The TEOGIC study project: a comprehensive characterization of early onset gastrointestinal cancer in the Northern area of Spain.

BACKGROUND: Gastrointestinal cancers represent one of the most prevalent diseases worldwide. Strikingly, the incidence of Early Onset Gastrointestinal Cancer (EOGIC) has been rising during the last decades and changes in lifestyle and environmental exposure seem to play a role. EOGIC has been defined as a different entity compared to on-average gastrointestinal cancer, with distinct clinical and molecular characteristics. Inherent to the particularities of younger age, there is an unmet need for a tailored approach for the management of these patients. The TEOGIC proposes a comprehensive study to characterize EOGIC patients in the northern of Spain. METHODS: Patients with histologically confirmed new diagnosis of colorectal, gastroesophageal and pancreatic adenocarcinoma will be considered for two cohorts: EOGIC (≤ 50 years old) and non-EOGIC (60-75 years old), with a ratio of 1:2. Two hundred and forty patients will be recruited in 4 Public Hospitals from northern Spain. After receiving unified informed consent, demographic and clinical data of the patients will be collected in a REDCap database. Lifestyle related data will be obtained in questionnaires assessing diet, physical activity and the general quality of life of the patients before diagnosis. Biological samples prior to any onco-specific treatment will be obtained for the analyses of circulating inflammatory proteins, gut microbiota, and the proteome of the tumor microenvironment. Histologic characteristics and routine biomarkers will be also collected. Thereafter, data will be integrated and analyzed to assess tumor specific, pan-tumor and sex-associated differential characteristics of EOGIC. DISCUSSION: The underlying risk factors and differential characteristics of EOGIC remain poorly studied, particularly in our geographical area. Although limited by the exploratory nature and the small sample size estimated to be recruited, TEOGIC represents the first attempt to comprehensively characterize these young patients, and thus attend to their special needs. Findings derived from this study could contribute to raise awareness and preventive behaviors in the population. In parallel, molecular studies could lead to the identification of potential novel non-invasive biomarkers and therapeutic targets that would help in the development of the tailored clinical management of these patients, focusing on screening programs for early diagnosis and precision medicine.

[Utility of the AGREE tool for the development and evaluation of clinical protocols: From theory to clinical practice]. / Utilidad del instrumento AGREE para la elaboración y la evaluación de protocolos clínicos: de la teoría a la práctica clínica.

INTRODUCTION AND OBJECTIVE: Clinical protocols are tools for the delivery of optimal and quality healthcare. However, there are often shortcomings in the quality of their design that invalidate their implementation. The aim of this study is to describe a systematic evaluation of clinical protocols, to analyse their quality in order to enable their implementation. MATERIALS AND METHODS: Descriptive study that included the clinical protocols assessed by the Committee of Reviewers of Clinical Practice Recommendations and Health Technologies of a tertiary hospital during 11years of its existence between 2013 and 2023. The AGREE instrument was used to assess the quality of the protocols received, calculating standardised scores by item and domain, and categorising them into: a)excellent (90-100%), b)good (70-89%), c)improvable (50-69%), d)very improvable (30-49%), e)deficient (10-29%), and f)very deficient: 0-9%. RESULTS: Of the 59 documents received by the Commission, 32 were subsidised for AGREE evaluation. The highest scoring domain was «Scope and objective¼, with excellent scores for 29 protocols; the remaining domains had scores ranging from 58.5%-100% for «Rigour in elaboration¼ and 0-100% for «Independence¼. By items, scores ranged from 85.7-100% for «Target users of the protocol are clearly defined¼ to 0-100% for the items «Potential costs of implementing recommendations¼ and «Conflict of interest¼. Of the 32 protocols, 9 were highly recommended, 22 were recommended with modifications/conditions and one was not recommended. CONCLUSIONS: The AGREE tool makes it possible to systematize both the drafting of clinical protocols by the authors and their evaluation by the Clinical Practice Recommendations and Health Technologies Review Committee. This makes it possible to have applicable and quality protocols in our hospital, which results in an improvement in the quality of healthcare.

