Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

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 burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Estudios de Caso sobre Ciencias Agropecuarias y Rurales en el siglo XXI.

Libro científico sobre estudios de casos en el medio agropecuario y ruralCon el advenimiento del siglo XXI y el avance de los procesos de globalización, el medio rural presenta diversos cambios económicos, sociales, políticos y culturales. Lo anterior significa que el campo es un objeto de estudio altamente dinámico, complejo e inasible. las ciencias agropecuarias y rurales, en la actualidad, requieren de un abordaje sistémico e interdisciplinario que den cuenta de la heterogeneidad de situaciones y contextos que enfrenta el campo mexicano. La presente obra agrupa 18 estudios de caso, que capturan algunas fotografías de las diversas problemáticas de la ruralidad mexicana, con lo cual se pretende dar cuenta tanto de los objetivos de estudio como de la perspectiva teórico metodológico desde que estos son abordados. lo anterior tiene que ver con el hecho de que las ciencias agropecuarias y rurales manifiestan un alto grado de observación empírica, motivo por el que los estudios de caso se convierten en la perspectiva metodológica idónea que permite ir y venir de la realidad a la teoría y viceversa para la construcción de objetos de estudio. En este volumen se aborda una gran diversidad de casos, que sintetizan la heterogeneidad de enfoques y perspectivas mediante las cuales los fenómenos agropecuarios y rurales han sido abordados en el Instituto de Ciencias Agropecuarias y Rurales de la Universidad Autónoma del Estado de México, en los últimos 30 años

