Short versus long course therapy in the treatment of febrile urinary tract infections in men based on serum PSA values.

BACKGROUND: Febrile urinary tract infections (fUTI) in men are frequently complicated with subclinical prostatic involvement, measured by a transient increase in serum prostate-specific-antigen (sPSA). The aim of this study was to evaluate recurrence rates in a 6-month follow-up period of 2-week versus 4-week antibiotic treatment in men with fUTI, based on prostatic involvement. Clinical and microbiological cure rates at the end-of-therapy (EoT) were also assessed. METHODS: Open label, not-controlled, prospective study. Consecutive men diagnosed of fUTI were included. Duration of therapy was 2 weeks for patients with a sPSA level <5mg/L (short duration therapy, SDT) or 4 weeks for PSA >5 mg/L (long duration therapy, LDT). RESULTS: Ninety-one patients were included; 19 (20%) received SDT. Median age was 56.9 years (range 23-88). Bacteremia was present in 9.8% of patients (Escherichia coli was isolated in 91%). Both groups had similar demographic, clinical characteristics and laboratory findings. Median PSA levels were 2.3 mg/L in the SDT group vs 23.4 mg/L in the LDT group. In the 6-month visit, 26% of patients had achieved complete follow-up. Nonsignificant differences between groups were found neither in recurrence rates after 6 months (9% in SDT vs 10% in LDT) nor in clinical or microbiological cure rates at EoT (100% in SDT vs 95% in LDT and 95% in SDT vs 93% in LDT respectively). CONCLUSIONS: One fifth of men with fUTI did not present apparent prostatic involvement. A 2-week regimen seems adequate in terms of clinical, microbiological cure and recurrence rates for those patients without PSA elevation.

Radicality of lymphadenectomy in lung cancer resections by thoracotomy and video-assisted thoracoscopic approach: A prospective, multicentre and propensity-score adjusted study.

OBJECTIVE: To analyse differences in intraoperative nodal assessment in patients undergoing lung cancer resection by thoracotomy and video-assisted thoracoscopy (VATS) in the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS: Prospective multicentre cohort study of anatomic pulmonary resections (n = 3533) performed from December 2016 to March 2018. Main surgical, clinical and oncological variables related with lymphadenectomy were compared according to surgical approach. Corresponding tests for homogeneity were performed. Multiple logistic regression analyses were used to determine the odds ratio (OR) and 95% confidence interval (95%CI). Covariate adjustment using the propensity score (PS) was performed to reduce confounding effects. RESULTS: After exclusions, 2532 patients were analysed. Systematic nodal dissection (SND) was performed in 65%, with a median of resected/sampled lymph nodes (LN) of 7 (IQR 4-12) and pathologic (p) N2 and uncertain (u) pNu rates of 9.4% and 28.9%, respectively. At multivariate analysis, the following were associated with thoracotomy (OR; 95%CI): SND (1.4; 1.08-1.96; p = 0.014), staging mediastinoscopy (2.6; 1.59-4.25; p < 0.001), tumor > 3 cm (2.1; 1.66-2.78; p < 0.001), central tumor (2.5; 1.90-3.24; p < 0.001); pN1 (1.8; 1.25-2.67; p < 0.002), pN2 (1.8; 1.18-2.76; p = 0.006), lower FEV1 (0.9; 0.98-0.99; p < 0.001), squamous cell carcinoma (1.5; 1.16-1.98; p = 0.002) and inexperienced surgeons in VATS (compared with > 100 VATS experience) (37.6; 13.55-104.6; p < 0.001). After PS adjustment, SND maintained the OR, but in the limit of signification (1.4; 1-1.98; p = 0.05). Nodal upstaging was significantly higher in the thoracotomy group. Complication rates of SND and no SND were similar. CONCLUSIONS: Thoracotomy was associated with a more thorough lymphadenectomy in GEVATS. Therefore, intraoperative lymph node evaluation performed at VATS should be improved to have better prognostic information and more solid grounds to indicate adjuvant therapy.

Recreational Drug Use in People Living with HIV in Spain: Factors Associated with Drug Use and the Impact on Clinical Outcomes.