[Characteristics of YouTube videos in Spanish about the influenza vaccine]. / Características de los vídeos de YouTube en castellano sobre la vacuna antigripal.

BACKGROUND: To analyze the characteristics of YouTube videos in Spanish about the influenza vaccine. METHODS: In April 2019, a search was conducted on YouTube with the term vacuna gripe. We studied the association between the type of author, and country of publication, and the rest of the variables (tone of the message, type of publication, and vaccination recommendations according to the Spanish Ministry of Health, among others) with univariate analysis and a multiple logistic regression model. RESULTS: In total, 208 videos were assessed; 51.0% had been published from Spain and Mexico, and 79.8% of the videos supported the use of influenza vaccines. The main topics discussed in the videos were whether the vaccine should be considered the most effective method to prevent influenza (64.4%) and recommendations concerning the vaccination of people over 65 years old (43.3%). The variables type of authorship (healthcare professionals) and country of publication (Spain) were associated with a positive attitude towards vaccination (OR: 2.91; 95%CI: 1.12-7.53 and OR: 0.31; 95%CI: 0.15-0.65, respectively). CONCLUSIONS: The existing information on YouTube about the influenza vaccine is not generally very complete, and it varies depending on the authorship of the videos and the country of publication. It would be advisable for healthcare professionals to publish videos promoting vaccination based on the guidelines from the Spanish Ministry of Health, and it is necessary to promote those videos for Spanish users who search for reliable information about this vaccine on YouTube.

Assessment of the main factors affecting the dynamics of nutrients in two rainfed cereal watersheds.

Nutrient dynamics and factors that control nutrient exports were observed in two watersheds, namely Latxaga and La Tejería, with similar climatic and management characteristics throughout 10 years (2007-2016). Similar patterns were observed in intra-annual and inter-annual dynamics with higher NO3- concentration and NO3--N yield during the humid seasons (i.e., winters and hydrological year 2013). Regarding concentration, Latxaga showed a higher decrease of nitrate due to a higher development of vegetated areas. High discharge events produced nitrate dilution due to the presence of tile-drainage at La Tejeria. At Latxaga, where tile-drainage was not observed, an increase in concentration occurred as a response to high discharge events. Comparing both watersheds, La Tejería presented ca. 73 ±â€¯25 mg NO3- L-1 while at Latxaga, the concentration observed was almost three times lower, with ca. 21 ±â€¯15 mg NO3- L-1 throughout the study period. Similar patterns were observed for the NO3--N yield, with 32 kg NO3--N ha-1 year-1 and 17 kg NO3--N ha-1 year-1 at La Tejería and Latxaga, respectively. Regarding phosphorous, the observed concentrations were 0.20 ±â€¯0.72 mg PO43- L-1 and 0.06 ±â€¯0.38 mg PO43- L-1 at La Tejería and Latxaga, respectively, with PO43--P yields being 71 kg PO43--P ha-1 year-1 and 33 kg PO43--P ha-1 year-1. Annual phosphate-P yield distribution in both watersheds followed similar patterns to those observed for the nitrate-N yield, with higher yields in the humid season. Regarding concentration, highly erosive rainfall that occurred in summer, mobilizing sediments and probably generating desorption of phosphorous in the stream channel, increased phosphate concentration. This research adds to the knowledge base regarding the dynamics of nutrients and the controlling factors in complex agricultural systems with Mediterranean characteristics.

Irrigation implementation promotes increases in salinity and nitrate concentration in the lower reaches of the Cidacos River (Navarre, Spain).