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

INCIDENCIA DE LA VALORACIÓN DE ENFERMERÍA EN EL AUTOCUIDADO DEL ADULTO MAYOR

The identification of nursing diagnoses in the self-care of the elderly is essential to provide quality care. A quantitative investigation with a positivist cross-sectional approach was carried out, 50 medical records were analyzed, the type and frequency of nursing diagnoses were identified by means of an observation card, the results were in the health promotion domain, the most relevant diagnosis is the disposition to improve the management of your own health; In the nutrition domain, the risk of unstable glycemic level is 82%, in the resting activity the diagnosis of impaired walking is 90%, in the safety and protection domain, the diagnosis of risk of falls has 80%. According to the results, the prevailing diagnoses are real diagnoses, showing that although older adults maintain a degree of independence, it is necessary to reinforce educational activities to improve their self-car. Keywords: elderly, health care, nursing support. References [1]G. Vargas, M. Lozano and Q. Rina, «Aproximación Teórica del Autocuidado del adulto mayor y los paradigmas de enfermería,» Universidad Ciencia y Tecnología, vol. 1, nº número especial, 2020. [2]Organización Panamericana de Salud , La Agenda de Salud de las Américas 2008-2017, Bogotá: OPS Colombia, 2012. [3]Organización Mundial de la Salud, 10 datos del envejecimiento y la salud, Washington, D. C: Editado por OMS: http://www.who.int/features/factfiles/ageing/es/, 2018. [4]A. Maita, Riesgos de accidentes en el adulto mayor que realiza actividades de rutina, usuarios de los servicios del Centro de Salud Conde de la Vega Baja, Lima 2014, Lima, Perú: Universidad Nacional Mayor de San Marcos. Facultad de Medicina. EAP de Enfermería, 2017. [5]P. Potter, A. Perry, P. Stockert and H. Amy, Fundamentos de Enfermería, Barcelona: Elsevier, 2015. [6]R. Salcedo, B. González, A. Mendoza, V. Nava, D. Cortés and M. Eugenio, «Autocuidado para el control de la hipertensión arterial en adultos mayores ambulatorios: una aproximación a la taxonomía NANDA-NOC-NIC,» Enfermería Universitaria, vol. 9, nº 3, p. 15, 2015. [7]Organización Panamericana de la Salud , Enseñanza de la enfermeria en salud del adulto mayor, Washington: OPS, 2012. [8]M. Abreu, G. Badin, E. Franzen, E. Da Rocha, M. Rubin, E. Rejane, M. Machado and M. Moraes, «Diagnósticos de enfermería e intervenciones prevalentes en el cuidado al anciano hospitalizado,» Revista Latinoamericana de Enfermería, vol. 16, nº 4, p. 10, 2016. [9]C. González and C. Chávez, Conocimiento del cuidador sobre factores de riesgo que predisponen los accidentes domiciliarios en el adulto mayor del Centro de Salud #7 Mapasingue. 2012, Guayaquil, Ecuador: Universidad de Guayaquil, Facultad de Ciencias Médicas, Carrera de Enfermería, 2018. [10]J. Silva, S. Ramón, S. Vergaray, V. Palacios and R. Partezani, «Percepción del paciente hospitalizado respecto a la atención de enfermería en un hospital público,» Elsevier, vol. 12, nº 2, pp. 80-87, 2015. [11]L. Ponti, R. Castillo , R. Vignatti, M. Monaco and J. Nuñez, Conocimientos y dificultades del proceso de atención de enfermería en la práctica, Túlcán, Ecuador:http://www.ems.sld.cu/index.php/ems/article/view/1006/577, 2017. [12]E. De Reales, El Proceso de Atención de Enfermería., Bogotá: Facultad de enfermería. Universidad Nacional de Bogotá, 2016. [13]G. Soliz, Salud integral y derechos del adulto mayor, Cuenca- Ecuador: Universidad de Cuenca https://dspace.ucuenca.edu.ec/bitstream/123456789/23361/1/15.pdf, 2015. [14]Organización Mundial de la Salud, Adultos mayores, Washington, D. C: Editado por OMS: http://www.who.int/mediacentre/factsheets/fs381/es/, 2015. [15]P. R. Gallegos, Aprendiendo el Desarrollo Endógeno Sostenible Construyendo la Diversidad Bio-cultural., Bolivia: Plural editores. Cuarta edición., 2015. [16]A. Ocampo, Manual de Atención de Enfermería a pacientes con edad adulta., México: Editorial Panamericana. Primera Edición, 2015. [17]OREM, Modelos y teorías, Barcelona: Cientificas y Técnicas S.A, 1999. [18]M. and W. M. Burke, Enfermería gerontológica. Cuidados integrales del adulto mayor., Washington.: Editorial Harcourt Brace. Cuarta edición, 2015. [19]F. Guillén, Manual de Geriatría, Barcelona: Edita Masson. Tercera Edición., 2018. [20]NANDA INTERNACIONAL, DIAGNOSTICOS DE ENFERMERIA, 2018. [21]F. Lolas, La Familia y el Anciano.., La Habana – Cuba: Editorial Científico-Técnica. Cuarta edición. , 2012. [22]M. Ortega and D. Suarez, «Diagnósticos de enfermería mas relevantes en el autocuidado del adulto mayor,» Guayaquil, 2020. [23]L. Buitrago, L. Cordon and R. Cortés, «Niveles de ansiedad y estrés en adultos mayores en la condición de abandono Familiar,» Revista científica y profesional de la Asociación Latinoamericana para la Formación y la Enseñanza de la Psicología . Volumen 6. Número 17. 2018., pp. pp. 70-82, 2016. [24]Y. Naranjo and J. Concepción, «Importancia del autocuidado en el adulto mayor con diabetes,» Revista Finlay, pp. pp. 215 - 222, 2016.La intervención del personal de enfermería en el autocuidado del adulto mayor es indispensable para asegurar un tratamiento adecuado de la salud. En este trabajo se analizaron 50 historias clínicas para reconocer la participación de la valoración de enfermería en la salud de los adultos mayores. Los resultados revelaron que es necesaria una mayor promoción de salud, para que el paciente comprenda la importancia, y adquiera una mejor disposición hacia el autocuidado. Con respecto al aspecto nutricional, fue posible observar que el riesgo de nivel de glicemia inestable se ubica en el 82%, por lo que es necesario a su vez, hacerle saber la importancia de la nutrición adecuada. Por otro lado, en el área de la actividad física se evidenció el deterioro de ambulación, en un 90%, mientras que el riesgo de caída estuvo en un 80%. Estos resultados apuntan a la necesidad de reforzar la atención en el adulto mayor, enfocándose principalmente en las actividades formativas para su cuidado. Palabras Clave: adulto mayor, cuidados en la salud, gestión de enfermería. Referencias [1]G. Vargas, M. Lozano y Q. Rina, «Aproximación Teórica del Autocuidado del adulto mayor y los paradigmas de enfermería,» Universidad Ciencia y Tecnología, vol. 1, nº número especial, 2020. [2]Organización Panamericana de Salud , La Agenda de Salud de las Américas 2008-2017, Bogotá: OPS Colombia, 2012. [3]Organización Mundial de la Salud, 10 datos del envejecimiento y la salud, Washington, D. C: Editado por OMS: http://www.who.int/features/factfiles/ageing/es/, 2018. [4]A. Maita, Riesgos de accidentes en el adulto mayor que realiza actividades de rutina, usuarios de los servicios del Centro de Salud Conde de la Vega Baja, Lima 2014, Lima, Perú: Universidad Nacional Mayor de San Marcos. Facultad de Medicina. EAP de Enfermería, 2017. [5]P. Potter, A. Perry, P. Stockert y H. Amy, Fundamentos de Enfermería, Barcelona: Elsevier, 2015. [6]R. Salcedo, B. González, A. Mendoza, V. Nava, D. Cortés y M. Eugenio, «Autocuidado para el control de la hipertensión arterial en adultos mayores ambulatorios: una aproximación a la taxonomía NANDA-NOC-NIC,» Enfermería Universitaria, vol. 9, nº 3, p. 15, 2015. [7]Organización Panamericana de la Salud , Enseñanza de la enfermeria en salud del adulto mayor, Washington: OPS, 2012. [8]M. Abreu, G. Badin, E. Franzen, E. Da Rocha, M. Rubin, E. Rejane, M. Machado y M. Moraes, «Diagnósticos de enfermería e intervenciones prevalentes en el cuidado al anciano hospitalizado,» Revista Latinoamericana de Enfermería, vol. 16, nº 4, p. 10, 2016. [9]C. González y C. Chávez, Conocimiento del cuidador sobre factores de riesgo que predisponen los accidentes domiciliarios en el adulto mayor del Centro de Salud #7 Mapasingue. 2012, Guayaquil, Ecuador: Universidad de Guayaquil, Facultad de Ciencias Médicas, Carrera de Enfermería, 2018. [10]J. Silva, S. Ramón, S. Vergaray, V. Palacios y R. Partezani, «Percepción del paciente hospitalizado respecto a la atención de enfermería en un hospital público,» Elsevier, vol. 12, nº 2, pp. 80-87, 2015. [11]L. Ponti, R. Castillo , R. Vignatti, M. Monaco y J. Nuñez, Conocimientos y dificultades del proceso de atención de enfermería en la práctica, Túlcán, Ecuador:http://www.ems.sld.cu/index.php/ems/article/view/1006/577, 2017. [12]E. De Reales, El Proceso de Atención de Enfermería., Bogotá: Facultad de enfermería. Universidad Nacional de Bogotá, 2016. [13]G. Soliz, Salud integral y derechos del adulto mayor, Cuenca- Ecuador: Universidad de Cuenca https://dspace.ucuenca.edu.ec/bitstream/123456789/23361/1/15.pdf, 2015. [14]Organización Mundial de la Salud, Adultos mayores, Washington, D. C: Editado por OMS: http://www.who.int/mediacentre/factsheets/fs381/es/, 2015. [15]P. R. Gallegos, Aprendiendo el Desarrollo Endógeno Sostenible Construyendo la Diversidad Bio-cultural., Bolivia: Plural editores. Cuarta edición., 2015. [16]A. Ocampo, Manual de Atención de Enfermería a pacientes con edad adulta., México: Editorial Panamericana. Primera Edición, 2015. [17]OREM, Modelos y teorías, Barcelona: Cientificas y Técnicas S.A, 1999. [18]M. y. W. M. Burke, Enfermería gerontológica. Cuidados integrales del adulto mayor., Washington.: Editorial Harcourt Brace. Cuarta edición, 2015. [19]F. Guillén, Manual de Geriatría, Barcelona: Edita Masson. Tercera Edición., 2018. [20]NANDA INTERNACIONAL, DIAGNOSTICOS DE ENFERMERIA, 2018. [21]F. Lolas, La Familia y el Anciano.., La Habana – Cuba: Editorial Científico-Técnica. Cuarta edición. , 2012. [22]M. Ortega y D. Suarez, «Diagnósticos de enfermería mas relevantes en el autocuidado del adulto mayor,» Guayaquil, 2020. [23]L. Buitrago, L. Cordon y R. Cortés, «Niveles de ansiedad y estrés en adultos mayores en la condición de abandono Familiar,» Revista científica y profesional de la Asociación Latinoamericana para la Formación y la Enseñanza de la Psicología . Volumen 6. Número 17. 2018., pp. pp. 70-82, 2016. [24]Y. Naranjo y J. Concepción, «Importancia del autocuidado en el adulto mayor con diabetes,» Revista Finlay, pp. pp. 215 - 222, 2016

