Perfil de función y discapacidad en pacientes pediátricos ambulatorios con cáncer

Introducción. El cáncer infantil, aunque tiene una baja prevalencia, genera un alto impacto en las metas de desarrollo y funcionalidad esperadas para la edad, impacto que puede ser descrito utilizando la nomenclatura propuesta por la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF). Objetivo. Describir los perfiles de función y discapacidad de los pacientes menores de 18 años atendidos en consulta externa del Servicio de Rehabilitación Oncológica del Instituto Nacional de Cancerología de Bogotá (Colombia). Métodos. Estudio observacional retrospectivo de corte transversal. Se construyeron perfiles de función y discapacidad mediante análisis de correspondencia múltiple. Resultados. Se incluyeron 127 historias clínicas analizadas en tres grupos etarios. En el de 0 a 5 años (15,75%) predominó la leucemia linfoblástica (40%) y los tumores de sistema nervioso central (20%), con mayor compromiso en estructuras del sistema nervioso, funciones sensoriales y la movilidad. En el de 6 a 10 años (19,68%) el diagnóstico más frecuente fue el tumor del sistema nervioso central (56%), con mayor compromiso en dominios de actividades y participación. En el de 11 a 18 años (64,56%) predominaron los tumores osteomusculares (52,43%), con compromiso en estructuras relacionadas con el movimiento, funciones sensoriales relacionadas con el dolor, funciones neuromusculoesqueléticas y restricciones para la movilidad y para la participación en actividades principales de la vida. Conclusión. El dominio funcionalcon mayor peso estadístico en la construcción de los perfiles funcionales es el de actividades y participación, el cual debe ser evaluado con medidas ajustadas a la edad para facilitar el seguimiento de rehabilitación en términos de metas del desarrollo y participación esperada para la edad

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Prevalence of disability in cancer diagnosis patient attended by first time in oncology rehabilitation service of the National Cancer Institute E.S.E. during the period from january 2013 to december 2015

El Instituto Nacional de Cancerología E.S.E (INC) es un centro de referencia Nacional para el tratamiento integral del paciente con diagnóstico de cáncer teniendo en cuenta la aproximación desde los pilares de tratamiento en oncología (quimioterapia, cirugia oncológica y radioterapia) en conjunto con REHABILITACION ONCOLOGICA, una de las áreas de apoyo terapéutico. Revelando entonces que la Institución dispone del talento humano con las competencias profesionales y humanas, para ofrecer un tratamiento Integral, correspondientes a diagnóstico, tratamiento y la Rehabilitación Específica de este grupo poblacional. Al ser un referente nacional no sólo para tratamiento en cáncer sino como orientador en políticas en salud, la DISCAPACIDAD ASOCIADA AL CANCER corresponde a un tema importante a considerar, para el desarrollo de guías de atención en REHABILITACION INTEGRAL DEL PACIENTE CON CANCER, para ello es importante la identificación del comportamiento de la Población con Diagnóstico de cáncer, referentes al impacto funcional derivados de la enfermedad y de los tratamientos oncológicos, con desarrollo de discapacidades temporales o permanentes. Información que NO se dispone en la Institución para hacer los correspondientes análisis y organizar programas de atención que aborden de forma global el impacto de la enfermedad oncológica en las estructuras y funciones corporales que condicionan cambios en la actividad y limitaciones en la participación. Por lo anterior y apoyados en la declaración presentada en el Informe Mundial sobre la Discapacidad del año 2011 integrado al Plan de Acción de la Organización Mundial de la Salud (OMS) 2014 – 2021 « Mejor salud para las personas con discapacidad »2, donde la OMS reconoce la discapacidad como un problema mundial de salud pública, una cuestión de derechos humanos y una prioridad del desarrollo, el grupo de Profesionales del Servicio de Rehabilitación Oncológica del Instituto Nacional de Cancerología E.S.E. proponen el hacer un análisis juicioso de la información disponible desde el año 2013 hasta el 2015, para dar el primer paso en dos de las nueve (9) recomendaciones emitidas por la Organización Mundial de la Salud, correspondientes a “Mejorar la recopilación de datos sobre discapacidad” y “ Reforzar y apoyar la investigación sobre discapacidad”The National Cancer Institute E.S.E (INC) is a national reference center for comprehensive treatment of the patient with cancer diagnosis taking into account the approach from the pillars of treatment in oncology (chemotherapy, surgery and radiation oncology) in REHABILITATION conjunction with ONCOLOGICA, one of the areas of therapeutic support. revealing then the institution has human talent with professional skills and human, to offer a comprehensive treatment, corresponding to diagnosis, treatment and Specific rehabilitation of this population group. Being a national benchmark not only for cancer treatment but as a guiding policy health, cancer-related disability corresponds to an important issue to consider, for the development of care guidelines PATIENT COMPREHENSIVE REHABILITATION WITH CANCER, for it is important to identify the behavior of the Population Cancer diagnosis concerning the functional impact resulting from the disease and cancer treatments, development of temporary or permanent disabilities. Information not available at the institution to make the necessary analysis and organize care programs globally to address the impact of the disease Oncological in structures and body functions that determine changes in activity and limitations on participation. For the above and supported the statement presented at the World Report Disability 2011 Integrated Plan of Action of the World Health Organization (WHO) 2014-2021 "Better health for people with disabilities' 2, where WHO recognizes disability as a global public health problem, a question of human rights and a development priority, the group of professionals Oncological Rehabilitation Service National Cancer Institute E.S.E. propose making judicious analysis data available from 2013 to 2015, to take the first step in two of the nine (9) recommendations issued by the corresponding to World Health Organization "Improving the collection of data on disability" and "strengthen and support research on disability

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care