Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- A nd middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

«Қырғи-қабақ» соғысынан кейінгі трансаймақтық жағдайлардағы голлисттік сыртқы саясат қағидалары

This article is dedicated to study one of the aspects of Charles de Gaulle`s legacy, the first President of the Fifth Republic in France, namely to his principles in foreign policy. How relevant are these principles today, in the conditions of the post cold war international relations? Key in concept of French diplomacy are terms of national independence. Whole General de Gaulle`s activity in period of exile, and in the period of presidency was devoted to general aim – to achieve true national independence of France in the international level. Official position and the concept of Gaullism in the issue of European integration was also subordinated to the task to preserve the independence of member states of the European Community. On the other hand, namely Charles de Gaulle advocated the principles of multilateralism. Despite the change of geopolitical situation after the end of the cold war, France retains basic principles of its own foreign policy founded by S. de Gaulle. The essence of these principles – preservation of national independence of France in the name of its national interests. Key words: Gaullism, French foreign policy, interregional cooperation, multilateralism, national interests

The Impact of Chinese SLOC Development within International Security Trends

Geopolitical ascendancy of China as a growing superpower entails to the development of new tendencies in the area of the international security. Chinese policy on sustaining of the energy security and active search of various crudes led to the development not only a transport and logistical strategy, but also to the shifts within strategic environment, especially in area of the India Ocean. Chinese SLOCs (Sea Lines of Communication) in the contemporary period play a crucial role under shaping and development of tendencies in the sphere of regional security. The theme and nature itself of Chinese SLOCs have a complex character and cover such areas like a transportation and logistics, foreign policy and strategy, development of military forces and PLAN capabilities. Key words: logistics and transportation, ports, tankers, PLAN (People`s Liberation Army Navy), strategy, energy

Республика Казахстан и Европейский Союз: сотрудничество в области региональной безопасности

Одним из важных во внешней политике Казахстана является европейское направление. Перспектива и необходимость развития отношений с Европейским Союзом для Казахстана определяются ролью и местом этого союза в европейской и мировой политике, экономике и культуре. Европейский Союз и Казахстан являются партнерами и проводят постоянно расширяющийся совместный диалог. С Европейским союзом Казахстан сближает общая заинтересованность в области региональной и международной безопасности, экономики, социального и культурного развития, в проведении инвестиционной деятельности, крупных международных проектов, привлечения в страну передовых технологий и знаний. Поддержание отношений нашей республики с Евросоюзом на высоком уровне является приоритетным направлением. Сотрудничество Казахстан и ЕС в своем развитии прошло несколько этапов. Современный период, свидетелями которого мы являемся, направлен на закрепление и расширение позиции ЕС на территории Центральной Азии и Каспийского региона. На сегодня ЕС уже выработал свое видение будущего Центральной Азии как региона, способного стать заслоном на пути наркотрафика, незаконной миграции и религиозного экстремизма

The Korea-Russia trade activation with the Arctic sea route cooperation

The potential for development in the Arctic Circle is wide and it is fully predictable that the development of resources in the region will accelerate further exploration of the Arctic sea route. Russia is showing high interest in developing resources that are not in the economic sanction list. Moreover, the exploration and utilization of the so-called Arctic sea route across the regional ocean is recently receiving massive attention along with the climate change. Korea and Russia have expanded the economic cooperation and now the two countries are looking for a new model of the work. They can share the goals through the further development of Russian Arctic Circle with the rapid exploitation of resources due to climate change and technological development. Korean companies have begun to bring the real economic benefits, having positive effects on related industries such as the construction of transport and special ships. There are many ways for realizing the goal, but we can specifically propose a Korea-Russia FTA. In the process of pursuing it, the government should also consider various tasks, such as harmonizing with the FTAs Korea has been signing, and dealing with the domestic law in accordance with the new FTA, based on the previous experiences. From Russia’s point of view, special circumstances such as the EAEU should be taken in consideration. The process of signing the FTA, which will serve as the international legal basis for cooperation between the partners, should be clearly marked for the purpose of ‘Sustainable Arctic Development’. Furthermore, these propositions should be able to be digested in the process of utilizing FTAs and readjusting domestic and international regulations, as well as the joint respond to the emergence of new industries, markets, and even unforeseen issues. In Korea’s perspective, it should consider the possibility that the FTA could be used in non-economic areas such as on the Korean Peninsula issue. Key words: Korea, Russia, Arctic Circle, Arctic Sea Route, Free Trade Agreement (FTA), Eurasian Economic Union (EAEU)

Западный вектор внешней политики Казахстана: состояние и перспективы

Западный вектор внешней политики Казахстана: состояние и перспектив

Main trends in combating transnational extremism and terrorism of regional and non-regional actors

The object of the research of this article is new trends in the spread of ideas of radicalism among young people in the conditions of modern geopolitical realities in Central Asia, taking into account international practice. The purpose of the article: to conduct a comprehensive scientific study aimed at identifying the causes of the spread of the ideological influence of transnational religious extremist organizations on the youth of the Central Asian countries and to prepare recommendations for the state structures of the Republic of Kazakhstan that form the system of regional and national security, taking into account the analysis of international experience and new trends in this area. Research methods: system approach, general historical methods, institutional and structural-functional analysis, level-sector analysis, scenario forecast and interdisciplinary approach, etc. The study identified effective measures to combat radicalism; studied the impact of geopolitical contradictions in the Eurasian space on the radicalization of young people in order to ensure the national and strategic interests of the Republic of Kazakhstan; analyzed the main areas of cooperation with international organizations to combat the spread of radical extremism, in order to identify opportunities to improve their effectiveness. The results obtained allow us to present recommendations and forecast estimates aimed at anticipating threats to national and regional security for state and non-state structures of the Republic of Kazakhstan. Key words: new trends, extremism, radicalism, terrorism, Central Asia

Евразийская интеграция как фактор противодействия глобальным рискам

Цели и задачи многовекторной политики Казахстана представляют собой сложную структуру. Во внутренней и внешней политике Казахстана вопросы обеспечения всеобъемлющей безопасности занимают важное место. Цель данной статьи – проанализировать вопросы обеспечения безопасности в рамках Евразийского Союза. Идея, которую предложил 1994 году Глава государства Н. Назарбаев, сегодня воплощена в создание ЕАЭС. Три страны в целях развития сотрудничества между собой и с мировым сообществом с учетом своих геополитических и геостратегических интересов создали интеграционное объединение. Евразийская интеграция имеет несколько измерений, в том числе и военно-политическое измерение, которое отражает задачи обеспечения внутренней безопасности, охраны границ и других аспектов безопасности. Казахстан вносит большой вклад в деле региональной интеграции. В рамках Евразийского Союза вопросы безопасности обеспечиваются деятельностью ОДКБ