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1.
Sci Total Environ ; 832: 154770, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35341873

RESUMO

BACKGROUND: When the COVID-19 case number reaches a maximum in a country, its capacity and management of health system face greatest challenge. METHODS: We performed a cross-sectional study on data of turning points for cases and deaths for the first three waves of COVID-19 in countries with more than 5000 cumulative cases, as reported by Worldometers and WHO Coronavirus (COVID-19) Dashboard. We compared the case fatality rates (CFRs) and time lags (in unit of day) between the turning points of cases and deaths among countries in different development stages and potential influence factors. As of May 10, 2021, 106 out of 222 countries or regions (56%) reported more than 5000 cases. Approximately half of them have experienced all the three waves of COVID-19 disease. The average mortality rate at the disease turning point was 0.038 for the first wave, 0.020 for the second wave, and 0.023 for wave 3. In high-income countries, the mortality rates during the first wave are higher than that of the other income levels. However, the mortality rates during the second and third waves of COVID-19 were much lower than those of the first wave, with a significant reduction from 5.7% to 1.7% approximately 70%. At the same time, high-income countries exhibited a 2-fold increase in time lags during the second and the third waves compared to the first wave, suggesting that the periods between the cases and deaths turning point extended. High rates in the first wave in developed countries are associated to multiple factors including transportation, population density, and aging populations. In upper middle- and lower middle-income countries, the decreasing of mortality rates in the second and third waves were subtle or even reversed, with increased mortality during the following waves. In the upper and lower middle-income countries, the time lags were about 50% of the durations observed from high-income countries. INTERPRETATION: Economy and medical resources affect the efficiency of COVID-19 mitigation and the clinical outcomes of the patients. The situation is likely to become even worse in the light of these countries' limited ability to combat COVID-19 and prevent severe outcomes or deaths as the new variant transmission becomes dominant.


Assuntos
COVID-19 , Estudos Transversais , Humanos , Renda , Densidade Demográfica , SARS-CoV-2
2.
Pediatr Blood Cancer ; 68(11): e29345, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34519435

RESUMO

INTRODUCTION: Inalignment with the World Health Organization (WHO) Global Initiative for Childhood Cancer (GICC), the International Society of Pediatric Oncology initiated a program to map global pediatric oncology services. As survival rates in Africa are low and data are scant, this continent was mapped first to identify areas with greatest need. METHODS: Beginning November 2018, an electronic survey was sent to all known stakeholders, followed by email communications and internet searches to verify data. Availability of pediatric oncologists, chemotherapy, surgical expertise, and radiotherapy was correlated with geographic region, World Bank income status, Universal Health Coverage, population < 15 and < 24 years, percentage of gross domestic product spent on healthcare, and Human Development Index (HDI). RESULTS: Responses were received from 48/54 African countries. All three treatment modalities were reportedly available in 9/48 countries, whereas seven countries reported no pediatric oncology services. Negative correlations were detected between provision of all three services and geographic region (P = 0.01), younger median population age (P = 0.002), low-income country status (P = 0.045), and lower HDI (P < 0.001). CONCLUSION: This study provides a comprehensive overview of pediatric oncology care in Africa, emphasizing marked disparities between countries: some have highly specialized services, whereas others have no services. A long-term strategy to eliminate disparities in African pediatric cancer care should be aligned with the WHO GICC aims and facilitated by SIOP Africa. MEETING ABSTRACTS: SIOP maps pediatric oncology services in Africa to address inequalities in childhood cancer services. Geel J, Ranasinghe N, Davidson A, Challinor J, Howard S, Wollaert S, Myezo K, Renner L, Hessissen L, Bouffet E. 51st Annual Congress of the International Society of Paediatric Oncology (SIOP), Lyon, France, October 2019. Pediatric Blood and Cancer Vol 66 S219-S219. Pediatric cancer care in Africa: SIOP Global Mapping Program report on economic and population indicators.


