Perception of the inltlation and evolutlon of symptomatology in hospitalized patients with cancer of the digestive tract

El estudio de las características del intervalo entre el primer síntoma y el diagnóstico del cáncer viene condicionado por la forma en que el paciente percibe y refiere la aparición de los signos y síntomas iniciales. El propósito de este estudio fue analizar los factores que influyen en dicha percepción. Para ello se entrevistaron 68 pacientes con neoplasia máligna del tubo digestivo, sintomáticos, ingresados en el Hospital del Mar de Barcelona, mediante un cuestionario estandarizado. El tiempo de aparición de toda la sintomatología fue de una semana en el 38 % de los pacientes, igual o inferior a un mes en el 53 %, e igual o inferior a 3 meses en el 75 %. Un 76 % de los enfermos acudieron al médico por el primer síntoma. Los síntomas que con mayor frecuencia motivaron la primera visita al médico por el proceso neoplásico fueron los hemorrágicos y los de aparición brusca o violenta; los síntomas menos asociados a la primera visita fueron el dolor abdominal y la anorexia. Sólo 5 enfermos manifestaron haber asociado el síntoma inicial a una enfermedad nueva y grave, el 61 % manifestaron no haber atribuido ninguna importancia al primer síntoma, un 15 % lo asociaron a otra enfermedad anterior, y un 17 % a una enfermedad nueva pero de carácter leve. Las mujeres refirieron 4 síntomas de mediana frente a 2 en los hombres (p<0,04). Mientras que el número de síntomas fue discretamente superior entre los pacientes no fumadores y en los afectos de un cáncer de estómago, no guardó relación con el nivel de estudios ni con el grado de diseminación de la neoplasia. Los primeros síntomas producidos por una enfermedad cancerosa no suelen relacionarse con una situación grave por el paciente, lo cual retrasa el diagnóstico. Es importante prestar atención a la percepción de los síntomas por los pacientes, así como a su forma de comunicarlos

A new genus of oak gall wasp, Striatoandricus Pujade-Villar (Hyenoptera: Cynipidae: Cynipini) from Americ with descriptions of two new Mexican species

A new genus of cynipid oak gall wasp, Striatoandricus Pujade-Villar (Hymenoptera: Cynipidae: Cynipini), is described. Striatoandricus gen. nov. includes four previously described species, Andricus nievesaldreyi n. comb., A. georgei n. comb., A. maesi n. comb., and A. barriosi n. comb., which induce pubescent leaves or twig galls on Quercus belonging to Quercus section. Two new species from México are also described: S. cuixarti Pujade-Villar n. sp. and S. sanchezi Pujade-Villar n. sp. in Quercus section. Descriptions of the genus and diagnostic characters, including DNA sequence data, are presented. This new genus is supported by both morphological and molecular data

Evaluación de la atención primaria: Aproximación mediante el primary care assessment Tools (PCAT)

