Wilms tumor: progress to date and future considerations

Wilms tumor is the most common tumor of renal origin found in children. In the last 50 years, remarkable progress has been made in the treatment and understanding of children with Wilms tumor. Through the development of multiagent chemotherapy and cooperative pediatric interdisciplinary groups conducting large randomized controlled clinical trials, survival has improved dramatically. In the next century it is expected that 80% of children with Wilms tumor will be long-term survivors. Therapy is progressing towards a risk-based management based not only on stage and histology but also incorporated genetic markers. This article reviews progress to date and possible future directions in the treatment of Wilms Tumor.     

Estimating the decline in excess risk of chronic obstructive pulmonary disease following quitting smoking – A systematic review based on the negative exponential model

We quantified the decline in COPD risk following quitting using the negative exponential model, as previously carried out for other smoking-related diseases. We identified 14 blocks of RRs (from 11 studies) comparing current smokers, former smokers (by time quit) and never smokers, some studies providing sex-specific blocks. Corresponding pseudo-numbers of cases and controls/at risk formed the data for model-fitting. We estimated the half-life (H, time since quit when the excess risk becomes half that for a continuing smoker) for each block, except for one where no decline with quitting was evident, and H was not estimable. For the remaining 13 blocks, goodness-of-fit to the model was generally adequate, the combined estimate of H being 13.32 (95% CI 11.86–14.96) years. There was no heterogeneity in H, overall or by various studied sources. Sensitivity analyses allowing for reverse causation or different assumed times for the final quitting period little affected the results. The model summarizes quitting data well. The estimate of 13.32 years is substantially larger than recent estimates of 4.40 years for ischaemic heart disease and 4.78 years for stroke, and also larger than the 9.93 years for lung cancer. Heterogeneity was unimportant for COPD, unlike for the other three diseases.     

Patterns of abuse amongst Sri Lankan women returning home after working as domestic maids in the Middle East: An exploratory study of medico-legal referrals

ObjectiveMigrant worker abuse is well recognised, but poorly characterised within the scientific literature. This study aimed to explore patterns of abuse amongst Sri Lankan women returning home after working as domestic maids.MethodsSri Lanka has over 2 million of its citizens employed overseas as international labor migrants. A cross-sectional study was conducted on Sri Lankan female domestic maids returning from the Middle East region who were referred for medico-legal opinion.ResultsA total of 20 women were included in the study. Average length of their employment overseas was 14 months. Complaints of physical violence directed mainly through their employers were made by 60% of women. Upon physical examination, two-thirds had evidence of injuries, with a third being subjected to repetitive/systematic violence. Eighty percent suffered some form of psychological trauma. Personal identity papers and travel documents had been confiscated by the employer in 85% of cases, with two thirds indicating they were prevented and/or restricted from leaving their place of work/residence.ConclusionsOur study demonstrates that female domestic maid abuse manifests through multiple pathways. Violence against such workers span the full spectrum of physical, financial, verbal, emotional abuse and neglect, as defined by the World Health Organization. Findings from this exploratory study cannot be generalized to the large volume of migrant worker outflows. Further research is needed to determine incidence and define patterns in other migrant worker categories such as low-skilled male workers.     

Building midwifery educator capacity using international partnerships: Findings from a qualitative study

Midwifery educators play a critical role in strengthening the midwifery workforce globally, including in low and lower-middle income countries (LMIC) to ensure that midwives are adequately prepared to deliver quality midwifery care. The most effective approach to building midwifery educator capacity is not always clear. The aim of this study was to determine how one capacity building approach in Papua New Guinea (PNG) used international partnerships to improve teaching and learning. A qualitative exploratory case study design was used to explore the perspectives of 26 midwifery educators working in midwifery education institutions in PNG. Seven themes were identified which provide insights into the factors that enable and constrain midwifery educator capacity building. The study provides insights into strategies which may aid institutions and individuals better plan and implement international midwifery partnerships to strengthen context-specific knowledge and skills in teaching. Further research is necessary to assess how these findings can be transferred to other contexts.     

Tumor Epigenetic Signature and Survival in Resected Gastric Cancer Patients

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Leisure participation for school-aged children with Down syndrome

Purpose.?To describe leisure participation for school-aged children with Down syndrome and to investigate how factors, classified by the World Health Organisation's International Classification of Functioning, Disability and Health, influence their leisure participation.

Method.?Families in Western Australia with a child aged 5–18 years with Down syndrome were surveyed in a population-based study (n == 208) in 2004.

Results.?One-third of parents reported that their child with Down syndrome had no friends although half reported two or more friends. Factors affecting number of friendships included the child's functional ability, behavioural issues and parent's availability of time. Those children with higher functional independence scores in daily tasks were more likely to have two or more friends than those with lower functional independence scores (OR: 1.02, 95%% CI 1.01–1.04 for a single point increase in WeeFIM score). All children participated in predominantly solitary and sedentary leisure activities.

Conclusions.?Leisure participation was affected by complex factors both within and external to the child with Down syndrome. Further investigation of the relevance of these factors to leisure may enable more satisfying and meaningful participation in leisure for school-aged children with Down syndrome.