PubMed · 16335692
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Julie St-Arnaud, Marie P Beaudet, Patricia Tully. 2005. Life expectancy.. https://pubmed.ncbi.nlm.nih.gov/16335692/
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PURPOSE: This report examines the incidence of and risk factors for strokes that occur in > or = 5-year survivors of childhood leukemia and brain tumors. PATIENTS AND METHODS: The rate of first occurrence of self-reported late-occurring strokes was determined for leukemia survivors (n = 4,828), brain tumor survivors (n = 1,871), and a comparison group of a random sample of cancer survivor siblings (n = 3,846). Relative risks (RRs) and 95% confidence intervals (CIs) of stroke by treatment exposures were examined by multivariate analyses. RESULTS: Thirty-seven leukemia survivors and 63 brain tumor survivors reported a late-occurring stroke. The rate of late-occurring stroke for leukemia survivors was 57.9 per 100,000 person-years (95% CI, 41.2 to 78.7). The RR of stroke for leukemia survivors compared with the sibling comparison group was 6.4 (95% CI, 3.0 to 13.8; P < .0001). The rate of late-occurring stroke for brain tumor survivors was 267.6 per 100,000 person-years (95% CI, 206.8 to 339.2). The RR of stroke for brain tumor survivors compared with the sibling comparison group was 29.0 (95% CI, 13.8 to 60.6; P < .0001). Mean cranial radiation therapy (CRT) dose of > or = 30 Gy was associated with an increased risk in both leukemia and brain tumor survivors in a dose-dependent fashion, with the highest risk after doses of > or = 50 Gy CRT. CONCLUSION: Survivors of childhood leukemia and brain tumors, particularly those with brain tumors treated with CRT at doses of greater than 30 Gy, are at an increased risk of stroke.
OBJECTIVE: To identify factors associated with age of smoking initiation and distinguish vulnerable periods for initiation according to those factors. METHOD: Discrete time hazards analysis was used to model smoking initiation as a function of age (5-23), demographic and familial influence variables (measured at age 13), and their interactions in a cohort of 6255 youths who completed six assessments over a 10-year period from age 13 to 23 years. RESULTS: Half of the sample had initiated smoking by age 13, and the hazard for initiation was greatest between ages 13 and 15. In addition to differences associated with race/ethnicity, protective factors for smoking initiation included high parental education and having an intact family of origin. Having an older sibling and participant's exposure to smoking by an important adult were both risk factors, with the latter having a stronger effect for females and Blacks. For all effects, the strength of the association differed across the age range. CONCLUSIONS: The impact of demographic and family influence factors on smoking initiation varies over time. However, the maximum risk for initiation is during the early teen years, and the range of considerable vulnerability is during middle school and high school.
OBJECTIVES: In this study, we assessed the effectiveness of physical counterpressure maneuvers (PCM) in daily life. BACKGROUND: There is presently no evidence-based therapy for vasovagal syncope. Current treatment consists of explanation and life-style advice. Physical counterpressure maneuvers have been shown to raise blood pressure and to control or abort vasovagal episodes in laboratory conditions. METHODS: We performed a multicenter, prospective, randomized clinical trial, which included 223 patients age 38.6 (+/-15.4) years with recurrent vasovagal syncope and recognizable prodromal symptoms. One hundred and seventeen patients were randomized to standardized conventional therapy alone, and 106 patients received conventional therapy plus training in PCM. RESULTS: The median yearly syncope burden during follow-up was significantly lower in the group trained in PCM than in the control group (p = 0.004). During a mean follow-up period of 14 months, overall 50.9% of the patients with conventional treatment and 31.6% of the patients trained in PCM experienced a syncopal recurrence (p = 0.005). Actuarial recurrence-free survival was better in the treatment group (log-rank p = 0.018), resulting in a relative risk reduction of 39% (95% confidence interval, 11% to 53%). No adverse events were reported. CONCLUSIONS: Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope and recognizable prodromal symptoms, and should be advised as first-line treatment in patients presenting with vasovagal syncope with prodromal symptoms. (The PC-Trial; http://www.controlled-trials.com/isrctn/trial/45146526/0/45146526.html; ISRCTN45146526).