Etiología de la mastitis crónica: propuesta de secuencia diagnóstica / Proposed diagnosis sequence for chronic mastitis aetiology

Introducción: Las lesiones inflamatorias mamarias precisan con frecuencia de estudio histopatológico por su capacidad de imitar a los tumores mamarios malignos. El objetivo es proponer una secuencia diagnóstica de las inflamaciones mamarias benignas crónicas. Material y método: Se han revisado en la literatura los métodos y algoritmos diagnósticos de las mastitis crónicas. Resultados: Se propone un algoritmo diagnóstico para los procesos inflamatorios crónicos mamarios. Requiere determinar el patrón histopatológico inflamatorio y su localización, así como un estudio microbiológico apropiado. Posteriormente puede precisar de nuevas pruebas bioquímicas y serológicas orientadas por una correlación clinicopatológica para establecer un diagnóstico específico. Discusión: No se han identificado en la literatura otros algoritmos diagnósticos avalados por estudios de alto nivel de evidencia. Los patrones histopatológicos no son uniformes. Conclusiones: El diagnóstico etiológico precisa identificar patrones histopatológicos inflamatorios benignos y su localización, un estudio microbiológico y pruebas orientadas por correlación clinicopatológica. Se precisan estudios de investigación con niveles de evidencia altos

Introduction: Inflammatory breast lesions require histopathological study due to their ability to clinically and radiologically mimic malignant mammary tumours. The objective is to propose a diagnostic technique for benign chronic inflammatory processes of the breast. Material and methods: We reviewed the literature on the diagnostic methods used in chronic mastitis. Results: We propose a diagnostic algorithm for chronic inflammatory processes of the breast. The aetiological diagnosis requires identifying benign inflammatory histopathologic patterns and locations, and microbiological study. New biochemical and serological tests oriented by clinicopathological correlation may then be required to establish a specific diagnosis. Discussion: No diagnostic algorithms based on studies with a high level of evidence have been identified. No uniformity in histopathologic patterns has been described. Conclusions: The etiologic diagnosis requires identifying benign inflammatory histopathologic patterns and locations, microbiological study and tests oriented by clinicopathological correlation. There is a lack of studies with a high level of evidence

Mediterranean diet adherence in individuals with prediabetes and unknown diabetes: the Di@bet.es Study.

BACKGROUND AND AIMS: Mediterranean diet (MedDiet) is causally related to diabetes and is a dietary pattern recommended to individuals with diabetes. We investigated MedDiet adherence in individuals with prediabetes and unknown (PREDM/UKDM) or known diabetes (KDM) compared to those with normal glucose metabolism (NORMAL). METHODS: This was a national, population-based, cross-sectional, cluster-sampling study. MedDiet adherence was scored (MedScore, mean ± SD 24 ± 5) using a qualitative food frequency questionnaire. Logistic regression was used to examine the association between MedScore and PREDM/UKDM or KDM versus control subjects. RESULTS: We evaluated 5,076 individuals. Mean age was 50 years, 57% were female, 826 (582/244) were PREDM/UKDM, 478 were KDM and 3,772 were NORMAL. Mean age increased across MedScore tertiles (46, 51 and 56 years, p < 0.0001). Higher age-adjusted adherence to MedDiet (5-unit increment in the MedScore) was associated with lower and nondifferent odds (OR, 95% CI) of prevalent PREDM/UKDM (0.88, 0.81-0.96, p = 0.001) and KDM (0.97, 0.87-1.07, p = 0.279), respectively, compared to individuals in the NORMAL group. CONCLUSIONS: In a representative sample of the whole Spanish population, MedDiet adherence is independently associated with PREDM/UKDM. Therapeutic intervention may be, in part, responsible for the lack of differences in adherence observed between the KDM and NORMAL groups. However, reverse causation bias cannot be ruled out in cross-sectional studies.

Olive oil has a beneficial effect on impaired glucose regulation and other cardiometabolic risk factors. Di@bet.es study.

BACKGROUND: Despite the marked increase in cardiovascular risk factors in Spain in recent years, the prevalence and incidence of cardiovascular diseases have not risen as expected. Our objective is to examine the association between consumption of olive oil and the presence of cardiometabolic risk factors in the context of a large study representative of the Spanish population. SUBJECTS AND METHODS: A population-based, cross-sectional, cluster sampling study was conducted. The target population was the whole Spanish population. A total of 4572 individuals aged ≥ 18 years in 100 clusters (health centers) were randomly selected with a probability proportional to population size. The main outcome measures were clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, body mass index, waist, hip and blood pressure) and oral glucose tolerance test (OGTT) (75 g). RESULTS: Around 90% of the Spanish population use olive oil, at least for dressing, and slightly fewer for cooking or frying. The preference for olive oil is related to age, educational level, alcohol intake, body mass index and serum glucose, insulin and lipids. People who consume olive oil (vs sunflower oil) had a lower risk of obesity (odds ratio (OR)=0.62 (95% confidence interval (CI)=0.41-0.93, P=0.02)), impaired glucose regulation (OR=0.49 (95% CI=0.28-0.86, P=0.04)), hypertriglyceridemia (OR=0.53 (95% CI=0.33-0.84, P=0.03)) and low HDL cholesterol levels (OR=0.40 (95% CI=0.26-0.59, P=0.0001)). CONCLUSIONS: The results show that consumption of olive oil has a beneficial effect on different cardiovascular risk factors, particularly in the presence of obesity, impaired glucose tolerance or a sedentary lifestyle.

Tumor bed segmentation: first step for partial breast irradiation

INTRODUCTION: In breast IMRT simultaneous integrated boost (SIB) treatment and accelerated partial breast irradiation (APBI), proper delineation of the tumor bed is necessary. Conservative oncoplastic surgery causes changes in peritumoral breast tissue that complicates locating the site of the tumor. Nevertheless, there are still centers that do not use surgical clips to delineate the site. This study aims to show how the lack of clips affects the techniques of SIB and APBI in terms of dose distribution and safety margins in the tumor bed. MATERIALS AND METHODS: On 30 patients, the defining of the tumor bed obtained from the pre-surgery CT scan to that outlined on the basis of clips on the post-surgery CT was compared. Tumor bed deviation from the original tumor site was quantified. In addition, the margins to the original tumor site necessary to guarantee the coverage of the tumor bed were calculated. RESULTS: Variations were detected in the distances between geometric centers of the PTV (minimum 0.5-maximum 3 cm). The maximum margin necessary to include the entire tumor bed was 4.5 cm. Lesions located in the upper outer quadrant required the widest margins. If margins are not added, the tumor bed volume defined with clips will be underdosed. CONCLUSIONS: The definition of the tumor bed based on studies before surgery does not have the necessary accuracy. Clips need to be placed in the surgical bed to identify the changes occurring after the restorative mammoplasty. Without clips, SIB and APBI are not safe (AU)

Evaluation of Health-Related Quality of Life according to Carbohydrate Metabolism Status: A Spanish Population-Based Study (Di@bet.es Study).

Objective. To evaluate the association between diabetes mellitus and health-related quality of life (HRQOL) controlled for several sociodemographic and anthropometric variables, in a representative sample of the Spanish population. Methods. A population-based, cross-sectional, and cluster sampling study, with the entire Spanish population as the target population. Five thousand and forty-seven participants (2162/2885 men/women) answered the HRQOL short form 12-questionnaire (SF-12). The physical (PCS-12) and the mental component summary (MCS-12) scores were assessed. Subjects were divided into four groups according to carbohydrate metabolism status: normal, prediabetes, unknown diabetes (UNKDM), and known diabetes (KDM). Logistic regression analyses were conducted. Results. Mean PCS-12/MCS-12 values were 50.9 ± 8.5/ 47.6 ± 10.2, respectively. Men had higher scores than women in both PCS-12 (51.8 ± 7.2 versus 50.3 ± 9.2; P < 0.001) and MCS-12 (50.2 ± 8.5 versus 45.5 ± 10.8; P < 0.001). Increasing age and obesity were associated with a poorer PCS-12 score. In women lower PCS-12 and MCS-12 scores were associated with a higher level of glucose metabolism abnormality (prediabetes and diabetes), (P < 0.0001 for trend), but only the PCS-12 score was associated with altered glucose levels in men (P < 0.001 for trend). The Odds Ratio adjusted for age, body mass index (BMI) and educational level, for a PCS-12 score below the median was 1.62 (CI 95%: 1.2-2.19; P < 0.002) for men with KDM and 1.75 for women with KDM (CI 95%: 1.26-2.43; P < 0.001), respectively. Conclusion. Current study indicates that increasing levels of altered carbohydrate metabolism are accompanied by a trend towards decreasing quality of life, mainly in women, in a representative sample of Spanish population.

Iodine intake in the adult population. Di@bet.es study.

BACKGROUND & AIMS: To date no nation-wide study has yet been undertaken in Spain to estimate the iodine deficiency. The aim was to evaluate iodine intake and its conditioning factors in a representative sample of the whole adult population. METHODS: The Di@bet.es Study is a national, cross-sectional, population-based survey conducted in 2009-2010 in Spain. RESULTS: The median urinary iodine (UI) was 117.2 µg/L. Iodized salt (IS) was consumed by 43.9% of the population. The median UI in those who consumed IS and in those who did not consume IS was 131.1 and 110.8 µg/L respectively (p<0.0001). The likelihood of having UI levels above 100 µg/L was significantly associated with the intake of IS (OR=1.47) and milk at least once a day (OR=1.22). Within each individual autonomous communities, the median UI levels in those who consumed IS correlated significantly with the median levels of those who did not consume IS (r=0.76, p=0.001). CONCLUSIONS: Though strictly speaking, Spain should be considered within the category of a country having an adequate iodine intake, the current value is too close to the cut point and does not guarantee that those groups with a greater need for iodine will have the required intake of iodine.

Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study.

AIMS/HYPOTHESIS: The Di@bet.es Study is the first national study in Spain to examine the prevalence of diabetes and impaired glucose regulation. METHODS: A population-based, cross-sectional, cluster sampling study was carried out, with target population being the entire Spanish population. Five thousand and seventy-two participants in 100 clusters (health centres or the equivalent in each region) were randomly selected with a probability proportional to population size. Participation rate was 55.8%. Study variables were a clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, BMI, waist and hip circumference, blood pressure) and OGTT (75 g). RESULTS: Almost 30% of the study population had some carbohydrate disturbance. The overall prevalence of diabetes mellitus adjusted for age and sex was 13.8% (95% CI 12.8, 14.7%), of which about half had unknown diabetes: 6.0% (95% CI 5.4, 6.7%). The age- and sex-adjusted prevalence rates of isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined IFG-IGT were 3.4% (95% CI 2.9, 4.0%), 9.2% (95% CI 8.2, 10.2%) and 2.2% (95% CI 1.7, 2.7%), respectively. The prevalence of diabetes and impaired glucose regulation increased significantly with age (p < 0.0001), and was higher in men than in women (p < 0.001). CONCLUSIONS/INTERPRETATION: The Di@bet.es Study shows, for the first time, the prevalence rates of diabetes and impaired glucose regulation in a representative sample of the Spanish population.

[Almotriptan vs. ergotamine plus caffeine for acute migraine treatment. A cost-efficacy analysis]. / Almotriptán frente a ergotamina más cafeína en el tratamiento de las crisis agudas de migraña. Análisis de coste-eficacia.

