Riesgo y aumento de la incidencia de cáncer de tiroides en una consulta monográfica en el periodo 2002-2017

El cáncer de tiroides constituye la neoplasia endocrina maligna más frecuente y la principal causa de muerte por tumores endocrinos. La incidencia del cáncer de tiroides (CDT) se ha visto aumentada en los últimos años de manera exponencial. Sin embargo, el riesgo de desarrollo de recurrencias y mortalidad sigue siendo bajo. Esto ha llevado a la creación de modelos de estadificación dinámica del riesgo que ofrecen una valoración a tiempo real del estado de la enfermedad del paciente en cualquier momento de su evaluación integrando la respuesta al tratamiento con las características del paciente. Nuestro objetivo es evaluar la progresión de la incidencia de CDT en nuestra área, así como la evolución de los pacientes en seguimiento en una consulta monográfica de cáncer de tiroides (UART) mediante la estadificación dinámica del riesgo y el cálculo del riesgo de recurrencia. Estudio observacional retrospectivo sobre los casos incidentes en el registro de tumores del periodo 2002-2017 y la evolución de los pacientes en seguimiento en UART. Se recogieron datos demográficos, clínicos e histológicos al diagnóstico, y de evolución en la última visita de seguimiento. La tasa de incidencia se calculó ajustada a la población de referencia en periodos de 3 años. 444 pacientes (78.5% mujeres) fueron diagnosticados durante el periodo 2002-2017, con una edad media de 52,1±14,9 años. Durante este periodo, la tasa de incidencia de CDT aumentó de 5,2 a 25,7 x 105 habitantes/año en mujeres y de 2,3 a 7,1 x 105 habitantes/año en varones (p<0.0001). El aumento de la incidencia registrada se asoció a un incremento no significativo en el número de diagnósticos de microcarcinomas papilares incidentales (29,4% a 32%). Al analizar la totalidad de los pacientes en seguimiento en la UART, se encontraron un total de 307 pacientes (78,8% mujeres) con una edad media de 58,3±13,6 años y un seguimiento medio desde el diagnóstico de 6,5±5,3 años. Al evaluar la histología se objetivó un 84% de carcinomas papilares, 12,4% carcinomas foliculares, 2,6% carcinomas medulares y 1% anaplásicos/desdiferenciados. El tamaño medio tumoral fue de 1,6±1,3 cm de diámetro. Al diagnóstico el 65,7% presentaban un riesgo bajo de recurrencia frente a un 14,5% de riesgo elevado (ATA2015). El estadio fue de 82,8%, 6,0%,19,9% y 0,3% para los estadios I, II, III y IV, respectivamente (AJCC 8edición). Al evaluar el riesgo de recurrencia al diagnóstico, un 75% de los pacientes con riesgo bajo presentaban respuesta excelente en el seguimiento frente a un 42,5% en el grupo de riesgo elevado (p<0,005) Al evaluar la estadificación dinámica del riesgo al diagnóstico y en la última visita de seguimiento, el 88,8% de los pacientes con respuesta excelente al diagnóstico se mantenían libres de enfermedad en la última visita de seguimiento. Sin embargo, aquellos pacientes con respuesta indeterminada o estructural incompleta al diagnóstico evolucionaban a respuesta excelente en un 55,8% y 42,9% de los casos respectivamente frente a un 14,8% en aquellos con respuesta bioquímica incompleta. (p<0,001). El aumento de la incidencia de CDT sigue una tendencia semejante a las publicadas en nuestro medio y es parcialmente atribuible al incremento de diagnósticos de carcinomas papilares. Los sistemas de estratificación del riesgo etiquetan adecuadamente a los pacientes en seguimiento y permiten adecuar las herramientas de diagnóstico y tratamiento, especialmente en los subgrupos de bajo riesgo.Grado en Medicin

ANALYSIS OF UNCERTAINTY IN THE STANDARIZATION OF CPUE INDEXES

Catch per unit effort (CPUE) indices are considered as one of the main information sources used in fish stock assessment models (Zou et al., 2019). There are many ways for the standardization of these indices: • Generalized lineal models (GLMs) • Generalized additive models (GAMs) • Geostatistical models. To evaluate the accuracy and uncertainty associated with CPUE indices derived from datasets with different spatial information. • How? With the standardization of CPUE indices using geostatistical models in different sampling scenarios, comparing them with GLMs and GAMs models

