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Miret C, Orive M, Sala M, García-Gutiérrez S, Sarasqueta C, Legarreta MJ, Redondo M, Rivero A, Castells X, Quintana JM, Garin O, Ferrer M. Correction: Reference values of EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-5L for women with non-metastatic breast cancer at diagnosis and 2 years after. Qual Life Res 2024; 33:1433-1435. [PMID: 38457055 PMCID: PMC11045562 DOI: 10.1007/s11136-024-03628-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Carme Miret
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, i Universitat Pompeu Fabra, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Miren Orive
- Departamento Psicología Social, Facultad Farmacia, UPV/EHU, Vitoria-Gasteiz, Araba, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Maria Sala
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, i Universitat Pompeu Fabra, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
| | - Susana García-Gutiérrez
- Osakidetza Basque Health Service, Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Bizkai, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Cristina Sarasqueta
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Biodonostia Health Research Institute, Donostia University Hospital, Donostia, Gipuzkoa, Spain
| | - Maria Jose Legarreta
- Osakidetza Basque Health Service, Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Bizkai, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Research and Innovation Unit, Hospital Costa del Sol, Marbella, Spain
| | - Amado Rivero
- Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
| | - Xavier Castells
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, i Universitat Pompeu Fabra, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
| | - José M Quintana
- Osakidetza Basque Health Service, Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Bizkai, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Olatz Garin
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
- Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
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Giannoula A, Comas M, Castells X, Estupiñán-Romero F, Bernal-Delgado E, Sanz F, Sala M. Exploring long-term breast cancer survivors' care trajectories using dynamic time warping-based unsupervised clustering. J Am Med Inform Assoc 2024; 31:820-831. [PMID: 38193340 PMCID: PMC10990519 DOI: 10.1093/jamia/ocad251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Long-term breast cancer survivors (BCS) constitute a complex group of patients, whose number is estimated to continue rising, such that, a dedicated long-term clinical follow-up is necessary. MATERIALS AND METHODS A dynamic time warping-based unsupervised clustering methodology is presented in this article for the identification of temporal patterns in the care trajectories of 6214 female BCS of a large longitudinal retrospective cohort of Spain. The extracted care-transition patterns are graphically represented using directed network diagrams with aggregated patient and time information. A control group consisting of 12 412 females without breast cancer is also used for comparison. RESULTS The use of radiology and hospital admission are explored as patterns of special interest. In the generated networks, a more intense and complex use of certain healthcare services (eg, radiology, outpatient care, hospital admission) is shown and quantified for the BCS. Higher mortality rates and numbers of comorbidities are observed in various transitions and compared with non-breast cancer. It is also demonstrated how a wealth of patient and time information can be revealed from individual service transitions. DISCUSSION The presented methodology permits the identification and descriptive visualization of temporal patterns of the usage of healthcare services by the BCS, that otherwise would remain hidden in the trajectories. CONCLUSION The results could provide the basis for better understanding the BCS' circulation through the health system, with a view to more efficiently predicting their forthcoming needs and thus designing more effective personalized survivorship care plans.
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Affiliation(s)
- Alexia Giannoula
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- Research Programme on Biomedical Informatics (GRIB), Department of Medicine and Life Sciences (MELIS), Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Mercè Comas
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Francisco Estupiñán-Romero
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences (IACS), Zaragoza, Aragon, 50009, Spain
| | - Enrique Bernal-Delgado
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences (IACS), Zaragoza, Aragon, 50009, Spain
| | - Ferran Sanz
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- Research Programme on Biomedical Informatics (GRIB), Department of Medicine and Life Sciences (MELIS), Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Sala
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
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Abbad-Gomez D, Domingo L, Comas M, Santiá P, Jansana A, Poblador B, Sanz T, Del Cura I, Ibañez B, Padilla M, Redondo M, Castells X, Sala M. Effect of comorbidity and multimorbidity on adherence to follow-up recommendations among long-term breast cancer survivors. Maturitas 2024; 182:107918. [PMID: 38280353 DOI: 10.1016/j.maturitas.2024.107918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/22/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES To study the impact of comorbidities, multimorbidity, and multimorbidity clusters on adherence to recommended follow-up guidelines among long-term breast cancer survivors. STUDY DESIGN Retrospective cohort study based on 2078 women diagnosed with breast cancer from 2000 to 2006 and followed up from 2012 to 2016. MAIN OUTCOME MEASURES Adherence to breast cancer follow-up recommendations (annual medical visit and imaging) was determined. Comorbidities were classified as acute/chronic. Multimorbidity was defined as the presence of two or more chronic comorbidities aside from breast cancer. Five multimorbidity clusters were considered. Multivariate logistic regression models were fitted to determine the relationship between adherence to recommendations and the presence of comorbidities and multimorbidity, considering both sociodemographic and clinical characteristics. RESULTS Overall adherence to recommendations was 79.5 %. Adherence was lower among long-term breast cancer survivors with no comorbidities (75.8 %). Among multimorbidity clusters, adherence was highest in the anxiety and fractures cluster (84.3 %) and was lowest in the musculoskeletal and cardiovascular cluster (76.4 %). In adjusted multivariate models, multimorbidity was associated with higher levels of adherence (OR = 1.52 95 %CI 1.16-1.99), and adherence was highest in the metabolic and degenerative cluster (OR = 2.2 95 %CI 1.4-3.5). CONCLUSION Adherence to follow-up recommendations was higher among long-term breast cancer survivors with multimorbidity than among those without. Adherence also differed by multimorbidity cluster. These results suggest suboptimal adherence to the current follow-up recommendations in certain groups, suggesting the need to adapt clinical practice guidelines to reflect patients' comorbidities and different characteristics.
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Affiliation(s)
- David Abbad-Gomez
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; PhD Program in Biomedicine, Universitat Pompeu Fabra, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain.
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Paula Santiá
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Anna Jansana
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Nutrition and Metabolism Branch, International Agency for Research On Cancer (IARC-WHO), 25 Avenue Tony Garnier, Lyon, France
| | - Beatriz Poblador
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Teresa Sanz
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Madrid Health Service, Primary Care Research Unit, Madrid, Spain
| | - Isabel Del Cura
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Madrid Health Service, Primary Care Research Unit, Madrid, Spain
| | - Berta Ibañez
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Navarrabiomed, HUN, UPNA, IdISNA. Pamplona, Spain
| | - Maria Padilla
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maximino Redondo
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
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Aránguiz-Ramírez J, Olivares-Tirado P, Baeza-Correa C, Castells X. Urinary incontinence in health workers as a predisposing factor for presenteeism in Chile: A mixed-methods exploratory study. Medwave 2024; 24:e2779. [PMID: 38412202 DOI: 10.5867/medwave.2024.01.2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Introduction Urinary incontinence negatively impacts the quality of life and can harm work activities, causing presenteeism in health professionals and decreasing the quality of care and patient safety. The objective of this study is to explore the self-perception of health workers who suffer from urinary incontinence as a predisposing factor for presenteeism. Methods Mixed study of an exploratory-descriptive nature. The sample was selected in a non-probabilistic and intentional way by criterion and convenience with a size of 14 volunteers, considering the saturation of the information. Reliability criteria defined by Guba for the process and analysis of thematic data were considered. Results The sample had a mean age of 38.9 + 7.1 years and a mean SPS-6 score of 15.8 + 3.5 points, showing alteration in the dimension of avoiding deconcentration. The narratives in the case study provide relevant information on how urinary incontinence affects the work performance of health workers through the interruption in their day, decreases the quality of clinical care, and increases their anxiety regarding their environment. Conclusions Urinary incontinence and presenteeism are subjective, and multidimensional experiences affect work performance. Therefore, further studies are recommended to identify predictor variables and the economic losses associated with this condition to establish improvements in the work environment and the self-care of female employees seeking greater benefits and better levels of efficiency in the organization.
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Affiliation(s)
- Julieta Aránguiz-Ramírez
- Programa de Doctorado en Metodología de la Investigación Biomédica y Salud Pública, Departamento de Pediatría, Obstetricia y Ginecología, Medicina Preventiva y Salud Pública, Universidad Autónoma de Barcelona, Barcelona, España
| | - Pedro Olivares-Tirado
- Centro de Investigación en Innovación Terapéutica del Programa de Postgrado en Gestión y Economía de la Salud, Universidad Federal de Pernambuco, Recife, Brasil
| | - Cecilia Baeza-Correa
- Escuela de Obstetricia y Neonatología, Facultad de Salud y Odontología, Universidad Diego Portales, Santiago, Chile
| | - Xavier Castells
- Departamento de Epidemiología y Evaluación, Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, España
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Laza C, Niño de Guzmán E, Gea M, Plazas M, Posso M, Rué M, Castells X, Román M. "For and against" factors influencing participation in personalized breast cancer screening programs: a qualitative systematic review until March 2022. Arch Public Health 2024; 82:23. [PMID: 38389068 PMCID: PMC10882761 DOI: 10.1186/s13690-024-01248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Personalized breast cancer screening is a novel strategy that estimates individual risk based on age, breast density, family history of breast cancer, personal history of benign breast lesions, and polygenic risk. Its goal is to propose personalized early detection recommendations for women in the target population based on their individual risk. Our aim was to synthesize the factors that influence women's decision to participate in personalized breast cancer screening, from the perspective of women and health care professionals. METHODS Systematic review of qualitative evidence on factors influencing participation in personalized Breast Cancer Screening. We searched in Medline, Web of science, Scopus, EMBASE, CINAHL and PsycINFO for qualitative and mixed methods studies published up to March 2022. Two reviewers conducted study selection and extracted main findings. We applied the best-fit framework synthesis and adopted the Multilevel influences on the cancer care continuum model for analysis. After organizing initial codes into the seven levels of the selected model, we followed thematic analysis and developed descriptive and analytical themes. We assessed the methodological quality with the Critical Appraisal Skills Program tool. RESULTS We identified 18 studies published between 2017 and 2022, conducted in developed countries. Nine studies were focused on women (n = 478) and in four studies women had participated in a personalized screening program. Nine studies focused in health care professionals (n = 162) and were conducted in primary care and breast cancer screening program settings. Factors influencing women's decision to participate relate to the women themselves, the type of program (personalized breast cancer screening) and perspective of health care professionals. Factors that determined women participation included persistent beliefs and insufficient knowledge about breast cancer and personalized screening, variable psychological reactions, and negative attitudes towards breast cancer risk estimates. Other factors against participation were insufficient health care professionals knowledge on genetics related to breast cancer and personalized screening process. The factors that were favourable included the women's perceived benefits for themselves and the positive impact on health systems. CONCLUSION We identified the main factors influencing women's decisions to participate in personalized breast cancer screening. Factors related to women, were the most relevant negative factors. A future implementation requires improving health literacy for women and health care professionals, as well as raising awareness of the strategy in society.
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Affiliation(s)
- Celmira Laza
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
| | - Ena Niño de Guzmán
- Cancer Prevention and Control Program, Institut Català d' Oncologia, Barcelona, Spain
| | - Montserrat Gea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
| | - Merideidy Plazas
- Cochrane Associated Center- University Foundation of Health Sciences, Bogotá, Colombia
| | - Margarita Posso
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Montserrat Rué
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
- Basic Medical Sciences, University of Lleida, Lleida, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain.
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Eriksson M, Román M, Gräwingholt A, Castells X, Nitrosi A, Pattacini P, Heywang-Köbrunner S, Rossi PG. European validation of an image-derived AI-based short-term risk model for individualized breast cancer screening-a nested case-control study. Lancet Reg Health Eur 2024; 37:100798. [PMID: 38362558 PMCID: PMC10866984 DOI: 10.1016/j.lanepe.2023.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024]
Abstract
Background Image-derived artificial intelligence (AI)-based risk models for breast cancer have shown high discriminatory performances compared with clinical risk models based on family history and lifestyle factors. However, little is known about their generalizability across European screening settings. We therefore investigated the discriminatory performances of an AI-based risk model in European screening settings. Methods Using four European screening populations in three countries (Italy, Spain, Germany) screened between 2009 and 2020 for women aged 45-69, we performed a nested case-control study to assess the predictive performance of an AI-based risk model. In total, 739 women with incident breast cancers were included together with 7812 controls matched on year of study-entry. Mammographic features (density, microcalcifications, masses, left-right breast asymmetries of these features) were extracted using AI from negative digital mammograms at study-entry. Two-year absolute risks of breast cancer were predicted and assessed after two years of follow-up. Adjusted risk stratification performance metrics were reported per clinical guidelines. Findings The overall adjusted Area Under the receiver operating characteristic Curve (aAUC) of the AI risk model was 0.72 (95% CI 0.70-0.75) for breast cancers developed in four screening populations. In the 6.2% [529/8551] of women at high risk using the National Institute of Health and Care Excellence (NICE) guidelines thresholds, cancers were more likely diagnosed after 2 years follow-up, risk-ratio (RR) 6.7 (95% CI 5.6-8.0), compared with the 69% [5907/8551] of women classified at general risk by the model. Similar risk-ratios were observed across levels of mammographic density. Interpretation The AI risk model showed generalizable discriminatory performances across European populations and, predicted ∼30% of clinically relevant stage 2 and higher breast cancers in ∼6% of high-risk women who were sent home with a negative mammogram. Similar results were seen in women with fatty and dense breasts. Funding Swedish Research Council.
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Affiliation(s)
- Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Marta Román
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Andrea Nitrosi
- Azienda Unitá Sanitaria Locale-IRCCS di Reggio Emilia, Reggia Emilia, Italy
| | | | | | - Paolo G. Rossi
- Azienda Unitá Sanitaria Locale-IRCCS di Reggio Emilia, Reggia Emilia, Italy
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Jørgensen SF, Sagstad S, Louro J, Román M, Castells X, Hofvind S, Njor S. Comparisons of assessment pathways after abnormal mammography screening in Denmark, Norway, and Spain. Breast Cancer Res Treat 2024:10.1007/s10549-023-07219-0. [PMID: 38285110 DOI: 10.1007/s10549-023-07219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To ensure high-quality screening programmes and effective utilization of resources, it is important to monitor how cancer detection is affected by different strategies performed at recall assessment. This study aimed to describe procedures performed at recall assessment and compare and evaluate the performance of the assessment in Denmark, Norway, and Spain in terms of screen-detected cancer (SDC) and interval cancer (IC) rates. METHODS We included women aged 50-69 years from Denmark, Norway, and Spain, who were recalled for assessment after screening mammography, and recorded all procedures performed during six months after diagnosis, and the timing of the procedures. Women were followed for two years and screen-detected and interval cancer, and sensitivity of recall was calculated and compared. RESULTS In total, data from 24,645 Danish, 30,050 Norwegian, and 41,809 Spanish women were included in the study. Most of the women had some assessment within 2 months in all three countries. SDC rates were higher in Denmark (0.57) and Norway (0.60) compared to Spain (0.38), as were the IC rates, i.e. 0.25 and 0.18 vs. 0.12, respectively. The sensitivity of the diagnostic follow-up was somewhat higher in Denmark (98.3%) and Norway (98.2%), compared to Spain (95.4%), but when excluding non-invasive assessment pathways, the sensitivities were comparable. CONCLUSION This comparison study showed variation in the assessment procedures used in the three countries as well as the SDC and IC rates and the sensitivity of recall.
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Affiliation(s)
- Susanne Fogh Jørgensen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NE, Denmark.
- Department of Data, Innovation and Research, Lillebaelt Hospital, Beriderbakken 4, 7100, Vejle, Denmark.
| | - Silje Sagstad
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Solveig Hofvind
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, The Arctic University of Norway, Tromsö, Norway
| | - Sisse Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NE, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Data, Innovation and Research, Lillebaelt Hospital, Beriderbakken 4, 7100, Vejle, Denmark
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Sisteré-Oró M, Du J, Wortmann DDJ, Filippi MD, Cañas-Ruano E, Arrieta-Aldea I, Marcos-Blanco A, Castells X, Grau S, García-Giralt N, Perez-Zsolt D, Boreika R, Izquierdo-Useros N, Güerri-Fernandez R, Meyerhans A. Pan-pox-specific T-cell responses in HIV-1-infected individuals after JYNNEOS vaccination. J Med Virol 2024; 96:e29317. [PMID: 38150509 DOI: 10.1002/jmv.29317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023]
Abstract
People living with human immunodeficiency virus (HIV) are the individuals most affected by the current Monkeypox virus outbreak that was first announced in May 2022. Here we report Pan-pox-specific T-cell responses in a cohort of HIV-1-infected individuals after receiving the nonreplicative, attenuated smallpox vaccine JYNNEOS from Bavarian Nordic. Intradermal (i.d.) and subcutaneous (s.c.) vaccination was safe without major side effects. Dose-sparing i.d. vaccination was superior to s.c. vaccination and promoted T-cell polyfunctionality, and the expression of the gut-homing marker α4β7 integrin on lymphocytes. HIV-1-infected individuals with CD4 T-cell counts ≤500/mm3 blood required at least a booster vaccination to exhibit efficient virus-specific T-cell responses. The magnitude of the Th1 response after this booster directly correlated with the CD4 T-cell count of the vaccinees. Further studies with a larger number of participants are warranted to confirm and expand our observations.
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Affiliation(s)
- Marta Sisteré-Oró
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Juan Du
- Infectious Diseases Unit, Hospital del Mar Research Institute, Barcelona, Spain
| | - Diana D J Wortmann
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Marina D Filippi
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | | | | | - Xavier Castells
- Preventive Medicine Unit, Hospital del Mar Research Institute, Barcelona, Spain
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Natalia García-Giralt
- Infectious Diseases Unit, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Daniel Perez-Zsolt
- IrsiCaixa, AIDS Research Institute, Can Ruti Campus, UAB, Badalona, Spain
| | - Rytis Boreika
- IrsiCaixa, AIDS Research Institute, Can Ruti Campus, UAB, Badalona, Spain
| | - Nuria Izquierdo-Useros
- IrsiCaixa, AIDS Research Institute, Can Ruti Campus, UAB, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Robert Güerri-Fernandez
- Infectious Diseases Unit, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona (UPF), Barcelona, Spain
| | - Andreas Meyerhans
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ICREA, Catalan Institution for Research and Advanced Studies Pg. Lluís Companys 23, Barcelona, Spain
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9
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Bessa X, Vidal J, Balboa JC, Márquez C, Duenwald S, He Y, Raymond V, Faull I, Burón A, Álvarez-Urturi C, Castells X, Bellosillo B, Montagut C. High accuracy of a blood ctDNA-based multimodal test to detect colorectal cancer. Ann Oncol 2023; 34:1187-1193. [PMID: 37805131 DOI: 10.1016/j.annonc.2023.09.3113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Detection of circulating tumor DNA (ctDNA) is a minimally invasive and convenient blood-based screening strategy that may increase effectiveness of colorectal cancer (CRC) screening. PATIENTS AND METHODS A novel multimodal ctDNA-based blood assay that integrates genomics, epigenomics and fragmentomics, as well as proteomics in a refined version, was tested in blood samples from two cohorts: (i) consecutive fecal immunochemical test (FIT)-positive individuals from the CRC Barcelona stool-based screening program; (ii) patients diagnosed with CRC. Primary endpoint was the performance of the test to detect CRC at different tumor-node-metastasis (TNM) stages. Secondary endpoint was the ability of the test to detect advanced precancerous lesions (advanced adenoma or advanced serrated lesion). RESULTS A total of 623 blood samples were analyzed in the primary analysis. Sensitivity and specificity of the assay to detect CRC was 93% and 90%, respectively. The sensitivity of CRC detection according to TNM stages was 84% for stage I, 94% for stage II and 96% for stage III (70/73) (P< 0.024). Sensitivity to detect advanced precancerous lesions was 23% with a refined version of the test (including protein and updating bioinformatic thresholding). CONCLUSION A blood-based multimodal ctDNA assay detected CRC with high accuracy. This minimally invasive, accessible and convenient assay may help to increase the effectiveness of CRC screening.
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Affiliation(s)
- X Bessa
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona.
| | - J Vidal
- Medical Oncology Department, Hospital del Mar Research Institute, CIBERONC, Barcelona, Spain
| | - J C Balboa
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona
| | - C Márquez
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona
| | | | - Y He
- Guardant Health Inc., Redwood City, USA
| | - V Raymond
- Guardant Health Inc., Redwood City, USA
| | - I Faull
- Guardant Health Inc., Redwood City, USA
| | - A Burón
- Epidemiology and Evaluation Department, Hospital del Mar Medical Research Institute, Barcelona, Spain; RICAPPS (Research Network on Chronicity, Primary Care and Prevention and Health Promotion), Madrid, Spain
| | - C Álvarez-Urturi
- Gastroenterology Department, Hospital del Mar Research Institute, Barcelona
| | - X Castells
- Epidemiology and Evaluation Department, Hospital del Mar Medical Research Institute, Barcelona, Spain; RICAPPS (Research Network on Chronicity, Primary Care and Prevention and Health Promotion), Madrid, Spain
| | - B Bellosillo
- Pathology Department, Hospital del Mar Medical Research Institute, CIBERONC, Barcelona, Spain
| | - C Montagut
- Medical Oncology Department, Hospital del Mar Research Institute, CIBERONC, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
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10
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Louro J, Román M, Moshina N, Olstad CF, Larsen M, Sagstad S, Castells X, Hofvind S. Personalized Breast Cancer Screening: A Risk Prediction Model Based on Women Attending BreastScreen Norway. Cancers (Basel) 2023; 15:4517. [PMID: 37760486 PMCID: PMC10526465 DOI: 10.3390/cancers15184517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND We aimed to develop and validate a model predicting breast cancer risk for women targeted by breast cancer screening. METHOD This retrospective cohort study included 57,411 women screened at least once in BreastScreen Norway during the period from 2007 to 2019. The prediction model included information about age, mammographic density, family history of breast cancer, body mass index, age at menarche, alcohol consumption, exercise, pregnancy, hormone replacement therapy, and benign breast disease. We calculated a 4-year absolute breast cancer risk estimates for women and in risk groups by quartiles. The Bootstrap resampling method was used for internal validation of the model (E/O ratio). The area under the curve (AUC) was estimated with a 95% confidence interval (CI). RESULTS The 4-year predicted risk of breast cancer ranged from 0.22-7.33%, while 95% of the population had a risk of 0.55-2.31%. The thresholds for the quartiles of the risk groups, with 25% of the population in each group, were 0.82%, 1.10%, and 1.47%. Overall, the model slightly overestimated the risk with an E/O ratio of 1.10 (95% CI: 1.09-1.11) and the AUC was 62.6% (95% CI: 60.5-65.0%). CONCLUSIONS This 4-year risk prediction model showed differences in the risk of breast cancer, supporting personalized screening for breast cancer in women aged 50-69 years.
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Affiliation(s)
- Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (J.L.); (M.R.); (X.C.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 48902 Barakaldo, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (J.L.); (M.R.); (X.C.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 48902 Barakaldo, Spain
| | - Nataliia Moshina
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Camilla F. Olstad
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Silje Sagstad
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (J.L.); (M.R.); (X.C.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 48902 Barakaldo, Spain
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
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11
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Badenes Bonet D, Caguana Vélez OA, Duran Jordà X, Comas Serrano M, Posso Rivera M, Admetlló M, Herranz Blasco A, Cuadrado Godia E, Marco Navarro E, Martin Ezquerra G, Pineiro Aguin Z, Cumpli Gargallo MC, Gonzalez Garcia JG, Balcells Vilarnau E, Rodriguez Chiaradia D, Castells X, Gea J, Horcajada JP, Villar-García J. Treatment of COVID-19 during the Acute Phase in Hospitalized Patients Decreases Post-Acute Sequelae of COVID-19. J Clin Med 2023; 12:4158. [PMID: 37373850 DOI: 10.3390/jcm12124158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The post-acute sequelae of SARS-CoV-2 (PASC) infection have caused a significant impact on our health system, but there is limited evidence of approved drugs focused on its prevention. Our objective was to identify risk factors that can determine the presence of PASC, with special attention to the treatment received in the acute phase, and to describe the profile of persistent symptoms in a multidisciplinary Post-Coronavirus Disease-19 (COVID-19) Unit. METHODS This one-year prospective observational study included patients following an acute COVID-19 infection, irrespective of whether they required hospital admission. A standardized symptom questionnaire and blood sampling were performed at the first follow-up visit, and demographic and clinical electronic data were collected. We compared subjects with PASC with those who had fully recovered. Multivariate logistic regression was performed to identify factors associated with PASC in hospitalized patients, and Kaplan-Meier curves were used to assess duration of symptoms according to disease severity and treatments received in the acute phase. RESULTS 1966 patients were evaluated; 1081 had mild disease, 542 moderate and 343 severe; around one third of the subjects had PASC, and were more frequently female, with obesity, asthma, and eosinophilia during acute COVID-19 disease. Patients who received treatment with dexamethasone and remdesivir during the course of the acute illness showed a lower median duration of symptoms, compared with those who received none of these treatments. CONCLUSION Treatment with dexamethasone and/or remdesivir may be useful to reduce the impact of PASC secondary to SARS-CoV-2 infection. In addition, we identified female gender, obesity, asthma, and disease severity as risk factors for having PASC.
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Affiliation(s)
- Diana Badenes Bonet
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Oswaldo Antonio Caguana Vélez
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Xavier Duran Jordà
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Assessoria Metodològica i Bioestadística (AMIB), 08003 Barcelona, Spain
| | - Merce Comas Serrano
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Margarita Posso Rivera
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Mireia Admetlló
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | | | - Ester Marco Navarro
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Zenaida Pineiro Aguin
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Otorrinolaringology Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Jose Gregorio Gonzalez Garcia
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Eva Balcells Vilarnau
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Diego Rodriguez Chiaradia
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Juan P Horcajada
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Judit Villar-García
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
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12
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Miret C, Orive M, Sala M, García-Gutiérrez S, Sarasqueta C, Legarreta MJ, Redondo M, Rivero A, Castells X, Quintana JM, Garin O, Ferrer M. Reference values of EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-5L for women with non-metastatic breast cancer at diagnosis and 2 years after. Qual Life Res 2023; 32:989-1003. [PMID: 36630024 PMCID: PMC10063520 DOI: 10.1007/s11136-022-03327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To obtain reference norms of EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-5L, based on a population of Spanish non-metastatic breast cancer patients at diagnosis and 2 years after, according to relevant demographic and clinical characteristics. METHODS Multicentric prospective cohort study including consecutive women aged ≥ 18 years with a diagnosis of incident non-metastatic breast cancer from April 2013 to May 2015. Health-related quality of life (HRQoL) questionnaires were administered between diagnosis and beginning the therapy, and 2 years after. HRQoL differences according to age, comorbidity and stage were tested with ANOVA or Chi Square test and multivariate linear regression models. RESULTS 1276 patients were included, with a mean age of 58 years. Multivariate models of EORTC QLQ-C30 summary score and EQ-5D-5L index at diagnosis and at 2-year follow-up show the independent association of comorbidity and tumor stage with HRQoL. The standardized multivariate regression coefficient of EORTC QLQ-C30 summary score was lower (poorer HRQoL) for women with stage II and III than for those with stage 0 at diagnosis (- 0.11 and - 0.07, p < 0.05) and follow-up (- 0.15 and - 0.10, p < 0.01). The EQ-5D-5L index indicated poorer HRQoL for women with Charlson comorbidity index ≥ 2 than comorbidity 0 both at diagnosis (- 0.13, p < 0.001) and follow-up (- 0.18, p < 0.001). Therefore, we provided the reference norms at diagnosis and at the 2-year follow-up, stratified by age, comorbidity index, and tumor stage. CONCLUSION These HRQoL reference norms can be useful to interpret the scores of women with non-metastatic breast cancer, comparing them with country-specific reference values for this population.
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Affiliation(s)
- Carme Miret
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, i Universitat Pompeu Fabra, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Miren Orive
- Departamento Psicología Social, Facultad Farmacia, UPV/EHU, Vitoria-Gasteiz, Araba, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Maria Sala
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, i Universitat Pompeu Fabra, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
| | - Susana García-Gutiérrez
- Osakidetza Basque Health Service, Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Bizkai, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Cristina Sarasqueta
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Biodonostia Health Research Institute, Donostia University Hospital, Donostia, Gipuzkoa, Spain
| | - Maria Jose Legarreta
- Osakidetza Basque Health Service, Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Bizkai, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Research and Innovation Unit, Hospital Costa del Sol, Marbella, Spain
| | - Amado Rivero
- Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
| | - Xavier Castells
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, i Universitat Pompeu Fabra, Barcelona, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
| | - José M Quintana
- Osakidetza Basque Health Service, Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Bizkai, Spain
- KRONIKGUNE-Institute for Health Service Research, Barakaldo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Olatz Garin
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
- Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
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13
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Bosch G, Comas M, Domingo L, Guillen-Sola A, Duarte E, Castells X, Sala M. Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality. Eur J Clin Invest 2023; 53:e13930. [PMID: 36477740 DOI: 10.1111/eci.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia can be highly concerning in hospitalized patients, increasing morbidity and mortality, making its early identification essential. We aimed to characterize dysphagia and its association with aspiration pneumonia and mortality in a tertiary hospital in Barcelona, Spain. METHODS Using data from all hospital discharges during the period 2018-2021, we identified the characteristics of patients with dysphagia and their distribution among hospital departments through the minimum data set, which codifies patients' diagnoses according to the International Classification of Diseases 10th Revision (ICD-10). We used logistic regression models to assess the association between dysphagia, aspiration pneumonia and mortality. RESULTS Dysphagia was present in 2.4% of all hospital discharges and was more frequent in older patients and in men. The diagnoses most frequently associated with dysphagia were aspiration pneumonia (48.2%) and stroke (14%). Higher prevalence of dysphagia was found in the acute geriatric unit (10.3%), neurology (7.6%) and internal medicine (7.5%) wards. Dysphagia was associated with aspiration pneumonia, aOR = 8.04 (95%CI, 6.31-10.25), and independently increased the odds of death among hospitalized patients, aOR = 1.43 (95%CI, 1.19-1.73). CONCLUSIONS We conclude that dysphagia is a prevalent and transversal condition, increasing the risk of mortality in all patients, and efforts should be intensified to increase its early detection and correct management.
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar - Pompeu Fabra University - Agència de Salut Pública de Barcelona), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Anna Guillen-Sola
- Department of Physical Medicine and Rehabilitation, PSMAR, Barcelona. Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, PSMAR, Barcelona. Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
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14
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Abiétar DG, Domingo L, Medina‐Perucha L, Saavedra N, Berenguera A, Lacueva L, Hurtado M, Castells X, Sala M. A Qualitative Exploration of Patient Safety in a Hospital Setting in Spain: Policy and Practice Recommendations on Patients’ and Companions’ Participation. Health Expect 2023. [PMID: 36971145 DOI: 10.1111/hex.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Patients' and companions' participation in healthcare could help prevent adverse events, which are a significant cause of disease and disability. Before designing interventions to increase participation, it is first necessary to identify attitudes to patient safety. This study aimed to explore patients' and companions' perceptions, attitudes and experiences of patient safety, taking into account contextual factors, such as cultural background, which are not usually captured in the literature. METHODS We conducted a qualitative study with a theoretical sampling of 13 inpatients and 3 companions in a university hospital in Barcelona, Spain. Information was obtained from individual and triangular interviews. A descriptive thematic content analysis was conducted by four analysts and a consensus was reached within the research team on the key categories that were identified. We also conducted a card-sorting exercise. RESULTS All informants emphasized the role of good communication with health professionals, a calm environment and the need for patient education. Discursive positions differed by cultural background. Informants from a Pakistani-Bangladeshi background emphasized language barriers, while those from European and Latin-American backgrounds stressed health professionals' lack of time and the need for more interdisciplinary teamwork. The card-sorting exercise identified several opportunities to enhance participation: checking patient identification and medication dispensation, and maintaining personal and environmental hygiene. CONCLUSION This exploration of informants' discourse on patient safety identified a wide variety of categories not usually considered from institutional perspectives. The findings of this study could enrich interventions in areas with diverse cultural backgrounds, as well as current frameworks based exclusively on institutional perspectives. PATIENT OR PUBLIC CONTRIBUTION The results of the study were communicated to patients and accompanying persons via telephone or email. Similarly, a focus group was held with a patient forum to comment on the results. In the design of subsequent interventions to improve patient safety at the hospital, the proposals of patients and companions for their participation will be included together with healthcare professionals' opinions.
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López B, Raya O, Baykova E, Saez M, Rigau D, Cunill R, Mayoral S, Carrion C, Serrano D, Castells X. APPRAISE-RS: Automated, updated, participatory, and personalized treatment recommender systems based on GRADE methodology. Heliyon 2023; 9:e13074. [PMID: 36798764 PMCID: PMC9925880 DOI: 10.1016/j.heliyon.2023.e13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose Clinical practice guidelines (CPGs) have become fundamental tools for evidence-based medicine (EBM). However, CPG suffer from several limitations, including obsolescence, lack of applicability to many patients, and limited patient participation. This paper presents APPRAISE-RS, which is a methodology that we developed to overcome these limitations by automating, extending, and iterating the methodology that is most commonly used for building CPGs: the GRADE methodology. Method APPRAISE-RS relies on updated information from clinical studies and adapts and automates the GRADE methodology to generate treatment recommendations. APPRAISE-RS provides personalized recommendations because they are based on the patient's individual characteristics. Moreover, both patients and clinicians express their personal preferences for treatment outcomes which are considered when making the recommendation (participatory). Rule-based system approaches are used to manage heuristic knowledge. Results APPRAISE-RS has been implemented for attention deficit hyperactivity disorder (ADHD) and tested experimentally on 28 simulated patients. The resulting recommender system (APPRAISE-RS/TDApp) shows a higher degree of treatment personalization and patient participation than CPGs, while recommending the most frequent interventions in the largest body of evidence in the literature (EBM). Moreover, a comparison of the results with four blinded psychiatrist prescriptions supports the validation of the proposal. Conclusions APPRAISE-RS is a valid methodology to build recommender systems that manage updated, personalized and participatory recommendations, which, in the case of ADHD includes at least one intervention that is identical or very similar to other drugs prescribed by psychiatrists.
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Affiliation(s)
- Beatriz López
- Control Engineering and Intelligent Systems (eXiT), University of Girona, Spain,Corresponding author.
| | - Oscar Raya
- Control Engineering and Intelligent Systems (eXiT), University of Girona, Spain
| | | | - Marc Saez
- Research Group on Statistics, Econometrics and Health, University of Girona, Spain,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Ruth Cunill
- Sant Joan de Deu-Numancia Health Park, Barcelona, Spain
| | | | - Carme Carrion
- Health Lab Research Group, Universitat Oberta de Catalunya, Spain
| | | | - Xavier Castells
- TransLab Research Group, Dept. of Medical Sciences, University of Girona, Spain
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Cunill R, Vives L, Pla M, Usall J, Castells X. Relationship between obsessive compulsive symptomatology and severity of psychotic symptoms in schizophrenia: Meta-analysis and meta-regression analysis. Schizophr Res 2023; 251:37-45. [PMID: 36549240 DOI: 10.1016/j.schres.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/13/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Schizophrenia patients often show obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) and their presence has been associated with poorer prognosis. However, the impact of OCS/OCD on psychotic severity remains unclear. The aim of this study is twofold: 1) to investigate the effect of OCS/OCD on the severity of positive, negative, and global psychotic symptoms of schizophrenia patients and 2) to analyze the effect of patient and study-related covariates on moderating this relationship. METHODS A systematic review and meta-analysis (SRMA) of studies comparing the severity of psychotic symptoms among schizophrenia patients with and without OCS/OCD was performed. Standardized mean difference (SMD) was calculated for positive, negative, and global psychotic symptoms. The difference of SMD (Diff SMD) was calculated to analyze the effect of covariates on study outcomes using meta-regression. RESULTS Sixty-seven studies involving 7740 patients were included. Patients with schizophrenia and OCS/OCD showed a slightly higher severity of positive (SMD = 0.17, p value = 0.0089) and global psychotic symptoms (SMD = 0.24, p value = 0.0104) than patients without OCS/OCD but no differences in negative symptoms were found between groups (SMD = 0.11, p value = 0.0367). Only one covariate "proportion of patients without antipsychotics (AP)" was found to modify the effect on psychotic severity (Diff SMD = -0.008, p value = 0.002). CONCLUSIONS Comorbid OCS/OCD in schizophrenia has, at most, a minor impact on psychotic severity. Variability in this effect was considerable and was poorly explained by the covariates analyzed.
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Affiliation(s)
- R Cunill
- Numància-Parc Sanitari Sant Joan de Déu, Barcelona, Catalonia, Spain.
| | - L Vives
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Catalonia, Spain
| | - M Pla
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Catalonia, Spain
| | - J Usall
- MERITT Group, Research Institute Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Catalonia, Spain
| | - X Castells
- Translab Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Catalonia, Spain
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Louro J, Posso M, Perez-Leon D, Ejarque B, Arranz M, Arenas N, Román M, Alcántara R, Castells X. Patient-assisted versus standard compression in mammography screening: A randomized trial. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Arenas N, Alcantara R, Posso M, Louro J, Perez-Leon D, Ejarque B, Arranz M, Maiques J, Castells X, Macià F, Román M, Rodríguez-Arana A. Comparison of technical parameters and women's experience between self-compression and standard compression modes in mammography screening: a single-blind randomized clinical trial. Eur Radiol 2022; 32:7480-7487. [PMID: 35536390 DOI: 10.1007/s00330-022-08835-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/19/2022] [Accepted: 03/29/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We compared the compression force, breast thickness, and glandular dose, as well as the severity of discomfort and women's experience between the patient-assisted compression (PAC) and standard compression (SC) modes. MATERIALS AND METHODS We conducted a prospective randomized controlled study at Hospital del Mar in Barcelona, Spain. We included 448 asymptomatic women aged 50 to 69 years old, attending their screening round from December 2017 to December 2019. Mammograms included the two bilateral views. In each woman, one breast was studied with SC and the other with PAC. The mode used in each breast was selected following a randomized list. Compression force, breast thickness, and average glandular dose were obtained for each of the 1792 images. We also recorded the degree of discomfort and women's experience, after mammogram acquisitions, using a predefined survey. RESULTS Higher compression forces were obtained with PAC than with SC (99.27 N vs 83.25 N, p < 0.001). Breast thickness mode (56.11 mm vs 57.52 mm, p = 0.015) and glandular dose (1.34 mGy vs 1.37 mGy, p = 0.018) were lower in PAC. The discomfort score was slightly higher with PAC (mean 3.94 vs 3.69, p = 0.042), but in the satisfaction survey, more women reported that PAC caused less discomfort. Additionally, 63.2% of women (289/448) preferred PAC. CONCLUSION PAC achieved higher compression forces without impairing the other technical imaging parameters and enhanced women's experience of screening mammography. We believe there were no clinically significant differences in the severity of discomfort between the two modes. KEY POINTS • Self-compression allows higher compression forces than the standard compression mode. • Self-compression does not affect technical imaging parameters. • Self-compression improved women's experience of screening mammography when standard compression was used on one breast and self-compression on the other.
