RESUMO
During treatment, children with acute lymphoblastic leukemia (ALL) gain fat mass and lose skeletal muscle mass. The great majority live in low- and middle-income countries with few studies of their body composition and none addressing the hypothesis that the disease itself contributes to nutritional morbidity. At diagnosis, children with ALL were compared to their siblings on socioeconomic status (SES). Nutritional status was assessed by mid-upper arm circumference (MUAC)-for-age Z scores and body composition by dual energy x-ray absorptiometry (DXA). Median SES scores for the patients (47.5) and their siblings (47.0) were very similar (P = 0.5). MUAC Z scores for patients aged >5 years were lower than for siblings (P < 0.001). On DXA siblings had a higher mean appendicular lean mass index Z score, a surrogate of skeletal muscle mass, than patients (P = 0.019). A logistic model to estimate the odds ratio (OR) of being severely/moderately under-nourished (classified by MUAC Z score) by SES revealed that, compared with siblings (n = 49), children with ALL (n = 60) had a higher probability of being under-nourished (OR 5.25, 95% CI 1.44-25.95, P = 0.02). The results support the hypothesis that children at diagnosis of ALL in Guatemala are more nutritionally depleted than their apparently healthy siblings.
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This report describes the results of an observational study dedicated to rhabdomyosarcoma developed by the Asociación de Hemato-oncología Pediatrica de Centro América (AHOPCA) between 2001 and 2018. Overall, 337 previously untreated patients < 18 years old were included in the analysis; 58% had unresected disease, and 19% were metastatic at diagnosis. With a median follow-up of 6.6 years, five-year event-free and overall survival rates were 30% and 33%, respectively. Local progression/relapse was the main cause of treatment failure.
Assuntos
Países em Desenvolvimento , Rabdomiossarcoma , Humanos , Lactente , Adolescente , Recidiva Local de Neoplasia/terapia , Rabdomiossarcoma/epidemiologia , Rabdomiossarcoma/terapia , Falha de Tratamento , Institutos de CâncerRESUMO
RESUMEN El estudio analizó el vínculo entre la didáctica de maestros y las habilidades cognoscitivas de atención, memoria, velocidad y fluidez verbal en estudiantes de primeros grados de un colegio público en Cúcuta-Colombia. Se propuso un diseño exploratorio concurrente con análisis cualitativo y recolección de datos de fuente mixta, con muestreo intencional de 22 estudiantes y 4 maestras. Se evaluaron habilidades cognoscitivas mediante pruebas neuropsicológicas estandarizadas para Colombia y la didáctica fue explorada mediante entrevista semiestructurada siguiendo categorías de enseñanza, aprendizaje y técnicas. Las habilidades cognoscitivas se analizaron mediante estadística descriptiva y las entrevistas por análisis de triangulación categorial, concluyendo en los niños sobresaliente memoria-velocidad y disminuida atención y fluidez verbal, hallazgos sobresalientes vinculados a didácticas basadas en uso de fichas de aprendizaje, repetición, mecanización, mientras que los resultados inferiores se asociaron al uso de video y pasatiempos.
RESUMO O estudo analisou a relação entre a didática de professores e as habilidades cognoscitivas de atenção, memória, velocidade e fluidez verbal em estudantes de primeiros anos de uma escola pública em Cúcuta - Colômbia. Utilizou-se um roteiro exploratório junto com análises qualitativa e levantamento de dados de fonte mista, com amostra intencional de 22 estudantes e 4 professores. Avaliaram-se habilidades cognoscitivas mediante testes neuropsicológicos normatizados para Colômbia e a didática foi explorada mediante entrevista semiestruturada seguindo categorias de ensino, aprendizagem e técnicas. As habilidades cognoscitivas foram analisadas mediante estatística descritiva e as entrevistas por análise de triangulação categorial, concluindo-se nas crianças importantes memória-velocidade e diminuída atenção e fluidez verbal, achados marcantes vinculados a didáticas baseadas no uso de fichas de aprendizagem, repetição, mecanização, enquanto os resultados inferiores foram associados ao uso de vídeo e passatempos.
