Objective
The prevalence of depressive symptoms immediately after the diagnosis of colorectal cancer (CRC) is high and has important implications both psychologically and on the course of the ...disease. The aim of this study is to analyse the association between depressive symptoms and CRC survival at 5 years after diagnosis.
Methods
This multicentre, prospective, observational cohort study was conducted on a sample of 2602 patients with CRC who completed the Hospital Anxiety and Depression Scale (HADS‐D) at 5 years of follow‐up. Survival was analysed using the Kaplan–Meier method and Cox regression models.
Results
According to our analysis, the prevalence of depressive symptoms after a CRC diagnosis was 23.8%. The Cox regression analysis identified depression as an independent risk factor for survival (HR = 1.47; 95% CI: 1.21–1.8), a finding which persisted after adjusting for sex (female: HR = 0.63; 95% CI: 0.51–0.76), age (>70 years: HR = 3.78; 95% CI: 1.94–7.36), need for help (yes: HR = 1.43; 95% CI: 1.17–1.74), provision of social assistance (yes: HR = 1.46; 95% CI: 1.16–1.82), tumour size (T3–T4: HR = 1.56; 95% CI: 1.22–1.99), nodule staging (N1–N2: HR = 2.46; 95% CI: 2.04–2.96), and diagnosis during a screening test (yes: HR = 0.71; 95% CI: 0.55–0.91).
Conclusions
There is a high prevalence of depressive symptoms in patients diagnosed with CRC. These symptoms were negatively associated with the survival rate independently of other clinical variables. Therefore, patients diagnosed with CRC should be screened for depressive symptoms to ensure appropriate treatment can be provided.
The delayed diagnosis of colorectal cancer (CRC) may be attributable to sociodemographic characteristics, to aspects of tumour histopathology or to the functioning of the health system. We seek to ...determine which of these factors most influences prolonged patient-attributable delay (PPAD) in the diagnosis and treatment of CRC.
A prospective, multicentre observational study was conducted in 22 Spanish hospitals. In total, 1,785 patients were recruited to the study between 2010 and 2012 and underwent elective or urgent surgery. PPAD is considered to occur when the time elapsed between a patient presenting the symptom and him/her seeking attention from the primary care physician or hospital emergency department exceeds 180 days. A bivariate analysis was performed to assess differences in variables segmented by tumour location and patient delay. Multivariate logistic regression analysis was performed on the outcome variable, PPAD.
The rate of PPAD among this population was 12.1%. PPAD was significantly associated with altered bowel rhythm (odds ratio OR, 1.36; 95% confidence interval CI, 1.02 to 1.83) and with adenocarcinoma histology, in comparison with mucinous adenocarcinoma (OR, 2.03; 95% CI, 1.11 to 3.71). Other sociocultural factors and clinicopathological features were not independent predictors of PPAD.
Many patients do not consider altered bowel rhythm an alarming symptom, warranting a visit to the doctor. PPAD could be reduced by improving health education, raising awareness of CRC-related symptoms.
A prospective study was performed of patients diagnosed with colorectal cancer (CRC), distinguishing between colonic and rectal location, to determine the factors that may provoke a delay in the ...first treatment (DFT) provided.2749 patients diagnosed with CRC were studied. The study population was recruited between June 2010 and December 2012. DFT is defined as time elapsed between diagnosis and first treatment exceeding 30 days.Excessive treatment delay was recorded in 65.5% of the cases, and was more prevalent among rectal cancer patients. Independent predictor variables of DFT in colon cancer patients were a low level of education, small tumour, ex-smoker, asymptomatic at diagnosis and following the application of screening. Among rectal cancer patients, the corresponding factors were primary school education and being asymptomatic.We conclude that treatment delay in CRC patients is affected not only by clinicopathological factors, but also by sociocultural ones. Greater attention should be paid by the healthcare provider to social groups with less formal education, in order to optimise treatment attention.
We investigate the clinical and pathological features related to variations in colorectal tumour apoptosis, proliferation and angiogenesis and the influence of the latter in short-term mortality (2 ...years); 551 tumour samples from a prospective cohort of patients with colorectal cancer were examined and tumour biology markers were determined as follows: percentage of apoptotic cells, by the terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling technique; Ki-67 antigen, as a cell proliferation marker and density of microvessels (as a marker of angiogenesis). An increase in the percentage of cellular apoptosis is significantly related to the presence of poorly differentiated tumours, with vascular invasion (p < 0.001). The CD105 angiogenesis marker is not related to any clinical–pathological parameter except that of higher frequency in older patients (p = 0.03). Ki-67 is more frequently expressed in tumours with less nervous invasion (p = 0.05). Neither apoptosis nor angiogenesis present any significant association with short-term survival. The only marker clearly related to 2-year survival is Ki-67, which is shown to be a good prognostic factor in the multivariate analysis (hazard ratio = 0.49; 95% confidence interval = 0.27–0.90). Therefore, in a prospective cohort of colorectal cancer patients, only Ki-67 is a marker of good prognosis in short-term follow-up.