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. Methods We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1,2017, and Dec 31,2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. Findings The cohort included 4064 children from 149 countries. The median age at diagnosis was 23.2 months (IQR 11.0-36.5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0.8%) of 636 children from high-income countries, 55 (5.4%) of 1027 children from upper-middle-income countries, 342 (19. 7%) of 1738 children from lower-middle-income countries, and 196 (42.9%) of 457 children from low-income countries. Enudeation surgery was available for all children and intravenous chemotherapy was available for 4014 (98.8%) of 4064 children. The 3-year survival rate was 99.5% (95% CI 98.8-100.0) for children from high-income countries, 91.2% (89.5-93.0) for children from upper-middle-income countries, 80.3% (78.3-82.3) for children from lower-middle-income countries, and 57.3% (524-63-0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16.67; 95% CI 4.76-50.00), cT4 advanced tumour compared to cT1 (8.98; 4.44-18.18), and older age at diagnosis in children up to 3 years (1.38 per year; 1.23-1.56). For children aged 3-7 years, the mortality risk decreased slightly (p=0.0104 for the change in slope). Interpretation This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Y

Global Retinoblastoma Presentation and Analysis by National Income Level

This cross-sectional analysis reports the retinoblastoma stage at diagnosis across the world during a single year, investigates associations between clinical variables and national income level, and investigates risk factors for advanced disease at diagnosis. Key PointsQuestionIs the income level of a country of residence associated with the clinical stage of presentation of patients with retinoblastoma? FindingsIn this cross-sectional analysis that included 4351 patients with newly diagnosed retinoblastoma, approximately half of all new retinoblastoma cases worldwide in 2017, 49.1\% of patients from low-income countries had extraocular tumor at time of diagnosis compared with 1.5\% of patients from high-income countries. MeaningThe clinical stage of presentation of retinoblastoma, which has a major influence on survival, significantly differs among patients from low-income and high-income countries, which may warrant intervention on national and international levels. ImportanceEarly 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. ObjectivesTo 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 ParticipantsA 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 MeasuresAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. ResultsThe 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 RelevanceThis 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

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally