Cancer and central nervous system disorders: protocol for an umbrella review of systematic reviews and updated meta-analyses of observational studies

BACKGROUND: The objective of this study will be to synthesize the epidemiological evidence and evaluate the validity of the associations between central nervous system disorders and the risk of developing or dying from cancer. METHODS/DESIGN: We will perform an umbrella review of systematic reviews and conduct updated meta-analyses of observational studies (cohort and case-control) investigating the association between central nervous system disorders and the risk of developing or dying from any cancer or specific types of cancer. Searches involving PubMed/MEDLINE, EMBASE, SCOPUS and Web of Science will be used to identify systematic reviews and meta-analyses of observational studies. In addition, online databases will be checked for observational studies published outside the time frames of previous reviews. Eligible central nervous system disorders will be Alzheimer's disease, anorexia nervosa, amyotrophic lateral sclerosis, autism spectrum disorders, bipolar disorder, depression, Down's syndrome, epilepsy, Huntington's disease, multiple sclerosis, Parkinson's disease and schizophrenia. The primary outcomes will be cancer incidence and cancer mortality in association with a central nervous system disorder. Secondary outcome measures will be site-specific cancer incidence and mortality, respectively. Two reviewers will independently screen references identified by the literature search, as well as potentially relevant full-text articles. Data will be abstracted, and study quality/risk of bias will be appraised by two reviewers independently. Conflicts at all levels of screening and abstraction will be resolved through discussion. Random-effects meta-analyses of primary observational studies will be conducted where appropriate. Parameters for exploring statistical heterogeneity are pre-specified. The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used for determining the quality of evidence for cancer outcomes. DISCUSSION: Our study will establish the extent of the epidemiological evidence underlying the associations between central nervous system disorders and cancer and will provide a rigorous and updated synthesis of a range of important site-specific cancer outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016052762

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Evaluación del uso de medidas de calidad de vida en la práctica clínica : aplicación a pacientes con cataratas

The objective of this work is the evaluation of the impact on health care of the systematic use of health related quality of life (HRQL) measures. A systematic review and a meta-analysis of randomized clinical trials were performed. A novel method was developed for the interpretation of scores that was based on Item Response Theory and it was applied to Visual Function Index VF-14, a perceived visual function measure for cataract patients. In a before-after trial, the visual function of 833 consecutive cataract patients attending 19 ophthalmologists in hospital and primary care based practices was routinely assessed. The results suggest that the feed back on HRQL and perceived health to health professionals might improve some aspects of medical care process, but not its outcome.El objetivo del presente trabajo es evaluar el impacto en la atención médica del uso sistemático de instrumentos de medida de la calidad de vida relacionada con la salud (CVRS). Para ello se realizó una revisión sistemática y meta-análisis de ensayos clínicos. Se desarrolló un método para la interpretación de las puntuaciones basado en Teoría de Respuesta al Ítem y se aplicó al Índice de Función Visual VF-14, una medida de función visual percibida para pacientes con cataratas. Se diseñó un estudio de intervención antes-después en el que se midió de forma sistemática la función visual de 833 pacientes con cataratas que acudieron de forma consecutiva a las consultas de 19 oftalmólogos en centros hospitalarios y de atención primaria. Los resultados indican que la administración de información sobre CVRS y salud percibida a los profesionales de la salud podría modificar algunos componentes del proceso de la atención sanitaria, pero no su resultado.L' objectiu del present treball és l'avaluació de l'impacto a l' atenció mèdica de l'us sistemàtic dels instruments de mesura de la qualitat de vida relacionada amb la salut (QVRS). Es realitzà una revisió sistemàtica i meta-anàlisi d'assaijos clínics. Es va desenvolupar un mètode per a la interpretació de les puntuacions basat en la Teoria de Resposta a l'Ítem que es va aplicar a l'Índex de Funció Visual VF-14, una mesura de funció visual percebuda per a pacients amb cataractes. Es va dissenyar un estudi d'intervenció abans-després en el que es mesurà de forma sistemàtica la funció visual de 833 pacients amb cataractes atesos de forma consecutiva a les consultas de 19 oftalmòlegs de centres hospitalaris i d'atenció primària. Els resultats indiquen que l'administració d'información sobre QVRS i salut percebuda als professionals de la salut pot modificar alguns components del procés de l' atenció sanitària, pero no el seu resultat

