Dose–volume histogram parameters of high-dose-rate brachytherapy for Stage I–II cervical cancer (≤4cm) arising from a small-sized uterus treated with a point A dose-reduced plan

We investigated the rectal dose-sparing effect and tumor control of a point A dose-reduced plan in patients with Stage I–II cervical cancer (≤4 cm) arising from a small-sized uterus. Between October 2008 and August 2011, 19 patients with Stage I–II cervical cancer (≤4 cm) were treated with external beam radiotherapy (EBRT) for the pelvis and CT-guided brachytherapy. Seven patients were treated with brachytherapy with standard loading of source-dwell positions and a fraction dose of 6 Gy at point A (conventional brachy-plan). The other 12 patients with a small uterus close to the rectum or small intestine were treated with brachytherapy with a point A dose-reduction to match D2cc of the rectum and <6 Gy as the dose constraint (‘point A dose-reduced plan’) instead of the 6-Gy plan at point A (‘tentative 6-Gy plan’). The total doses from EBRT and brachytherapy were added up and normalized to a biological equivalent dose of 2 Gy per fraction (EQD2). The median doses to the high-risk clinical target volume (HR-CTV) D90 in the conventional brachy-plan, tentative 6-Gy plan and point A dose-reduced plan were 62 GyEQD2, 80 GyEQD2 and 64 GyEQD2, respectively. The median doses of rectal D2cc in the corresponding three plans were 42 GyEQD2, 62 GyEQD2 and 51 GyEQD2, respectively. With a median follow-up period of 35 months, three patients developed Grade-1 late rectal complications and no patients developed local recurrence. Our preliminary results suggested that CT-guided brachytherapy using an individualized point A dose-reduced plan might be useful for reducing late rectal complications while maintaining primary tumor control.     

Examination of the relationship between technology use of 5–6 year-old children and their social skills and social status*

The primary objective of this study is to determine the predictive effect of technology use durations of 5–6 year-old children on their social skill levels and social status. In this study, children’s technology usage is restricted to the use of television, portable computers, tablets and smartphones. The sample group of the study consisted of 162 children aged 5 and 6 years old who are actively enrolled in seven kindergartens. The data required for the study were obtained from children, parents and teachers. The ‘Determination of Use of Technology by Children–Parent Form’, the ‘Social Skills Evaluation Scale’, ‘The Picture Sociometry Scale’ and ‘The Personal Information Form’ were used. The results revealed that the use of mobile technologies had no predictive effect on the social skill level, whereas, some mobile devices have predictive effects on the social preference and social impact.     

Factors associated with objectively measured physical activity and sedentary time of 5–6-year-old children in the STEPS Study

Background: The factors associated with preschool-aged children’s physical activity (PA) remains unclear. The aim of this cross-sectional study was to examine how different factors were associated with preschool-aged children’s objectively measured PA and sedentary time. Methods: The study population was 5–6-year-old children (n?=?140) and their parents (n?=?138) from the STEPS Study in Turku in Southwest Finland in 2013–2014. PA and sedentary time were measured objectively by accelerometers from children and parents and body mass index with Tanita scale. Other factors (siblings, day care, organized PA and parents’ education) were collected with questionnaires. Linear models were conducted. Results: Child’s PA was positively associated with mother’s PA and day care attendance. Child’s sedentary time was positively associated with mother’s sedentary time. Father’s PA and sedentary time were associated with respective variables in children, but only among fathers with high education. Conclusion: Parental role modelling is essential in developing child’s physically active and less sedentary lifestyle.     

Relationship between habitual physical activity,motor capacity,and capability in children with cerebral palsy aged 4–5 years across all functional abilities

Background

Children with cerebral palsy (CP) have lower habitual physical activity (HPA) than their typically developing peers. There are limited studies of HPA in young children with CP under the age of 5 years.

Comparison between the GHQ-28 and SF-36 (MH 1–5) for the assessment of the mental health in patients with ischaemic heart disease

