Morbidity and mortality rates for childhood cancer in Argentina. 2006-2008

Introducción. El cáncer en los niños es un problema importante de salud pública en un país por el número elevado de años de vida perdidos prematuramente. Objetivo. Describir la morbimortalidad por cáncer en los argentinos menores de 15 años de edad en el trienio 2006-2008. Método. Se analizaron tasas de mortalidad específicas y tasas de incidencia expresadas por millón de habitantes menores de 15 años de edad, según el tipo de tumor y por sexo. Se utilizaron datos de estadísticas vitales a partir de bases de datos provistas por la Dirección de Estadísticas e Información de Salud del Ministerio de Salud y la población de niños de entre 0 y 14 años estimada por el Instituto Nacional de Estadísticas y Censos (INDEC). En relación con los datos de morbilidad, se utilizó la información publicada por el Registro Oncopediátrico Hospitalario Argentino (ROHA). Resultados. La tasa de mortalidad por neoplasias fue de 43,8 por millón (3,5% de las muertes totales en el grupo etario) y la tasa de incidencia, de 123,7 por millón. La leucemia presentó la mayor tasa de mortalidad específica (14,9 por millón), seguida de los tumores del sistema nervioso central (12,7 por millón). Estos tumores también registraron las mayores tasas de incidencia (45,2 y 15,5 por millón respectivamente). Conclusiones. La mortalidad por tumores representó el 3,5% de las muertes en menores de 15 años de la Argentina. La leucemia y los tumores del sistema nervioso central presentaron las mayores tasas de mortalidad específica y de incidencia.Introduction. Childhood cancer is a serious public health problem in any country given the large number of years of life lost in an early manner. Objective. To describe morbidity and mortality rates for cancer in Argentinean children and adolescents younger than 15 years old in the 2006-2008 three year period. Method. Specific mortality rates and incidence rates per million inhabitants were analyzed in children and adolescents younger than 15 years old by type of tumor and gender. Vital statistics data were used based on the databases provided by the Statistics and Health Information Department of the Ministry of Health of Argentina and the population of 0-14 year old children estimated by the National Statistics and Censuses Institute of Argentina (Instituto Nacional de Estadísticas y Censos, INDEC). In relation to morbidity data, the information published by the Argentine Hospital Oncopediatric Registry (Registro Oncopediátrico Hospitalario Argentino, ROHA) was used. Results. Mortality rate from malignancies was 43.8 per million (3.5% of total deaths in this age group) and the incidence rate was 123.7 per million. Leukemia had the highest specific mortality rate (14.9 per million), followed by tumors in the central nervous system (12.7 per million). The highest incidence rates were also registered for these tumors (45.2 and 15.5 per million, respectively). Conclusions. Mortality from malignancies accounted for 3.5% of deaths in children and adolescents younger than 15 years old in Argentina. Leukemia and tumors in the central nervous system had the highest specific mortality and incidence rates.Fil: Pujol, Celine Jeanne Aurelie. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones y Estudio Sobre Cultura y Sociedad; ArgentinaFil: Acosta, Laura Débora. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones y Estudio Sobre Cultura y Sociedad; ArgentinaFil: Bertone, Carola Leticia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones y Estudio Sobre Cultura y Sociedad; Argentin

Adolescent mortality in Argentina and Brazil, a pending issue?

Si bien el nivel de la mortalidad en la adolescencia es bajo comparado con el de las restantes edades, un estudio reciente de Viner y colaboradores (2011) revela que, en 50 países, en los últimos 50 años la tasa de mortalidad de los adolescentes experimenta una menor reducción con relación a la de los primeros años de vida. Ello resulta grave, al menos, por dos razones: primero, porque la mayor parte de las defunciones responden a causas evitables y; segundo, porque existen diferencias entre sectores sociales y geográficos, cuestiones que atentan contra la equidad ante el derecho a la vida. Dado que el citado trabajo no incluye a Argentina y Brasil, a partir del análisis de estadísticas oficiales disponibles, intentamos responder los siguientes interrogantes: ¿Cuál es la situación de la mortalidad adolescente en estos países? ¿Presenta diferencias con respecto a la señalada por Viner y colaboradores (2011)? Los resultados muestran similitudes con el estudio mencionado en cuanto al descenso en los niveles de mortalidad. Respecto a la estructura de la mortalidad por causas, las variaciones a lo largo del periodo difieren entre una y otra investigación. A pesar de ello, ambos trabajos coinciden en la falta de atención hacia los adolescentes y a las causas de muerte, en gran parte evitables, lo cual evidencia una expresión de injusticia social que compromete a los Estados como principales garantes de derechos.While adolescent death rate is low compared with those among other age groups, a recent study by Viner et al. (2011) reveals that in 50 countries, over the past 50 years, this rate reduces in a smaller proportion than in early years of life. This is a serious question, at least, for two reasons: first, because most of deaths are preventable; and second, because there are differences between social and geographic sectors that undermine equity in the exercise of the right to life. Since this research does not include Argentina and Brazil, from the analysis of official statistics, we try to answer the following questions: Which is the situation of adolescent mortality in these countries? Are there differences from the conclusions of Viner et al. (2011)? As for mortality trends, the results show similarities with the study mentioned. Regarding the evolution of structure of the mortality by causes, there are differences. However, both studies agree on the lack of attention to the adolescents and their causes of death, largely preventable. That is an expression of social injustice that commits the States as main guarantors of human rights.Fil: Rojas Cabrera, Eleonora Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones y Estudio Sobre Cultura y Sociedad; ArgentinaFil: Santillan Pizarro, María Marta. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones y Estudio Sobre Cultura y Sociedad; ArgentinaFil: Pujol, Celine Jeanne Aurelie. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones y Estudio Sobre Cultura y Sociedad; Argentin