Definition and study of the innovative façade Natura, made of independent pre-vegetated and water storage type panels

Definition and study of the innovative façade Natura, made of independent pre-vegetated and water storage type panel

Metodología de la ecoinnovación PDCA, aplicada al prototipo de fachada vegetal aljibe Naturpanel en el Proyecto SOS-Natura

Este artículo expone la metodología de trabajo desarrollada en las investigaciones del Departamento de Construcción y Tecnología Arquitectónicas de la UPM, basada en el concepto de ecoinnovación, y en la normativa AENOR de Ecodiseño (UNE-EN ISO 14006), en normativas relacionadas como la UNE-EN ISO 9001 y 14001, entre otras. Dicha metodología considera los aspectos medioambientales desde las primeras fases de la investigación, para aumentar la ecoeficiencia de las propuestas producidas, de manera que satisfagan las necesidades humanas y proporcionen una mejor calidad de vida, a la vez que reduzcan progresivamente los impactos ambientales y la intensidad de consumo de recursos a lo largo de su ciclo de vida, hasta un nivel, al menos, en línea con la capacidad de asimilación de la Tierra. El objetivo de esta comunicación es explicar y dar a conocer, mediante ejemplos concretos, dicha metodología; los beneficios de la misma y cómo influye su utilización en el diseño arquitectónico de fachadas vegetales

Metodología de ecoinnovación PDCA, aplicada al prototipo de fachada vegetal aljibe Naturpanel en el Proyecto SOS-Natura

Este artículo expone la metodología de trabajo desarrollada en las investigaciones del Departamento de Construcción y Tecnología Arquitectónicas de la UPM, basada en el concepto de ecoinnovación, y en la normativa AENOR de Ecodiseño (UNE-EN ISO 14006), en normativas relacionadas como la UNE-EN ISO 9001 y 14001, entre otras. Dicha metodología considera los aspectos medioambientales desde las primeras fases de la investigación, para aumentar la ecoeficiencia de las propuestas producidas, de manera que satisfagan las necesidades humanas y proporcionen una mejor calidad de vida, a la vez que reduzcan progresivamente los impactos ambientales y la intensidad de consumo de recursos a lo largo de su ciclo de vida, hasta un nivel, al menos, en línea con la capacidad de asimilación de la Tierra. El objetivo de esta comunicación es explicar y dar a conocer, mediante ejemplos concretos, dicha metodología; los beneficios de la misma y cómo influye su utilización en el diseño arquitectónico de fachadas vegetales

Hypertension in the very old; prevalence, awareness, treatment and control: a cross-sectional population-based study in a Spanish municipality

<p>Abstract</p> <p>Background</p> <p>Information on hypertension in the very elderly is sparse. Until recently evidence of benefits from pharmacological treatment was inconclusive. We estimated the prevalence of hypertension in subjects aged 80 or more, the proportion of awareness, treatment and control. Explanatory variables associated with good control were also studied.</p> <p>Methods</p> <p>Cross sectional, population-based study, conducted in Martorell, an urban Spanish municipality, in 2005. By simple random sampling from the census, 323 subjects aged 80 or more were included. Patients were visited at home or in the geriatric institution and after giving informed consent, the study variables were collected. These included: supine and standing blood pressure and information about diagnosis and treatment of hypertension. The estimation and 95% confidence interval were obtained and a logistic regression model was used to study explanatory variables associated with blood pressure below 140/90 mm Hg.</p> <p>Results</p> <p>The prevalence of hypertension was 72.8% (95%CI: 69.5 – 76.6%) and 93% of the patients were aware of this condition, of whom 96.3% (95%CI: 93.65 – 97.9%) had been prescribed pharmacological treatment and 30.7% (95%CI: 25.8 – 36.1%) had blood pressure below 140/90 mm Hg. Some of the patients (43%) had one antihypertensive drug and 39.5% had two in combination. Explanatory variables associated with blood pressure below 140/90 mm Hg included prescription of a diuretic, OR: 0.31 (95%CI: 0.14 – 0.66), and history of ischemic heart disease, OR: 0.21 (95%CI: 0.1 – 0.47).</p> <p>Conclusion</p> <p>The prevalence of hypertension in population aged 80 or more was over 70%. Most patients were aware of this condition and they had antihypertensive medication prescribed. Approximately one third of treated patients had blood pressure below 140/90 mm Hg. Patients with heart disease and with diuretics had more frequently blood pressure below this value.</p

