ABSTRACT
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.
ABSTRACT
PURPOSE: This study aimed to describe and assess the regional experience of a pediatric hematology/oncology fellowship program based in Guatemala. METHODS: The Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala, is the only hospital in Central America dedicated exclusively to childhood and adolescent cancer. To address the regional need for specialists, a fellowship program in pediatric hematology/oncology was launched in 2003. The UNOP fellowship program comprises 3 years of training. Although the program is based at UNOP, it also includes rotations locally and internationally to enhance clinical exposure. The curriculum is based on international standards to cover clinical expertise, research, professionalism, communication, and health advocacy. Trainees are selected according to country or facility-level need for pediatric hematologists/oncologists, with a plan for them to be hired immediately after completing their training. RESULTS: Forty physicians from 10 countries in Latin America have completed training. In addition, there are currently 13 fellows from five countries in training. Of the graduates, 39 (98%) are now practicing in pediatric hematology/oncology in Latin America. Moreover, many of them have leadership positions within their institutions and participate in research, advocacy, and policy making. Graduates from the UNOP program contribute to institutions by providing care for an increasing number of patients with pediatric cancer. The UNOP program is the first pediatric hematology/oncology fellowship program in the world to be accredited by Accreditation Council for Graduate Medical Education-International, an international body accrediting clinical training programs. CONCLUSION: The UNOP program has trained specialists to increase the available care for children with cancer in Latin America. This regional approach to specialist training can maximize resources and serve as a model for other programs and regions.
Subject(s)
Fellowships and Scholarships , Hematology , Medical Oncology , Pediatrics , Humans , Guatemala , Hematology/education , Fellowships and Scholarships/organization & administration , Medical Oncology/education , Pediatrics/education , Child , Adolescent , Neoplasms , FemaleABSTRACT
Aproximadamente el 70 por ciento de las muertes de niños menores de 5 años están asociadas con una o más de las enfermedades prevalentes de la infancia. En la actualidad el 50 por ciento de niños menores de 5 años sufren algún grado de desnutrición; razón por la cual se decide realizar el presente estudio que consisten en un diseño operativo cuasi-experimental de series de tiempo; para el efecto se tomó un grupo de niños/niñas (64), clasificados de acuerdo a la curva de hogar de la AIEPI en peso no muy bajo y peso muy bajo con o sin problemas de alimentación con edades comprendidas entre 2 meses y 2 años, con dos controles ponderales previos en quienes se aplicó el esquema de tratamiento de la desnutrición AIEPI; utilizando la hoja de registro de atención, para evaluar el inicio de la recuperación nutricional. La intervención nutricional consistió en valoración clínica y antropométrica de los niños/niñas involucrados a los 0, 15 y 30 días, asesoramiento nutricional a los familiares y al personal de los centros de cuidado diario. Además a la muestra procedente de los centros de salud se realizó visitas domiciliarias. Los resultados revelan que con un buen control de las patologías prevalentes de la infancia y con una educación nutricional adecuada se consigue un mejoramiento de la condición nutricional de los niños/niñas, alcanzando un 37.5 por ciento de la muestra, la normalidad ponderal.