We analysed the impact of recreational drug use (RDU) on different outcomes in people living with HIV (PLHIV). A multicentre retrospective cohort study was performed with two cohorts of PLHIV included: people using recreational drugs (PURD) vs. people not using recreational drugs (PNURD). Overall, 275 PLHIV were included. RDU was associated with men having sex with men (OR 4.14, 95% CI [1.14, 5.19]), previous sexually transmitted infections (OR 4.00, 95% CI [1.97, 8.13]), and current smoking (OR 2.74, 95% CI [1.44, 5.19]). While the CD4/CD8 ratio increased amongst PNURD during the follow-up year, it decreased amongst PURD (p = 0.050). PURD presented lower scores of self-reported and multi-interval antiretroviral adherence (p = 0.017, and p = 0.006, respectively), emotional well-being (p < 0.0001), and regular follow-up (p = 0.059), but paid more visits to the emergency unit (p = 0.046). RDU worsens clinical, immunological, and mental health outcomes amongst PLHIV.

RESUMEN: Analizamos el impacto del consumo de drogas recreativas sobre variables relacionadas con la salud en personas con VIH (PVIH). Estudio multicéntrico retrospectivo con dos cohortes de PVIH: consumidores de drogas recreativas (CDR) y no consumidores (NCDR). Se incluyeron 275 PVIH. El consumo de drogas recreativas se asoció al colectivo de hombres que mantienen sexo con hombres (OR 4.14, IC95% [1.14, 5.19]), a infecciones de transmisión sexual previas (OR = 4.00, IC95% [1.97, 8.13]) y a ser fumador (OR = 2.74, IC95% [1.44, 5.19]). El ratio CD4/CD8 aumentó entre los NCDR durante el año de seguimiento y disminuyó en los CDR (p = 0.050). Los CDR presentaron peor adherencia al tratamiento antiretroviral medida con dos métodos indirectos (p = 0.017 y p = 0.006, respectivamente), y bienestar emocional (p < 0.0001). Además, visitaron menos al especialista en enfermedades infecciosas (p = 0.059), y más a urgencias (p = 0.046). El consumo de drogas recreativas empeora los resultados clínicos y de salud mental entre las PVIH.

Fixed Ratio versus Lower Limit of Normality for Diagnosing COPD in Primary Care: Long-Term Follow-Up of EGARPOC Study.

Purpose: The best criterion for diagnosing airway obstruction in COPD, fixed ratio (FR: FEV1/FVC<0.7) or lower limit of normality (LLN), remains controversial. We compared the long-term evolution of COPD patients according to the initial obstruction criteria. Patients and Methods: Between 2005 and 2008, we evaluated 1728 subjects over 45 years of age with smoking history, pertaining to a primary care center. A total of 424 patients were obstructive by FR, after a bronchodilator test. Of those, 289 patients met obstruction criteria for both FR and LLN and were considered concordant patients (FR+LLN+), while 135 patients were obstructive by FR but non-obstructive by LLN and were defined as discordant patients (FR+LLN-). Results: Forty-eight patients (11.3%) were lost in follow-up, and 158 died (37.3%). After a median time of 120.4 months (IQR 25-75%: 110.2-128.8), 215 patients were spirometrically reevaluated. The annualized loss of FEV1/FVC was greater in discordant (FR+LLN-) patients [0.54 (0.8) vs 0.82 (0.7); p = 0.008], while 81% became concordant (FR+LLN+) during the follow-up. Hospitalization for COPD exacerbations was more frequent in concordant (FR+LLN+) patients (1.57±3.51 vs 0.77±2.29; p = 0.002). Adjusting for age, concordant (FR+LLN+) patients had greater COPD mortality (HR: 2.97; CI 95%: 1.27-7.3; p = 0.02). Conclusion: LLN seems to be less useful for COPD diagnosis in primary care. Discordant (FR+LLN-) patients lost more FEV1/FVC during their evolution and tended to become concordant. LLN predicted COPD hospitalizations and mortality more poorly.

Prevalence and patterns of illicit drug use in people living with HIV in Spain: A cross-sectional study.

