C-Reactive Protein Concentration in Steady-State Bronchiectasis: Prognostic Value of Future Severe Exacerbations. Data From the Spanish Registry of Bronchiectasis (RIBRON) / Concentración de la proteína C reactiva en las bronquiectasias en fase estable: valor pronóstico de futuras exacerbaciones graves. Datos del registro español de pacientes con bronquiectasias (RIBRON)

BACKGROUND: Both systemic inflammation and exacerbations have been associated with greater severity of bronchiectasis. Our objective was to analyze the prognostic value of the peripheral concentration of C-reactive protein (CRP) for the number and severity of exacerbations in patients with bronchiectasis. METHODS: Patients from the Spanish Bronchiectasis Registry (RIBRON) with valid data on their CRP value (in a clinically stable phase) and valid data on exacerbations during the first year of follow-up were included. A logistic regression analysis was used to evaluate the prognostic value of the CRP concentration (divided into tertiles) with the presence of at least one severe exacerbation or at least two mild-moderate exacerbations during the first year of follow-up. RESULTS: 802 patients (mean age: 68.1 [11.1 years], 65% female) were included. Of these, 33.8% and 13%, respectively, presented ≥ 2 mild-moderate exacerbations or at least one severe exacerbation during the first year of follow-up. The mean value of the CRP was 6.5 (17.6 mg/L). Patients with a CRP value between 0.4 and 2.7 mg/L (second tertile) and ≥ 2.7 mg/L (third tertile) presented a 2.9 (95%CI: 1.4-5.9) and 4.2 (95% CI: 2.2-8.2) times greater probability, respectively, of experiencing a severe exacerbation than those with < 0.4 mg/L (control group), regardless of bronchiectasis severity or a history of previous exacerbations. However, the CRP value did not present any prognostic value for the number of mild-moderate exacerbations. CONCLUSIONS: The CRP value was associated with a greater risk of future severe exacerbations but not with mild or moderate exacerbations in patients with steady-state bronchiectasis

CONTEXTO GENERAL: Tanto la inflamación sistémica como las exacerbaciones se han asociado con una mayor gravedad de las bronquiectasias. Nuestro objetivo fue analizar el valor de la concentración en sangre periférica de proteína C reactiva (PCR) para predecir el número y la gravedad de las exacerbaciones en pacientes con bronquiectasias. MÉTODOS: Se incluyeron pacientes del Registro Español de Pacientes con Bronquiectasias (RIBRON) con datos válidos sobre sus niveles de PCR (en fase clínicamente estable) y datos válidos sobre exacerbaciones durante el primer año de seguimiento. Se utilizó un análisis de regresión logística para evaluar el valor pronóstico de la concentración de PCR (dividida en terciles) con la presencia de al menos una exacerbación grave o al menos dos exacerbaciones leves-moderadas durante el primer año de seguimiento. RESULTADOS: Se incluyeron 802 pacientes (edad media: 68,1 [11,1] años, 65% mujeres). De ellos, el 33,8% y el 13%, respectivamente, presentaron ≥ 2 exacerbaciones leves-moderadas o al menos una exacerbación grave durante el primer año de seguimiento. El valor medio de la PCR fue de 6,5 (17,6) mg/L. Los pacientes con un valor de PCR entre 0,4 y 2,7 mg/L (segundo tercil) y ≥ 2,7 mg/L (tercer tercil) presentaron 2,9 veces (IC 95%: 1,4-5,9) y 4,2 veces (IC 95%: 2,2-8,2) más probabilidad, respectivamente, de experimentar una exacerbación grave que aquellos con < 0,4 mg/L (grupo de control), independientemente de la gravedad de las bronquiectasias o de presentar antecedentes de exacerbaciones previas. Sin embargo, el valor de la PCR no presentó ninguna utilidad pronóstica para el número de exacerbaciones leves-moderadas. CONCLUSIONES: El valor de la PCR se asoció a un mayor riesgo de exacerbaciones graves en el futuro, pero no a las exacerbaciones leves o moderadas en pacientes con bronquiectasias en fase estable

Estrategia invasiva precoz ajustada al riesgo en pacientes con síndrome coronario agudo sin elevación de segmento ST en Unidades de Cuidados Intensivos Cardiológicos / Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units

