Intervenciones promotoras de habilidades de crianza y salud: ¿cómo influye la adherencia? / Parenting skills and health promoting interventions: what is the impact of adherence?

OBJETIVO: Identificar los factores asociados a una baja adherencia de un programa de habilidades parentales. MÉTODOS: Estudio transversal realizado en una muestra por conveniencia de 624 personas entre 2017 y 2018 en Barcelona. Se definió como baja adherencia acudir a menos del 70% del total de sesiones del programa. Se ajustaron modelos de regresiones logísticas multinivel y se examinaron variables sociodemográficas, del programa y de las profesionales secuencialmente para determinar los factores asociados. RESULTADOS: Un 35% de los participantes no cumplió con la asistencia mínima establecida. La adherencia aumenta cuando la institución que lidera la intervención pertenece a servicios de salud, la intervención se realiza por la mañana y las profesionales tienen experiencia en el trabajo con familias. CONCLUSIONES: La adherencia se asocia a factores del programa y de las profesionales. Se deberían seguir invirtiendo esfuerzos en mejorarla haciendo énfasis en la correcta recogida y monitorización de los datos sobre la asistencia, que permitan ampliar la investigación en este ámbito

OBJECTIVE: To identify factors associated with low adherence to a parental skills programme. METHODS: A cross-sectional study was performed on a sample of 624 people between 2017 and 2018 in Barcelona. Low adherence was defined as lower than 70% attendance at all established sessions. Multilevel logistic regression model were performed. Sociodemographic, programme and professional variables were sequentially examined to determine which factors were associated with non-adherence. RESULTS: A total of 35% of participants did not meet the minimum attendance requirement. Adherence increased when the institution that led the intervention belonged to health services, when the intervention was held in the morning and when professionals had experience working with families. CONCLUSIONS: Adherence is associated with both programme and professional factors. Further efforts should be made to improve the programme. Special emphasis should be placed on correct collection and monitoring of data on attendance, which would facilitate further research in this area

Neutrophil-lymphocyte ratio in metastatic breast cancer is not an independent predictor of survival, but depends on other variables.

The prognostic impact of neutrophil-lymphocyte ratio (NLR) in metastatic breast cancer (MBC) has been previously evaluated in early and metastatic mixed breast cancer cohorts or without considering other relevant prognostic factors. Our aim was to determine whether NLR prognostic and predictive value in MBC was dependent on other clinical variables. We studied a consecutive retrospective cohort of patients with MBC from a single centre, with any type of first line systemic treatment. The association of NLR at diagnosis of metastasis with progression free survival (PFS) and overall survival (OS) was evaluated using Cox univariate and multivariate proportional hazard models. In the full cohort, that included 263 MBC patients, a higher than the median (>2.32) NLR was significantly associated with OS in the univariate analysis (HR 1.36, 95% CI 1.00-1.83), but the association was non-significant (HR 1.12, 95% CI 0.80-1.56) when other clinical covariates (performance status, stage at diagnosis, CNS involvement, visceral disease and visceral crisis) were included in the multivariate analysis. No significant association was observed for PFS. In conclusion, MBC patients with higher baseline NLR had worse overall survival, but the prognostic impact of NLR is likely derived from its association with other relevant clinical prognostic factors.

38th Annual San Antonio Breast Cancer Symposium. Resumen de las aportaciones más relevantes / 38th Annual San Antonio Breast Cancer Symposium. Summary of key contributions

