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Background:Despite advances in the treatment of childhood cancer, some children continue to die from their disease. This study aimed to assess the impact of specialist paediatric palliative care services (SPPCSs) on the number of hospital admissions in children who subsequently died from cancer in Yorkshire, UK.Methods:An extract of patients aged 0-19 years from the Yorkshire Specialist Register of Cancer in Children and Young People (YSRCCYP) diagnosed from 1990 to 2009 were linked to inpatient hospital episodes data and a SPPCS database. Deaths were included if they occurred before 31 August 2011. Differences in hospital admission patterns were assessed using negative binomial regression and presented as incidence rate ratios (IRRs).Results:Of 2508 children on the YSRCCYP, 657 (26%) had died by the censoring date. A total of 211 children had been referred to the local SPPCS, of whom 182 (86%) had subsequently died. Referral to SPPCS was associated with a significant reduction in the rate of planned hospital admissions (IRR=0.60, 95% CI 0.43-0.85). Central nervous system tumours showed significant decreases for all planned and emergency admissions compared with all other diagnostic groups.Conclusion:Referral to SPPCS significantly reduced the number of planned hospital admissions for children and young people with cancer before their death, which are often integral to paediatric oncology treatment regimens. Overall, our findings show that SPPCS have a role in reducing hospital admissions during end of life care of paediatric cancer patients with potential personal, social and economic benefits. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined epidemiological differences between ethnic groups for children and young adults with cancer.Methods: Subjects aged 0-29 years, diagnosed between 1990 and 2005 in the former Yorkshire Regional Health Authority, were included in the analysis. Ethnicity (south Asian or not) was assigned using name analysis program and Hospital Episode Statistics data. Differences in incidence (per 1,000,000 person-years) rates and trends were analysed using joinpoint and Poisson regression analysis.Results: Overall cancer incidence was similar for south Asians (12.1, 95% CI: 10.7-13.5; n=275) and non-south Asians (12.6, 95% CI: 12.2-13.1; n=3259). Annual incidence rates increased significantly by 1.9% per year on average (95% CI: 1.2-2.6%), especially for south Asians (7.0%; 95% CI: 4.2-9.9%).Conclusion: If present trends continue, the higher rate of increase seen among south Asians aged 0-29 years in Yorkshire will result in three times higher cancer incidence than non-south Asians by 2020. [ABSTRACT FROM AUTHOR]

Aims To provide a population-based clinical audit of children and young people with diabetes, reporting outcomes, including glycaemic control, for named individual units. Methods Clinical audit data on care processes and glycated haemoglobin (HbA1c) were collected for 1742 children and young people treated in 16 paediatric units in Yorkshire, from January 2005 to March 2006. The Yorkshire Register of Diabetes in Children and Young People provided information technology support and validation that enhanced data quality. Multi-level linear regression modelling investigated factors affecting glycaemic control. Results An HbA1c measure was recorded for 91.6% of patients. The National Institute for Clinical Excellence-recommended target level for HbA1c of < 7.5% was achieved for 14.7% of patients. HbA1c was positively associated with duration of diabetes and later age at diagnosis. Patients living in deprived areas had significantly poorer control compared with those from affluent areas. Significant between-unit variation in HbA1c was not reflected by any association with unit size. Conclusions Our population-based clinical audit of children with diabetes is the product of an effective collaboration between those who deliver care and health services researchers. High levels of recording the key care process measuring diabetes control, compared with national figures, suggests collaboration has translated into improved services. The interesting association between poor diabetes control and higher deprivation is noteworthy and requires further investigation. Future audits require recording of clinical management and clinic structures, in addition to resources to record, assemble and analyse data. [ABSTRACT FROM AUTHOR]