The Effect of Physical Activity and High Body Mass Index on Health-Related Quality of Life in Individuals with Metabolic Syndrome

[EN] The main objective of this study was to examine the relationship between the level of physical activity (PA) and the degree of obesity with health-related quality of life (HRQoL) in individuals with metabolic syndrome (MetS) who participated in the Predimed-Plus study. A total of 6875 subjects between 55 and 75 years of age with MetS were selected and randomized in 23 Spanish centers. Subjects were classified according to categories of body mass index (BMI). PA was measured with the validated Registre Gironi del Cor (REGICOR) questionnaire and subjects were classified according to their PA level (light, moderate, vigorous) and the HRQoL was measured with the validated short-form 36 (SF-36) questionnaire. By using the ANOVA model, we found a positive and statistically significant association between the level of PA and the HRQoL (aggregated physical and mental dimensions p < 0.001), but a negative association with higher BMI in aggregated physical dimensions p < 0.001. Furthermore, women obtained lower scores compared with men, more five points in all fields of SF-36. Therefore, it is essential to promote PA and body weight control from primary care consultations to improve HRQoL, paying special attention to the differences that sex incurs.SIThe Predimed-Plus trial was supported by the Spanish government’s official funding agency for biomedical research, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (three coordinated FIS projects led by Jordi Salas-Salvadó and Josep Vidal, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/0147, PI14/00636, PI14/00972, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01,332), the Special Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-PLUS grant to Jordi Salas-Salvadó, the European Research Council (Advanced Research Grant 2013–2018; 340918) grant to Miguel Ángel Martínez-Gonzalez, the Recercaixa grant to Jordi Salas-Salvadó (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant and FEDER funds (CB06/03 and CB12/03), Olga Castaner is funded by the JR17/00,022 grant, ISCIII. Christopher Papandreou is supported by a postdoctoral fellowship granted by the Autonomous Government of Catalonia (PERIS 2016–2020 Incorporació de Científics i Tecnòlegs, SLT002/0016/00,428). María Rosa Bernal-Lopez was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER, Ignacio M.Giménez-Alba is supported by a FPU predoctoral contract (reference FPU18/01703) from the Ministerio de Ciencia, Innovación y Universidades, Spain

Negative symptoms and sex differences in first episode schizophrenia: What's their role in the functional outcome? A longitudinal study

Introduction: Negative symptoms (NS) include asociality, avolition, anhedonia, alogia, and blunted affect and are linked to poor prognosis. It has been suggested that they reflect two different factors: diminished expression (EXP) (blunted affect and alogia) and amotivation/pleasure (MAP) (anhedonia, avolition, asociality). The aim of this article was to examine potential sex differences among first-episode schizophrenia (FES) patients and analyze sex-related predictors of two NS symptoms factors (EXP and MAP) and functional outcome. Material and methods: Two hundred and twenty-three FES (71 females and 152 males) were included and evaluated at baseline, six-months and one-year. Repeated measures ANOVA was used to examine the effects of time and sex on NS and a multiple linear regression backward elimination was performed to predict NS factors (MAP-EXP) and functioning. Results: Females showed fewer NS (p = 0.031; Cohen's d = −0.312), especially those related to EXP (p = 0.024; Cohen's d = −0.326) rather than MAP (p = 0.086), than males. In both male and female group, worse premorbid adjustment and higher depressive symptoms made a significant contribution to the presence of higher deficits in EXP at one-year follow-up, while positive and depressive symptoms predicted alterations in MAP. Finally, in females, lower deficits in MAP and better premorbid adjustment predicted better functioning at one-year follow-up (R2 = 0.494; p < 0.001), while only higher deficits in MAP predicted worse functioning in males (R2 = 0.088; p = 0.012). Conclusions: Slightly sex differences have been found in this study. Our results lead us to consider that early interventions of NS, especially those focusing on motivation and pleasure symptoms, could improve functional outcomes

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p