Real world evidence of adjuvant trastuzumab in HER2 positive early breast cancer.

Adjuvant trastuzumab in HER2+ breast cancer reduces recurrence and mortality, and has been the standard treatment since 2006. The objective was to analyze health outcomes in the real world. Observational, retrospective study of patients with HER2+ breast cancer, stages I-III, treated with adjuvant trastuzumab in the past 15 years in only one center and for the first time in Spain. Survival was analyzed according to the number of cycles and cardiotoxicity. Two hundred and seventy-five HER2positive patients (18.60%) out of 1479 received adjuvant (73%) or neoadjuvant/adjuvant (26%) trastuzumab, concomitantly (90%) or sequentially (10%) with chemotherapy. The probability of overall and disease-free survival (OS and DFS) at 5 years was 0.93 (95% CI 0.89-0.96), and 0.88 (95% CI 0.83-0.92). The number of cases with a significant and asymptomatic decrease in ventricular ejection fraction and heart failure were 54 (19.64%) and 12 (4.36%), respectively. Sixty-eight patients (24.70%) received 16 or fewer cycles, especially those older than 65 (OR 0.371, 95% CI 0.152-0.903; p = 0.029) and with cardiotoxicity (OR 15.02, 95% CI 7.437-30.335; p < 0.001). The risk of cardiotoxicity was associated with having received radiotherapy (OR 0.0362, 95% CI 0.139-0.938; p = 0.037). Arterial hypertension (HR 0.361, 95% CI 0.151-0.863, p = 0.022), neoadjuvant treatment (HR 0.314, 95% CI 0.132-0.750, p = 0.009) and cardiotoxicity (HR 2.755, 95% CI 1.235-6.143, p = 0.013) maintained significant association with OS. Only neoadjuvant treatment maintained a significant association with DFS (HR 0.437, 95% CI 0.213-0.899, p = 0.024). The effectiveness of neoadjuvant and adjuvant trastuzumab can be considered comparable to those of clinical trials. In the real world, factors such as age, hypertension, radiotherapy, neoadjuvant treatment, and cardiotoxicity should be taken into consideration to optimize outcomes.

Evaluation of waiting times for breast cancer diagnosis and surgical treatment

Purpose: To analyse any delays in breast cancer diagnosis and surgical treatment, influence of clinical and biological factors and influence of delays on survival. Methods/patients: A descriptive, observational, and retrospective study was conducted between 2006 and 2016 on stages I-III breast cancer patients. This is a retrospective review of health records to collect data on delays, patients’ clinical data, biological features of the tumour and information on treatment. Mortality data from the National Death Index. Results: In 493 evaluable patients, the median of days from the first symptom to mammography, biopsy, and surgery was 41, 57, and 92, respectively. The median of days from screening mammography to biopsy and surgery was 10 and 51, respectively. From biopsy to surgery, the median was 34 days in every case. Over the last 5 years, an increase in biopsy-surgery delay has been observed (p = 0.0001). Tumour stages I and II vs. stage III (RR 1.74. 95% CI 1.08-2.80, p = 0.027), diagnosis in screening (RR 0.66. 95% CI 0.45-0.96, p = 0.030), and use of magnetic resonance imaging (RR 2.08. 95 CI 1.21-3.56, p = 0.008) condition a greater biopsy-surgery delay. No influence of delays on survival has been identified. Conclusions: Delays in diagnosis and surgery in the case of women diagnosed on the basis of symptoms may be improved. There is a temporary tendency to a greater delay in surgery. Some clinical and biological factors must be taken into account to optimise delays. Survival results are not adversely affected by delays

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Evaluation of waiting times for breast cancer diagnosis and surgical treatment.

PURPOSE: To analyse any delays in breast cancer diagnosis and surgical treatment, influence of clinical and biological factors and influence of delays on survival. METHODS/PATIENTS: A descriptive, observational, and retrospective study was conducted between 2006 and 2016 on stages I-III breast cancer patients. This is a retrospective review of health records to collect data on delays, patients' clinical data, biological features of the tumour and information on treatment. Mortality data from the National Death Index. RESULTS: In 493 evaluable patients, the median of days from the first symptom to mammography, biopsy, and surgery was 41, 57, and 92, respectively. The median of days from screening mammography to biopsy and surgery was 10 and 51, respectively. From biopsy to surgery, the median was 34 days in every case. Over the last 5 years, an increase in biopsy-surgery delay has been observed (p = 0.0001). Tumour stages I and II vs. stage III (RR 1.74. 95% CI 1.08-2.80, p = 0.027), diagnosis in screening (RR 0.66. 95% CI 0.45-0.96, p = 0.030), and use of magnetic resonance imaging (RR 2.08. 95 CI 1.21-3.56, p = 0.008) condition a greater biopsy-surgery delay. No influence of delays on survival has been identified. CONCLUSIONS: Delays in diagnosis and surgery in the case of women diagnosed on the basis of symptoms may be improved. There is a temporary tendency to a greater delay in surgery. Some clinical and biological factors must be taken into account to optimise delays. Survival results are not adversely affected by delays.

