Nuevos factores asociados a la densidad mamográfica

El cáncer de mama es el tipo de cáncer más frecuente en las mujeres españolas, con una cifra estimada de 25.000 casos nuevos cada año. Uno de los marcadores de riesgo más importantes y más estudiados en la actualidad para este tipo de tumor es la densidad mamográfica (DM), que se corresponde con la proporción de área clara de la imagen mamográfica. La DM se ha asociado con la mayoría de los factores de riesgo clásicos de cáncer de mama, pero existen aún lagunas sobre su posible relación con exposiciones asociadas al riesgo de tener este tumor, como por ejemplo, la disrupción del ritmo circadiano, o en exposiciones cuya relación con el cáncer de mama está aún en estudio como son los problemas tiroideos.Según la Agencia Internacional para la Investigación en Cáncer (IARC), el trabajo en turnos de noche que implica disrupción circadiana es probablemente carcinogénico en humanos (Grupo-2A). Es una exposición frecuente, ya que del 12% al 22% de los trabajadores en España lo hacen en turno de noche. A pesar de estos datos, el estudio del trabajo en turnos nocturnos y de problemas de sueño con relación a la DM es muy escaso..

Association of nutritional support programs with zinc deficiency in Colombian children: a cross-sectional study

Background: Zinc is an essential trace element that plays a key role in the immune, gastrointestinal, respiratory and nervous systems. In Colombia, a vast percentage of children live in low-income households with food insecurity and nutritional deficiencies, including zinc. In an effort to improve children's well-being, public health measures such as nutritional support programs that provide meals have targeted the poorest populations. The aim of the present study was to assess the role of nutritional support programs on zinc deficiency in Colombian children, while considering their wealth and food security.Methods: Cross-sectional study using data from the 2010 Colombian National Nutrition Survey, a population-based study representative of Colombia. A total of 4275 children between 12 and 59months of age were included in the study. Stepwise logistic regressions were modelled with SPSS, first for zinc deficiency on wealth and food security, then adding enrolment in a nutritional support program, and finally, adjusting for socio-demographic variables.Results: A zinc deficiency prevalence of 49% was found. The adjusted models showed an association of wealth quintiles: very poor (OR=1.48) and poor (OR=1.39), food security (OR=0.75) and enrolment in a nutritional support program (OR=0.76) with zinc deficiency. Enrolment in nutritional programs did not modify the relationship of wealth and food security to zinc deficiency.Conclusion: Zinc deficiency is associated with wealth, food security and enrolment in nutritional support programs. Nutritional programs may be a good alternative against zinc deficiency, if they focus appropriately on the needs of children according to their wealth and food security