OBJETIVO: Las guías de práctica clínica recomiendan la estrategia invasiva precoz ajustada al riesgo (EIPAR) en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST). El objetivo fue analizar la aplicación de la EIPAR, sus condicionantes e impacto sobre el pronóstico en pacientes con SCASEST ingresados en Unidades de Cuidados Intensivos Cardiológicos (UCIC). DISEÑO: Estudio de cohortes prospectivo. ÁMBITO: UCIC de 8 hospitales en Cataluña. PACIENTES: Pacientes consecutivos con SCASEST entre octubre del 2017 y marzo del 2018. El perfil de riesgo se definió mediante los criterios de la Sociedad Europea de Cardiología. INTERVENCIONES: Se definió como EIPAR la realización de coronariografía en las primeras 6 h en pacientes de muy alto riesgo o en 24 h en pacientes de alto riesgo. VARIABLES DE INTERÉS: Mortalidad/reingreso a los 6 meses. RESULTADOS: Se incluyó a 629 pacientes (edad media 66,6 años), 225 (35,9%) de muy alto riesgo y 392 (62,6%) de alto riesgo. La estrategia invasiva fue mayoritaria (96,2%). La EIPAR se aplicó en 284 pacientes (45,6%), especialmente pacientes más jóvenes, con menos comorbilidades. Estos pacientes presentaron menor estancia en UCIC y hospitalaria, así como menor incidencia de SCA, revascularizaciones y menor incidencia de muerte/reingreso a 6 meses. Tras ajustar por factores de confusión, la asociación entre adherencia y muerte/reingreso a 6 meses persistió de manera significativa (razón de riesgos: 0,66 [0,45-0,97] p = 0,035). CONCLUSIONES: La EIPAR se aplica en una minoría de SCASEST ingresados en UCIC, asociándose con una menor incidencia de eventos

OBJECTIVE: Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN: A prospective cohort study was carried out. SETTING: The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS: Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS: EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES: Mortality or readmission at 6 months. RESULTS: A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS: The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes

Actualización del registro español de hemoglobinopatías de niños y adultos / Update of the Spanish registry of haemoglobinopathies in children and adults

ANTECEDENTES Y OBJETIVO: Los pacientes con talasemia mayor (TM) y enfermedad de células falciformes (ECF) en España se han empezado a contabilizar desde la creación del registro español de hemoglobinopatías (REHem). El objetivo del trabajo es actualizar los datos publicados previamente, tras el aumento de casos por la inclusión de adultos y la introducción del cribado neonatal en casi todo el país. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, multicéntrico y ambispectivo, que incluye pacientes con hemoglobinopatías registrados en REHem, iniciado en enero de 2014 y de seguimiento anual. Los datos presentados corresponden hasta el 31 de diciembre de 2017. RESULTADOS: Se recogieron 959 pacientes. Se registraron 75 casos de talasemia (62 TM), 826 de ECF y 58 de otro tipo de hemoglobinopatías. El motivo de diagnóstico principal en la TM fue la clínica de anemia (70,6%), con una media de edad al diagnóstico de 0,7 años; en la ECF fue el cribado neonatal (33,1%), con una media de edad al diagnóstico de 2,7 años; 26 pacientes con TM (41,9%) y 30 con ECF (3,6%) fueron sometidos a trasplante. Hubo 2 fallecimientos (3,2%) con TM y 19 (2,3%) con ECF. La supervivencia global fue del 96,7% en la TM y del 97,5% en la ECF a los 15 años. CONCLUSIONES: Desde la publicación previa y tras la difusión del cribado neonatal, el método diagnóstico más frecuente, en la mayoría de comunidades autónomas, y la inclusión de pacientes adultos al registro, el REHem se ha visto incrementado en más de 240 casos, llegando hasta un total de 959 registros