The shift from rainfed to irrigated agriculture is associated with a change in the fertilization rates due to increases in expected production and the fact of growing more N demanding crops. In addition, the circulation of irrigation return flows (IRF) mobilizes soluble salts stored in soils or geological materials. As a consequence, it implies severe modifications in the dynamics and total amount of soluble salts and nitrogen exported, especially in semi-arid watersheds. In this study, long-term data collected by the regional authorities was used to assess the effects of irrigation implementation on salinity (using electrical conductivity, EC, as a proxy) and nitrate concentration (NO3-) after the transformation of ca. 77 km2 from rainfed to irrigated agriculture in the Cidacos River (CR) watershed. The results indicate that water quality in the lower reaches of the CR was significantly modified after the diffuse incorporation of IRF. In contrast, neither EC nor NO3- were different in those monitoring stations whose contributing watersheds did not include transformed area. In addition, the temporal dynamics in the analysed variables shifted from a rainfed land signal typical in the region to an irrigated land signal, and the hydrochemical type of the CR shifted from mixed-to-Na+-mixed-to-HCO3- to mostly Na+-mixed type, typical of waters affected by IRF in the region. Groundwater EC and NO3- also increased in those wells located within the irrigated area. Although there are great uncertainties in the actual amount of salt and N reaching the CR via IRF, the expected contribution of waste water spilled into the CR is minor in comparison to other sources, mostly agricultural sources in the case of N. The observed changes have promoted the designation of the lower reaches of the CR as "affected" by NO3- pollution, and the whole CR watershed as a Nitrate Vulnerable Zone, with the emergent question about whether irrigation implementation as carried out currently in Spain is against the environmental objectives of the Water Framework Directive.

Endotracheal intubation through laryngeal Ambu® Auragain™ mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis. / Intubación orotraqueal a través de mascarilla laríngea Ambu® Auragain™ en paciente pediátrico con lipomatosis infiltrante congénita.

Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu® Auragain ™) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis.

[Absenteeism and associated factors in scheduled visits to a Preventive Medicine outpatient clinic]. / Absentismo, y factores asociados, en las citas programadas de una consulta externa de Medicina Preventiva.

BACKGROUND: Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department. PATIENTS AND METHODS: The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found. RESULTS: Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19). CONCLUSIONS: The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

[Effect of weight reduction on the clinical and hormonal condition of obese anovulatory women]. / Efecto de la reducción de peso en la condición clínica y hormonal de mujeres anovulatorias obesas.

Obesity is associated to a variety of endocrine abnormalities that might lead to chronic anovulation in women. Weight loss may improve the hormonal profile and then restore ovulation in some of them. The aim of the current study was to evaluate the effect of a weight loss program on the clinical and hormonal characteristics of anovulatory obese women attending our reproductive clinic. We studied a group of 30 anovulatory obese patients between 18 and 35 years old without any thyroid disease. Before and after a weight loss of at least 5% of initial body weight we analyzed LH, FSH, estradiol, prolactine, testosterone, dehydroepiandrosterone sulfate, oral glucose tolerance test and progesterone, weight, BMI, waist/hip ratio and total body fat percentage. The mean weight loss was 9.5 +/- 4.3 kg. which represents a weight loss of 10.96% from initial body weight, with 26 patients (86.6%) resuming spontaneous ovulation. The women's mean plasma testosterone, LH, estradiol and DHEA-S decreased significantly and there was significantly increased on progesterone. At the beginning a total of 12 patients showed an impaired oral glucose tolerance test and after weight loss 9 of them improved it. The results shown in this study demonstrate that even a small weight reduction and a decrease in total body fat percentage improve the hormonal profile and restore ovulation in anovulatory obese women. Thus weight loss should be considered before starting with ovulation induction therapy.

[Evaluation of health information about the influenza vaccine on internet]. / Evaluación de la información sanitaria disponible en Internet sobre la vacuna antigripal.