LA MORTALIDAD DE LOS ADOLESCENTES DE ARGENTINA Y BRASIL, ¿UNA CUESTIÓN PENDIENTE?

Si bien el nivel de la mortalidad en la adolescenciaes bajo comparado con el de las restantes edades, unestudio reciente de Viner y colaboradores (2011) revelaque, en 50 países, en los últimos 50 años la tasade mortalidad de los adolescentes experimenta unamenor reducción con relación a la de los primerosaños de vida. Ello resulta grave, al menos, por dosrazones: primero, porque la mayor parte de las defuncionesresponden a causas evitables y; segundo,porque existen diferencias entre sectores sociales ygeográficos, cuestiones que atentan contra la equidadante el derecho a la vida. Dado que el citadotrabajo no incluye a Argentina y Brasil, a partir delanálisis de estadísticas oficiales disponibles, intentamosresponder los siguientes interrogantes: ¿Cuáles la situación de la mortalidad adolescente en estospaíses? ¿Presenta diferencias con respecto a la señaladapor Viner y colaboradores (2011)? Los resultadosmuestran similitudes con el estudio mencionadoen cuanto al descenso en los niveles de mortalidad.Respecto a la estructura de la mortalidad por causas,las variaciones a lo largo del periodo difierenentre una y otra investigación. A pesar de ello, ambostrabajos coinciden en la falta de atención hacialos adolescentes y a las causas de muerte, en granparte evitables, lo cual evidencia una expresión deinjusticia social que compromete a los Estados comoprincipales garantes de derechos

Evolución de la mortalidad por tumores en las provincias argentinas, 1991-2007

Objetivo: Analizar la mortalidad por tumores en las provincias argentinas y algunos factores que podrían favorecer su incidencia entre 1991 y 2007, habida cuenta de que el cáncer constituye la segunda causa de muerte en el país y de la heterogeneidad que presenta su distribución en el territorio. Datos y métodos: Se utiliza información producida por diversos organismos oficiales sobre la que se realiza un análisis estadístico descriptivo e inferencial. Resultados: Se destaca la correlación existente entre la tasa de mortalidad por tumores y el consumo de alcohol y tabaco, y, en menor medida, con el porcentaje de superficie sembrada; así como también la correlación negativa entre la misma y el nivel de pobreza que coincidiría con un retraso en el proceso de transición epidemiológica. Conclusiones: De estos resultados se desprende la necesidad de profundizar las investigaciones sobre los factores que influyen en las defunciones a causa de tumores

Cancer mortality in Argentine provinces, 1991- 2007

Objetivo: Analizar la mortalidad por tumores en las provincias argentinas y algunos factores que podrían favorecer su incidencia entre 1991 y 2007, habida cuenta de que el cáncer constituye la segunda causa de muerte en el país y de la heterogeneidad que presenta su distribución en el territorio. Datos y métodos: Se utiliza información producida por diversos organismos oficiales sobre la que se realiza un análisis estadístico descriptivo e inferencial. Resultados: Se destaca la correlación existente entre la tasa de mortalidad por tumores y el consumo de alcohol y tabaco, y, en menor medida, con el porcentaje de superficie sembrada; así como también la correlación negativa entre la misma y el nivel de pobreza que coincidiría con un retraso en el proceso de transición epidemiológica. Conclusiones: De estos resultados se desprende la necesidad de profundizar las investigaciones sobre los factores que influyen en las defunciones a causa de tumores.Purpose: To analyze cancer mortality in Argentine and some factors associated with it during the period 1991-2007. Data and methods: Data from government agencies. Descriptive and inferential statistics. Results: Correlations between cancer mortality rate and tobacco and alcohol consumption, poverty level and percentage of sown area are observed. Conclusions: More research about factors associated with cancer mortality is needed.Fil: Bertone, Carola Leticia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; ArgentinaFil: Pujol, Celine Jeanne Aurelie. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; ArgentinaFil: Alvarez, María Franci Sussan. Universidad Nacional de Villa María; ArgentinaFil: Rojas Cabrera, Eleonora Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; Argentin

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

The FANCM:p.Arg658* truncating variant is associated with risk of triple-negative breast cancer.

Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic variants in DNA repair genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 are associated with breast cancer risk. FANCM, which encodes for a DNA translocase, has been proposed as a breast cancer predisposition gene, with greater effects for the ER-negative and triple-negative breast cancer (TNBC) subtypes. We tested the three recurrent protein-truncating variants FANCM:p.Arg658*, p.Gln1701*, and p.Arg1931* for association with breast cancer risk in 67,112 cases, 53,766 controls, and 26,662 carriers of pathogenic variants of BRCA1 or BRCA2. These three variants were also studied functionally by measuring survival and chromosome fragility in FANCM -/- patient-derived immortalized fibroblasts treated with diepoxybutane or olaparib. We observed that FANCM:p.Arg658* was associated with increased risk of ER-negative disease and TNBC (OR = 2.44, P = 0.034 and OR = 3.79; P = 0.009, respectively). In a country-restricted analysis, we confirmed the associations detected for FANCM:p.Arg658* and found that also FANCM:p.Arg1931* was associated with ER-negative breast cancer risk (OR = 1.96; P = 0.006). The functional results indicated that all three variants were deleterious affecting cell survival and chromosome stability with FANCM:p.Arg658* causing more severe phenotypes. In conclusion, we confirmed that the two rare FANCM deleterious variants p.Arg658* and p.Arg1931* are risk factors for ER-negative and TNBC subtypes. Overall our data suggest that the effect of truncating variants on breast cancer risk may depend on their position in the gene. Cell sensitivity to olaparib exposure, identifies a possible therapeutic option to treat FANCM-associated tumors

The FANCM:p.Arg658* truncating variant is associated with risk of triple-negative breast cancer

Abstract: Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic variants in DNA repair genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 are associated with breast cancer risk. FANCM, which encodes for a DNA translocase, has been proposed as a breast cancer predisposition gene, with greater effects for the ER-negative and triple-negative breast cancer (TNBC) subtypes. We tested the three recurrent protein-truncating variants FANCM:p.Arg658*, p.Gln1701*, and p.Arg1931* for association with breast cancer risk in 67,112 cases, 53,766 controls, and 26,662 carriers of pathogenic variants of BRCA1 or BRCA2. These three variants were also studied functionally by measuring survival and chromosome fragility in FANCM−/− patient-derived immortalized fibroblasts treated with diepoxybutane or olaparib. We observed that FANCM:p.Arg658* was associated with increased risk of ER-negative disease and TNBC (OR = 2.44, P = 0.034 and OR = 3.79; P = 0.009, respectively). In a country-restricted analysis, we confirmed the associations detected for FANCM:p.Arg658* and found that also FANCM:p.Arg1931* was associated with ER-negative breast cancer risk (OR = 1.96; P = 0.006). The functional results indicated that all three variants were deleterious affecting cell survival and chromosome stability with FANCM:p.Arg658* causing more severe phenotypes. In conclusion, we confirmed that the two rare FANCM deleterious variants p.Arg658* and p.Arg1931* are risk factors for ER-negative and TNBC subtypes. Overall our data suggest that the effect of truncating variants on breast cancer risk may depend on their position in the gene. Cell sensitivity to olaparib exposure, identifies a possible therapeutic option to treat FANCM-associated tumors

Functional mechanisms underlying pleiotropic risk alleles at the 19p13.1 breast-ovarian cancer susceptibility locus

A locus at 19p13 is associated with breast cancer (BC) and ovarian cancer (OC) risk. Here we analyse 438 SNPs in this region in 46,451 BC and 15,438 OC cases, 15,252 BRCA1 mutation carriers and 73,444 controls and identify 13 candidate causal SNPs associated with serous OC (P=9.2 × 10-20), ER-negative BC (P=1.1 × 10-13), BRCA1-associated BC (P=7.7 × 10-16) and triple negative BC (P-diff=2 × 10-5). Genotype-gene expression associations are identified for candidate target genes ANKLE1 (P=2 × 10-3) and ABHD8 (P<2 × 10-3). Chromosome conformation capture identifies interactions between four candidate SNPs and ABHD8, and luciferase assays indicate six risk alleles increased transactivation of the ADHD8 promoter. Targeted deletion of a region containing risk SNP rs56069439 in a putative enhancer induces ANKLE1 downregulation; and mRNA stability assays indicate functional effects for an ANKLE1 3′-UTR SNP. Altogether, these data suggest that multiple SNPs at 19p13 regulate ABHD8 and perhaps ANKLE1 expression, and indicate common mechanisms underlying breast and ovarian cancer risk

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication