RESUMO
BACKGROUND: Increasing representation in clinical trials is a priority for the National Cancer Institute and Children's Oncology Group (COG). Our survey of COG-affiliated institutions revealed that many sites have insufficient processes and resources to enroll children whose parents use languages other than English (LOE). We describe reported barriers and facilitators to enrolling children in clinical trials when parents use LOE and propose opportunities for improvement. PROCEDURES: We sent a 20-item survey to COG-affiliated institutions. Five items allowed respondents to expand on replies to questions about (a) local institutional review board (IRB) requirements regarding translation of consent documents, (b) contributors to provider discomfort consenting parents who use LOE, (c) available language services and resources, and (d) barriers to enrolling children whose parents use LOE or offer ideas about approaches to improvements. Two pairs of researchers independently coded free-text responses and compared results for concordance. RESULTS: A total of 139 (N = 230; 60%) institutions returned the survey. Respondents were mainly physician principal investigators (n = 79/139; 57%) at the United States sites (n = 118/139; 85%) serving less than 100 newly diagnosed children per year (n = 99/139, 71%). They described challenges at multiple levels. Proposed approaches to improvements included centralized provision of translated materials and video educational materials in various languages, and collaborating with IRBs on regulatory processes that protect families and facilitate equitable clinical trial access. CONCLUSIONS: Clinical trial consortia, such as COG, face challenges in enrolling representative samples. Further research is required to design and implement multilevel interventions to ensure equitable access for all, regardless of language used, and mitigate disparate research participation.
RESUMO
BACKGROUND: The food choices of migrants are frequently limited by lack of access to sufficient and adequate food. Food insecurity (FI) during adolescence has potential negative health consequences, however the experiences of FI of adolescent in-transit migrants have seldom been reported. OBJECTIVE: To explore the experiences of FI of adolescent in-transit migrants and their ways of coping with it. METHODS: Qualitative study, with 19 semi-structured interviews with adolescents (ages 13-19 years), in shelters for migrants in Mexico in 2022-2023. We followed a reflexive thematic analysis strategy. RESULTS: Most participants had experienced FI during the journey, and responded by limiting intake, choosing food according to price, seeking temporary work or asking for food or money in the streets. We defined "solidarity through food" as a central theme that summarized participants' experiences of sharing food with other migrants, as givers or recipients. Solidarity through food was a response to FI, benefitting the more disadvantaged (e.g. young children, those who had been robbed). Despite their young age, interviewees took part in this, giving their food to others and restricting their intake to prioritize younger siblings. DISCUSSION/CONCLUSIONS: Solidarity through food was a form of generalized reciprocity, enacted not only among family members or friends, but extended to other migrants sharing the route. In further studies, it will be important to explore the role and nuances of food sharing as a practice of social exchange of responsibility and care, on adolescent migrants' health, and in their psychological and relational development into adulthood.
Assuntos
Insegurança Alimentar , Pesquisa Qualitativa , Migrantes , Humanos , Adolescente , México , Feminino , Masculino , Migrantes/psicologia , Adulto Jovem , América Central/etnologia , Adaptação Psicológica , Abastecimento de AlimentosRESUMO
BACKGROUND: Pediatric Epstein-Barr virus-negative monomorphic post solid organ transplant lymphoproliferative disorder [EBV(-)M-PTLD] comprises approximately 10% of M-PTLD. No large multi-institutional pediatric-specific reports on treatment and outcome are available. METHODS: A multi-institutional retrospective review of solid organ recipients diagnosed with EBV(-)M-PTLD aged ≤21 years between 2001 and 2020 in 12 centers in the United States and United Kingdom was performed, including demographics, staging, treatment, and outcomes data. RESULTS: Thirty-six patients were identified with EBV(-)M-PTLD. Twenty-three (63.9%) were male. Median age (range) at transplantation, diagnosis of EBV(-)M-PTLD, and interval from transplant to PTLD were 2.2 years (0.1-17), 14 years (3.0-20), and 8.5 years (0.6-18.3), respectively. Kidney (n = 17 [47.2%]) and heart (n = 13 [36.1%]) were the most commonly transplanted organs. Most were Murphy stage III (n = 25 [69.4%]). Lactate dehydrogenase was elevated