BACKGROUND: The quality of health information on internet is a question of concern to governments and users. Our aim was to determine the extent to which information about the influenza vaccine adheres to the gold standard set by the Spanish Health Ministry. METHODS: Between June and July 2014 information on indications, adverse effects and counter-indications of the vaccine was evaluated to see if it adhered to this gold standard. This information was obtained through Google, using terms provided by medical students. A univariate analysis was performed, where the variable result was getting information that adhered correctly to the standard, and explanatory variables were the type of origin of the information and its country. RESULTS: Using the terms provided by 104 students, we obtained 134 different web links. Adhesion reached 65.7% (88/134) with respect to indication in health workers (HW). Nineteen point four percent provided incorrect information on indication in pregnant women. There was significantly better adherence in the information from official public health bodies (indication in HW (OR: 2.6), pregnant women (OR: 5.4) and immunodepressed patients (OR: 2.2)). Adherence of information on Spanish web links was worse (indication in pregnancy (OR: 0.3) and counter-indication if allergic to eggs (OR: 0.5). CONCLUSIONS: Adhesion was improvable. It's necessary to promote that internet users use official public health bodies websites when they search information regarding influenza vaccine on internet.

Nab-paclitaxel: a flattering facelift.

The application of nanotechnology in oncology has increased the efficacy and efficiency of some cytotoxic agents. The paradigm in this field is nab-paclitaxel, a soluble form of paclitaxel that is linked to albumin nanoparticles. The development of nanotechnology as a delivery system for paclitaxel has provided better pharmacokinetic and pharmacodynamic characteristics, neutralizing its hydrophobicity. This procedure significantly improves the treatment of metastatic breast cancer compared to conventional paclitaxel-based therapies, including other type of cancers such as metastatic pancreatic cancer, stage IIIB-IV non-small cell lung cancer (NSCLC) and metastatic melanoma. In these last cases, significant differences were found in primary end-points for patients treated with nab-paclitaxel-based chemotherapy compared to those treated with conventional treatments. The application of nanotechnology in cancer treatment may also improve the efficacy of other known drugs, as a result of improved pharmacokinetic and pharmacodynamic profiles, similarly to paclitaxel.

[Assessment of an educational program for the prevention of healthcare-associated infections]. / Evaluación de un programa formativo para la prevención de las infecciones relacionadas con la asistencia sanitaria.

OBJECTIVE: To evaluate the effectiveness of an educational program for the prevention of healthcare-associated infections (HCAIs), based on Care Bundles. MATERIAL AND METHODS: A quasi-experimental study conducted in a university hospital from May 2011 to February 2012. An educational intervention (21 training sessions) was carried out in all Departments with the support of the contents in a leaflet, which included evidence-based Care Bundles for prevention of different HCAIs. The leaflet was also distributed through all Hospital Departments. We assessed the knowledge of health care workers (HCWs) as regards preventive measures before and after each training session using a self-administered questionnaire, and we studied the frequency of patients with HCAIs before and after the intervention. RESULTS: One-hundred-and-sixty-five out of 398 HCWs (41.5%) attended the training sessions. Their knowledge improved significantly, mainly in terms of: a) antimicrobial activity of alcohol-based solutions, b) preventive measures for cathether-associated urinary tract infections, and c) best place to insert a central venous catheter. These areas increased after training by 53.1, 29.7, and 28.2 points, respectively. There was a non-significant decrease in the incidence of patients with HCAIs by multiresistant microorganisms, and a non-significant increase in the prevalence of patients with HCAIs. CONCLUSIONS: The educational program improved the knowledge of the HCWs about preventive measures for HCAIs, whereas the prevalence of patients with HCAIs did not show significant changes in the period of study.

[Impact of short-stay units on the quality of medical care in Spain]. / Influencia de las unidades de corta estancia en la calidad de la atención hospitalaria en España. Revisión sistemática.