ABSTRACT The study analyzed the relationship between teacher didactics and cognitive skills of attention, memory, speed and verbal fluidity in first-year students of a public school in Cúcuta-Colombia. An exploratory script was used, together with qualitative analysis and mixed-source data collection, with an intentional sample of 22 students and 4 teachers. Cognitive abilities were evaluated through neuropsychological tests standardized for Colombia, and didactics were explored through semi-structured interviews following categories of teaching, learning and techniques. Cognitive skills were analyzed using descriptive statistics and interviews by categorical triangulation analysis, concluding in important children memory-speed and reduced attention and verbal fluidity, remarkable findings linked to didactics based on the use of learning sheets, repetition, mechanization, while lower results were associated with the use of video and hobbies.
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BACKGROUND: At least 80% of children with cancer live in low- and middle-income countries where the prevalence of malnutrition and socioeconomic disadvantage is high. We examined the relationship between nutritional status (NS), assessed by arm anthropometry, and socioeconomic status (SES) in children diagnosed with cancer at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala over a three-year period. METHOD: Patients aged 0 to 18 years of age diagnosed between January 2015 and December 2017 were included. NS was evaluated by mid-upper arm circumference, triceps skin fold thickness, and serum albumin level, and subjects were classified as adequately nourished, moderately depleted, and severely depleted nutritionally. SES was measured by a 15-item instrument developed at UNOP. RESULTS: Of 1365 patients diagnosed in the study period, 1060 (78%) fulfilled the eligibility criteria. Only 6% of patients were classified as medium to high, the remainder as medium-low to extremely low SES. Almost 47% were severely depleted at diagnosis, 19% moderately depleted, and 34% adequately nourished. SES was shown to be a determinant of NS; with progressively lower SES, the probability of a decline in NS increased by a factor of 1.04 points (P < 0.0001). Leukemia and lymphoma were also important predictors of nutritional depletion with odds ratios of 6.08 (95% CI, 1.74-28.28; P = 0.008) for leukemias and 4.83 (95% CI, 1.33-23.03; P = 0.03) for lymphomas. CONCLUSION: Both low SES and a diagnosis of leukemia or lymphoma are strong predictors of poor NS at diagnosis in children with cancer in Guatemala.
Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Classe Social , Fatores Socioeconômicos , Adolescente , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Feminino , Seguimentos , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Estado Nutricional , Prognóstico , Estudos RetrospectivosRESUMO
Resumen Investiga la historia oral de la enfermedad de Hansen en dos comunidades de Colombia que fueron hasta 1961 lazaretos. La historia oral en torno de la enfermedad ha permitido conjugar la memoria individual con la memoria colectiva. Esta historia ha quedado en la oralidad y pocos trabajos académicos la han recopilado. Utilizamos la historia oral como método de investigación cualitativo, para analizar cómo enfermos y convivientes se posicionan ante la enfermedad y cómo atraviesa toda su existencia, resignificando los conceptos de salud y enfermedad, de normalidad y anormalidad, y cómo en sus trayectorias de vida emprendieron estrategias de resistencia que les permitiera aproximarse a la normalidad, desde sus propias significaciones socioculturales.
Abstract: The paper examines the oral history of Hansen's disease in two Colombian communities that were leper colonies until 1961. The oral history around the disease allows us to connect individuals' memories with collective memory. This history remains an oral one, and few academic studies have documented it. We use oral history as a qualitative research method in order to analyze how the patients and those who lived alongside them positioned themselves in terms of the disease and how it permeated their entire existence, re-signifying the concepts of health and disease, normality and abnormality. We examine how, over the course of their lives, they engaged in resistance strategies that allowed them to get closer to normality, in their own sociocultural terms.