INTRODUCTION: Almotriptan has proven to be more efficacious and tolerable than ergotamine plus caffeine but is more expensive, thus raising the question about its cost-efficacy. METHODS: The course of migraine attacks during 24 hours treated with almotriptan and ergotamine plus caffeine was modelled with a decision tree, using efficacy data from a recent randomized, double-blind clinical trial comparing the two drugs. Costs were calculated from the social perspective (including indirect costs due to absenteeism and loss of productivity) and from the Spanish National Health System (NHS) perspective (only including drug costs). The impact on quality of life was estimated using utilities assigned in the literature to different health states of migraine patients. RESULTS: Treatment response was 57.7% for patients treated with almotriptan vs. 44.5% with ergotamine plus caffeine. Sustained pain-free status was achieved by 20.3% vs. 11.5%. Working days lost due to absenteeism and reduced productivity amounted to 0.24 vs. 0.38 days. Quality of life during attacks was estimated at an average utility of 0.548 vs. 0.422. From the NHS perspective, incremental costs per attack treated with almotriptan vs. ergotamine plus caffeine was euro 5.05, rendering an incremental cost-efficacy ratio of euro38.26 per additional response, euro57.39 per additional complete response, and euro14,709 per quality- adjusted life-year gained. From the social perspective almotriptan saved euro7.50 vs. ergotamine plus caffeine. CONCLUSIONS: Almotriptan can be considered cost-efficacious vs. ergotamine plus caffeine from the NHS perspective and is the dominant option (both more efficacious and more economical) from the social perspective.

Prevalence and comorbidity of common mental disorders in primary care.

OBJECTIVE: To estimate the prevalence and comorbidity of the most common mental disorders in primary care practice in Spain, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire. DESIGN: A systematic sample of 7936 adult primary care patients was recruited by 1925 general practitioners in a large cross-sectional national epidemiological study. The PRIME-MD was used to diagnose psychiatric disorders. SETTING: 1356 primary care units proportionally distributed throughout the country. RESULTS: 53.6% of the sample presented one or more psychiatric disorder. The most prevalent were affective (35.8%), anxiety (25.6%), and somatoform (28.8%) disorders. 30.3% of the patients had more than one current mental disorder. 11.5% presented comorbidity between affective, anxiety, and somatoform disorders. CONCLUSIONS: The study provides further evidence of the high prevalence and high comorbidity of mental disorders in primary care. Given the large overlap between affective, anxiety and somatoform disorders, future diagnostic classifications should reconsider the current separation between these entities.

Almotriptán frente a ergotaminamás cafeína en el tratamientode las crisis agudas de migraña. Análisis de coste-eficacia / Almotriptan vs. ergotamine plus caffeine for acute migraine treatment. A cost-efficacy analysis

Introducción. Almotriptán ha mostrado ser más eficaz y tolerableque ergotamina más cafeína, pero tiene un precio superior, por loque se plantea la pregunta de su coste-eficacia.Métodos. Se modeló mediante un árbol de decisión el curso durante24 h de ataques de migraña tratados con ambos fármacosusando datos de eficacia de un reciente ensayo clínico doble ciegoaleatorizado. Los costes fueron determinados desde las perspectivassocial y del sistema sanitario. El impacto sobre la calidad de vida seestimó a partir de índices asignados en la literatura a los diferentesestados de salud posibles en pacientes con migraña.Resultados. La respuesta al tratamiento fue del 57,7% con almotriptánfrente a 44,5% con ergotamina más cafeína; 20,3 frente a11,5% de pacientes alcanzaron ausencia mantenida de dolor durante24 h. Se perdieron 0,24 frente a 0,38 días laborales por absentismoy baja productividad. La calidad de vida durante el ataque sevaloró en una utilidad media de 0,548 frente a 0,422. Desde la perspectivadel sistema sanitario el diferencial de costes fue de 5,05 por ataque, resultando en un coste incremental de 38,26 por respuestaadicional conseguida con almotriptán, de 57,39 por respuestacompleta adicional y de 14.709 por año de vida ajustado por calidadganado. Desde la perspectiva social, almotriptán ahorró 7,50 por ataque en comparación con ergotamina más cafeína.Conclusiones. Almotriptán puede considerarse coste-eficazfrente a ergotamina más cafeína desde la perspectiva del sistema sanitarioy es la opción dominante (simultáneamente más eficaz y máseconómica) desde la perspectiva social (U)