Differences Within Churra Breed Sheep in the Early Immune Response to the Infection by Teladorsagia circumcincta

Trabajo presentado al: 27th International Conference of the World Association for the Advancement of Veterinary Parasitology. Abstract book, Oral Session OA41.05, pp. 155. Madison (USA), 7-11 julio 2019.In the present study, the mechanisms by which Churra breed sheep can present di@erent resistance phenotypes were studied in adults during the early stage of the infection by Teladorsagia circumcincta. For that, 12 animals were classified as resistant (6) or susceptible (6) to the infection by T. circumcincta based on their cumulative faecal egg count after an initial experimental infection. A negative correlation was found between the cumulative FEC at the end of the infection and the level of IgA in serum at day 3 pi (r=-0.764; P= 0.004), when IgAs reached the highest values in the resistant group. Sheep were dewormed and were infected again to be slaughtered at day 7 post infection. At slaughter, level of IgA in serum and gastric mucus was higher in the resistant group although only showing slight significant di@erences in serum samples (P=0.1). At the necropsy, abomasum tissue samples were collected for histological and immunohistochemistry analysis. A positive correlation was found between CD4+ and %&+ T cells (r= 0.714; P= 0.04), suggesting that both cell populations could participate in the early immune response. Moreover, we found an association between the number of %&+ T cells and eosinophils (r= 0.600; P=0.05); this association was even stronger in the resistant group (r= 0.900; P= 0.037), but absent in the susceptible animals, suggesting that the activation of this mechanism could play an important role in the resistance to the infection. On the other hand, the susceptible group showed a negative correlation between globule leukocytes and %&+ T cells (r= -0.812; P=0.05) but also slight with CD4+ T cells (r= -0.800; P=0.1). Therefore, it is possible that in the susceptible group the immune response was not strong enough to activate the recruitment of a higher number of globule leukocytes to protect against the infection.Peer reviewe

The relationship between air pollution and multimorbidity: Can two birds be killed with the same stone?

Data de publicació electrònica: 16-01-2023Air pollution and multimorbidity are two of the most important challenges for Public Health worldwide. Although there is a large body of evidence linking air pollution with the development of different single chronic conditions, the evidence about the relationship between air pollution and multimorbidity (the co-occurrence of multiple long-term conditions) is sparse. To obtain evidence about this relationship could be challenging and different aspects should be considered, such as its multifaceted and complex nature, the specific pollutants and their potential influence on health, their levels of exposure over time, or the data that could be used for its study. This evidence could be instrumental to inform the development of new recommendations and measures to reduce harmful levels of air pollutants, as means to prevent the development of multimorbidity and reduce its burden

Patient-reported outcomes: pathways to better health, better services, and better societies.

While the use of PROs in research is well established, many challenges lie ahead as their use is extended to other applications. There is consensus that health outcome evaluations that include PROs along with clinician-reported outcomes and administrative data are necessary to inform clinical and policy decisions. The initiatives presented in this paper underline evolving recognition that PROs play a unique role in adding the patient perspective alongside clinical (e.g., blood pressure) and organizational (e.g., admission rates) indicators for evaluating the effects of new products, selecting treatments, evaluating quality of care, and monitoring the health of the population. In this paper, we first explore the use of PRO measures to support drug approval and labeling claims. We critically evaluate the evidence and challenges associated with using PRO measures to improve healthcare delivery at individual and population levels. We further discuss the challenges associated with selecting from the abundance of measures available, opportunities afforded by agreeing on common metrics for constructs of interest, and the importance of establishing an evidence base that supports integrating PRO measures across the healthcare system to improve outcomes. We conclude that the integration of PROs as a key end point within individual patient care, healthcare organization and program performance evaluations, and population surveillance will be essential for evaluating whether increased healthcare expenditure is translating into better health outcomes.Jose M. Valderas was supported by an NIHR Clinician Scientist Award (NIHR/CS/010/024)