Impact of age and comorbidities on health-related quality of life for patients with prostate cancer: evaluation before a curative treatment

<p>Abstract</p> <p>Background</p> <p>Interpretation of comparative health-related quality of life (HRQOL) studies following different prostate cancer treatments is often difficult due to differing patient ages. Furthermore, age-related changes can hardly be discriminated from therapy-related changes. The evaluation of age-and comorbidity-related changes was in focus of this study.</p> <p>Methods</p> <p>HRQOL of 528 prostate cancer patients was analysed using a validated questionnaire (Expanded Prostate Cancer Index Composite) before a curative treatment. Patients were divided into age groups ≤65, 6670, 7175 and >75 years. The impact of specific comorbidities and the Charlson Comorbidity Index (CCI) were evaluated. The questionnaire comprises 50 items concerning the urinary, bowel, sexual and hormonal domains for function and bother. For assessment of sexual and hormonal domains, only patients without prior hormonal treatment were included (n = 336).</p> <p>Results</p> <p>Urinary incontinence was observed increasingly with higher age (mean function scores of 92/88/85/87 for patients ≤65, 6670, 7175 and >75 years) complete urinary control in 78%/72%/64%/58% (p < 0.01). Sexual function scores decreased particularly (48/43/35/30), with erections sufficient for intercourse in 68%/50%/36%/32% (p < 0.01) a decrease of more than a third comparing patients ≤65 vs. 6670 (36%) and 6670 vs. 7175 years (39%). The percentage of patients with comorbidities was lowest in the youngest group (48% vs. 66%/68%/63% for ages 6670/7175/>75 years; p < 0.05). A multivariate analysis revealed an independent influence of both age and comorbidities on urinary incontinence, specifically diabetes on urinary bother, and both age and diabetes on sexual function/bother. Rectal domain scores were not significantly influenced by age or comorbidities. A CCI>5 particularly predisposed for lower urinary and sexual HRQOL scores.</p> <p>Conclusion</p> <p>Urinary continence and sexual function are the crucial HRQOL domains with age-related and independently comorbidity-related decreasing scores. The results need to be considered for the interpretation of comparative studies or longitudinal changes after a curative treatment.</p

From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways

The human body hosts an enormous abundance and diversity of microbes, which perform a range of essential and beneficial functions. Our appreciation of the importance of these microbial communities to many aspects of human physiology has grown dramatically in recent years. We know, for example, that animals raised in a germ-free environment exhibit substantially altered immune and metabolic function, while the disruption of commensal microbiota in humans is associated with the development of a growing number of diseases. Evidence is now emerging that, through interactions with the gut-brain axis, the bidirectional communication system between the central nervous system and the gastrointestinal tract, the gut microbiome can also influence neural development, cognition and behaviour, with recent evidence that changes in behaviour alter gut microbiota composition, while modifications of the microbiome can induce depressive-like behaviours. Although an association between enteropathy and certain psychiatric conditions has long been recognized, it now appears that gut microbes represent direct mediators of psychopathology. Here, we examine roles of gut microbiome in shaping brain development and neurological function, and the mechanisms by which it can contribute to mental illness. Further, we discuss how the insight provided by this new and exciting field of research can inform care and provide a basis for the design of novel, microbiota-targeted, therapies.GB Rogers, DJ Keating, RL Young, M-L Wong, J Licinio, and S Wesseling

Escala de Coma de Glasgow: subestimação em pacientes com respostas verbais impedidas Escala de Coma de Glasgow: subestimación en pacientes con respuestas verbales impedidas Glasgow Coma Scale: underestimation in patients with verbal responses impeded