Disturbance-Disturbance uncertainty relation: The statistical distinguishability of quantum states determines disturbance.

The Heisenberg uncertainty principle, which underlies many quantum key features, is under close scrutiny regarding its applicability to new scenarios. Using both the Bell-Kochen-Specker theorem establishing that observables do not have predetermined values before measurements and the measurement postulate of quantum mechanics, we propose that in order to describe the disturbance produced by the measurement process, it is convenient to define disturbance by the changes produced on quantum states. Hence, we propose to quantify disturbance in terms of the square root of the Jensen-Shannon entropy distance between the probability distributions before and after the measurement process. Additionally, disturbance and statistical distinguishability of states are fundamental concepts of quantum mechanics that have thus far been unrelated; however, we show that they are intermingled thereupon we enquire into whether the statistical distinguishability of states, caused by statistical fluctuations in the measurement outcomes, is responsible for the disturbance's magnitude.

Influencia de los factores clínicos y biográficos en la calidad de vida de las mujeres durante la quimioterapia adyuvante por cáncer de mama / Influence of clinic Hospital Universitario Puerta del Mar, Cádiz, Españaal and biographical factors on the quality of life of women with breast cancer receiving adjuvant chemotherapy

Objetivo. La quimioterapia adyuvante afecta a diferentes aspectos de la calidad de vida de la mujer con cáncer de mama. Se ha estudiado su efecto en la calidad de vida y el impacto de las variables clínicas y biográficas. Material y método. Una cohorte de mujeres con cáncer de mama, tratadas con quimioterapia adyuvante, participantes en un ensayo clínico aleatorizado de intervención no farmacológica (ClinicalTrials.gov Identifier: NCT00964522), completó los cuestionarios de calidad de vida EORTC QOL-C30 y QOL-BR23 antes, a mitad y al terminar el tratamiento. Resultados. Cincuenta mujeres completaron los cuestionarios. La salud global empeoró con el tiempo (p=0,01). El funcionamiento físico (p=0,0001) y la imagen corporal (p=0,002) fueron las escalas más deterioradas. La astenia (p=0,004), las náuseas y vómitos (p=0,05) y anorexia (p=0,025) fueron los síntomas con mayor efecto temporal de la quimioterapia. Las mujeres desempleadas sufrieron peor funcionamiento físico (p=0,046) y de rol (p=0,005). Las mayores presentaron más diarrea (p=0,013). Las más educadas mostraron peor puntuación en la escala de dificultades financieras (p=0,034). Los casos con estadios más avanzados sufrieron mayor deterioro en su imagen corporal (p=0,001) y estuvieron más preocupados por su futuro (p=0,006). Las tratadas con antraciclinas y taxanos sintieron también peor perspectiva de futuro (p=0,02). Conclusiones. La quimioterapia adyuvante deteriora la calidad de vida de mujeres con cáncer de mama, sobre todo en su funcionamiento físico e imagen corporal. La astenia y toxicidad digestiva son los efectos secundarios predominantes. Las mujeres necesitan soporte si son mayores, desempleadas, mejor formadas, con estadio III y tratadas con antraciclinas y taxanos(AU)

Objective. Adjuvant chemotherapy affects the life of women with breast cancer in different ways. The aim of this work is to study the effect of adjuvant chemotherapy on the quality of their lives and the impact of their clinical and biographical characteristics. Patients and method. Women with breast cancer, candidates for adjuvant chemotherapy, participating in a randomised trial with non-pharmacological intervention (ClinicalTrials.gov Identifier: NCT00964522), completed the EORTC QOL-C30 and QOL-BR23 quality of life questionnaires before, in the middle, and at the end of the treatment. Results. Fifty women completed the questionnaires. Overall health got worse over time (p=0.01). Physical functioning (p=0.0001) and body image (p=0.002) were the scales that deteriorated most, and asthenia (p=0.004), nausea/vomiting (p=0.05), and anorexia (p=0.025), were the symptoms with the largest temporary impact of the chemotherapy. Unemployed women had worse physical functioning (p=0.046) and role functioning (p=0.005). Older women had more diarrhoea (p=0.013). The most qualified women had a worse score in financial difficulties scale (p=0.034). Women with advanced stage (III) underwent more deterioration in the body image (p=0.001) and were more concerned about the future (p=0.006). Women treated with anthracycline and taxane also had a worse perspective of the future (p=0.02). Conclusions. Adjuvant chemotherapy deteriorates the quality of life of patients with breast cancer, basically in physical functioning and body image areas. Asthenia and gastrointestinal toxicity are the side effects that affect patients most. Women need support if they are older, unemployed, more educated, and have stage III breast cancer treated with anthracycline and taxane based chemotherapy(AU)