in 22/34 (64.7%) and ≥2 times upper limit of normal in 11/34 (32.4%). Pathological diagnoses included diffuse large B-cell lymphoma (n = 31 [86.1%]) and B-non-Hodgkin lymphoma (B-NHL) not otherwise specified (NOS) (n = 5 [13.9%]). Of nine different regimens used, the most common were: pediatric mature B-NHL-specific regimen (n = 13 [36.1%]) and low-dose cyclophosphamide, prednisone, and rituximab (n = 9 [25%]). Median follow-up from diagnosis was 3.0 years (0.3-11.0 years). Three-year event-free survival (EFS) and overall survival (OS) were 64.8% and 79.9%, respectively. Of the seven deaths, six were from progressive disease. CONCLUSIONS: EFS and OS were comparable to pediatric EBV(+) PTLD, but inferior to mature B-NHL in immunocompetent pediatric patients. The wide range of therapeutic regimens used directs our work toward developing an active multi-institutional registry to design prospective studies. PLAIN LANGUAGE SUMMARY: Pediatric Epstein-Barr virus-negative monomorphic post solid organ transplant lymphoproliferative disorders (EBV(-)M-PTLD) have comparable outcomes to EBV(+) PTLD, but are inferior to diffuse large B-cell lymphoma in immunocompetent pediatric patients. The variety of treatment regimens used highlights the need to develop a pediatric PTLD registry to prospectively evaluate outcomes. The impact of treatment regimen on relapse risk could not be assessed because of small numbers. In the intensive pediatric B-non-Hodgkin lymphoma chemoimmunotherapy group, 11 of 13 patients remain alive in complete remission after 0.6 to 11 years.
Assuntos
Infecções por Vírus Epstein-Barr , Linfoma Difuso de Grandes Células B , Linfoma não Hodgkin , Transtornos Linfoproliferativos , Transtornos Mieloproliferativos , Transplante de Órgãos , Criança , Humanos , Masculino , Feminino , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/epidemiologia , Herpesvirus Humano 4 , Estudos Prospectivos , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/etiologia , Linfoma não Hodgkin/complicações , Linfoma Difuso de Grandes Células B/patologia , Transtornos Mieloproliferativos/complicações , Estudos Retrospectivos , Transplante de Órgãos/efeitos adversosRESUMO
Burkitt lymphoma arising in paediatric post-solid-organ transplantation-Burkitt lymphoma (PSOT-BL) is a clinically aggressive malignancy and a rare form of post-transplant lymphoproliferative disorder (PTLD). We evaluated 35 patients diagnosed with PSOT-BL at 14 paediatric medical centres in the United States. Median age at organ transplantation was 2.0 years (range: 0.1-14) and age at PSOT-BL diagnosis was 8.0 years (range: 1-17). All but one patient had late onset of PSOT-BL (≥2 years post-transplant), with a median interval from transplant to PSOT-BL diagnosis of 4.0 years (range: 0.4-12). Heart (n = 18 [51.4%]) and liver (n = 13 [37.1%]) were the most frequently transplanted organs. No patients had loss of graft or treatment-related mortality. A variety of treatment regimens were used, led by intensive Burkitt lymphoma-specific French-American-British/Lymphomes Malins B (FAB/LMB), n = 13 (37.1%), and a low-intensity regimen consisting of cyclophosphamide, prednisone and rituximab (CPR) n = 12 (34.3%). Median follow-up was 6.7 years (range: 0.5-17). Three-year event-free and overall survival were 66.2% and 88.0%, respectively. Outcomes of PSOT-BL patients receiving BL-specific intensive regimens are comparable to reported BL outcomes in immunocompetent children. Multi-institutional collaboration is feasible and provides the basis of prospective data collection to determine the optimal treatment regimen for PSOT-BL.
Assuntos
Linfoma de Burkitt , Transtornos Linfoproliferativos , Transplante de Órgãos , Humanos , Criança , Lactente , Pré-Escolar , Adolescente , Linfoma de Burkitt/terapia , Linfoma de Burkitt/tratamento farmacológico , Transplante de Órgãos/efeitos adversos , Ciclofosfamida/uso terapêutico , Rituximab/uso terapêutico , Prednisona/uso terapêutico , Transtornos Linfoproliferativos/etiologia , Resultado do Tratamento , Estudos Retrospectivos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversosRESUMO
Postsolid organ transplant Burkitt lymphoma (PSOT-BL) is rare but more aggressive than other post-transplant lymphoproliferative disorders (PTLD). Little is known about optimal treatment and outcome of postcardiac transplant Burkitt lymphoma (BL). We report an 8-year-old boy with a history of heart transplant who developed Epstein-Barr virus positive, late-onset PSOT-BL. He was successfully treated with BL specific chemoimmunotherapy and cessation of baseline immunosuppression. In this pediatric case of PSOT-BL, the use of standard intensive pediatric based chemoimmunotherapy regimen without modifications was feasible, well tolerated and resulted in complete remission. Long-term toxicities need further study.