This study assessed the prevalence and patterns of drug use among people living with HIV (PLHIV) in Spain. We conducted an observational cross-sectional study including 1401 PLHIV. Data were collected through 33 sites across Spain using an online computer-assisted self-administered interview. The survey measured use of illicit drugs and other substances, treatment adherence and health-related variables. To analyse patterns of drug use we performed cluster analysis in two stages. The most frequently consumed substances were: alcohol (86.7%), tobacco (55.0%), illicit drugs (49.5%), other substances (27.1%). The most prevalent illicit drugs used were cannabis (73.8%), cocaine powder (53.9%), and poppers (45.4%). Results found four clusters of PLHIV who used drugs. Two of them were composed mainly of heterosexuals (HTX): Cluster 1 (n = 172) presented the lowest polydrug use and they were mainly users of cannabis, and Cluster 2 (n = 84) grouped mostly men who used mainly heroin and cocaine; which had the highest percentage of people who inject drugs and presented the lowest level of treatment adherence (79.8±14.2; p < .0001). The other two clusters were composed mainly of men who have sex with men (MSM), who were mostly users of recreational drugs. Cluster 3 (n = 285) reported moderate consumption, both regarding frequency and diversity of drugs used, while Cluster 4 (n = 153) was characterized by the highest drug polyconsumption (7.4±2.2; p < .0001), and 4 grouped MSM who injected recreational drugs, and who reported the highest frequency of use of drugs in a sexual context (2.6±0.8; p < .0001) and rates of sexually transmitted infections (1.8±1.1; p < .01). This is the largest multi-centre cross-sectional study assessing the current prevalence and patterns of drug use among PLHIV in Spain. The highest prevalence of drug use was found among MSM, although HTX who used heroin and cocaine (Cluster 2) had the most problems with adherence to HIV treatment and the worst health status.

Psychosocial determinants of HIV testing across stages of change in Spanish population: a cross-sectional national survey.

BACKGROUND: The goal of this research is to study the psychosocial determinants of HIV-testing as a function of the decision or change stage concerning this health behavior. The determinants considered in the major ongoing health models and the stages contemplated in the Precaution Adoption Process Model are analysed. METHODS: A cross-sectional survey was administered to 1,554 people over 16 years of age living in Spain by a computer-assisted telephone interview (CATI). The sample design was randomised, with quotas of sex and age. The survey measured various psychosocial determinants of health behaviors considered in the main cognitive theories, the interviewees' stage of change concerning HIV-testing (lack of awareness, decision not to act, decision to act, action, maintenance, and abandonment), and the signal for the action of getting tested or the perceived barriers to being tested. RESULTS: Approximately two thirds of the population had not ever had the HIV test. The predominant stage was lack of awareness. The most frequently perceived barriers to testing were related to the health system and to the stigma. We also found that the psychosocial determinants studied differed depending on the respondents' stage of change. Perception of risk, perceived self-efficacy, proximity to people who had been tested, perceived benefits of knowing the diagnosis, and a positive instrumental and emotional attitude were positively associated with the decision and maintenance of testing behavior. However, unrealistic underestimation of the risk of HIV infection, stereotypes about the infection, and the perceived severity of HIV were associated with the decision not to be tested. CONCLUSIONS: There are various sociocognitive and motivational profiles depending on people's decision stage concerning HIV-testing. Knowing this profile may allow us to design interventions to influence the psychosocial determinants that characterise each stage of change.

Which is the Best Screening Strategy for COPD among Smokers in Primary Care?