[Influence of clinical and biographical factors on the quality of life of women with breast cancer receiving adjuvant chemotherapy]. / Influencia de los factores clínicos y biográficos en la calidad de vida de las mujeres durante la quimioterapia adyuvante por cáncer de mama.

OBJECTIVE: Adjuvant chemotherapy affects the life of women with breast cancer in different ways. The aim of this work is to study the effect of adjuvant chemotherapy on the quality of their lives and the impact of their clinical and biographical characteristics. PATIENTS AND METHOD: Women with breast cancer, candidates for adjuvant chemotherapy, participating in a randomised trial with non-pharmacological intervention (ClinicalTrials.gov Identifier: NCT00964522), completed the EORTC QOL-C30 and QOL-BR23 quality of life questionnaires before, in the middle, and at the end of the treatment. RESULTS: Fifty women completed the questionnaires. Overall health got worse over time (p=0.01). Physical functioning (p=0.0001) and body image (p=0.002) were the scales that deteriorated most, and asthenia (p=0.004), nausea/vomiting (p=0.05), and anorexia (p=0.025), were the symptoms with the largest temporary impact of the chemotherapy. Unemployed women had worse physical functioning (p=0.046) and role functioning (p=0.005). Older women had more diarrhoea (p=0.013). The most qualified women had a worse score in financial difficulties scale (p=0.034). Women with advanced stage (III) underwent more deterioration in the body image (p=0.001) and were more concerned about the future (p=0.006). Women treated with anthracycline and taxane also had a worse perspective of the future (p=0.02). CONCLUSIONS: Adjuvant chemotherapy deteriorates the quality of life of patients with breast cancer, basically in physical functioning and body image areas. Asthenia and gastrointestinal toxicity are the side effects that affect patients most. Women need support if they are older, unemployed, more educated, and have stage III breast cancer treated with anthracycline and taxane based chemotherapy.

[Local recurrence after non-small cell lung cancer surgery: prognosis variables]. / Recidiva local tras la cirugía del cáncer de pulmón no microcrítico: factores pronósticos.

OBJECTIVES: Retrospectively to analyse the influence of clinical and histo-pathological characteristics in the local recurrence after non-small cell lung cancer surgery. METHOD: 146 patients were included and studied during a minimum of two years. The free survival of disease function (FSD) was constructed according to the Kaplan-Meier method. The univariant comparison of the FSD by Mantel-Haenszel means of logarithmic ranks test and the multivariant analysis by Cox regression model. RESULTS: In the univariant analysis 20 months of FSD and the following predicting factors of a smaller FSD: Radiological contact of the tumour with the pleura (p=0.005), peritumoral margin affectation (p=0.001), pleural affectation (p=0.006), T stratification factor (p=0.04) and N factor (p=0.002). Other factors like age, initial symptoms, second neoplasias, radiological spiculations or cavitations, transtoracic puncion, type of surgery, peribronquial affectation, so large margin tumorlike and histological type, did not show statistically significant differences in the FSD. In the multivariant study they maintain its value prognosis the pleural affectation (p=0.0014), ganglionary affectation (p=0.02) and degree of differentiation (p=0.03). CONCLUSIONS: The most important prognosis factor of local recurrence after surgery in these patients were the infiltration of the pleura, followed of the hilio-mediastinic ganglionary affectation and the degree of histological differentiation.

Recidiva local tras la cirugía del cáncer de pulmón no microcrítico. Factores pronósticos / Local recurrence after non-small cell lung cancer surgery. Prognosis variables

