Safety and efficacy of salvage conventional re-irradiation following stereotactic radiosurgery for spine metastases

Purpose@#There has been limited work assessing the use of re-irradiation (re-RT) for local failure following stereotactic spinal radiosurgery (SSRS). We reviewed our institutional experience of conventionally-fractionated external beam radiation (cEBRT) for salvage therapy following SSRS local failure. @*Materials and Methods@#We performed a retrospective review of 54 patients that underwent salvage conventional re-RT at previously SSRS-treated sites. Local control following re-RT was defined as the absence of progression at the treated site as determined by magnetic resonance imaging. @*Results@#Competing risk analysis for local failure was performed using a Fine-Gray model. The median follow-up time was 25 months and median overall survival (OS) was 16 months (95% confidence interval [CI], 10.8–24.9 months) following cEBRT re-RT. Multivariable Cox proportional-hazards analysis revealed Karnofsky performance score prior to re-RT (hazard ratio [HR] = 0.95; 95% CI, 0.93–0.98; p = 0.003) and time to local failure (HR = 0.97; 95% CI, 0.94–1.00; p = 0.04) were associated with longer OS, while male sex (HR = 3.92; 95% CI, 1.64–9.33; p = 0.002) was associated with shorter OS. Local control at 12 months was 81% (95% CI, 69.3–94.0). Competing risk multivariable regression revealed radioresistant tumors (subhazard ratio [subHR] = 0.36; 95% CI, 0.15–0.90; p = 0.028) and epidural disease (subHR = 0.31; 95% CI, 0.12–0.78; p =0.013) were associated with increased risk of local failure. At 12 months, 91% of patients maintained ambulatory function. @*Conclusion@#Our data suggest that cEBRT following SSRS local failure can be used safely and effectively. Further investigation is needed into optimal patient selection for cEBRT in the retreatment setting.

Avaliação dos níveis lipídicos na população adulta do estudo ESATU: associação com a obesidade / Evaluation of lipid profile in adult population of ESATU study: association with obesity

Introdução: Atualmente, a doença aterosclerótica detém uma posição indiscutível de principal causa de mortalidade nos países desenvolvidos. Mesmo sendo de caráter multifatorial, é determinante a relação direta das dislipidemias e riscos de eventos cardiovasculares e obesidade. O objetivo do estudo foi determinar os níveis séricos do perfil lipídico e prevalência de dislipidemia na população adulta de um município no Sul do Brasil e sua associação com a obesidade. Métodos: Estudo transversal de base populacional com adultos residentes em Tubarão, Santa Catarina, entre novembro de 2011 e junho de 2012. Os participantes foram submetidos à entrevista, coleta de sangue para realização de exames laboratoriais, aferição da pressão arterial e antropometria. Resultados: Foram estudados 369 adultos, com média de idade de 40,6±12,2 anos, 64,0% mulheres. Entre os fatores comportamentais 31,4% eram fumantes/ ex-fumantes, 8,4% eram alcoolistas, 61,0% eram sedentários e 62,1% não apresentavam um padrão alimentar considerado saudável. Quanto às condições clínicas, foi verifi cado que 6,0% eram diabéticos, 36,9% apresentavam hipertensão arterial sistêmica, 27,1% eram obesos e 65% dislipidêmicos. Houve associação positiva entre dislipidemia e idade mais avançada, ter companheiro fixo, baixa escolaridade, tabagismo, obesidade e hipertensão arterial sistêmica. Conclusão: A prevalência de dislipidemia foi de 65%, e obesidade e tabagismo foram fatores associados de forma independente ao desfecho. Os resultados indicam a necessidade de intervenções que promovam um estilo de vida saudável, com ênfase na adoção de hábitos alimentares adequados e exercício físico (AU)

Introduction: At present atherosclerosis holds an undisputed position as the leading cause of death in developed countries. Despite its multifactorial nature, the direct relationship of dyslipidemia and risk of cardiovascular events and obesity is determinant. The aim of the study was to determine serum lipid profiles and prevalence of dyslipidemia in the adult population of a city in south Brazil and their association with obesity. Methods: Cross-sectional population-based study with adults living in Tubarão, Santa Catarina, between November 2011 and June 2012. Participants underwent an interview, blood collection for laboratory tests, blood pressure measurement and anthropometry. Results: We studied 369 adults with a mean age of 40.6 ± 12.2 years, 64.0% women. Among behavioral factors, 31.4 % were smokers/ex-smokers, 8.4% were alcoholics, 61.0 % were sedentary, and 62.1 % did not have an eating pattern considered healthy. Regarding clinical conditions, we found that 6.0% were diabetic , 36.9% had high blood pressure, 27.1% were obese and 65% had dyslipidemia. There was a positive correlation of dyslipidemia with older age, having a steady partner, low education, smoking, obesity and hypertension. Conclusion: The prevalence of dyslipidemia was 65%, and obesity and smoking were independently associated factors with the outcome. The results indicate the need for interventions that promote a healthy lifestyle, with an emphasis on adopting proper eating habits and exercise (AU)

Uso da internet pelos pacientes como fonte de informação em saúde e a sua influência na relação médico-paciente / Use of the internet by patients as a source of health information and its influence on the physician-patient relationship

Introdução: O amplo desenvolvimento no campo tecnológico facilitou o acesso à informação principalmente pela internet. O objetivo deste estudo foi avaliar o uso da internet como ferramenta de busca de informações em saúde pelos pacientes, comparando os atendidos na rede pública e privada de saúde, e sua influência na relação médico-paciente. Métodos: Estudo transversal. Participaram do estudo pacientes entre 18-60 anos, em sala de espera para atendimento ambulatorial na clínica Pró-vida e da Secretaria de Saúde no Município de Tubarão, Santa Catarina. Foi utilizado questionário com questões sobre o uso da internet pelos pacientes e a sua influência na relação médico-paciente. Resultados: Dos 216 pacientes participantes, a média de idade foi de 41,2 (DP=12,4) e 67,1% eram mulheres. Maior escolaridade, cor de pele branca, maior renda familiar e uso de convênio médico ou atendimento particular estiveram associados ao grupo atendido na Clínica Pró-vida. Do total, 63,4% acessavam a internet. Houve associação entre uso da internet e atendimento na rede privada (p=0,007). Indivíduos na faixa etária entre 31-45 anos de idade utilizavam mais a internet (42,3%; p<0,001) e as mulheres consultavam mais a internet para informações sobre saúde (p=0,003). Conclusão: Metade dos pacientes utiliza a internet como fonte de informações sobre saúde, 25,5% conversa com o seu médico sobre as informações adquiridas pela internet, sem mudar ou interferir no tratamento médico e, dos pacientes que contam para seus médicos a busca de informações na internet, apenas 16% apresentaram reação negativa por parte do médico, não prejudicando a relação médico-paciente

Introduction: The widespread development in the technological field has facilitated access to information, especially through the internet. The aim of this study was to evaluate the use of the internet by patients as a tool for finding health information, comparing those served by public and private health networks, and its influence on the doctor-patient relationship. Methods: A cross-sectional study including outpatients aged 18-60 years in the waiting rooms of línica Pro-vida and the public Health Department of Tubarão, Santa Catarina. We used a questionnaire with questions about Internet use by patients and its influence on the doctor-patient relationship. Results: Of the 216 participants, the mean age was 41.2 (SD = 12.4) and 67.1% were women. Higher schooling, white skin color, higher family income, and use of private health insurance or care were associated with the group treated at Clínica Pró-vida. Of the total, 63.4% accessed the internet. There was an association of internet use with care in the private network (p = 0.007). Individuals aged between 31-45 years used the internet more (42.3%, p <0.001), and more women searched the internet for health information (p = 0.003). Conclusion: Half the patients use the internet as a source of health information, 25.5% talk with their doctors about internet-acquired information, without changing or interfering with the medical treatment. Of the patients who tell their doctors about their search for information on the internet, only 16% reported a negative reaction by the physician, but without negatively interfering with the doctor-patient relationship