Circulating DNA and survival in solid tumors

[Background]: The ability to undertake molecular analysis to inform on prognosis and predictors of response to therapy is limited by accessibility of tissue. Measurement of total circulating free DNA (cfDNA) or circulating tumor DNA (ctDNA) in peripheral blood may allow easier access to tumor material and help to predict clinical outcomes. [Methods]: A systematic review of electronic databases identified publications exploring the association between cfDNA or ctDNA and overall survival (OS) in solid tumors. HRs for OS were extracted from multivariable analyses and included in a meta-analysis. Pooled HRs were computed and weighted using generic inverse variance and random-effect modeling. For studies not reporting multivariable analyses, univariable ORs were estimated from Kaplan-Meier curves for OS at 1 and 3 years. [Results]: Thirty-nine studies comprising 4,052 patients were included in the analysis. Detection of ctDNA was associated with a significantly worse OS in multivariable analyses [HR, 2.70; 95% confidence interval (CI), 2.02-3.61; P < 0.001). Similar results were observed in the univariable analyses at 3 and 1 year (OR, 4.83; 95% CI, 3.20-7.28; P < 0.001).There was also a statistically significant association between high total cfDNA and worse OS for studies reporting multivariable and univariate data at 3 years (HR, 1.91; 95% CI, 1.59-2.29; P < 0.001 and OR, 2.82; 95% CI, 1.93-4.13; P < 0.001, respectively). [Conclusions]: High levels of total cfDNA and presence of ctDNA are associated with worse survival in solid tumors. [Impact]: Circulating DNA is associated with worse outcome in solid tumors.This work was supported by grants from CRIS cancer foundation (to A. Ocaña and A. Pandiella).Peer Reviewe

Role of cooperative groups and funding source in clinical trials supporting guidelines for systemic therapy of breast cancer

Clinical research is conducted by academia, cooperative groups (CGs) or pharmaceutical industry. Here, we evaluate the role of CGs and funding sources in the development of guidelines for breast cancer therapies. We identified 94 studies. CGs were involved in 28 (30%) studies while industry either partially or fully sponsored 64 (68%) studies. The number of industry funded studies increased over time (from 0% in 1976 to 100% in 2014; p for trend = 0.048). Only 10 (11%) government or academic studies were identified. Studies conducted by GCs included a greater number of subjects (median 448 vs. 284; p = 0.015), were more common in the neo/adjuvant setting (p < 0.0001), and were more often randomized (p = 0.018) phase III (p < 0.0001) trials. Phase III trial remained significant predictor for CG-sponsored trials (OR 7.1 p = 0.004) in a multivariable analysis. Industry funding was associated with higher likelihood of positive outcomes favoring the sponsored experimental arm (p = 0.013) but this relationship was not seen for CG-sponsored trials (p = 0.53). ASCO, ESMO, and NCCN guidelines were searched to identify systemic anti-cancer therapies for early-stage and metastatic breast cancer. Trial characteristics and outcomes were collected. We identified sponsors and/or the funding source(s) and determined whether CGs, industry, or government or academic institutions were involved. Chi-square tests were used for comparison between studies. Industry funding is present in the majority of studies providing the basis for which recommendations about treatment of breast cancer are made. Industry funding, but not CG-based funding, was associated with higher likelihood of positive outcomes in clinical studies supporting guidelines for systemic therapy

Autobiographical emotional induction in older people through popular songs: Effect of reminiscence bump and enculturation.