Objetivos: Analizar retrospectivamente la influencia de características clínicas e histo-patológicas en la recidiva local tras cirugía del carcinomano microcítico de pulmón. Método: Se incluyeron en el estudio 146 pacientes seguidos durante un mínimo de 2 años. La función de supervivencia libre de enfermedad (SLE) se construyó según el método de Kaplan-Meier. La comparación univariante de la SLE se realizó mediante test de los rangos logarítmicos de Mantel-Haenszel y para el análisis multivariante se aplicó el modelo de regresión de Cox. Resultados: La mediana de la SLE fue de 20 meses En el análisis univariante, se encontraron los siguientes factores predictores de una menor SLE: contacto radiológico del tumor con la pleura (p = 0,005), grado de indiferenciación histológica (p = 0,03), afectación del margen peritumoral (p = 0,001), afectación pleural (p = 0,006), estadificación T(p = 0,04) y estadificación N (p = 0,002). Otros factores como la edad, presencia inicial de síntomas, segundas neoplasias, presencia radiológica de espiculaciones o cavitación, punción transtorácica, tipo de cirugía, afectación del margen peribronquial, tamaño tumoral y tipo histológico, no mostraron diferencias estadísticamente significativas en la SLE. En el estudio multivariante mantienen su valor pronóstico la afectación pleural (p = 0,0014), afectación ganglionar (p = 0,02) y grado de diferenciación (p = 0,03). Conclusiones: El factor pronóstico más importante de recidiva local tras cirugía en estos pacientes fue la infiltración de la pleura, seguido de la afectación ganglionar hilio-mediastínica y el grado de diferenciación histológica

Objetives: Retrospectively to analyse the influence of clinical and histo-pathological characteristics in the local recurrence after non-smallcell lung cancer surgery. Method: 146 patients were included and studied during a minimum of two years. The free survival of disease function (FSD) was constructed according to the Kaplan-Meier method. The univariante comparison of the FSD by Mantel-Haenszel means of logarithmic ranks test and the multivariante analysis by Cox regression model. Results: In the univariante analysis 20 months of FSD and the following predicting factors of a smaller FSD: Radiological contact of the tumour with the pleura (p = 0.005), peritumoral margin affectation (p =0.001), pleural affectation (p = 0.006), T stratification factor (p = 0.04) and N factor (p = 0.002). Other factors like age, initial symptoms, second neoplasias, radiological spiculaciones or cavitations, transtoracic puncion, type of surgery, peribronquial affectation, so large margin tumor like and histological type, did not show statistically significant differences in the FSD. In the multivariante study they maintain its value prognosis the pleural affectation (p = 0.0014), ganglionary affectation (p = 0.02) and degree of differentiation (p = 0.03). Conclusions: The most important prognosis factor of local recurrence after surgery in these patients were the infiltration of the pleura, followed of the hilio-mediastínica ganglionary affectation and the degree of histological differentiation

Antibioterapia empírica en el pie diabético y no diabético / Empirical antibiotic therapy for diabetic and non-diabetic foot

Introducción. La neuropatía, la isquemia y la infección son los tres factores directamente relacionados con la aparición y desarrollo de las úlceras en los pacientes diabéticos. La infección definida mediante parámetros clínicos y apoyada por cultivos microbiológicos es el principal factor pronóstico de la lesión. Objetivo. Estudiar la etiología infecciosa de las úlceras en pacientes diabéticos y no diabéticos, así como la sensibilidad in vitro a antimicrobianos de los microorganismos aislados, nos permitirá establecer la mejor pauta antibiótica empírica en nuestro medio asistencial. Pacientes y métodos. Estudio observacional, transversal y prospectivo de 200 pacientes consecutivos, diabéticos y no diabéticos, ingresados por la presencia de úlceras isquémicas o neuropáticas con signos locales de infección. Toma de tres muestras microbiológicas el día del ingreso previa administración del tratamiento empírico (ciprofloxacino + clindamicina) y valoración de su respuesta clínica y sus modificaciones a específico por resistencia de los microorganismos. Resultados. En la mayoría de los cultivos se aisló microbiota polimicrobiana con predominio de aerobios-anaerobios gramnegativos y aerobios grampositivos. Staphylococcus aureus (10,6%), Pseudomonas aeruginosa y Bacteroides fragilis fueron los microorganismos más frecuentemente aislados. La terapia empírica tuvo que modificarse en más del 50% de los casos por resistencia. La mayor sensibilidad in vitro para los microorganismos grampositivos fue para la vancomicina, seguida de cloxacilina y amoxicilina/clavulánico. En el caso de aerobios-anaerobios gramnegativos, fue para meropenem, tobramicina e imipenem, y para los anaerobios, imipenem, cefoxitina y amoxicilina/clavulánico. Conclusiones. La administración de amoxicilina/clavulánico solo o asociado a tobramicina constituye una pauta antibiótica con amplio espectro para los pacientes ambulatorios. En régimen de ingreso el antibiótico de elección sería imipenem, seguido de piperacilina/tazobactam

Introduction. Neuropathy, ischaemia and infection are the three factors directly related to the appearance and development of ulcers in diabetic patients. Infection defined by means of clinical parameters and backed up by microbiological cultures is the main prognostic factor of the lesion. Aims. To study the infectious causation of ulcers in diabetic and non-diabetic patients, in addition to the in vitro sensitivity to antimicrobials of the microorganisms that were recovered, in order to enable us to develop a better empirical antibiotic regimen in our health care area. Patients and methods. We conducted a prospective, cross-sectional, observational study involving 200 consecutive diabetic and non-diabetic patients who were admitted to hospital due to the presence of ischaemic or neuropathic ulcers with local signs of infection. Three microbiological samples were taken on the day of admission before administration of the empirical treatment (ciprofloxacin + clindamycin) and their clinical response and modifications in the specific due to resistance of the microorganisms were evaluated. Results. Polymicrobial microbiota were recovered from most of the cultures, with predominance of gram-negative aerobic-anaerobics and gram-positive aerobics. Staphylococcus aureus (10.6%), Pseudomonas aeruginosa and Bacteroides fragilis were the most frequently recovered micro-organisms. The empirical therapy had to be modified in over 50% of cases due to resistance. The highest sensitivity in vitro for the grampositive micro-organisms was to vancomycin, followed by cloxacillin and amoxicillin/clavulanic acid. In the case of gram-negative aerobic-anaerobics, it was found to be meropenem, tobramycin and imipenem, while the anaerobics were seen to be more sensitive to imipenem, cefoxitin and amoxicillin/clavulanic acid. Conclusions. Administration of amoxicillin/ clavulanic acid alone or in association with tobramycin constitutes a wide-spectrum antibiotic regimen for outpatients. If the patient is hospitalised, the preferred antibiotic would be imipenem, followed by piperacillin/ tazobactam

Relación entre factores precipitantes y mortalidad en el delirio agitado en Cuidados Paliativos / Relation of precipitating factors and mortality in agitate delirum of Palliative Care patients

Objetivo: el delirio agitado aparece con frecuencia en los pacientes con enfermedad oncológica avanzada. El objetivo de este estudio es analizarla etiología del delirio agitado y su relación con la mortalidad observada. Método: estudio retrospectivo de 631 pacientes de Cuidados Paliativos. Los factores etiológicos se clasificaron en: opioides, infección, iones metabólico, insuficiencia respiratoria, lesión del sistema nervioso central, o desconocido. Analizamos su relación con la mortalidad y el momento de aparición del delirio. Se aplicó el test de Chi cuadrado para variables cualitativas y t de Student para variables cuantitativas. Resultados: el delirio agitado se diagnosticó en 53 pacientes (8,4%). Edad media 67 años (DE 12,9). La neoplasia primaria se localizaba en pulmón (39,6%), aparato genitourinario (24,5%), aparato digestivo (17,0%), mama (9,4%) y otros (9,4%). Los precipitantes fueron: opioides (26,4%), infección (26,4%), iones-metabólico (17,0%), insuficiencia respiratoria(15,1%), lesión en el sistema nervioso central (7,5%) y desconocido (7,5%). La presencia de estos factores fue distinta dependiendo de que el delirio fuese el motivo de ingreso (opioides 32,4%, infección 29,4%) o apareciese durante la hospitalización (insuficiencia respiratoria 36,8%, infección 21,1%); p = 0,019. Se observó mayor mortalidad durante la hospitalización en los pacientes que presentaron delirio respecto a los que no (67,9vs. 41,2%, OR 3,03, IC 95%: 1,7-5,7). No encontramos diferencia en el número acumulado de factores etiológicos en los pacientes con delirio que fallecieron y en los que no (2,56 vs. 2,59). La mortalidad fue inferior, casi significativo, cuando la infección fue el factor precipitante (50,0 vs. 75,0-78,6%); p = 0,23. Conclusión: la infección y el inicio o aumento de dosis de opioides, factores tratables, fueron los precipitantes más frecuentes de delirio. Ninguno de los factores estudiados, ni el número acumulado de los mismos, se relacionó de una manera significativa a menor mortalidad (AU)