We examined population-based information on relapsed childhood haematological cancers, investigating factors that might influence both overall survival and survival following relapse among the 1177 children (0-14 years) diagnosed with a haematological malignancy in Yorkshire from 1974 to 2003, of whom 342 (29%) relapsed at least once. Leukaemia patients from more deprived areas were significantly less likely to relapse (odds ratio=0.54, 95% confidence interval 0.32-0.93 for most deprived quintile vs least deprived quintile; P(trend)=0.06), especially those with acute myeloid leukaemia (P=0.04). Neither ethnic group nor distance to the main treatment centre was associated with risk of relapse. Overall, patients who relapsed at least once had 5-year survival rates of 46% (41-51%) compared with 79% (76-81%) of those who did not. Five-year survival rates from the time of first relapse increased from 20% in 1974-1983 to 45% in 1984-2003. Length of first remission was a strong predictor of survival for leukaemia with a 46% reduced risk of death for every additional year of event-free survival. Of children who experienced a relapse, 46% survived at least 5 years, whereas just under half of patients survived 5 years beyond disease recurrence. This provides a baseline for future comparisons and demonstrates that relapsed childhood cancer need not imply a poor outcome. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Infections have been suggested to play a role in the aetiology of type 1 diabetes. The presence of space—time clustering is consistent with the notion of an environmental component in disease aetiology, possibly linked to infections. We tested for evidence of space—time clustering among children and young adults under 30 years of age using data from a population-based register in Yorkshire, UK. Subjects and methods: Two data sets of children and young people diagnosed with type 1 diabetes were analysed: (1) children aged 0–14 years and resident in Yorkshire during 1978–2002; (2) those aged 15–29 years and resident in West Yorkshire during 1991–2002. Tests for space–time interactions between cases were applied. Addresses at diagnosis were geo-coded and used as the basis for the analyses. Results: The study analysed 3,019 type 1 diabetic patients in the 0–14 years age group and 989 patients in the 15–29 years group. Statistically significant space—time clustering based on place and time of diagnosis was detected both for the 10–14-year-olds (p=0.04) and for the 15–19-year-olds (p=0.01). Conclusions/interpretation: Previous studies of clustering of type 1 diabetes have generally been restricted to childhood. Our results from a data set that includes teenagers and young adults show that space—time clustering was limited to young people aged 10–19 years. This finding is consistent with an aetiology involving late exposure to infection. However, the question of whether this is directly diabetogenic or unmasks latent diabetes cannot be addressed by this methodology. [ABSTRACT FROM AUTHOR]

The authors describe the incidence and survival of 480 patients diagnosed under 30 years with a CNS tumor in Yorkshire, UK between 1990 and 2001. The effect on survival from deprivation and other prognostic factors was examined. Young adults (aged 15–29) were significantly less likely to develop CNS tumors than children (p = .001), largely because of an excess of medulloblastoma and ependymoma in the pediatric age range. No significant temporal trends in incidence were present apart from young adults with “other CNS” tumors showing an average annual increase of 10.7% (95% CI 1.3–21.0%; p = .03). Young adults had significantly lower survival rates than children (hazard ratio = 1.52, 95%CI 1.10–2.10). The highest risk of death was observed for patients from the most affluent areas. The overall burden of CNS tumors appears to be relatively constant, but the significantly poorer survival for young people needs further rapid investigation. [ABSTRACT FROM AUTHOR]

Abstract Aims To investigate whether the rising incidence of Type 1 diabetes in children is evident in young adults and determine whether age at onset has decreased over time. Methods Two geographically defined datasets from the population-based Yorkshire Diabetes Register were analysed: (i) 2718 children diagnosed under 15 years with Type 1 diabetes from 1978 to 2000 in Yorkshire; (ii) 631 young adults (15–29 years) diagnosed from 1991 to 1999 in West Yorkshire. Log-linear regression and age-period-cohort modelling evaluated changes in incidence over time and age at onset. Results Incidence rose steadily for 0–14-year-olds in Yorkshire with an average annual increase of 2.9%[95% confidence interval (CI) 2.0, 3.8]. In West Yorkshire between 1991 and 1999, the time trends for 0–14 and 15–29-year-olds were significantly different (P = 0.014). Stable rates in 15–29-year-olds contrasted with an average annual increase of 5.9% (95% CI 2.7, 9.2) for 0–14-year-olds. The mean age at onset fell from 9.2 to 8.4 years for 0–14-year-olds and from 16.0 to 14.6 years for 0–29-year-olds. Age-period-cohort modelling showed a statistically significant (P < 0.001) increased risk of developing diabetes was associated with decreasing age for those diagnosed more recently. Conclusions A steady and continuing rise in the incidence of Type 1 diabetes over time is observed for children but not for young adults. In parallel, the age at onset is gradually decreasing and more recent birth cohorts are at increased risk. This overall pattern is consistent with the influence of an environmental agent that is gradually affecting children at younger and younger ages. Diabet. Med. 20, 437–441 (2003). [ABSTRACT FROM AUTHOR]

The article focuses on a study which examines the epidemiological differences between ethnic groups such as south Asians and non-south Asians for children and young adults with cancer in Yorkshire, England. It assigns ethnicity with the use of name analysis program and Hospital Episode Statistics data. It presents the result of the overall cancer incidence in Yorkshire.

Long term cure and maximising reintegration into society are major goals of childhood cancer treatment. Whether reintegration had occurred was. assessed using geographic mobility as an objective proxy. Age, sex, and socioeconomic status were identified as being independently associated with mobility whereas diagnosis and relapse were hot. [ABSTRACT FROM AUTHOR]