Assuntos
Linfoma de Burkitt , Infecções por Vírus Epstein-Barr , Transplante de Coração , Transtornos Linfoproliferativos , Linfoma de Burkitt/tratamento farmacológico , Linfoma de Burkitt/terapia , Criança , Infecções por Vírus Epstein-Barr/complicações , Transplante de Coração/efeitos adversos , Herpesvirus Humano 4 , Humanos , Transtornos Linfoproliferativos/tratamento farmacológico , MasculinoRESUMO
BACKGROUND: U.S. physicians lack training in caring for patients with obesity. For family medicine, the newly developed Obesity Medicine Education Collaborative (OMEC) competencies provide an opportunity to compare current training with widely accepted standards. We aimed to evaluate the current state of obesity training in family medicine residency programs. METHODS: We conducted a study consisting of a cross-sectional survey of U.S. family medicine residency program leaders. A total of 735 directors (including associate/assistant directors) from 472 family medicine residency programs identified from the American Academy of Family Physicians public directory were invited via postal mail to complete an online survey in 2018. RESULTS: Seventy-seven program leaders completed surveys (16% response rate). Sixty-four percent of programs offered training on prevention of obesity and 83% provided training on management of patients with obesity; however, 39% of programs surveyed reported not teaching an approach to obesity management that integrates clinical and community systems as partners, or doing so very little. Topics such as behavioral aspects of obesity (52%), physical activity (44%), and nutritional aspects of obesity (36%) were the most widely covered (to a great extent) by residency programs. In contrast, very few programs extensively covered pharmacological treatment of obesity (10%) and weight stigma and discrimination (14%). Most respondents perceived obesity-related training as very important; 65% of the respondents indicated that expanding obesity education was a high or medium priority for their programs. Lack of room in the curriculum and lack of faculty expertise were reported as the greatest barriers to obesity education during residency. Only 21% of the respondents perceived their residents as very prepared to manage patients with obesity at the end of the residency training. CONCLUSION: Family medicine residency programs are currently incorporating recommended teaching to address OMEC competencies to a variable degree, with some topic areas moderately well represented and others poorly represented such as pharmacotherapy and weight stigma. Very few program directors report their family medicine residents are adequately prepared to manage patients with obesity at the completion of their training. The OMEC competencies could serve as a basis for systematic obesity training in family medicine residency programs.
Assuntos
Internato e Residência , Benchmarking , Estudos Transversais , Currículo , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/educação , Humanos , Obesidade/prevenção & controle , Inquéritos e Questionários , Estados UnidosRESUMO
The Inaugural Symposium on Childhood Cancer Health Disparities was held in Houston, Texas, on November 2, 2016. The symposium was attended by 109 scientists and clinicians from diverse disciplinary backgrounds with interests in pediatric cancer disparities and focused on reviewing our current knowledge of disparities in cancer risk and outcomes for select childhood cancers. Following a full day of topical sessions, everyone participated in a brainstorming session to develop a working strategy for the continued expansion of research in this area. This meeting was designed to serve as a springboard for examination of childhood cancer disparities from a more unified and systematic approach and to enhance awareness of this area of need.