AimsThis study is based on two experiments, the first, with an exploratory character. The aim of which is to assess the capacity of native vs international pop songs (NAT vs INT) from two consecutive life stages, Reminiscence bump (RB) and the immediately subsequent period (No reminiscence bump, NORB) to elicit positive emotions and autobiographical memories.MethodA total of 15 middle-aged adults and 15 older adults participated in Experiment 1 (E1). Emotionality, song familiarity and associated autobiographical memories were assessed. Each participant was exposed to 20 randomly selected age-specific songs. Pre-and post-test measures of mood state were also included. Experiment 2 (E2) focused on late adulthood, using a sample of 35 persons. The experimental design was similar to that used in E1. However, this second experiment also included an analysis of the types of autobiographical memories generated by the experimental task and a study of their relationship with the characteristics of the songs, their familiarity and the emotions they produced, and the number of trials. The aim was to delve into the effects that influence the effectiveness of the induction procedure, particularly as regards emotional positivity and memory specificity.ResultsRegarding age effect, E1 results varied: under some conditions, emotionality showed no difference between groups, others showed positive older adult bias. In E2, the analysis of the relationships between memory types and the selected variables suggests the latter are not useful predictors of differences between memory types. The study design yielded a relatively high level of memory specificity and emotional positivity.ConclusionThe findings question positivity bias in the elderly. RB music produces different effects depending on age. Enculturation can be an important mediating factor in emotionality and memory. Finally, experimental design improves specific memory and positivity

Group cognitive-behavioral therapy for insomnia: a meta-analysis

Antecedentes: el insomnio es un trastorno de elevada prevalencia tanto entre la población general como en la práctica clínica. Aunque el tratamiento farmacológico para el insomnio es el más extendido, es el tratamiento psicológico el que mantiene sus efectos a lo largo del tiempo. El objetivo principal de este metaanálisis es evaluar la eficacia de la terapia cognitivo-conductual grupal para el tratamiento del insomnio. Método: búsqueda sistemática de ensayos clínicos de terapia cognitivoconductual para el insomnio en Pubmed, PsycINFO, PsycARTICLES, Scielo, WOK, Cochrane, Scopus y Embase. Se revisaron 153 artículos, de los que 9 cumplieron con los criterios de inclusión para formar parte del metaanálisis. En estos 9 estudios 699 personas completaron el post-test. Resultados: aparecen mejoras significativas con el tratamiento cognitivoconductual para el insomnio en las escalas Pittsburgh Sleep Quality Index e Insomnia Severity Index, en latencia del sueño, en tiempo despierto después de iniciar el sueño y en eficiencia del sueño. No aparecen mejoras significativas en el tiempo total de sueño. Conclusiones: los resultados de los estudios experimentales sobre terapia cognitivo-conductual para el tratamiento del insomnio sugieren que esta tiene un claro impacto positivo sobre los síntomas, evaluados tanto mediante escalas validadas como mediante diarios del sueño.Background: insomnia is a highly prevalent disorder in the general population and in clinical practice. Although pharmacological treatment is the most widespread choice, psychological treatment appears to have longer lasting effects. The main objective of this meta-analysis was to assess the cognitive-behavioural group therapy treatment for insomnia. Method: a systematic search for cognitive-behavioural therapy clinical trials in Pubmed, PsycINFO, PsycARTICLES, Scielo, WOK, Cochrane, Scopus and Embase. 153 articles were reviewed, of which 9 met inclusion criteria for the metaanalysis. Adding up the data from all 9 trials, a total of 699 people completed the post-test phase. Results: after finishing cognitive-behavioural therapy, significant improvements regarding insomnia were found according to the Pittsburgh Sleep Quality Index and Insomnia Severity Index, sleep latency, wake after sleep onset and sleep efficiency. There were no significant improvements in total sleep time. Conclusions: the results from experimental studies on cognitivebehavioural therapy as an insomnia treatment clearly suggest a positive impact on symptoms, as assessed using both validated scales and sleep diarie

Group cognitive-behavioral therapy for insomnia: a meta-analysis. [Terapia cognitivo-conductual grupal para el tratamiento del insomnio: metaanálisis]