PREVENTION OF ORAL MUCOSITIS IN CANCER PATIENTS WITH ANTINEOPLASIC TREATMENT: A SYSTEMATIC REVIEW

Objective: To evaluate the effectiveness of interventions for the prevention of oral mucositis in cancer patients antineoplasic treated.Methods: The Cochrane Oral Health Group Trials Register, MEDLINE LILACS y SCIELO were searched. Randomized clinical trials were selected. The preventive measures must have been begun the first day of the antineoplasic treatment. Only were include the studies publish in the last 10 years. Review the title and abstract of each result of the search and extracted the outcome measures and results in duplicate. Meta-analysis was performed when two or more studies use the same intervention and was comparable. The statistical analysis was made by EPIDAT y RevMan 5.Results: Forty six studies were eligible, 24 were excluded. Fifteen interventions were evaluated, of the included interventions in this study nine showed evidence of some benefit for either preventing or reducing the severity of mucositis, three interventions were present in more than one study and comparable for performing meta-analysis: amifostine, laser He/Ne y zinc. The meta-analysis of zinc was the only one that showed beneficial effect in preventing moderate and severe mucositis.Conclusions: Especially administration of zinc, honey and sucralfate had showed some benefit at preventing or reducing the severity of mucositis associated with cancer treatment. Nevertheless the quality and the sample size of these studies are not enough for recommend and specific intervention instead of another.Objetivo: Evaluar la efectividad clínica de intervenciones preventivas sistémicas o tópicas para la mucositis oral secundaria a tratamientos antineoplásicos en adultos con cáncer.Materiales y métodos: Se realizaron búsquedas en Cochrane, MEDLINE, LILACS y SCIELO. Fueron seleccionados ensayos clínicos controlados aleatorizados. Las medidas preventivas debían ser iniciadas el mismo día del inicio del tratamiento antineoplásico. Se incluyeron límites de tiempo en la búsqueda. Inicialmente se revisaron título y resumen de todos los estudios resultantes de la búsqueda y posteriormente en texto completo, la extracción de resultados se realizó por duplicado y las diferencias fueron resueltas por discusión. Se hizó un metanálisis con los estudios que fueron comparables en los programas EPIDAT y REVMAN 5.Resultados: Cuarenta y seis estudios fueron elegibles de los cuales se excluyeron 24. Se evaluaron 15 intervenciones preventivas, de ellas, nueve presentaron algún beneficio, tres intervenciones se presentaron en más de un estudio y fueron comparables para la realización de metanálisis: el amifostine, láser He/Ne y zinc. El zinc fue el único que mostró beneficio; el riesgo de desarrollar mucositis grado 2 en los pacientes que recibieron zinc fue 20% menor que en el grupo control y 73% menor para desarrollar mucositis grado 3.Conclusiones: La administración del zinc, la miel y el sucralfate han mostrado algún beneficio en la prevención o la reducción de la severidad de la mucositis asociada con el tratamiento del cáncer. La calidad y el tamaño de la muestra de estos estudios no son suficientes para recomendar estas intervenciones específicas.[Otero JA, Torres H, Pedraza AM, González AE. Prevención de la mucositis oral secundaria a tratamientos oncológicos en adultos con cáncer: revisión sistemática. Ustasalud 2011; 10: 11 - 28

Long-term nightshift work and breast cancer risk: An updated systematic review and meta-analysis with special attention to menopausal status and to recent nightshift work

This systematic review discusses long-term NSW and female BC risk, with special attention to differences between pre-and postmenopausal BC, to test the association with recent NSW. The review follows PRISMA guidelines (Prospero registry: CRD42018102515). We searched PubMed, Embase, and WOS for case–control, nested case–control, and cohort studies addressing long-term NSW (≥15 years) as risk exposure and female BC as outcome until 31 December 2020. Risk of bias was evaluated with the Newcastle–Ottawa scale. Eighteen studies were finally in-cluded (eight cohorts; five nested case–control; five case–control). We performed meta-analyses on long-term NSW and BC risk; overall and by menopausal status; a subanalysis on recent long-term NSW, based on studies involving predominantly women below retirement age; and a dose– response meta-analysis on NSW duration. The pooled estimate for long-term NSW and BC was 1.13 (95%CI = 1.01–1.27; 18 studies, I2 = 56.8%, p = 0.002). BC risk increased 4.7% per 10 years of NSW (95%CI = 0.94–1.09; 16 studies, I2 = 33.4%, p = 0.008). The pooled estimate for premenopausal BC was 1.27 (95%CI = 0.96–1.68; six studies, I2 = 32.0%, p = 0.196) and for postmenopausal BC 1.05 (95%CI = 0.90–1.24, I2 = 52.4%; seven studies, p = 0.050). For recent long-term exposure, the pooled estimate was 1.23 (95%CI = 1.06–1.42; 15 studies; I2 = 48.4%, p = 0.018). Our results indicate that long-term NSW increases the risk for BC and that menopausal status and time since exposure might be relevant.This research received no external funding

