Institute for Indian Mother and Child

PURPOSE:Soon after the Russian invasion of Ukraine in February 2022, an initiative was organized to evacuate Ukrainian children with cancer, most initially to Poland. This study assessed the impact of this rapid increase in clinical need on the Polish system of pediatric cancer care. METHODS:This multicenter longitudinal approach was performed among all 19 Polish Pediatric Oncology Centers (PPOCs). We compared PPOC capacity before the invasion with that during the first 11 weeks after the invasion, using three ratios: patients to physicians (PtP), patients to nurses (PtN), and patients to beds (PtB). In addition, we used national data from an ongoing leukemia clinical trial to assess differences between the two study periods in the time required to comply with protocol-indicated medical procedures requiring general anesthesia. RESULTS:During the study period, 237 Ukrainian refugee children with cancer were treated in PPOCs; 60% of them arrived during the first 21 days of the war. The relative increase in patients varied significantly among the PPOCs, ranging from 42% to 460%. The average PtP, PtN, and PtB ratios increased significantly by 85%, 131%, and 105%, respectively. The portion of patients experiencing a delay in obtaining medical procedures requiring general anesthesia increased from 15% before the war to 18.2% (P = .043). CONCLUSION:Because of the large number of Ukrainian children with cancer were evacuated to Poland, capacity of PPOCs was reduced, affecting cancer care for all patients. Maintaining standards of pediatric oncology care in Poland would not be possible without further patient referral to medical facilities around the world by international humanitarian collaborative action.

According to the 2022 World Health Organization Classification, high-grade B-cell lymphoma with 11q aberration (HGBCL-11q) is a MYC-negative lymphoma with 11q duplication and terminal deletion as specific chromosomal aberrations for this neoplasm. However, there is a growing number of reports defying this definition, describing cases with the co-occurrence of 11q aberration and MYC rearrangement (HGBCL-11q,MYCR). This research has 2 aims. First, to compare the unique HGBCL-11q,MYCR group of 9 cases with 26 HGBCL-11q cases on chromosomal, mutational, and clinicopathological levels. The second objective was to investigate the association of the new HGBCL-11q,MYCR group with HGBCL-11q and 2 other closely related MYC-positive aggressive lymphoma subtypes: Burkitt lymphoma (BL) (n = 17) and HGBCL, not otherwise specified with MYCR (n = 10). Genetic results were obtained by classical cytogenetics, fluorescence in situ hybridization, microarrays, and whole exome sequencing. In parallel histopathologic/immunohistochemical analyses (HP/IHC)with flow cytometry (FCM), in conjunction with clinical presentation and treatment outcomes, are presented. Our findings reveal that HGBCL-11q,MYCR exists as an independent nosologic entity, distinct from BL and HGBCL-11q at the cytogenetic, molecular, and clinicopathological levels, although it contains common features of both lymphoma subtypes. Common features with BL include following: MYCR with the immunoglobulin (Ig) genes, patterns of secondary chromosomal aberrations like dup(1q), del(17p), and high number of MYC and CCND3 mutations. Other BL features are: frequent extranodal abdominal presentation, morphology, germinal center B-cell-like cell of origin determined by IHC and FCM, immunophenotypical features such as MYC(+)/LMO2(-) detected by following flow cytometric features: CD45(+)weaker, more cases with CD43(+) and CD44(-) expression, only expression of IgD and IgM heavy chain, and CD38(+)higher overexpression, which correlates with MYCR assessed by FCM. Similarity to HGBCL-11q includes the existence of 11q aberration, presence of DDX3X, ETS1, GNA13, NFRKB, and KMT2D, and the lack of TCF3 and ID3 mutations. Additionally, frequent nodal and tonsillar presentation, morphology, germinal center B-cell-like cell of origin, and immunophenotypical features, including CD56(+) expression measured using FCM, are observed, which are associated with NCAM duplication/amplification on 11q, and pathogenesis not associated with Epstein-Barr virus infection. The distinctive chromosomal change of HGBCL-11q,MYCR was the gain or amplification of 3q29. Our cohort of patients with HGBCL-11q,MYCR had similar relapse-free survival to that of patients with HGBCL-11q and BL, if treated with BL-directed regimens.

Background: Active travel to/from school can contribute to adolescents' overall physical activity. This study aimed to examine factors that stimulate or discourage 12-to 15-year-old adolescents' cycling to/from school from the perspective of adolescents, parents, and teachers in 5 European countries. Methods: We conducted concept mapping sessions with 437 secondary school students, 89 parents, and 72 teachers. Participants generated ideas regarding the needs of adolescents to cycle daily to/from school, individually sorted all ideas (on self-perceived similarity), and rated their importance (for being able to cycle to/from school) and feasibility on a 5-point Likert-scale. Clusters representing potential determinants were created using multidimensional scaling and hierarchical cluster analysis and categorized according the Model of Children's Active Travel. Results: Participants identified 30 different potential determinants, of which 28 were by adolescents, 26 were by parents, and 26 were by teachers. Fifteen potential determinants were categorized in the "objective" environmental domain of Model of Children's Active Travel (eg, "A good and safe cycling infrastructure"); 10 in the child perceptions domain (eg, "A sense of safety"); 4 in the "objective" child, parent, and family characteristics domain (eg, "Skills & knowledge"); and 1 in the parents' perceptions domain (ie, "Parents support & perceptions"). Potential determinants considerably differed across stakeholder groups and countries. Conclusions: Adolescents, parents, and teachers identified a wide range of potential determinants for cycling to/from school in adolescents. Our findings indicate that future interventions might benefit from including the perspectives of adolescents, parents, and teachers, focusing on determinants from all domains of the Model of Children's Active Travel model.

ObjectivesThe aim of this study was to examine the association between oral health and health literacy, gender, age, family affluence and country of origin amongst adolescents from Slovakia and Poland, using data from the Health Behaviour in School-aged Children study.MethodsWe analysed data from the cross-sectional Health Behaviour in School-aged Children study conducted in 2022 on a representative sample of 6,289 Slovak and Polish 13- and 15-year old adolescents (mean age 14.48; SD = 1.01; 50.5% boys). Data was collected through self-administered online questionnaires completed by respondents in schools during classes. Binomial logistic regression models were used to assess associations between oral health and health literacy, gender, age, family affluence and country of origin amongst adolescents from Slovakia and Poland.ResultsThe results indicate that boys (odds ratio/95% confidence interval OR/95% CI 0.431/0.381–0.489) are substantially less likely to engage in regular toothbrushing compared to girls, highlighting a persistent gender disparity in oral hygiene behaviour. Additionally, lower socioeconomic status, as measured by family affluence, is associated with a decreased likelihood of frequent toothbrushing (OR/95% CI 0.486/0.399–0.592 for low family affluence; OR/95% CI 0.761/0.647–0.895 for medium family affluence). Similarly, health literacy emerges as a key determinant, with adolescents exhibiting lower health literacy levels demonstrating significantly reduced engagement in regular toothbrushing (OR/95% CI 0.475/0.384–0.587 for low health literacy; OR/95% CI 0.666/0.550–0.808 for medium health literacy).ConclusionThis study highlights the significant impact of gender, family affluence and health literacy on toothbrushing frequency amongst adolescents in Poland and Slovakia. The findings underscore the need for targeted oral health promotion strategies that consider gender differences, socioeconomic inequalities and the importance of health literacy in improving oral hygiene practises amongst adolescents.

Understanding the healthcare needs of child migrants and war refugees, one of the most affected groups during armed conflicts, is essential for evidence-informed humanitarian response, planning, and preparedness. This study analyzed the evolving health needs of this vulnerable group, as reflected in their hospital care utilization in Poland, to inform future health policies, incl. healthcare organization, disease prevention, and health promotion. We used a nationwide hospital discharge database from the National Institute of Public Health NIH-NRI to identify Ukrainian children admitted to Polish hospitals from the outbreak of the war in Ukraine (February 24, 2022) until the end of 2023. A total of 5,000 hospital admissions of Ukrainian children were recorded, with 45.3% occurring within the first 100 days of the war. The mean age was 6.2 years (SD = 5.2), median age was 5.0 years and 54.6% were boys. In the first 100 days of the war, the leading causes of hospital admissions were infectious diseases (ICD-10: A00-B99, 25.5%), symptoms and abnormal clinical findings (R00-R99, 15.7%), and respiratory diseases (J00-J99, 14.1%). In the subsequent period, neoplasms (C00-D48, 13.5%) were the most common cause, followed by respiratory diseases (J00-J99, 10.3%) and injuries (S00-T98, 8.8%). Vaccine-preventable diseases accounted for 685 hospitalizations (13.7%), with the most common diagnoses being rotaviral enteritis (49.1%), COVID-19 (24.2%), and influenza (14.5%). 78% of these hospitalizations occurred within the first 100 days of the war. As a community of researchers and public health practitioners, we should build on existing networks and partnerships to leverage data collected during hospital stays, which reflect the health needs of child migrants and war refugees in the host country, and collaborate closely with public health institutions at the national, regional, and global levels to transform evidence into action. • It is essential to address the changing healthcare needs of migrants and war refugees due to the significant humanitarian and public health implications. • The data related to hospitalization can be used as a valuable indicator to assess the health status of migrant and war refugees population and their specific health needs.