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Aims: To investigate the relationship between structural and functional social support and patient activation, diabetes-related emotional distress, perceived diabetes care, self-management behaviour and HbA(1c) levels among patients with Type 2 diabetes., Methods: Self-administered questionnaires were collected from 2572 patients with Type 2 diabetes. After adjusting for gender, age and education, Tobit and logistic regression models were used to examine associations between social network and patient activation, psychosocial problems, self-management behaviours and HbA(1c) levels., Results: Frequent contact with friends was associated with more positive scores for activation, fewer psychosocial problems, more positive assessment of care and health-promoting self-management behaviours such as frequent exercising and frequent foot examinations. Frequent contact with family was associated with more positive assessments of care. Living with a partner was associated with lower prevalence of smoking, a higher frequency of foot examinations and higher HbA(1c) levels. A poor functional social network, measured as perceived lack of help in the event of severe illness, was associated with low patient activation, greater emotional distress, negative assessment of care, less health-promoting eating habits and less frequent foot examinations., Conclusions: Good social support is significantly associated with health-promoting behaviours and well-being among patients with Type 2 diabetes. However, HbA(1c) levels are higher for cohabitant persons, indicating barriers for social support. Intervention research is needed to investigate the causal relationship between social networks and health-promoting behaviours. This knowledge should be used in clinical practice when targeting and designing education, support and care for patients with Type 2 diabetes., (© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.)

Introduction: The management of patients with cervical lymph node metastases from unknown primary tumours is a major challenge in oncology. This study presents data collected from all five oncology centres in Denmark., Materials and Methods: Of the 352 consecutive patients with squamous cell or undifferentiated tumours seen from 1975 to 1995, a total of 277 (79%) were treated with radical intent. Most patients received radiotherapy to both sides of the neck as well as elective irradiation of the mucosal sites in nasopharynx, oropharynx, hypopharynx and larynx (81%). Irradiation of the ipsilateral neck only was done in 26 patients (10%). Radical surgery was the only treatment in 23 N1-N2 patients (9%)., Results: The five-year estimates of neck control, disease-specific survival and overall survival for radically treated patients were 51%, 48% and 36%, respectively. The emergence of the occult primary was observed in 66 patients (19%). About half of the emerging primaries were within the head and neck region with oropharynx, hypopharynx and oral cavity being the most common sites. Emerging primaries outside the head and neck region were primarily located in the lung (19 patients) and oesophagus (five patients). The most important factor for neck control was nodal stage (5-year estimates 69% [N1], 58% [N2] and 30% [N3]). Other important parameters for neck control and disease-specific survival included haemoglobin, gender and overall treatment time. Patients treated with ipsilateral radiotherapy had a relative risk of recurrence in the head and neck region of 1.9 compared to patients treated at both neck and mucosa. At five years, the estimated control rates were 27% (ipsilateral) and 51% (bilateral; p = 0.05). The 5-year disease-specific survival estimates were 28% and 45%, respectively (p = 0.10)., Discussion: Extensive irradiation to both sides of the neck and the mucosa in the entire pharyngeal axis and larynx resulted in significantly fewer loco-regional failures compared to patients treated with ipsilateral techniques, but only a trend towards better survival. Determination of the optimal strategy in terms of loco-regional control, survival and morbidity requires a prospective randomized trial.

Through a 14-months extended surveillance of meningococcal disease in Denmark, all 322 notified cases were investigated for possible connection with a military camp where 3 cohorts of recruits (n = 1069) were studied prospectively for meningococcal carriage. One case occurred in a recruit who was a constant non-carrier during the preceding 3 months. The invasive Neisseria meningitidis B:1:P1.1,7 strain was isolated from the pharynx only in 3 out of 17 room-mates (18%); the strains were identical as assessed by genotyping (PFGE and ribotyping). Two civilian cases outside the camp had direct contact with 2 recruits, but neither these 2 nor other recruits in the relevant divisions carried the invasive strains on any occasion. Six civilian cases had marginal relationship with the camp, but no contact with the recruits. In conclusion, pheno- and genotyping concordantly demonstrated a high carriage rate of the invasive strain among the room-mates to a recruit with meningococcal disease. Transmission to the patient most likely occurred shortly before onset of illness. The extended surveillance did, however, not identify any unexpected epidemiological links and restriction of antibiotic chemoprophylaxis to household/sleeping/kissing contacts in sporadic cases of meningococcal disease seems appropriate and relevant.

Eighty-one patients with metastatic or locally advanced colorectal cancer were treated at four oncological centers in Denmark with a regimen consisting of 5-fluorouracil 400 mg/m2 and leucovorin 20 mg/m2 for 5 consecutive days every 4 weeks. The response rate was 21% among all 81 patients (CR 3, PR 14). The median survival was 10 months regardless of measurability, sex and location of disease. Toxicity was mild, 6 (7%) patients were excluded from the study due to gastrointestinal side-effects and 15 (19%) patients had the 5-FU dose reduced due to side-effects. The results are comparable to those of other studies using different doses of leucovorin.