Pembrolizumab for advanced prostate adenocarcinoma: findings of the KEYNOTE-028 study.

Background: Patients with castration-resistant prostate cancer derive only modest clinical benefit from available therapies. Blockade of the inhibitory programmed death 1 (PD-1) receptor by monoclonal antibodies has been effective in several malignancies. Results from the prostate adenocarcinoma cohort of the nonrandomized phase Ib KEYNOTE-028 trial of pembrolizumab in advanced solid tumors are presented. Materials and methods: Key eligibility criteria included advanced prostate adenocarcinoma, unsuccessful standard therapy, measurable disease per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1), and PD-1 ligand (PD-L1) expression in ≥1% of tumor or stromal cells. Patients received pembrolizumab 10 mg/kg every 2 weeks until disease progression or intolerable toxicity for up to 24 months. Primary end point was objective response rate (ORR) per RECIST v1.1 by investigator review. Results: Median patient age in this cohort (n = 23) was 65 years; 73.9% of patients received at least two prior therapies for metastatic disease. There were four confirmed partial responses, for an ORR of 17.4% [95% confidence interval (CI) 5.0%-38.8%]; 8 of 23 (34.8%) patients had stable disease. Median duration of response was 13.5 months. Median progression-free survival (PFS) and overall survival (OS) were 3.5 and 7.9 months, respectively; 6-month PFS and OS rates were 34.8% and 73.4%, respectively. One patient remained on treatment at data cutoff. After a median follow-up of 7.9 months, 14 (60.9%) patients experienced treatment-related adverse events (TRAEs), most commonly nausea (n = 3, 13.0%). Four (17.3%) experienced grade 3/4 TRAEs: grade 3 peripheral neuropathy, grade 3 asthenia, grade 3 fatigue, and grade 4 lipase increase. No pembrolizumab-related deaths or discontinuations occurred. Conclusion: Pembrolizumab resulted in durable objective response in a subset of patients with heavily pretreated, advanced PD-L1-positive prostate cancer, and its side effect profile was favorable. ClinicalTrials.gov Identifier: NCT02054806.

Tumor recurrence and tumor-related mortality in endometrial cancer: Analysis in 276 patients.

BACKGROUND: In this manuscript, we assessed tumor recurrence and tumor-related mortality in a clinical series of endometrial cancer patients. MATERIALS AND METHODS: A retrospective evaluation of 276 patients (mean age 64 years) with histologically confirmed endometrial cancer treated at a single hospital in Madrid (Spain) was conducted. The median follow-up was estimated using the inverse Kaplan-Meier method. RESULTS: Salient findings were endometrioid carcinoma (84.8% of cases), grade G1 (48.9%) and stages IB (35.1%) and IC (23.2%). Myometrial infiltration >50% was documented in 31.2% of cases and lymphovascular space invasion in 11.9%. After surgery, 52.5% of patients were classified into the low risk group, 21.4% into the intermediate risk group and 26.1% into the high risk group. Tumor recurrence occurred in 14.5% of patients, with an estimated median follow-up of 45 months (95% confidence interval (CI): 41.2-48.8), locoregional recurrence in 42.5% and distant recurrences in 57.5%. Furthermore, 40% of tumor recurrences developed during the first year after primary treatment and 90% over the first 3 years of follow-up. The tumor-related mortality rate was 15.9%. The estimated median follow-up was 46 months (95% CI: 43.0-49.0). Furthermore, 5.07% of death because of tumor developed during the first year after primary treatment and 13.77% over the first 3 years of follow-up. CONCLUSION: The rates of tumor-related death and tumor recurrence in endometrial cancer patients are low, with the highest percentages occurring within 3 years of primary treatment. Most of the recurrences occur outside the pelvis.

Identification of unknown ocular pathogens in clinically suspected eye infections using ribosomal RNA gene sequence analysis.

DNA sequence-based identification of pathogens from ocular samples of patients with clinically suspected eye infections was accomplished using 16S and internal transcribed spacer (ITS) ribosomal RNA gene sequence analysis. PCR was positive for 24 of 99 samples tested. Both culture and 16S rDNA sequence analysis identified Pseudomonas aeruginosa, streptococci and Enterobacteriaceae. Isolates misidentified as Burkholderia cepacia by biochemical tests were identified as Ralstonia mannitolilytica by 16S rDNA sequence analysis. Sequence analysis identified the following microorganisms from 19 culture-negative samples: Haemophilus influenzae, Sphingomonas sp., Klebsiella pneumoniae, Staphylococcus haemolyticus, Morganella morganii, Mycobacterium sp., Chryseobacterium sp., Pseudomonas saccharophila (Xanthomonas) and the fungus, Phaeoacremonium inflatipes.