Se resumen en este trabajo las comunicaciones más relevantes y con mayor impacto clínico presentadas en el Simposio Internacional de Cáncer de Mama, celebrado en San Antonio en diciembre de 2015. Desde el punto de vista translacional, las principales aportaciones han sido las referidas a la dinámica clonal y a la heterogeneidad tumoral, así como a la posibilidad de estudiar mutaciones emergentes relacionadas con resistencia mediante biopsia líquida y técnicas de secuenciación masiva, como demuestran los datos de los ensayos BELLE-2 y BOLERO-2. Desde el punto de vista clínico, los resultados finales del estudio BCIRG-006 y los intermedios del estudio ExteNET en cáncer de mama HER2 modifican el panorama de la adyuvancia en este grupo de pacientes. Los resultados del estudio ABCSG-18 con denosumab adyuvante en enfermedad luminal apoyan los resultados previos con bifosfonatos. En enfermedad triple negativa, se han aportado datos interesantes acerca de la utilización de carboplatino y nab-paclitaxel en esquemas neoadyuvantes. El estudio CREATE-X con capecitabina adyuvante plantea la posibilidad de mejorar el pronóstico de las pacientes que no alcanzan respuesta completa tras neoadyuvancia, especialmente en el grupo triple negativo. La posibilidad de reducir la intensidad del tratamiento en algunos subgrupos de pacientes, las controversias sobre la irradiación nodal y el manejo quirúrgico de la axila, y los datos iniciales sobre inmunoterapia completan este resumen (AU)

We summarise the most interesting and clinically relevant works presented at the 38th Annual San Antonio Breast Cancer Symposium (December 2015). In the field of translational research, the main contributions were made in clonal dynamics and tumour heterogeneity, as well as in the possibility of studying emerging resistance mutations with liquid biopsy and next-generation sequencing, as shown by data from the BELLE-2 and BOLERO-2 trials. From the clinical point of view, the final analysis of BCIRG-006 trial and the intermediate analysis of the ExteNET trial will probably change the adjuvant treatment of HER2 breast cancer patients. The results of the ABCSG-18 trial with adjuvant denosumab in luminal breast cancer are consistent with previous data from trials of adjuvant bisphosphonate therapy. In triple-negative breast cancer, interesting data were reported supporting the addition of carboplatin and nab-paclitaxel to neoadjuvant chemotherapy regimens. The CREATE-X trial is the first study showing a survival benefit (larger in triple negative disease) of adjuvant chemotherapy with capecitabine in those patients without pathologic complete response after neoadjuvant chemotherapy. Finally, other problems addressed during the meeting were treatment de-escalation in some patient subgroups, the controversies surrounding and integration of nodal irradiation and axillary surgery, and early clinical results with immune therapy (AU)

Impacto de una intervención farmacéutica en la prevención de recaídas en depresión en atención primaria / Impact of pharmaceutical intervention in preventing relapses in depression in Primary Care

OBJETIVO: Evaluar el impacto a largo plazo de una intervención farmacéutica (IF) respecto a la atención habitual (AH) en la prevención de recaídas en depresión. DISEÑO: Ensayo clínico aleatorizado (estudio PRODEFAR). Emplazamiento: Atención primaria. PARTICIPANTES: Ciento setenta y nueve pacientes con depresión mayor que inician antidepresivos, de estos, se seleccionaron para este análisis secundario los 113 cuyos síntomas habían remitido (definición principal) a los 6 meses (grupo intervención [GI] = 58; grupo control [GC] = 55). Intervención: Se realizó una entrevista personal en la farmacia comunitaria para mejorar la adhesión terapéutica durante la dispensación de medicación. MEDICIONES PRINCIPALES: Se realizaron 3 mediciones (línea base, 3 y 6 meses). La gravedad de síntomas depresivos (PHQ-9) fue evaluada a los 6 meses y se seleccionaron aquellos pacientes que presentaban remisión. Se revisaron sus historias clínicas para identificar recaídas, mediante 4 indicadores, en los siguientes 12 meses. RESULTADOS: La proporción de recaídas (variable principal) fue menor en el GI respecto al GC a los 18 meses de haber iniciado el tratamiento, pero la diferencia no fue estadísticamente significativa, ni en análisis por intención de tratar (OR = 0,734 [IC 95% 0,273;1,975]) ni en el análisis por protocolo (OR = 0,615 [95% CI 0,183; 2,060]). Todos los análisis de sensibilidad mostraron resultados consistentes. El tamaño de la muestra y la adhesión al protocolo en el GI fueron bajos. CONCLUSIÓN: El GI mostró una tendencia no significativa a presentar un menor número de recaídas. Esto podría relacionarse con la mejora en la adhesión entre los pacientes que recibieron la IF

