RESUMO
Aside from existing opportunistic screening, an organised screening programme (OSP) for cervical cancer (CC) was implemented in 2006/2007 in Poland. We applied joinpoint regression and age-period-cohort model to look for the impact of the OSP on CC incidence/mortality trends. Decline of age-standardised incidence rates (ASIRs) in the screening-age group (25-59 years) accelerated from -2.2% (95% CI -2.7 to -1.7%) between 1993 and 2008 to -6.1% (95% CI -7.7 to -4.4%) annually after 2008. In women aged 60+ years, ASIRs declined from 1986 until 2005 [annual percent change (APC) = -2.6%, 95% CI -2.9 to -2.4%] and stabilised thereafter. Decline of age-standardised mortality rates (ASMRs) in the screening-age group accelerated from -1.3% (95% CI -1.5 to -1.1%) between 1980 and 2005 to -4.7% (95% CI -5.6 to -3.8%) annually after 2005. In women aged 60+ ASMR declined between 1991 and 2004 (APC = -2.9%, 95% CI -3.5 to -2.3%) and stabilised thereafter. Relative risks of CC diagnosis and death were 0.63 (95% CI 0.62-0.65) and 0.61 (95% CI 0.59-0.63), respectively, for the most recent period compared to the reference around 1982. Implementation of the OSP possibly accelerated downward trends in the burden of CC in Polish women under the age of 60, but recent stabilisation of trends in older women requires actions.
Assuntos
Detecção Precoce de Câncer/métodos , Programas de Rastreamento/organização & administração , Mortalidade/tendências , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Polônia/epidemiologia , Avaliação de Programas e Projetos de Saúde , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço VaginalRESUMO
BACKGROUND: Male breast cancer (MBC) represents a rare cause of vertebral body compression fractures along with severe pain restricting the patient's daily functioning. Limited number of cases, lack of awareness among patients and physicians leading to delayed management, further increase the average age and disease progression at presentation, resulting in a poor prognosis. Additionally, studies on MBC treatment protocols and the use of female algorithms are unavailable. The implementation of vertebroplasty or kyphoplasty often results in unsatisfactory outcome due to recurrent pain and loss of vertebral height. Stentoplasty could become an alternative procedure, as described in the following case study. CASE REPORT: 54-yr-old male patient with history of breast carcinoma presented with pain in the vertebral column. Baseline X-ray and CT scan revealed multiple osteosclerotic and osteolytic metastatic lesions in the thoracic vertebrae along with a compression fracture at T9. Stentoplasty was performed to limit fracture progression. Intraoperative scan revealed restoration of the vertebral body shape. Following surgery, direct reduction in pain was obtained. Postoperative 1-year follow-up did not show any loss in height of the operated vertebra. Results of adjuvant chemotherapy administration and a new method of treatment of compression fractures caused by metastatic lesions were compared with previously published studies. CONCLUSIONS: Stentoplasty with Vertebral Body Stenting-System is an innovative method that can be applied in kyphoplasty for compression fractures caused by metastatic lesions. Nevertheless, further research on the systemic treatment of MBC is needed.