Assuntos
Oncologia , Neoplasias , Pediatria , África , Criança , Humanos , Oncologia/tendências , Neoplasias/epidemiologia , Neoplasias/terapia , Pediatria/tendências , Fatores Socioeconômicos , Inquéritos e Questionários , Taxa de Sobrevida
3.
Bone Marrow Transplant ; 56(3): 536-543, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32893265

RESUMO

Severe blood disorders and cancer are the leading cause of death and disability from noncommunicable diseases in the global pediatric population and a major financial burden. The most frequent of these conditions, namely sickle cell disease and severe thalassemia, are highly curable by blood or bone marrow transplantation (BMT) which can restore a normal health-related quality of life and be cost-effective. This position paper summarizes critical issues in extending global access to BMT based on ground experience in the start-up of several BMT units in middle-income countries (MICs) across South-East Asia and the Middle East where close to 700 allogeneic BMTs have been performed over a 10-year period. Basic requirements in terms of support systems, equipment, and consumables are summarized keeping in mind WHO's model essential lists and recommendations. BMT unit setup and maintenance costs are summarized as well as those per transplant. Low-risk BMT is feasible and safe in MICs with outcomes comparable to high-income countries but at a fraction of the cost. This report might be of assistance to health care institutions in MICs interested in developing hematopoietic stem cell transplantation services and strengthening context appropriate tertiary care and higher medical education.


Assuntos
Medula Óssea , Transplante de Células-Tronco Hematopoéticas , Transplante de Medula Óssea , Criança , Humanos , Oriente Médio , Qualidade de Vida
4.
Lancet Oncol ; 19(5): e252-e266, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29726390

RESUMO

In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middle-income countries over 10 years. We assessed the impact of the projects in these regions by using baseline assessments that were done in 2006. Based on these data, estimated 5-year survival in 2016 increased by a median of 5·1%, ranging from -1·5% in Venezuela to 17·5% in Ukraine. Of the 26 861 children per year who develop cancer in the ten index countries with My Child Matters projects that were evaluated in 2006, an estimated additional 1343 children can now expect an increase in survival outcome. For example, in Paraguay, a network of paediatric oncology satellite clinics was established and scaled up to a national level and has managed 884 patients since initiation in 2006. Additionally, the African Retinoblastoma Network was scaled up from a demonstration project in Mali to a network of retinoblastoma referral centres in five sub-Saharan African countries, and the African School of Paediatric Oncology has trained 42 physicians and 100 nurses from 16 countries. The My Child Matters programme has catalysed improvements in cancer care and has complemented the efforts of government, civil society, and the private sector to sustain and scale improvements in health care to a national level. Key elements of successful interventions include strong and sustained local leadership, community engagement, international engagement, and capacity building and support from government.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Países em Desenvolvimento , Disparidades em Assistência à Saúde , Oncologia/métodos , Neoplasias/terapia , Pediatria/métodos , Parcerias Público-Privadas , Adolescente , Idade de Início , Criança , Pré-Escolar , Prestação Integrada de Cuidados de Saúde/economia , Países em Desenvolvimento/economia , Disparidades em Assistência à Saúde/economia , Humanos , Renda , Lactente , Recém-Nascido , Oncologia/economia , Neoplasias/diagnóstico , Neoplasias/economia , Neoplasias/mortalidade , Pediatria/economia , Prognóstico , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Parcerias Público-Privadas/economia , Medição de Risco , Fatores de Risco
5.
Pediatr Blood Cancer ; 64 Suppl 52017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29297619

RESUMO

Many children with cancer in low- and middle-income countries are treated in hospitals lacking key infrastructure, including diagnostic capabilities, imaging modalities, treatment components, supportive care, and personnel. Childhood cancer treatment regimens adapted to local conditions provide an opportunity to cure as many children as possible with the available resources, while working to improve services and supportive care. This paper from the Adapted Treatment Regimens Working Group of the Pediatric Oncology in Developing Countries committee of the International Society of Pediatric Oncology outlines the design, development, implementation, and evaluation of adapted regimens and specifies levels of services needed to deliver them.


Assuntos
Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde , Oncologia , Neoplasias/tratamento farmacológico , Criança , Humanos , Oncologia/métodos , Oncologia/normas , Sociedades Médicas
6.
Lancet ; 387(10033): 2133-2144, 2016 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-26578033

RESUMO

Investments in cancer control--prevention, detection, diagnosis, surgery, other treatment, and palliative care--are increasingly needed in low-income and particularly in middle-income countries, where most of the world's cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities, 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US$20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.


Assuntos
Atenção à Saúde/economia , Saúde Global/economia , Neoplasias/economia , Países em Desenvolvimento/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Humanos , Renda , Neoplasias/diagnóstico , Neoplasias/mortalidade , Neoplasias/terapia
8.
Lancet Oncol ; 14(3): e104-16, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23434340

RESUMO

Patterns of cancer incidence across the world have undergone substantial changes as a result of industrialisation and economic development. However, the economies of most countries remain at an early or intermediate stage of development-these stages are characterised by poverty, too few health-care providers, weak health systems, and poor access to education, modern technology, and health care because of scattered rural populations. Low-income and middle-income countries also have younger populations and therefore a larger proportion of children with cancer than high-income countries. Most of these children die from the disease. Chronic infections, which remain the most common causes of disease-related death in all except high-income countries, can also be major risk factors for childhood cancer in poorer regions. We discuss childhood cancer in relation to global development and propose strategies that could result in improved survival. Education of the public, more and better-trained health professionals, strengthened cancer services, locally relevant research, regional hospital networks, international collaboration, and health insurance are all essential components of an enhanced model of care.


Assuntos
Neoplasias/economia , Neoplasias/epidemiologia , Criança , Pré-Escolar , Atenção à Saúde , Países Desenvolvidos , Saúde Global , Humanos , Pediatria , Fatores de Risco
9.
Lancet Oncol ; 14(3): e125-35, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23434339

RESUMO

Childhood cancer is a major global health issue. Every year, almost 100 000 children die from cancer before the age of 15 years, more than 90% of them in resource-limited countries. Here, we review the key policy issues for the delivery of better care, research, and education of professionals and patients. We present a key list of time-limited proposals focusing on change to health systems and research and development. These include sector and system reforms to make care affordable to all, policies to promote growth of civil society around both cancer and Millennium Development Goals, major improvements to public health services (particularly the introduction of national cancer plans), improved career development, and increased remuneration of specialist health-care workers and government support for childhood cancer registries. Research and development proposals focus on sustainable funding, the establishment of more research networks, and clinical research specifically targeted at the needs of low-income and middle-income countries. Finally, we present proposals to address the need for clinical trial innovation, the complex dichotomy of regulations, and the threats to the availability of data for childhood cancers.


Assuntos
Política de Saúde/economia , Neoplasias , Adolescente , Criança , Ensaios Clínicos como Assunto , Países Desenvolvidos/economia , Governo , Humanos , Neoplasias/economia , Neoplasias/epidemiologia , Pesquisa
10.
Arch Dis Child ; 98(2): 155-60, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23201550