OBJECTIVE: To evaluate the long-term impact of a brief pharmacist intervention (PI) compared with usual care (UC) on prevention of depression relapse. DESIGN: randomised controlled clinical trial SETTING: Primary Care. PARTICIPANTS: Of the 179 depressed patients initiating antidepressants, the 113 whose clinical symptoms had remitted (main definition) at 6 months assessment were selected for this secondary study (PI = 58; UC = 55). Intervention: PI was an interview to promote medication adherence when patients get antidepressants from pharmacy. MAIN MEASUREMENTS: Baseline, 3 months, and six-months follow-up assessments were made. The severity of depressive symptoms was evaluated with PHQ9. Patients presenting a remission of symptoms were selected. The patient medical records were reviewed to identify a relapse in the following 12 months by using 4 indicators. RESULTS: There was a lower proportion of patients that relapsed in the PI group than in the UC group 18 months after initiation of treatment, but the difference was not statistically significant either in the intent-to-treat analysis (OR = 0.734 [95%CI; 0.273-1.975]) or the per-protocol analysis (OR = 0.615 [95%CI; 0.183 -2.060]). All the sensitivity analyses showed consistent results. The sample size and adherence to the protocol in the intervention group were low. CONCLUSION: PI group showed a non-statistically significant tendency towards presenting fewer relapses. This could be related to the improvement in adherence among patients that received the intervention

[Impact of pharmaceutical intervention in preventing relapses in depression in Primary Care]. / Impacto de una intervención farmacéutica en la prevención de recaídas en depresión en atención primaria.

OBJECTIVE: To evaluate the long-term impact of a brief pharmacist intervention (PI) compared with usual care (UC) on prevention of depression relapse. DESIGN: randomised controlled clinical trial SETTING: Primary Care PARTICIPANTS: Of the 179 depressed patients initiating antidepressants, the 113 whose clinical symptoms had remitted (main definition) at 6 months assessment were selected for this secondary study (PI=58; UC=55). INTERVENTION: PI was an interview to promote medication adherence when patients get antidepressants from pharmacy. MAIN MEASUREMENTS: Baseline, 3 months, and six-months follow-up assessments were made. The severity of depressive symptoms was evaluated with PHQ9. Patients presenting a remission of symptoms were selected. The patient medical records were reviewed to identify a relapse in the following 12 months by using 4 indicators. RESULTS: There was a lower proportion of patients that relapsed in the PI group than in the UC group 18 months after initiation of treatment, but the difference was not statistically significant either in the intent-to-treat analysis (OR=0.734 [95%CI; 0.273-1.975]) or the per-protocol analysis (OR=0.615 [95%CI; 0.183 -2.060]). All the sensitivity analyses showed consistent results. The sample size and adherence to the protocol in the intervention group were low. CONCLUSION: PI group showed a non-statistically significant tendency towards presenting fewer relapses. This could be related to the improvement in adherence among patients that received the intervention.

Isolation and Molecular Characterization of Acanthamoeba Strains from Dental Units in Costa Rica.

Free-living amoebae are protozoa widely distributed in nature, which can be found in a variety of environments. Four genera are recognized as causal agents of infections in humans and animals: Acanthamoeba, Naegleria, Balamuthia, and Sappinia. In this study, the presence of Acanthamoeba in dental units was determined and the isolates obtained were molecularly characterized; osmotolerance and thermotolerance assays were also performed to evaluate multiplication under these conditions, frequently associated with pathogenicity. The morphological analysis and partial sequencing of the 18S rDNA gene revealed the presence of Acanthamoeba genotype T4 in 14% of the units sampled. Osmotolerance and thermotolerance tests were positive for more than 80% of the isolates. Up to date, this is the first study that reports the detection, identification, and genotyping of Acanthamoeba isolated from dental units in Costa Rica and even in Latin-America. Further assays to determine the potential pathogenicity of these Acanthamoeba isolates are underway.