High mammographic density in long-term night shift workers: DDM-Spain /Var-DDM

[EN] Background: Night-shift work (NSW) has been suggested as a possible cause of breast cancer, and its association with mammographic density (MD), one of the strongest risk factors for breast cancer, has been scarcely addressed. This study examined NSW and MD in Spanish women. Methods: The study covered 2,752 women aged 45-68 years recruited in 2007-2008 in 7 population-based public breast cancer screening centers, which included 243 women who had performed NSW for at least one year. Occupational data and information on potential confounders were collected by personal interview. Two trained radiologist estimated the percentage of MD assisted by a validated semiautomatic computer tool (DM-scan). Multivariable mixed linear regression models with random screening center-specific intercepts were fitted using log-transformed percentage of MD as the dependent variable and adjusting by known confounding variables. Results: Having ever worked in NSW was not associated with MD [e(beta):0.96; 95% confidence interval (CI), 0.86-1.06]. However, the adjusted geometric mean of the percentage of MD in women with NSW for more than 15 years was 25% higher than that of those without NSW history (MD>15 (years):20.7% vs. MDnever:16.5%; e(beta):1.25; 95% CI, 1.01-1.54). This association was mainly observed in postmenopausal participants (e(beta):1.28; 95% CI, 1.00-1.64). Among NSW-exposed women, those with <= 2 night-shifts per week had higher MD than those with 5 to 7 nightshifts per week (e(beta):1.42; 95% CI, 1.10-1.84). Conclusions: Performing NSW was associated with higherMD only in women with more than 15 years of cumulated exposure. These findings warrant replication in futures studies. (C)2017 AACR.We would like to thank the participants in the DDM-Spain/Var-DDM-Spain study for their contribution to breast cancer research. Other members of DDM-Spain/Var-DDM: Gonzalo. López-Abente, Roberto Pastor-Barriuso, Pablo Fernández-Navarro, Anna Cabanes, Soledad Laso, Manuela Alcaraz, María Casals, Inmaculada Martínez, Juan Carlos Pérez Cortés, Joaquín Antón, Nieves Ascunce, Isabel González-Román, Ana Belén Fernández, Montserrat Corujo, Soledad Abad, and Jesús Vioque. A.M. Pedraza-Flechas FI14CIII/00013 PFIS; B. Perez-Gomez FIS PS09/0790; M. Pollán FIS PI060386, EPY1306/06 collaboration agreement between Astra-Zeneca and ISCIII, and FECMA 485 EPY 1170 10; R. LLobet Gent per Gent Fund (EDEMAC Project); All authors: European Regional Development Fund (FEDER). The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.Pedraza-Flechas, AM.; Lope, V.; Sanchez-Contador, C.; Santamarina, C.; Pedraz-Pingarron, C.; Moreo, P.; Ederra, M.... (2017). High mammographic density in long-term night shift workers: DDM-Spain /Var-DDM. Cancer Epidemiology Biomarkers & Prevention. 26(6):905-913. https://doi.org/10.1158/1055-9965.EPI-16-0507S90591326

Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study

[EN] We explored the relationship between sleep patterns and sleep disorders and mammographic density (MD), a marker of breast cancer risk. Participants in the DDM-Spain/var-DDM study, which included 2878 middle-aged Spanish women, were interviewed via telephone and asked questions on sleep characteristics. Two radiologists assessed MD in their left craneo-caudal mammogram, assisted by a validated semiautomatic-computer tool (DM-scan). We used log-transformed percentage MD as the dependent variable and fitted mixed linear regression models, including known confounding variables. Our results showed that neither sleeping patterns nor sleep disorders were associated with MD. However, women with frequent changes in their bedtime due to anxiety or depression had higher MD (e¿:1.53;95%CI:1.04¿2.26).This work was supported by grants from the Spanish Ministry of Economy and Competitiveness - Carlos III Institute of Health (ISCIII) (FI14CIII/00013, FIS PI060386 & PS09/0790), from the Spanish Federation of Breast Cancer Patients (FECMA 485 EPY 1170-10), Gent per Gent Fund (EDEMAC Project), the EPY1306/06 collaboration agreement between Astra-Zeneca and the ISCIII and partially funded by the European Regional Development Fund (FEDER)Pedraza-Flechas, AM.; Lope, V.; Moreo, P.; Ascunce, N.; Miranda-García, J.; Vidal, C.; Sánchez-Contador, C.... (2017). Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study. Maturitas. 99:105-108. https://doi.org/10.1016/j.maturitas.2017.02.015S1051089

Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

En Colombia, actualmente no existen parámetros claros para el diagnóstico de pacientes con talla baja, ni sobre el tratamiento de esta población con hormona de crecimiento recombinante humana (somatropina), lo cual se ve favorecido por la diversidad de programas de formación de profesionales en endocrinología pediátrica. En respuesta a esta problemática se realizó el primer acuerdo colombiano de expertos en talla baja liderado por la Asociación Colegio Colombiana de Endocrinología Pediátrica (ACCEP); este trabajo contó con la participación y el aval de expertos clínicos de importantes instituciones de salud públicas y privadas del país, además de expertos metodológicos del instituto Keralty, quienes garantizaron la estandarización del uso de la somatropina. Después de realizar una minuciosa revisión de la literatura, se propone la unificación de definiciones, un algoritmo diagnóstico, los parámetros de referencia de las pruebas bioquímicas y dinámicas, una descripción de las consideraciones de uso de la somatropina para el tratamiento de las patologías con aprobación por la entidad regulatoria de medicamentos y alimentos en Colombia y, por último, un formato de consentimiento informado y de ficha técnica del medicamento.In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinanthuman growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation,the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order tostandardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium ofclinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada deServicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private healthinstitutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia ClínicaKeralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm,biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use amongthe indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consentand a medication fact sheet available for parents and patients.https://orcid.org/0000-0002-7856-7213https://orcid.org/0000-0003-2241-7854Revista Nacional - Indexad

Gynaecological cancer and night shift work: A systematic review

Night shift work can affect hormonal balance, and so might be a risk factor for gynaecological malignancies. This report presents a systematic review on the association between this occupational exposure and the incidence of gynaecological cancers other than breast cancer. We searched for original articles addressing this issue in PubMed/MEDLINE, EMBASE and Web of Science, and used the Newcastle–Ottawa Quality Index to evaluate the methodological quality of those reports selected for review. Globally, we found only six articles, which provided the results of just six research studies: four examined ovarian cancer, two endometrial tumours and two cervical cancer. Our results show that this matter has received scant attention from the research community, and that the little evidence available does not show any clear relationship between night shift work and ovarian, endometrial or cervical cancer. More prospective rigorous studies are needed to evaluate these associations. © 2018 Elsevier B.V

Association of nutritional support programs with zinc deficiency in Colombian children: a cross-sectional study

Background: Zinc is an essential trace element that plays a key role in the immune, gastrointestinal, respiratory and nervous systems. In Colombia, a vast percentage of children live in low-income households with food insecurity and nutritional deficiencies, including zinc. In an effort to improve children's well-being, public health measures such as nutritional support programs that provide meals have targeted the poorest populations. The aim of the present study was to assess the role of nutritional support programs on zinc deficiency in Colombian children, while considering their wealth and food security.Methods: Cross-sectional study using data from the 2010 Colombian National Nutrition Survey, a population-based study representative of Colombia. A total of 4275 children between 12 and 59months of age were included in the study. Stepwise logistic regressions were modelled with SPSS, first for zinc deficiency on wealth and food security, then adding enrolment in a nutritional support program, and finally, adjusting for socio-demographic variables.Results: A zinc deficiency prevalence of 49% was found. The adjusted models showed an association of wealth quintiles: very poor (OR=1.48) and poor (OR=1.39), food security (OR=0.75) and enrolment in a nutritional support program (OR=0.76) with zinc deficiency. Enrolment in nutritional programs did not modify the relationship of wealth and food security to zinc deficiency.Conclusion: Zinc deficiency is associated with wealth, food security and enrolment in nutritional support programs. Nutritional programs may be a good alternative against zinc deficiency, if they focus appropriately on the needs of children according to their wealth and food security

Hepatitis B virus infection and vaccine-induced immunity in Madrid (Spain)

Objective: To estimate the prevalence of hepatitis B virus (HBV) infection and vaccine-induced immunity in the region of Madrid, and to analyze their evolution over time. Methods: An observational, analytical, cross-sectional study was carried out in the population aged 16–80 years between 2008 and 2009. This was the last of four seroprevalence surveys in the region of Madrid. The prevalence of HBV infection and vaccine-induced immunity was estimated using multivariate logistic models and were compared with the prevalences in the 1989, 1993 and 1999 surveys. Results: In the population aged 16–80 years, the prevalence of HBV infection was 11.0% (95% CI: 9.8–12.3) and that of chronic infection was 0.7% (95% CI: 0.5–1.1). The prevalence of vaccine-induced immunity in the population aged 16–20 years was 73.0% (95% CI: 70.0–76.0). Compared with previous surveys, there was a decrease in the prevalence of HBV infection. Conclusions: Based on the prevalence of chronic infection (<1%), Madrid is a region with low HBV endemicity. Preventive strategies against HBV should especially target the immigrant population