RESUMO

Approximately 90% of children with cancer reside in low-income and middle-income countries (LMIC) where healthcare resources are scarce and allocation decisions difficult. The cost effectiveness of treating childhood cancers in these settings is unknown. The objective of the present work was to determine cost-effectiveness thresholds for common paediatric cancers using acute lymphoblastic leukaemia (ALL) in Brazil and Burkitt lymphoma (BL) in Malawi as examples. Disability-adjusted life years (DALYs) prevented by treatment were compared to the gross domestic product (GDP) per capita of each country to define cost-effectiveness thresholds using WHO-CHOICE ('CHOosing Interventions that are Cost-Effective') guidelines. The case examples were selected due to the data available and because ALL and BL both have the potential to yield significant health gains at a low cost per patient treated. The key findings were as follows: the 3:1 cost/DALY prevented to GDP/capita ratio for ALL in Brazil was US $771,225; expenditures below this threshold were cost effective. Costs below US $257,075 (1:1 ratio) were considered very cost effective. Analogous thresholds for BL in Malawi were US $42,729 and US $14,243. Actual costs were far less. In Brazil, US $16,700 was spent to treat each patient while in Malawi total drug costs were less than US $50 per child. In summary, treatment of certain paediatric cancers in LMIC is very cost effective. Future research should evaluate actual treatment and infrastructure expenditures to help guide policymakers.


Assuntos
Linfoma de Burkitt/economia , Leucemia Linfoide/economia , Adolescente , Brasil , Linfoma de Burkitt/tratamento farmacológico , Criança , Pré-Escolar , Análise Custo-Benefício , Países em Desenvolvimento , Custos de Cuidados de Saúde , Humanos , Renda , Lactente , Leucemia Linfoide/tratamento farmacológico , Malaui , Avaliação de Resultados em Cuidados de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento
11.
PLoS One ; 7(8): e43639, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22928008

RESUMO

BACKGROUND: Infection remains the most common cause of death from toxicity in children with cancer in low- and middle-income countries. Rapid administration of antibiotics when fever develops can prevent progression to sepsis and shock, and serves as an important indicator of the quality of care in children with acute lymphoblastic leukemia and acute myeloid leukemia. We analyzed factors associated with (1) Longer times from fever onset to hospital presentation/antibiotic treatment and (2) Sepsis and infection-related mortality. METHOD: This prospective cohort study included children aged 0-16 years with newly diagnosed acute leukemia treated at Benjamin Bloom Hospital, San Salvador. We interviewed parents/caregivers within one month of diagnosis and at the onset of each new febrile episode. Times from initial fever to first antibiotic administration and occurrence of sepsis and infection-related mortality were documented. FINDINGS: Of 251 children enrolled, 215 had acute lymphoblastic leukemia (85.7%). Among 269 outpatient febrile episodes, median times from fever to deciding to seek medical care was 10.0 hours (interquartile range [IQR] 5.0-20.0), and from decision to seek care to first hospital visit was 1.8 hours (IQR 1.0-3.0). Forty-seven (17.5%) patients developed sepsis and 7 (2.6%) died of infection. Maternal illiteracy was associated with longer time from fever to decision to seek care (P = 0.029) and sepsis (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.09-8.63; P = 0.034). More infectious deaths occurred in those with longer travel time to hospital (OR 1.36, 95% CI 1.03-1.81; P = 0.031) and in families with an annual household income

Assuntos
Antibacterianos/uso terapêutico , Febre/complicações , Sepse/diagnóstico , Sepse/tratamento farmacológico , Classe Social , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , El Salvador/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Leucemia/complicações , Masculino , Sepse/complicações , Sepse/mortalidade , Fatores de Tempo
12.
Pediatr Blood Cancer ; 58(4): 492-7, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22147674

RESUMO

Uneven strides in research and care have led to discrepancies in childhood cancer outcomes between high and low income countries (LICs). Collaborative research may help improve outcomes in LICs by generating knowledge for local scientific communities, augmenting knowledge translation, and fostering context-specific evaluation of treatment protocols. However, the risks of such research have received little attention. This paper investigates the relationship between pediatric oncology research in LICs and four core issues in the ethics literature: standard of care, trial benefits, ethics review, and informed consent. Our aims are to highlight the importance of this field and the need for further inquiry.