Questão freqüente no uso da Escala de Coma de Glasgow (ECGl), na fase aguda, em pacientes internados devido ao trauma crânio-encefálico (TCE) é a subestimação decorrente de situações impeditivas como intubação endotraqueal/traqueostomia, sedação e edema palpebral. O objetivo deste estudo foi identificar e determinar a subestimação na pontuação total da ECGl quando se utiliza a pontuação 1 nas situações de impedimento para a sua avaliação. A amostra estudada foi de 76 pacientes internados com TCE no Hospital das Clínicas da FMUSP. Em 42 (55,3%) pacientes, não havia impedimentos e foram realizadas 136 avaliações. Em 34 (44,7%), havia impedimentos caracterizados por intubação ou traqueostomia, podendo estar ou não associados com edema palpebral e sedação, e o total de avaliações foi de 310. A pontuação nesses pacientes total variou de 3 a 11, com os escores mais freqüentes de 3 e 6. Pelos valores estimados pela regressão linear, a partir das pontuações obtidas em AO e MRM foram obtidas as seguintes subestimações: média=1,03 ±1,36, mediana=0,54 (intubação ou traqueostomia); média=0,40 ±0,79, mediana=0,00 (intubação ou traqueostomia + sedação); média=0,57 ±0,96, mediana=0,27 (intubação ou traqueostomia + sedação + edema palpebral). Conclui-se que, no TCE grave, a pontuação total da ECGl fixando a MRV em 1, embora subestimada, encontra-se próxima da real.<br>Cuestionamiento frecuente en el uso de la Escala de Coma de Glasgow (ECG), en la fase aguda, en pacientes internados debido al trauma craneoencefalico es la subestimación decorrient de situaciones impeditivas como intubación endotraqueal/traqueostomía, sedación y edema palpebral. El objetivo de ese estudio fue identificar y determinar la subestimación en la puntuación total de la ECG cuando es utilizada la puntuación 1 en las situaciones de impedimiento para su avaliación. La muestra estudiada fue de 76 pacientes internados por TEC en el Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. En 42 (55.3%) pacientes, no habia impedimientos y fueron realizadas 136 avaliaciones. Em 34 (44,7%), habia impedimientos caracterizados por intubación o traqueostomía, estando o no asociados con edema palpebral y sedación y el total de avaliaciones fue de 310. En eses, la puntuación total varió de 3 para 11 con los escores más frecuentes en 3 y 6. Por los valores estimados por la regresión linear a partir de las puntuaciones obtenidas en AO y MRM, fueron obtenidas las seguintes subestimaciones: media=1.03±1.36, mediana=0.54 (intubatión o traqueostomía), media=0,40±0.79, mediana=0,00 (intubatión o traqueostomía + sedatión), media=0.57± 0.96, mediana=0.27 (intubatión o traqueostomía + sedatión + edema palpebral). Fue concluído que, en el TEC grave, la puntuación total de la ECG1 mantenendo la MRV en 1, mismo subestimada, se encuentra prójima de la real.<br>Frequent question in the use of Glasgow Coma Scale (GCS), on the acute phase, on inpatients due to encephalic cranial trauma (TBI) is the subestima because of the impeditive situations such as tracheostomy/endotracheal intubation, sedation and palpebral edema. The aim of this study was identify and determining the subestima on the total score of GCS when the score 1 is used on the impediment situations for your assessment. The sample studied had 76 inpatients for TBI at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Within 42 (55,3%) inpatients, there are not impediments and were carried out 136 assessments. In 34 (44,7%), there are impediments characterized by intubation or tracheostomy, being or not related to palpebral edema and sedation and the total evaluation was 310. Within them, the total score varied of 3 to 11 with the more frequent scores in 3 and 6. Through estimated values by linear regression since the scores obtained in EO and VRM, the following subestimas were obtained: mean=1.03±1.36, median=0.54 (intubation or tracheostomy), mean=0,40±0.79, median=0,00 (intubation or tracheostomy + sedation), mean=0.57±0.96, median=0.27 (intubation or tracheostomy + sedation + palpebral edema). It was concluded that, in the serious ECT, the total score of GCS maintained a VRM in 1, although underestimated, it is near the real one

Reduced Labor Force Participation Among Primary Care Patients with Headache

OBJECTIVE: To assess the long-term impact of headache on labor force participation among primary care patients with headache. DESIGN: A 2-year cohort study comparing employment status of primary care patients with headache and that of patients with back pain. PARTICIPANTS: Patients with headache (n=662) or back pain (n=1,024) sampled from persons visiting a primary care physician who completed baseline, 1-year and 2-year follow-up interviews. MEASUREMENTS AND MAIN RESULTS: The percentage of subjects unemployed at baseline, 1 year or 2 years was determined, excluding the retired and homemakers. Among all patients, the percentage unable to obtain or keep full-time work in the year prior to each interview because of headache or back pain was also assessed. Over the 3-year period covered by the study interviews, 13% of headache and 18% of back pain patients were unable to obtain or keep full-time work because of their pain condition. Among those in the labor force, 12% of headache patients and 12% of back pain patients were unemployed for any reason at one or more interviews. Among the one in five headache patients with a poor long-term outcome, 36% were unable to obtain or keep full-time work because of headache at some time compared with 4% of headache patients with a good outcome. Among headache patients, women, persons aged 18 to 24 years, those with lower levels of education, persons with depressive symptoms, and migraineurs were more likely to have reduced labor force participation owing to headache. CONCLUSIONS: The likelihood of reduced labor force participation among primary care patients with headache was considerable and concentrated among the one in five patients with a poor long-term outcome. Headache patients at a social disadvantage in attaining occupational role stability (e.g., younger women or poorly educated patients) were more likely to report reduced labor force participation