Assuntos
Atenção à Saúde , Neoplasias , Adolescente , Criança , Pré-Escolar , Congressos como Assunto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias/epidemiologia , Neoplasias/terapia , Fatores de Risco , TexasAssuntos
Betacoronavirus , Infecções por Coronavirus , Doenças Hematológicas , Neoplasias , Pandemias , Pneumonia Viral , Adolescente , Adulto , COVID-19 , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/terapia , Humanos , Lactente , Masculino , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Prevalência , Estudos Retrospectivos , SARS-CoV-2 , Fatores SexuaisRESUMO
BACKGROUND: A strong evidence base indicates that maternal caregivers' experience of intimate partner violence [IPV] impacts children's health, cognitive development, and risk-taking behaviors. Our objective was to review peer-reviewed literature describing the associations between a child's indirect exposure to IPV and corresponding nutrition outcomes, with a particular focus on fragile settings in low and middle-income countries [LMICs]. METHODS: We conducted a rapid evidence assessment to synthesize quantitative associations between maternal caregivers' IPV experience and children's nutrition/growth outcomes (birthweight, feeding, and growth indicators). We included peer-reviewed research, published in English or Spanish after the year 2000, conducted in fragile settings in LMICs. RESULTS: We identified 86 publications that fit inclusion criteria. Amongst all associations assessed, a maternal caregiver's experience of combined forms of IPV (physical, sexual and emotional) or physical IPV only, were most consistently associated with lower birthweight, especially during pregnancy. Women of child-bearing age, including adolescents, exposed to at least one type of IPV showed a decreased likelihood of following recommended breastfeeding practices. Lifetime maternal experience of combined IPV was significantly associated with stunting among children under 5 years of age in the largest study included, though findings in smaller studies were inconsistent. Maternal experience of physical or combined IPV were inconsistently associated with underweight or wasting in the first five years. Maternal experience of sexual IPV during pregnancy appeared to predict worsened lipid profiles among children. CONCLUSION: Maternal caregivers' experience of IPV is significantly associated with low birthweight and suboptimal breastfeeding practices, whereas studies showed inconsistent associations with child growth indicators or blood nutrient levels. Future research should focus on outcomes in children aged 2 years and older, investigation of feeding practices beyond breastfeeding, and examination of risk during time periods physiologically relevant to the outcomes. Programmatic implications include incorporation of GBV considerations into nutrition policies and programming and integrating GBV prevention and response into mother and child health and nutrition interventions in LMIC contexts.
Assuntos
Violência por Parceiro Íntimo , Recém-Nascido , Gravidez , Adolescente , Humanos , Feminino , Pré-Escolar , Peso ao Nascer , Violência por Parceiro Íntimo/psicologia , Mães/psicologia , Emoções , Recém-Nascido de Baixo PesoRESUMO
BACKGROUND: Persons who speak languages other than English are underrepresented in clinical trials, likely in part because of inadequate multilevel resources. We conducted a survey of institutions affiliated with the Children's Oncology Group (COG) to characterize current research recruitment practices and resources regarding translation and interpretation services. METHODS: In October 2022, a 20-item survey was distributed electronically to institutions affiliated with COG to assess consent practices and resources for recruiting participants who speak languages other than English to COG trials. Descriptive statistics were used to summarize responses; responses were compared by institution size and type as well as respondent role. RESULTS: The survey was sent to 230 institutions, and the response rate was 60% (n = 139). In total, 60% (n = 83) of those respondents had access to short-form consent forms. Full consent form translation was required at 50% of institutions, and 12% of institutional review boards restricted use of centrally translated consent forms. Forty-six percent (n = 64) of institutions reported insufficient funding to support translation costs; 19% (n = 26) had access to no-cost translation services. Forty-four percent (n = 61) were required to use in-person interpreters for consent discussions; the most frequently cited barrier (56%) to obtaining consent was lack of available in-person interpreters. Forty-seven percent (n = 65) reported that recruiting persons who speak languages other than English to clinical trials was somewhat or very difficult. CONCLUSIONS: Institutions affiliated with COG face resource-specific challenges that impede recruitment of participants who speak languages other than English for clinical trials. These findings indicate an urgent need to identify strategies aimed at reducing recruitment barriers to ensure equitable access to clinical trials.
Assuntos
Ensaios Clínicos como Assunto , Barreiras de Comunicação , Idioma , Seleção de Pacientes , Humanos , Criança , Tradução , Termos de Consentimento , Inquéritos e Questionários , Consentimento Livre e Esclarecido , Neoplasias/terapiaRESUMO
It is increasingly clear that social determinants of health impact health, well-being, and quality of life. How these factors can impact cancer-related mortality has only recently included the impact on childhood cancer mortality. Hoppman and colleagues examined the impact of historically prevalent poverty on children with cancer in Alabama, a state with elevated pediatric poverty. Their findings provide a revised framework for understanding the contribution of neighborhood-level factors to pediatric cancer outcomes, identifying previously unrecognized gaps and directing us toward new study approaches to better inform interventions at the individual, institutional and policy levels to improve childhood cancer survival. We provide additional commentary on the implications of these findings, unanswered questions, and considerations for the next generation of interventions to improve childhood cancer survival. See related article by Hoppmann et al., p. 380.