Regression of melanoma metastases following treatment with the n-bisphosphonate zoledronate and localised radiotherapy.

We report a case of regression of pulmonary and bony metastases in a patient with malignant melanoma following palliative treatment with systemic zoledronate and localised radiotherapy to the bone. Zoledronate is a potent new bisphosphonate used for the treatment of metabolic bone diseases including bone metastases due to its inhibitory effect on osteoclasts. In the context of metastatic cancer zoledronate is routinely used to improve bone pain and reduce the frequency of skeletal events. There is also an increasing body of evidence suggesting that bisphosphonates exhibit anti-tumour properties. Bisphosphonates are able to activate Vgamma9Vdelta2 gamma-delta T cells which can be key players in the immune defence against malignant cells. Furthermore bisphosphonates have direct anti-proliferative, anti-metastatic and pro-apoptotic effects on tumour cells. These actions, together with their low side effect profile, may prove to be useful therapeutic tools in the treatment of cancer even in the absence of bone metastases. On the basis of this case report we here review the current literature on present preclinical and clinical studies using bisphosphonates for the treatment of cancer.

Histeroscopia en hiperplasia y cáncer de endometrio / Hysteroscopy in hyperplasia and endometrial cancer

La histeroscopia permite observar directamente el interior del útero, La hiperplasia endometrial definida como una proliferación de glándulas, de forma y tamaño irregular, no presenta patrón histeroscópico determinado para cada tipo de hiperplasia. Cuando valoramos eficacia y correlación del diagnostico clínico con el histológico, la eficacia diagnóstica para hiperplasia oscila entre el 56 y el 83%, La normalidad de imagen histeroscópica no excluye la posibilidad de patología. La sensibilidad es del 98% con una especificidad del 99.9% en determinados grupos especialmente entrenados, entre los que nos encontramos, en el adenocarcinoma endometrial hacen a la histeroscopia herramienta imprescindible. La afectación cervical es diagnosticada con una sensibilidad que oscila entre el 64-100%, especificidad 73-98%. El VPN es de 100% y un VPP entre el 38.4 y 93.3%. La histeroscopia es el método de elección en el diagnostico y manejo de la patología maligna endometrial, favoreciendo el hallazgo temprano y el estadiaje del cáncer endometrial. Precisa entrenamiento y aprendizaje para la obtención de su mejor rendimiento diagnostico. Con una elevada sensibilidad, especificidad

The hysteroscopy allows to observe the interior of the uterus directly. The endometrial hyperplasia defined as a proliferation of glands, of form and irregular size, it doesn’t present hysteroscopic patron certain for each hyperplasia type. When we value effectiveness and correlation of the diagnose clinical with the histology, the effectiveness diagnostic for hyperplasia oscillates between the 56 and 83%. The normality of image hysteroscopic doesn’t exclude the pathology possibility. The sensibility is of 98% with a specificity of 99.9% in certain specially trained groups, in those that we find ourselves , the carcinoma endometrial makes to the hysteroscopy indispensable tool. The cervical affectation is diagnosed with a sensibility that oscillates between 64-100%, specificity 73-98%. The VPN is of 100% and a VPP between the 38.4 and 93.3%. The hysteroscopy is the election method in the diagnose and manage of the pathology wicked endometrial, favoring the early discovery and the stage of the endometrial cancer. It is necessary a training and a learning for the obtainig of their best yield diagnose. With a high sensibility, specificity

Supraestructure maxillectomy and orbital exenteration for treatment of basal cell carcinoma of inferior eyelid: case report and review.