Development of a questionnaire to measure the effects of chronic pain on health-related quality of life in dogs

Objective—To develop a reliable, validated questionnaire that can be used for the assessment of chronic pain and its impact on health-related quality of life (HRQL) in dogs. Sample Population—17 owners of dogs that had chronic pain associated with chronic degenerative joint disease and 165 other dog owners. Procedures—Psychometric methods were used to identify relevant domains, create an item pool, select and validate items, and construct and preliminarily test a structured questionnaire. Relevant domains were identified through semi structured interviews. Descriptor-generating exercises provided the terms owners used to describe these domains and formed an item pool. A selection from this pool was validated and used to construct a questionnaire that underwent preliminary testing. Results—The structured questionnaire contained 109 simple, familiar, descriptive terms associated with good health or chronic pain (most describing subtle aspects of behavior that owners interpreted as expressions of subjective experiences of their dogs) for 13 possible HRQL domains. Each descriptor was associated with a 7-point numeric scale. Conclusions and Clinical Relevance—The questionnaire was intended to facilitate rapid, sensitive, and accurate rating of a comprehensive range of relevant domains by naïve raters with minimal burden on respondents. The principles underlying the development and design of this structured questionnaire offer a novel approach to the proxy measurement of HRQL and changes in HRQL associated with chronic pain for a range of animal species. Impact for Human Medicine—This novel approach may be applicable to other nonverbal populations (eg, young children or elderly people with cognitive impairment)

Espondilolistese traumática do áxis: epidemiologia, conduta e evolução Traumatic spondylolisthesis of the axis: epidemiology, management and outcome

OBJETIVO: Avaliar casos de espondilolistese traumática do áxis e descrevê-los com relação à epidemiologia, classificação, déficit neurológico, tempo de consolidação e tratamento. MÉTODO: Análise retrospectiva dos prontuários dos pacientes tratado de 2002 a 2010 no IOT-HCFMUSP. Critério de inclusão: fratura da pars interarticularis de C2. RESULTADOS: 68% dos pacientes do sexo masculino com idade média de 39,1 anos. Utilizamos a classificação de Effendi, modificada por Levine-Edwards. Observamos fratura do tipo I em cinco pacientes (31,2%) e tipo II em oito pacientes (50%). Apenas três pacientes (18%) apresentaram fratura do tipo IIa. Não houve casos do tipo III. Mecanismo: Oito acidentes automobilísticos e quatro quedas. Outros mecanismos: atropelamento e mergulho. Tratamento: tração com halo craniano em onze pacientes. Foram usados gesso minerva e halo-gesso. Tempo de consolidação: 3,6 meses. Tempo de seguimento: 9,6 meses. DISCUSSÃO: Nossos resultados confirmam que fratura do enforcado apresenta bom prognóstico. Não houve necessidade de cirurgia em nenhum caso. A incidência de déficit neurológico é baixa. Nenhum paciente apresentou fratura instável, tipo III. CONCLUSÃO: Este trabalho sugere que a espondilolistese traumática do áxis continua sendo uma lesão satisfatoriamente tratada de forma conservadora na maioria dos casos. Nível de Evidência IV, Série de casos.<br>OBJECTIVE: To evaluate cases of traumatic spondylolisthesis of the axis and describe them in relation to epidemiology, classification, neurological deficit, healing time and treatment method. METHOD: A retrospective analysis of the medical records of patients treated between 2002 and 2010 at IOT-FMUSP. Inclusion criteria: pars interarticularis fracture of C2. RESULTS: 68% were male patients, with a mean age of 39.1 years. We used the classification by Effendi, modified by Levine-Edwards. Type I fractures were observed in five patients (31.2%) and type II in eight patients (50%). Only three patients (18%) had type IIa fracture. There were no cases of type III. Mechanism: Eight car accidents and four falls. Other mechanisms: being run over, and diving accidents. Treatment with halo traction was used in eleven patients, using minerva cast and halo-cast. Healing time: 3.6 months. Follow-up time: 9.6 months. DISCUSSION: In general, hangman fracture has a good prognosis, which is confirmed by our results. There was no need for surgery in any of the cases. The incidence of neurological deficit is low. No patient had unstable fracture (type III). CONCLUSION: This paper suggests that traumatic spondylolisthesis of the axis continues to be an injury that is successfully treated by conservative treatment in most cases. Level of Evidence -IV, Case series