Background: insomnia is a highly prevalent disorder in the general population and in clinical practice. Although pharmacological treatment is the most widespread choice, psychological treatment appears to have longer lasting effects. The main objective of this meta-analysis was to assess the cognitive-behavioural group therapy treatment for insomnia. Method: a systematic search for cognitive-behavioural therapy clinical trials in Pubmed, PsycINFO, PsycARTICLES, Scielo, WOK, Cochrane, Scopus and Embase. 153 articles were reviewed, of which 9 met inclusion criteria for the metaanalysis. Adding up the data from all 9 trials, a total of 699 people completed the post-test phase. Results: after finishing cognitive-behavioural therapy, significant improvements regarding insomnia were found according to the Pittsburgh Sleep Quality Index and Insomnia Severity Index, sleep latency, wake after sleep onset and sleep efficiency. There were no significant improvements in total sleep time. Conclusions: the results from experimental studies on cognitive-behavioural therapy as an insomnia treatment clearly suggest a positive impact on symptoms, as assessed using both validated scales and sleep diaries

Miedo a las caídas en las personas mayores no institucionalizadas Fear of falling in elderly community-dwelling individuals

Objetivo: Determinar si hay asociación entre el miedo a caerse y el estado de salud, el antecedente de caídas previas y las características personales en una muestra representativa de personas de edad avanzada. Método: Estudio observacional de prevalencia y asociación cruzada, de ámbito comunitario, realizado en Albacete, en 919 mayores de 65 años seleccionados utilizando muestreo aleatorio simple. Los participantes fueron interrogados (entrevista semiestructurada) sobre antecedentes de caídas, miedo a caerse, enfermedades y características sociodemográficas. Mediante análisis multivariado se comprobó la asociación del miedo a caerse con sus posibles factores condicionantes. Resultados: El 26,3% de los entrevistados se había caído durante el año anterior, y manifestaron mucho miedo a caerse el 49,4% de todos los participantes. Una elevada proporción (78,9%) consideró muy importantes las consecuencias de las caídas, pero sólo para el 44,7% la mayoría podría evitarse. Las variables asociadas a un mayor miedo a caerse fueron el sexo femenino (odds ratio [OR]=5,5; intervalo de confianza del 95% [IC95%]: 3,9-7,6), tener más de 75 años (OR=2,0; IC95%: 1,5-2,8), ser analfabeto o que sólo lee/escribe (OR=1,5; IC95%: 1,1-2,1), ser consumidor de psicofármacos (OR=1,6; IC95%: 1,1-2,2), padecer enfermedades cardiocirculatorias (OR=1,5; IC95%: 1,1-2,2) o del aparato locomotor (OR=2,2; IC95%: 1,5-3,1) y tener antecedentes de caídas (OR=1,9; IC95%: 1,3-2,7). Conclusiones: Aproximadamente la mitad de los entrevistados manifiesta una gran preocupación por las caídas. Tanto los antecedentes de caídas como algunas características clínicas y sociodemográficas constituyen factores condicionantes del miedo a caerse. Para la mayoría constituyen un problema con importantes consecuencias, pero menos de la mitad considera que gran parte de las caídas son evitables.<br>Objective: To determine the association between fear of falling and health status, a history of previous falls and personal characteristics in a representative sample of elderly people. Method: We conducted an observational, cross-sectional prevalence study in the community setting in Albacete (Spain) of 921 people older than 65 years old selected through simple randomization. Participants underwent semi-structured interviews about their history of falls, fear of falling, illnesses and sociodemographic characteristics. Multivariate analysis was used to evaluate the association between fear of falling and its possible conditioning factors. Results: In the previous year, 26.3% of interviewees had fallen and 49.4% expressed a strong fear of falling. A high proportion (78.9%) considered the consequences of falls to be very serious, but only 44.7% believed that most of these falls could be prevented. The variables associated with a greater fear of falling were female sex (OR=5.5; 95% CI: 3.9-7.6), age more than 75 years old (OR=2.0; 95% CI: 1.5-2.8), illiteracy or lack of education beyond reading/writing skills (OR= 1.5; 95% CI: 1.1-2.1), taking psychotropic medication (OR=1.6; 95% CI: 1.1-2.2), and having cardiocirculatory disease (OR=1.5; 95% CI: 1.1-2.2), disorders of the locomotor system (OR=2.2; 95% CI: 1.5-3.1) and a history of falls (OR=1.9; 95% CI: 1.3-2.7). Conclusions: Approximately half of the interviewees expressed strong concern about falls. The factors associated with a fear of falling were a history of falls and certain clinical and sociodemographic characteristics. Most of the interviewees considered that falls had serious consequences but less than half believed that a large proportion of falls could be avoided