BACKGROUND AND OBJECTIVE: Patients with thalassaemia major (TM) and sickle cell disease (SCD) in Spain have been counted since the creation of the Spanish registry of haemoglobinopathies (REHem). The objective of this paper is to update the published data after the increase in cases due to the inclusion of adults and introduction of new-born screening in almost the whole country. MATERIAL AND METHODS: An observational, descriptive, multicentre and ambispective study that included patients with haemoglobinopathies registered in the REHem, started in January 2014 and followed up annually. The data presented correspond until December 31, 2017. RESULTS: Nine hundred and fifty-nine patients were collected. There were 75 cases of thalassaemia (62 TM), 826 of ECF and 58 of other types of haemoglobinopathies. The main diagnostic reason in the TM cohort was anaemia symptoms (70.6%), with a mean age at diagnosis of .7 years; in the SCD cohort it was neonatal screening (33.1%), with a mean age at diagnosis of 2.7 years; 26 patients with TM (41.9%) and 30 with SCD (3.6%) underwent a transplant. There were 2 deaths (3.2%) with TM and 19 (2.3%) with SCD. Overall survival was 96.7% in the TM and 97.5% in the SCD cases at 15 years. CONCLUSIONS: Since the previous publication and after the diffusion of new-born screening, the most frequent diagnostic method, to the majority of autonomous regions, and the inclusion of adult patients to the registry, the REHem has increased by more than 240 cases, reaching a total of 959 records

Preserving quantifiable ethnographic records of disappearing human lifeways.

The human evolutionary sciences place high value on quantitative data from traditional small-scale societies that are rapidly modernizing. These data often stem from the sustained ethnographic work of anthropologists who are today nearing the end of their careers. Yet many quantitative ethnographic data are preserved only in summary formats that do not reflect the rich and variable ethnographic reality often described in unpublished field notes, nor the deep knowledge of their collectors. In raw disaggregated formats, such data have tremendous scientific value when used in conjunction with modern statistical techniques and as part of comparative analyses. Through a personal example of longitudinal research with Batek hunter-gatherers that involved collaboration across generations of researchers, we argue that quantifiable ethnographic records, just like material artifacts, deserve high-priority preservation efforts. We discuss the benefits, challenges, and possible avenues forward for digitizing, preserving, and archiving ethnographic data before it is too late.

Outcomes of very elderly trauma ICU PATIENTS: Results from the Spanish trauma ICU registry / Desenlace de los pacientes traumáticos muy ancianos en la unidad de cuidados intensivos. Resultados del Registro Español de Trauma en las UCI

OBJECTIVE: To analyze outcomes and factors related to mortality among very elderly trauma patients admitted to intensive care units (ICUs) participating in the Spanish trauma ICU registry. DESIGN: A multicenter nationwide registry. Retrospective analysis. November 2012-May 2017. SETTING: Participating ICUs. PATIENTS: Trauma patients aged ≥ 80 years. INTERVENTIONS: None. Main variables of interest: The outcomes and influence of limitation of life sustaining therapy (LLST) were analyzed.comparisons were established using the Wilcoxon test, Chi-squared test or Fisher's exact test as appropriate. Multiple logistic regression analysis was performed to analyze variables related to mortality. A p-value < 0.05 was considered statistically significant. RESULTS: The mean patient age was 83.4 ± 3.3 years; 281 males (60.4%). Low-energy falls were the mechanisms of injury in 256 patients (55.1%). The mean ISS was 20.5 ± 11.1, with a mean ICU stay of 7.45 ± 9.9 days. The probability of survival based on the TRISS methodology was 69.8 ± 29.7%. The ICU mortality rate was 15.5%, with an in-hospital mortality rate of 19.2%. The main cause of mortality was intracranial hypertension (42.7%). The ISS, the need for first- and second-tier measures to control intracranial pressure, and being admitted to the ICU for organ donation were independent mortality predictors. LLST was applied in 128 patients (27.9%). Patients who received LLST were older, with more severe trauma, and with more severe brain injury. CONCLUSIONS: Very elderly trauma ICU patients presented mortality rates lower than predicted on the basis of the severity of injury

OBJETIVO: Analizar el desenlace y los factores relacionados con la mortalidad de los pacientes traumáticos muy ancianos ingresados en las Unidades de Cuidados Intensivos (UCI) participantes en el Registro Español de Trauma en las UCI (RETRAUCI). DISEÑO: Registro multicéntrico nacional. Análisis retrospectivo. Noviembre de 2012-mayo de 2017. Ámbito: Las UCI participantes. Pacientes o PARTICIPANTES: Pacientes traumáticos con edad ≥ 80 años. INTERVENCIONES: Ninguna. Variables de interés principales: Analizamos el desenlace y la influencia de la limitación de los tratamientos de soporte vital (LLST). Las comparaciones entre grupos se realizaron mediante la prueba de Wilcoxon, la prueba de Chi-cuadrado y la prueba exacta de Fisher según estuviera indicado. Se realizó un análisis multivariante mediante regresión logística para analizar las variables asociadas a la mortalidad. Un valor de p < 0,05 se consideró el límite de la significación estadística. RESULTADOS: La edad media fue de 83,4 ± 3,3 años. Varones 281 (60,4%). La causa principal del traumatismo fueron las caídas de baja energía en 256 pacientes (55,1%). El Injury Severity Score (ISS) medio fue de 20,5 ± 11,1. La estancia media en las UCI fue de 7,45 ± 9,9 días. La probabilidad de supervivencia, de acuerdo con la metodología TRISS fue de 69,8 ± 29,7%. La mortalidad en las UCI fue del 15,5%. La mortalidad hospitalaria fue del 19,2%. La causa principal fue la hipertensión intracraneal (42,7%). El ISS, la necesidad de medidas de primer o segundo nivel para controlar la presión intracraneal y el ingreso en las UCI orientado a la donación de órganos fueron predictores independientes de mortalidad. Se documentó la LLST en 128 pacientes (27,9%). Los pacientes con LLST fueron mayores, con una mayor gravedad lesional y un traumatismo craneoencefálico más grave. CONCLUSIONES: Los pacientes traumáticos muy ancianos en las UCI presentaron menor mortalidad de la predicha por la gravedad del traumatismo

Asking for Identification and Retail Tobacco Sales to Minors.

BACKGROUND AND OBJECTIVES: A previous single-county study found that retail stores usually asked young-looking tobacco customers to show proof-of-age identification, but a large proportion of illegal tobacco sales to minors occurred after the customers had shown identification proving they were too young to purchase tobacco. We sought to investigate these findings on a larger scale. METHODS: We obtained state reports for federal fiscal years 2017 and 2018 from a federal agency that tracks tobacco sales to supervised minors conducting compliance checks in retail stores. We used descriptive and multivariable logistic regression methods to determine (1) how often stores in 17 states requested identifications, (2) what proportion of violations occurred after identification requests, and (3) if violation rates differed when minors were required versus forbidden to carry identification. RESULTS: Stores asked minors for identification in 79.6% (95% confidence interval: 79.3%-80.8%) of compliance checks (N = 17 276). Violations after identification requests constituted 22.8% (95% confidence interval: 20.0%-25.6%; interstate range, 1.7%-66.2%) of all violations and were nearly 3 times as likely when minors were required to carry identification in compliance checks. Violations were 42% more likely when minors asked for a vaping product versus cigarettes. CONCLUSIONS: Stores that sell tobacco to underage customers are more likely to be detected and penalized when youth inspectors carry identification during undercover tobacco sales compliance checks. The new age-21 tobacco sales requirement presents an opportunity to require identifications be carried and address other long-standing weaknesses in compliance-check protocols to help combat the current adolescent vaping epidemic.

Neuromonitorización en el traumatismo craneoencefálico grave. Datos del Registro español de Trauma en UCI (RETRAUCI) / Neuromonitoring in the severe traumatic brain injury. Spanish Trauma ICU Registry (RETRAUCI)

OBJETIVOS: Analizar el empleo de la monitorización de la presión intracraneal (PIC) y la oxigenación cerebral en los pacientes con traumatismo craneoencefálico (TCE) grave de acuerdo con los datos del Registro español de Trauma en las Unidades de Cuidados Intensivos (RETRAUCI). MÉTODOS: Se incluyó a los pacientes con TCE y una puntuación en la escala de coma de Glasgow ≤ 8 puntos. El contraste de hipótesis se realizó con el test de la t de Student o de Wilcoxon (variables cuantitativas) y el test de la chi al cuadrado (variables categóricas). Se realizó un análisis multivariante mediante regresión logística para analizar las variables asociadas al empleo de monitorización de la PIC. RESULTADOS: Se analizó a 1.463 pacientes. Edad 49,1 años, hombres 1.130 (77,3%). Mecanismo lesional: caídas accidentales 350 casos (23,9%). Injury Severity Score 27,9. Un 39,3% presentó midriasis uni o bilateral en la recogida. Cirugía craneal < 24 h 331 pacientes (22,7%). La PIC se monitorizó en 635 pacientes (45,1%), la presión tisular de oxígeno en 122 pacientes (8,6%), la saturación yugular de oxígeno en 19 pacientes (1,34%) y se empleó el espectroscopia del infrarrojo cercano en 25 casos (1,77%). Tras el análisis multivariante, la edad, la midriasis bilateral al ingreso y la toma previa antiagregantes o anticoagulantes se asociaron negativamente a la probabilidad de monitorización de la PIC. La gravedad lesional y la necesidad de neurocirugía urgente aumentaron la probabilidad de monitorización. CONCLUSIONES: Nuestro trabajo muestra una foto fija de la monitorización de la PIC en el TCE grave en nuestro medio. El empleo de técnicas de oximetría cerebral en nuestro país es muy limitado