La Atención Primaria (AP) es un nivel clave en un sistema sanitario y la evaluación es una de las principales herramientas básicas para mejorar los servicios. Según el modelo de AP definido por B Starfield y de amplio consenso internacional, ésta debe: a) ser accesible y ser utilizada como el primer contacto con el sistema de salud; b) ofrecer una atención continuada y global, y c) estar coordinada con los otros niveles del sistema sanitario, además de tener un enfoque familiar y comunitario, y competencia cultural. Así, B Starfield definió las cuatro dimensiones esenciales de la atención primaria como: primer contacto, longitudinalidad, integralidad y coordinación; y las dimensiones relacionadas: enfoque familiar, orientación comunitaria y competencia cultural. En Estados Unidos, Starfield y Shy diseñaron un conjunto de instrumentos para valorar las dimensiones de la AP, Primary Care Assessment Tools (PCAT). El objetivo general de esta tesis fue obtener instrumentos de evaluación del modelo teórico de la Atención Primaria (AP) que permitan su utilización en Catalunya y en el contexto español, y a partir de ellos hacer una primera evaluación en Catalunya bajo la perspectiva de desigualdades sociales. Para ello se realizaron dos procesos independientes de adaptación del cuestionario Primary Care Assessment Tools (PCAT), uno para poder utilizarlo en una encuesta de salud y otro para obtener medidas de los Equipos de Atención Primaria (EAP). La metodología ha sido en gran parte la misma, en base a las recomendaciones de adaptación transcultural, siguiendo los siguientes pasos: traducción, retrotraducción, comité de expertos, prueba pretest y medición de propiedades psicométricas del cuestionario obtenido. Para la valoración de la AP en Catalunya se incluyó en el cuestionario de la encuesta de Salud de Catalunya del año 2006 el conjunto de ítems seleccionados en uno de los trabajos que se presentan en esta tesis doctoral. Se aplicó a una muestra representativa de la población mayor de 15 años (N=13.292). Se ajustaron modelos multivariados de regresión negativa para la obtención de las razones de prevalencia y sus intervalos de confianza del 95%. Como resultados de esta tesis doctoral, se han obtenido dos instrumentos independientes, ambos en catalán y en castellano: a) un conjunto de ítems para poder incluir en la encuesta de salud, un PCAT abreviado de 10 ítems para adultos, y 2) el PCAT-Equipo de Atención Primaria versión extensa que permitirá el análisis de todas las dimensiones de la AP definidas por B Starfield (primer contacto, longitudinalidad, integralidad, coordinación, enfoque familiar, orientación comunitaria y competencia cultural). El PCAT-10 incluido en la Encuesta de Salud de Catalunya del año 2006 permitió conocer que la valoración de la AP obtenía una puntación de 7 sobre 10, y sin presentar un patrón de desigualdad, ya que no se mostraron diferencias en las puntuaciones según clase social. En conclusión, a partir del trabajo realizado se encuentran ya disponibles unos instrumentos en catalán y castellano que amplían el marco de evaluación de la AP en el contexto del sistema sanitario en España y Catalunya. Además permiten utilizar el enfoque de evaluación desde la población potencialmente usuaria así como de los equipos encargados de realizar la atención, los Equipos de Atención Primaria. Desde la perspectiva de la población, el PCAT-10 ha presentado buenas propiedades métricas, proporciona un índice para la evaluación de la AP y permitirá la monitorizado en el tiempo y el análisis en subgrupos y en el total de la población. A partir de la valoración de los directores/as de EAP se podrá evaluar el modelo teórico completo de la AP definido por B. Starfield.Primary Care is a key level in the health system, and evaluation is one of the main instruments to improve services. According to the model defined by B Starfield, one with broad international consensus, PC has to be: a) accessible and used as the first contact with the health system; b) it must offer longitudinal and comprehensiveness attention, and c) it must be coordinated with the other levels of the health care system, be focused on family, with community orientation, and demonstrate cultural competence. B. Starfield defines the four essential dimensions of PC: first contact, longitudinality, comprehensiveness and coordination; and as related dimensions: family focus, community orientation and cultural competence. In the United States, Starfield and Shy designed a group of instruments to evaluate the PC dimensions, the Primary care Assessment Tools (PCAT). The main objective of this thesis is to obtain instruments for the evaluation of the theoretical model of Primary Care (PC) for use in Catalonia, and in the Spanish context in general, and from them to make a first evaluation in Catalonia from the perspective of social inequalities. To this end, two independent processes of adapting the Primary Care Assessment Tool (PCAT) questionnaire have been made, one to use in a health survey and the other to obtain measurements of the PC facilities. To a great extent, the methodology has been the same for both, based of the recommendations for transcultural adaptation: translation, retro translation, committee of experts, pretest and measurement of psychometric properties of the obtained questionnaire. For the assessment of PC in Catalonia, the set of items selected in one of the works presented in this doctoral thesis was included in the questionnaire of 2006 - the Catalan Health Survey. It was conducted on a representative sample of the population over 15 years (N=13.292). It has been adjusted with multivariate negative binomial regression models to obtain prevalence ratios and their 95% confidence intervals. Two independent instruments have been obtained, in Catalan and Spanish: a) a set of items to be included in the health survey, a brief PCAT of 10 items for adults and b) PCAT- PC team, extended version, which will allow the analysis of all the dimensions of the PC defined by B Starfield (first contact, longitudinality, comprehensiveness, coordination, family centeredness, community orientation and cultural competence). The PCAT-10 included in the Health Survey of Catalonia in 2006 revealed that the evaluation of the AP resulted in a mark of 7 over 10, showing no pattern of inequality, since differences in the scores were not according to social class. In conclusion, there are already available instruments in Catalan and Spanish that extend the frame of evaluation of the PC in the context of the health system in Spain and Catalonia. From the perspective of the population, the abbreviated PCAT-10 has presented good metric properties and provides an index for the evaluation of the PC that will allow monitoring over time and analysis in sub-groups, as well as in the total population. Through the evaluation of directors of PC teams, the complete theoretical model of the AP defined by B Starfield will be able to be evaluated

Methodological Deficits in Diagnostic Research Using ‘-Omics’ Technologies: Evaluation of the QUADOMICS Tool and Quality of Recently Published Studies

