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

Hospedabilidade de plantas melhoradoras de solo à Rotylenchulus reniformis Linford e Oliveira (1940)

No Brasil, o nematoide reniforme é um dos principais problemas fitossanitários da cultura do algodoeiro, podendo ocasionar perdas superiores a 60% na produção. Uma forma de manejo que tem sido apontada como uma prática na redução dos danos causados por este nematoide é o uso de espécies de plantas não hospedeiras que são utilizadas como plantas melhoradoras de solo e em rotação de culturas. O objetivo do trabalho foi avaliar a hospedabilidade de espécies de plantas melhoradoras de solo ao parasitismo de Rotylenchulus renfiormis. Foram avaliadas 11 espécies de plantas melhoradoras de solo e como testemunha de suscetibilidade utilizou-se o cultivar de algodão 'CD 401' (Gossypium hirsuturm). O delineamento estatístico utilizado foi o inteiramente casualizado com 10 repetições. Baseado nos fatores de reprodução, o estilosante 'Campo Grande' (Stylosantes capitata x S. macrocephala), a Brachiaria ruziziensis, a mucuna anã (Mucuna deeringiana), o sorgo 'SI-3204' (Sorghum vulgare) e o capim moha (Setaria italica) comportaram-se como resistentes; já o milho 'IPR115' (Zea mays), o milheto 'BRS1501' (Pennisetum glaucum) e o capim pé de galinha gigante (Eleusine coracana) como imunes. No entanto, o guandu anão 'IAPAR43' (Cajanus cajan) e o guandu 'Fava Larga' (C. cajan) comportaram-se como suscetíveis, com médias de número de ovos maiores que a testemunha. De acordo com os resultados conclui-se que as espécies S. vulgare, S. italica, B. ruziziensis, M. deerringiana, Z. mays, P. glaucum, E. coracana e Stylosanthes Campo Grande podem ser utilizadas como uma opção no manejo de R. reniformis, tornando-se uma alternativa rentável para o produtor, pois poderá diminuir a população desse nematoide

The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study

Background Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and&nbsp;Asia. Methods Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income&nbsp;level. Results As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start&nbsp;shortly. Conclusions This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of&nbsp;settings.</p