Assuntos
Pobreza Infantil , Neoplasias , Criança , Humanos , Alabama , Qualidade de Vida , PobrezaRESUMO
BACKGROUND: An emerging evidence base has explored the nutritional consequences of gender-based violence (GBV) perpetrated against girls during childhood/adolescence. We conducted a rapid evidence assessment of quantitative studies describing associations between GBV and girls' nutrition. METHODS: We adapted systematic review methods and included empirical, peer-reviewed studies, published after 2000 (until November, 2022), that were written in Spanish or English and reported quantitative associations between girls' exposure to GBV and nutrition outcomes. A variety of GBV forms were considered: childhood sexual abuse (CSA), child marriage, preferential feeding of boys, sexual IPV and dating violence. Nutrition outcomes included anemia, underweight, overweight, stunting, micronutrient deficiencies, meal frequency, and dietary diversity. RESULTS: In total, 18 studies were included, 13 of which were conducted in high-income countries. Most sources utilized longitudinal or cross-sectional data to quantify associations between CSA, sexual assault, and intimate partner/dating violence and elevated BMI/overweight/obesity/adiposity. Findings suggest that CSA perpetrated by parents/caregivers is associated with elevated BMI/overweight/obesity/adiposity via cortisol reactivity and depression; this relationship may be compounded by additional intimate partner/dating violence in adolescence. The effects of sexual violence on BMI are likely to emerge during a sensitive period of development between late adolescence and young adulthood. Emerging evidence was found regarding the relationship between child marriage (and the related exposure: age at first pregnancy) and undernutrition. The association between sexual abuse and reduced height and leg length was inconclusive. CONCLUSION: Given that only 18 studies were included, the relationship between girls' direct exposure to GBV and malnutrition has received little empirical attention, especially with respect to studies conducted in LMIC and fragile settings. Most studies focused on CSA and overweight/obesity, where significant associations were found. Future research should test the moderation and mediation effects of intermediary variables (depression, PTSD, cortisol reactivity, impulsivity, emotional eating) and consider sensitive periods of development. Research should also explore the nutritional consequences of child marriage.
Assuntos
Violência de Gênero , Violência por Parceiro Íntimo , Masculino , Criança , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Estudos Transversais , Sobrepeso , Hidrocortisona , ObesidadeRESUMO
Background: Although migrants in transit through Mexico have been known to consume insufficient food, data measuring food insecurity (FI) in this vulnerable population is scarce. This study assesses FI in migrants transiting Mexico by examining economic, physical and social food access. Methods: Using a mixed-methods design and a convenience sample of migrants residing in a temporary shelter in Saltillo, Coahuila in northern Mexico, we applied 1) the Food Insecurity Experience Scale (adapted), and 2) a semi-structured interview exploring FI coping strategies. Results: Of the 54 participants, 74.1% reported moderate or severe FI and 24.1% reported severe FI, especially reduced food quantity. Interviewees reported poverty, cargo train travel, and crime as FI contributing factors. All interviewees used FI coping strategies, principally altering food intake and using social resources. Many strategies reported implied negative consequences for both nutrition and general health. Conclusions: This study provides a comprehensive assessment of FI in a mobile population using a standard international measure. Results confirm widespread and severe FI, highlighting a potential humanitarian crisis requiring both national and international attention. Further research is critical to inform strategies for guaranteeing the right to food access for migrants in transit through third (non-destination) countries.
RESUMO
Food insecurity contributes to negative outcomes for health and wellbeing, and its impact may be exacerbated during periods of vulnerability. While food insecurity is both a driver and a consequence of migration, anecdotal evidence indicates that it is also common during migration when people are 'on the move', although its prevalence and severity during these periods are largely undocumented. Food security monitoring is critical to ensuring the universal right to food for migrants, and instruments must be designed which capture the unique challenges faced during these 'extra-ordinary' periods of mobility, including in the context of emergencies such as the COVID-19 pandemic. This paper reviews knowledge on food security in migrants on the move and examines how active mobility intersects with food security and its measurement. Considering the potential consequences on health and wellbeing, we call for interdisciplinary research using standard instruments to document food insecurity in migrants on the move.