Assuntos
Neoplasias da Mama Masculina/complicações , Neoplasias da Mama Masculina/terapia , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/terapia , Fraturas por Compressão/etiologia , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/prevenção & controle , Carcinoma Ductal de Mama/complicações , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Fluoruracila/uso terapêutico , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia , Metástase Linfática , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia , Stents , Tamoxifeno/administração & dosagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , VertebroplastiaRESUMO
BACKGROUND: We aimed to compare AS03-adjuvanted inactivated trivalent influenza vaccine (TIV) with non-adjuvanted TIV for seasonal influenza prevention in elderly people. METHODS: We did a randomised trial in 15 countries worldwide during the 2008-09 (year 1) and 2009-10 (year 2) influenza seasons. Eligible participants aged at least 65 years who were not in hospital or bedridden and were without acute illness were randomly assigned (1:1) to receive either AS03-adjuvanted TIV or non-adjuvanted TIV. Randomisation was done in an internet-based system, with a blocking scheme and stratification by age (65-74 years and 75 years or older). Participants were scheduled to receive one vaccine in each year, and remained in the same group in years 1 and 2. Unmasked personnel prepared and gave the vaccines, but participants and individuals assessing any study endpoint were masked. The coprimary objectives were to assess the relative efficacy of the vaccines and lot-to-lot consistency of the AS03-adjuvanted TIV (to be reported elsewhere). For the first objective, the primary endpoint was relative efficacy of the vaccines for prevention of influenza A (excluding A H1N1 pdm09) or B, or both, that was confirmed by PCR analysis in year 1 (lower limit of two-sided 95% CI had to be greater than zero to establish superiority). From Nov 15, to April 30, in both years, participants were monitored by telephone or site contact and home visits every week or 2 weeks to identify cases of influenza-like illness. After onset of suspected cases, we obtained nasal and throat swabs to identify influenza RNA with real-time PCR. Efficacy analyses were done per protocol. This trial is registered with ClinicalTrials.gov, number NCT00753272. FINDINGS: We enrolled 43 802 participants, of whom 21 893 were assigned to and received the AS03-adjuvanted TIV and 21 802 the non-adjuvanted TIV in year 1. In the year 1 efficacy cohort, fewer participants given AS03-adjuvanted than non-adjuvanted TIV were infected with influenza A or B, or both (274 [1·27%, 95% CI 1·12-1·43] of 21 573 vs 310 [1·44%, 1·29-1·61] of 21 482; relative efficacy 12·11%, 95% CI -3·40 to 25·29; superiority not established). Fewer participants in the year 1 efficacy cohort given AS03-adjuvanted TIV than non-adjuvanted TIV were infected with influenza A (224 [1·04%, 95% CI 0·91-1·18] vs 270 [1·26, 1·11-1·41]; relative efficacy 17·53%, 95% CI 1·55-30·92) and influenza A H3N2 (170 [0·79, 0·67-0·92] vs 205 [0·95, 0·83-1·09]; post-hoc analysis relative efficacy 22·0%, 95% CI 5·68-35·49). INTERPRETATION: AS03-adjuvanted TIV has a higher efficacy for prevention of some subtypes of influenza than does a non-adjuvanted TIV. Future influenza vaccine studies in elderly people should be based on subtype or lineage-specific endpoints. FUNDING: GlaxoSmithKline Biologicals SA.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Vírus da Influenza A/imunologia , Vírus da Influenza B/imunologia , Vacinas contra Influenza/administração & dosagem , Influenza Humana/imunologia , Influenza Humana/prevenção & controle , Polissorbatos/administração & dosagem , Esqualeno/administração & dosagem , alfa-Tocoferol/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Vacinas contra Influenza/imunologia , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Estações do Ano , Esqualeno/imunologia , Vacinas de Produtos Inativados/administração & dosagem , Vacinas de Produtos Inativados/imunologia , alfa-Tocoferol/imunologiaRESUMO
The study is an outline of the historical development of rehabilitation as a new medical discipline in Poland and worldwide. Rehabilitation has developed dynamically in the interwar period. In the US, it was pioneered by Howard Rusk, while in Poland, rehabilitation was introduced by Wiktor Dega. Medical rehabilitation is an interdisciplinary approach and is an integral and irremovable element of treatment at all treatment stages. Of note is the contribution of Wiktor Dega, who has developed and presented the Polish concept of rehabilitation, considered by the World Health Organization (WHO) as worth of being followed. Wiktor Dega believed that rehabilitation should be started possibly early--as soon as in the active disease stage and should provide and maintain good functional results after surgical treatment. The article discusses the contribution of pioneer specialists in rehabilitation in two first rehabilitation centers in Poland, established after World War II in Poznan and Konstancin near Warsaw.
Assuntos
Procedimentos Ortopédicos/história , Especialidade de Fisioterapia/história , Medicina Física e Reabilitação/história , Reabilitação/história , Saúde Global , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , História Medieval , Humanos , Procedimentos Ortopédicos/reabilitação , Ortopedia/história , PolôniaRESUMO
Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity. Because of that many different methods of diagnostics is used to make proper diagnosis. Few of them, like: MRI, ultrasounds or nerve conductivity speed are used more often than others. Also among surgical methods of treatment some gain an advantage over others. In this paper we present opinion on the diagnostics and treatment of carpal tunnel syndrome according to our experience and references.