Objective: agitated delirium is frequently detected in patients suffering from advanced cancer. The objective of this study was to analyze the etiology of agitated delirium and the relation to mortality. Method: retrospective study of 631 terminally ill cancer patients. Putative etiologic factors were: opioid therapy, infection, metabolic disorders, respiratory insufficiency, central nervous system lesion or unknown. We tried to find their relation to mortality and onset of delirium. It was used the Chi square test for qualitative variables and t Student for quantitative variables. Results: agitated delirium was diagnosed in 53 patients (8.4%). Mean age was 67 years (SD 12.9); male: female 2: 1. Primary neoplasms were located at lung (39.6%), genitourinary system (24.5%), digestive system (17.0%), breast (9.4%) and others (9.4%). Inducing factors were: opioid therapy (26.4%), infection (26.4%), metabolic disorders (17.0%), respiratory insufficiency (15.1%), central nervous system lesion (7.5%) and unknown (7.5%). Frequency of precipitating factors was different whether the delirium was the cause of admission (opioid therapy 32.4%, infection 29.4%) or was developed during hospitalization (respiratory insufficiency 36.8%, infection 21.1%); p = 0.019. Higher mortality during hospitalization was observed in patients with delirium contrasting with those without it (67.9 vs. 41.2%, OR 3.03, 95% CI: 1.7-5.7). There was no difference in the accumulated number of etiologic factors inpatients with delirium who died and those who did not: 2.56 vs. 2.59. Mortality was lower, near significantly, when infection was the precipitating factor (50.0 vs. 75.0-78.6%); p = 0.23. Conclusion: infection and onset or an increase in the doses of opioids, two treatable causes, were the most recurrent precipitating factors of delirium. None of studied factors neither the accumulated number of them was related to mortality with statistical difference (AU)

Síntomas relacionados con fobia social en personal sanitario / Symptoms in relation with social phobia in health personal

Fundamentos: la prevalencia de fobia social en la población general oscila entre el 8-15,6 per cent, considerándose un trastorno de ansiedad infradiagnosticada. Se desconoce su prevalencia en personal sanitario, quien precisa de realizar actividades de educación a la comunidad y de comunicación científica. Objetivos: determinar la prevalencia de síntomas relacionados con fobia social en personal sanitario. Diseño: observacional, descriptivo transversal. Ámbito de estudio: distrito sanitario de Atención Primaria. Sujetos: se incluyen como participantes personal sanitario (médico y enfermero) con ejercicio en 15 centros de salud. Mediciones: se solicita cumplimentación, de forma anónima y voluntaria, de un cuestionario elaborado al efecto, escalas de ansiedad social de Liebowitz (LSAS) y de ansiedad/depresión de Goldberg (EADG) al personal médico y de enfermería trabajadores de 13 centros de salud, en un distrito sanitario de Atención Primaria (población a estudio = 266 sujetos).Resultados: grado de respuesta del 39 per cent (n=104). Se detectó ansiedad social grave en el 1,8 per cent de los casos (2 individuos), moderada en el 25,7 per cent (22 individuos) y leve o no patológica en el 76,5 per cent (80 individuos). Para el conjunto global de profesionales a estudio, se detecta coexistencia entre síntomas relacionados con fobia social y subescalas de la EADG para la ansiedad y depresión con significación estadística (p<0,012 para la categoría de ansiedad leve y p<0,034 para la categoría de ansiedad moderada o severa). Conclusiones principales: Alta prevalencia de síntomas relacionados con fobia social entre el personal sanitario del distrito a estudio. Es precisa, una atención especial a esta sintomatología, y a la manifiesta coexistencia de síntomas de ansiedad y/o depresión detectadas (AU)

[Prevalence of goitre and iodine deficiency in a school population from a traditionally endemic health area]. / Prevalencia de bocio y deficiencia de yodo en población escolar de una zona básica de salud tradicionalmente endémica.

OBJECTIVES: To determine the current prevalence of simple goitre in the school population of a health district where goitre is traditionally endemic. Calculation of the deficiency or otherwise of iodine through the determination of mean urinary excretion of iodine in the population under study. DESIGN: Cross-sectional descriptive study. SETTING: Olvera Health District (Cádiz). PARTICIPANTS: School students in the health district between 6 and 14 years old out of a total of 1969. Sample size of 92 school students was chosen at random, for a 95% confidence interval. MEASUREMENTS AND MAIN RESULTS: Dependent variables were the existence of goitre found in a physical examination, urinary excretion of iodine measured in microg/dl in the first urine of the morning, origin of water consumed and habitual consumption of iodised salt in their diet. 87% of the population under study habitually drank water from the normal supply, 4% from wells or springs, and 9% mineral water. 57% of parents did not know whether the salt in their normal diet was iodised or not. 29.3% of school students included in the study had some degree of goitre. The mean excretion of iodine in urine was 13.78 microg/dl (95% CI, 12.30-15.26). Ioduria was below 9.9 microg/dl in 28.2%, within the endemic figures. CONCLUSIONS: The mean amount of iodine in urinary excretion in the sample means that the risk of developing goitre is low, although the prevalence of goitre continues at endemic figures.

