The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey.

STUDY QUESTION To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease? SUMMARY ANSWER Many women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres. WHAT IS KNOWN ALREADY The existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only. STUDY DESIGN, SIZE, DURATION A cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries. PARTICIPANTS/MATERIALS, SETTING, METHODS Women diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women's Health) and the Short Form 36 version 2 (SF-36v2). MAIN RESULTS AND THE ROLE OF CHANCE Of 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosis had affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2. LIMITATIONS, REASONS FOR CAUTION The fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population. WIDER IMPLICATIONS OF THE FINDINGS This international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The WERF EndoCost study is funded by the World Endometriosis Research Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto.

Prophylaxis of infectious complications with colony-stimulating factors in adult cancer patients undergoing chemotherapy-evidence-based guidelines from the Infectious Diseases Working Party AGIHO of the German Society for Haematology and Medical Oncology (DGHO).

BACKGROUND Current evidence on myelopoietic growth factors is difficult to overview for the practicing haematologist/oncologist. International guidelines are sometimes conflicting, exclude certain patient groups, or cannot directly be applied to the German health system. This guideline by the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Medical Oncology (DGHO) gives evidence-based recommendations for the use of G-CSF, pegylated G-CSF, and biosimilars to prevent infectious complications in cancer patients undergoing chemotherapy, including those with haematological malignancies. METHODS We systematically searched and evaluated current evidence. An expert panel discussed the results and recommendations. We then compared our recommendations to current international guidelines. RESULTS We summarised the data from eligible studies in evidence tables, developed recommendations for different entities and risk groups. CONCLUSION Comprehensive literature search and expert panel consensus confirmed many key recommendations given by international guidelines. Evidence for growth factors during acute myeloid leukaemia induction chemotherapy and pegfilgrastim use in haematological malignancies was rated lower compared with other guidelines.

International validation of a behavioral scale in Parkinson's disease without dementia.

The "Ardouin Scale of Behavior in Parkinson's Disease" is a new instrument specifically designed for assessing mood and behavior with a view to quantifying changes related to Parkinson's disease, to dopaminergic medication, and to non-motor fluctuations. This study was aimed at analyzing the psychometric attributes of this scale in patients with Parkinson's disease without dementia. In addition to this scale, the following measures were applied: the Unified Parkinson's Disease Rating Scale, the Montgomery and Asberg Depression Rating Scale, the Lille Apathy Rating Scale, the Bech and Rafaelsen Mania Scale, the Positive and Negative Syndrome Scale, the MacElroy Criteria, the Patrick Carnes criteria, the Hospital Anxiety and Depression Scale, and the Mini-International Neuropsychiatric Interview. Patients (n = 260) were recruited at 13 centers across four countries (France, Spain, United Kingdom, and United States). Cronbach's alpha coefficient for domains ranged from 0.69 to 0.78. Regarding test-retest reliability, the kappa coefficient for items was higher than 0.4. For inter-rater reliability, the kappa values were 0.29 to 0.81. Furthermore, most of the items from the Ardouin Scale of Behavior in Parkinson's Disease correlated with the corresponding items of the other scales, depressed mood with the Montgomery and Asberg Depression Rating Scale (ρ = 0.82); anxiety with the Hospital Anxiety and Depression Scale-anxiety (ρ = 0.56); apathy with the Lille Apathy Rating Scale (ρ = 0.60). The Ardouin Scale of Behavior in Parkinson's disease is an acceptable, reproducible, valid, and precise assessment for evaluating changes in behavior in patients with Parkinson's disease without dementia. © 2015 International Parkinson and Movement Disorder Society.

Blood and lymphatic vessel invasion in pT1 colorectal cancer: an international concordance study

AIM This study was performed to evaluate the concordance in pathological assessments of blood and lymphatic vessel invasion (BLI) in pT1 colorectal cancers and to assess the effect of diagnostic criterion on consistency in the assessment of BLI. METHODS Forty consecutive patients undergoing surgical resection of pT1 colorectal cancers were entered into this study. H&E-stained, D2-40-stained and elastica-stained slides from the tumours were examined by 18 pathologists from seven countries. The 40 cases were divided into two cohorts with 20 cases each. In cohort 1, pathologists diagnosed BLI using criteria familiar to them; all Japanese pathologists used a criterion of BLI from the Japanese Society for Cancer of the Colon and Rectum (JSCCR). In cohort 2, all pathologists used the JSCCR diagnostic criterion. RESULTS In cohort 1, diagnostic concordance was moderate in the US/Canadian and European pathologists. There were no differences in the consistency compared with results for Japanese pathologists, and no improvement in the diagnostic concordance was found for using the JSCCR criterion. However, in cohort 2, the JSCCR criterion decreased the consistency of BLI diagnosis in the US/Canadian and European pathologists. The level of decreased consistency in the assessment of BLI was different between the US/Canadian and European pathologists. CONCLUSIONS A uniform criterion strongly influences the diagnostic consistency of BLI but may not always improve the concordance. Further study is required to achieve an objective diagnosis of BLI in colorectal cancer. The varying effects of diagnostic criterion on the pathologists from Japan, the USA/Canada and Europe might reflect varied interpretations of the criterion. Internationally accepted criterion should be developed by participants from around the world.

