The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis

This work was supported by the Spanish Association Against Cancer [Asociación Española contra el Cáncer, PROYE20023SANC “High resolution study of social inequalities in cancer (HiReSIC)”], the Cancer Epidemiological Surveillance Subprogram of the CIBER of Epidemiology and Public Health and the Health Institute Carlos III (VICA), and the Health Institute Carlos III (PI18/01593 “Multilevel population-based study of socioeconomic inequalities in the geographical distribution of cancer incidence, mortality and net survival”). DP was supported by a Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain (MCIN/AEI, JC2019- 039691-I, http://doi.org/10.13039/501100011033, Accessed October 4, 2021). The funders had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1183244/full#supplementary-materialIntroduction: Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival. Materials and methods: We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist. Results: Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31–73), k = 18, of the diagnosis interval 35 days (95% CI = 21–38),k = 11, and of the treatment interval 30 days (95% CI = 23–53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates. Conclusion: Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.Asociación Española contra el Cáncer, PROYE20023SANCCancer Epidemiological Surveillance Subprogram of the CIBER of Epidemiology and Public HealthHealth Institute Carlos III (VICA)Health Institute Carlos III: PI18/01593MCIN/AEI, JC2019-039691-

Catalizadores para biorrefinerías: productos de C3 a partir de la hidrogenólisis de glicerol

El objetivo de este trabajo es evaluar catalizadores de Ni y Pt en la reacción de hidrogenólisis de glicerol para la obtención de productos C3 en fase líquida, utilizando un soporte a base de sílice modificado por inclusión de ácido tungstofosfórico.Facultad de Ingenierí

Neuroprotective Effect of Tauroursodeoxycholic Acid on N-Methyl-D-Aspartate-Induced Retinal Ganglion Cell Degeneration

Retinal ganglion cell degeneration underlies the pathophysiology of diseases affecting the retina and optic nerve. Several studies have previously evidenced the anti-apoptotic properties of the bile constituent, tauroursodeoxycholic acid, in diverse models of photoreceptor degeneration. The aim of this study was to investigate the effects of systemic administration of tauroursodeoxycholic acid on N-methyl-D-aspartate (NMDA)-induced damage in the rat retina using a functional and morphological approach. Tauroursodeoxycholic acid was administered intraperitoneally before and after intravitreal injection of NMDA. Three days after insult, full-field electroretinograms showed reductions in the amplitudes of the positive and negative-scotopic threshold responses, scotopic a- and b-waves and oscillatory potentials. Quantitative morphological evaluation of whole-mount retinas demonstrated a reduction in the density of retinal ganglion cells. Systemic administration of tauroursodeoxycholic acid attenuated the functional impairment induced by NMDA, which correlated with a higher retinal ganglion cell density. Our findings sustain the efficacy of tauroursodeoxycholic acid administration in vivo, suggesting it would be a good candidate for the pharmacological treatment of degenerative diseases coursing with retinal ganglion cell loss.This work was supported by project grants from Spanish Ministerio de Economía y Competitividad-FEDER (http://www.mineco.gob.es) #BFU2012‐36845, Instituto de Salud Carlos III RETICS (http://www.oftared.com) #RD12/0034/0010 and Organización Nacional de Ciegos Españoles (http://www.once.es) to NC; Ministerio de Ciencia e Innovación #JCI‐2009‐05224 to VGV; Universidad de Alicante (http://www.ua.es) #2010-48536273 to GE; Instituto de Salud Carlos III (http://www.isciii.es) #PI13/02098 and RETICS #RD12/0034/0006 to PdV; and FUNDALUCE

Duration of the patient interval in breast cancer and factors associated with longer delays in low‐and middle‐income countries: A systematic review with meta‐analysis

