Atención al adolescente con cáncer. ¿Qué ha cambiado en nuestro país en una década? / Adolescent cancer care: What has changed in Spain in the past decade?

Introducción y objetivo: En el año 2012 el Grupo de trabajo de adolescentes con cáncer publicó los resultados de una encuesta sobre la asistencia a adolescentes en España como punto de partida para futuras actuaciones. Nuestro objetivo fue evaluar si las líneas de trabajo han supuesto cambios asistenciales en la última década. Material y métodos: Encuesta que consta de las mismas preguntas analizadas y publicadas en el año 2012. La encuesta se divide en: epidemiología, atención psicosocial, infraestructuras, tratamiento y seguimiento de los adolescentes con cáncer. Se envió a todos los hospitales con unidades de hematología y oncología pediátrica. Se realizó un análisis estadístico descriptivo de los resultados. Resultados: El porcentaje de pacientes hasta los 18 años tratados en unidades pediátricas ha aumentado del 35,9% al 77,5%. Las hemopatías malignas tratadas en unidades pediátricas se incrementan del 31% al 52% y los tumores sólidos del 49% al 85%. En 2012 30 (39) unidades referían que los casos nuevos de adolescentes representaban un 10%. Actualmente 14 (40) mantienen este porcentaje. Hace una década no existían unidades específicas para adolescentes con cáncer en España. Actualmente, 7 (40) centros disponen de unidades. La atención psicológica para adolescentes apenas ha variado. El seguimiento de supervivientes se realiza por especialistas pediátricos en el 82,5% de los centros. Conclusiones: El trabajo para centralizar los cuidados de adolescentes con cáncer en unidades específicas multidisciplinarias, o en su defecto pediátricas, se ve reflejado en los cambios en la atención sanitaria en nuestro país en la última década. Aún queda un largo recorrido en pilares fundamentales en el abordaje de esta población. (AU)

Introduction and objective: In 2012, the Adolescents with Cancer working group published the results of a survey on care delivery for the adolescent population in Spain as a starting point for future intervention. The aim of this nationwide survey was to outline the current situation and assess whether the implemented strategies have resulted in changes in care delivery. Material and methods: Survey consisting of the same items analysed and published in 2012. The questionnaire was structured into sections devoted to epidemiology, psychosocial care, infrastructure, treatment and follow-up of adolescents with cancer. It was submitted to all hospitals in Spain with a paediatric haematology and oncology unit. We conducted a descriptive analysis of the results. Results: The percentage of patients aged up to 18 years managed in paediatric units has increased from 35.9% to 77.5% in the past decade. The proportion of malignant blood tumours treated in paediatric units increased from 31% to 52%, and the proportion of solid tumours from 49% to 85%. In 2012, 30 units (out of 39) reported that new cases in adolescents amounted to up to 10% of the total. At present, only 14 (out of 40) continue to report this percentage. A decade ago, there were no specific adolescent cancer units in Spain. Now, 7 centres (out of 40) have specific multidisciplinary units. There has been little change in psychological support services for adolescents. The follow-up of survivors is carried out by paediatric specialists in 82.5% of the hospitals. Conclusions: The efforts made to centralise the care of adolescents with cancer in specific multidisciplinary adolescent units or, failing that, paediatric units, is reflected in the changes in care delivery in Spain in the past decade. Much remains to be done in key components of the management of adolescents with cancer. (AU)

Adolescent cancer care: What has changed in Spain in the past decade?

INTRODUCTION AND OBJECTIVES: In 2012, the Adolescents with Cancer Working Group published the results of a survey on care delivery for the adolescent population in Spain as a starting point for future intervention. The aim of this nationwide survey was to outline the current situation and assess whether the implemented strategies have resulted in changes in care delivery. MATERIAL AND METHODS: Survey consisting of the same items analysed and published in 2012. The questionnaire was structured into sections devoted to epidemiology, psychosocial care, infrastructure, treatment and follow-up of adolescents with cancer. It was submitted to all hospitals in Spain with a paediatric haematology and oncology unit. We conducted a descriptive analysis of the results. RESULTS: The percentage of patients aged up to 18 years managed in paediatric units has increased from 35.9% to 77.5% in the past decade. The proportion of malignant blood tumours treated in paediatric units increased from 31% to 52%, and the proportion of solid tumours from 49% to 85%. In 2012, 30 units (out of 39) reported that new cases in adolescents amounted to up to 10% of the total. At present, only 14 (out of 40) continue to report this percentage. A decade ago, there were no specific adolescent cancer units in Spain. Now, 7 centres (out of 40) have specific multidisciplinary units. There has been little change in psychological support services for adolescents. The follow-up of survivors is carried out by paediatric specialists in 82.5% of the hospitals. CONCLUSIONS: The efforts made to centralise the care of adolescents with cancer in specific multidisciplinary adolescent units or, failing that, paediatric units, is reflected in the changes in care delivery in Spain in the past decade. Much remains to be done in key components of the management of adolescents with cancer.

Juvenile Hemochromatosis due to a Homozygous Variant in the HJV Gene.

