Children with central nervous system (CNS) tumours may present with a multitude of symptoms, ranging from elevated intracranial pressure to focal neurological deficit. In everyday practice, some ...signs may be misleading, thereby causing prolonged prediagnostic symptomatic intervals. Prediagnostic symptomatic intervals are longer for pediatric brain tumors than for other childhood malignancies. This study evaluated prediagnostic symptomatic intervals and parental and diagnostic intervals for pediatric patients with CNS tumours in Austria. It also considered socioeconomic factors.
Patients ≤ 19 years of age treated at the Medical University of Vienna and diagnosed during the years 2008 to 2013 were included. Patients diagnosed incidentally or by screening were excluded.
Two hundred twelve consecutive patients were included in the study. They reflected the expected spectrum of CNS tumors. Patients presented with a median of five symptoms at diagnosis, most frequently with signs of elevated intracranial pressure. The median prediagnostic symptomatic interval was 60 days (0 days to seven years), the median parental interval was 30 days (0 days to 6.7 years), and the median diagnostic interval was three days (0 days to 6.5 years). In spinal tumors alone (n = 7), the median prediagnostic symptomatic interval was 70 days (ten days to seven years), and three of seven patients had a prediagnostic symptomatic interval longer than 320 days. Young age, higher tumor grade, and ataxia were associated with a shorter prediagnostic symptomatic interval. Localization in the supratentorial midline, histology of craniopharyngioma, and endocrine symptoms prolonged the prediagnostic symptomatic interval. There was a clear trend for longer prediagnostic symptomatic interval in non-native speakers.
Results are comparable to other industrialized countries. However, long delays in diagnosis of central nervous system tumors still occur, urging increased awareness.
IntroductionWhile the factors commonly associated with an increased risk of child maltreatment (CM) were found to be increased during COVID-19, reports of actual maltreatment showed varying trends. ...Similarly, evidence regarding the impact of COVID-19 on CM within the European Cooperation on Science and Technology and Network Collaborative (COST) Action countries remains inconsistent. This scoping review aims to explore the extent and nature of evidence pertaining to CM within the countries affiliated with the Child Abuse and Neglect in Europe Action Network (Euro-CAN), funded by the COST.Methods and analysisKey electronic databases were searched to identify eligible papers, reports and other material published between January 2020 and April 2023: PubMed, EMBASE, PsycINFO, Social Policy and Practice, Scopus and Web of Science. To cover the breadth of evidence, a systematic and broad search strategy was applied using a combination of keywords and controlled vocabulary for four concepts: children, maltreatment, COVID-19 and Euro-CAN countries, without restrictions on study design or language. Grey literature was searched in OpenGrey and Google Scholar. Two reviewers will independently screen full-text publications for eligibility and undertake data extraction, using a customised grid. The screening criteria and data charting will be piloted by the research team.The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews will be followed to present the results. Results will be summarised in a tabular form and narratively.Ethics and disseminationThis review will identify and summarise publicly available data, without requiring ethical approval. The findings will be disseminated to the Euro-CAN Network and reported to the COST Association. They will also be published in a peer-reviewed journal. This protocol is registered on Open Science Framework.
Purpose: Numerous acute effects of chemotherapeutics on kidney function are well described. However, data on the long-term effects of chemotherapy in the growing population of childhood central ...nervous system (CNS) tumor survivors is limited. We aimed to evaluate the kidney function of a cohort of long-term CNS tumor survivors treated with different standard chemotherapeutic regimens. Methods: Patients treated for a CNS tumor were prospectively evaluated up to 12 years after completion of their therapy. Examination of kidney function was performed during routine follow-up visits. Blood pressure and blood and urine parameters were analyzed for kidney function evaluation. Glomerular function was assessed by calculating the estimated glomerular filtration rate (eGFR), tubular functions were analyzed by measuring serum electrolytes, bicarbonate and phosphate reabsorption, and proteinuria was assessed by calculating the protein/creatinine ratio and phosphate reabsorption. Results: None of the 65 patients evaluated suffered from clinically relevant kidney impairment (eGFR < 90 mL/min/L, 73 m2). There was no association between chemotherapy dose and eGFR. Only two patients showed mild signs of tubulopathy and 11 patients were diagnosed with elevated blood pressure. Conclusion: With adequate supportive measures, such as sufficient hydration according to chemotherapy protocol guidelines, as well as avoidance or close monitoring of additional nephrotoxic medication, impaired kidney function is rare in CNS tumor survivors treated with standard chemotherapy. Nonetheless, long-term follow-up is essential for early detection of mild impairment of kidney function.