We developed a questionnaire to detect cases of chronic obstructive pulmonary disease (COPD) and compared its reliability with other strategies. In order to develop the new questionnaire (COPD screening questionnaire from Terrassa [EGARPOC]) we used data from an epidemiological study on the prevalence of COPD in smokers and calculated the odds ratio for each variable showing significance for the diagnosis of COPD on regression analysis. For comparison among questionnaires and the portable spirometer COPD-6, a cross-sectional multicenter study was performed. The study included 407 smokers or ex-smokers over the age of 40 years with no known diagnosis of COPD, who completed the different questionnaires (EGARPOC, Respiratory Health Screening Questionnaire, COPD-population screener and 2 questions) and underwent spirometry with the COPD-6. We determined the sensitivity, specificity, positive and negative predictive values (S, Sp, PPV and NPV, respectively) and the area under the receiver operating characteristic ROC curve (AUC ROC) of all the questionnaires and the different COPD-6 cut-offs. The prevalence of COPD was 26.3%. The EGARPOC questionnaire showed an S of 81.8%, an Sp of 70.6%, and an NPV of 91.8%; 73.3% of individuals were correctly classified, and the AUC ROC was 0.841. On comparing the questionnaires by the Chi-square test, the 2-question questionnaire showed the worst discrimination; while with an optimal cut-off of forced expiratory volume in one 1 second (FEV1)/FEV6 of 0.78, the COPD-6 was significantly better than the questionnaires in the detection of COPD. Using a cut-off of FEV1/FEV6 of 0.78 the COPD-6 was found to be the best screening tool for COPD in primary care compared to the questionnaires tested, which did not show differences among them.

Prevalence, Risk Factors and Diagnostic Accuracy of COPD Among Smokers in Primary Care.

The prevalence of COPD is high, and most cases remain undiagnosed. In contrast, some patients labeled and treated as COPD do not have spirometric confirmation. Our objective was to determine the prevalence of COPD among smokers aged 45 years or older and investigate the accuracy of diagnosis of COPD in primary care. A population-based, epidemiological study was conducted in a primary care centre among subjects older than 45 years with a history of smoking. The participants underwent a clinical questionnaire and spirometry with bronchodilator test. Additionally, participants with newly diagnosed COPD, defined as postbronchodilator FEV1/FVC<0.7, underwent 4-week treatment with formoterol and budesonide to rule out reversible airflow obstruction. A total of 1,738 individuals (84.4% male) with a mean age of 59.9 years were included. The prevalence of COPD was 24.3% (95%, CI 22.3-26.4), with an overall underdiagnosis of 56.7%. Patients with COPD were older, more frequently male, with a lower body mass index, a longer history of smoking, lower educational level, previous occupational exposure, and more cardiovascular co-morbidity (all p < 0.001). After 4 weeks of treatment, 16% of initially obstructed patients had normal spirometry; in addition, 15.6% of individuals with a diagnosis of COPD did not have airflow obstruction. One out of four smokers 45 years or older presenting in primary care have airflow obstruction, mostly undiagnosed. However, among those with an initial diagnosis of COPD up to 16% will normalise spirometry after 4 weeks of treatment. There is also a significant number of individuals misdiagnosed with COPD.

Occupation, smoking, and chronic obstructive respiratory disorders: a cross sectional study in an industrial area of Catalonia, Spain.

BACKGROUND: Few studies have investigated the independent effects of occupational exposures and smoking on chronic bronchitis and airflow obstruction. We assessed the association between lifetime occupational exposures and airflow obstruction in a cross-sectional survey in an urban-industrial area of Catalonia, Spain. METHODS: We interviewed 576 subjects of both sexes aged 20-70 years (response rate 80%) randomly selected from census rolls, using the ATS questionnaire. Forced spirometry was performed by 497 subjects according to ATS normative. RESULTS: Lifetime occupational exposure to dust, gases or fumes was reported by 52% of the subjects (63% in men, 41% in women). Textile industry was the most frequently reported job in relation to these exposures (39%). Chronic cough, expectoration and wheeze were more prevalent in exposed subjects with odds ratios ranging from 1.7 to 2.0 being highest among never-smokers (2.1 to 4.3). Lung function differences between exposed and unexposed subjects were dependent on duration of exposure, but not on smoking habits. Subjects exposed more than 15 years to dusts, gases or fumes had lower lung function values (FEV1 -80 ml, 95% confidence interval (CI) -186 to 26; MMEF -163 ml, CI -397 to 71; FEV1/FVC ratio -1.7%, CI -3.3 to -0.2) than non-exposed. CONCLUSION: Chronic bronchitis symptoms and airflow obstruction are associated with occupational exposures in a population with a high employment in the textile industry. Lung function impairment was related to the duration of occupational exposure, being independent of the effect of smoking.