Objective: Breast cancer survival is lower in low‐ and middle‐income countries (LMICs) partially due to many women being diagnosed with late‐stage disease. The patient interval refers to the time elapsed between the detection of symptoms and the first consultation with a healthcare provider and is considered one of the core indicators for early diagnosis and treatment. The goal of the current research was to conduct a meta‐analysis of the duration of the patient interval in LMICs and investigate the socio‐demographic and socio‐cultural factors related to longer delays in presentation. Methods: We conducted a systematic review with meta‐analysis (pre‐registered protocol CRD42020200752). We searched seven information sources (2009–2022) and included 50 articles reporting the duration of patient intervals for 18,014 breast cancer patients residing in LMICs. Results: The longest patient intervals were reported in studies from the Middle East (3–4 months), followed by South‐East Asia (2 months), Africa (1–2 months), Latin America (1 month), and Eastern Europe (1 month). Older age, not being married, lower socio‐economic status, illiteracy, low knowledge about cancer, disregarding symptoms or not attributing them to cancer, fear, negative beliefs about cancer, and low social support were related to longer delays across most regions. Longer delays were also related to use of alternative medicine in the Middle East, South‐East Asia, and Africa and distrust in the healthcare system in Eastern Europe. Conclusions: There is large variation in the duration of patient intervals across LMICs in different geographical regions. Patient intervals should be reduced and, for this purpose, it is important to explore their determinants taking into account the social, cultural, and economic context.Centro de Investigacion Biomedica en Red de Epidemiologia y Salud PublicaAgencia Estatal de InvestigacionFundacion Cientifica Asociacion Espanola Contra el Cance

Correlation between SD-OCT, immunocytochemistry and functional findings in an animal model of retinal degeneration

Purpose: The P23H rhodopsin mutation is an autosomal dominant cause of retinitis pigmentosa (RP). The degeneration can be tracked using different anatomical and functional methods. In our case, we evaluated the anatomical changes using Spectral-Domain Optical Coherence Tomography (SD-OCT) and correlated the findings with retinal thickness values determined by immunocytochemistry.Methods: Pigmented rats heterozygous for the P23H mutation, with ages between P18 and P180 were studied. Function was assessed by means of optomotor testing and ERGs. Retinal thicknesses measurements, autofluorescence and fluorescein angiography were performed using Spectralis OCT. Retinas were studied by means of immunohistochemistry. Results: Between P30 and P180, visual acuity decreased from 0.500 to 0.182 cycles per degree (cyc/deg) and contrast sensitivity decreased from 54.56 to 2.98 for a spatial frequency of 0.089 cyc/deg. Only cone-driven b-wave responses reached developmental maturity. Flicker fusions were also comparable at P29 (42 Hz). Double flash-isolated rod-driven responses were already affected at P29. Photopic responses revealed deterioration after P29.A reduction in retinal thicknesses and morphological modifications were seen in OCT sections. Statistically significant differences were found in all evaluated thicknesses. Autofluorescence was seen in P23H rats as sparse dots. Immunocytochemistry showed a progressive decrease in the outer nuclear layer (ONL), and morphological changes. Although anatomical thickness measures were significantly lower than OCT values, there was a very strong correlation between the values measured by both techniques.Conclusions: In pigmented P23H rats, a progressive deterioration occurs in both retinal function and anatomy. Anatomical changes can be effectively evaluated using SD-OCT and immunocytochemistry, with a good correlation between their values, thus making SD-OCT an important tool for research in retinal degeneration.Dr. Pinilla and Dr. Cuenca were supported by grants from the Spanish Ministry of Economy and Competitiveness-FEDER (BFU2012-36845), Instituto de Salud Carlos III (FIS PI13/01124, PS0901854, PI042399 and RETICS RD12/0034/0010), Fundación Gangoiti, ONCE (Organización Nacional de Ciegos Españoles) and FUNDALUCE. Dr. Yves Sauvé is a recipient of the Barbara Tuck/MacPhee Family Vision Research Award in Macular Degeneration

Sex Differences and Predictors of In-Hospital Mortality among Patients with COVID-19: Results from the ANCOHVID Multicentre Study

Spain is one of the countries most affected by the COVID-19 pandemic. Although risk factors for severe disease are published, sex differences have been widely neglected. In this multicentre study, we aimed to identify predictors of in-hospital mortality in men and women hospitalised with COVID-19. An observational longitudinal study was conducted in the cohort of patients admitted to four hospitals in Andalusia, Spain, from 1 March 2020 to 15 April 2020. Sociodemographic and clinical data were collected from hospital records. The Kaplan–Meier method was used to estimate 30-day survival and multiple Cox regression models were applied. All analyses were stratified by sex. A total of 968 patients were included (54.8% men, median age 67.0 years). In-hospital mortality reached 19.1% in men and 16.0% in women. Factors independently associated with an increased hazard of death were advanced age, higher CURB-65 score and not receiving azithromycin treatment, in both sexes; active cancer and autoimmune disease, in men; cardiovascular disease and chronic lung disease, in women. Disease outcomes and predictors of death differed between sexes. In-hospital mortality was higher in men, but the long-term effects of COVID-19 merit further research. The sex-differential impact of the pandemic should be addressed in public health policies

