Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Comparison of response to 2-years’ growth hormone treatment in children with isolated growth hormone deficiency, born small for gestational age, idiopathic short stature, or multiple pituitary hormone deficiency: combined results from two large observational studies

<p>Abstract</p> <p>Background</p> <p>Few studies have compared the response to growth hormone (GH) treatment between indications such as isolated growth hormone deficiency (IGHD), born small for gestational age (SGA), idiopathic short stature (ISS), and multiple pituitary hormone deficiency (MPHD). The aim of this analysis of data, collected from two large ongoing observational outcome studies, was to evaluate growth and insulin-like growth factor-I (IGF-I) response data for children of short stature with IGHD, MPHD, SGA, or ISS following two years of treatment with the recombinant GH product Norditropin® (Novo Nordisk A/S, Bagsværd, Denmark).</p> <p>Methods</p> <p>Analysis of auxologic data from two ongoing prospective observational studies, NordiNet® International Outcomes Study (NordiNet® IOS) and NovoNet®/American Norditropin® Studies: Web-enabled Research (ANSWER) Program®.</p> <p>Results</p> <p>4,582 children aged <18 years were included: IGHD, n = 3,298; SGA, n = 678; ISS, n = 334; and MPHD, n = 272. After two years’ GH treatment, change in height standard deviation score (SDS) was +1.03 in SGA and +0.84 in ISS vs. +0.97 in IGHD (<it>p =</it> 0.047; <it>p <</it> 0.001 vs. IGHD, respectively). Height gain was comparable between IGHD and MPHD. In pre-pubertal children vs. total population, height SDS change after two years was: IGHD, +1.24 vs. +0.97; SGA, +1.17 vs. +1.03; ISS, +1.04 vs. +0.84; and MPHD, +1.16 vs. +0.99 (all <it>p</it> < 0.001).</p> <p>Conclusions</p> <p>After two years’ GH treatment, change in height SDS was greater in SGA and less in ISS, compared with IGHD; the discrepancy in responses may be due to the disease nature or confounders (i.e. age). Height SDS increase was greatest in pre-pubertal children, supporting early treatment initiation to optimize growth outcomes.</p

Uso dos recursos de Internet na Enfermagem: uma revisão Uso de los recursos de la Internet en la Enfermería: una revisión Use of Internet resources in Nursing: a review

Os recursos do sistema Internet estão cada vez mais popularizados em todas as áreas das atividades humanas na sociedade. Este artigo teve como objetivo identificar e descrever as principais modalidades de utilização da Internet pela enfermagem nas áreas de Educação, Assistência e Pesquisa. Trata-se de um estudo bibliográfico cuja fonte de dados foi a base de dados MEDLINE, usando-se expressões de pesquisa pertinentes às áreas enfocadas. Dos trabalhos referidos, 63 artigos foram selecionados. A principal utilização na área de Educação é o desenvolvimento de aplicações para promover ensino à distância; na área de Educação ao Paciente é a disponibilização de informação de saúde; na área de Assistência são as aplicações que oferecem protocolos assistenciais para promover a prática baseada em evidências e na área de Pesquisa é a coleta de dados on-line. Conclui-se que a enfermagem vem utilizando satisfatoriamente os recursos do sistema Internet e, isto tem contribuído para o próprio desenvolvimento da profissão.<br>Los recursos del sistema Internet son amplamente popularizados en la mayoria de las actividades humanas en la sociedad. Esto artículo objectiva identificar y describir las principales modalidades de utilización de la Internet por la enfermería en las areas de Educación, Asistencia y Pesquisa. Es un estudio de revisión bibliográfica cuya fuente de datos fue la base de datos MEDLINE, usandose descriptores pertinentes a las areas enfocadas. De los trabajos referidos, 63 articulos fueran selecionados. La principal utilización en la area de Educación es el desarrollo de aplicaciones para promover la educacion a distancia; en la area de Educación al Paciente es la disponibilización de información de salud; en la area de Asistencia son las aplicaciones con protocolos asistenciales para promover la practica basada en evidencias y en la area de Pesquisa es la recolecta de datos online. Se ha concluyido que la enfermería utiliza satisfactoriamente los recursos del sistema Internet y esto ha contribuido para el proprio desarrollo de la profesión.<br>Resources of Internet system are widely popularized in most of all human activities in the society. This paper aims to identify and to describe major modalities of Internet utilization in nursing areas of Education, Care, and Research. This is a bibliographic review which data source was MEDLINE database, using pertinent descriptors for the focused areas. From referred publications, it was selected 63 articles. Major utilization in Education area is the development of applications to promote distance education; in Patient Education area is the development of applications to make health information available; in Care area are the applications to make care protocols available to promote evidence-based practice, and in Research area is online data collection. It was concluded that nursing is using Internet resources in a satisfactory way, and it has contributed for the profession evolution