Assuntos
Bioética , Pesquisa Biomédica , Países em Desenvolvimento/economia , Oncologia , Pesquisa Biomédica/economia , Pesquisa Biomédica/ética , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Oncologia/economia , Oncologia/ética
13.
Eur J Cancer ; 44(16): 2388-96, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18799306

RESUMO

Despite increasing globalisation, international mobility and economic interdependence, 9.7 million children aged less than 5 years in low income countries will die this year, almost all from preventable or treatable diseases. Diarrhoea, pneumonia and malaria account for 5 million of these deaths each year, compared to about 150,000 deaths from childhood cancer in low- and middle-income countries. In high-income countries, 80% of the 50,000 children diagnosed with cancer each year survive, yet cancer remains the leading disease-related cause of childhood death. In low- and middle-income countries, where 80% of children live, the 200,000 children diagnosed with cancer each year have limited access to curative treatment, and only about 25% survive. Some might argue that death from paediatric cancer in poor countries is insignificant compared to death from other causes, and that scarce health resources may be better used in other areas of public health. Is there a role for the treatment of children with cancer in these regions? Do international partnerships or 'twinning' programmes enhance local health care or detract from other public health priorities? What is ethical and what is possible? This review examines the health challenges faced by infants and children in low-income countries, and assesses the role and impact of international paediatric oncology collaboration to improve childhood cancer care worldwide.


Assuntos
Serviços de Saúde da Criança/organização & administração , Prioridades em Saúde , Oncologia/organização & administração , Neoplasias/terapia , Pediatria/organização & administração , Adolescente , Antineoplásicos/provisão & distribuição , Pesquisa Biomédica , Institutos de Câncer/organização & administração , Institutos de Câncer/normas , Causas de Morte , Criança , Serviços de Saúde da Criança/normas , Pré-Escolar , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Saúde Global , Pessoal de Saúde/educação , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Cooperação Internacional , Masculino , Oncologia/normas , Neoplasias/mortalidade , Pediatria/normas , Prática Profissional , Sistema de Registros
14.
Lancet Oncol ; 9(8): 721-9, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18672210

RESUMO

BACKGROUND: Childhood-cancer survival is dismal in most low-income countries, but initiatives for treating paediatric cancer have substantially improved care in some of these countries. The My Child Matters programme was launched to fund projects aimed at controlling paediatric cancer in low-income and mid-income countries. We aimed to assess baseline status of paediatric cancer care in ten countries that were receiving support (Bangladesh, Egypt, Honduras, Morocco, the Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam). METHODS: Between Sept 5, 2005, and May 26, 2006, qualitative face-to-face interviews with clinicians, hospital managers, health officials, and other health-care professionals were done by a multidisciplinary public-health research company as a field survey. Estimates of expected numbers of patients with paediatric cancer from population-based data were used to project the number of current and future patients for comparison with survey-based data. 5-year survival was postulated on the basis of the findings of the interviews. Data from the field survey were statistically compared with demographic, health, and socioeconomic data from global health organisations. The main outcomes were to assess baseline status of paediatric cancer care in the countries and postulated 5-year survival. FINDINGS: The baseline status of paediatric oncology care varied substantially between the surveyed countries. The number of patients reportedly receiving medical care (obtained from survey data) differed markedly from that predicted by population-based incidence data. Management of paediatric cancer and access to care were poor or deficient (ie, nonexistent, unavailable, or inconsistent access for most children with cancer) in seven of the ten countries surveyed, and accurate baseline data on incidence and outcome were very sparse. Postulated 5-year survival were: 5-10% in Bangladesh, the Philippines, Senegal, Tanzania, and Vietnam; 30% in Morocco; and 40-60% in Egypt, Honduras, Ukraine, and Venezuela. Postulated 5-year survival was directly proportional to several health indicators (per capita annual total health-care expenditure [Pearson's r(2)=0.760, p=0.001], per capita gross domestic product [r(2)=0.603, p=0.008], per capita gross national income [r(2)=0.572, p=0.011], number of physicians [r(2)=0.560, p=0.013] and nurses [r(2)=0.506, p=0.032] per 1000 population, and most significantly, annual government health-care expenditure per capita [r(2)=0.882, p<0.0001]). INTERPRETATION: Detailed surveys can provide useful data for baseline assessment of the status of paediatric oncology, but cannot substitute for national cancer registration. Alliances between public, private, and international agencies might rapidly improve the outcome of children with cancer in these countries.


