Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT

Ablació; Càncer colorectal; Metàstasis del fetgeAblación; Cáncer colorrectal; Metástasis en el hígadoAblation; Colorectal cancer; Liver metastasesThe prognosis for oligometastatic colorectal cancer has improved in recent years, mostly because of recent advances in new techniques and approaches to the treatment of oligometastases, including new surgical procedures, better systemic treatments, percutaneous ablation, and stereotactic body radiation therapy (SBRT). There are several factors to consider when deciding on the better approach for each patient: tumor factors (metachronous or synchronous metastases, RAS mutation, BRAF mutation, disease-free interval, size and number of metastases), patient factors (age, frailty, comorbidities, patient preferences), and physicians’ factors (local expertise). These advances have presented major challenges and opportunities for oncologic multidisciplinary teams to treat patients with limited liver and lung metastases from colorectal cancer with a curative intention. In this review, we describe the different treatment options in patients with limited liver and lung metastases from colorectal cancer, and the possible combination of three approaches: systemic treatment, surgery, and local ablative treatments.This research received no external funding

Intraoperative electron radiation therapy after salvage surgery in gynecological cancers and retroperitoneal sarcomas: outcomes and adverse effects

Background: Salvage surgery is considered an option for isolated recurrences of retroperitoneal and pelvic tumors, in patients who have undergone previous radiotherapy. In order to increase local control intra operative electron radiation therapy (IOERT) can be used in these patients to administer additional radiation dose. We evaluated the outcomes and adverse effects in patients with retroperitoneal sarcoma and gynecologic tumors after salvage surgery and IOERT. Materials and methods: Twenty patients were retrospectively analyzed. Twenty-three IOERT treatments were performed after surgery. Six (30%) were sarcoma and 14 (70%) were gynecological carcinoma. Administered dose depended on previous dose received with external beam radiotherapy (EBRT) and proximity to critical structures. The toxicities were scored using the Common Terminology Criteria for Adverse Events version 4.0. Results: The median age of the patients was 51 years (range 34–70). After a median follow-up of 32 months (range 1–68), in the sarcoma group the local control rate was 66.6%; while in the gynecological group the local control rate was 64.3%. In relation to late toxicity, one patient had a Grade 2 vesicovaginal fistula, and one patient presented Grade 4 enterocolitis and enteric intestinal fistula. Conclusions: IOERT could have a role in the treatment of retroperitoneal sarcomas in primary tumors after EBRT, as it may suggest a benefit in local control or recurrences after surgical resection in those at high risk of microscopic residual disease. The addition of IOERT to salvage resection for isolated recurrence of gynecologic cancers suggest favorable local control in cases with concern for residual microscopic disease

Pharmaceutical cost and multimorbidity with type 2 diabetes mellitus using electronic health record data

