Prevalencia del cáncer del tracto urinario. Análisis de la cohorte española del estudio IDENTIFY / Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study

Introducción Los tumores malignos del tracto urinario están asociados a gran morbimortalidad siendo su prevalencia variable a nivel global. Recientemente el estudio IDENTIFY ha publicado resultados sobre la prevalencia del cáncer del tracto urinario a nivel internacional. Este estudio evalúa la prevalencia de cáncer dentro de la cohorte española del estudio IDENTIFY para determinar si los resultados publicados son extrapolables a nuestra población. Material y métodos Se realizó un análisis de los datos de la cohorte de pacientes españoles del estudio IDENTIFY. Se trata de una cohorte prospectiva de pacientes derivados al hospital con sospecha de cáncer, predominantemente por hematuria. Los pacientes fueron reclutados entre diciembre de 2017 y diciembre de 2018. Resultados En total 706 pacientes procedente de 9 centros españoles fueron analizados. Doscientos setenta y siete pacientes (39,2%) fueron diagnosticados de cáncer, 259 (36,7%) de cáncer vejiga, 10 (1,4%) de tracto urinario superior, 9 (1,2%) renal y 5 (0,7%) de próstata. El aumento de la edad (OR: 1,05; IC 95%: 1,03-1,06; p<0,001), presencia de hematuria visible (OR: 2,19; IC 95%: 1,13-4,24; p=0,02) y el hábito tabáquico (exfumadores: OR: 2,11; IC 95%: 1,30-3,40; p=0,002; fumadores: OR: 2,36; IC 95%: 1,40-3,95; p=0,001) se asocia con mayor probabilidad de cáncer vesical. Conclusión Este estudio resalta el riesgo que existe en pacientes con HV y hábito tabáquico de presentar cáncer de vejiga. El cáncer de vejiga presentó la mayor prevalencia, siendo esta mayor que la expuesta en series previas y la presentada en el estudio IDENTIFY. Trabajos futuros deben evaluar otros factores asociados que permitan crear modelos de predicción de cáncer para seguir aumentando la detección de estos en nuestros pacientes. (AU)

Introduction Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. Patients and methods An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. Results A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR: 1.05; 95% CI: 1.03-1.06; P<.001), visible hematuria (VH) OR: 2.19; 95% CI: 1.13-4.24; P=.02)and smoking (ex-smokers: OR: 2.11; 95% CI: 1.30-3.40; P=.002); (smokers: OR: 2.36; 95% CI: 1.40-3.95; P=.001) were associated with higher probability of bladder cancer. Conclusion This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients. (AU)

Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study.

INTRODUCTION: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey.

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic.

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Milling with ceramic inserts of austempered ductile iron (ADI): process conditions and performance.

In the work here presented, the high performance of ceramic insert tools in milling of ADI 1000 iron casting is analyzed. Austempered ductile irons (ADI) are ductile iron castings with strength and mechanical properties enhanced after specific heat treatment, achieving 1000 MPa or even more. Sintered carbide tools are state of the art in many industrial applications, including iron casting machining, but ceramic inserts are a feasible and promising option since cutting speed can be improved by 5 or even 10 times. A complete testing campaign was performed, starting with coated sintered carbides and aiming at the use of whisker reinforced Al2O3 ceramics and Si3N4 tools. The two most important conclusions are as follows: firstly, that the milling type so-called up-milling (or conventional) is more recommended than down-milling, also known as climb milling, and secondly, that dry machining enhances ceramics performance in comparison with using emulsion coolants (oil in water). Finally, results regarding economic aspects were analyzed based on the tools cost-performance ratio.

Acute abdomen caused by torsion of the pedicle in a wandering spleen.

A case of acute abdomen caused by acute torsion of a wandering spleen in a 20-year-old female patient is presented. It underscores the efficiency of the ultrasonic examination in the diagnosis of this type of pathology.