Assuntos
COVID-19 , Migrantes , Humanos , Pandemias , PrevalênciaRESUMO
Background: Migration during adolescence constitutes an important stressor that particularly impacts unaccompanied minors (UAM). Adolescent UAM in the United States (U.S.) are relatively understudied, especially regarding their resilience and emotional well-being after resettlement. Small school-based studies have documented the mental health status of UAM who resettled reuniting with their parents. However, many do not resettle with parents and less is known about the degree to which post-resettlement household composition impacts resilience and emotional well-being. Methods: Our goal was to examine how migration characteristics, supports, resilience, and emotional well-being vary by UAM resettlement household composition (reunification with parents, reunification with a non-parental family member, or living in a household not containing any family members). Using a mixed-methods (quantitative-qualitative) cross-sectional approach, we assessed 46 Latin American adolescent UAM to the U.S. who resettled into these three household types. Results: Youth experienced support differently by household type, influencing their strategies for adapting and coping post-resettlement, impacting their resilience (Kruskal Wallis-H 4.8; p<0.09) and emotional well-being (Kruskal Wallis 5.3; p<0.07). Youth living in households without relatives (n = 9) had lower resilience (Fisher's exact test p<0.002) and positive affect (Fisher's exact test p<0.003) and needed to expend greater efforts to mobilize social supports than youth living with parents (n = 22) or with non-parental family members (n = 15). Conclusion: The needs and coping abilities of UAM migrants vary with the composition of their immediate receiving environment, their post-resettlement household. Understanding differences associated with these household characteristics can guide interventions to maximize emotional health and resilience.
RESUMO
PURPOSE OF REVIEW: Post-transplant lymphoproliferative disorders are a rare and heterogeneous group of diseases, where large prospective studies have been difficult to perform and treatment paradigms are often based on retrospective studies. Here, we critically analyze and present the clinical algorithms commonly used for this disease, with a special focus on the challenges and differences of the approaches in the adult and pediatric populations. RECENT FINDINGS: Clinical trials exploring combinations of immunochemotherapies with a sequential and risk-stratified strategy have demonstrated exciting results, but are hampered from specialty and age-determined silos. Approaches introducing novel-targeted therapies and cellular therapies are currently being explored with a goal of joining efforts across the pediatric and adult age spectra. We propose that future therapeutic approaches would benefit from combining pediatric and adult PTLD efforts, gaining from the experience garnered from the age- and subtype-specific tailored strategies, with the aim of limiting treatment-related toxicities while maximizing the efficacy. Joining of efforts holds enormous potential for accelerating access to novel therapeutic strategies for PTLD in the near future.
Assuntos
Transtornos Linfoproliferativos/terapia , Adulto , Antineoplásicos Imunológicos/uso terapêutico , Transplante de Medula Óssea/efeitos adversos , Criança , Humanos , Imunoterapia , Imunoterapia Adotiva , Transtornos Linfoproliferativos/etiologia , Transtornos Linfoproliferativos/imunologia , Rituximab/uso terapêutico , Transplante de Células-Tronco/efeitos adversosRESUMO
BACKGROUND: vitamin D (VD) may be a protective factor for retinoblastoma, though no temporal association has been reported during pregnancy or the child's first year of life. Serum VD concentrations are determined by both distal (DF) and proximal factors (PF). OBJECTIVE: To identify if DF and PF can predict VD insufficiency (VDI) and VD deficiency (VDD) in women of childbearing age; and to test whether maternal exposure to DF and PF during pregnancy and a child's exposure during the first 11.9 months postpartum are associated with sporadic retinoblastoma (SRb) in children. METHODS: This is a secondary analysis of data from the Epidemiology of SRb in Mexico (EpiRbMx) study and the National Health and Nutrition Survey 2018-2019 (ENSANUT 2018-2019, for its acronym in Spanish). The association of DF and PF with VDD or VDI was estimated using ENSANUT 2018-2019, and the association of DF and PF with SRb using EpiRbMx. All were estimated using logistic regression, with comparable samples selected from ENSANUT 2018-2019 and EpiRbMx. RESULTS: Altitude, latitude and obesity predicted VDI and VDD in ENSANUT women. In EpiRbMx, residence in a rural location during pregnancy increased the risk of SRb. For children, rural residence and latitude increased the risk of SRb, while the number of days exposed to the spring-summer season during months 6 to 11.9 of life was protective. CONCLUSIONS: risk of VDI and VDD in women (ENSANUT 2018-2019) increased with altitude, urban dwelling, overweight and obesity. The child and mother's place of residence, including altitude, latitude and rural classification were important predictors of SRb in EpiRbMx.