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Affiliation(s)
- Natalia Arenas
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | | | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Daniela Perez-Leon
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain
| | - Belén Ejarque
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Mónica Arranz
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Jose Maiques
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Ana Rodríguez-Arana
- Radiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Roman M, Louro J, Vázquez I, Saladié F, Peñalva L, Bargalló X, Quintana M, Del Riego J, Vidal C, Castells X. Long-term breast cancer risk after benign breast disease in population-based screening. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Checa C, Canelo-Aybar C, Suclupe S, Ginesta-López D, Berenguera A, Castells X, Brotons C, Posso M. Effectiveness and Cost-Effectiveness of Case Management in Advanced Heart Failure Patients Attended in Primary Care: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:13823. [PMID: 36360704 PMCID: PMC9656967 DOI: 10.3390/ijerph192113823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
AIMS Nurse-led case management (CM) may improve quality of life (QoL) for advanced heart failure (HF) patients. No systematic review (SR), however, has summarized its effectiveness/cost-effectiveness. We aimed to evaluate the effect of such programs in primary care settings in advanced HF patients. We examined and summarized evidence on QoL, mortality, hospitalization, self-care, and cost-effectiveness. METHODS AND RESULTS The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I2 = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I2 = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I2 = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I2 = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI -0.84 to 2.17; participants = 450; studies = 3; I2 = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY. CONCLUSIONS Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries.
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Affiliation(s)
- Caterina Checa
- Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Primary Healthcare Centre Dreta de l’Eixample, 08013 Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025 Barcelona, Spain
| | - Stefanie Suclupe
- Department of Clinical Epidemiology and Public Health, de la Santa Creu i Sant Pau (IIB Sant Pau) University Hospital, 08041 Barcelona, Spain
| | | | - Anna Berenguera
- Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Xavier Castells
- Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Carlos Brotons
- Biomedical Research Institute (IBB Sant Pau), Sardenya Primary Health Care Center, 08025 Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
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21
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Comas M, Domingo L, Jansana A, Lafuente E, Civit A, García-Pérez L, Lasso de la Vega C, Cots F, Sala M, Castells X. Cost-effectiveness Analysis of Peripherally Inserted Central Catheters Versus Central Venous Catheters for in-Hospital Parenteral Nutrition. J Patient Saf 2022; 18:e1109-e1115. [PMID: 35587883 DOI: 10.1097/pts.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Our objective was to evaluate the cost-effectiveness of the use of peripherally inserted central venous catheters (PICCs) by a vascular access team (VAT) versus central venous catheters (CVCs) for in-hospital total parenteral nutrition (TPN). METHODS The study used a cost-effectiveness analysis based on observational data retrospectively obtained from electronic medical records from 2018 to 2019 in a teaching hospital. We included all interventional procedures requiring PICCs or CVCs with the indication of TPN. We recorded the costs of insertion, maintenance, removal, and complications. The main outcome measure was the incidence rate of catheter-associated bacteremia per 1000 catheter days. Cost-effectiveness analysis was performed from the hospital perspective within the context of the publicly funded Spanish health system. Confidence intervals for costs and effectiveness differences were calculated using bootstrap methods. RESULTS We analyzed 233 CVCs and 292 PICCs from patients receiving TPN. Average duration was longer for PICC (13 versus 9.4 days, P < 0.001). The main reason for complications in both groups was suspected infection (9.77% CVC versus 5.18% PICC). Complication rates due to bacteremia were 2.44% for CVC and 1.15% for PICC. The difference in the incidence of bacteremia per 1000 catheter days was 1.29 (95% confidence interval, -0.89 to 3.90). Overall, costs were lower for PICCs than for CVCs: the difference in mean overall costs was -€559.9 (95% confidence interval, -€919.9 to -€225.4). Uncertainty analysis showed 86.37% of results with lower costs and higher effectiveness for PICC versus CVC. CONCLUSIONS Placement of PICC by VAT compared with CVC for TPN reduces costs and may decrease the rate of bacteremia.
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Affiliation(s)
| | | | | | - Elisabeth Lafuente
- Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona
| | - Anna Civit
- Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona
| | | | - Carmen Lasso de la Vega
- Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona
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Aguiló O, Castells X, Miró Ò, Mueller C, Chioncel O, Trullàs JC. The prognostic significance of bundle branch block in acute heart failure: a systematic review and meta-analysis. Clin Res Cardiol 2022:10.1007/s00392-022-02105-z. [DOI: 10.1007/s00392-022-02105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
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23
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Ramírez-Saco D, Barcheni M, Cunill R, Sáez M, Farré M, Castells X. Nocebo Response in Attention Deficit Hyperactivity Disorder: Meta-Analysis and Meta-Regression of 105 Randomized Clinical Trials. J Atten Disord 2022; 26:1412-1421. [PMID: 35102771 DOI: 10.1177/10870547221075845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine nocebo response in ADHD, identify covariates modifying nocebo response, and study the relationship between nocebo response and drug safety. METHOD Systematic review of randomized, double-blind, placebo-controlled clinical trials (RCT) investigating the efficacy and safety of pharmacological interventions for ADHD patients. The influence of covariates was studied using meta-regression. RESULTS A total of 105 studies with 8,743 patients in placebo arms were included. Slightly over half (55.5%) of the patients experienced adverse events (AE) while receiving placebo. Nocebo response was associated positively with age, treatment length and method for collecting AEs. Studies with the largest nocebo response showcased the greatest drug response and the best outcome for drug safety. CONCLUSION Nocebo response in ADHD RCTs is remarkable, showing a positive relationship with drug response, and a negative relationship with drug safety.
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Affiliation(s)
| | - Maghie Barcheni
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Ruth Cunill
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Sant Joan de Déu, Institut de Recerca, Sant Boi de Llobregat, Barcelona, Spain
| | - Marc Sáez
- Research Group on Statistics, Econometrics and Health (GRECS), Economy Department, Universitat de Girona, Girona, Spain.,Consortium for Biomedical Research Center of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Center for Research in Health and Economics (CRES), Economy and Business Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Magí Farré
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain.,Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Xavier Castells
- TransLab research group, Department of Medical Sciences, Universitat de Girona, Girona, Spain
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Bosch G, Posso M, Louro J, Roman M, Porta M, Castells X, Macià F. Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study. eLife 2022; 11:77434. [PMID: 35686727 PMCID: PMC9212994 DOI: 10.7554/elife.77434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background: To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain. Methods: We conducted a before-and-after, study to evaluate participation, recall, false positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012–2019). Using multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571women. Results: During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR = 0.90 [95% CI = 0.84–0.96]) and in those who had previously participated regularly and irregularly (aOR = 0.63 [95% CI = 0.59–0.67] and aOR = 0.95 [95% CI = 0.86–1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR = 1.10 [95% CI = 1.01–1.20]). The recall rate decreased in both prevalent and incident screening (aOR = 0.74 [95% CI = 0.56–0.99] and aOR = 0.80 [95% CI = 0.68–0.95], respectively). False positives also decreased in both groups (prevalent aOR = 0.92 [95% CI = 0.66–1.28] and incident aOR = 0.72 [95% CI = 0.59–0.88]). No significant differences were observed in compliance with recall (OR = 1.26, 95% CI = 0.76–2.23), cancer detection rate (aOR = 0.91 [95% CI = 0.69–1.18]), or cancer stages. Conclusions: The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays. Funding: This study has received funding by grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Roman
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Miquel Porta
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital del Mar Institute of Medical Research (IMIM PSMar), Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
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25
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Amaro-Hosey K, Castells X, Blanco-Silvente L, Loma-Osorio P, Capellà D. Drug-induced Sudden Death: A Scoping Review. Curr Drug Saf 2022; 18:307-317. [PMID: 35619276 DOI: 10.2174/1574886317666220525115232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The risk of sudden cardiac death (SCD) can be increased with the use of drugs. However, it has been described heterogeneously in the literature. OBJECTIVE The study aims to systematically review epidemiological studies dealing with drug-induced sudden death, to describe their methodologies and to summarize the results found. METHODS A scoping review has been carried out using Medline electronic database. The search was limited up to 2020. Epidemiological studies were included, and case-reports or case-series were excluded. RESULTS Out of 3,114 potential articles, 74 were included. Most studies originated from North America (40.5%) or Europe (39.2%). Case-control (47.3%) or cohort (40.5%) studies were the most common designs. The data for outcomes and exposure was retrieved mainly from administrative databases (37.8%) or medical charts/hospital discharge reports (32.4%) but most studies used several sources of information. A composite variable of sudden death or SCD mainly with ventricular arrhythmia was the most frequently used endpoint. Only 18.9% of the studies included autopsy results to confirm the death. Psychotropic drugs were the most frequently studied. An increased risk of different outcomes for typical antipsychotics, tricyclic antidepressants, domperidone, and antiepileptics is suggested. CONCLUSION The methodologies used were highly heterogeneous and the results were, in general, not conclusive. An improvement of the methodologies is needed to achieve a conclusion regarding the risk of SCD associated to drug use.
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Affiliation(s)
- Kristopher Amaro-Hosey
- Clinical Pharmacology Service. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain.,Department of Pharmacology, Therapeutics and Toxicology. Faculty of Medicine. Autonomous University of Barcelona. Barcelona. Spain.,Department of Medical Sciences. Faculty of Medicine. University of Girona. Girona. Spain
| | - Xavier Castells
- Department of Pharmacology, Therapeutics and Toxicology. Faculty of Medicine. Autonomous University of Barcelona. Barcelona. Spain
| | - Lidia Blanco-Silvente
- TransLab Research Group. Department of Medical Sciences. Faculty of Medicine. University of Girona. Girona. Spain
| | - Pablo Loma-Osorio
- Departament of Medical Sciences. Faculty of Medicine. University of Girona. Girona. Spain
| | - Dolors Capellà
- Department of Medical Sciences. Faculty of Medicine. University of Girona. Girona. Spain
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Roux A, Cholerton R, Sicsic J, Moumjid N, French DP, Giorgi Rossi P, Balleyguier C, Guindy M, Gilbert FJ, Burrion JB, Castells X, Ritchie D, Keatley D, Baron C, Delaloge S, de Montgolfier S. Study protocol comparing the ethical, psychological and socio-economic impact of personalised breast cancer screening to that of standard screening in the "My Personal Breast Screening" (MyPeBS) randomised clinical trial. BMC Cancer 2022; 22:507. [PMID: 35524202 PMCID: PMC9073478 DOI: 10.1186/s12885-022-09484-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/02/2022] [Indexed: 12/11/2022] Open
Abstract
Background The MyPeBS study is an ongoing randomised controlled trial testing whether a risk-stratified breast cancer screening strategy is non-inferior, or eventually superior, to standard age-based screening at reducing incidence of stage 2 or more cancers. This large European Commission-funded initiative aims to include 85,000 women aged 40 to 70 years, without prior breast cancer and not previously identified at high risk in six countries (Belgium, France, Italy, Israel, Spain, UK). A specific work package within MyPeBS examines psychological, socio-economic and ethical aspects of this new screening strategy. It compares women’s reported data and outcomes in both trial arms on the following issues: general anxiety, cancer-related worry, understanding of breast cancer screening strategy and information-seeking behaviour, socio-demographic and economic characteristics, quality of life, risk perception, intention to change health-related behaviours, satisfaction with the trial. Methods At inclusion, 3-months, 1-year and 4-years, each woman participating in MyPeBS is asked to fill online questionnaires. Descriptive statistics, bivariate analyses, subgroup comparisons and analysis of variations over time will be performed with appropriate tests to assess differences between arms. Multivariate regression models will allow modelling of different patient reported data and outcomes such as comprehension of the information provided, general anxiety or cancer worry, and information seeking behaviour. In addition, a qualitative study (48 semi-structured interviews conducted in France and in the UK with women randomised in the risk-stratified arm), will help further understand participants’ acceptability and comprehension of the trial, and their experience of risk assessment. Discussion Beyond the scientific and medical objectives of this clinical study, it is critical to acknowledge the consequences of such a paradigm shift for women. Indeed, introducing a risk-based screening relying on individual biological differences also implies addressing non-biological differences (e.g. social status or health literacy) from an ethical perspective, to ensure equal access to healthcare. The results of the present study will facilitate making recommendations on implementation at the end of the trial to accompany any potential change in screening strategy. Trial registration Study sponsor: UNICANCER. My personalised breast screening (MyPeBS). Clinicaltrials.gov (2018) available at: https://clinicaltrials.gov/ct2/show/NCT03672331 Contact: Cécile VISSAC SABATIER, PhD, + 33 (0)1 73 79 77 58 ext + 330,142,114,293, contact@mypebs.eu. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09484-6.
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Affiliation(s)
- Alexandra Roux
- IRIS (UMR8156 CNRS & U997 INSERM), Paris 13 University, Aubervilliers, France
| | | | | | - Nora Moumjid
- Université Lyon 1, P2S EA 4129, Centre Léon Bérard, F-69373, Lyon, France
| | | | | | | | - Michal Guindy
- Assuta Medical Centers, Tel Aviv, Israel.,Ben Gurion University, Beersheba, Israel
| | | | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | | | - Suzette Delaloge
- Institut Gustave Roussy, Villejuif, France.,Unicancer, Paris, France
| | - Sandrine de Montgolfier
- IRIS (UMR8156 CNRS & U997 INSERM), Paris 13 University, Aubervilliers, France. .,Paris Est Creteil University, Créteil, France.
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Leis A, Casadevall D, Albanell J, Posso M, Macià F, Castells X, Ramírez-Anguita JM, Martínez Roldán J, Furlong LI, Sanz F, Ronzano F, Mayer MA. Exploring the Association of Cancer and Depression in Electronic Health Records: Combining Encoded Diagnosis and Mining Free Text Clinical Notes (Preprint). JMIR Cancer 2022; 8:e39003. [PMID: 35816382 PMCID: PMC9315897 DOI: 10.2196/39003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background A cancer diagnosis is a source of psychological and emotional stress, which are often maintained for sustained periods of time that may lead to depressive disorders. Depression is one of the most common psychological conditions in patients with cancer. According to the Global Cancer Observatory, breast and colorectal cancers are the most prevalent cancers in both sexes and across all age groups in Spain. Objective This study aimed to compare the prevalence of depression in patients before and after the diagnosis of breast or colorectal cancer, as well as to assess the usefulness of the analysis of free-text clinical notes in 2 languages (Spanish or Catalan) for detecting depression in combination with encoded diagnoses. Methods We carried out an analysis of the electronic health records from a general hospital by considering the different sources of clinical information related to depression in patients with breast and colorectal cancer. This analysis included ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis codes and unstructured information extracted by mining free-text clinical notes via natural language processing tools based on Systematized Nomenclature of Medicine Clinical Terms that mentions symptoms and drugs used for the treatment of depression. Results We observed that the percentage of patients diagnosed with depressive disorders significantly increased after cancer diagnosis in the 2 types of cancer considered—breast and colorectal cancers. We managed to identify a higher number of patients with depression by mining free-text clinical notes than the group selected exclusively on ICD-9-CM codes, increasing the number of patients diagnosed with depression by 34.8% (441/1269). In addition, the number of patients with depression who received chemotherapy was higher than those who did not receive this treatment, with significant differences (P<.001). Conclusions This study provides new clinical evidence of the depression-cancer comorbidity and supports the use of natural language processing for extracting and analyzing free-text clinical notes from electronic health records, contributing to the identification of additional clinical data that complements those provided by coded data to improve the management of these patients.
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Affiliation(s)
- Angela Leis
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - David Casadevall
- Cancer Research Program, Hospital del Mar Research Institute, Barcelona, Spain
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Joan Albanell
- Cancer Research Program, Hospital del Mar Research Institute, Barcelona, Spain
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology, Hospital del Mar Research Institute, Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology, Hospital del Mar Research Institute, Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology, Hospital del Mar Research Institute, Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Laura I Furlong
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Francesco Ronzano
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel A Mayer
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Cunill R, Castells X, González-Pinto A, Arrojo M, Bernardo M, Sáiz PA, Flórez G, Torrens M, Tirado-Muñoz J, Fonseca F, Arranz B, Garriga M, Goikolea JM, Zorrilla I, Becoña E, López A, San L. Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use. Adicciones 2022; 34:168-178. [PMID: 34171106 DOI: 10.20882/adicciones.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence.
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García M, Redondo M, Zarcos I, Louro J, Rivas-Ruiz F, Téllez T, Pérez D, Medina Cano F, Machan K, Domingo L, del Mar Vernet M, Padilla-Ruiz M, Castells X, Sala M. Impact of Detection Mode in a Large Cohort of Women Taking Part in a Breast Screening Program. Eur J Breast Health 2022; 18:182-189. [DOI: 10.4274/ejbh.galenos.2022.2021-11-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 12/01/2022]
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Torrens M, Tirado-Muñoz J, Fonseca F, Farré M, Gonzalez-Pinto A, Arrojo M, Bernardo M, Arranz B, Garriga M, Sáiz PA, Flórez G, Goikolea JM, Zorrilla I, Cunill R, Castells X, Becoña E, López A, San L. Clinical practice guideline on pharmacological and psychological management of adult patients with depression and a comorbid substance use disorder. Adicciones 2022; 34:128-141. [PMID: 33768269 DOI: 10.20882/adicciones.1559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.
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31
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Sáiz PA, Flórez G, Arrojo M, Bernardo M, González-Pinto A, Goikolea JM, Zorrilla I, Cunill R, Castells X, Becoña E, López A, Torrens M, Fonseca F, Tirado-Muñoz J, Arranz B, Garriga M, San L. Clinical practice guideline on pharmacological and psychological management of adult patients with an anxiety disorder and comorbid substance use. Adicciones 2022; 34:157-167. [PMID: 34171105 DOI: 10.20882/adicciones.1548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.
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Utzet M, Benavides FG, Villar R, Burón A, Sala M, López LE, Gomar P, Castells X, Diaz P, Ramada JM, Serra C. Non-Pharmacological Preventive Measures Had an Impact on COVID-19 in Healthcare Workers before the Vaccination Effect: A Cohort Study. Int J Environ Res Public Health 2022; 19:ijerph19063628. [PMID: 35329313 PMCID: PMC8955756 DOI: 10.3390/ijerph19063628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 12/21/2022]
Abstract
Healthcare workers have been and still are at the forefront of COVID-19 patient care. Their infection had direct implications and caused important challenges for healthcare performance. The aim of this study is to assess the impact of non-pharmacological preventive measures against COVID-19 among healthcare workers. This study is based on a dynamic cohort of healthcare workers (n = 5543) who had been hired by a Spanish hospital for at least one week during 2020. Negative binomial regression models were used to estimate the incidence rate and the rate ratio (RR) between the two waves (defined from 15 March to 21 June and from 22 June to 31 December), considering natural immunity during the first wave and contextual variables. All models were stratified by socio-occupational variables. The average COVID-19 incidence rate per 1000 worker-days showed a significant reduction between the two waves, dropping from 0.82 (CI95%: 0.73-0.91) to 0.39 (0.35-0.44). The adjusted RR was 0.54 (0.48-0.87) when natural immunity was acquired during the first wave, and contextual variables were considered. The significant reduction of the COVID-19 incidence rate could be explained mainly by improvement in the non-pharmacological preventive interventions. It is needed to identify which measures were more effective. Young workers and those with a replacement contract were identified as vulnerable groups that need greater preventive efforts. Future preparedness plans would benefit from these results.
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Affiliation(s)
- Mireia Utzet
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain; (F.G.B.); (R.V.); (P.D.); (J.M.R.); (C.S.)
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- CIBER of Epidemiology and Public Health, 28029 Madrid, Spain
- Correspondence:
| | - Fernando G. Benavides
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain; (F.G.B.); (R.V.); (P.D.); (J.M.R.); (C.S.)
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- CIBER of Epidemiology and Public Health, 28029 Madrid, Spain
| | - Rocío Villar
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain; (F.G.B.); (R.V.); (P.D.); (J.M.R.); (C.S.)
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- CIBER of Epidemiology and Public Health, 28029 Madrid, Spain
- Occupational Health Service, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Andrea Burón
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- Department of Epidemiology and Evaluation, Parc de Salut Mar, 08003 Barcelona, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 08003 Barcelona, Spain
| | - Maria Sala
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- Department of Epidemiology and Evaluation, Parc de Salut Mar, 08003 Barcelona, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 08003 Barcelona, Spain
| | - Luis-Eugenio López
- Consorci Mar Parc de Salut de Barcelona, 08003 Barcelona, Spain; (L.-E.L.); (P.G.)
| | - Pau Gomar
- Consorci Mar Parc de Salut de Barcelona, 08003 Barcelona, Spain; (L.-E.L.); (P.G.)
| | - Xavier Castells
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- Department of Epidemiology and Evaluation, Parc de Salut Mar, 08003 Barcelona, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 08003 Barcelona, Spain
| | - Pilar Diaz
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain; (F.G.B.); (R.V.); (P.D.); (J.M.R.); (C.S.)
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- Occupational Health Service, Parc de Salut Mar, 08003 Barcelona, Spain
| | - José María Ramada
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain; (F.G.B.); (R.V.); (P.D.); (J.M.R.); (C.S.)
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- CIBER of Epidemiology and Public Health, 28029 Madrid, Spain
- Occupational Health Service, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Consol Serra
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain; (F.G.B.); (R.V.); (P.D.); (J.M.R.); (C.S.)
- IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (A.B.); (M.S.); (X.C.)
- CIBER of Epidemiology and Public Health, 28029 Madrid, Spain
- Occupational Health Service, Parc de Salut Mar, 08003 Barcelona, Spain
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Román M, Louro J, Posso M, Vidal C, Bargalló X, Vázquez I, Quintana MJ, Alcántara R, Saladié F, del Riego J, Peñalva L, Sala M, Castells X. Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography. Int J Environ Res Public Health 2022; 19:ijerph19052625. [PMID: 35270331 PMCID: PMC8909630 DOI: 10.3390/ijerph19052625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022]
Abstract
Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies.
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Affiliation(s)
- Marta Román
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
| | - Javier Louro
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Margarita Posso
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Carmen Vidal
- Cancer Prevention and Monitoring Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain;
| | - Xavier Bargalló
- Department of Radiology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Ivonne Vázquez
- Pathology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Rodrigo Alcántara
- Radiology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - Francina Saladié
- Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain;
| | - Javier del Riego
- Department of Radiology, Parc Taulí University Hospital-UAB, 08208 Sabadell, Spain;
| | - Lupe Peñalva
- Breast Cancer Screening Technical Office, Private Foundation Asil Hospital, 08402 Granollers, Spain;
| | - Maria Sala
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
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Domingo L, Sala M, Miret C, Montero-Moraga JM, Lasso de la Vega C, Comas M, Castells X. Perceptions from nurses, surgeons, and anesthetists about the use and benefits of the surgical checklist in a teaching hospital. J Healthc Qual Res 2022; 37:52-59. [PMID: 34344625 DOI: 10.1016/j.jhqr.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess attitudes and perceptions from nursing staff, surgeons and anesthetists about compliance, utility, and impact on patient's safety of the surgical checklist in a teaching hospital. We also aimed to identify improvement opportunities for strengthening the usefulness of the checklist in the operating theater. METHODS We carried out a questionnaire-based an observational cross-sectional study. A questionnaire was distributed to operating room staff, including nursing staff, surgeons, and anesthetists. In addition to the information about surgical checklist, We also collected information regarding years of experience in the operating theater. Fisher's exact was used to compare proportions in each statement. Group discussion meetings with key professionals were held to jointly assess the results, propose improvement actions, and evaluate their feasibility. RESULTS The overall response rate was 36.2% (131/362). Nursing staff was perceived as the most supportive group in the use of surgical checklist. A 64.3% of surgeons considered that using the checklist prevented adverse events vs 84.2% and 85.7% among anesthetists and nurses, respectively; p=0.028. Junior staff showed a supportive attitude toward the use of surgical checklist, considering it as a tool that gives them confidence. We ended up with a list of improvement actions aiming at strengthening the surgical checklist reliability and compliance. CONCLUSIONS The perception of the surgical checklist usefulness as a tool to prevent adverse events was moderate among surgeons, but well appreciated by junior staff. Nursing staff were especially critical regarding compliance and support by other professionals. To reinforce the usefulness perception of the surgical checklist it is needed to increase the involvement of all professionals, especially senior staff and surgical leaders.
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Affiliation(s)
- L Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain.
| | - M Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - C Miret
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - J M Montero-Moraga
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - C Lasso de la Vega
- Methodology, Quality and Nursing Research Department, Consorci Parc de Salut MAR de Barcelona, Barcelona, Spain
| | - M Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - X Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
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Anton A, Nolivos K, Pazos M, Fatti G, Ayala ME, Martínez-Prats E, Peral O, Poposki V, Tsiroukis E, Morilla-Grasa A, Comas M, Castells X. Diagnostic Accuracy and Detection Rate of Glaucoma Screening with Optic Disk Photos, Optical Coherence Tomography Images, and Telemedicine. J Clin Med 2021; 11:jcm11010216. [PMID: 35011957 PMCID: PMC8746039 DOI: 10.3390/jcm11010216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the diagnostic accuracy of optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. Methods: A population-based sample of 4113 persons was randomly selected. The screening examination included a fundus photograph and OCT images. Images were evaluated on a deferred basis. All participants were then invited to a complete glaucoma examination, including gonioscopy, visual field, and dilated fundus examination. The detection rate, sensitivity, specificity, and positive and negative predictive values were calculated. Results: We screened 1006 persons. Of these, 201 (19.9%) were classified as glaucoma suspects; 20.4% were identified only by retinographs, 11.9% only by OCT images, and 46.3% by both. On ophthalmic examination at the hospital (n = 481), confirmed glaucoma was found in 58 (12.1%), probable glaucoma in 76 (15.8%), and ocular hypertension in 10 (2.1%), and no evidence of glaucoma was found in 337 (70.0%). The detection rate for confirmed or probable glaucoma was 9.2%. Sensitivity ranged from 69.4% to 86.2% and specificity from 82.1% to 97.4%, depending on the definition applied. Conclusions: The combination of OCT images and fundus photographs yielded a detection rate of 9.2% in a population-based screening program with moderate sensitivity, high specificity, and predictive values of 84–96%.