Norm enforcement in the city revisited: An international field experiment of altruistic punishment, norm maintenance, and broken windows

In laboratory experiments, people are willing to sanction norms at a cost—a behavioral tendency called altruistic punishment. However, the degree to which these findings can be generalized to real-world interactions is still debated. Only a small number of field experiments have been conducted, and initial results suggest that punishment is less frequent outside of the lab. This study replicates one of the first field experiments on altruistic punishment and builds ties to research on norm compliance and the broken windows theory. The original study addressed the enforcement of the anti-littering norm in Athens. We replicate this study in Bern, Zurich, and New York City. As an extension, we investigate how the experimental context (clean vs littered) impacts social norm enforcement. As a second extension, we investigate how opportunity structure impacts the maintenance of the anti-littering norm. Findings indicate that norms are universally enforced, although significantly less than in the standard laboratory experiment,and that enforcement is significantly more common in Switzerland than in New York. Moreover, individuals prefer more subtle forms of enforcement to direct punishment. We also find that enforcement is less frequent in littered than in clean contexts, suggesting that broken windows might not only foster deviant behavior but also weaken informal social control. Finally, we find that opportunity structure can encourage people to maintain norms, as indicated by the fact that people are more likely to voluntarily pick up litter when it is closer to a trash bin.

An international registry for primary ciliary dyskinesia.

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder leading to chronic upper and lower airway disease. Fundamental data on epidemiology, clinical presentation, course and treatment strategies are lacking in PCD. We have established an international PCD registry to realise an unmet need for an international platform to systematically collect data on incidence, clinical presentation, treatment and disease course.The registry was launched in January 2014. We used internet technology to ensure easy online access using a web browser under www.pcdregistry.eu. Data from 201 patients have been collected so far. The database is comprised of a basic data form including demographic and diagnostic information, and visit forms designed to monitor the disease course.To establish a definite PCD diagnosis, we used strict diagnostic criteria, which required two to three diagnostic methods in addition to classical clinical symptoms. Preliminary analysis of lung function data demonstrated a mean annual decline of percentage predicted forced expiratory volume in 1 s of 0.59% (95% CI 0.98-0.22).Here, we present the development of an international PCD registry as a new promising tool to advance the understanding of this rare disorder, to recruit candidates for research studies and ultimately to improve PCD care.

Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association) Registry.

BACKGROUND Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012. FACTOR Racial background. OUTCOMES & MEASUREMENTS Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence. RESULTS 868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups. LIMITATIONS No data for socioeconomic status, blood group, and HLA profile. CONCLUSIONS We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.

Career Guidance: Challenges for the New Century under an International Perspective

This paper is dedicated to key issues of the actual challenges in all societies regardless their developmental level and how the international guidance community is coping with these challenges. It deals with the importance of guidance in a changing society, quality assurance, access to services and qualification of guidance practitioners under an international perspective.

Career Guidance: Challenges for the New Century under an International Perspective

This paper is dedicated to key issues of the actual challenges in all societies regardless their developmental level and how the international guidance community is coping with these challenges. It deals with the importance of guidance in a changing society, quality assurance, access to services and qualification of guidance practitioners under an international perspective.

Career Guidance: Challenges for the New Century under an International Perspective

This paper is dedicated to key issues of the actual challenges in all societies regardless their developmental level and how the international guidance community is coping with these challenges. It deals with the importance of guidance in a changing society, quality assurance, access to services and qualification of guidance practitioners under an international perspective.

Radiocarbon dates of Mytilus shells and peat and wood samples collected on Drayton Island

A multidisciplinary study was undertaken at the Qijurittuq Site (IbGk-3) on Drayton Island in Low-Arctic Quebec (Canada) to document the relationships between climatic, environmental, and cultural changes and the choice of Thule/Inuit dwelling style in the eastern Arctic. Several marine terraces were 14C-dated with shells in order to reconstruct the area's uplift (glacioisostatic rebound) curve. Plant macrofossil analysis of peat was conducted to reconstruct past vegetation and, indirectly, past climate. Archaeological surveys and excavations characterized the structure of subterranean sod houses at the Qijurittuq Site and were supplemented with open interviews with Inuit elders for a better understanding of site location and the use of household space. The sites selected for habitation were well-drained sandy marine terraces in a valley sheltered from prevailing winds. Sod houses were in turn made possible by the abundance of driftwood on the island and the presence of nearby peatland. Thule/Inuit people used semi-subterranean houses rather than igloos at the Qijurittuq Site during the dry, cold conditions toward the end of the Little Ice Age. Stable environmental conditions and food supply during winter possibly explain the use of those semipermanent houses on Drayton Island. However, it does not exclude the use of igloos during short expeditions on ice.

Radiocarbon ages and major n-alkane homologues of peat cores LVPS4 and LVPS5B, Russian Arctic

Coupled analyses of n-alkane biomarkers and plant macrofossils from a peat plateau deposit in the northeast European Russian Arctic were carried out to assess the effects of past hydrology on the molecular contributions of plants to the peat. The n-alkane biomarkers accumulated over 9.6 kyr of local paleohydrological changes in this complex peat profile in which a succession of vegetation changes occurred during a transition from a wet fen to a relatively dry peat plateau bog. This study shows that the contribution of the n-C31 alkane from rootlets to peat layers rich in fine and dark roots is important. The results further indicate that the n-alkane Paq and n-C23/n-C29 biomarker proxies that have been useful to reconstruct past water table levels in many peat deposits can be misleading when the contributions of Betula and Sphagnum fuscum to the peat are large. Under these conditions, the C23/(C27 + C31) n-alkane ratio seems to correct for the presence of Betula and S. fuscum and provides a better description for the relative amounts of moisture. The average chain length (ACL) n-alkane proxy also appears to be a good paleohydrology proxy in having larger values during dry and cold conditions in this Arctic bog setting.

Vegetation cover and radiocarbon dates of palsa and peat plateaus in the Hudson Bay Lowlands

The Holocene development of a treed palsa bog and a peat plateau bog, located near the railroad to Churchill in the Hudson Bay Lowlands of northeastern Manitoba, was traced using peat macrofossil and radiocarbon analyses. Both sites first developed as wet rich fens through paludification of forested uplands around 6800 cal. yr BP. Results show a 20th-century age for the palsa formation and repeated periods of permafrost aggradation and collapse at the peat plateau site during the late Holocene. This timing of permafrost dynamics corroborates well with that inferred from previous studies on other permafrost peatlands in the same region. The developmental history of the palsa and peat plateau bogs is similar to that of adjacent permafrost-free fens, except for the specific frost heave and collapse features associated with permafrost dynamics. Permafrost aggradation and degradation is ascribed to regional climatic, local autogenic and other factors. Particularly the very recent palsa development can be assessed in terms of climatic changes as inferred from meteorological data and surface hydrological changes related to construction of the railroad. The results indicate that cold years with limited snowfall as well as altered drainage patterns associated with infrastructure development may have contributed to the recent palsa formation.

Radiocarbon dating of peat profiles from the subarctic ecoclimatic region, west-central Canada

Long-term vegetation succession and permafrost dynamics in subarctic peat plateaus of west-central Canada have been studied through detailed plant macrofossil analysis and extensive AMS radiocarbon dating of two peat profiles. Peatland inception at these sites occurred around 5800-5100 yr BP (6600-5900 cal. BP) as a result of paludification of upland forests. At the northern peat plateau site, located in the continuous permafrost zone, palaeobotanical evidence suggests that permafrost was already present under the forested upland prior to peatland development. Paludification was initiated by permafrost collapse, but re-aggradation of permafrost occurred soon after peatland inception. At the southern site, located in the discontinuous permafrost zone, the aggradation of permafrost occurred soon after peatland inception. In the peat plateaus, permafrost conditions have remained very stable until present. Sphagnum fuscum-dominated stages have alternated with more xerophytic communities characterized by ericaceous shrubs. Local peat fires have occurred, but most of these did not cause degradation of the permafrost. Starting from 2800-1100 yr BP (2900-1000 cal. BP) consistently dry surface conditions have prevailed, possibly related to continued frost heave or nearby polygon crack formation.