Basal cell carcinoma (BCC) is the most frequent type of skin cancer in humans, with cumulative exposure to ultraviolet radiation as an important risk factor for development of illness such as severe solar burns during childhood or adolescence. BCC is mainly located on sun-exposed sites, head and neck being the areas of more incidences; although nose, eyelids and periorbitary tissue are unfavorable due to cosmetic results that BCC involves. Tumors can be classified as nodular, superficial, micronodular, morphea variety, infiltrating, pigmented, metatypic and fibroepithelioma of Pinkus. Several treatment options such as surgical and nonsurgical are available. The goal of treatment is complete excision of the tumor with preservation of surrounding structures in a way aesthetically acceptable. Mohs' micrographic surgery is the standard treatment for all nonmelanoma skin cancers. Orbital exenteration is also used for treatment of malignancies of ocular tissues, mainly squamous cell carcinoma, sebaceous cell carcinoma and BCC. The tissue beneath the surgical site can be left for second-intention granulation or covered with a cutaneous implant of partial thickness. The case of a 77-year-old patient is presented with BCC of inferior eyelid of 14 years' duration, formerly managed with radiotherapy; however, due to recurrent illness and invasion to the maxillary antrum, he needed supraestructure maxillectomy with left orbital exenteration.

Efecto del tratamiento con eprosartán sobre la presión de pulso. Factores predictores de la respuesta / Effect of eprosartan treatment on pulse pressure. Predictive factors of response

Fundamento. La presión de pulso (PP) o diferencial viene siendo reconocida como uno de los principales factores de riesgo cardiovascular, especialmente en individuos de avanzada edad o con hipertensión arterial (HTA) sistólica aislada. El objetivo del presente trabajo ha sido el de evaluar el efecto del tratamiento antihipertensivo con eprosartán sobre la PP, así como los factores que influyen en dicho efecto. Métodos. Estudio observacional efectuado con 4.067 pacientes afectos de HTA esencial (55 por ciento mujeres) con una edad media de 67 años. Completaron 12 semanas de tratamiento con eprosartán 3.133 pacientes (87 por ciento en monoterapia) prescrito a criterio de los médicos investigadores por nuevo fármaco o falta de eficacia de la terapia previa. El ámbito de actuación fue la Atención Primaria y la medida de presión se llevó a cabo con un aparato oscilométrico validado OMRON 705CP, provisto de impresora. Resultados. Eprosartán produjo un descenso significativo (p < 0,001) de la PP (13,5 mmHg) a las 12 semanas de tratamiento. Los descensos de presión arterial sistólica (PAS) (26,0 mmHg), presión arterial diastólica (PAD) (12,6 mmHg) y presión arterial media (PAM) (17,1 mmHg) fueron igualmente significativos. Tras corregir la PP por la intensidad de la HTA (cociente PP/PAM) se observó un efecto del fármaco en la reducción de dicho cociente, que pasó del 62 por ciento al 58 por ciento, hecho que indica una reducción del 4 por ciento del componente pulsátil independiente del componente estático. Esta reducción fue más marcada en los pacientes mayores de 60 años, con un cociente basal más elevado y con complicaciones cardiovasculares. La tasa de reacciones adversas al fármaco fue del 1,5 por ciento. Conclusión. Eprosartán es un fármaco efectivo y bien tolerado capaz de reducir la presión de pulso, en parte de forma independiente a la reducción de otros componentes tensionales. Este hecho puede ser importante en términos de seguridad y protección de órganos diana (AU)

Análisis de la aplicación del índice pronóstico de Van Nuys en carcinoma in situ de mama y su influencia en la adecuación del tratamiento / An analysis of the application of de Van Nuys prognosstic index of in situ breast cancer and its influence on treatment adjustment

En la práctica diaria y por el advenimiento de los programas de detección mamaria, el diagnóstico de carcinoma in situ de mama es cada vez más frecuente. En nuestro material del 10 por ciento en el primer período analizado (1984-1989), hemos pasado al 55 por ciento en el período 1996-2001.La valoración de los carcinomas en función del VNPI fue la siguiente: VN 3 o 4 en 16 casos (17 por ciento); VN 5,6 o 7 en 34 casos (35 por ciento); VN 8 o 9 en 18 casos (19 por ciento) y VN no valorable en 28 casos (29 por ciento).El empleo de puntuación (en este caso el VNPI) nos permite individualizar el tratamiento adecuando nuestro árbol de decisión al tamaño de la lesión, márgenes de seguridad y el grado de diferenciación histológica, unida a la presencia o no de necrosis tumoral. Por tanto, en nuestra casuística la progresión del tratamiento conservador ha pasado del 43 al 65 por ciento en los períodos estudiados (AU)

Prevalence of pain in the Spanish population: telephone survey in 5000 homes.

