Diseño del instrumento de ayuda para la toma de decisiones: “alternativas de tratamiento para el cáncer de próstata: ¿qué opción prefiero?”

Purpose: To design a Decision-making Aid within the ‘Benign Prostatic Hyperplasia’ healthcare process modelling of the Andalusian Public Health System (SSPA) for the therapeutic approach of early-stage disease. Methods: The Decision Aid design was conducted in four phases: 1) Explore the receptiveness of professionals in the mainstream of the SSPA Decision Aid “Benign Prostatic Hyperplasia” process; 2) Select a Decision Aid from international experiences; 3) Transcultural adaptation of above selected Decision Aid; 4) Decision Aid Validation in the SSPA. Results: The results of the validation of Decision Aid “Alternative treatment for prostate cancer: What option do I prefer?” have shown that the document is well taken by patients, their design is attractive and the quality of clinical information it contains is high. The instrument meets the concerns of patients (95%), the language is simple and suitable (92%) and summarizes the essential information to make the decision (92%). The Decision Aid offers relevant information that help the patient in the decision making process (lack of decisional confl ict: 88.93), generates a sense of support (92.82), concerning the decision (86.88) and a sense of availability of information (90.51). Conclusion: Patients and professionals agree to recommend the use of Decision Aid. To improve information and enhance the tranquillity of the patient, the Decision Aid facilitates communication doctor patient consultation and the involvement of patients during the decision-making process.Objetivo: Diseñar un Instrumento de Ayuda para la Toma de Decisiones (IATD) en el Proceso Asistencial Integrado ‘Hipertrofia benigna de próstata. Cáncer de próstata’ del Sistema Sanitario Público de Andalucía (SSPA) para el abordaje terapéutico de esta enfermedad en estadio inicial. Método: El diseño del IATD se realizó en cuatro fases: 1) Explorar la receptividad de los profesionales del SSPA sobre la incorporación de IATD en el proceso “Cáncer de próstata”. 2. Seleccionar un IATD entre las experiencias internacionales. 3. Adaptar transculturalmente del IATD seleccionado al entorno del SSPA. 4. Validar el IATD en el SSPA. Resultado: Los resultados de la validación del IATD “Alternativas de tratamiento para el cáncer de próstata: ¿Qué opción prefiero?” han mostrado que el documento es bien cogido por los pacientes, su diseño resulta atractivo y la calidad en la información clínica que contiene es elevada. El Instrumento resuelve las dudas de los pacientes (95%), el lenguaje resulta sencillo y asequible (92%) y resume la información esencial para tomar la decisión (92%). El IATD ofrece información relevante que prepara al paciente para la toma de decisiones (ausencia de conflicto decisional: 88,93), genera sentimiento de apoyo (92,82), seguridad en la decisión (86,88) y sensación de disponibilidad de información (90,51). Conclusiones: Pacientes y profesionales coinciden en recomendar la utilización del Instrumento. Al mejorar la información y aumentar la tranquilidad del paciente, el IATD facilita la comunicación médico-paciente en la consulta y la participación en la toma de decisiones

Social inequities in the impact of COVID-19 lockdown measures on the mental health of a large sample of the Colombian population (PSY-COVID study)

The identification of general population groups particularly vulnerable to the impact of COVID-19 lockdown measures on mental health and the development of healthcare policies are priority challenges in the current and future pandemics. This study aimed to identify the personal and social determinants of the impact of COVID-19 lockdown measures on mental health in a large sample of the Colombian population. In this cross-sectional study, an anonymous online survey was answered by 18,061 participants from the general population residing in Colombia during the first wave of the COVID-19 outbreak (from 20 May to 20 June 2020). The risk of depression, anxiety, and somatization disorders were measured using the Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and Somatic Symptom Questionnaire (SSQ-5), respectively. Overall, 35% of participants showed risk of depression, 29% of anxiety, and 31% of somatization. According to the analysis of social determinants of health, the most affected groups were people with low incomes, students, and young adults (18-29 years). Specifically, low-income young females were the most at-risk population group. These findings show how the lockdown measures affected the general population's mental health in Colombia and highlight some social risk factors in health

Design a decision-making aid: "alternative treatment for prostate cancer: what option do you prefer?"

Purpose: To design a Decision-making Aid within the ‘Benign Prostatic Hyperplasia’ healthcare process modelling of the Andalusian Public Health System (SSPA) for the therapeutic approach of early-stage disease. Methods: The Decision Aid design was conducted in four phases: 1) Explore the receptiveness of professionals in the mainstream of the SSPA Decision Aid “Benign Prostatic Hyperplasia” process; 2) Select a Decision Aid from international experiences; 3) Transcultural adaptation of above selected Decision Aid; 4) Decision Aid Validation in the SSPA. Results: The results of the validation of Decision Aid “Alternative treatment for prostate cancer: What option do I prefer?” have shown that the document is well taken by patients, their design is attractive and the quality of clinical information it contains is high. The instrument meets the concerns of patients (95%), the language is simple and suitable (92%) and summarizes the essential information to make the decision (92%). The Decision Aid offers relevant information that help the patient in the decision making process (lack of decisional confl ict: 88.93), generates a sense of support (92.82), concerning the decision (86.88) and a sense of availability of information (90.51). Conclusion: Patients and professionals agree to recommend the use of Decision Aid. To improve information and enhance the tranquillity of the patient, the Decision Aid facilitates communication doctor patient consultation and the involvement of patients during the decision-making process

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Genomics and proteomics approaches to the study of cancer-stroma interactions

<p>Abstract</p> <p>Background</p> <p>The development and progression of cancer depend on its genetic characteristics as well as on the interactions with its microenvironment. Understanding these interactions may contribute to diagnostic and prognostic evaluations and to the development of new cancer therapies. Aiming to investigate potential mechanisms by which the tumor microenvironment might contribute to a cancer phenotype, we evaluated soluble paracrine factors produced by stromal and neoplastic cells which may influence proliferation and gene and protein expression.</p> <p>Methods</p> <p>The study was carried out on the epithelial cancer cell line (Hep-2) and fibroblasts isolated from a primary oral cancer. We combined a conditioned-medium technique with subtraction hybridization approach, quantitative PCR and proteomics, in order to evaluate gene and protein expression influenced by soluble paracrine factors produced by stromal and neoplastic cells.</p> <p>Results</p> <p>We observed that conditioned medium from fibroblast cultures (FCM) inhibited proliferation and induced apoptosis in Hep-2 cells. In neoplastic cells, 41 genes and 5 proteins exhibited changes in expression levels in response to FCM and, in fibroblasts, 17 genes and 2 proteins showed down-regulation in response to conditioned medium from Hep-2 cells (HCM). Nine genes were selected and the expression results of 6 down-regulated genes (<it>ARID4A</it>, <it>CALR</it>, <it>GNB2L1</it>, <it>RNF10</it>, <it>SQSTM1</it>, <it>USP9X</it>) were validated by real time PCR.</p> <p>Conclusions</p> <p>A significant and common denominator in the results was the potential induction of signaling changes associated with immune or inflammatory response in the absence of a specific protein.</p

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%