[Long-term renal function in Wilms tumor survivors]. / Función renal a largo plazo en supervivientes de tumor de Wilms.

OBJETIVE: To evaluate long-term renal function and morbimortality in non-syndromic Wilms tumor (WT) survivors. METHODS: Retrospective study about WT patients treated in 1993-2017, according to SIOP protocols. Mortality, glomerular filtration rate (GFR), prevalence of hypertension and requirement of dialysis and renal transplant were evaluated. Chronic kidney disease (CKD) was defined as GFR <90 ml/min/1.73 m2. RESULTS: Thirty-nine children were treated in the 25 analyzed years. Median time of follow-up was 6 years (0.5-21 years). 48% (19 patients) debuted with stage I or II. Four cases had high-grade histo-logy. Mortality rate was 10%. GFR data were found in 37 patients. Chronic kidney disease (grade I-II) turned up in 6 patients (16%). No patient required renal replacement therapy or renal transplant. 16% of patients developed CKD in both unilateral and bilateral WT, (p>0.05); OR 1.04 (IC 95% 0.09-10.9). Identical results were obtained comparing patients treated with or without radiotherapy (16%). Children with stage I-III had CKD in 11% vs. 40% of patients with stage IV (p=0.12); OR 5.3 (IC 95% 0.61-45). None of them presented hypertension in addition. CONCLUSIONS: In the current study the prevalence of CKD was low but not negligible, although no patients required renal replacement therapy or renal transplant. Bilateral renal involvement and radiotherapy were not associated with CKD development. Metastatic disease determines a higher risk of CKD.

OBJETIVOS: Evaluar la función renal y la morbimortalidad a largo plazo, en supervivientes de tumor de Wilms (TW) no sindrómico. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con TW entre 1993-2017 tratados según protocolos SIOP. Evaluamos mortalidad, filtrado glomerular (FG), prevalencia de hipertensión arterial (HTA), necesidad de diálisis y trasplante renal. Se definió enfermedad renal crónica (ERC) como FG <90 ml/min/1,73 m2. RESULTADOS: En los 25 años analizados se trataron 39 pacientes con edad media diagnóstica de 3,6 años (0,3-11 años). Mediana de seguimiento 6 años (0,5-21 años). El 48% (19 pacientes) debutaron con estadio I o II. Cuatro pacientes presentaron histología de alto riesgo (10%). La mortalidad fue del 10%. El 16% (6 pacientes) desarrolló ERC (grados I-II). Ningún paciente precisó terapia renal sustitutoria (TRS) o trasplante. La presencia de ERC tanto en enfermedad unilateral como bilateral fue del 16%, p>0,05; OR 1,04 (IC 95% 0,09-10,9). Se obtuvieron idénticos resultados (16%) comparando pacientes que recibieron radioterapia frente a aquellos que no. Los pacientes en estadio I, II y III presentaron una prevalencia de ERC del 11% vs. 40% en estadio IV (p=0,12); OR 5,3 (IC 95% 0,61-45). Ningún paciente asoció HTA crónica. CONCLUSIONES: En el presente estudio la prevalencia de ERC en supervivientes de TW no sindrómico es baja pero no desdeñable, aunque ninguno precisó trasplante renal o TRS. La presencia de enfermedad bilateral y la radioterapia no se asociaron al desarrollo de ERC. La enfermedad metastásica condiciona un riesgo mayor de ERC.

Análisis en áreas pequeñas del cáncer pediátrico en el municipio de Murcia / Analysis of small areas of pediatric cancer in the municipality of Murcia (Spain)

INTRODUCCIÓN: Ocasionalmente, los pediatras, sobre todo los de Atención Primaria, alertan de la presencia de pequeños agrupamientos de casos de cáncer pediátrico (CP) y con frecuencia sus expectativas se ven frustradas al aplicar los métodos estadísticos. El estudio de áreas pequeñas en epidemiología espacial ha permitido realizar algunos avances en la identificación de clústeres y de los factores de riesgo medioambientales implicados. El objetivo de este trabajo es describir la incidencia del CP y la distribución espacial a nivel de sección censal, así como presentar el primer mapa urbano municipal de CP de España. MATERIAL Y MÉTODOS: Estudio descriptivo de base poblacional, por sexo, grupos de edad, subperiodos y tipo tumoral de los casos de CP diagnosticados en menores de 15 años, entre 1998 y 2013 en el municipio de Murcia. Georreferenciación de casos en el momento del diagnóstico y análisis de clústeres espaciales y espacio-temporales a nivel de sección censal mediante los estadísticos FleXScan y SatScan. RESULTADOS: Un total de 155 casos fueron diagnosticados. La incidencia global (138 por millón de niños menores de 15 años) y por tipos tumorales está dentro de los márgenes de referencia del área europea. Identificación de un clúster espacio-temporal de linfomas de Hodgkin. CONCLUSIONES: El análisis de áreas pequeñas de los casos diagnosticados de CP es una herramienta útil para identificar clústeres de casos que permita plantear hipótesis sobre las causas que originan la enfermedad y desarrollar modelos urbanos de vigilancia ambiental del cáncer infantil

INTRODUCTION: Occasionally, primary care pediatricians notice the presence of small clusters of pediatric cancer (PC), but are often frustrated by the findings after statistical analysis. The study of small areas in spatial epidemiology has led to advances in identifying clusters and the environmental risk factors involved. The purpose of this study was to describe the PC incidence and the spatial distribution at the minimum level of disaggregation possible in Murcia, presenting the first urban municipality map of PC in Spain. MATERIALS AND METHODS: A population-based descriptive study was conducted on the PC cases diagnosed in children younger than 15 years, between 1998 and 2013 in the municipality of Murcia. Cases were classified by sex, age group, and tumor type. Coordinates of home addresses at the time of diagnosis were assigned to each case, and spatial and spatio-temporal analyses were carried out at the level of census tracts, using FleXScan and SatScan. RESULTS: A total of 155 cases of PC were diagnosed during this period. The overall incidence of PC (138/106 of children under the age of 15) and the incidence for individual tumor types were within the expected ranges for Europe. A spatio-temporal cluster of Hodgkin lymphoma was identified. CONCLUSIONS: Small area analysis of PC cases may be a useful tool for the identification of PC clusters, which would allow for the generation of hypotheses regarding disease etiology, as well as developing urban models for environmental surveillance of PC

[Analysis of small areas of pediatric cancer in the municipality of Murcia (Spain)]. / Análisis en áreas pequeñas del cáncer pediátrico en el municipio de Murcia.

INTRODUCTION: Occasionally, primary care pediatricians notice the presence of small clusters of pediatric cancer (PC), but are often frustrated by the findings after statistical analysis. The study of small areas in spatial epidemiology has led to advances in identifying clusters and the environmental risk factors involved. The purpose of this study was to describe the PC incidence and the spatial distribution at the minimum level of disaggregation possible in Murcia, presenting the first urban municipality map of PC in Spain. MATERIALS AND METHODS: A population-based descriptive study was conducted on the PC cases diagnosed in children younger than 15 years, between 1998 and 2013 in the municipality of Murcia. Cases were classified by sex, age group, and tumor type. Coordinates of home addresses at the time of diagnosis were assigned to each case, and spatial and spatio-temporal analyses were carried out at the level of census tracts, using FleXScan and SatScan. RESULTS: A total of 155 cases of PC were diagnosed during this period. The overall incidence of PC (138/10(6) of children under the age of 15) and the incidence for individual tumor types were within the expected ranges for Europe. A spatio-temporal cluster of Hodgkin lymphoma was identified. CONCLUSIONS: Small area analysis of PC cases may be a useful tool for the identification of PC clusters, which would allow for the generation of hypotheses regarding disease etiology, as well as developing urban models for environmental surveillance of PC.

