Dilemes ètics en la gestió de la incapacitat transitòria

La gestió de la Incapacitat Transitòria (IT), planteja freqüents dubtes al metge i sobretot al metge d'atenció primària. Amb l'objectiu de servir de guia i il·lustrar el que és el raonament ètic aplicat a la consulta diària, exposarem un cas en el ben entès que, encara que no s'hagi d'aplicar mimèticament a altres similars, puguin orientar al nostre col·lectiu. Aquest cas, l'utilitzarem per a dissenyar els passos a seguir en cada situació i intentar establir un marc general de maneig de la IT. Quedi clar que ens importa quasi més el raonament ètic que el resultat final donat al cas, doncs el lector pot arribar a solucions diferents des de l'òptica de la seva realitat concreta. En tot cas, el dolor moral que produeix l'error, sempre queda atenuat pel fet d'haver-nos esforçat en cercar la millor solució

Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992–2003

<p>Abstract</p> <p>Background</p> <p>The objective of this study was to assess trends in cancer mortality by educational level in Barcelona from 1992 to 2003.</p> <p>Methods</p> <p>The study population comprised Barcelona inhabitants aged 20 years or older. Data on cancer deaths were supplied by the system of information on mortality. Educational level was obtained from the municipal census. Age-standardized rates by educational level were calculated. We also fitted Poisson regression models to estimate the relative index of inequality (RII) and the Slope Index of Inequalities (SII). All were calculated for each sex and period (1992–1994, 1995–1997, 1998–2000, and 2001–2003).</p> <p>Results</p> <p>Cancer mortality was higher in men and women with lower educational level throughout the study period. Less-schooled men had higher mortality by stomach, mouth and pharynx, oesophagus, larynx and lung cancer. In women, there were educational inequalities for cervix uteri, liver and colon cancer. Inequalities of overall and specific types of cancer mortality remained stable in Barcelona; although a slight reduction was observed for some cancers.</p> <p>Conclusion</p> <p>This study has identified those cancer types presenting the greatest inequalities between men and women in recent years and shown that in Barcelona there is a stable trend in inequalities in the burden of cancer.</p

Cancer mortality by educational level in the city of Barcelona

The objective of this study was to examine the relationship between educational level and mortality from cancer in the city of Barcelona. The data were derived from a record linkage between the Barcelona Mortality Registry and the Municipal Census. The relative risks (RR) of death and 95% confidence intervals (CIs) according to level of education were derived from Poisson regression models. For all malignancies, men in the lowest educational level had a RR of death of 1.21 (95% CI 1.13–1.29) compared with men with a university degree, whereas for women a significant decreasing in risk was observed (RR 0.81; 95% CI 0.74–0.90). Among men, significant negative trends of increasing risk according to level of education were present for cancer of the mouth and pharynx (RR 1.70 for lowest vs. highest level of education), oesophagus (RR 2.14), stomach (RR 1.99), larynx (RR 2.56) and lung (RR 1.35). Among women, cervical cancer was negatively related to education (RR 2.62), whereas a positive trend was present for cancers of the colon (RR 0.76), pancreas (RR 0.59), lung (RR 0.55) and breast (RR 0.65). The present study confirms for the first time, at an individual level, the existence of socioeconomic differences in mortality for several cancer sites in Barcelona, Spain. There is a need to implement health programmes and public health policies to reduce these inequities. © 1999 Cancer Research Campaig

Ultrafine particles and black carbon personal exposures in asthmatic and non-asthmatic children at school age.

Traffic-related air pollution (TRAP) exposure during childhood is associated with asthma; however, the contribution of the different TRAP pollutants in each microenvironment (home, school, transportation, others) in asthmatic and non-asthmatic children is unknown. Daily (24-h) personal black carbon (BC), ultrafine particle (UFP), and alveolar lung-deposited surface area (LDSA) individual exposure measurements were obtained from 100 children (29 past and 21 current asthmatics, 50 non-asthmatics) aged 9±0.7 years from the INMA-Sabadell cohort (Catalonia, Spain). Time spent in each microenvironment was derived by the geolocation provided by the smartphone and a new spatiotemporal map-matching algorithm. Asthmatics and non-asthmatics spent the same amount of time at home (60% and 61%, respectively), at school (20% and 23%), on transportation (8% and 7%), and in other microenvironments (7% and 5%). The highest concentrations of all TRAPs were attributed to transportation. No differences in TRAP concentrations were found overall or by type of microenvironment between asthmatics and non-asthmatics, nor when considering past and current asthmatics, separately. In conclusion, asthmatic and non-asthmatic children had a similar time-activity pattern and similar average exposures to BC, UFP, and LDSA concentrations. This suggests that interventions should be tailored to general population, rather than to subgroups defined by disease

