Chemotherapy-induced polyneuropathy in cancer care-the patient perspective

PURPOSE

Chemotherapy-related polyneuropathy (CIPN) is a very common, often dose-limiting side effect that affects the patients' quality of life. Treatment usually consists of a combination of medicinal, medical, and individualized treatment approaches, although the effectiveness of these therapies is insufficient for many patients. The aim of this article is to review and evaluate the impact of CIPN on patients' daily lives and possible effective treatment approaches.

METHODS

A standardized questionnaire was developed based on ten anonymous telephone interviews with CIPN patients. The content of the questionnaire was divided into 5 categories: demographics, clinical presentation, everyday symptoms, treatment of CIPN symptoms, and medical care. Mostly closed questions were used but multiple choice and individual additions by free text answers were possible.

RESULTS

CIPN limits patients' quality of life over a long period of time. In addition to diurnal and situational fluctuations, the emotional burden negatively affects patients' daily lives in many ways. From the patients' point of view, the individually implemented therapy measures were most effective in treating their complaints. But even the combination of different therapy methods insufficiently alleviates the symptoms of the patients.

CONCLUSION

It is important and necessary to comprehensively inform patients about CIPN as a possible side effect, to point out prevention strategies, and to critically examine and evaluate different therapy approaches. In this way, misunderstandings of the doctor-patient relationship can be avoided. In addition, patient satisfaction and quality of life can be increased in the long term.

Peak neutralizing and cross-neutralizing antibody levels to human papillomavirus types 6/16/18/31/33/45/52/58 induced by bivalent and quadrivalent HPV vaccines

We performed an independent comparison of neutralizing and cross-neutralizing antibody (ab) levels seven months after initiation of three-dose, six-month vaccination schedules with the bivalent and quadrivalent human papillomavirus (HPV) vaccines in adolescent Finnish and Indian females, respectively. We used a semi-automated Pseudovirion-Based Neutralization Assay and observed significantly higher HPV16/18 peak ab-levels in bivalent as compared to quadrivalent vaccine recipients. Bivalent vaccine induced cross-neutralizing HPV31/33/45/52/58 antibodies significantly more frequently and to higher levels than the quadrivalent vaccine. The correlation of bivalent vaccine-induced HPV45 ab-levels with HPV16/18 ab-levels was stronger than that of corresponding quadrivalent vaccine-induced ab-levels, suggesting a qualitatively different cross-reactive response. Our findings on the comparison of the immunogenicity of two HPV vaccine tested in two different populations indicate that further head-to-head studies are warranted.

Validation of Multiplex Serology detecting human herpesviruses 1-5

Human herpesviruses (HHV) cause a variety of clinically relevant conditions upon primary infection of typically young and immunocompetent hosts. Both primary infection and reactivation after latency can lead to more severe disease, such as encephalitis, congenital defects and cancer. Infections with HHV are also associated with cardiovascular and neurodegenerative disease. However, most of the associations are based on retrospective case-control analyses and well-powered prospective cohort studies are needed for assessing temporality and causality. To enable comprehensive investigations of HHV-related disease etiology in large prospective population-based cohort studies, we developed HHV Multiplex Serology. This methodology represents a low-cost, high-throughput technology that allows simultaneous measurement of specific antibodies against five HHV species: Herpes simplex viruses 1 and 2, Varicella zoster virus, Epstein-Barr virus, and Cytomegalovirus. The newly developed HHV species-specific ('Monoplex') assays were validated against established gold-standard reference assays. The specificity and sensitivity of the HHV species-specific Monoplex Serology assays ranged from 92.3% to 100.0% (median 97.4%) and 91.8% to 98.7% (median 96.6%), respectively. Concordance with reference assays was very high with kappa values ranging from 0.86 to 0.96 (median kappa 0.93). Multiplexing the Monoplex Serology assays resulted in no loss of performance and allows simultaneous detection of antibodies against the 5 HHV species in a high-throughput manner.

The role of linked birth and infant death certificates in maternal and child health epidemiology in the United States

Linked birth and infant death certificates allow measurement of birthweight-specific infant mortality. Jack Smith, MS, to whom this issue of the American Journal of Preventive Medicine is dedicated, played a key role in the National Infant Mortality Surveillance (NIMS) project. NIMS provided national data on birthweight-specific infant mortality for the 1980 birth cohort, updated data previously collected by the National Center for Health Statistics (NCHS) for the 1960 birth cohort, and supported NCHS's implementation of an annual linked file in 1983. NIMS illustrated themes in infant mortality that remain important: the role of low birthweight (LBW) as a contributor to infant mortality, the contribution of disparities in LBW and birthweight-specific mortality to black-white gaps in infant mortality, and the nation's greater success in reducing mortality among LBW infants than in preventing LBW. Linked birth and infant death records are used nationally and by states to study an array of maternal and infant health topics, from the quality of vital records to the impact of therapeutic and public health interventions. By supplementing birth and infant death records with linkages to program and hospital discharge data, epidemiologists and health service researchers are extending the utility of vital statistics data to monitor maternal and infant health.

Solid phase synthesis of N-carboxy alkyl-containing peptides derived from enantiopure alpha-keto-beta-aminoacids

alpha-Keto-beta-aminoacids 5a-c can be reductively aminated with the peptide sequence H2N-Leu-Val-Phe-Phe on a solid support to afford N-carboxy alkyl peptides 1a-c. The N-carboxy alkyl lysine derivative 7 was subsequently extended from the N-terminus with glutamine and histidine residues.