Introduction. Almotriptan has proven to be more efficaciousand tolerable than ergotamine plus caffeine but is more expensive,thus raising the question about its cost-efficacy.Methods. The course of migraine attacks during 24 hours treatedwith almotriptan and ergotamine plus caffeine was modelledwith a decision tree, using efficacy data from a recent randomized,double-blind clinical trial comparing the two drugs. Costs werecalculated from the social perspective (including indirect costs dueto absenteeism and loss of productivity) and from the Spanish NationalHealth System (NHS) perspective (only including drug costs).The impact on quality of life was estimated using utilities assignedin the literature to different health states of migraine patients.Results. Treatment response was 57.7% for patients treatedwith almotriptan vs. 44.5% with ergotamine plus caffeine. Sustainedpain-free status was achieved by 20.3% vs. 11.5%. Workingdays lost due to absenteeism and reduced productivityamounted to 0.24 vs. 0.38 days. Quality of life during attackswas estimated at an average utility of 0.548 vs. 0.422. From theNHS perspective, incremental costs per attack treated with almotriptanvs. ergotamine plus caffeine was 5.05, rendering an incrementalcost-efficacy ratio of 38.26 per additional response, 57.39 per additional complete response, and 14,709 per quality-adjusted life-year gained. From the social perspective almotriptansaved 7.50 vs. ergotamine plus caffeineConclusions. Almotriptan can be considered cost-efficaciousvs. ergotamine plus caffeine from the NHS perspective and is thedominant option (both more efficacious and more economical)from the social perspective (AU)

Day centres for severe mental illness.

BACKGROUND: The number of people with severe mental illness who receive treatment whilst living at home has increased greatly over the last 30 years. Day centres and day hospitals frequently supplement this treatment. OBJECTIVES: To determine the effects of non-medical day centre care for people with severe mental illness. SEARCH STRATEGY: We updated our search in September 2005. All databases and searches are detailed in the body of the text. SELECTION CRITERIA: We would have included all randomised controlled trials where seriously mentally ill people were allocated to non-medical day centre care. DATA COLLECTION AND ANALYSIS: We reliably selected studies, quality rated them and extracted data. For dichotomous data, it had been hoped to estimate the fixed effects Relative Risk (OR) with 95% confidence intervals (CI) and the number needed to treat statistic (NNT). Analysis was to have been by intention-to-treat. Normal continuous data were to have been summated using the weighted mean difference (WMD) and scale data presented only for those tools that had attained pre-specified levels of quality. MAIN RESULTS: Electronic searches identified over 300 citations but none were relevant to this review. We found no trials of non-medical day centres. AUTHORS' CONCLUSIONS: We feel that the inclusion of any studies less rigorous than randomised trials would result in misleading findings and that it is not unreasonable to expect well designed, conducted and reported randomised controlled trials of day centre care. More precise nomenclature would greatly help identify relevant work. At present non-randomised comparative studies give conflicting messages about the roles provided by day centres and the clinical and social needs they are able to meet. It is therefore probably best that people with serious mental illness and their carers, if given the choice, take a pragmatic decision on which type of unit best meets their needs. There is a clear need for randomised controlled trials of day centre care compared to other forms of day care, and when resources are limited, day centre care within the context of a pragmatic randomised trial may be the only way of ensuring equity of provision.

Prognostic value of the interpectoral lymph nodes in breast cancer. A 20-year survival study.

INTRODUCTION: The indication and extent of axillary lymph node dissection in breast cancer remains open to controversy. MATERIALS AND METHOD: In this context, a 20-year survival study has been made of 1600 breast cancer patients subjected during surgical treatment to systematic dissection of the acromiothoracic vascular pedicle together with the accompanying lymph nodes (Rotter and Grossman interpectoral lymph node groups). An anatomical study of these nodes was also conducted in 100 necropsies, with the evaluation of 200 acromiothoracic vascular pedicles. RESULTS: The interpectoral lymph nodes were anatomically present in 42% of the necropsies and in 35.1% of the patients subjected to surgery. The prognosis was much worse in cases of neoplastic infiltration of the interpectoral lymph nodes (Kaplan-Meier survival study), regardless of the influence of other prognostic factors. CONCLUSIONS: In view of the results obtained, the designation of grade N3 of the TNM classification is proposed for malignancies with positive interpectoral lymph node infiltration.

