Temporal and geospatial trends of pediatric cancer incidence in Nebraska over a 24-year period

BACKGROUND

Data from the Surveillance, Epidemiology, and End Results (SEER) revealed that the incidence of pediatric cancer in Nebraska exceeded the national average during 2009-2013. Further investigation could help understand these patterns.

METHODS

This retrospective cohort study investigated pediatric cancer (0-19 years old) age adjusted incidence rates (AAR) in Nebraska using the Nebraska Cancer Registry. SEER AARs were also calculated as a proxy for pediatric cancer incidence in the United States (1990-2013) and compared to the Nebraska data. Geographic Information System (GIS) mapping was also used to display the spatial distribution of cancer in Nebraska at the county level. Finally, location-allocation analysis (LAA) was performed to identify a site for the placement of a medical center to best accommodate rural pediatric cancer cases.

RESULTS

The AAR of pediatric cancers was 173.3 per 1,000,000 in Nebraska compared to 167.1 per 1,000,000 in SEER. The AAR for lymphoma was significantly higher in Nebraska (28.1 vs. 24.6 per 1,000,000; p = 0.009). For the 15-19 age group, the AAR for the 3 most common pediatric cancers were higher in Nebraska (p < 0.05). Twenty-three counties located >2 h driving distance to care facilities showed at least a 10% higher incidence than the overall state AAR. GIS mapping identified a second potential treatment site that would alleviate this geographic burden.

CONCLUSIONS

Regional differences within Nebraska present a challenge for rural populations. Novel use of GIS mapping to highlight regional differences and identify solutions for access to care issues could be used by similar states.

[Treatment of hyperkinetic children in the home environment]

Twenty children with hyperkinetic disorders with or without conduct disorders were treated in a home-treatment setting, as an alternative to inpatient treatment, by nurses specialized in child psychiatry and under the constant supervision of an experienced child psychiatrist. Conduct disorders were influenced positively in the child's natural surroundings. Parents were trained as co-therapists. Good cooperation by the family is required for therapy to have positive effects. Case studies serve to illustrate how treatment can be conducted at home.

Breast cancer in Nebraska: recent trends in incidence, mortality, and screening

Data from the Nebraska Cancer Registry indicate that the State's female breast cancer incidence rate did not increase or decrease significantly during the period 1987-1993, although the percentage of in situ diagnoses increased from 8% to 13%. Similarly, breast cancer mortality among Nebraska women has remained relatively constant during the past decade (1985-1994). According to Nebraska's Behavioral Risk Factor Survey, screening mammography rates among Nebraska women have shown striking increases in recent years: in 1994, nearly half (48%) of all women 50 and older reported that they had had a mammogram within the past year, up from 24% in 1988. Nebraska's breast cancer incidence, mortality, and screening rates remain lower than U.S. rates.

Breast cancer screening: recent trends in the use of mammography in Nebraska

Although the efficacy of screening mammography has been surrounded in controversy of late, the evidence that it can reduce breast cancer mortality among women 50-74 years of age is extremely sound. In Nebraska, data from the state's Behavioral Risk Factor Survey show, that during the years 1988 to 1992, the percentage of women age 50 years and older who had ever had a mammogram rose from 50% to 65%, while the percentage of women of the same age who had had a mammogram within the past year rose from 24% to 34%. Nebraska BRFS data also show that the percentage of women 50 years of age and older who have had a mammogram within the past year varies considerably by age, income, education, and county of residence. Among women who have not had a mammogram within the past year, 66% reported that they had seen a physician within the past year for a routine check-up. Prompt and appropriate follow-up of abnormal findings by both physicians and health-care organizations is also essential to ensure the maximum benefit of screening mammography.

Breast cancer screening: recent trends in the use of mammography in Nebraska

Although the efficacy of screening mammography has been surrounded in controversy of late, the evidence that it can reduce breast cancer mortality among women 50-74 years of age is extremely sound. In Nebraska, data from the state's Behavioral Risk Factor Survey show, that during the years 1988 to 1992, the percentage of women age 50 years and older who had ever had a mammogram rose from 50% to 65%, while the percentage of women of the same age who had had a mammogram within the past year rose from 24% to 34%. Nebraska BRFS data also show that the percentage of women 50 years of age and older who have had a mammogram within the past year varies considerably by age, income, education, and county of residence. Among women who have not had a mammogram within the past year, 66% reported that they had seen a physician within the past year for a routine check-up. Prompt and appropriate follow-up of abnormal findings by both physicians and health-care organizations is also essential to ensure the maximum benefit of screening mammography.

Evidence for cytomegalovirus and human immunodeficiency virus infection of the retina in AIDS

Characteristic ophthalmopathological features of retinal lesions in a patient with the acquired immunodeficiency syndrome (AIDS) are reported. In situ hybridization, immunohistochemistry and electron microscopy revealed severe unilateral cytomegalovirus (CMV) retinitis. The opposite retina which was not involved by CMV showed nonspecific signs of ischaemia in the nerve fiber layer corresponding to cotton-wool spots. Occasional cells of both retinas were positively stained by a mouse monoclonal antibody to the p24 HIV-1 antigen indicating infection of retinal cells by HIV. It is suggested that HIV may directly or indirectly damage retinal tissue and interact with opportunistic pathogens, thus leading to a variety of ocular abnormalities associated with AIDS.

[Malignant hyperthermia. A case report (author's transl)]

An exceptionally serious case of malignant hyperthermia in a 17 year old male is presented. A detailed description of the case is given concerning symptomatology, course, laboratory data and morphologic alterations. Our patient died after 7 weeks of intensive care due to therapy resistant septicemia and coagulation disorder. Intense adynamia and advanced muscular atrophy were present. Necropsy showed regionally different extensive lysis of skeletal muscles. In the discussion the advantage of an "ice gravel" producing machine in cooling measures, the necessity of higher procaine doses and problems of long term therapy in trauma patients coincidentally affected with malignant hyperthermia, are stressed.