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.[EN] Background: The objective of the study is to estimate the frequency of multimorbidity in type 2 diabetes patients classified by health statuses in a European region and to determine the impact on pharmaceutical expenditure. Methods: Cross-sectional study of the inhabitants of a southeastern European region with a population of 5,150,054, using data extracted from Electronic Health Records for 2012. 491,854 diabetic individuals were identified and selected through clinical codes, Clinical Risk Groups and diabetes treatment and/or blood glucose reagent strips. Patients with type 1 diabetes and gestational diabetes were excluded. All measurements were obtained at individual level. The prevalence of common chronic diseases and co-occurrence of diseases was established using factorial analysis. Results: The estimated prevalence of diabetes was 9.6 %, with nearly 70 % of diabetic patients suffering from more than two comorbidities. The most frequent of these was hypertension, which for the groups of patients in Clinical Risk Groups (CRG) 6 and 7 was 84.3 % and 97.1 % respectively. Regarding age, elderly patients have more probability of suffering complications than younger people. Moreover, women suffer complications more frequently than men, except for retinopathy, which is more common in males. The highest use of insulins, oral antidiabetics (OAD) and combinations was found in diabetic patients who also suffered cardiovascular disease and neoplasms. The average cost for insulin was 153€ and that of OADs 306€. Regarding total pharmaceutical cost, the greatest consumers were patients with comorbidities of respiratory illness and neoplasms, with respective average costs of 2,034.2€ and 1,886.9€. Conclusions: Diabetes is characterized by the co-occurrence of other diseases, which has implications for disease management and leads to a considerable increase in consumption of medicines for this pathology and, as such, pharmaceutical expenditure.This study was financed by a grant from the Fondo de Investigaciones de la Seguridad Social Instituto de Salud Carlos III, the Spanish Ministry of Health (FIS PI12/0037).Sancho Mestre, C.; Vivas Consuelo, DJJ.; Alvis, L.; Romero, M.; Usó Talamantes, R.; Caballer Tarazona, V. (2016). Pharmaceutical cost and multimorbidity with type 2 diabetes mellitus using electronic health record data. BMC Health Services Research. 16(394):1-8. https://doi.org/10.1186/s12913-016-1649-2S1816394Whiting DR, Guariguata L, Weil C, Shaw J. IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22079683Soriguer F, Goday A, Bosch-Comas A, Bordiu E, Calle-Pascual A, Carmena R, et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] Study. Diabetologia. 2012;55:88–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21987347WHO | Rio Political Declaration on Social Determinants of Health. WHO. World Health Organization; 2011. Available from: http://www.who.int/sdhconference/declaration/Rio_political_declaration.pdf?ua=1Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M. Multimorbidity’s many challenges. BMJ. 2007;334:1016–7. BMJ Group [cited 2016 Aug 4]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17510108Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7:357–63. [cited 2016 Aug 4]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19597174Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57:1288–94. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15617955Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, et al. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28:516–23. [Internet]. 2011 [cited 2016 Aug 4]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21436204Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43. [cited 2014 Nov 5] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22579043Holden L, Scuffham PA, Hilton MF, Muspratt A, Ng SK, Whiteford HA. Patterns of multimorbidity in working Australians. Popul Heal Metr. 2011;9:15. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21635787Starfield B. Threads and yarns: weaving the tapestry of comorbidity. Ann Fam Med. 2006;4:101–3. [cited 2016 Aug 4]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16569711Abdul-Rahim HF, Holmboe-Ottesen G, Stene LCM, Husseini A, Giacaman R, Jervell J, et al. Obesity in a rural and an urban Palestinian West Bank population. Int J Obes. 2003;27:140–6. Available from: http://dx.doi.org/10.1038/sj.ijo.0802160Boutayeb A, Boutayeb S, Boutayeb W. Multi-morbidity of non communicable diseases and equity in WHO Eastern Mediterranean countries. Int J Equity Heal. 2013;12:60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23961989Teljeur C, Smith SM, Paul G, Kelly A, O’Dowd T. Multimorbidity in a cohort of patients with type 2 diabetes. Eur J Gen Pract. 2013;19:17–22. Available from: http://informahealthcare.com/doi/abs/10.3109/13814788.2012.714768 , http://www.ncbi.nlm.nih.gov/pubmed/23432037Hughes JS, Averill RF, Eisenhandler J, Goldfield NI, Muldoon J, Neff JM, et al. Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care management. Med Care. 2004;42:81–90. [cited 2016 Feb 29]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14713742Vivas-Consuelo D, Alvis-Estrada L, Uso-Talamantes R, Caballer-Tarazona V, Buigues-Pastor L, Sancho-Mestre C. Multimorbidity Pharmaceutical Cost of Diabetes Mellitus. Value in Health. 2014;17:A341–2. Elsevier [cited 2016 Apr 21]. Available from: http://www.sciencedirect.com/science/article/pii/S1098301514026102Inoriza JM, Pérez M, Cols M, Sánchez I, Carreras M. Análisis de la población diabética de una comarca : perfil de morbilidad, utilización de recursos, complicaciones y control metabólico. Aten Primaria. 2016;45. Available from: http://www.sciencedirect.com/science/article/pii/S0212656713001340Vivas-Consuelo D, Usó-Talamantes R, Trillo-Mata JL, Caballer-Tarazona M, Barrachina-Martínez I, Buigues-Pastor L. Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups. Health Policy. 2014;116:188–95. Available from: http://www.sciencedirect.com/science/article/pii/S0168851014000256Kho AN, Hayes MG, Rasmussen-Torvik L, Pacheco JA, Thompson WK, Armstrong LL, et al. Use of diverse electronic medical record systems to identify genetic risk for type 2 diabetes within a genome-wide association study. J Am Med Inform Assoc. 2016;19:212–8. [cited 2016 Feb 18]. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3277617&tool=pmcentrez&rendertype=abstractPrados-Torres A, Poblador-Plou B, Calderón-Larrañaga A, Gimeno-Feliu LA, González-Rubio F, Poncel-Falcó A, et al. Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis. PLoS One. 2012;7:e32190. Public Library of Science [cited 2016 Apr 21]. Available from: http://dx.doi.org/10.1371/journal.pone.0032190Islam MM, Valderas JM, Yen L, Dawda P, Jowsey T, McRae IS. Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns. PLoS One. 2014;9:e83783. Public Library of Science [cited 2016 Mar 25]. Available from: http://dx.doi.org/10.1371/journal.pone.0083783Fortin M, Bravo G, Hudon C, Lapointe L, Dubois MF, Almirall J. Psychological distress and multimorbidity in primary care. Ann Fam Med. 2006;4:417–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17003141Nuttall M, van der Meulen J, Emberton M. Charlson scores based on ICD-10 administrative data were valid in assessing comorbidity in patients undergoing urological cancer surgery. J Clin Epidemiol. 2006;59:265–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16488357Klompas M, Eggleston E, McVetta J, Lazarus R, Li L, Platt R. Automated detection and classification of type 1 versus type 2 diabetes using electronic health record data. Diabetes Care. 2013;36:914–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23193215Alonso-Moran E, Orueta JF, Fraile Esteban JI, Arteagoitia Axpe JM, Luz Marques Gonzalez M, Toro Polanco N, et al. The prevalence of diabetes-related complications and multimorbidity in the population with type 2 diabetes mellitus in the Basque Country. BMC Public Health. 2014;14. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197247/Pantalone KM, Hobbs TM, Wells BJ, Kong SX, Kattan MW, Bouchard J, et al. Clinical characteristics, complications, comorbidities and treatment patterns among patients with type 2 diabetes mellitus in a large integrated health system. BMJ open diabetes Res Care. 2015;3:e000093. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4513350&tool=pmcentrez&rendertype=abstractAlonso-Moran E, Satylganova A, Orueta JF, Nuno-Solinis R. Prevalence of depression in adults with type 2 diabetes in the Basque Country: relationship with glycaemic control and health care costs. BMC Public Health. 2014;14. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-769Kilzieh N, Rastam S, Maziak W, Ward KD. Comorbidity of depression with chronic diseases: a population-based study in Aleppo, Syria. Int J Psychiatry Med. 2008;38:169–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18724568Almawi W, Tamim H, Al-Sayed N, Arekat MR, Al-Khateeb GM, Baqer A, et al. Association of comorbid depression, anxiety, and stress disorders with Type 2 diabetes in Bahrain, a country with a very high prevalence of Type 2 diabetes. J Endocrinol Invest. 2008;31:1020–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19169060Giralt Muiña P, Gutiérrez Ávila G, Ballester Herrera MJ, Botella Romero F, Angulo Donado JJ. Prevalencia de diabetes y diabetes oculta en adultos de Castilla-La Mancha. TITLEREVISTA. 2011;137:484–90. Available from: http://zl.elsevier.es/es/revista/medicina-clinica-2/prevalencia-diabetes-diabetes-oculta-adultos-castilla-la-mancha-90028329-originales-2011Mata-Cases M, Roura-Olmeda P, Berengué-Iglesias M, Birulés-Pons M, Mundet-Tuduri X, Franch-Nadal J, et al. Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain. Int J Clin Pract. 2012;66:289–98. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3584513&tool=pmcentrez&rendertype=abstractEgede LE, Gebregziabher M, Zhao Y, Dismuke CE, Walker RJ, Hunt KJ, et al. Differential Impact of Mental Health. 2015;21:535–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26295353Huber CA, Diem P, Schwenkglenks M, Rapold R, Reich O. Estimating the prevalence of comorbid conditions and their effect on health care costs in patients with diabetes mellitus in Switzerland. Diabetes Metab Syndr Obes. 2014;7:455–65. Dove Press [cited 2016 Aug 4]. Available from: https://www.dovepress.com/estimating-the-prevalence-of-comorbid-conditions-and-their-effect-on-h-peer-reviewed-article-DMS

Le Rôle de l'odontologiste médico-légal à la lumière de l'I.R.C.G.N. (De la théorie à la pratique)

L'IRCGN est le laboratoire de police scientifique de la Gendarmerie Nationale française qui contribue dans le cadre d'enquétes judiciaires, à la révélation des preuves scientifiques et notamment l'identification de personnes retrouvées décédées suite à une disparition, à un crime ou suite à une catastrophe de masse. L'identification de ces victimes est une nécessité morale, légale et administrative pour l'établissement de l'acte de décès. Le rôle de l'odontologiste médico-légal est primordial au sein de l'équipe pluridisciplinaire d'identification humaine avec pour mission de comparer les odontogrammes post-mortem et ante-mortem dans un but d'identification. Par l'examen de la denture, et à la demande des enquêteurs, il s'attache à préciser, entre autre, l'origine humaine, l'âge, le sexe et l'origine ethnique. Par l'étude d'un cas, nous illustrons dans quelle mesure, les données dentaires apportent des informations pertinentes lors d'une reconstruction faciale. Quelques exemples d'identification médico-légale sont détaillés dans ce mémoire de thèse afin de montrer d'une part, le travail de l'odontologiste médico-légal, et de préciser d'autre part les motivations dans le choix des techniques utilisées au sein de l'IRCGN.The IRCGN is the lorensic laboratory of the French National Gendarmerie contributing through judicial surveys, the revelation of scientific evidence including identification of persons found dead after a disappearance, a crime or after mass disaster. The identification 01 these victims is a moral, legal and administrative setting the death certificate. The role 01 the dentist is crucial lorensic within the multidisciplinary team 01 human identification with the mission to compare odontograms post-mortem and ante-mortem identification purposes. By examination of the teeth, and at the request of investigators, he endeavors to clarify, among other things, human origin, age, sex and ethnicity. Through a case study, we illustrate how the dental data provide relevant information on a facial reconstruction. Sorne examples of forensic identification are detailed in this thesis to show the one hand, the work of forensic dentistry, and specify other motivations in the choice of techniques used in the IRCGN.MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Odontologie (341722110) / SudocSudocFranceF