Programa de largo seguimiento de supervivientes de cáncer pediátrico en la Región de Murcia: preferencias y actitudes de los profesionales de Atención Primaria / Long-term follow up of childhood cancer survivors in the Murcia Region: preferences and attitudes of Primary Care professionals

OBJETIVO: Evaluar actitudes, creencias y conocimientos de los profesionales médicos de Atención Primaria acerca del seguimiento de los supervivientes de cáncer pediátrico (SCP) y divulgar el Programa de Largo Seguimiento de Supervivientes de Cáncer Pediátrico en la Región de Murcia (PLASESCAP-MUR). MATERIAL Y MÉTODOS: Estudio transversal descriptivo mediante cuestionario estructurado y autocumplimentado. Se enviaron cuestionarios a todos los profesionales médicos de Atención Primaria del Área de Salud 1 del Servicio Murciano de Salud. RESULTADOS: Tasa de respuesta del 58% (100/172). El 71 y el 22% eran médicos de familia y pediatras, respectivamente. El 49% atendió algún SCP en los últimos 5 años. El 84% refiere que nunca o pocas veces recibió un informe detallado de evaluación global del superviviente. Más del 75% encuentran bastante o muy útiles el acceso a información detallada de largo seguimiento. El 95% prefiere atender a los supervivientes conjuntamente con consulta de largo seguimiento. Un 80% considera que mejorando la calidad ambiental del entorno podría disminuir la morbimortalidad de los supervivientes. Se encontró una relación estadísticamente significativa entre años practicando medicina y percepción de importancia de algunos factores medioambientales. CONCLUSIONES: Para el largo seguimiento de los SCP parece importante aumentar la capacitación de los profesionales sanitarios de Atención Primaria y la información detallada a través de un plan personalizado de largo seguimiento de cada superviviente. PLASESCAP-MUR proporciona un seguimiento integrativo a los supervivientes de cáncer pediátrico en un modelo de atención compartida entre la Unidad de Largo Seguimiento y Atención Primaria

OBJECTIVE: To assess attitudes, beliefs and knowledge of primary medical care professionals as regards the follow-up of Childhood Cancer Survivors (CCS) and the introduction of a Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR). MATERIAL AND METHODS: Descriptive cross-sectional study using a structured, self-administered questionnaire. These questionnaires were sent to all primary medical care professionals in Murcia Health District 1. RESULTS: Response rate of 58% (100/172), with 71% and 22% being family physicians and pediatricians, respectively, of whom 49% provided medical care to a CCS in the last 5 years, with 84% reporting that they never or rarely received a detailed report of overall assessment of the survivor. More than 75% found that access to detailed follow-up information was quite or very useful; 95% prefer to consult experts when providing medical care to survivors, and 80% believe that improving the quality of the environment may decrease the morbidity and mortality of the survivors. A statistically significant relationship was found between the length of practicing medicine and the perception of the importance of environmental factors. CONCLUSIONS: It seems to be important to increase the training of primary care professionals for the long-term follow-up of CCS, as well as having the detailed information through a personalized long-term follow-up of each survivor. PLASESCAP-MUR offers an integrated follow-up to CCS in a model of shared care between Long Term Monitoring Units and Primary Care Units

Factores ambientales relacionados con la duración de la lactancia: estudio de seguimiento a 1 año / Environmental factors related with breastfeeding duration: a one year follow-up study

Objetivo: Estudiar los factores protectores y de riesgo relacionados con la duración de la lactancia materna completa (LMC) y total (LMT) en la Región de Murcia. Material y métodos: Estudio de seguimiento desde el nacimiento hasta el año de vida de 327 recién nacidos y sus familias entre 2009 y 2010. Estudio descriptivo, de supervivencia de la lactancia y regresión de Cox. Resultados: La duración media de la LMC fue de 82 días y la prevalencia a los 6 meses del 15%. La prevalencia de la LMT a los 12 meses fue del 20%. El riesgo relativo (RR) para la LMC a los 6 meses variaba según las diferentes situaciones: madre fumadora (1,79; intervalo de confianza [IC] del 95%: 1,35-2,38), ausencia de «contacto precoz» (1,18; IC del 95%: 1,08-1,28), ingesta de alcohol -al menos una bebida/semana- (1,57; IC del 95%: 1,12-2,21), arrastrar trazas de tóxicos del trabajo a casa -en ropa o zapatos- durante el embarazo (1,43; IC del 95%:1,10-1,87), estudios maternos universitarios (0,48; IC del 95%: 0,33-0,70) y duración de la baja maternal (días) (0,99, IC del 95%: 0,98-0,99). El RR para la LMT a los 12 meses también difería según el tabaquismo materno (cigarros/semana) (1,01; IC del 95%: 1,01-1,02), la duración de las experiencias previas de lactancia materna (semanas) (0,98; IC del 95%: 0,97-0,99) y el tiempo de baja maternal (días) (0,99; IC del 95%: 0,98-0,99). Conclusiones: Los programas enfocados a conseguir una lactancia materna prolongada deberían contemplar un abordaje integral que ayude a crear ambientes más saludables desde la etapa periconcepcional, que incluya eliminar la exposición a drogas legales e ilegales, disminuir la contaminación química del trabajo hacia el hogar, fortalecer el contacto precoz en el paritorio, dedicar más recursos a las mujeres con menos estudios y contemplar mecanismos legales que prolonguen la baja por maternidad (AU)

