Different studies have shown that carrying an alpha-1 antitrypsin (AAT) deficiency allele is an independent risk factor for developing lung cancer (LC). However, to date, little is known regarding ...whether carrying a deficiency allele may be a prognostic factor in the evolution of LC. A prospective observational study was carried out which consecutively included patients diagnosed with LC in University Hospital "Nuestra Señora de Candelaria" between December 2017 and August 2020. A blood sample was taken from each of the patients in order to determine both AAT serum concentration and genotype. Based on AAT genotype, patients were divided into the deficiency (
≠
) or non-deficiency (
) group. One hundred and sixty-four patients were included. The average length of follow-up was 13±10 months. Patients were classified as stage I (4.2%), stage II (8.3%), stage III (31.2%) and stage IV (56.3%), according to tumour, node and metastasis (TNM) staging. Twenty-eight patients (17%) were carriers of a deficiency allele (6
, 1
, 1
). No significant differences were found with respect to baseline characteristics between
≠
and
Patients in the
≠
group had a higher risk of death in the first 6 months after the LC diagnosis compared to
subjects (HR =2.04; 95% CI: 1.04-4.0; P=0.038). The presence of an AAT deficiency genotype could be a potential prognostic marker in LC. However, larger studies that justify these findings are needed.
Suicidal behavior is highly prevalent in schizophrenia. Among the risk factors, insight has been little studied and has yielded contradictory results. In addition, it has been studied neglecting ...relevant psychological aspects, such as beliefs about illness and coping styles.
We assessed 133 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Evaluation included sociodemographic, general clinical, psychopathological, psychological and suicidal behavior variables.
Neither insight nor insight coupled with negative beliefs and/or coping styles were associated with suicidal behavior. Nevertheless, insight coupled with negative beliefs and/or coping styles was associated with greater hopelessness and depression, internalized stigma, worse control over illness and greater global severity as compared to insight coupled with positive beliefs and coping styles. Suicide attempt and suicidal ideation groups showed greater depression and hopelessness, worse global beliefs and worse control over illness, higher socio-economic level, and greater number of previous psychiatric admissions compared to the non-suicidal group.
Insight coupled with negative beliefs and/or coping style was not associated with suicidal behavior. Nevertheless, it was associated with greater depression and hopelessness, both of which are firmly established risk factors for suicide in schizophrenia. Prospective studies with long-term follow-up and large samples are needed to clarify this issue. Clinicians should assess these psychological features associated with insight, both in patients with insight and in those with poor insight when promoting it.
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Los trastornos de la conducta alimentaria (TCA) se presentan con mayor frecuencia en personas jóvenes de sexo femenino. Tras la pandemia por COVID-19, se ha descrito un aumento en su ...incidencia en niños y adolescentes, manifestándose a edades más tempranas, y con un estado ponderal y nutricional más deficiente. Este estudio pretende constatar si esa tendencia se cumple también en nuestro medio.
Se realizó un estudio de cohortes descriptivo, retrospectivo en el que se incluye a los pacientes pediátricos con diagnóstico de TCA, remitidos durante los tres años previos y posteriores a la declaración del estado de alerta por la pandemia. Se analizaron y compararon parámetros clínicos, antropométricos, analíticos, bioimpedancia eléctrica y densitometría ósea (DMO).
De los 129 pacientes de la muestra, 28 se derivaron en periodo preconfinamiento y 101 tras el mismo. En comparación, el segundo grupo presentó mayor tiempo de evolución hasta su primera valoración (11,87±6,75 vs. 6,64±4,36 meses), más hospitalizaciones (14,1% vs. 10,1%), y una reducción de los valores de vitamina D (28,19±9,95 vs. 34,39±11,87 ng/mL). Asimismo, estos pacientes asociaban con más frecuencia autolesiones e intentos de suicidio.
Se comprobó la tendencia creciente de los TCA en niños y adolescentes en nuestro medio. Además, se observaron diferencias en algunas de sus características clínicas, en su gravedad, y en el tiempo de evolución hasta el diagnóstico, en comparación con los pacientes remitidos antes de la pandemia.
.
Eating disorders (EDs) develop more frequently in young females. Following the COVID-19 pandemic, there has been evidence of an increase in children and adolescents, with an earlier onset and a worse body weight and nutritional status. The aim of this study was to determine whether this trend has also been observed in our region over the past 6 years.