Objective: To assess the mental health of patients admitted to hospital with suspected ischaemic heart disease, by means of two instruments, the General Health Questionnaire (GHQ-28) and the MH (1–5) dimension of the SF-36 Health Survey Questionnaire, and to compare the psychometric properties of both questionnaires in this population. Methods: A study was conducted of 185 patients consecutively admitted to hospital with suspected ischaemic heart disease, classified into four groups: Acute Myocardial Infarctus (AMI), unstable angina, non-ischaemic cardiologies, and non-cardiological conditions. Their mental health was assessed by means of the GHQ-28 and the MH 1–5 sub-scales of the SF-36; the validity of the results were analysed by the association of each instrument with socio-demographic (age, sex, social class, and educational level) and clinical (co-morbidity, risk factors, diagnostic groups and background to the illness) variables. The correlation of each instrument with other sub-scales of the SF-36 was studied. The internal consistency was measured by Cronbach's , together with the item-internal consistency and item-discriminant validity. Results: Of the population studied, 71.9% were males and the mean age was 60.2 years (SD: 10.4). The diagnosis for 33.5% was AMI and for 37.8% unstable angina. For all the variables studied, the scores in the two instruments were ordered in the same way, and were significantly worse for females and for the most disadvantaged social class. None of the scales discriminated in respect of the diagnostic group or the presence of comorbidity. However, a linear relationship was observed with risk factors. Cronbach's was 0.95 for the GHQ-28 and 0.80 for the MH 1–5. Correlations with the other dimensions showed ranges of –0.35 to –0.61 for the GHQ-28 and of 0.26 to 0.61 for the MH 1–5. These were highest for the Vitality and Social Functioning sub-scales in both instruments. Conclusions: The subjective perception of mental health is measured in a similar way by both the MH 1–5 scale of the SF-36 and the GHQ-28. However, since the MH 1–5 questionnaire is shorter, it should be administratively easier to introduce into routine cardiological practice.     

Measuring preference-based quality of life in children aged 6–7 years: a comparison of the performance of the CHU-9D and EQ-5D-Y—the WAVES Pilot Study

Purpose

To examine the performance of the child health utility 9D (CHU-9D) and EuroQol 5D-youth (EQ-5D-Y) in children aged 6–7 years.

Method

The CHU-9D and EQ-5D-Y were interviewer-administered to 160 children aged 6–7 years at six schools across the West Midlands. Missing values, time taken to complete instruments and interviewer ratings were recorded to assess feasibility/acceptability. Construct validity was assessed by testing convergent validity hypotheses. Reliability was examined via a test–retest of a sub-sample. Psychometric properties were further examined by exploring distributions of utility scores, qualitative notes and design of the questionnaires.

Results

No missing responses were recorded with over 80% of children’s understanding being rated as good/excellent for both questionnaires. The average completion time for both instruments was less than 3 minutes, demonstrating excellent feasibility/acceptability. Evidence of construct validity was recorded with 12 of the 13 convergent hypotheses being supported. Test–retest reliability was relatively poor for both instruments with weighted kappa coefficients ranging from fair to moderate.

Conclusion

Children aged 6–7 years can feasibly complete utility instruments when interviewer-administered. The reliability of the instruments is of concern and requires further study. With respect to content validity and other psychometric properties, the CHU-9D is favoured to the EQ-5D-Y. Until the EuroQol group produces tariff values for the EQ-5D-Y, we recommend that the EQ-5D-Y is not used for utility elicitation in this age group.     

Immunogenicity and safety of two novel human papillomavirus 4- and 9-valent vaccines in Chinese women aged 20–45 years: A randomized,blinded, controlled with Gardasil (type 6/11/16/18), phase III non-inferiority clinical trial

BackgroundHuman papillomavirus (HPV) infections were the main cause of anogenital cancers and warts. HPV 6/11/16/18 vaccines provide protection against the high-risk types of HPV responsible for 70% of cervical cancers and 90% of genital warts. This randomized, blinded, non-inferiority phase III trial was to determine whether immunogenicity and tolerability would be non-inferior among women after receiving two novel 4- and 9-valent HPV vaccines (4vHPV, HPV 6/11/16/18; 9vHPV, HPV 6/11/16/18/31/33/45/52/58) compared with those receiving Gardasil 4 (4-valent).Methods1680 females between 20 and 45 years were randomized in a 2:1:1 ratio to 20–26, 27–35, or 36–45 y groups. Subjects then equally assigned to receive 4vHPV, 9vHPV or Gardasil 4 (control) vaccine at months 0, 2, and 6. End points included non-inferiority of HPV-6/11/16/18 antibodies for 4vHPV versus control, and 9vHPV versus control and safety. The immunogenicity non-inferiority was pre-defined as the lower bound of 95% confidence interval (CI) of seroconversion rate (SCR) difference > ?10% and the lower bound of 95% CI of geometric mean antibody titer (GMT) ratio > 0.5.ResultsAmong the three vaccine groups, more than 99% of the participants seroconverted to all 4 HPV types. The pre-specified statistical non-inferiority criterion for the immunogenicity hypothesis was met: all the lower bounds of 95% CIs on SCR differences exceeded ?10% for each vaccine HPV type and the corresponding lower bounds of 95% CIs for GMT ratios > 0.5. Across vaccination groups, the most common vaccination reaction were injection-site adverse events (AEs), including pain, swelling, and redness. General and serious AEs were similar in the three groups. There were no deaths.ConclusionsThis study demonstrated that the novel 4- and 9-valent HPV vaccination was highly immunogenic and generally well tolerated, both of which were non-inferior to Gardasil 4 in immunogenicity and safety.