ABSTRACT
Retinoblastoma (RB) is the most common intraocular tumor of childhood. In low income countries, Time to diagnosis (TTD: interval between first symptom and diagnosis) has been associated with extraocular disease, metastasis and mortality. However, the relationship between TTD and prognosis is complex and not simply a linear correlation, particularly if TTD is <6 months. This systematic review aims to identify studies reporting TTD of retinoblastoma in Latin America, highlighting factors affecting TTD, alongside proposals and initiatives to obtain shorter intervals. The review also aims to discuss the methodology linked to cancer pathways studies. The study respected PRISMA recommendations, was registered on Prospero, an international database for systematic review registries under number CRD42017076777. MEDLINE/PUBMED, LILACS and SCIELO databases were searched. Studies from Latin America and the Caribbean, published between 1997 and 2017, reporting TTD and age at diagnosis of patients with retinoblastoma were selected. Nine studies were selected, concerning 1560 patients from Argentina, Brazil, Chile, Honduras, Mexico and Peru. The median TTD ranged from 3 to 5 months and the median age at diagnosis ranged from 16.5 to 22.2 months. A prolonged TTD was observed and was associated to damaging results on retinoblastoma outcomes, particularly increasing extraocular disease, and mortality rates. Methodological heterogeneity was observed and reiterates the importance of standardization of TTD studies, allowing more reliable comparisons and greater knowledge about retinoblastoma pathways before diagnosis. Reports on successful initiatives against delayed diagnosis were scarce, emphasizing a need for further studies.
Subject(s)
Eye Neoplasms/diagnosis , Retinoblastoma/diagnosis , Age Factors , Child, Preschool , Delayed Diagnosis , Early Detection of Cancer , Early Diagnosis , Eye Neoplasms/epidemiology , Humans , Infant , Infant, Newborn , Latin America/epidemiology , Prognosis , Retinoblastoma/epidemiology , Socioeconomic Factors , Time FactorsABSTRACT
OBJECTIVES: To present the main aspects of an approach to urban violence among children and adolescents and to point out the social and educational role of pediatricians. SOURCES OF DATA: A literature review based on MEDLINE, LILACS and SciELO was carried out for the years 1993 to 2005, using the following keywords: urban violence, children and adolescents. In addition to the review, policies and institutional reports on violence were also analyzed. SUMMARY OF THE FINDINGS: The causal relationship of violence is presented in a range of different ways, from personal points of view to broader structural aspects. The literature suggests that urban violence results from varied actions, and also from specific risk behaviors. It is a worrying and complex phenomenon that results in high levels of morbidity and mortality, affecting children and adolescents. Special attention was given to homicide and to the psychological results of violent acts. Firearms are the most lethal instruments among adolescents and young males when compared to all other causes of death. CONCLUSIONS: Urban violence is one of the main social problems in Brazil. Violence prevention requires intersectoral and multiprofessional actions with the participation of the government and of the organized civil society. Children, and above all adolescents, are the groups that are most widely exposed to the consequences of urban violence. Pediatricians can have an important role in the process of prevention, diagnosis and treatment. Through their wide-ranging abilities, pediatricians are well-positioned to help victims and their families to establish a healthy and dynamic relationship with their environment and with themselves.
Subject(s)
Social Environment , Urban Health , Violence/statistics & numerical data , Adolescent , Adolescent Behavior , Brazil/epidemiology , Cause of Death , Child , Female , Humans , Male , Risk Factors , Socioeconomic Factors , Urban Health/statistics & numerical data , Violence/classification , Violence/prevention & control , Wounds, Gunshot/mortalityABSTRACT
OBJETIVOS: Apresentar os principais aspectos da abordagem da criança e do adolescente vítima de violência urbana e destacar o papel do pediatra nas ações socioeducativas para o seu enfrentamento. FONTES DOS DADOS: Busca bibliográfica em base de dados MEDLINE, LILACS e SciELO, no período de 1993 a 2005, utilizando as palavras-chave "violência urbana em crianças e adolescentes". Políticas e relatórios institucionais sobre violência urbana também foram utilizados. SíNTESE DE DADOS: Apresenta-se uma discussão sobre a relação causal da violência, partindo de um enfoque pessoal até chegar a uma visão macroestrutural. A literatura sugere que a violência urbana seja um produto da ação de determinantes pertencentes à várias instâncias e também de comportamento de risco específico. Trata-se de um fenômeno complexo, preocupante, que apresenta elevados índices de morbimortalidade em crianças e adolescentes. Especial atenção foi dada aos homicídios e aos desfechos psicológicos decorrentes de atos violentos. A arma de fogo é o instrumento que mais mata os adolescentes e jovens do sexo masculino, mesmo quando comparada com todas as outras causas de óbito nessa faixa etária. CONCLUSÕES: A violência urbana é um dos principais problemas sociais no Brasil. Sua prevenção exige ações intersetoriais e multiprofissionais, com a participação articulada do Estado e da sociedade civil. Através de uma prática assistencial ampliada, os pediatras são capazes de atuar na prevenção, detecção e tratamento das vítimas e suas famílias, ajudando-as a estabelecer relações saudáveis e dinâmicas com seu ambiente e com elas próprias.