Assuntos
Serviços de Saúde da Criança/economia , Proteção da Criança/economia , Apoio Financeiro , Renda , Oncologia/organização & administração , Pediatria/normas , Criança , Serviços de Saúde da Criança/normas , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento , Feminino , Pesquisas sobre Atenção à Saúde , Gastos em Saúde , Humanos , Lactente , Masculino , Oncologia/economia , Oncologia/normas , Neoplasias/mortalidade , Neoplasias/terapia , Pediatria/economia , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Fatores Socioeconômicos , Análise de Sobrevida
15.
Cancer ; 112(3): 461-72, 2008 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-18072274

RESUMO

Global studies of childhood cancer provide clues to cancer etiology, facilitate prevention and early diagnosis, identify biologic differences, improve survival rates in low-income countries (LIC) by facilitating quality improvement initiatives, and improve outcomes in high-income countries (HIC) through studies of tumor biology and collaborative clinical trials. Incidence rates of cancer differ between various ethnic groups within a single country and between various countries with similar ethnic compositions. Such differences may be the result of genetic predisposition, early or delayed exposure to infectious diseases, and other environmental factors. The reported incidence of childhood leukemia is lower in LIC than in more prosperous countries. Registration of childhood leukemia requires recognition of symptoms, rapid access to primary and tertiary medical care (a pediatric cancer unit), a correct diagnosis, and a data management infrastructure. In LIC, where these services are lacking, some children with leukemia may die before diagnosis and registration. In this environment, epidemiologic studies would seem to be an unaffordable luxury, but in reality represent a key element for progress. Hospital-based registries are both feasible and essential in LIC, and can be developed using available training programs for data managers and the free online Pediatric Oncology Networked Data Base (www.POND4kids.org), which allows collection, analysis, and sharing of data.


Assuntos
Países em Desenvolvimento , Neoplasias/epidemiologia , Pobreza , Adolescente , Criança , Pré-Escolar , Atenção à Saúde/organização & administração , Humanos , Incidência , Modelos Estatísticos , Sistema de Registros
16.
Pediatr Blood Cancer ; 48(5): 598-9, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-16883599

RESUMO

Treatment of hematologic disorders in low-income countries (LIC) is difficult. This report summarizes treatment of sickle cell disease and aplastic anemia by pediatric hematologists from 15 LIC who participate in the Monza International School of Pediatric Hematology/Oncology (MISPHO). Patients with severe sickle cell disease were treated with low dose hydroxyurea, which safely reduced vaso-occlusive crises. Patients with severe aplastic anemia fared poorly due to lack of availability and high cost of anti-thymocyte globulin and cyclosporine and lack of access to stem cell transplantation. Appropriate therapy was most likely to occur in MISPHO centers with an active twinning program with a center in a high-income country.


Assuntos
Anemia Aplástica/terapia , Anemia Falciforme/tratamento farmacológico , Hidroxiureia/uso terapêutico , Soro Antilinfocitário/economia , Soro Antilinfocitário/uso terapêutico , Criança , Ciclosporina/economia , Ciclosporina/uso terapêutico , Países em Desenvolvimento , Humanos , Cooperação Internacional , América Latina
17.
Pediatr Blood Cancer ; 49(6): 817-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17009236

RESUMO

BACKGROUND: In developed countries, more than 90% of children with retinoblastoma present with limited-stage disease and are cured; however, in countries with limited resources, like Honduras, most patients present with advanced disease and cure rates are less than 50%. Early diagnosis is necessary to improve the survival of children with retinoblastoma in these countries. PROCEDURE: We describe the preliminary results of a retinoblastoma education program linked to a national vaccination campaign in Honduras. Posters and flyers were designed to be accessible to poorly educated readers, to convey the severity of retinoblastoma, and to provide contact information. Charts and an electronic database were reviewed to determine age at diagnosis, presenting signs and symptoms, date of diagnosis, and outcome. RESULTS: During the eight previous years (July 1995-June 2003), 73% of the 59 diagnosed cases of retinoblastoma were extraocular; in contrast, during the post-campaign period (June 2003-January 2005), only 35% of the 23 diagnosed cases showed extraocular spread (P = 0.002). More than one-third of patients in both time periods either refused therapy or abandoned treatment. CONCLUSION: This inexpensive approach is an effective first step toward improving survival of childhood retinoblastoma. Abandonment and refusal of therapy are continuing obstacles.


Assuntos
Educação Médica Continuada , Neoplasias Oculares/diagnóstico , Retinoblastoma/diagnóstico , Criança , Pré-Escolar , Bases de Dados Factuais , Diagnóstico Diferencial , Intervalo Livre de Doença , Educação Médica Continuada/economia , Neoplasias Oculares/economia , Neoplasias Oculares/mortalidade , Neoplasias Oculares/terapia , Feminino , Honduras , Humanos , Masculino , Retinoblastoma/economia , Retinoblastoma/mortalidade , Retinoblastoma/terapia , Estudos Retrospectivos , Taxa de Sobrevida , Vacinação
18.
Transfus Med Rev ; 21(1): 1-12, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17174216

RESUMO

Febrile nonhemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine premedication before more than 50% of blood component transfusions. Acetaminophen and diphenhydramine are effective therapies for fever and allergy, respectively, so their use in transfusion has some biologic rationale. However, these medications also have potential toxicity, particularly in ill patients, and in the studies performed to date, they have failed to prevent transfusion reactions. Whether the benefits of routine prophylaxis with acetaminophen and diphenhydramine outweigh their risks and cost requires reexamination, particularly in light of the low reaction rates reported at many institutions even when premedication is not prescribed.


Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Antialérgicos/uso terapêutico , Transfusão de Componentes Sanguíneos/efeitos adversos , Difenidramina/uso terapêutico , Hipersensibilidade/prevenção & controle , Acetaminofen/efeitos adversos , Acetaminofen/economia , Analgésicos não Narcóticos/efeitos adversos , Analgésicos não Narcóticos/economia , Antialérgicos/efeitos adversos , Transfusão de Componentes Sanguíneos/economia , Transfusão de Componentes Sanguíneos/mortalidade , Difenidramina/efeitos adversos , Difenidramina/economia , Febre/economia , Febre/etiologia , Febre/mortalidade , Febre/prevenção & controle , Humanos , Hipersensibilidade/economia , Hipersensibilidade/etiologia , Hipersensibilidade/mortalidade
19.
Lancet ; 362(9385): 706-8, 2003 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-12957095

RESUMO

The causes of treatment failure in childhood acute lymphoblastic leukaemia are thought to differ between resource-rich and resource-poor countries. We assessed the records of 168 patients treated for this disease in Honduras. Abandonment of treatment (n=38), the main cause of failure, was associated with prolonged travel time to the treatment facility (2-5 h: hazard ratio 3.1, 95% CI 1.2-8.1 vs >5 h: 3.7, 1.3-10.9) and age younger than 4.5 years (2.6, 1.1-6.3). 35 patients died of treatment-related effects. Outcome could be substantially improved by interventions that help to prevent abandonment of therapy (such as funding for transport, satellite clinics, and support groups), and by prompt treatment of infection.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Área Carente de Assistência Médica , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Falha de Tratamento , Adolescente , Criança , Pré-Escolar , Países em Desenvolvimento/economia , Feminino , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Honduras , Humanos , Lactente , Masculino , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Fatores de Risco
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