Assuntos
Retinoblastoma/sangue , Vitamina D/sangue , Adulto , Altitude , Estudos de Casos e Controles , Dieta , Feminino , Humanos , Lactente , Recém-Nascido , México/epidemiologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Gravidez , Retinoblastoma/epidemiologia , Fatores de Risco , Estações do Ano , Luz Solar , População Urbana , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologiaRESUMO
BACKGROUND: Prior ecologic studies suggest that UV exposure through sunlight to the retina might contribute to increased retinoblastoma incidence. AIMS: Our study objectives were (1) to examine the relationship between exposure to sunlight during postnatal retinal development (prior to diagnosis of sporadic disease) and the risk of retinoblastoma, and (2) to examine the relationship between sun exposure during postnatal retinal development, and the extent of disease among children with unilateral and bilateral retinoblastoma. METHODS AND RESULTS: We interviewed 511 mothers in the EpiRbMx case-control study about their child's exposure to sunlight during postnatal retinal cell division by examining three time periods prior to Rtb diagnosis coinciding with developmental stages in which outdoor activities vary. Weekly sun exposure was compared by age period, between unilateral (n = 259), bilateral (n = 120), and control (n = 132) children, accounting for two factors affecting UV exposure: residential elevation and reported use of coverings to shield eyes. For cases, association between sunlight exposure and clinical stage was examined by laterality at each age period. After adjusting for maternal education and elevation, sun exposure was lower in cases than controls in all three age periods especially during the first 6 months, and in children 12-23 months whose mothers did not cover their eyes when outdoors. In children diagnosed after 12 months of age, sun exposure during the second year of life (age 12-23 months) appeared inversely correlated (r = -0.25) with more advanced intraocular disease in bilateral Rtb children after adjusting for maternal education, residential elevation, and age of diagnosis (p < .09) consistent with effects of Vitamin D exposure on intraocular spread in earlier transgenic murine models of retinoblastoma, and suggesting potential chemopreventive strategies. CONCLUSION: Sun exposure in early childhood is protective for retinoblastoma and may decrease degree of intraocular spread in children with bilateral Rtb.
Assuntos
Oftalmopatias/prevenção & controle , Mães/estatística & dados numéricos , Neoplasias da Retina/prevenção & controle , Retinoblastoma/prevenção & controle , Luz Solar , Adulto , Estudos de Casos e Controles , Oftalmopatias/etiologia , Oftalmopatias/patologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Prognóstico , Neoplasias da Retina/etiologia , Neoplasias da Retina/patologia , Retinoblastoma/etiologia , Retinoblastoma/patologia , Fatores de Risco , Adulto JovemRESUMO
Despite anecdotal reports of food insufficiency in the overland migration through Mexico, little is known about the frequency and extent of food insecurity during this transit. In a shelter in north central Mexico, we interviewed 95 Central American migrants traveling overland to the US regarding their experiences of food insecurity in transit. 74% experienced some degree of food insecurity, ranging from having only one meal to no food at all in one or several consecutive 24 h periods. Factors associated with relatively more severe food insecurity included more days in active transit, more severe illness impacting mobility, or travel companion illness in the prior 2 weeks. Illness was predicted by a pre-migration diagnosis of chronic disease. Understanding the factors associated with relative severity of food insecurity during overland migration can inform policies for prioritizing assistance and prevention.
Assuntos
Insegurança Alimentar , Migrantes , Abastecimento de Alimentos , Hispânico ou Latino , Humanos , MéxicoRESUMO
Post-transplant lymphoproliferative disease (PTLD) is a severe complication after solid organ transplantation (SOT). Classical Hodgkin lymphoma-type (HL-) PTLD is a rare subtype, and systematic data on treatment and prognosis are lacking. We report on 17 pediatric patients with classical HL-PTLD. HL-PTLD developed late at a median of 8.1 years after SOT. It was commonly EBV-positive (16/17) and expressed both CD30 (all tumors) and CD20 (8/17 tumors). Patients were treated with chemotherapy +/- involved field radiotherapy (IF-RT) according to the respective GPOH-HD protocol tailored by stage and LDH. Overall survival at 2 and 5 years was 86% with 81% of patients surviving event-free. Six patients had additional rituximab treatment; in two it was given as upfront monotherapy and in four was given concurrently with their chemotherapy. Rituximab monotherapy did not lead to long-term remission. In conclusion, treatment of HL-PTLD with classical HL chemotherapy is effective and tolerable. New treatment modalities such as CD30-targeted or EBV-specific agents may diminish toxicity.