Prevalencia de bocio y deficiencia de yodo en población escolar de una zona básica de salud tradicionalmente endémica / Prevalence of goitre and iodine deficiency in a school population in a traditionally endemic health area

Objetivos. Determinar la prevalencia actual de bocio simple en la población escolar de una zona básica de salud tradicionalmente endémica para bocio. Estimación de la deficiencia o no de yodo mediante la determinación de la excreción media urinaria de yodo en la población de estudio. Diseño. Estudio descriptivo, transversal. Emplazamiento. Zona básica de salud de Olvera (Cádiz).Participantes. Escolares de la zona básica de salud de 6-14 años sobre un total de 1.969. Se selecciona tamaño muestral de 92 escolares, aleatoriamente, para un nivel de confianza del 95 por ciento. Medición y resultados principales. Las variables dependientes son la existencia de bocio detectada en una exploración física, la excreción urinaria de yodo medida en µg/dl en la primera orina de la mañana, origen del agua de consumo y consumo habitual en la dieta de sal yodada. Un 87 por ciento de la población estudiada consume agua de la red corriente de forma habitual, el 4 por ciento de pozo o fuentes naturales y el 9 por ciento utiliza habitualmente agua mineral. El 57 por ciento de los padres desconoce si la sal que usan en la dieta es o no yodada. Un 29,3 por ciento de escolares incluidos en el estudio presentó algún grado de bocio. La media en la excreción urinaria de yodo de la muestra fue de 13,78 µg/dl (IC del 95 por ciento, 12,30-15,26). La yoduria fue inferior a 9,9 µg/dl en un 28,2 por ciento de los individuos, dentro de valores endémicos. Conclusiones. El valor medio de la excreción urinaria de yodo de la muestra sitúa el riesgo poblacional de desarrollar bocio como bajo, aunque la prevalencia de bocio se mantiene dentro de cifras de endemia (AU)

Risk factors for hepatocellular carcinoma in patients with liver cirrhosis.

OBJECTIVE: Although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence the risk for HCC in patients with cirrhosis. This study was designed to identify differences in cirrhosis-related risk factors for developing HCC in relation to epidemiological characteristics, stage of the disease and etiology. METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprotein (AFP) concentration was measured. RESULTS: The average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of follow-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infection (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) and AFP levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients, only age (risk increased by 15% per year), and hepatitis C virus infection (relative risk: 5.4) were risk factors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex (relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4.9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% were infected with hepatitis C virus. Alcoholism, Child-Pugh stage and duration of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: The risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infection was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered AFP level.

[Evaluation of theory-practice knowledge on inhalation systems in primary care physicians, post-graduates in training and undergraduates]. / Evaluación del conocimiento teórico-práctico de los sistemas de inhalación en médicos de atención primaria, posgrados en formación y pregrado.

OBJECTIVE: To find the theoretical and practical knowledge concerning inhalation systems of primary care doctors, postgraduates in training--family & community medicine (FCM) residents--and undergraduates who had passed their course in pneumology. DESIGN: Crossover, descriptive study. SETTING: FCM teaching unit of the Puerta del Mar Hospital (Cadiz), the Cadiz Faculty of Medicine and seven primary care centres on the Bay of Cadiz. PARTICIPANTS: 31 practising primary care doctors, 25 third-year FCM residents and 31 medical students were evaluated. MEASUREMENTS AND MAIN RESULTS: A thirteen-point questionnaire was used to evaluate the subjects theoretical knowledge of inhalation systems. The percentage of correct replies was used to establish reply levels. Their techniques of handling different systems of inhalation (pressurised cartridge, pressurised cartridge with spacing chamber, Turbuhaler and Accuhaler) were assessed according to the guidelines of the SEPAR (Spanish Society of Pneumology and Thoracic Surgery). 26% of the practising doctors and residents answered over 75% of the questionnaire correctly, with no significant differences between the two groups (p > 0.66). No undergraduate reached 75% of correct answers. After exclusion of asthmatic participants, three of the practising doctors (9.7%) and one of the residents (4.8%) performed the technique correctly with the four systems: there were no differences between the two groups (p > 0.87). No undergraduate performed them satisfactorily. CONCLUSIONS: Specific training for primary care doctors in handling inhalation therapy is recommended.