Infant mortality by birthweight and other characteristics: United States, 1985 birth cohort

This report presents information from the national linked birth and infant death data set for the birth cohort of 1985, a new National Center for Health Statistics (NCHS) resource for studying infant mortality. In the linked tile, birth certificates for infants born in 1985 who died before their first birthday are linked to death certificates for the same infants, thereby making available for analysis of infant mortality a large number of variables from the birth certificate that are relevant to the infant's death. Previous national linked files were developed by the Division of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion (CCDPHP), Centers for Disease Control and Prevention (CDC) for the 1980 birth cohort, and by NCHS for the 1960 birth cohort. This report is in four parts: The first part includes a brief history of linked birth and infant death record projects in the Public Health Service (PHS) and a description of the methodology by which linked files were created in the present project. The second part presents a descriptive analysis of infant mortality for selected variables by race for the 1985 birth cohort. The third part examines infant mortality rates for detailed race groups, comparing cohort and period rates. The final section provides detailed tables of live births and infant deaths and mortality rates for selected variables by race of child and age at death.

Long term survival in non-encapsulated primary liposarcoma of the mediastinum

An elderly woman presented with dyspnoea secondary to extensive mediastinal invasion by a primary well differentiated liposarcoma of the mediastinum. Five years after partial resection and postoperative radiotherapy (45 Gy) she is alive and well. To our knowledge, long term survival has not previously been reported for a non-encapsulated mediastinal liposarcoma treated by incomplete resection and subsequent radiation therapy.

The lowest birth-weight infants and the US infant mortality rate: NCHS 1983 linked birth/infant death data

The National Center for Health Statistics Linked Birth and Infant Death Data Set, 1983 birth cohort, shows that infants weighing less than 750 g, comprising only 0.3% of all births, account for 25% of deaths in the first year of life and for 41% of deaths in the first week. If interventions had prevented the death of these very small babies, the infant mortality rate would have been 8.3 per 1000 live births instead of 10.9, and the Black/White mortality differential would have been reduced by 25%.

Differences in infant mortality by race, nativity status, and other maternal characteristics

The objective of this study was to examine the effects of nativity status (native vs foreign born) and other maternal characteristics (age, parity, education, and marital status) on infant, neonatal, and postneonatal mortality among white and black mothers. The design of this nonrandomized cohort study was based on birth and death certificates. The setting involved live births among US residents (excluding California, Texas, and Washington) in 1983 and 1984. The participants included white mothers with 4.4 million births and black mothers with 926,000 births in single deliveries. There were no interventions. With regard to measurements (the main results), after adjusting for other risk factors, neonatal mortality risk was 22% lower among the black foreign-born mothers than among the black native-born mothers, while among white infants, there was no risk difference by nativity. Relative risks were more similar for postneonatal mortality, ie, 24% lower among black foreign-born mothers and 20% lower among white foreign-born mothers. Combining the several categories of risk factors into three broad maternal risk groups, there was a near-doubling of black and near-tripling of white infant mortality rates between the low and high levels of maternal risk. We concluded that if the infant mortality rate in the low-risk groups could be achieved by the moderate- and high-risk groups, there would be a 30% reduction in infant deaths within each race. Since the black infant mortality rate is twice the white infant mortality rate and black foreign-born mothers have much lower rates than black native-born mothers, it is likely that further improvement is possible among black infants.

The NCHS pilot project to link birth and infant death records: stage 1

The National Center for Health Statistics (NCHS) has completed a pilot test of its method to develop national linked files of birth and infant death records. A linked file of the 1982 birth cohort was produced that successfully linked 97 percent of the death records for infants who died in a nine-State area. The method NCHS uses to create national linked files takes full advantage of two existing data sources: the NCHS fully coded natality and mortality files and State files of matched births and infant deaths. For the nine-State pilot area, NCHS obtained computerized linked files from the States and extracted from them the certificate numbers on matching birth and death records. With the use of these numbers, NCHS selected and linked birth and death statistical records from its final natality and mortality files, thus creating new statistical linked records. The initial match rate of 93.2 percent for the project's linked record file was increased to 96.7 percent as a result of efforts by the pilot States to complete the matching of birth and infant death records. Matching in the nine-State linked file appears to be highly accurate, based on the results of two evaluation studies. In the second stage of the project, now underway, NCHS will continue to evaluate and improve State and national linked files for the four birth cohorts of 1983-86. With funding from the Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation, stage 2 will be conducted in collaboration with each of the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, and New York City, an independent registration area.

Smoking and drinking behavior before and during pregnancy of married mothers of live-born infants and stillborn infants

Data from the 1980 National Natality Survey (NNS) and the 1980 National Fetal Mortality Survey (NFMS) are used to describe the drinking and smoking behavior of married mothers before and during pregnancy according to maternal race and Hispanic origin, age, and education. Typically, smokers were white mothers under 25 years of age with a high school education or less, and drinkers were white mothers 25 years of age and older with more than a high school education. When pregnancy was confirmed, reductions in smoking and drinking occurred. However, mothers of stillborn infants were less likely to stop smoking than were the mothers of live-born infants. Although the prevalence of drinking was much higher than was the prevalence of smoking among the mothers included in these surveys, the reduction in drinking was much more pronounced than was the reduction in smoking. For nearly every sociodemographic subgroup, the prevalence of smoking was higher and the prevalence of drinking was lower among mothers of stillborn infants than among mothers of live-born infants. Some of these differences are due to the age-race-health status makeup of the two NNS-NFMS populations sampled, and carefully controlled multivariate analyses are required to specify the relationship of maternal smoking and drinking to birth outcome. This descriptive analysis is the first step in that process.