OBJECTIVES: To analyze the use of intracranial pressure (ICP) and cerebral oximetry monitoring in patients with severe traumatic brain injury (TBI) according to the Spanish Trauma ICU Registry (RETRAUCI). METHODS: We included TBI patients with Glasgow Coma Scale score ≤ 8. Hypotheses were tested using the Student-T or Wilcoxon tests (quantitative variables) and the Chi-square test (categorical variables). Multivariate analysis using logistic regression was performed to analyze the variables associated with the use of ICP monitoring. RESULTS: We analyzed 1463 patients. Age 49.1 years. Males 1130 (77.3%). Mechanism of injury: falls in 350 cases (23.9%). Injury Severity Score 27.9. Uni- or bilateral mydriasis was present in 39.3% of the patients. Neurosurgical intervention within 24 hours was performed in 331 patients (22.7%). ICP was monitored in 635 patients (45.1%), pbtO2 in 122 patients (8.6%), SjVO2 in 19 patients (1.34%) and NIRS was used in 25 cases (1.77%). In the multivariate analysis, age, bilateral mydriasis at admission and previous use of antiplatelets or anticoagulants was inversely related with ICP monitoring. Severity of injury and the need of neurosurgical intervention increased the probability of ICP monitoring. CONCLUSIONS: Our study shows a picture of ICP monitoring in severe TBI patients in our environment. Use of cerebral oximetry techniques is very limited

[Suggestion for recommendations for the wise use of social media in French internal medicine - take control of online reputation]. / Utilisation avisée des réseaux sociaux pour la gestion de la e-réputation des médecins internistes français ­ proposition de recommandations.

Social networks (or SoMe) expanded exponentially over the last ten years, including healthcare. SoMe have changed the doctor's daily life and the relationship with patients. Poor management of SoMe can impact on "e-reputation". On the other hand, the proper use of SoMe allows the opening up of new functionalities in both clinical and research settings. Several scientific societies have made recommendations for the proper handling of SoMe in order to protect the personal information and privacy of physicians. Professionals are advised to differentiate between a professional account and a personal account. Confidentiality settings and certain "codes" for managing publications must be followed. Physicians must be aware that their publications are indelible and can damage their "e-reputation". The proper handling of SoMe will allow internists to organize their bibliographic monitoring, increase the altmetric of their articles, facilitate communication between researchers and modify the relationship with their patients.

The Washtenaw ID Project: A Government-Issued ID Coalition Working Toward Social, Economic, and Racial Justice and Health Equity.

Introduction. The policing of identities through policies that restrict access to IDs issued by U.S. governmental entities disparately affects communities of color; communities who identify as low-income, immigrant, older, and/or transgender; and community members who experience chronic mental illness, housing instability, or incarceration. Yet government-issued IDs are increasingly needed to access health-promoting resources such as housing, banking, social services, and health care, and in interactions with law enforcement. Methods. Since 2012, the Washtenaw ID Project's coalition-building process has involved communities affected by restrictive ID policies, advocates, and institutional stakeholders to enact community and systems change regarding inequities in government-issued IDs. We discuss the coalition-building process that culminated in the implementation of a photo ID issued by Washtenaw County government as a policy change strategy. We also highlight the community-academic research partnership evaluating the effectiveness of the Washtenaw ID in order to ensure equity in Washtenaw ID access and acceptance. Results. In 2015, 77% of Washtenaw ID holders reported having no other locally accepted ID. At follow-up, Washtenaw ID holders reported favorable Washtenaw ID acceptance rates in several domains (e.g., health care, school), but not when accessing banking services and housing. Additionally, community discussions suggested racial inequities in carding and ID acceptance. We discuss next steps for policy improvement to ensure equitable impact of the ID. Conclusions. Without national policy reform instating access to government-issued IDs for all, the social movement to establish local IDs may improve access to health-related resources contingent on having an ID. Careful attention must be paid to community organizing processes, policy implementation, and evaluation to ensure equity.