Background: QUADOMICS is an adaptation of QUADAS (a quality assessment tool for use in systematic reviews of diagnostic accuracy studies), which takes into account the particular challenges presented by '-omics' based technologies. Our primary objective was to evaluate the applicability and consistency of QUADOMICS. Subsequently we evaluated and describe the methodological quality of a sample of recently published studies using the tool. Methodology/Principal Findings: 45'-omics'- based diagnostic studies were identified by systematic search of Pubmed using suitable MeSH terms (>Genomics>, >Sensitivity and specificity>, >Diagnosis>). Three investigators independently assessed the quality of the articles using QUADOMICS and met to compare observations and generate a consensus. Consistency and applicability was assessed by comparing each reviewer's original rating with the consensus. Methodological quality was described using the consensus rating. Agreement was above 80% for all three reviewers. Four items presented difficulties with application, mostly due to the lack of a clearly defined gold standard. Methodological quality of our sample was poor; studies met roughly half of the applied criteria (mean ± sd, 54.7±18.4°%). Few studies were carried out in a population that mirrored the clinical situation in which the test would be used in practice, (6, 13.3%);none described patient recruitment sufficiently; and less than half described clinical and physiological factors that might influence the biomarker profile (20, 44.4%). Conclusions: The QUADOMICS tool can consistently be applied to diagnostic '-omics' studies presently published in biomedical journals. A substantial proportion of reports in this research field fail to address design issues that are fundamental to make inferences relevant for patient care. © 2010 Parker et al.This work was supported by the Spanish Agency for Health Technology Assessment, Exp PI06/90311, Instituto de Salud Carlos III and CIBER en Epidemiología y Salud Pública (CIBERESP) in SpainPeer Reviewe

Comparison of [18F] fluorocholine PET/CT with [99mTc] sestamibi and ultrasonography to detect parathyroid lesions in primary hyperparathyroidism: a prospective study.

Background: Primary hyperparathyroidism is a common endocrine disorder produced by the increase of parathyroid hormone (PTH) due to a benign adenoma of a single parathyroid gland, or as multiple gland hyperplasia, or as a rare malignant tumor. Preoperative imaging scans are frequently necessary for the minimally invasive parathyroidectomies to identify the location of enlarged parathyroid glands and to design the procedure. Methods: The diagnostic reliability of [18F]fluorocholine positron emission tomography/computed tomography (FCH PET/CT), [99mTc]sestamibi [multiplexed ion beam imaging (MIBI)] and cervical ultrasonography was analyzed in 37 patients diagnosed with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy. The three preoperative imaging techniques were correlated with intraoperative and histopathological findings as well as changes in biochemical parameters (serum PTH and calcium levels). Statistical analysis was carried out with SPSS version 24.0. Results: In 30 of 37 patients (81.1%), FCH PET/CT correctly localized the pathological gland. In 3 cases of ectopic adenomas, the accuracy of the techniques was 100% (3/3) for FCH PET/CT, 66.7% (2/3) for MIBI, and 33.3% (1/3) for neck ultrasonography. Neither neck ultrasonography nor MIBI were able to locate pathological parathyroid glands in those patients with multiglandular disease, while FCH PET/CT correctly located one patient (1/3, 33.3%) with two adenomas and 3 patients (3/6, 50.0%) with hyperplasia. The three imaging techniques, FCH PET/CT, MIBI and neck ultrasound yielded a sensitivity of 92.1%, 57.9% and 32.4%, a positive predictive value of 94.6%, 84.6% and 78.6%, and a diagnostic accuracy of 96.4%, 85.7% and 79.0%, respectively. Conclusions: In this group of patients diagnosed with primary hyperparathyroidism, FCH PET/CT was superior to MIBI and neck ultrasound in detecting adenomas, particularly in the presence of ectopic glands or multiglandular disease

Evaluation of the COVID-19 response in Spain: principles and requirements

A resurgence of COVID-19 infections is occurring in Spain, with some of the worst figures in Europe. In August, 2020, we urged the Spanish Central Government and regional governments to independently evaluate their COVID-19 response to identify areas where public health and the health and social care system need to be improved

Assessing causal relationships in genomics: From Bradford-Hill criteria to complex gene-environment interactions and directed acyclic graphs

Observational studies of human health and disease (basic, clinical and epidemiological) are vulnerable to methodological problems -such as selection bias and confounding- that make causal inferences problematic. Gene-disease associations are no exception, as they are commonly investigated using observational designs. A rich body of knowledge exists in medicine and epidemiology on the assessment of causal relationships involving personal and environmental causes of disease; it includes seminal causal criteria developed by Austin Bradford Hill and more recently applied directed acyclic graphs (DAGs). However, such knowledge has seldom been applied to assess causal relationships in clinical genetics and genomics, even in studies aimed at making inferences relevant for human health. Conversely, incorporating genetic causal knowledge into clinical and epidemiological causal reasoning is still a largely unexplored area