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Affiliation(s)
- Alfonso Anton
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
- Medical School, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
- Correspondence: ; Tel.: +34-93-254-0565 (ext. 4000-4002); Fax: +34-93-254-0567
| | - Karen Nolivos
- Department of Medicine, Institut Mar d’Investigacions Mèdiques (IMIM), 08005 Barcelona, Spain;
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
| | - Marta Pazos
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic de Barcelona, Institut d’Investigacions Mèdiques, 08036 Barcelona, Spain;
| | - Gianluca Fatti
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
| | - Miriam Eleonora Ayala
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | | | | | - Vladimir Poposki
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
| | - Evangelos Tsiroukis
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | - Antonio Morilla-Grasa
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | - Merce Comas
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Knobel P, Serra C, Grau S, Ibañez R, Diaz P, Ferrández O, Villar R, Lopez AF, Pujolar N, Horcajada JP, Roman M, Comas M, Sala M, Castells X. Coronavirus disease 2019 (COVID-19) mRNA vaccine effectiveness in asymptomatic healthcare workers. Infect Control Hosp Epidemiol 2021; 42:1517-1519. [PMID: 34167610 PMCID: PMC8280388 DOI: 10.1017/ice.2021.287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Pablo Knobel
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Consol Serra
- Occupational Health Service, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Rocio Ibañez
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Pilar Diaz
- Occupational Health Service, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Olivia Ferrández
- Department of Pharmacy, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Rocío Villar
- Occupational Health Service, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Alonso Fernando Lopez
- Occupational Health Service, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Nuria Pujolar
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Juan Pablo Horcajada
- Service of Infectious Diseases, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Marta Roman
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barakaldo, Biscay, Spain
| | - Merce Comas
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barakaldo, Biscay, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barakaldo, Biscay, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barakaldo, Biscay, Spain
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Montero-Moraga JM, Buron A, Sala M, Santia P, Lupia M, Beltrán A, Villar R, Horcajada JP, Castells X, Gil OD, León EP, Serra C. Impact and Management of COVID-19 Among Healthcare Workers in Two Acute Care Hospitals and Two Associated Long-term Care Centres in Barcelona, Spain. J Occup Environ Med 2021; 63:e586-e591. [PMID: 34491967 DOI: 10.1097/jom.0000000000002290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics of COVID-19-related episodes in healthcare workers (HCW) of two hospitals. METHODS Prospective study of HCW with COVID-like symptoms and/or who were close contacts of confirmed COVID-19. The percentage of positive PCRs among those with symptoms was calculated, and symptom's positive predictive value and negative predictive value. The characteristics of contacts were described, as well as the secondary clinical attack rate. RESULTS We registered 1222 episodes of HCW with COVID-like symptoms; 340 (27.8%) had a positive PCR. In 885 episodes, a HCW was a close contact of a confirmed case. In 45.5% of these, the HCW had contact with another HCW. The secondary clinical attack rate of contacts of HCW was 14.5%. CONCLUSION We found a high prevalence of disease and transmission between HCW during the first wave of the SARS-CoV-2 pandemic.
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Affiliation(s)
- Jose Maria Montero-Moraga
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, Barcelona 08003, Spain (Dr Montero-Moraga, Dr Buron, Dr Sala, Santia, and Dr Castells); Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Passeig Marítim 25-29, Barcelona 08003, Spain (Dr Montero-Moraga and Santia); Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain (Dr Buron, Dr Sala, and Dr Castells); Occupational Health Service, Parc de Salut Mar, Passeig Marítim 25-29, Barcelona 08003, Spain (Lupia, Beltrán, Villar, and Serra); Centre for Research in Occupational Health (CiSAL), IMIM-Hospital del Mar Medical Research Institute/Pompeu Fabra University, Barcelona, Spain (Lupia, Beltrán, Villar, and Serra); CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain (Villar and Serra); Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain (Horcajada); Department of Microbiology, Laboratorio de Referencia de Catalunya, Hospital del Mar, Barcelona, Spain (Gil and León)
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Castells X, Saez M, Barcheni M, Cunill R, Serrano D, López B, van Lissa CJ. Placebo Response and Its Predictors in Attention Deficit Hyperactivity Disorder: A Meta-Analysis and Comparison of Meta-Regression and MetaForest. Int J Neuropsychopharmacol 2021; 25:26-35. [PMID: 34355753 PMCID: PMC8756096 DOI: 10.1093/ijnp/pyab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND High placebo response in attention deficit hyperactivity disorder (ADHD) can reduce medication-placebo differences, jeopardizing the development of new medicines. This research aims to (1) determine placebo response in ADHD, (2) compare the accuracy of meta-regression and MetaForest in predicting placebo response, and (3) determine the covariates associated with placebo response. METHODS A systematic review with meta-analysis of randomized, placebo-controlled clinical trial investigating pharmacological interventions for ADHD was performed. Placebo response was defined as the change from baseline in ADHD symptom severity assessed according to the 18-item, clinician-rated, DSM-based rating scale. The effect of study design-, intervention-, and patient-related covariates in predicting placebo response was studied by means of meta-regression and MetaForest. RESULTS Ninety-four studies including 6614 patients randomized to placebo were analyzed. Overall, placebo response was -8.9 points, representing a 23.1% reduction in the severity of ADHD symptoms. Cross-validated accuracy metrics for meta-regression were R2 = 0.0012 and root mean squared error = 3.3219 for meta-regression and 0.0382 and 3.2599 for MetaForest. Placebo response among ADHD patients increased by 63% between 2001 and 2020 and was larger in the United States than in other regions of the world. CONCLUSIONS Strong placebo response was found in ADHD patients. Both meta-regression and MetaForest showed poor performance in predicting placebo response. ADHD symptom improvement with placebo has markedly increased over the last 2 decades and is greater in the United States than the rest of the world.
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Affiliation(s)
- Xavier Castells
- TransLab Research Group, Universitat de Girona, Girona, Spain,Department of Medical Sciences, Universitat de Girona, Girona, Spain,Economy Department; Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain,Correspondence: Xavier Castells, MD, PhD, Department of Medical Sciences, Universitat de Girona, C/ Emili Grahit, 77, esc. B, 2n. Campus Centre. 17003 Girona, Spain ()
| | - Marc Saez
- Centre for Biomedical Research Network in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maghie Barcheni
- Pharmacology, Toxicology and Therapeutics Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruth Cunill
- Parc Sanitari Sant Joan de Déu-Numància, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Domènec Serrano
- Department of Medical Sciences, Universitat de Girona, Girona, Spain,Economy Department; Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain,Institut d’Assistència Sanitària, Girona, Spain
| | - Beatriz López
- Control and Intelligent Systems Engineering Research Group, Electrical; Electronic and Automatic Engineering Department, Universitat de Girona, Girona, Spain (Dr López)
| | - Caspar J van Lissa
- Department of Methodology and Statistics, Universiteit Utrecht, Utrecht, The Netherlands (Dr van Lissa)
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Castells X, Ramon M, Cunill R, Olivé C, Serrano D. Relationship Between Treatment Duration and Efficacy of Pharmacological Treatment for ADHD: A Meta-Analysis and Meta-Regression of 87 Randomized Controlled Clinical Trials. J Atten Disord 2021; 25:1352-1361. [PMID: 32075485 DOI: 10.1177/1087054720903372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To determine the relationship between treatment duration and the efficacy of pharmacological treatment for reducing ADHD symptoms. Method: We conducted a systematic review of randomized, double-blind, placebo-controlled clinical trials investigating the efficacy of pharmacological interventions in patients with ADHD. The last bibliographic search was performed in April 15, 2019. The effect of treatment duration on efficacy was studied using meta-regression. Results: A total of 87 studies lasting from 3 to 28 weeks were included. Pharmacological treatment improved ADHD symptom severity by -7.35 points. Treatment duration did not moderate the efficacy of pharmacological treatment. Consistent results were found for psychostimulant drugs, methylphenidate, amphetamine derivatives, atomoxetine, and α2-agonists. A negative correlation was found between baseline ADHD severity efficacy (Coefficient = -.250, p = .013). Conclusion: The efficacy of pharmacological treatment for ADHD remains stable over time. A greater efficacy in more severe patients is suggested.
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Affiliation(s)
| | | | - Ruth Cunill
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain
| | | | - Domènec Serrano
- University of Girona, Spain.,Institut d'Assistència Sanitària, Girona, Spain
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Jansana A, Poblador-Plou B, Gimeno-Miguel A, Lanzuela M, Prados-Torres A, Domingo L, Comas M, Sanz-Cuesta T, Del Cura-Gonzalez I, Ibañez B, Abizanda M, Duarte-Salles T, Padilla-Ruiz M, Redondo M, Castells X, Sala M. Multimorbidity clusters among long-term breast cancer survivors in Spain: Results of the SURBCAN study. Int J Cancer 2021; 149:1755-1767. [PMID: 34255861 DOI: 10.1002/ijc.33736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022]
Abstract
The disease management of long-term breast cancer survivors (BCS) is hampered by the scarce knowledge of multimorbidity patterns. The aim of our study was to identify multimorbidity clusters among long-term BCS and assess their impact on mortality and health services use. We conducted a retrospective study using electronic health records of 6512 BCS from Spain surviving at least 5 years. Hierarchical cluster analysis was used to identify groups of similar patients based on their chronic diagnoses, which were assessed using the Clinical Classifications Software. As a result, multimorbidity clusters were obtained, clinically defined and named according to the comorbidities with higher observed/expected prevalence ratios. Multivariable Cox and negative binomial regression models were fitted to estimate overall mortality risk and probability of contacting health services according to the clusters identified. 83.7% of BCS presented multimorbidity, essential hypertension (34.5%) and obesity and other metabolic disorders (27.4%) being the most prevalent chronic diseases at the beginning of follow-up. Five multimorbidity clusters were identified: C1-unspecific (29.9%), C2-metabolic and neurodegenerative (28.3%), C3-anxiety and fractures (9.7%), C4-musculoskeletal and cardiovascular (9.6%) and C5-thyroid disorders (5.3%). All clusters except C5-thyroid disorders were associated with higher mortality compared to BCS without comorbidities. The risk of mortality in C4 was increased by 64% (adjusted hazard ratio 1.64, 95% confidence interval 1.52-2.07). Stratified analysis showed an increased risk of death among BCS with 5 to 10 years of survival in all clusters. These results help to identify subgroups of long-term BCS with specific needs and mortality risks and to guide BCS clinical practice regarding multimorbidity.
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Affiliation(s)
- Anna Jansana
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,European Higher Education Area Doctoral Program in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Poblador-Plou
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Manuela Lanzuela
- Radiotherapy Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alexandra Prados-Torres
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Sanz-Cuesta
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, Madrid, Spain
| | - Isabel Del Cura-Gonzalez
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, Madrid, Spain
| | - Berta Ibañez
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Mercè Abizanda
- Department of Organization and Communication, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria Padilla-Ruiz
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
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Montero-Moraga JM, Posso M, Román M, Burón A, Sala M, Castells X, Macià F. Effect of an information leaflet on breast cancer screening participation: A cluster randomized controlled trial. BMC Public Health 2021; 21:1301. [PMID: 34217258 PMCID: PMC8254065 DOI: 10.1186/s12889-021-11360-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/16/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To evaluate the impact of an information leaflet about the risk-benefit balance of breast cancer screening on women’s participation. Methods This cluster randomized controlled trial was conducted within a population-based breast cancer screening program and included women from the catchment areas of two hospitals in Barcelona, Spain. We evaluated women aged 50–69 years invited to screening between September 2019 and January 2020. The intervention group received an information leaflet on the benefits and harms of mammography screening. The control group received the usual invitation letter. The clusters consisted of the processing days of the invitation letter, assigned to the intervention with a simple random allocation scheme. We compared the participation rate at the individual level between groups, stratified by hospital and by per-protocol and intention-to-treat analyses. Results We included 11,119 women (137 clusters): 5416 in the intervention group (66 clusters) and 5703 in the control group (71 clusters). A total of 36% (1964/5393) of the women in the intervention group and 37% (2135/5694) of those in the control group attended screening, respectively. Overall, we found no differences in participation among groups (difference in participation − 1.1%; 95%CI; − 2.9 to 0.7%). In a hospital attending a population with a low socioeconomic status, attendance was lower in the intervention group (− 1.4, 95%CI: − 5.7% to − 0.03%). Conclusions Overall participation in our program was unaffected by a new information leaflet on the risk-benefit balance of breast cancer screening. However, participation was lower in certain populations with lower socioeconomic status Trial registration Trial registration number ISRCTN13848929. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11360-0.
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Affiliation(s)
- Jose Maria Montero-Moraga
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain. .,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain.
| | - Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Andrea Burón
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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Petrović T, Alves I, Bugada D, Pascual J, Vučković F, Skelin A, Gaifem J, Villar-Garcia J, Vicente MM, Fernandes Â, Dias AM, Kurolt IC, Markotić A, Primorac D, Soares A, Malheiro L, Trbojević-Akmačić I, Abreu M, Sarmento E Castro R, Bettinelli S, Callegaro A, Arosio M, Sangiorgio L, Lorini LF, Castells X, Horcajada JP, Pinho SS, Allegri M, Barrios C, Lauc G. Composition of the immunoglobulin G glycome associates with the severity of COVID-19. Glycobiology 2021; 31:372-377. [PMID: 33174592 PMCID: PMC7717252 DOI: 10.1093/glycob/cwaa102] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/20/2022] Open
Abstract
A large variation in the severity of disease symptoms is one of the key open questions in COVID-19 pandemics. The fact that only a small subset of people infected with SARS-CoV-2 develop severe disease suggests that there have to be some predisposing factors, but biomarkers that reliably predict disease severity have not been found so far. Since overactivation of the immune system is implicated in a severe form of COVID-19 and the IgG glycosylation is known to be involved in the regulation of different immune processes, we evaluated the association of inter-individual variation in IgG N-glycome composition with the severity of COVID-19. The analysis of 166 severe and 167 mild cases from hospitals in Spain, Italy and Portugal revealed statistically significant differences in the composition of the IgG N-glycome. The most notable difference was the decrease in bisecting N-acetylglucosamine (GlcNAc) in severe patients from all three cohorts. IgG galactosylation was also lower in severe cases in all cohorts, but the difference in galactosylation was not statistically significant after correction for multiple testing.
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Affiliation(s)
- Tea Petrović
- Genos Glycoscience Research Laboratory, Borongajska cesta 83h, 10000 Zagreb, Croatia
| | - Inês Alves
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Jûlio Amaral de Carvalho 45, 4200-135, Porto, Portugal.,Institute for Research and Innovation in Health (I3S), University of Porto, Rua Alferdo Allen 208, 4200-135, Porto Portugal.,Medical Faculty, University of Porto, Praça de Gomes Teixeira, 4099-002 Porto, Portugal
| | - Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII° Hospital, Piazza OMS, 1, 24127 Bergamo BG, Italy.,Italian Pain Group, 20100 Milan, Italy
| | - Julio Pascual
- Hospital del Mar-IMIM, Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Frano Vučković
- Genos Glycoscience Research Laboratory, Borongajska cesta 83h, 10000 Zagreb, Croatia
| | - Andrea Skelin
- Genos Glycoscience Research Laboratory, Borongajska cesta 83h, 10000 Zagreb, Croatia
| | - Joana Gaifem
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Jûlio Amaral de Carvalho 45, 4200-135, Porto, Portugal.,Institute for Research and Innovation in Health (I3S), University of Porto, Rua Alferdo Allen 208, 4200-135, Porto Portugal
| | | | - Manuel M Vicente
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Jûlio Amaral de Carvalho 45, 4200-135, Porto, Portugal.,Institute for Research and Innovation in Health (I3S), University of Porto, Rua Alferdo Allen 208, 4200-135, Porto Portugal.,Institute of Biomedical Sciences of Abel Salazar, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Ângela Fernandes
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Jûlio Amaral de Carvalho 45, 4200-135, Porto, Portugal.,Institute for Research and Innovation in Health (I3S), University of Porto, Rua Alferdo Allen 208, 4200-135, Porto Portugal
| | - Ana M Dias
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Jûlio Amaral de Carvalho 45, 4200-135, Porto, Portugal.,Institute for Research and Innovation in Health (I3S), University of Porto, Rua Alferdo Allen 208, 4200-135, Porto Portugal
| | - Ivan-Christian Kurolt
- Hospital for Infectious Diseases Fran Mihaljević, Mirogojska 8, 10 000 Zagreb, Croatia
| | - Alemka Markotić
- Hospital for Infectious Diseases Fran Mihaljević, Mirogojska 8, 10 000 Zagreb, Croatia
| | - Dragan Primorac
- St. Catharine Hospital, Trpinjska ul. 7 10 000 Zagreb, Croatia.,Eberly College of Science, Penn State University, 517 Thomas Building, University Park, PA 16802, United States.,University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia.,University of Osijek School of Medicine, Ul. Josipa Huttlera 4, 31000, Osijek.,University of Osijek Faculty of Dental Medicine and Health, Ul. Josipa Huttlera 4, 31000, Osijek, Croatia.,Medical School REGIOMED, Coburg, Gustav-Hirschfeld-Ring 3, 96450 Coburg, Germany
| | - Adriana Soares
- Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| | - Luis Malheiro
- Medical Faculty, University of Porto, Praça de Gomes Teixeira, 4099-002 Porto, Portugal.,Infectious Diseases Department, Centro Hospitalar Vila Nova de Gaia/Espinho, R. Dr. Francisco Sá Carneiro 4400-129, Porto, Portugal
| | | | - Miguel Abreu
- Institute of Biomedical Sciences of Abel Salazar, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.,Infectious Diseases Department, Centro Hospitalar e Universitćrio do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Rui Sarmento E Castro
- Institute of Biomedical Sciences of Abel Salazar, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.,Infectious Diseases Department, Centro Hospitalar e Universitćrio do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Silvia Bettinelli
- Biobank Unit, ASST Papa Giovanni XXIII°, Piazza OMS, 1, 24127 Bergamo BG, Italy
| | - Annapaola Callegaro
- Biobank Unit, ASST Papa Giovanni XXIII°, Piazza OMS, 1, 24127 Bergamo BG, Italy
| | - Marco Arosio
- Biobank Unit, ASST Papa Giovanni XXIII°, Piazza OMS, 1, 24127 Bergamo BG, Italy
| | - Lorena Sangiorgio
- Biobank Unit, ASST Papa Giovanni XXIII°, Piazza OMS, 1, 24127 Bergamo BG, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII° Hospital, Piazza OMS, 1, 24127 Bergamo BG, Italy
| | - Xavier Castells
- Hospital del Mar-IMIM, Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Juan P Horcajada
- Hospital del Mar-IMIM, Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Salomé S Pinho
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Jûlio Amaral de Carvalho 45, 4200-135, Porto, Portugal.,Institute for Research and Innovation in Health (I3S), University of Porto, Rua Alferdo Allen 208, 4200-135, Porto Portugal.,Medical Faculty, University of Porto, Praça de Gomes Teixeira, 4099-002 Porto, Portugal.,Institute of Biomedical Sciences of Abel Salazar, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Massimo Allegri
- Pain Service, Policlinico of Monza Hospital, Via Carlo Amati, 111, 20900 Monza MB, Italy.,Italian Pain Group, 20100 Milan, Italy
| | - Clara Barrios
- Hospital del Mar-IMIM, Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Gordan Lauc
- Genos Glycoscience Research Laboratory, Borongajska cesta 83h, 10000 Zagreb, Croatia.,University of Zagreb Faculty of Pharmacy and Biochemistry, Ante Kovačića 1, 10 000 Zagreb, Croatia
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Jansana A, Comas M, Domingo L, Prados-Torres A, Gimeno-Miguel A, Poblador-Plou B, Castells X, Sala M. Multimorbidity patterns among long-term breast cancer survivors: a Spanish population-based study. Breast 2021. [DOI: 10.1016/s0960-9776(21)00241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jansana A, Domingo L, Ibañez B, Prados A, Del Cura I, Padilla-Ruiz M, Sanz T, Poblador B, Tamayo I, Gimeno A, Alberquilla A, Abizanda M, Comas M, Lanzuela M, Burgui R, Holgado AD, Duarte-Salles T, Moreno C, Louro J, Baquedano J, Molina C, Del Carmen Martinez M, Gorricho J, Redondo M, Castells X, Sala M. Use of health services among long-term breast cancer survivors in Spain: longitudinal study based on real-world data. J Cancer Surviv 2021; 16:132-141. [PMID: 33759086 DOI: 10.1007/s11764-021-01011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to evaluate health service utilization in Spain among long-term breast cancer survivors and to compare it with that among women with no history of breast cancer. METHODS Study based on the SURBCAN cohort includes a sample of long-term breast cancer survivors and a sample of women without breast cancer from 5 Spanish regions. Healthcare utilization was assessed through primary care, hospital visits, and tests during the follow-up period (2012 to 2016) by using electronic health records. Annual contact rates to healthcare services were calculated, and crude and multivariate count models were fitted to estimate the adjusted relative risk of healthcare services use. RESULTS Data were obtained from 19,328 women, including 6512 long-term breast cancer survivors. Healthcare use was higher among breast cancer survivors (20.9 vs 16.6; p < 0.0001) and decreased from >10 years of survival. Breast cancer survivors who underwent a mastectomy were more likely to have a primary care visit (RR = 3.10 95% CI 3.08-3.11). Five to ten years survivors were more likely to have hospital inpatient visits and imaging test compared to women without breast cancer (RRa = 1.35 95% CI 1.30-1.39 and RRa = 1.27 95% CI 1.25-1.29 respectively). CONCLUSION This study shows higher use of health services in long-term breast cancer survivors than in women without breast cancer regardless of survival time. IMPLICATIONS FOR CANCER SURVIVORS These results help to estimate the health resources needed for the growing group of breast cancer survivors and to identify risk factors that drive higher use of health services.
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Affiliation(s)
- Anna Jansana
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,European Higher Education Area Doctoral Program in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Berta Ibañez
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Alexandra Prados
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,IIS Aragon, Miguel Servet University Hospital, EpiChron Research Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Isabel Del Cura
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain.,Department of Preventive Medicine and Public Health, University Rey Juan Carlos, Avenida de Atenas, 28922, Alcorcón, Madrid, Spain
| | - Maria Padilla-Ruiz
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Teresa Sanz
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain
| | - Beatriz Poblador
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,IIS Aragon, Miguel Servet University Hospital, EpiChron Research Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Ibai Tamayo
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Antonio Gimeno
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Angel Alberquilla
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain
| | - Mercè Abizanda
- Department of Organization and Communication, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Manuela Lanzuela
- Radiotherapy Department, Miguel Servet University Hospital, Saragossa, Spain
| | - Rossana Burgui
- Instituto de Salud Pública y Laboral de Navarra (ISPLN), IdiSNA, Pamplona, Spain
| | - Antonio Diaz Holgado
- Madrid Health Service, Technical Direction of Sanitary Information System, Calle San Martín de Porres, 6- 5ª planta, 28035, Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Conchi Moreno
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Instituto de Salud Pública y Laboral de Navarra (ISPLN), IdiSNA, Pamplona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Javier Baquedano
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Servicio Navarro de Salud-Osasunbidea, Gerencia de Atención Primaria, Pamplona, Spain
| | - Cristobal Molina
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maria Del Carmen Martinez
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Javier Gorricho
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Servicio de Evaluación y Difusión de resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Maximino Redondo
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Autonomous University of Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.
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Louro J, Román M, Posso M, Vázquez I, Saladié F, Rodriguez-Arana A, Quintana MJ, Domingo L, Baré M, Marcos-Gragera R, Vernet-Tomas M, Sala M, Castells X. Developing and validating an individualized breast cancer risk prediction model for women attending breast cancer screening. PLoS One 2021; 16:e0248930. [PMID: 33755692 PMCID: PMC7987139 DOI: 10.1371/journal.pone.0248930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several studies have proposed personalized strategies based on women's individual breast cancer risk to improve the effectiveness of breast cancer screening. We designed and internally validated an individualized risk prediction model for women eligible for mammography screening. METHODS Retrospective cohort study of 121,969 women aged 50 to 69 years, screened at the long-standing population-based screening program in Spain between 1995 and 2015 and followed up until 2017. We used partly conditional Cox proportional hazards regression to estimate the adjusted hazard ratios (aHR) and individual risks for age, family history of breast cancer, previous benign breast disease, and previous mammographic features. We internally validated our model with the expected-to-observed ratio and the area under the receiver operating characteristic curve. RESULTS During a mean follow-up of 7.5 years, 2,058 women were diagnosed with breast cancer. All three risk factors were strongly associated with breast cancer risk, with the highest risk being found among women with family history of breast cancer (aHR: 1.67), a proliferative benign breast disease (aHR: 3.02) and previous calcifications (aHR: 2.52). The model was well calibrated overall (expected-to-observed ratio ranging from 0.99 at 2 years to 1.02 at 20 years) but slightly overestimated the risk in women with proliferative benign breast disease. The area under the receiver operating characteristic curve ranged from 58.7% to 64.7%, depending of the time horizon selected. CONCLUSIONS We developed a risk prediction model to estimate the short- and long-term risk of breast cancer in women eligible for mammography screening using information routinely reported at screening participation. The model could help to guiding individualized screening strategies aimed at improving the risk-benefit balance of mammography screening programs.