Pain has become the most common accompanying symptom in patients seeking medical advice, and it is one of the main issues in public health. In Spain, there are no reliable data about the impact of pain in general population. The aim of the study was to estimate the prevalence of acute and chronic pain in the Spanish general population. An epidemiological observational population-based cross-sectional study was carried out by means of a telephone survey. Multistep stratified quota-adjusted sampling was performed with people aged 18-95 years. A computer-assisted questionnaire was administered, covering physical pain symptoms, site, frequency, perceived cause, therapeutic measures and interference with daily life activities. There were 11,980 useful contacts, with 5000 effective interviews (42% of useful sample). Of the interviewees, 29.6% (95% confidence interval, 28.3-30.8%) reported having had pain the day before (women, 37.6%; men, 20.9%) and 43.2% the week before. Most common pain sites were lower extremities (22.7%) and back (cervical and lumbar levels) (21.5%), followed by head (20.5%). Frequency of pain increased with age, reaching 42.6% for people older than 65 years. Among people complaining of pain during the last day or week, duration of symptoms was higher than 3 months in 54% (chronic pain), representing 23.4% of the Spanish general population; most common causes of chronic pain were arthritis, rheumatism and migraine. Regarding treatment, 61.7% of people complaining of pain said they were taking drugs. Source of drug treatment advice was a physician or a nurse in 66.4% of cases and self-prescription in 29%. It is concluded that pain, particularly chronic pain, has a high prevalence in the Spanish general population and a significant impact on occupational and social relationships.

Semaphorin 3A elicits stage-dependent collapse, turning, and branching in Xenopus retinal growth cones.

The semaphorin receptor, neuropilin-1 (NP-1), was first identified in Xenopus as the A5 antigen and is expressed abundantly in developing retinal ganglion cells (RGCs). Here we show that growth cones acquire responsiveness to semaphorin 3A (Sema 3A) with age and that the onset of responsiveness correlates with the appearance of NP-1 immunoreactivity. Growth cones from "old" (stage 35/36) retinal explants collapse rapidly (5-10 min) in response to Sema 3A and turn away from a gradient of Sema 3A, whereas "young" growth cones (stage 24) are insensitive to Sema 3A. Moreover, transfection of full-length NP-1 into young neurons confers premature Sema 3A sensitivity. When young neurons are aged in culture they develop Sema 3A sensitivity in parallel with those in vivo, suggesting that an intrinsic mechanism of NP-1 regulation mediates this age-dependent change. Sema 3A-induced collapse is transient, and after recovery approximately 30% of growth cones extend new branches within 1 hr, implicating Sema 3A as a branching factor. Pharmacological inhibitors were used to investigate whether these three Sema 3A-induced behaviors (collapse, turning, and branching) use distinct second messenger signaling pathways. All three behaviors were found to be mediated via cGMP. In situ hybridization shows that Sema 3A is expressed in the tectum and at the anterior boundary of the optic tract where axons bend caudally, suggesting that Sema 3A/NP-1 interactions play a role in guiding axons in the optic tract and in stimulating terminal branching in the tectum.

Criteria used by general practitioners in prescribing prokinetic or antisecretory drugs in patients with functional dyspepsia.

OBJECTIVE: To analyze the clinical factors considered by general practitioners for the prescription of prokinetic or antisecretory drugs in patients with functional dyspepsia (FD), and to assess therapeutic outcomes and factors predicting effectiveness. DESIGN: Multicentric, prospective and observational study. PATIENTS: 1,021 patients with FD were included. One hundred and thirty-two (132) were excluded from the analysis because they were taking ASA or NSAID. Patients were classified according to their predominant symptoms as reflux, ulcer, dysmotility or non-specific. At the physician discretion, treatment with alkali drugs was prescribed to 38 patients, prokinetic drugs to 574, antisecretory drugs to 123 and a combined therapy to 154. One month later, patient self-perception of symptomatic improvement was evaluated in patients treated with prokinetic drugs and antisecretory drugs. RESULTS: 85% of the patients reported symptomatic improvement after one month of treatment. Patients with non-specific FD had lower improvement rates regardless of the drug used (prokinetic or antisecretory) (77%) compared to all the other types (p = 0.03). Prescription of prokinetics was associated to female gender (OR: 0.43; 95% CI: 0.28-0.66) and early satiety (OR: 2.5; 95% CI: 1.6-4.1). A longer symptomatic evolution (OR 0.92: 95% CI: 0.88-0.97) was the only independent predictive factor of a poor response to prokinetic drugs. CONCLUSIONS: Among patients with FD attended by general practitioners, female gender and early satiety symptom were associated to the prescription of prokinetic drugs. Early symptomatic effectiveness rates for prokinetic or antisecretory drugs alike were high (85%). Patients with non-specific dyspepsia or long symptomatic evolution showed less favorable symptomatic response to prokinetic drugs.