Objective: To study the risk and protective factors related for the length of breastfeeding and full breastfeeding (FB) in the Region of Murcia, Spain. Methods: Follow-up study from birth until the first year of 327 newborns and their families between 2009 and 2010. We present the descriptive study, survival analysis of breastfeeding and Cox regression model. Results: The median duration of FB was 82 days and 6 months with a prevalence of 15%. The prevalence of breastfeeding at 12 months was 20%. Relative risk (RR) for FB at 6 months: mother smoking (1.79; 95%CI: 1.35-2.38), absence of 'early skin-to-skin contact' -after the first hour- (1.18; 95%CI: 1.08-1.28), alcohol intake (at least one drink/week) (1.57; 95%CI: 1.12-2.21), take-homes exposures (chemicals from the work can come home on clothing and shoes) during pregnancy (1.43; 95%CI: 1.10-1.87), maternal university studies (0.48; 95%CI: 0.33-0.70) and maternity leave length (days) (0.99; 95%CI: 0.98-0.99). The RR for breastfeeding at 12 months: maternal smoking (cigarettes/wk) (1.01; 95%CI: 1.01-1.02), duration of previous breastfeeding experiences (weeks) (0.98; 95%CI: 0.97-0.99) and maternity leave length (days) (0.99; 95%CI: 0.98-0.99). Conclusions: A comprehensive approach that helps create healthier environments from the periconcepcional stage must be considered in the development of programs focused on achieving sustained breastfeeding. Factors to consider in program development include: the elimination of exposure to legal and illegal drugs, reduction of take-homes (para-occupational) exposures, expedite early mother-newborn contact in the delivery room, devote more resources to less educated women, and contemplate legal reforms to extend maternity leave (AU)

[Long-term follow up of childhood cancer survivors in the Murcia Region: preferences and attitudes of Primary Care professionals]. / Programa de largo seguimiento de supervivientes de cáncer pediátrico en la Región de Murcia: preferencias y actitudes de los profesionales de Atención Primaria.

OBJECTIVE: To assess attitudes, beliefs and knowledge of primary medical care professionals as regards the follow-up of Childhood Cancer Survivors (CCS) and the introduction of a Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR). MATERIAL AND METHODS: Descriptive cross-sectional study using a structured, self-administered questionnaire. These questionnaires were sent to all primary medical care professionals in Murcia Health District 1. RESULTS: Response rate of 58% (100/172), with 71% and 22% being family physicians and pediatricians, respectively, of whom 49% provided medical care to a CCS in the last 5 years, with 84% reporting that they never or rarely received a detailed report of overall assessment of the survivor. More than 75% found that access to detailed follow-up information was quite or very useful; 95% prefer to consult experts when providing medical care to survivors, and 80% believe that improving the quality of the environment may decrease the morbidity and mortality of the survivors. A statistically significant relationship was found between the length of practicing medicine and the perception of the importance of environmental factors. CONCLUSIONS: It seems to be important to increase the training of primary care professionals for the long-term follow-up of CCS, as well as having the detailed information through a personalized long-term follow-up of each survivor. PLASESCAP-MUR offers an integrated follow-up to CCS in a model of shared care between Long Term Monitoring Units and Primary Care Units.