Evaluation of the speed-oligo direct Mycobacterium tuberculosis assay for molecular detection of mycobacteria in clinical respiratory specimens.

We present the first evaluation of a novel molecular assay, the Speed-oligo Direct Mycobacterium tuberculosis (SO-DMT) assay, which is based on PCR combined with a dipstick for the detection of mycobacteria and the specific identification of M. tuberculosis complex (MTC) in respiratory specimens. A blind evaluation was carried out in two stages: first, under experimental conditions on convenience samples comprising 20 negative specimens, 44 smear- and culture-positive respiratory specimens, and 11 sputa inoculated with various mycobacterium-related organisms; and second, in the routine workflow of 566 fresh respiratory specimens (4.9% acid-fast bacillus [AFB] smear positives, 7.6% MTC positives, and 1.8% nontuberculous mycobacteria [NTM] culture positives) from two Mycobacterium laboratories. SO-DMT assay showed no reactivity in any of the mycobacterium-free specimens or in those with mycobacterium-related organisms. Compared to culture, the sensitivity in the selected smear-positive specimens was 0.91 (0.92 for MTC and 0.90 for NTM), and there was no molecular detection of NTM in a tuberculosis case or vice versa. With respect to culture and clinical data, the sensitivity, specificity, and positive and negative predictive values for the SO-DMT system in routine specimens were 0.76 (0.93 in smear positives [1.0 for MTC and 0.5 for NTM] and 0.56 in smear negatives [0.68 for MTC and 0.16 for NTM]), 0.99, 0.85 (1.00 in smear positives and 0.68 in smear negatives), and 0.97, respectively. Molecular misidentification of NTM cases occurred when testing 2 gastric aspirates from two children with clinically but not microbiologically confirmed lung tuberculosis. The SO-DMT assay appears to be a fast and easy alternative for detecting mycobacteria and differentiating MTC from NTM in smear-positive respiratory specimens.

[Cooperation between primary care and mental health services]. / Cooperación entre atención primaria y servicios de salud mental.

PURPOSE: To find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated. DESIGN: Cross-sectional descriptive study. SETTING: Eighty PC centres representing the seven health regions of Catalonia. PARTICIPANTS: Selection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services. RESULTS: The PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas. CONCLUSIONS: The cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased.

Cooperación entre atención primaria y servicios de salud mental / Cooperation between primary care and mental health services

ObjetivoConocer el grado de coordinación/cooperación entre la atención primaria (AP) de Cataluña y los centros de salud mental de adultos (CSMA), los centros de atención y seguimiento a las drogodependencias (CASD) y los centros de salud mental infanto-juvenil (CSMIJ). Evaluar si hay diferencias en coordinación en función del carácter urbano o rural de los municipios.DiseñoEstudio descriptivo transversal.Emplazamiento80 centros de AP representativos de las 7 regiones sanitarias de Cataluña.ParticipantesSelección mediante muestreo aleatorio estratificado; 356 de los 618 médicos de familia a los que se ofreció participar completaron una encuesta que evaluaba diferentes aspectos de coordinación con los servicios especializados.ResultadosLos participantes indicaron un peor acceso a los CSMA que a los CASD y a los CSMIJ. Sin embargo, la formación proporcionada por los CSMA era mejor que la de los otros dos dispositivos en todos los indicadores empleados. No se hallaron diferencias significativas en las variables de acceso y formación entre zonas urbanas y rurales.ConclusionesLa cooperación entre la AP y los servicios especializados en salud mental de Cataluña es óptima en algunos aspectos. No obstante, sería conveniente que se redujera el tiempo de espera para las primeras visitas en los CSMA y que los CASD y los CSMIJ incrementaran las actividades de formación(AU)

PurposeTo find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated.DesignCross-sectional descriptive study.SettingEighty PC centres representing the seven health regions of Catalonia.ParticipantsSelection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services.ResultsThe PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas.ConclusionsThe cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased(AU)