We conducted a retrospective and descriptive cohort study in paediatric patients with a diagnosis of ED, referred during the 3 years preceding and following the declaration of the state of alarm due to the pandemic. We analysed and compared clinical, anthropometric and laboratory variables and bioelectrical impedance and bone density data.
Of the 129 patients in the sample, 28 were referred before the lockdown period and 101 after. When we compared these groups, we found a longer time elapsed from onset to the initial assessment (mean delay, 11.87 SD, 6.75 vs 6.64 SD, 4.36 months), a greater hospitalization rate (14.1% vs 10.1%), and lower vitamin D values (mean level, 28.19 SD, 9.95 vs 34.39 SD, 11.87 ng/mL) in the post-lockdown group. We also found a greater frequency of self-harm suicide attempts in these patients.
This study confirms the increasing trend in EDs in children and adolescents in our area. Moreover, we found differences in the clinical characteristics and time elapsed to diagnosis compared to the patients referred to the hospital before the pandemic.
Background
Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. ...T‐Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterisation by a multifactorial approach. The general purpose of this study is to evaluate the effectiveness and cost‐effectiveness of the T‐Control catheter versus the Foley‐type catheter in patients with Acute Urine Retention (AUR).
Study design
This is a pragmatic, open, multicentre, controlled clinical trial with random allocation to the T‐Control catheter or a conventional Foley‐type catheter in patients with AUR.
Endpoints
The magnitude of infections will be analysed as a primary endpoint. While as secondary endpoint, the following will be analysed: rate of symptomatic and asymptomatic infections; days free of infection; quality of life‐related to self‐perceived health; indication of associated antibiotic treatments; determination of biofilm; number of catheter‐related adverse events; use of each type of catheterisation's healthcare resources; level of satisfaction and workload of health professionals and acceptability of the T‐Control device as well as the patient experience.
Patients and methods
Eligible patients are male adults aged ≥50 years, with AUR and with an indication of bladder catheterisation for at least 2 weeks. The estimated sample size is 50 patients. Patient follow‐up includes both the time of catheter insertion and its removal or change 2 weeks later, plus 2 weeks after this time when the patient will be called for an in‐depth interview.
Background: The identification of factors associated with nonadherence to psychotherapy would allow a better prevention of this problem.
Aim: To investigate factors associated with nonadherence in ...psychotherapy, its possible effect on outcomes, and reasons for therapy dropout.
Method: Prospective analytic observational study of patients who initiated psychotherapy (N = 144). Sociodemographic, general clinical, treatment-related, subjective, psychological, psychopathologic, and outcome variables were evaluated at baseline and 1, 3, 6, and 12 months later. Objective nonadherence (dropout and irregularity), subjective nonadherence (poor patient engagement), and global nonadherence (combination of both) were analyzed.
Results: Global nonadherence was 66%. Global nonadherence was associated with substance use or abuse (OR = 2.64) and younger age (OR = 0.97). Objective nonadherence was associated with active working status (OR = 4.11), younger age (OR = 1.04) and substance use or abuse (OR = 2.35). Subjective nonadherence was associated with worse insight in psychotherapy (OR = 0.95) and poor pharmacologic adherence (OR = 0.55). Contextual reasons (25.8%) were the most commonly reported cause of dropout. Time in psychotherapy was associated with outcome variables.
Conclusions: Nonadherence to psychotherapy is frequent. To reduce nonadherence in psychotherapy, specific interventions for reducing substance use and abuse, measures aimed at facilitating access to Community Mental Health Units, and enhancing insight in psychotherapy should be implemented.
To analyse the cost-effectiveness of multicomponent interventions designed to improve outcomes in type 2 diabetes mellitus (T2DM) in primary care in the Canary Islands, Spain, within the INDICA ...randomised clinical trial, from the public health system perspective.
An economic evaluation was conducted for the within-trial period (2 years) comparing the four arms of the INDICA study.
Primary care in the Canary Islands, Spain.
2334 patients with T2DM without complications were included.
Interventions for patients (PTI), for primary care professionals (PFI), for both (combined intervention arm for patients and professionals, CBI) and usual care (UC) as a control group.
The main outcome was the incremental cost per quality-adjusted life-years (QALY). Only the intervention and the healthcare costs were included.
Multilevel models were used to estimate results, and to measure the size and significance of incremental changes. Missed values were treated by means of multiple imputations procedure.