Hegemonic masculinities and femininities in food industry packaging

The aim of this study is to analyze the formal and graphic elements around the hegemonic masculinities and femininities of the packaging of industrial bakery and biscuit products aimed at children and young people. A content analysis was conducted on 10 of the most widely consumed brands of industrial bakery and biscuit products in Spain and widely present on the international market. In addition, a scale of dominant masculinity was developed as a tool to analyze the most egalitarian narratives on the packaging. The results suggest that there are unequal narratives linked to hegemonic masculinity and femininity. The use of blue and yellow, the latter not having a traditional link to masculinity, is related to men in terms of aggressiveness and bravery stereotypes. The women represented on packaging with these same colours are presented in terms of sympathy or kindness, as well as stereotypes connected to beauty. The products contain homogeneous stereotypes and are associated more with men than with women. However, 2 out of 10 brands do not insert characters linked to sexual attributes or gender stereotypes. Therefore, our findings suggest that hegemonic gender scripts are inscribed on packaging less obviously than in other traditional media.The work was supported by the University of Alicante (Vice Rectorate for Research) [Aii20-07]; Valencian Regional Ministry of Innovation, Universities, Science and Digital Society [ACIF/2021/119]; AICO, Generalitat Valenciana (2022- 2024) [CIAICO/2021/019]

Red de Salud Pública y Género

Las desigualdades de género en salud determinan la exposición, severidad y riesgo de enfermedad, la forma en la que los síntomas son percibidos y la accesibilidad y utilización de los servicios sanitarios. La formación desde los grados universitarios de futuros profesionales sociosanitarios para su detección y abordaje es esencial. El objetivo de la Red Docente de Salud Pública y Género del curso académico 2021-2022 ha sido evaluar e incorporar la perspectiva de género de forma transversal en la asignatura Salud Pública para el Trabajo Social. Se realizó un análisis de la perspectiva de género de la guía docente y del contenido y materiales de las sesiones prácticas que se imparten. El trabajo en red ha permitido elaborar un instrumento metodológico para el análisis con perspectiva de género de la guía docente y los materiales de prácticas aplicable a otras asignaturas de nuestra área. La aplicación de este instrumento evidenció algunas deficiencias respecto al uso del lenguaje inclusivo y la visibilidad otorgada a la autoría de las mujeres en la bibliografía recomendada. El trabajo en red favoreció la reflexión y formación conjunta del profesorado para reducir los sesgos de género que se transmiten en la docencia universitaria.El presente trabajo ha contado con una ayuda del Programa de Redes de investigación en docencia universitaria del Instituto de Ciencias de la Educación de la Universidad de Alicante (convocatoria 2021-22). Ref.: [5578]”

Cuaderno de prácticas. Salud Pública para el Trabajo Social. Código 19513 - Grado en Trabajo Social

El cuaderno de prácticas forma parte del trabajo de la Red docente de Salud Pública y Género (cod: 5578). Este se plantea con el objetivo de incorporar la perspectiva de género y mejorar la docencia de la asignatura de Salud Pública para el Trabajo Social. Para ello, se ha realizado una selección, revisión, y desarrollo de materiales prácticos de la asignatura realizada y pilotada durante los cursos académicos 2021-2022 y 2022-2023.Este trabajo contó con el apoyo financiero del programa Redes de Investigación e Innovación en Docencia Universitaria de la Universidad de Alicante otorgado a la Red docente de Salud Pública y Género (cod. 5578)

Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT

The prognosis for oligometastatic colorectal cancer has improved in recent years, mostly because of recent advances in new techniques and approaches to the treatment of oligometastases, including new surgical procedures, better systemic treatments, percutaneous ablation, and stereotactic body radiation therapy (SBRT). There are several factors to consider when deciding on the better approach for each patient: tumor factors (metachronous or synchronous metastases, RAS mutation, BRAF mutation, disease-free interval, size and number of metastases), patient factors (age, frailty, comorbidities, patient preferences), and physicians' factors (local expertise). These advances have presented major challenges and opportunities for oncologic multidisciplinary teams to treat patients with limited liver and lung metastases from colorectal cancer with a curative intention. In this review, we describe the different treatment options in patients with limited liver and lung metastases from colorectal cancer, and the possible combination of three approaches: systemic treatment, surgery, and local ablative treatment