Measuring incremental line width and appearance in the tooth cementum of recent and archaeological human teeth to identify irregularities: First insights using a standardized protocol.

OBJECTIVE: Irregular incremental lines (ILs) in the tooth cementum were previously associated with pregnancy and certain diseases. This study aims to identify irregular ILs and assess their patterns and reproducibility. MATERIALS: 24 recent and 32 archaeological teeth from the nineteenth century with known birth history. METHODS: Histological sections of tooth roots were microscopically assessed. The width and appearance of 16,605 ILs were measured according to a standardized protocol. RESULTS: Irregular appearing ILs were present in earlier deposited ILs, which correspond to younger years in life. Irregular appearances decreased as the IL number increased, whereas irregular width was spread evenly across all ILs. Within-section reproducibility was relatively high for irregular appearance (intra class correlation close to 0.70 in recent and archaeological teeth) and irregular width (intra class correlation: recent: 0.49; archaeological: 0.58), whereas the across-section reproducibility was moderate. CONCLUSIONS: Irregular width and appearance in ILs were identified successfully with within-section reproducibility. The moderate reproducibility across sections needs to be addressed in further studies by more systematic sampling of sections. SIGNIFICANCE: The proposed protocol identifies irregularities in a reproducible manner and may suggest that irregular ILs could be used in paleopathology to identify pregnancies and diseases. LIMITATIONS: The correlation between the identified irregular ILs and known pregnancies has not been assessed as part of this study. SUGGESTIONS FOR FURTHER RESEARCH: The identified irregular ILs need to be validated by correlating them with known life history data.

Systematized protocol for interventional pathology reports. Pathology report paradigm for pathologist-performed Ultrasound Guided Fine Needle Aspiration (USFNA) and Ultrasound Guided Core Needle Biopsy (USCNB) / Protocolo sistematizado para informes de patología intervencionista. Informe de anatomía patológica para punción-aspiración con aguja fina con ecografía (EcoPAAF) y biopsia con aguja gruesa con ecografía (EcoBAG)

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Technological Advances in Herpetoculture.

Technology plays a vital role in herpetoculture because ectothermic animals rely on their environment to carry out basic physiologic functions. Controlling the environment appropriately ensures the health and welfare of captive reptiles and amphibians. This article summarizes some of the technological advances and products currently available, including lighting, climate control, and recordkeeping.

Completeness of a newly implemented general cancer registry in northern France: Application of a three-source capture-recapture method.

BACKGROUND: Completeness, timeliness and accuracy are important qualities for registries. The objective was to estimate the completeness of the first two years of full registration (2008/2009) of a new population-based general cancer registry, at the time of national data centralisation. METHODS: Records followed international standards. Numbers of cases missed were estimated from a three-source (pathology labs, healthcare centres, health insurance services) capture-recapture method, using log-linear models for each gender. Age and place of residence were considered as potential variables of heterogeneous catchability. RESULTS: When data were centralized (2011/2012), 4446 cases in men and 3642 in women were recorded for 2008/2009 in the Registry. Overall completeness was estimated at 95.7% (95% CI: 94.3-97.2) for cases in men and 94.8% (95% CI: 92.6-97.0) in women. Completeness appeared higher for younger than for older subjects, with a significant difference of 4.1% (95% CI: 1.4-6.7) for men younger than 65 compared with their older counterparts. Estimates were collated with the number of cases registered in 2014 for the years 2008/2009 (4566 cases for men/3755 for women), when additional structures had notified cases retrospectively to the Registry. These numbers were consistent with the stratified capture-recapture estimates. CONCLUSION: This method appeared useful to estimate the completeness quantitatively. Despite a rather good completeness for the new Registry, the search for cases among older subjects must be improved.

Evaluation of a surgical task sharing training programme's logbook system in Sierra Leone.

BACKGROUND: Personal logbooks are universally applied for monitoring and evaluation of surgical trainees; however, the quality and accuracy of such logbooks in low income countries (LICs) are poorly examined. Logbooks are kept by the individual trainee and detail every surgical procedure they perform and their role during the procedure. The aim of this study was to evaluate the quality of such a logbook system in Sierra Leone and to identify areas of improvement. METHODS: The last 100 logbook entries for students and graduates participating in a surgical task sharing training programme were compared with hospital records (HRs). The logbook entries were categorized as matching, close matching or over-reported. Moreover, HRs were checked for under-reported procedures. Semi-structured interviews were conducted with the study participants on logbook recording routines. The results were analysed using mixed effects logistic regression models. RESULTS: Three thousand one hundred sixty-nine database entries from 35 participants were analysed. Of that amount, 62.2% of the entries matched the HRs, 10.4% were close matches and 26.9% were over-reported. 20.7% of the investigated HRs were under-reported. CONCLUSIONS: Information gathered from surgical logbook systems must be applied with care, and great efforts must be made to ensure that the logbook systems used provide reliable data. Based on analysis of the logbook data and interviews, focus areas are suggested to ensure reliable logbook data in LICs. Clear instructions and proper training should be provided when introducing the logbook system to the users. The importance of logging all procedures, including minor ones, should be emphasized. The logbook system should be user friendly and only as extensive as necessary. Lastly, keeping the logbooks exclusively digital is recommended, combined with sufficient IT equipment and training.

Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk?

INTRODUCTION: It is not known whether out-of-province Canadians, who travel to Alberta for work, are at increased risk of occupational injury. METHODS: Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under-reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta. RESULTS: Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12-0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out-of-province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00-0.40). CONCLUSION: Differential rates of under-reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time-loss 1 to 30 days.

Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia / Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registry

Objetivo: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. Método: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. Resultados: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. Conclusiones: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido

Objective: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epilepsy. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. Results: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). Conclusions: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs

The effects of herd size on the welfare of dairy cows in a pasture-based system using animal- and resource-based indicators.

Animal welfare assessments were conducted on 50 Australian pasture-based dairy farms of varying herd sizes: 16 small (<300 cows), 15 medium-sized (300-500 cows), 11 large (501-750 cows), and 10 very large (751+ cows). A protocol based on elements of Welfare Quality adapted for Australian conditions was developed to assess the broad categories of good feeding, housing, health, and appropriate behavior. Farm records, body condition scores, integument injuries, fecal plaques, avoidance distance of humans, and fecal pat scoring for acidosis assessment were undertaken. The mean maximum kilograms of grain fed per day significantly increased with herd size, from 5.2 ± 0.38 (small), 7.7 ± 0.29 (medium-sized), 8.8 ± 0.45 (large), to 10.1 ± 0.80 kg (very large). Acidosis was not related to herd size based on either farm records or fecal pat scoring. All cows had access to water for more than 12 h in a 24-h period. More larger farms had water points on the farm tracks or at the dairy. Very large farms (90%) were more likely than others (36-39%) to provide water suitable for human consumption. Integument lesions were not related to herd size and were uncommon; 56 and 84% of farms had no cows with lesions or hairless areas, respectively, and no farm had >6% integument lesions. Heat stress is an important welfare risk in Australia. All farms had some form of cooling strategy; shade in all paddocks was more common on smaller farms (>90%) than others (<75%). Sprinklers were more common on large or very large farms (>80%) than others (<65%). Mastitis and lameness were the most common health conditions, followed by dystocia, downer cows, and gastrointestinal diseases. Prevalence of lameness, mastitis, downer cows, dystocia, and gastrointestinal disease were not related to farm size. Larger farms were more likely to have electronic infrastructure to monitor or electronically draft cows for inspection. We found wide variation in the avoidance distance of humans, but this was not related to farm size. Larger farms had longer walking distances to pasture and longer time away from pasture, which could affect the time available for behaviors such as lying down. Animal welfare risks differ on Australian farms compared with housed cattle. As animal welfare is multidimensional, both animal- and resource-based indicators can be useful. Animal-based indicators have strengths in that, when measured accurately, they genuinely reflect the outcome being measured, but they also have weaknesses in that the point-estimate of a disease prevalence on a given day may not be representative of other times of year or differences in case definition may exist when farm records are used. Similarly, resource-based indicators have strengths in that they may be applicable to longer periods, but weaknesses because the fact a resource is present does not guarantee it is being used. Identifying the major risks to animal welfare on individual farms and ensuring a plan is in place to effectively manage them should be an important element of any on-farm animal welfare assessment protocol.