Various methods used by different countries’ governments to control the spread of coronavirus disease 2019 (COVID-19), the cause of pandemic in 2020, affected air quality. The aim of this study was ...to evaluate the effects of lockdown in Armenia on the content of the main air pollutants—dust, SO2 and NO2. This was a cross-sectional study. We analyzed data on the concentrations of SO2, NO2 and dust from March to June, 2019 and the same period in 2020 as well as data on positive COVID-19 cases from Yerevan, Vanadzor and Hrazdan. In 2020, dust was found to be lower in Yerevan and in Hrazdan and higher in Vanadzor than in the same period in 2019. The same pattern was present for SO2 concentrations: in Yerevan and Hrazdan there was a decrease, and there was an increase in Vanadzor. The concentrations of NO2 increased in Yerevan and Hrazdan, with a slight decrease in Vanadzor. New cases of COVID-19 had a negative correlation with dust and a positive correlation with SO2. The strict quarantine measures were effective in containing the spread of COVID-19.
El presente artículo de revisión describe el Protocolo Psicológico para la evaluación de pacientes candidatos a implante de neuromodulación que se realiza en la Unidad Multidisciplinar de tratamiento ...del Dolor del Hospital Universitario y Politécnico la Fe de Valencia. Se recogen datos sobre factores cognitivos, emocionales y sensoriales. Se realiza un dictamen inicial: positivo, parcialmente negativo o negativo. Los pacientes con dictamen positivo realizan una terapia de preparación de modalidad grupal y muy estructurada, acompañados por un colaborador ya implantado en la Unidad. En esta terapia se abordan aspectos sobre fisiopatología del dolor, aspectos psicológicos del dolor y aspectos técnicos. Se incide sobre todas aquellas creencias y expectativas que tiene el paciente sobre el implante y se procede a la segunda parte, el protocolo quirúrgico, y a incluir en lista de quirófano. El protocolo presentado está demostrando ser un instrumento valioso para discriminar a pacientes idóneos, siendo de especial relevancia la preparación psicológica.
Treatment of hepatitis C is based on the combination of peginterferon alfa-2a or -2b plus ribavirin; the more effective peginterferon for this purpose has not been established. The aim of this study ...is to compare the effectiveness of hepatitis C treatment according to the type of peginterferon used.
A prospective cohort study was performed from November 2002 to May 2004, with up to 12 months of follow-up in all patients after completion of treatment. The study included naïve monoinfected patients, divided into two groups: Group A: peginterferon alfa-2a plus ribavirin and Group B: peginterferon alfa-2b plus ribavirin. The main variables studied were plasma glutamate pyruvate transferase levels (biochemical response), viral load (virologic response), and treatment effectiveness (biochemical and virologic response).
A total of 202 patients were studied (Group A: 87; Group B: 115), there were no significant differences in baseline characteristics between the two groups. Sustained biochemical response: 75.8% vs. 76.2% (P = .908); Sustained virological response: 71.3% vs. 64.3% (P = .293); Effectiveness of treatment: 64.2% vs. 60.87% (P = .628).
No differences in the sustained virological or biochemical response were found between groups receiving peginterferon alfa-2a or peginterferon alfa-2b plus ribavirin, suggesting that the two types of peginterferon alfa are similarly effective for treating hepatitis C in monoinfected patients.
determinar en una unidad neonatal de nivel II la frecuencia de nacimientos tras fecundación in vitro (FIV) incluyendo FIV-ICSI
(intracytoplasmic sperm injection) y comparar sus características con ...los de fecundación natural (FN), según sean gemelares o únicos.
estudio prospectivo mediante revisiones fetales desde la semana 12 de gestación tras FIV, al nacer y al año de vida. Del 1 de enero de 2004 al 31 de marzo de 2007 nacieron 7.008 recién nacidos (RN), 113 tras FIV y 6.895 por FN.
la gemelaridad es del 2,4% en FN y el 56,6% en FIV (p<0,001). La edad materna media en únicos es 28±9 años en FN y 36±4 en FIV (p<0,05); en gemelares es 29±10 años en FN y 35±4 en FIV (p<0,05). La edad gestacional media en únicos es 38±4 semanas en FN y 39±2 en FIV y 36±1 semanas en gemelares FN y FIV. La tasa de prematuridad (<37 semanas) y la de bajo peso (<2.500
g) no difiere estadísticamente entre únicos y gemelares FN y FIV. El 23,13% de los únicos FN y el 51,02% de los únicos FIV nacieron por cesárea (p<0,001), pero la diferencia entre gemelares FN (71,42%) y FIV (79,69%) no es estadísticamente significativa. El 5,3% de los RN vivos FIV y el 1,1% de los FN nacieron con defectos congénitos (p<0,002). El riesgo relativo (RR) de defectos congénitos de los FIV frente a los FN es 4,83 (intervalo de confianza del 95%, 2,14–10,83).
si se comparan según número de fetos, los FIV suponen el 1,61% de los RN, difieren de los FN en edad materna, gemelaridad, cesáreas (únicos) y defectos congénitos, pero no en prematuridad ni bajo peso.
