pairs, respectively (p < 0.001). The lifetime GP prevalence for relatives of twins with GP was 51% for non-twin siblings, 47% for parents. Twenty-three percent of twin individuals with GP met RLS criteria compared with 8% of twin individuals without GP (p = 0.03). Of the twins with GP concordance, 19% met RLS criteria compared with 2% of twins with GP discordance (p = 0.01). In two MZ pairs, one had GP and the other RLS. The lifetime prevalence of RLS was 40% for mothers, and 24% for fathers and 18% for non-twin siblings.

CONCLUSION

This first twin family study of GP provides evidence for a genetic aetiology and for a genetic relationship to RLS.

Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups

BACKGROUND

Bone marrow has been shown to be superior to peripheral blood, as a stem cell source, in young patients (<20 years of age) with acquired aplastic anemia undergoing a matched sibling transplant. The aim of this study was to test whether this currently also holds true for older patients with acquired aplastic anemia.

DESIGN AND METHODS

We analyzed 1886 patients with acquired aplastic anemia who received a first transplant from a human leukocyte antigen identical sibling between 1999 and 2009, with either bone marrow (n=1163) or peripheral blood (n=723) as the source of stem cells.

RESULTS

In multivariate Cox analysis negative predictors for survival were: patient's age over 20 years (RR 2.0, P<0.0001), an interval between diagnosis and transplantation of more than 114 days (RR 1.3, P=0.006), no anti-thymocyte globulin in the conditioning (RR 1.6, P=0.0001), a conditioning regimen other than cyclophosphamide (RR=1.3, P=0.008) and the use of peripheral blood as the source of stem cells (RR 1.6, P<0.00001). The survival advantage for recipients of bone marrow rather than peripheral blood was statistically significant in patients aged 1-19 years (90% versus 76% P<0.00001) as well as in patients aged over 20 years (74% versus 64%, P=0.001). The advantage for recipients of bone marrow over peripheral blood was maintained above the age of 50 years (69% versus 39%, P=0.01). Acute and chronic graft-versus-host disease were more frequent in peripheral blood transplants. Major causes of death were graft-versus-host disease (2% versus 6% in bone marrow and peripheral blood recipients, respectively), infections (6% versus 13%), and graft rejection (1.5% versus 2.5%).

CONCLUSIONS

This study shows that bone marrow should be the preferred stem cell source for matched sibling transplants in acquired aplastic anemia, in patients of all age groups.

P3-05-08: Hormone Receptor Heterogeneity in Ductal Intraepithelial Neoplasia (Ductal Carcinoma In Situ) of the Breast

Background: Ductal Intraepithelial Neoplasia [DIN] often shows heterogeneity of both morphology and nuclear grade within the same patient. It is unknown whether this implies heterogeneity with respect to hormone receptor status that may affect treatment. We sought to determine the rate of heterogeneity in terms of nuclear grade and receptor status in DIN patients.

Methods: A hospital tumor registry was queried for patients diagnosed with DIN between 1980 and 2010. Of the 746 patients identified, 579 (77.6%) had a concomitant invasive tumor. Of the remaining 167 patients, 70 were diagnosed prior to 2007 (when ASCO-CAP guidelines for hormone receptor measurements were released), 2 were found to have lobular intraepithelial neoplasia rather than DIN, and in 11 cases, pathology slides were not available for review. Of the 84 remaining patients with DIN, 17 (20.2%) had DIN 1 alone, 19 (22.6%) had DIN 2 alone, and 7 (8.3%) had DIN 3 alone. 41 (48.8%) of the patients had more than one grade of DIN. These patients formed the cohort of interest. Slides were reviewed by a single pathologist who evaluated ER and PR positivity within the different grades of DIN in each patient, classifying tumors staining 1% or greater as positive. Statistical analyses were performed using SPSS.