Evaluation of cervical cancer prevention plan in a remote rural area in Bolivia

Objetivos: Evaluar el plan de prevención del cáncer de cérvix en Roboré como ejemplo de zona rural remota de Bolivia e identificar los principales elementos favorables y desfavorables a la implantación del mismo para formular recomendaciones. Material y métodos: Estudio descriptivo transversal realizado mediante una combinación de métodos: análisis de indicadores relacionados con la cobertura de cribado, oportunidad de tratamiento y cobertura vacunal durante 2018 y 2019; cuestionario sobre conocimientos, actitudes y prácticas dirigido a usuarias del programa de cribado; cuestionario a profesionales implicados en el programa de cribado sobre los puntos fuertes y débiles del programa. Resultados: Las coberturas de cribado fueron bajas (41-46%) en los últimos 2 años, así como la oportunidad de tratamiento (13-16,7%). Las coberturas vacunales fueron altas (92-98%). Tras entrevistar a 82 usuarias se evidenció que un mayor conocimiento sobre el cáncer de cérvix está asociado a un mayor nivel de estudios y a una mayor frecuencia de citologías. Las mujeres tienen una actitud positiva hacia la vacunación a pesar del escaso conocimiento sobre el virus del papiloma humano (VPH) y la vacuna. Los profesionales sanitarios refieren contar con un personal implicado pero escaso, la falta de infraestructuras y la necesidad de incrementar las campañas de concienciación. Conclusiones: Recomendamos aumentar las campañas de concienciación y las estrategias de cribado móviles, disponer de un consultorio propio para la realización de las citologías, incrementar el personal a cargo del programa y mejorar el seguimiento de las mujeres.Objectives: Evaluate the cervical cancer prevention programme in Roboré as an example of a remote rural area of Bolivia, and identify its main strengths and weaknesses in order to formulate recommendations. Materials and methods: Cross-sectional descriptive study using a combination of methods: analysis of indicators related to screening coverage, treatment opportunities, and vaccination coverage during 2018 and 2019; questionnaire to users of the screening programme on their knowledge, attitudes and practices; questionnaire to professionals involved in the screening programme about the strengths and weaknesses of the programme. Results: Screening coverage was low (41-46%) in the last 2 years, as was the opportunity for treatment (13-16.7%). Vaccine coverage was high (92-98%). After interviewing 82 users, it was shown that a greater knowledge of cervical cancer is associated with a higher level of education and a higher frequency of cytologies. Women have a positive attitude towards vaccination despite poor knowledge of human papillomavirus (HPV) and the vaccine. Health professionals report having committed but limited staff, lack of infrastructure and the need to increase awareness campaigns. Conclusions: We recommend increasing the number of awareness campaigns and mobile screening strategies, having separate offices to carry out cytologies, increasing the staff in charge of the programme and improving the follow-up of women

The patient, diagnostic, and treatment intervals in adult patients with cancer from high- and lower-income countries: A systematic review and meta-analysis