To determine the number of deliveries after 31 weeks gestation (w), from in vitro fertilization (IVF), including Intracytoplasmic Sperm Injection (ICSI), and to compare characteristics with those achieved by natural fertilization (NF). We analyse twin and singleton pregnancies separately.
This descriptive and prospective study monitors children from foetus, from 12 weeks after IVF, to 12 months of age, including the newborn period. There were 7008 newborns between 1st January 2004 and 31st March 2007 of which there were 113 from IVF and 6895 from NF.
Twin-pregnancies in NF is 2.4%, whereas in IVF it is 56.6%, (p<0.001). Mean mother age is 28±9 years (y) in NF and 36±4y in IVF singletons (p<0.05), and 29±10 y in NF and 35±4 y in IVF twins (p<0.05). Mean gestational age is 38±4 w and 39±2w in NF and IVF singletons and 36±1 w in NF and IVF twins. No statistically significant differences were found in prematurity rate (<37 w) and low birth weight (< 2500
g) between singletons and twins from IVF or NF. Caesarean sections were 23.13% and 51.02% from singleton NF and IVF (p<0.001). No statistically differences were found between twins NF (71.42%) and IVF (79.69%).
Malformations at birth were observed in 5.3% of IVF and in 1.1% of NF newborns (p<0.002). Relative risk of malformations (RR) IVF versus NF is 4.83 (95% CI, 2.14–10.83).
Only 1.61% of newborns comes from IVF techniques. There are significant differences in age of mother, twin- pregnancies, caesarean sections (singletons) and congenital defects between them and NF newborns. There were no differences found in prematurity and low birth weight between them and NF newborns, when compared by number of foetus.
Background: In college students, higher risk alcohol
consumption (drunkenness and binge drinking-BD) has negative
consequences on their development and and probably
facilitates risk sexual behaviors. ...The objective was to study if
risky sexual behaviors when consuming alcohol (RSBA) are
associated with higher risk consumption.
Methods: Cross-sectional multicenter study with
UniHcos Project, 1st year university students from 11 universities
in Spain, academic years 2011-2012 to 2017-2018 data.
This data were collected by self-administered questionnaire.
A uni and bivariate analysis was performed, evaluated the statistical
significance of the differences in prevalence with chisquare.
Mean and standard deviation were used for quantitative
variables and Student’s t test statistic was used.
Results: 9,862 subjects (72.2% women). 90.3% reported
having consumed alcohol and 60.9% had drunk the last year,
49% BD in last month. It was deteded in men, significantly
higher consumption in the last month and drunkenness. Last
month consumption and drunkenness were significantly higher
in men and in <21 years. The RSBA were significantly higher
among who were drunk (15.7% unprotected sex, 1.9% sexual
abuse and 0.7% taking sexual advantage) and had BD (17.1%,
1.9% and 0.7 %). Women with both risk consumptions had
more sexual abuse (2.2%), and men had greater behaviors of
taking sexual advantage of someone (drunk: 1.2%; BD: 1.3%).
Conclusions: Alcohol consumption was above similar
groups. BD consumption was similar by gender and age. Risk
sexual behaviors appear mainly in problematic consumption.
Gender differences are not detected in alcohol consumers in
unprotected sex but deteded in the rest.
Fundamentos: En universitarios, el consumo de alcohol
de mayor riesgo (borracheras y binge drinking (BD), tiene
consecuencias negativas sobre su desarrollo y probablemente
facilita conductas sexuales de riesgo. El objetivo de
este trabajo fue estudiar si las conductas sexuales de riesgo
al consumir alcohol (CSRA) se asocian a los consumos de
mayor riesgo.
Métodos: Estudio multicéntrico transversal con datos
del Proyecto uniHcos, de universitarios de 1er año de 11
universidades españolas, entre los cursos 2011-2012 y 2017-
2018. Datos recogidos mediante cuestionario autoadministrado.
Se realizó un análisis uni y bivariable, evaluando la significación
estadística de las diferencias de prevalencia con
chi-cuadrado. Se utilizó media y desviación típica para variables
cuantitativas y como estadístico de contraste t de Student.
Resultados: 9.862 participantes (72,2% mujeres). El
90,3% consumió alcohol y el 60,9% tuvo borracheras en último
año; el 49% tuvo BD en el último mes. El consumo en
el último mes y las borracheras fueron mayores en hombres
y < 21 años. Las CSRA fueron superiores entre los que se
emborracharon (15,7% sexo sin protección, 1,9% abuso sexual
y 0,7% aprovecharse sexualmente) y consumieron en
BD (17,1%, 1,9% y 0,7%). Las mujeres con ambos consumos
de riesgo presentaron más abusos sexuales (2,2%), y los
hombres fueron quienes más se aprovecharon sexualmente de
otros (borracheras:1,2%; BD: 1,3%).
Conclusiones: El consumo de alcohol está por encima
de grupos similares. El BD tiene un patrón similar por género
y edad. Las CSRA se asocian a los consumos de mayor riesgo,
no detectándose en este grupo diferencias por género en sexo
sin protección, sí en otras CSRA.
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