Results: The median patient age was 53 years old. Of the 41 patients with multiple grades of DIN, 32 (78.0%) had DIN 1 and 2, 6 (14.6%) had DIN 2 and 3, and 3 (7.3%) had DIN 1, 2, and 3 within the same tumor. 93.8%, 94.7% and 88.9% of DIN 1, 2 and 3 lesions respectively were ER-positive. A difference in hormone receptor status between different grades of DIN within the same tumor was noted in 12 (29.3%) of patients; of these 3 (10.3%) varied in ER status and 10 (34.5%) varied in PR status. Of the 2 patients with ER-negative DIN 1, both had ER-positive higher grade DIN within the same tumor. Of the 2 patients with ER-negative DIN 2, one had ER-positive DIN 1 while the other had ER-negative DIN 3. Therefore, of the total 41 patients, 40 (97.6%) had at least one component of DIN that was ER-positive, and evaluating more than one grade of DIN for ER allowed 75% of patients with at least one ER-negative component to be offered hormonal therapy.

Conclusions: Nearly 50% of patients with DIN will have more than one nuclear grade in the same tumor. These different nuclear grades vary in hormone receptor status in approximately 30% of patients. The majority of patients (97.6%) have at least one component of their DIN that is ER-positive. For those who have at least one component that is ER-negative, up to 75% may be offered hormonal therapy by considering other grades of DIN in treatment decision-making.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-05-08.

Effects of boron doping on the structural and optical properties of silicon nanocrystals in a silicon dioxide matrix

Doping of Si nanocrystals is an important topic in the emerging field of Si nanocrystals based all-Si tandem solar cells. Boron-doped Si nanocrystals embedded in a silicon dioxide matrix were realized by a co-sputtering process, followed by high temperature annealing. The x-ray photoelectron spectroscopy B 1s signal attributable to Si-B (187 eV) and/or B-B (188 eV) indicates that the boron may exist inside Si nanocrystals. A higher probability of effective boron doping was suggested for Si-rich oxide films with a low oxygen content, Then, structural and optical properties were characterized with a focus on the effects of the boron content on Si quantum dots. The results show that as the boron content increases, the nanocrystal size is slightly reduced and the Si crystallization is suppressed. The photoluminescence intensity of the films is decreased as the boron content increases. This is due to boron-induced defects and/or Auger processes induced by effective doping. These results can provide optimal conditions for future Si quantum dot based solar cells.

After radiotherapy, do bone metastases from gastrointestinal cancers show response rates similar to those of bone metastases from other primary cancers?

PURPOSE

Reports investigating whether the response rates to palliative radiation therapy (RT) for painful bone metastases from gastrointestinal (GI) cancers are similar to rates for bone metastases from other primary cancer sites have been limited. The present study evaluated response rates for symptomatic bone metastases from gi cancers after palliative outpatient rt in the Rapid Response Radiotherapy Program (RRRP).

PATIENTS AND METHODS

We identified 69 patients with bone metastases from gi primaries who received palliative rt in the RRRP clinic during 1999-2006. We extracted records for 31 of these patients during 1999-2003 from an RRRP database that used the Edmonton Symptom Assessment Scale (ESAS). Record for the remaining 38 patients during 2003-2006 were extracted from an RRRP database that used the Brief Pain Inventory (BPI). Eligibility criteria for encryption in the two RRRP databases and for collection of patient demographic information (age, sex, primary cancer site, and Karnofsky performance status) were identical. Response rates for this cohort of metastatic gi patients were then compared to rates for 479 patients receiving palliative RT for bone metastases from other primary cancer sites. Pain scores from the ESAS and BPI and data on analgesic consumption were collected at baseline and by telephone follow-up at 4, 8, and 12 weeks after RT for all patients. Complete (CR), partial (PR), and overall (CR+PR) responses were evaluated according to International Consensus Endpoints.

RESULTS

Assessment of the 69 patients with metastatic GI cancers revealed CR, PR, and CR+PR rates of 18%, 42%, and 61% at 4 weeks; 22%, 35%, and 57% at 8 weeks; and 50%, 21%, and 71% at 12 weeks for evaluable patients. The 479 evaluable patients with metastatic cancer from other primary cancer sites had CR, PR, and CR+PR rates of 25%, 27%, and 51% at 4 weeks; 26%, 22%, and 48% at 8 weeks; and 22%, 29%, and 51% at 12 weeks. No statistically significant differences were observed in RT response rates for bone metastases from GI cancers than from other primary cancer sites.

CONCLUSIONS

After palliative RT, bone metastases from gi cancers demonstrate response rates that are similar to rates for metastases from other primary cancer sites. Patients with symptomatic bone metastases from GI malignancies should be referred for palliative RT as readily as patients with osseous metastases from other primary cancer sites.