18FDG PET/CT & arterial inflammation: predicting cardiovascular events in lung cancer

BACKGROUND

18F-FDG PET/CT predicts cardiovascular disease. To analyze the predictive value of cardiovascular events from inflammation and arterial calcification in patients who underwent an 18F-FDG PET/CT for lung cancer.

METHODS

A retrospective study of 274 patients with primary lung neoplasia. We determined: (i) TBR (target-to-background ratio), and (ii) the calcium score, at eight common arterial segments. We took as arteriosclerosis, a TBR ≥1.6 and ≥15 Calcium Score sum. We registered cardiovascular risk factors, comorbidities, histology, stage, treatment, status at the last clinical review, cause of death and cardiovascular event during the follow-up.

RESULTS

The territory presenting the greatest uptake of 18F-FDG, was the thoracic aorta with an average of 1.77 (± 0.27 TBR) in the aortic arch, while the greatest degree of calcification was obtained in the abdominal aorta (52% with a Calcium Score ≥ 3). 24% of the patients presented a sum Calcium Score ≥15, and 17% a TBR ≥1.6. Patients with high TBR, (17%), had not a higher frequency of cardiovascular comorbidities beforehand, nor did they in the follow-up. However, those with a sum Calcium Score ≥15 (24%), were older, had more cardiovascular risk factors and ischemic events during follow-up. The calcium score, but not the TBR, predicted the emergence of a cardiovascular event (HR 4.9 IC95% 2.1-9.1, P < 0.05).

CONCLUSION

In our cohort, a high Calcium Score was an independent predictor for developing cardiovascular events.

Periodontitis impacts quality of life in postmenopausal women

AIM

Interrelationships between traditional dental variables are becoming more evident in far-reaching aspects of life such as psychosocial interaction, self-esteem, overall health and even occupational performance. This study compares quality of life in postmenopausal women with chronic periodontitis with that of healthy postmenopausal women.

METHOD

A total of 128 randomly recruited postmenopausal women received a comprehensive periodontal evaluation and completed the Utian Quality of Life Survey. The participants were divided into healthy and periodontitis groups based on comprehensive periodontal examination. Mean scores were calculated for each quality-of-life item, domain and the overall summary score. Periodontitis patients' quality-of-life outcomes were compared to those of healthy patients using the t-test with threshold of significance at p < 0.05.

RESULTS

Quality-of-life scores in all fields measured were significantly poorer in the periodontitis patients compared to the healthy patients, occupational (25.74 ± 8.25 vs. 21.40 ± 9.19), health (26.46 ± 5.93 vs. 19.64 ± 10.24), emotional (21.04 ± 10.20 vs. 16.40 ± 10.84), sexual (9.23 ± 4.92 vs. 5.96 ± 5.20), and total score (82.48 ± 23.74 vs. 63.69 ± 26.61).

CONCLUSION

This study has identified that postmenopausal women with chronic periodontitis report significantly poorer quality of life than healthy patients. Clinicians caring for postmenopausal women should be aware that periodontitis also impacts quality of life when making referral decisions for oral health care.

Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors

BACKGROUND

Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA. This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. The effect of anti-TNF-alpha therapy on periodontitis also was assessed.

METHODS

Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20). To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-alpha before randomization. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index (PI), RA disease activity score 28 (DAS28), and erythrocyte sedimentation rate (ESR) were measured at baseline and 6 weeks later. Linear mixed models were used to identify significant differences between subjects who received periodontal treatment and those who did not.

RESULTS

Patients receiving periodontal treatment showed a significant decrease in the mean DAS28, ESR (P <0.001), and serum TNF-alpha (P <0.05). There was no statistically significant decrease in these parameters in patients not receiving periodontal treatment. Anti-TNF-alpha therapy resulted in a significant improvement in CAL, PD, BOP, and GI.

CONCLUSIONS

Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition. Anti-TNF-alpha therapy without periodontal treatment had no significant effect on the periodontal condition.

[Veracity of smokers' reports of abstinence at smoking cessation clinics]

OBJECTIVE

To assess the reliability of smokers' response as criteria for measuring abstinence and the necessity or not of confirming abstinence with carbon monoxide (CO) measurement.

PATIENTS AND METHODS

A multicenter, prospective, longitudinal study was carried out on patients over 18 years of age from 5 smoking cessation clinics who underwent treatment with nicotine or bupropion. When the patient attended the clinic at 15, 30, 60, 90, and 180 days, abstinence was checked by self-reporting and expired-air CO levels. Sensitivity, specificity, and positive, negative, and overall predictive value of patient reporting, measured CO levels, and the 2 procedures in combination were calculated.

RESULTS

A total of 904 smokers (476 men and 428 women) with a mean (SD) age of 42.51 (10.09) years were enrolled in the study. Of the 904 patients that made up the study population, 820, 776, 687, 719, and 679, respectively, attended the scheduled visits to check abstinence. Self-reported point-prevalence abstinence at 15 days was 74.5% and at 180 days was 57.6% while abstinence determined by expired-air CO was 75.7% and 59.4% respectively. Results according to self-reporting, CO measurement, and the 2 methods in combination were not significantly different (P<.05) at any of the points in time. Neither sensitivity nor specificity showed significant differences in relation to patient variables.

CONCLUSION

The reliability of self-reported abstinence from smoking is high. Measurement of CO is therefore not essential, although it could be advisable for motivating patients rather than as a way of confirming abstinence.

[Functional ability and social-care problems of the elderly in the Cáceres health area]

OBJECTIVE

To describe the social environment and to identify the health problems and the functional and mental ability of the elderly in the community.

DESIGN

Cross-sectional, observational study by means of a questionnaire.

PATIENTS

228 people over 71 and not living in an institution.

SETTING

Cáceres Health Area.

MAIN MEASUREMENTS

Questionnaire on social and demographic details, main pathologies, social assessment (Gijón scale), functional assessment (Barthel and Lawton-Brody scales), mental assessment (Pfeiffer test), geriatric problems and visits from health professionals.

RESULTS

67% of the 228 people in the sample were women, with an average age of 79. Comorbidity, present in over 70% of the elderly, was significantly related to multi-medication, falls, hospital admission, depression and insomnia. The most common social and family situation was of a person living with his/her partner (38.3%; CI, 6.31) or children, in a dwelling with architectural barriers (43.0%; CI, 6.43), with a good relationship to his/her social surroundings (61.0%; CI, 6.33). The Barthel test showed a significant relationship with all the geriatric problems declared. The Pfeiffer test showed a relationship with falls (t=3.10; P=.00214), with hearing problems (t=1.98; P=.048), with incontinence (t=3.59; P=.0040) and constipation (t=2.64; P=.0086). The Lawton-Brody test was related, in women, with falls (t=4.27; P=.00034), admissions (t=2.02; P=.044), constipation and sight and hearing problems; and in men, with depression and incontinence.

CONCLUSIONS

Elderly people in the Cáceres Health Area showed good functional ability in their basic daily tasks, less ability in instrumental activities and high comorbidity.

Diagnostic performance of arginase activity in colorectal cancer

Arginase activity was measured in serum and biopsy from healthy individuals and colorectal cancer patients. Arginase activity in tumor samples (87 +/- 7.7 U/g tissue) was significantly higher than in controls (40.7 +/- 3.3 U/g tissue). However, serum arginase activity did not show any significant change in both groups. Finally, the micromethod used to quantify arginase activity in this study is superior to other methods because it has increased sensitivity, requires less sample, and is less time-consuming. Arginase differences are significant, according to the t-test (P<0.05)

[Research and the recent evolution of primary health care]

Primary care in Spain has undergone a burgeoning phase in the 80's, followed by a decade of stagnation in the 90's, with little creativity, a routinisation of tasks, and the set up of service port-folios and program-contracts. On the other hand, the recent changes in the orientation of the research promoted by the health administration, in favor of basic research, at the expense of health services research and clinical epidemiology, are in contrast with the importance of primary care as a natural setting for the management of many causal agents and risk factors for health. Despite such limitations, the culture of research has become present in many primary care centres and pharmacies, and primary care research is increasingly present in scientific journals. Nevertheless, it is necessary, also for the case of primary care, to manage research, in differentiated and specific ways, favoring priorization, evaluation and responsibility through flexible organisational formulas and information systems. This should include contracting procedures allowing for at least part-time research, as well as professional career models acknowledging research and teaching activities. Scientific and professional associations in primary care face the challenge of maintaning research projects, of increasing their presence among professionals, of formulating opinions regarding the problems of their sector, as well as of reinforcing their organizational and communication capabilities.

[The debate on the organization, functions and efficiency of nursing in primary care: apropos of a qualitative study]

OBJECTIVE

To show the opinions that doctors and nurses express on the organisation and competences of primary care nursing, and on inter-professional relations.

DESIGN

Qualitative research study based on the group discussion technique known as Philips 66.

SETTING AND PARTICIPANTS

Three discussion groups, one of nurses, one of doctors and a third mixed, with 6 components each, half from Cáceres and the rest from other provinces, and all involved in primary care health delivery.

MEASUREMENTS AND MAIN RESULTS

In the discussions, the three groups coincided in the importance given to nursing clinics and home visits, in the organisational advantages that the attachment as a norm of the population to a nursing clinic would bring, in the ability of nurses to perform the techniques they have habitually used, and in defence of one sole clinical record per patient. They blamed each other mutually for making few home visits. Doctors attributed to nurses under-use of records and nurses alleged doctors took no notice of their notes. On the question of their relations, doctors thought that nurses did not take on joint responsibility for the work-loads in health centres; and nurses thought that doctors did not wish to share tasks, but rather delegate or order them.

CONCLUSIONS

The attachment of the population to nursing clinics would favour the extension of care, the commitment to the population and the real delivery of services, as well as professional autonomy and recognition.

[The mortality at 2 years in chronic patients confined to home]

OBJECTIVE

To analyse the relationship between the mortality of the chronically ill confined to their homes and the risk of death predicted by the doctor and other variables.

DESIGN

Longitudinal descriptive study.

PATIENTS

223 patients were studied over 2 years.

MEASUREMENTS AND MAIN RESULTS

Survival was related to the variables measured at the beginning of the follow-up: age, sex, social class, time of confinement, number of diagnoses, hours in bed, evaluation with the Katz index and the Nottingham health profile, number of medicines, family help available, and doctor's opinion on the risk of death. 67% of the patients considered at very serious risk of death died within 6 months, as against 6.91 who died in the same period but had a different prognosis. 40.6% at serious risk died within a year, against 12.4% with a different prognosis. The variables independently associated with higher mortality are: the doctor considering that the risk of death is serious/very serious, OR and 95% CI; 2.57 (1.64-4.03); remaining over 16 hours a day in bed, OR 2.39 (1.31-4.36); being over 80, OR 3.41 (1.74-6.66) and being male, OR 1.61 (1.11-2.33).

CONCLUSIONS

The prognostic judgement of the general doctor behaved as a predictor of mortality, and may be an indirect indicator of his/her capacity to foresee the need for health services.

[The frequency of illnesses attended and its relationship with the maintenance of the family doctor's skill]

OBJECTIVE

To describe the incidence of health problems dealt with less often in primary care medical consultations, and to discuss its relationship with the maintenance of professional skill, with in-work training and case-load planning.

DESIGN

A prospective observational study based on a year's recording.

SETTING

The clinics of 44 primary care doctors from 10 autonomous communities.

PATIENTS

418,98 people were attended.

INTERVENTIONS

The unit of analysis was the care episode. The incidence per 1000 people attended, in total and by demographic mean, of the less common health complaints (incidence less than 1/1000) was calculated.

RESULTS

Primary care doctors attended at greater frequency than 1/1000 all diseases of eyes, ears, mastoids (except salpingitis) and menstrual disorders codifiable under the classification CIPSAP; almost all the respiratory, skin and locomotive diseases, and more than half of the circulatory, genito-urinary, digestive and endocrine-metabolic diseases. Incidence was less than 1/1000 in all the malignant tumours and contagious diseases, except viral hepatitis and tuberculosis in the urban setting.

CONCLUSIONS

Primary care doctors do not often attend certain serious diseases, which are nevertheless present in many differential diagnoses (malignant tumours). This should be borne in mind in the training strategies aimed at maintaining doctor's diagnostic skills.