Hemochromatosis type 2 or juvenile hemochromatosis has an early onset of severe iron overload resulting in organ manifestation such as liver fibrosis, cirrhosis, cardiomyopathy, arthropathy, hypogonadism, diabetes, osteopathic medicine, and thyroid abnormality, before age of 30. Juvenile hemochromatosis type 2a and 2b is an autosomal recessive disease caused by pathogenic variants in HJV and HAMP genes, respectively. We report a child with hepatic iron overload and family history of hemochromatosis. We aim to raise awareness of juvenile hemochromatosis, especially in families with a positive family history, as early diagnosis and treatment may prevent organ involvement and end-stage disease. The purpose of this study was to identify the gene variant that causes the disease. The genetic study was performed with a targeted gene panel: HFE, HJV, HAMP, TFR2, SLC40A1, FTL, and FTH1. We identified the variant c.309C > G (p.Phe103Leu) in the HJV gene in the homozygous state in the patient.

Teaching and Learning Modalities in Higher Education During the Pandemic: Responses to Coronavirus Disease 2019 From Spain.

The effects of the pandemic have affected and continue to affect education methods every day. The education methods are not immune to the pandemic periods we are facing, so teachers must know how to adapt their methods in such a way that teaching, and its quality, is not negatively affected. This study provides an overview of different types of teaching methodology before, during, and after the coronavirus disease 2019 (COVID-19) pandemic. This study describes the different types of teaching (e.g., presence learning, blended learning, and distance education) used in two Spanish Universities (i.e., one private and one public) during the pandemic. A new teaching methodology is proposed. The purpose of this study report is to share what we learned about the response to COVID-19. Results provide a basis for reflection about the pros and cons of teaching and learning modalities in higher education. The current situation demands that we continue to rethink what is the best methodology for teaching so that the education of students is not affected in any way. This study is useful for learning about different teaching methods that exist and which ones may suit us best depending on the context, situation, and needs of our students.

Intracapsular pressure in children with septic arthritis of the hip.

Elevated intracapsular pressure in the hip causes occlusion of the retinacular vessels and may result in avascular necrosis of the proximal femoral epiphysis (ANPFE) and growth disturbances. Our goal is to study intraarticular pressure in children with septic arthritis of the hip and its potential correlation with body weight, systemic blood pressure and the volume of synovial fluid aspirated from the joint. Thirteen septic arthritis of the hip were studied. Inclusion criteria: pain, limping, fever, leukocytosis, elevated C-reactive protein and ultrasonographic effusion >5 mm. Traumatic, inflammatory, rheumatic or tumoral origin were excluded. Mean age was 3.7 years. Girls were 58%. Mean time to articular drainage was 15 h. Arthrocentesis was performed. An STIC self-calibrating monitoring system with an error of ±1 mmHg was used. Measurements were taken: intracapsular pressure, volume of fluid aspirated, systolic and diastolic pressures and weight. Follow-up was 6.3 years. Descriptive and nonparametric tests were performed: U Mann-Whitney and Kruskal-Wallis. Statistical significance was P <0.05. Mean intracapsular pressure was 50.5 mmHg; fluid aspirated was 2.9 ml; systolic and diastolic pressures were 107.5 and 44.3 mmHg, respectively; weight was 16.2 kg. Intracapsular pressure exceeded 30 mmHg in eight children (61.5%) and was lower than 50 mmHg in 73%. Variables studied had no significance on intracapsular pressure. Complications: coxa magna in three patients (23%) and Harris lines in three (23%). Surgical drainage of septic arthritis of hip must be performed urgently, within the first 24 hours, to reduce the time with high intracapsular pressure and to avoid risk of ANPFE.

Monitoring antebrachial compartmental pressure in displaced supracondylar elbow fractures in children.

PURPOSE: Our aim was to measure antebrachial volar compartment pressure in displaced supracondylar elbow fractures in children. METHODS: We conducted a prospective, observational study of 42 fractures. The mean age was 5.2 years. There was type II displacement in nine cases (21.4%) and type III in 33 (78.6%). A wick catheter (1.5 mm in diameter) was placed perioperatively and compartmental pressure was monitored on a intra-compartmental pressure monitor system (STIC monitor) with a +/- 1 mmHg margin of error. Compartmental, systolic and diastolic pressures were measured every day for the first three postoperative days and then for a 2-week follow-up period. Descriptive statistics, t-test and correlation with a P < 0.05 significance were studied. RESULTS: Mean compartmental pressure before reduction was 8.3 mmHg and 6.7, 4, 2.4, 1.7 and 1 mmHg during the first 3 days and at 1 and 2 weeks post-reduction, respectively. Pressure decreased 40% (P = 0.0005) from the first to the second day and 75% (P = 0.0005) from the first day to the first week. There was no correlation between compartmental pressure and systolic and diastolic pressure. The compartmental pressure decreased significantly by the third postoperative day (P = 0.02). CONCLUSION: Compartmental pressure decreased 60% the first 3 days. In displaced supracondylar fractures with clinical risk factors, it is advisable to monitor compartmental pressure during the first 24-48 h.