Factores de riesgo de aparición del carcinoma hepatocelular en pacientes con cirrosis hepática / Risk Factors for hepatocellular carcinoma in patients with liver cirrhosis

OBJETIVO: determinar la existencia de diferencias en el riesgo de presentar un carinoma hepatocelular (CHC) en pacientes con cirrosis en función de sus características epidemiológicas, evolución de la hepatopatía y su etiología. PACIENTES Y MÉTODOS: 512 pacientes cirróticos en grado A/13 de Child-Pugh menores de 70 años fueron valorados periódicamente mediante ecografía y determinaciones de alfa-fetoproteína (AFP). RESULTADOS: tras un seguimiento medio de 37 meses se detectaron 52 CHC (riesgo acumulado del 17 por ciento a los 5 años). El modelo de Cox demostró que por cada año de edad el riesgo de CHC se incrementó un 8 por ciento. El sexo varón (RR: 3,4), la infección por virus C (RR: 4,6), la infección por el virus B (RR: 2,9) y la alteración de la AFP (RR: 2,5) también se mostraron como factores de riesgo. Entre los pacientes etílicos, sólo la edad (incremento del 15 por ciento por cada año transcurrido) y la infección por el virus C (RR: 5,4) fueron factores de riesgo. En los pacientes infectados por el virus C supusieron un mayor riesgo: la edad (S por ciento por cada año), el sexo varón (RR: 3,9), la coinfección por el virus B (RR: 4,9) y la elevación de la AFP (RR: 2,8). El 71 por ciento de los pacientes con CHC tenían infección por el virus C. El etilismo y la duración de la cirrosis no incrementaron el riesgo de aparición del tumor, CONCLUSIONES: el riesgo de aparición del CHC asciende al 17 por ciento tras 5 años de seguimiento en pacientes con cirrosis en grado A/B de Child-Pugh. El virus C es el principal factor de riesgo en nuestro medio. Otros factores demostrados son la edad, el sexo varón, la infección por el virus B y la alteración de la AFP. El etilismo y la duración de la hepatopatía no influye en el riesgo de aparición del tumor (AU)

Evaluación del conocimiento teórico-práctico de los sistemas de inhalación en médicos de atención primaria, posgrados en formación y pregrado / Evaluation of the theoretical and practical knowledge concerning inhalation systems of primary care doctors, postgraduates in training and undergraduates

Objetivo. Conocer el nivel de conocimientos teórico-prácticos sobre sistemas de inhalación en médicos de atención primaria, posgrado en formación (residentes de medicina familiar y comunitaria) y pregrado con la asignatura de neumología aprobada. Diseño. Estudio descriptivo transversal. Emplazamiento. Unidad docente de MFyC del Hospital Puerta del Mar (Cádiz), Facultad de Medicina de Cádiz y 7 centros de atención primaria de la bahía de Cádiz. Participantes. Fueron evaluados 31 médicos en ejercicio en atención primaria, 25 residentes de tercer año de MFyC y 31 estudiantes de medicina. Mediciones y resultados principales. Se valoró el conocimiento teórico de los sistemas de inhalación mediante cuestionario de 13 preguntas. Se establecieron niveles de respuesta en función del porcentaje de respuestas correctas. La técnica inhalatoria en el manejo de los distintos sistemas (cartucho presurizado, cartucho presurizado con cámara espaciadora, Turbuhaler® y Accuhaler®) fue evaluada según normativa de la SEPAR (Sociedad Española de Neumología y Cirugía Torácica). Un 26 por ciento de los médicos en ejercicio y residentes respondió correctamente a más del 75 por ciento del cuestionario, sin diferencias significativas entre ambos (p > 0,66). Ningún pregrado alcanzó un 75 por ciento de respuestas correctas. Excluyendo a los participantes asmáticos, realizaron correctamente la técnica con los 4 sistemas evaluados tres de los médicos en ejercicio (9,7 por ciento) y uno de los residentes (4,8 por ciento), sin que hubiera diferencias entre ambos colectivos (p > 0,87). Ningún pregrado las realizó satisfactoriamente. Conclusiones. Es recomendable formación específica a los profesionales de atención primaria en el manejo de la terapia inhalada (AU)

Underreporting of percutaneous exposure accidents in a teaching hospital in Spain.

The study's objectives were to determine the frequency of biological-risk accidents involving percutaneous exposure and to identify factors associated with underreporting. Two hundred fifty healthcare professionals from inpatient services at high risk for exposure at the Puerta del Mar University Hospital of Cádiz, Spain, participated in the study. A questionnaire was used to measure personal and work variables, the number of accidents suffered and reported in the last year, and the circumstances motivating the reporting or nonreporting. Two hundred thirty-two persons (92.8%) completed the questionnaire. The accident rate was 12 per 100,000 hours worked. Physicians were the most frequent accident victims (rate 22/100,000 hours). The general surgery and emergency services had higher rates than other services (rates 19.82 and 14.17, respectively). Sixty-six percent of the accidents were not reported to the register. The main predictors of the underreporting were length of professional service greater than 19 years, working in the surgery service, and the perception that the accidents did not involve health risk. The true accident rate was higher than that reflected in the Accident Register. Underreporting was high. The main variables associated with underreporting were length of professional service, work area or department, and perception of risk from the accident.