Dilemes ètics en la gestió de la incapacitat transitòria

La gestió de la Incapacitat Transitòria (IT), planteja freqüents dubtes al metge i sobretot al metge d'atenció primària. Amb l'objectiu de servir de guia i il·lustrar el que és el raonament ètic aplicat a la consulta diària, exposarem un cas en el ben entès que, encara que no s'hagi d'aplicar mimèticament a altres similars, puguin orientar al nostre col·lectiu. Aquest cas, l'utilitzarem per a dissenyar els passos a seguir en cada situació i intentar establir un marc general de maneig de la IT. Quedi clar que ens importa quasi més el raonament ètic que el resultat final donat al cas, doncs el lector pot arribar a solucions diferents des de l'òptica de la seva realitat concreta. En tot cas, el dolor moral que produeix l'error, sempre queda atenuat pel fet d'haver-nos esforçat en cercar la millor solució

Long-term effectiveness of irreversible electroporation in a murine model of colorectal liver metastasis

Irreversible electroporation (IRE) has recently gained in popularity as an ablative technique, however little is known about its oncological long-term outcomes. To determine the long-time survival of animals treated with a high dose of IRE and which histological changes it induces in tumoral tissue, IRE ablation was performed in forty-six athymic-nude mice with KM12C tumors implanted in the liver by applying electric current with different voltages (2000 V/cm, 1000 V/cm). The tumors were allowed to continue to grow until the animals reached the end-point criteria. Histology was harvested and the extent of tumor necrosis was semi-quantitatively assessed. IRE treatment with the 2000 V/cm protocol significantly prolonged median mouse survival from 74.3 +/- 6.9 days in the sham group to 112.5 +/- 15.2 days in the 2000 V/cm group. No differences were observed between the mean survival of the 1000 V/cm and the sham group (83.2 +/- 16.4 days, p = 0.62). Histology revealed 63.05% +/- 23.12 of tumor necrosis in animals of the 2000 V/cm group as compared to 17.50% +/- 2.50 in the 1000 V/cm group and 25.6% +/- 22.1 in the Sham group (p = 0.001). IRE prolonged the survival of animals treated with the highest electric field (2000 V/cm). The animals in this group showed significantly higher rate of tumoral necrosis

Long-term effectiveness of irreversible electroporation in a murine model of colorectal liver metastasis

Irreversible electroporation (IRE) has recently gained in popularity as an ablative technique, however little is known about its oncological long-term outcomes. To determine the long-time survival of animals treated with a high dose of IRE and which histological changes it induces in tumoral tissue, IRE ablation was performed in forty-six athymic-nude mice with KM12C tumors implanted in the liver by applying electric current with different voltages (2000V/cm, 1000V/cm). The tumors were allowed to continue to grow until the animals reached the end-point criteria. Histology was harvested and the extent of tumor necrosis was semi-quantitatively assessed. IRE treatment with the 2000V/cm protocol significantly prolonged median mouse survival from 74.3±6.9 days in the sham group to 112.5±15.2 days in the 2000V/cm group. No differences were observed between the mean survival of the 1000V/cm and the sham group (83.2±16.4 days, p=0.62). Histology revealed 63.05%±23.12 of tumor necrosis in animals of the 2000V/cm group as compared to 17.50%±2.50 in the 1000V/cm group and 25.6%±22.1 in the Sham group (p=0.001). IRE prolonged the survival of animals treated with the highest electric field (2000V/cm). The animals in this group showed significantly higher rate of tumoral necrosis