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Affiliation(s)
- Javier Louro
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- European Higher Education Area (EHEA) Doctoral Programme in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Marta Román
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- * E-mail:
| | - Margarita Posso
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | | | - Francina Saladié
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | | | - M. Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laia Domingo
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Marisa Baré
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Parc Taulí University Hospital, Sabadell, Spain
| | - Rafael Marcos-Gragera
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Department of Health, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria Sala
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
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Canelo-Aybar C, Carrera L, Beltrán J, Posso M, Rigau D, Lebeau A, Gräwingholt A, Castells X, Langendam M, Pérez E, Giorgi Rossi P, Van Engen R, Parmelli E, Saz-Parkinson Z, Alonso-Coello P. Digital breast tomosynthesis compared to diagnostic mammographic projections (including magnification) among women recalled at screening mammography: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Cancer Med 2021; 10:2191-2204. [PMID: 33675147 PMCID: PMC7982617 DOI: 10.1002/cam4.3803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diagnostic mammography projections (DxMM) have been traditionally used in the assessment of women recalled after a suspicious screening mammogram. Digital breast tomosynthesis (DBT) reduces the tissue overlap effect, thus improving image assessment. Some studies have suggested DBT might replace DxMM with at least equivalent performance. Objective To evaluate the replacement of DxMM with DBT in women recalled at screening. Methods We searched PubMed, EMBASE, and the Cochrane Library databases to identify diagnostic paired cohort studies or RCTs comparing DBT vs DxMM, published in English that: reported accuracy outcomes, recruited women recalled for assessment at mammography screening, and included a reference standard. Subgroup analysis was performed over lesion characteristics. We provided pooled accuracy estimates and differences between tests using a quadrivariate model. We assessed the certainty of the evidence using the GRADE approach. Results We included ten studies that reported specificity and sensitivity. One study included 7060 women while the remaining included between 52 and 738 women. DBT compared with DxMM showed a pooled difference for the sensitivity of 2% (95% CI 1%–3%) and a pooled difference for the specificity of 6% (95%CI 2%–11%). Restricting the analysis to the six studies that included women with microcalcification lesions gave similar results. In the context of a prevalence of 21% of breast cancer (BC) in recalled women, DBT probably detects 4 (95% CI 2–6) more BC cases and has 47 (95%CI 16–87) fewer false‐positive results per 1000 assessments. The certainty of the evidence was moderate due to risk of bias. Conclusion The evidence in the assessment of screen‐recalled findings with DBT is sparse and of moderate certainty. DBT probably has higher sensitivity and specificity than DxMM. Women, health care providers and policymakers might value as relevant the reduction of false‐positive results and related fewer invasive diagnostic procedures with DBT, without missing BC cases.
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Affiliation(s)
- Carlos Canelo-Aybar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Jessica Beltrán
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Margarita Posso
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - David Rigau
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Annette Lebeau
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Elsa Pérez
- University Hospital Dr. Josep Trueta, Girona, Spain
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ruben Van Engen
- LRCB, Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Montané E, Castells X. Epidemiology of drug-related deaths in European hospitals: A systematic review and meta-analysis of observational studies. Br J Clin Pharmacol 2021; 87:3659-3671. [PMID: 33629366 DOI: 10.1111/bcp.14799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/15/2021] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Eva Montané
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Castells
- Department of Medical Sciences, University of Girona, Girona, Spain
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Nogués X, Sánchez-Martinez F, Castells X, Díez-Pérez A, Sabaté RA, Petit I, Brasé A, Horcajada JP, Güerri-Fernández R, Pascual J. Hospital-at-Home Expands Hospital Capacity During COVID-19 Pandemic. J Am Med Dir Assoc 2021; 22:939-942. [PMID: 33639115 PMCID: PMC7847393 DOI: 10.1016/j.jamda.2021.01.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Abstract
A Coronavirus Disease 2019 (COVID-19)–specific Hospital-at-Home was implemented in a 400-bed tertiary hospital in Barcelona, Spain. Senior or immune-compromised physicians oversaw patient care. The alternative to inpatient care more than doubled beds available for hospitalization and decreased the risk of transmission among patients and health care professionals. Mild cases from either the emergency department or after hospital discharge were deemed suitable for admission to the Hospital-at-Home. More than half of all patients had pneumonia. Standardized protocols and management criteria were provided. Only 6% of cases required referral for inpatient hospitalization. These results are promising and may provide valuable insight for centers undertaking Hospital-at-Home initiatives or in the case of new COVID-19 outbreaks.
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Affiliation(s)
- Xavier Nogués
- Department of Internal Medicine Hospital del Mar, Hospital-at-Home Hospital del Mar Institute for Medical Research (IMIM), CIBER on Frailty and Healthy Ageing-CIBERFES, Barcelona, Spain; Hospital-at-Home, Department of Geriatrics, Hospital del Mar, IMIM, CIBER on Frailty and Healthy Ageing-CIBERFES, Barcelona, Spain.
| | - Francisca Sánchez-Martinez
- Department of Internal Medicine Hospital del Mar, Hospital-at-Home Hospital del Mar Institute for Medical Research (IMIM), CIBER on Frailty and Healthy Ageing-CIBERFES, Barcelona, Spain; Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, and Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Adolfo Díez-Pérez
- Department of Internal Medicine Hospital del Mar, Hospital-at-Home Hospital del Mar Institute for Medical Research (IMIM), CIBER on Frailty and Healthy Ageing-CIBERFES, Barcelona, Spain
| | - Rosa Ana Sabaté
- Hospital-at-Home, Department of Geriatrics, Hospital del Mar, IMIM, CIBER on Frailty and Healthy Ageing-CIBERFES, Barcelona, Spain
| | - Irene Petit
- Department of Internal Medicine Hospital del Mar, Hospital-at-Home Hospital del Mar Institute for Medical Research (IMIM), CIBER on Frailty and Healthy Ageing-CIBERFES, Barcelona, Spain
| | - Ariadna Brasé
- Department of Internal Medicine Hospital del Mar, Hospital-at-Home Hospital del Mar Institute for Medical Research (IMIM), CIBER on Frailty and Healthy Ageing-CIBERFES, Barcelona, Spain
| | | | | | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
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Kifer D, Bugada D, Villar-Garcia J, Gudelj I, Menni C, Sudre C, Vučković F, Ugrina I, Lorini LF, Posso M, Bettinelli S, Ughi N, Maloberti A, Epis O, Giannattasio C, Rossetti C, Kalogjera L, Peršec J, Ollivere L, Ollivere BJ, Yan H, Cai T, Aithal GP, Steves CJ, Kantele A, Kajova M, Vapalahti O, Sajantila A, Wojtowicz R, Wierzba W, Krol Z, Zaczynski A, Zycinska K, Postula M, Lukšić I, Čivljak R, Markotić A, Brachmann J, Markl A, Mahnkopf C, Murray B, Ourselin S, Valdes AM, Horcajada JP, Castells X, Pascual J, Allegri M, Primorac D, Spector TD, Barrios C, Lauc G. Effects of Environmental Factors on Severity and Mortality of COVID-19. Front Med (Lausanne) 2021; 7:607786. [PMID: 33553204 PMCID: PMC7855590 DOI: 10.3389/fmed.2020.607786] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Most respiratory viruses show pronounced seasonality, but for SARS-CoV-2, this still needs to be documented. Methods: We examined the disease progression of COVID-19 in 6,914 patients admitted to hospitals in Europe and China. In addition, we evaluated progress of disease symptoms in 37,187 individuals reporting symptoms into the COVID Symptom Study application. Findings: Meta-analysis of the mortality risk in seven European hospitals estimated odds ratios per 1-day increase in the admission date to be 0.981 (0.973-0.988, p < 0.001) and per increase in ambient temperature of 1°C to be 0.854 (0.773-0.944, p = 0.007). Statistically significant decreases of comparable magnitude in median hospital stay, probability of transfer to the intensive care unit, and need for mechanical ventilation were also observed in most, but not all hospitals. The analysis of individually reported symptoms of 37,187 individuals in the UK also showed the decrease in symptom duration and disease severity with time. Interpretation: Severity of COVID-19 in Europe decreased significantly between March and May and the seasonality of COVID-19 is the most likely explanation.
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Affiliation(s)
- Domagoj Kifer
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Dario Bugada
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Judit Villar-Garcia
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ivan Gudelj
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Carole Sudre
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | | | - Ivo Ugrina
- Faculty of Science, University of Split, Split, Croatia
| | - Luca F. Lorini
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Margarita Posso
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Silvia Bettinelli
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Nicola Ughi
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Maloberti
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Oscar Epis
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristina Giannattasio
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Rossetti
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Livije Kalogjera
- Department of Otolaryngology-Head and Neck Surgery, Zagreb School of Medicine, University Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
| | - Jasminka Peršec
- Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Zagreb, Croatia
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Luke Ollivere
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Benjamin J. Ollivere
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Huadong Yan
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Department of Infectious Diseases, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Ting Cai
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Department of Infectious Diseases, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Guruprasad P. Aithal
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Anu Kantele
- Inflammation Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mikael Kajova
- Inflammation Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Olli Vapalahti
- Department of Virology, Helsingin ja Uudenmaan Sairaanhoitopiiri Diagnostic Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Antti Sajantila
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Rafal Wojtowicz
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Waldemar Wierzba
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Zbigniew Krol
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Artur Zaczynski
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Katarina Zycinska
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
- Medical University of Warsaw, Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Warsaw, Poland
| | - Ivica Lukšić
- University of Zagreb School of Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Fran Mihaljević”, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital for Infectious Diseases “Fran Mihaljević”, Catholic University of Croatia, Zagreb, Croatia
- Medical School, University of Rijeka, Rijeka, Croatia
| | - Alemka Markotić
- University Hospital for Infectious Diseases “Fran Mihaljević”, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Johannes Brachmann
- REGIOMED Kliniken, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
| | | | | | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ana M. Valdes
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Juan P. Horcajada
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Xavier Castells
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Julio Pascual
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Massimo Allegri
- Pain Therapy Service Policlinico of Monza Hospital, Monza, Italy
| | - Dragan Primorac
- REGIOMED Kliniken, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
- St. Catharine Hospital, Zagreb, Croatia
- Eberly College of Science, Penn State University, University Park, PA, United States
- University of Osijek School of Medicine, Osijek, Croatia
- Faculty of Dental Medicine and Health, University of Rijeka School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Clara Barrios
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Gordan Lauc
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
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Padilla-Ruiz M, Zarcos-Pedrinaci I, Rivas-Ruiz F, Téllez T, García-Gutiérrez S, González N, Rivero A, Sarasqueta C, Serrano-Aguilar P, Castells X, Quintana JM, Sala M, Redondo M, Castells X, Comas M, Domingo L, Macià F, Roman M, Romero A, Sala M, Barata T, de la Lastra ID, de la Vega M, Bare M, Torà N, Ferrer J, Castanyer F, Carmona C, García S, Martín M, González N, Orive M, Valverde MA, Saez A, Barredo I, de Toro M, Ferreiro J, Quintana JM, Pérez J, Rivero A, Valcárcel C, Padilla M, Redondo M, Téllez T, Zarcos I, Churruca C, Perales A, Recio J, Ruiz I, Sarasqueta C, Urraca JM, Michelena MJ, Moreno J, Mallabiabarrena G, Cobos P, Otero B, Gorostiaga J, Troya I. Factors that Influence Treatment Delay for Patients with Breast Cancer. Ann Surg Oncol 2020; 28:3714-3721. [PMID: 33247362 DOI: 10.1245/s10434-020-09409-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/03/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The diagnosis or treatment of breast cancer is sometimes delayed. A lengthy delay may have a negative psychological impact on patients. The aim of our study was to evaluate the sociodemographic, clinical and pathological factors associated with delay in the provision of surgical treatment for localised breast cancer, in a prospective cohort of patients. METHODS This observational, prospective, multicentre study was conducted in ten hospitals belonging to the Spanish national public health system, located in four Autonomous Communities (regions). The study included 1236 patients, diagnosed through a screening programme or found to be symptomatic, between April 2013 and May 2015. The study variables analysed included each patient's personal history, care situation, tumour history and data on the surgical intervention, pathological anatomy, hospital admission and follow-up. Treatment delay was defined as more than 30 days elapsed between biopsy and surgery. RESULTS Over half of the study population experienced surgical treatment delay. This delay was greater for patients with no formal education and among widows, persons not requiring assistance for usual activities, those experiencing anxiety or depression, those who had a high BMI or an above-average number of comorbidities, those who were symptomatic, who did not receive NMR spectroscopy, who presented a histology other than infiltrating ductal carcinoma or who had poorly differentiated carcinomas. CONCLUSIONS Certain sociodemographic and clinical variables are associated with surgical treatment delay. This study identifies factors that influence surgical delays, highlighting the importance of preventing these factors and of raising awareness among the population at risk and among health personnel.
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Affiliation(s)
- María Padilla-Ruiz
- Research Unit, Agencia Sanitaria Costa del Sol, Hospital Costa del Sol University of Málaga, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
| | - Irene Zarcos-Pedrinaci
- Oncology Service, Hospital Costa del Sol, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
| | - Francisco Rivas-Ruiz
- Research Unit, Agencia Sanitaria Costa del Sol, Hospital Costa del Sol University of Málaga, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
| | - Teresa Téllez
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
| | - Susana García-Gutiérrez
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Research Unit, Galdakao-Usansolo Hospital Osakidetza, Galdakao, Bizkaia, Spain
| | - Nerea González
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Research Unit, Galdakao-Usansolo Hospital Osakidetza, Galdakao, Bizkaia, Spain
| | - Amado Rivero
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Canary Islands Foundation for Health Care Research (FUNCANIS), Tenerife, Spain
| | - Cristina Sarasqueta
- Unidad de Investigación, Instituto de Investigación Sanitaria BioDonostia, Hospital Universitario Donostia - REDISSEC, Donostia, Gipuzkoa, Spain
| | - Pedro Serrano-Aguilar
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain
| | - Xavier Castells
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain
| | - José María Quintana
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Research Unit, Galdakao-Usansolo Hospital Osakidetza, Galdakao, Bizkaia, Spain
| | - María Sala
- Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.,Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain
| | - Maximino Redondo
- Research Unit, Agencia Sanitaria Costa del Sol, Hospital Costa del Sol University of Málaga, Marbella, Spain. .,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain.
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