The ubiquitin-specific protease USP25 interacts with three sarcomeric proteins.

The biological functions of the more than one hundred genes coding for deubiquitinating enzymes in the human genome remain mostly unknown. The USP25 gene, located at 21q11.2, encodes three protein isoforms produced by alternative splicing. While two of the isoforms are expressed nearly ubiquituously, the expression of the longer USP25 isoform (USP25m) is restricted to muscular tissues and is upregulated during myogenesis. USP25m interacts with three sarcomeric proteins: actin alpha-1 (ACTA1), filamin C (FLNC), and myosin binding protein C1 (MyBPC1), which are critically involved in muscle differentiation and maintenance, and have been implicated in the pathogenesis of severe myopathies. Biochemical analyses demonstrated that MyBPC1 is a short-lived proteasomal substrate, and its degradation is prevented by over-expression of USP25m but not by other USP25 isoforms. In contrast, ACTA1 and FLNC appear to be stable proteins, indicating that their interaction with USP25m is not related to their turnover rate.

Prognostic value of the interpectoral lymph nodes in breast cancer. A 20-year survival study

No disponible

Introduction. The indication and extent of axillarylymph node dissection in breast cancer remainsopen to controversy.Materials and method. In this context, a 20-yearsurvival study has been made of 1600 breast cancerpatients subjected during surgical treatment to systematicdissection of the acromiothoracic vascularpedicle together with the accompanying lymphnodes (Rotter and Grossman interpectoral lymphnode groups). An anatomical study of these nodeswas also conducted in 100 necropsies, with the evaluationof 200 acromiothoracic vascular pedicles.Results. The interpectoral lymph nodes were anatomicallypresent in 42% of the necropsies and in35.1% of the patients subjected to surgery. The prognosiswas much worse in cases of neoplastic infiltrationof the interpectoral lymph nodes (Kaplan-Meier survival study), regardless of the influence ofother prognostic factors.Conclusions. In view of the results obtained, thedesignation of grade N3 of the TNM classification isproposed for malignancies with positive interpectorallymph node infiltration

[Knowledge and perception about depression in the Spanish population]. / Conocimiento y percepción de la depresión entre la población española.

INTRODUCTION: The aim of this study is to investigate the Spanish people's perception of depression. Identification of the existing mistakes in depression perception will be the first step to correct them and to contribute to the patients' well being. MATERIAL AND METHODS: More than 1,000 structured surveys were conducted all around Spain with segmented representation for each regional community. RESULTS: Two out of three interviewed people considered depression to be a disease, in a somewhat higher degree those who had suffered from depression (67%). Forty two percent of people thought depression affects more than 25% of the population. Spanish people think that the incidence of depression will increase in the future. Their opinion of the importance of depression is high, considering it among the three most prevalent diseases, even exceeding that of coronary diseases. Most people interviewed would not accept a pharmacological treatment of at least one year of duration. The most mentioned adverse effect of antidepressants is dependency, and it is the reason why interviewed people are reluctant to maintain long term treatment. Only 50% of people treated for depression thought they had had enough family and social support. Eighteen percent of depressed people hide their diagnosis, basically for fear of stigma at work. CONCLUSIONS: Nowadays, the Spanish population has a good knowledge of depression. However, there are still some prejudices that make more difficult both the treatment and the recovery of depressed people and their social readjustment. These beliefs make up small stigmas that hinder treatment adherence, which is doubtlessly the most important factor to improve the outcome of depression.