Assuntos
Humanos , História do Século XX , Pacientes , Processo Saúde-Doença , Hanseníase , Entrevistas como Assunto , Colômbia , História do Século XXRESUMO
BACKGROUND: The National Pediatric Oncology Unit (UNOP) is the only pediatric hemato-oncology center in Guatemala. METHODS: Patients ages 1 to 17 years with acute lymphoblastic leukemia (ALL) were treated according to modified ALL Intercontinental Berlin-Frankfurt-Münster (IC-BFM) 2002 protocol. Risk classification was based on age, white blood cell count, immunophenotype, genetics (when available), and early response to therapy. RESULTS: From July 2007 to June 2014, 787 patients were treated, including 160 who had standard-risk ALL, 450 who had intermediate-risk ALL, and 177 who had high-risk ALL. The induction death rate was 6.6%, and the remission rate was 92.9%. The rates of death and treatment abandonment during first complete remission were 4.8% and 2.5%, respectively. At a median observation time of 3.6 years, and with abandonment considered an event, the 5-year event-free survival and overall survival estimates ( ± standard error) were 56.2% ± 2.1% and 64.1% ± 2.1%, respectively, with a 5-year cumulative incidence of relapse of 28.9% ± 2.0%. Twenty-one of 281 patients (7.5%) investigated were positive for the ets variant 6/runt-related transcription factor 1 (ETV6/RUNX1) fusion. CONCLUSIONS: A well organized center in a low-middle-income country can overcome the disadvantages of malnutrition and reduce abandonment. Outcomes remain suboptimal because of late diagnosis, early death, and a high relapse rate, which may have a partly genetic basis. Earlier diagnosis, better management of complications, and better knowledge of ALL will improve outcomes. Cancer 2017;123:436-448. © 2016 American Cancer Society.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Adolescente , Asparaginase/administração & dosagem , Criança , Pré-Escolar , Daunorrubicina/administração & dosagem , Intervalo Livre de Doença , Feminino , Guatemala/epidemiologia , Humanos , Lactente , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prednisona/administração & dosagem , Indução de Remissão , Fatores de Risco , Resultado do Tratamento , Vincristina/administração & dosagemRESUMO
The paper examines the oral history of Hansen's disease in two Colombian communities that were leper colonies until 1961. The oral history around the disease allows us to connect individuals' memories with collective memory. This history remains an oral one, and few academic studies have documented it. We use oral history as a qualitative research method in order to analyze how the patients and those who lived alongside them positioned themselves in terms of the disease and how it permeated their entire existence, re-signifying the concepts of health and disease, normality and abnormality. We examine how, over the course of their lives, they engaged in resistance strategies that allowed them to get closer to normality, in their own sociocultural terms.
Investiga la historia oral de la enfermedad de Hansen en dos comunidades de Colombia que fueron hasta 1961 lazaretos. La historia oral en torno de la enfermedad ha permitido conjugar la memoria individual con la memoria colectiva. Esta historia ha quedado en la oralidad y pocos trabajos académicos la han recopilado. Utilizamos la historia oral como método de investigación cualitativo, para analizar cómo enfermos y convivientes se posicionan ante la enfermedad y cómo atraviesa toda su existencia, resignificando los conceptos de salud y enfermedad, de normalidad y anormalidad, y cómo en sus trayectorias de vida emprendieron estrategias de resistencia que les permitiera aproximarse a la normalidad, desde sus propias significaciones socioculturales.
RESUMO
Investiga la historia oral de la enfermedad de Hansen en dos comunidades de Colombia que fueron hasta 1961 lazaretos. La historia oral en torno de la enfermedad ha permitido conjugar la memoria individual con la memoria colectiva. Esta historia ha quedado en la oralidad y pocos trabajos académicos la han recopilado. Utilizamos la historia oral como método de investigación cualitativo, para analizar cómo enfermos y convivientes se posicionan ante la enfermedad y cómo atraviesa toda su existencia, resignificando los conceptos de salud y enfermedad, de normalidad y anormalidad, y cómo en sus trayectorias de vida emprendieron estrategias deresistencia que les permitiera aproximarse a la normalidad, desde sus propias significaciones socioculturales.(AU)