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

Vers une pédagogie institutionnelle /

Bibliogr.: p. 271-28

De la classe coopérative à la pédagogie institutionnelle /

V.

Vers une pédagogie institutionnelle / Aïda Vasquez, Fernand Oury ; préface du docteur Françoise Dolto

Collection : Textes à l'appui ; 18Contient une table des matièresAvec mode text

De la classe coopérative à la pédagogie institutionnelle (4 éd.) / Aïda Vasquez, Fernand Oury

Collection : Fondations ; 9Contient une table des matièresAvec mode text

Concepções da iniciação científica no ensino médio: uma proposta de pesquisa Conceptions of scientific initiation at the secondary level: a research proposal

Aborda-se, aqui, o tema da orientação acadêmica de alunos do Ensino Médio que participam do Programa de Vocação Científica (Provoc). Criado em 1986 pela Fiocruz, o Provoc consolidou-se como um modelo educacional na área de iniciação científica que ultrapassa os limites do campus de Manguinhos, no Rio de Janeiro, para difundir-se junto a outras instituições de pesquisa do país. O objetivo é propor uma análise das formas de participação de pesquisadores de renomadas instituições científicas, como orientadores de jovens que ainda não fizeram suas escolhas profissionais. A relevância estratégica desse tipo de programa institucional tem levado um grande número de pesquisadores-orientadores do Programa a refletir sobre questões e problemas, até então, abordados exclusivamente por especialistas em educação. A maioria dessas discussões resulta na formulação de propostas pedagógicas que devem ser levadas em consideração pelos atores sociais envolvidos no processo de consolidação e ampliação do Programa. Todavia, não são os resultados quantitativos, em si, que precisam ser avaliados, mas sim os argumentos que têm norteado as ações dos pesquisadores. Além da compreensão dos princípios gerais que orientaram a institucionalização do Provoc, busca-se entender como, por que e em que contextos culturais específicos se constroem as concepções da iniciação científica no Ensino Médio.<br>This work deals with the issue of the academic orientation of secondary school pupils that are taking part in the Scientific Vocation Programme (Provoc). Created in 1986 by Fiocruz, Provoc established itself as an educational model for the early stages of scientific learning. Its work in this field has gone beyond the limits of the Manguinhos campus in Rio de Janeiro and spread to a number of other research institutions in this country. The objective here is to put forward a proposal for an institutional project in which researchers from well known scientific institutions will provide guidance for those young people that have not yet made their professional choices. The strategic relevance of this type of institutional programme has encouraged a large number of the Programme's researchers-tutors to reflect upon issues and problems that - so far - had only been approached by educational experts. The ensuing discussions have often led to the formulation of pedagogical proposals that can be assessed by the very actors involved in the process of the Programme's consolidation and expansion. It is not a question of analysing the quantitative results per se, but the arguments that have guided the researchers' actions. We will be attempting to understand both the general principles that guided Provoc's institutionalisation, and how, why and in which specific cultural contexts the concepts of scientific initiation at the Secondary Level may be built