The global population was affected by the unprecedented coronavirus COVID-19 pandemic. The impact of the pandemic on children who suffer child maltreatment has not been explored sufficiently. Child ...abuse is known to increase in stressful circumstances, and therefore potentially during this pandemic.We aimed to identify and measure the impact of pandemic-related stress in families with a suspicion or confirmed child maltreatment. In addition, other parameters were determined, including resilience factors and family dynamics.We conducted a pilot study at the Medical University of Vienna, Forensic Examination Centre for Children and Adolescents (FOKUS Safeguarding team). Parents, carers and legal guardians of children who were referred for potential child abuse (study group) participated by completing two questionnaires, one year apart, covering the following periods: pre-COVID, during-COVID and post-COVID. Simultaneously, a control group was devised with patients who presented to the Paediatric Emergency Department with unrelated conditions (other than child maltreatment concerns). The questionnaires addressed psychological stress factors and were completed face-to-face and/or via telephone. A total of 35 carers participated, with almost equal numbers in both intervention and control groups.Results show that there was statistically significantly higher stress level perception before and during the pandemic period in the study group. Several families in this group commented on the positive effect of support received from health professionals, especially after the pandemic.
Background and objective
To improve the currently low conviction rate in cases of child abuse a forensic examination center for children and adolescents (FOKUS) was established in Vienna, Austria. ...Besides a state of the art treatment combined with forensic documentation, one of FOKUS’ key goals is to identify potential areas for improvements within the process legal proceedings in cases of child abuse through constant scientific monitoring. The accompanying study at hand includes all patients referred to FOKUS within a two year timeframe (
n
= 233), monitoring their progression from first contact with the medical professionals from FOKUS to the end of criminal proceedings. A detailed analysis of case files was performed in those cases that were reported to the legal authorities by the clinicians of FOKUS (
n
= 87). Aim of the study is to investigate which factors contribute to the initiation of legal proceedings and a successful conviction.
Results
Multivariate logistic regression analyses showed that main proceedings were opened more often in cases where the offender was an adult (
p
< 0.001) or admitted his guilt (
p
< 0.001) and if digital traces were available (
p
= 0.001) or trial support (
p
= 0.024) present. Furthermore, the combined occurrence of medical documentation and victim disclosure was related to a higher probability of opening main trials.
Conclusion
These findings underline how challenging the successful persecution of an offender in cases of child abuse is.
Abstract
BACKGROUND
Malignant brain tumors carry a high risk for leptomeningeal dissemination, but tumor cells floating in the CSF are often not affected by systemic and/or antiangiogenic ...chemotherapy. Since liposomal cytarabine was removed from the market, alternatives for intraventricular therapy are desperately needed. We report on our experience with an intraventricular therapy consisting of alternating cycles of etoposide, aqueous cytarabine and topotecan. PATIENTS AND
METHODS
Between 2008 and 2017, 26 patients aged 1 to 17 years (median 7 years) with various malignant brain tumors received intraventricular therapy via an Ommaya reservoir, consisting of alternating etoposide 0.5mg on five consecutive days (<1 year 0.25mg), topotecan 0.4mg twice a week (>1 and <2 years 0.25mg, >2 and <3 years 0.32mg) and aqueous cytarabin 30mg twice a week (<1 year 16mg, >1 and <2 years 20mg, >2 and <3 years 26mg).
RESULTS
1899 doses of etoposide (4–166/patient), corresponding to 2–36 five-day-cycles/patient (median 17), alternating with 307 doses of topotecan (1–49/patient, median 10), and 101 doses of aqueous cytarabine (1–28/patient, median 4) were administered. Treatment was given over a period of 1 – 115 months (median 12 months). Alternating intraventricular treatment was generally well tolerated. One boy with multiple recurrences of an ependymoma in the posterior fossa showed increased tremor after topotecan, another girl reported fatigue after topotecan.
CONCLUSION
Alternating intraventricular therapy with etoposide, aqueous cytarabine and topotecan is feasible and generally well tolerated, and can be an important addition for patients with malignant brain tumors.
Objective
To assess rates of neonaticide after the implementation of a preventative ‘anonymous delivery’ law in mid‐2001 in Austria. Women are allowed to access antenatal care and give birth in a ...hospital anonymously, without showing any ID and free of charge.
Design
Retrospective study.
Setting
A complete census of police‐reported neonaticides was obtained from the police statistics of Austria, Sweden and Finland.
Population
All neonaticides reported to the police, 1991–2009.
Main outcome measures
Neonaticide rates before (1991–2001) and after (2002–2009) the introduction of anonymous delivery legislation per 100 000 births.
Methods
The Mann–Whitney U‐test for two independent samples was used to compare neonaticide rates in the period before the new law was introduced with the rates observed after the implementation of the new law for each country.
Results
On average the rate of police‐reported neonaticides was 7.2 per 100 000 births (SD 3.5, median 7.1) in Austria prior to the new law being passed, and 3.1 per 100 000 births (SD 2.1, median 2.6) after the law was passed. A significant decrease in neonaticide was observed in Austria after the implementation of anonymous delivery (Mann–Whitney U‐test P = 0.017). Whereas the Finnish and Swedish rates were lower than the Austrian rates before and after the implementation of the Austrian law, they remained unchanged over the study period.
Conclusions
Our data demonstrate a significant decrease in the number of police‐reported neonaticides in Austria after the implementation of anonymous delivery. Even though underlying factors associated with neonaticide are complex, the findings could indicate an effect of anonymous delivery in the prevention of this crime.
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