Conocimiento y percepción de la depresión entre la población española / Knowledge and perception about depression in the Spanish population

Introducción. El objetivo de este estudio es conocer cómo percibe la población española la depresión. Poner de manifiesto los errores existentes en la consideración de la misma será el primer paso para poderlos corregir y poder contribuir a un mayor bienestar de los pacientes. Material y métodos. Se realizaron más de 1.000 entrevistas estructuradas por toda la geografía española, con representación segmentada para cada comunidad autónoma. Resultados. Dos tercios de los entrevistados consideraron que la depresión es una enfermedad; algo más quienes la habían padecido (67 por ciento). El 42 por ciento opinó que la depresión afecta a más del 25 por ciento de la población. La población española cree que en el futuro la incidencia irá en aumento. Los españoles otorgan gran importancia a la depresión, considerándola entre las tres enfermedades de mayor incidencia, superando a las enfermedades coronarias. La mayoría de los encuestados no aceptaría un tratamiento farmacológico de al menos 1 año de duración. El efecto adverso de los antidepresivos mencionado con mayor frecuencia es la dependencia, motivo por el cual los entrevistados son reacios a seguir un tratamiento durante largo tiempo. Sólo un 50 por ciento de los tratados por depresión consideró que recibió suficiente apoyo familiar y social. El 18 por ciento de los afectados por depresión ocultó su trastorno, fundamentalmente por motivos relacionados con el estigma laboral. Conclusiones. La población española actual tiene un notable conocimiento de la depresión. Sin embargo, siguen existiendo prejuicios que dificultan tanto el tratamiento y la recuperación del paciente deprimido como su reinserción social. Estas creencias constituyen pequeños estigmas que dificultan la adherencia al tratamiento, sin duda el factor más importante para mejorar el pronóstico de la depresión (AU)

Psychosocial factors associated with cancer behavioural risk in relatives of cancer patients.

The European Code against Cancer includes some primary cancer prevention behaviours, which can be studied in the framework of psychosocial models of human behaviour as the ASE model (attitude-social influence-efficacy model). The objective of this study was to detect the factors that better explain cancer behavioural risk in relatives of cancer patients. A convenience sample of 3031 people was selected in primary care centres. A three-step multivariate analysis was carried out by means of a multiple linear regression, introducing cancer behavioural risk as the dependent variable and the following covariables: psychosocial factors in the ASE model, sociodemographic variables and the family history of cancer. At least five difficulties and four needs were perceived in following the preventive advice by 25% of patients. The main difficulties were tobacco and alcohol addiction and the demands of a social life. Principal needs were access to cessation programmes, family support, and being controlled and pressured by health workers. The highest risk profile is to be a young man with a low sociocultural level. The ASE determinants were the best predictors of cancer behavioural risk, so programmes that forget these predictors may not achieve any impact and may waste resources.

Estudio longitudinal de los síntomas de estreñimiento y hábitos dietéticos en la población infantil. Estudio FREI / Longitudinal study of constipation symptoms and dietetic habits in children. FREI study

El objetivo de este estudio es el seguimiento clínico y nutricional de los niños con problemas de estreñimiento, tras informar a sus padres sobre las medidas higiénico-dietéticas a seguir para la corrección del mismo. Mediante un diseño prospectivo y unicéntrico, se recogieron datos clínicos basales y de seguimiento de 307 niños. Se utilizó una encuesta nutricional cada 3 meses durante un período de observación de 6 meses. El número de deposiciones durante el período de seguimiento aumentó significativamente. La incidencia de rectorragia disminuyó de forma estadísticamente significativa así como la necesidad de enemas. Entre el 93 y 100 por ciento de los niños reportaron que consumían lácteos durante el desayuno, observándose un relativo descenso en la ingesta de repostería a lo largo del estudio. El número de pacientes que refirieron consumir fruta durante la comida aumentó tras la intervención, mientras que en la cena se observó un aumento gradual del consumo de verduras y frutas. La actuación precoz en la modificación de hábitos dietéticos mejora los síntomas del estreñimiento infantil. Es necesario el seguimiento posterior para procurar mantener la adhesión a estos hábitos por parte de los niños y de sus progenitores. (AU)