Background: Longer time intervals to diagnosis and treatment are associated with worse survival for various types of cancer. The patient, diagnostic, and treatment intervals are considered core indicators for early diagnosis and treatment. This review estimated the median duration of these intervals for various types of cancer and compared it across high- and lower-income countries. Methods and findings: We conducted a systematic review with meta-analysis (prospectively registered protocol CRD42020200752). Three databases (MEDLINE, Embase, and Web of Science) and information sources including grey literature (Google Scholar, OpenGrey, EThOS, ProQuest Dissertations & Theses) were searched. Eligible articles were published during 2009 to 2022 and reported the duration of the following intervals in adult patients diagnosed with primary symptomatic cancer: patient interval (from the onset of symptoms to first presentation to a healthcare professional), diagnostic interval (from first presentation to diagnosis), and treatment interval (from diagnosis to treatment start). Interval duration was recorded in days and study medians were combined in a pooled estimate with 95% confidence intervals (CIs). The methodological quality of studies was assessed using the Aarhus checklist. A total of 410 articles representing 68 countries and reporting on 5,537,594 patients were included. The majority of articles reported data from high-income countries (n = 294, 72%), with 116 (28%) reporting data from lower-income countries. Pooled meta-analytic estimates were possible for 38 types of cancer. The majority of studies were conducted on patients with breast, lung, colorectal, and head and neck cancer. In studies from high-income countries, pooled median patient intervals generally did not exceed a month for most cancers. However, in studies from lower-income countries, patient intervals were consistently 1.5 to 4 times longer for almost all cancer sites. The majority of data on the diagnostic and treatment intervals came from high-income countries. Across both high- and lower-income countries, the longest diagnostic intervals were observed for hematological (71 days [95% CI 52 to 85], e.g., myelomas (83 days [47 to 145])), genitourinary (58 days [50 to 77], e.g., prostate (85 days [57 to 112])), and digestive/gastrointestinal (57 days [45 to 67], e.g., colorectal (63 days [48 to 78])) cancers. Similarly, the longest treatment intervals were observed for genitourinary (57 days [45 to 66], e.g., prostate (75 days [61 to 87])) and gynecological (46 days [38 to 54], e.g., cervical (69 days [45 to 108]) cancers. In studies from high-income countries, the implementation of cancer-directed policies was associated with shorter patient and diagnostic intervals for several cancers. This review included a large number of studies conducted worldwide but is limited by survivor bias and the inherent complexity and many possible biases in the measurement of time points and intervals in the cancer treatment pathway. In addition, the subintervals that compose the diagnostic interval (e.g., primary care interval, referral to diagnosis interval) were not considered. Conclusions: These results identify the cancers where diagnosis and treatment initiation may take the longest and reveal the extent of global disparities in early diagnosis and treatment. Efforts should be made to reduce help-seeking times for cancer symptoms in lower-income countries. Estimates for the diagnostic and treatment intervals came mostly from high-income countries that have powerful health information systems in place to record such information.This work was supported by the Spanish Association against Cancer (Asociación Española contra el Cáncer, PROYE20023SANC “High resolution study of social inequalities in cancer (HiReSIC)” to MJS), the Cancer Epidemiological Surveillance Subprogram of the CIBER of Epidemiology and Public Health and the Health Institute Carlos III (VICA to MJS), and the Health Institute Carlos III (PI18/01593 “Multilevel population-based study of socioeconomic inequalities in the geographical distribution of cancer incidence, mortality and net survival” to DP). DP is supported by a Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain (MCIN/AEI, JC2019-039691-I, http://doi.org/10.13039/501100011033, Accessed 4 October 2021). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Concreción y evaluación de los resultados de aprendizaje en la Facultad de Educación. Proyecto piloto en el Grado de Pedagogía y el Máster de Educación Especial

Se presenta la Memoria del Proyecto Innova Gestión Calidad del curso 2018-2019 titulado : Concreción y evaluación de los resultados de aprendizaje en la Facultad de Educación. Proyecto piloto en el Grado de Pedagogía y el Máster de Educación Especial

Pulmonary tumor thrombotic microangiopathy: report of 3 cases and review of the literature

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinical entity where tumor cell embolisms in pulmonary circulation induce thrombotic microangiopathy (TMA), respiratory failure, and subacute cor pulmonale.We describe 3 cases of PTTM that presented as the initial manifestation of metastatic gastric adenocarcinoma with TMA and pulmonary infiltrates.All 3 cases had similar clinical and laboratory features, which included moderate thrombocytopenia without renal failure, hemolysis with extremely high serum lactate dehydrogenase levels, leukoerythroblastosis in peripheral blood smear, altered coagulation tests, lymphadenopathies, and interstitial pulmonary infiltrates. All patients died within 2 weeks of diagnosis. Two cases were initially misdiagnosed as idiopathic thrombotic thrombocytopenic purpura and treated with plasma exchange with no response. One patient had bone marrow infiltration by malignant cells. Autopsies revealed PTTM associated with gastric disseminated adenocarcinoma (signet-ring cell type in 2 patients and poorly differentiated type in 1).PTTM should be considered in the differential diagnosis of patients with fulminant microangiopathic hemolytic anemia, such as atypical thrombotic thrombocytopenic purpura, mainly those with pulmonary infiltrates, disseminated intravascular coagulation, or Trousseau syndrome