OBJECTIVE: Short-stay units (SSUs) have been developed as an alternative to conventional hospitalisation. The aim of this study is to analyse the impact of short-stay units on the quality of medical care in Spain. MATERIAL AND METHODS: A systematic review was performed by retrieving studies that analysed the results of SSUs in Spain, in terms of clinical effectiveness, efficiency and satisfaction among patients, using an electronic database search (Pubmed/Medline and Spanish Medical Index) and a review of selected references. The data collected included, mortality, length of stay and re-admission rates, as well as other variables. RESULTS: Twenty-seven articles were found, with a great heterogeneity in both study design and type of SSU analysed. After analysing results, it was observed that SSUs in Spain provided effective clinical care. Low-quality evidence was also found supporting the hypothesis that SSUs are able to reduce overall length of stay in the whole hospital or department where they were created. There are not enough data to support any other advantages or benefits of SSUs, when compared with other hospitalisation units. CONCLUSIONS: SSUs may be able to effectively improve clinical care in selected patients, and may help to shorten overall length of stay. Further research is needed in order to define their exact role and to establish their optimal model.

[Mortality attributable to smoking in Spain in 2006]. / Mortalidad atribuible al consumo de tabaco en España en el año 2006.

BACKGROUND: Tobacco consumption is a worldwide public health problem. Our aim was to estimate the mortality attributable to smoking and its impact on premature mortality in Spain in the year 2006. METHODS: Descriptive, cross-sectional study, carried out on the Spanish population aged > or = 35 years in 2006. The number of deaths by age, sex and cause was obtained from the vital statistics of the National Institute of Statistics. The prevalence of smoking by age and sex was obtained from the national health survey. The relative risks of death employed were adjusted by age, sex, educational level, civil status, type of work, consumption of fruit/vegetables and other confounding factors specific to certain diseases. The proportion and number of deaths attributable to tobacco, by sex and age group, were estimated on the basis of the etiological fraction of the study population. Similarly, potential years of life lost (PYLL) were calculated. RESULTS: In 2006, smoking caused 58,573 deaths (45,028 men; 13,545 women), which accounted for 16.15% of all deaths (23.94% in men; 7.76% in women). By cause, the attributable deaths were distributed in 25,500 malign tumours, 19,117 cardiovascular diseases and 13,956 respiratory diseases. Trachea-bronchial-lung cancer in men and other cardiopathies in women were those that most contributed to that mortality (33.9% and 30.9%). The PYLL were 211,251.8 (176,765.3 in men; 34,486.5 in women). CONCLUSIONS: Tobacco consumption makes a very notable contribution to mortality in Spain. The impact that this habit has on our society is an unacceptable burden.

[Satisfaction among patients attending outpatient preventive medicine clinic]. / Satisfacción de los pacientes atendidos en una consulta externa de medicina preventiva.

INTRODUCTION: To evaluate satisfaction among patients attending the outpatient clinics of a Preventive Medicine Department and to identify any problems with the care they receive. MATERIAL AND METHODS: We performed a cross-sectional study in outpatient clinics of the Preventive Medicine Department, at Hospital General Universitario in Alicante, during January 2009. A questionnaire was given to all patients after their visit. Patients were satisfied if the final score was > or = 8. Socio-demographic variables were: age, sex, educational level, marital status and type of user (external or internal). chi(2) were used to study the association between these variables and satisfaction. RESULTS: The response rate was 84.4% (119/141), 94.1% were correctly completed (112/119), and 82.1% had a final score of > or = 8. The worst aspects were: comfort of waiting room, signs and wait time (percentage dissatisfied: 54.5%, 46.4% and 30.4%, respectively). The rest of the items obtained the following satisfaction percentages: medical treatment (97.3%), privacy of care (95.5%), information received (93.7%), easy next appointment (93.7%), visit length (92.9%), clarity of information (92.9%), to arrange the first appointment (90.2%), nursing treatment (87.5%), time to date of appointment (81.2%). Educational level was the only variable significantly associated with satisfaction. CONCLUSIONS: General satisfaction was good, although aspects like waiting time and signs could be better, if changes were made to management of appointments and the signs in the Hospital Department were increased.