Conocimientos y actitudes de los mayores hacia el documento de voluntades anticipadas Seniors' knowledge of and attitudes to advance directive documents

Objetivos: El objetivo de este estudio es determinar los conocimientos y las actitudes que presentan las personas mayores hacia el documento de voluntades anticipadas. Métodos: Estudio descriptivo transversal, realizado en atención primaria en las provincias de Albacete y Guadalajara (n = 464). Resultados: El 86,2% (intervalo de confianza del 95% [IC95%]: 83,0-89,5) de los sujetos no conocía el documento y solo el 3,4% (IC95%: 1,7-5,3) lo había formalizado. El 76,7% (IC95%: 72,8-80,7) consideró que la existencia del documento es conveniente. Las variables asociadas mediante regresión logística con una mejor actitud hacia las voluntades anticipadas fueron el nivel de instrucción (odds ratio [OR] = 4,7; IC95%: 2,6-8,4) y haber vivido una experiencia en que el documento hubiese ayudado (OR = 1,9; IC95%: 1,1-3,4). Conclusiones: Los mayores muestran una actitud positiva hacia las voluntades anticipadas, pero la proporción de personas que conocen el documento es baja.<br>Objectives: The aim of this study was to determine seniors' knowledge of and attitudes toward advance directive documents. Methods: We carried out a cross-sectional descriptive study in a primary care setting in the provinces of Albacete and Guadalajara, Spain (n = 464). Results: A total of 86.2% (95% CI: 83.0-89.5) of the participants were unaware of advance directive documents and only 3.4% (95% CI: 1.7-5.3) had formalized one. These documents were positively viewed by 76.7% of the participants (95% CI: 72.8-80.7). The variables associated with positive attitudes toward advance directives in logistic regression were educational level (OR = 4.7; 95% CI: 2.6-8.4) and experience of a situation in which such a document would have helped (OR = 1.7; 95% CI: 1.1-3.4). Conclusions: Seniors had positive attitudes toward advance directives, but the proportion of persons aware of these documents was low

Adherencia a las recomendaciones para evitar caídas en personas mayores de Albacete durante 2009

Fundamento: Existen recomendaciones para que las personas mayores eviten las caídas. Nuestro objetivo es determinar el grado de conocimiento y adhesión a tales recomendaciones, así como analizar las características sociodemográficas y de morbilidad asociadas. Métodos: Estudio descriptivo observacional. La población diana son las personas mayores que viven en la comunidad. Los sujetos fueron seleccionados mediante muestreo aleatorio (n=919) y entrevistados sobre los conocimientos y el nivel de adherencia a las recomendaciones que existen para prevenir caídas, recabando también información sobre sus problemas de salud y sus características sociodemográficas. Se realizó un análisis descriptivo y se comparó a los sujetos «más cumplidores» con el resto de los participantes. Usando un análisis multivariante se comprobó la asociación de la adherencia con sus posibles factores condicionantes. Resultados: El 50,8% desconocía que existen ejercicios físicos recomendados para prevenir caídas y el 22,0% que cuidar los pies puede contribuir a este fin. Las recomendaciones con mayor adherencia son las referentes al cuarto de baño, donde el 62,2% utiliza la ducha para el aseo personal y el 83,5% utiliza alfombra o suelo antideslizante en la ducha o bañera. Las variables asociadas con un mayor cumplimiento son: presencia de 3 o más problemas de salud (OR: 1,6), edad superior a 80 años (OR: 1,4), mayor nivel de escolarización (OR: 1,5) y sujetos solteros, viudos o divorciados (OR: 1,4). Conclusiones: Aunque, en general, las personas mayores poseen unos conocimientos aceptables sobre las recomendaciones para evitar las caídas, se desconoce de los ejercicios físicos que existen para prevenir caídas. Probablemente las personas más cumplidoras son también las más frágiles y las que tienen más miedo a caerse