There were no differences between arms in terms of costs (p=0.093), while some differences were observed in terms of QALYs after 2 years of follow-up (p=0.028). PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and the UC arms were very small in terms of QALYs, but significant in terms of healthcare costs (p=0.045). The total cost of the PTI arm (€2571, 95% CI €2317 to €2826) was lower than the cost in the UC arm (€2750, 95% CI €2506 to €2995), but this difference did not reach statistical significance. Base case estimates of the incremental cost per QALY indicate that the PTI strategy was the cost-effective option.
The INDICA intervention designed for patients with T2DM and families is likely to be cost-effective from the public healthcare perspective. A cost-effectiveness model should explore this in the long term.
NCT01657227.
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La valoración nutricional en anorexia nerviosa (AN) incluye determinar la composición corporal y monitorizar su evolución a lo largo del periodo de tratamiento. La prueba gold ...standard para el estudio de la composición corporal es la absorciometría de rayos X de energía dual (DEXA), si bien la bioimpedancia eléctrica (BIA) se postula como una alternativa más accesible, barata, rápida y que no irradia.
Se reclutaron secuencialmente a 33 mujeres adolescentes (11,7-16,3 años) diagnosticadas de AN. Se recogieron parámetros clínicos, antropométricos y analíticos, y se realizó BIA y DEXA a la inclusión en el estudio y a la finalización del mismo con separación media de un año, durante la fase de rehabilitación nutricional.
Se objetivó mejoría significativa a nivel nutricional, reflejada en la composición corporal obtenida mediante antropometría y BIA. El ángulo de fase aumentó significativamente durante el periodo de seguimiento. Una mayor pérdida ponderal se correlacionó con la presencia de amenorrea secundaria y con una menor densidad mineral ósea en columna.
La BIA es una herramienta útil para la valoración y el seguimiento del estado nutricional en pacientes con AN en edad pediátrica. La DEXA sigue siendo imprescindible para conocer la afectación de la densidad mineral ósea. El papel de hormonas como la leptina está aún por determinar.
Nutritional status assessment in anorexia nervosa (AN) includes the evaluation and monitoring of body composition throughout the treatment period. The gold standard for the study of body composition is dual-energy X-ray absorptiometry (DEXA), although electrical bioimpedance (BIA) is a more accessible, cheaper and faster method that does not involve exposure to radiation.
We recruited 33 female adolescents with AN (age, 11.7-16.3 years) by consecutive sampling. We collected data on clinical, anthropometric and laboratory variables. Patients were assessed with BIA and DEXA at inclusion in the study and at the end of the study, with a mean duration of followup of 1 year, during the nutritional rehabilitation phase.
There was significant improvement in nutritional status, reflected by the body composition obtained by anthropometric measurements and BIA. The phase angle increased significantly during the followup. Greater weight loss was associated with the presence of secondary amenorrhoea and decreased bone mineral density in the spine.
Electrical BIA is a useful tool for assessment and monitoring of nutritional status in paediatric patients with AN. Dual-energy X-ray absorptiometry continues to be essential to assess bone mineral density. The role of hormones such as leptin remains to be elucidated.
INTRODUCTIONThere is still an undiscovered territory about the sequelae and lung ultrasound (LUS) findings after SARS-CoV2 acute infection. This study aims to investigate the post-COVID period from a ...clinical, psychosocial, and radiological point of view, analyze LUS on COVID-19 follow-up and detect whether these outcomes are related to the patient situation. METHODSWe conducted an observational study on patients diagnosed with SARS-CoV2 pneumonia and admitted to the University Hospital of La Candelaria (Tenerife, Spain) from 1st March to 31st August 2020. We performed a descriptive analysis on post-COVID manifestations, LUS score, health-related quality of life measured through the Euroqol 5D-5L questionnaire, and lung function parameters on follow-up, and we compared these variables to the outcomes during the hospital admission. RESULTS77 patients were included; the mean age was 57 years and the follow-up mean time from hospital discharge was 16 weeks. 87% of the cases had symptoms on follow-up, the most common was dyspnea (65%); these manifestations were more frequent in females (p = 0,015). 76,5% of the cases had lung aeration alteration in LUS on follow-up; lower PaO2/FiO2 and greater CRP and IL-6 levels on admission were related to LUS score ≥1. CONCLUSIONSAlmost 90% of the patients had persistent symptoms after 16 weeks of hospital discharge due to COVID-19, the most common manifestation presented was dyspnea. Altered lung aeration pattern in LUS was observed on more than 70% of the patients on follow-up.
The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology ...assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.
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