Organ donation and family decision-making within the Spanish donation system.

This study analyses the variables associated with the decisions made by families of potential organ donors to give or deny consent for the extraction of organs. Different indicators were recorded in 68 cases of family interview for petition of consent carried out in 13 Spanish hospitals. Those variables showing the strongest relation with family decision (donation/refusal of consent) are knowledge shown by the family about the deceased's wishes with regard to donation (p<0.001), family relationship climate (p<0.01), expression of family's satisfaction level with medical attention received (p<0.01) and number of relatives present at the consent request interview (p<0.01). Logistic regression on family decision with considered variables correctly predicted relatives' final choice in 98.4% of cases. In turn, multivariate exploratory analysis highlights a potential association between the expression of the deceased's wishes and several concurrent variables in the process (satisfaction with personal treatment and medical attention received, emotional reactions in the interviews of notification of death and consent request). It also shows that patterns of reaction and family participation in this process may vary according to the sex of the deceased relative. Results suggest that both educational efforts devoted to promoting a positive attitude toward donation in the general population and the training of health professionals involved in the generation of organs may be key factors in reducing organ shortage.

Validation of the Spanish version of the Glasgow Dyspepsia Severity Score.

OBJECTIVE: To translate, adapt and validate the Spanish version of the Glasgow Dyspepsia Severity Score (GDSS). METHOD: The translation into Spanish and the adaptation of the scale was carried out by specialized medical translators. The comprehensibility of the translated scale was assessed by two independent observers and by the research team. GDSS includes eight items and was filled out once by 40 healthy subjects (control group) and twice by 131 patients with functional dyspepsia. After the first measurement, patients were prescribed a H2 blocker (roxatidine) for 2 months. A second evaluation was carried out 6 months after the beginning of the treatment. RESULTS: The comprehensibility of the questionnaire was good. It showed acceptable internal consistency both for the control group (0.6) and for the patients at the inclusion visit (0.6) and good consistency for the patients at the 6 month follow-up evaluation (0.8). After treatment, the overall score decreased almost to half (p < 0.0001) in the patients, thus confirming the effectiveness of the treatment 4 months after its discontinuation, although their score was still higher than the score of the control group (p < 0.001). CONCLUSIONS: Results suggest the usefulness of including the GDSS scale in the dyspeptic symptoms recording protocols, since it allow to estimate, with appropriate objectivity and in an easy and quickly way, the degree of impairment due to dyspeptic symptoms, as well as the perception of well-being and the effectiveness of a given therapy.

Criterios de los médicos de atención primaria para la indicación de tratamiento con procinéticos o antisecretores en pacientes con dispepsia funcional / Criteria used by ge neral practitioners in prescribing prokinetic or antisecretory drugs in patients with functional dyspepsia

Objetivo: analizar los factores clínicos que valoran los médicos de atención primaria para la prescripción de procinéticos o antisecretores en pacientes con dispepsia funcional (DF) y evaluar los resultados terapéuticos y factores predictivos de efectividad. Diseño: estudio multicéntrico, prospectivo y observacional. Pacientes: se incluyeron 1.021 pacientes con DF, se excluyeron 132 porque tomaban AAS o AINE. Se clasificaron según sintomatología predominante en tipo reflujo, ulceroso, dismotilidad e inespecífica. A criterio del facultativo se prescribió tratamiento con alcalinos en 38 pacientes, procinéticos en 574, antisecretores en 123 o mixto en 154. Al mes se evaluó la percepción de mejoría sintomática de los pacientes tratados con procinéticos y antisecretores. Resultados: se produjo mejoría sintomática en un 85 por ciento de pacientes al mes de tratamiento. Los pacientes con DF tipo inespecífico, tanto con procinéticos como con antisecretores, tuvieron menores tasas de mejoría (77 por ciento) que el resto de subtipos (p = 0,03). La prescripción de procinéticos se relacionó con el sexo femenino (OR: 0,43; IC 95 por ciento: 0,28-0,66) y el síntoma saciedad precoz (OR: 2,5; IC 95 por ciento: 1,6-4,1). Una evolución sintomática más larga (OR 0,92: IC 95 por ciento: 0,88-0,97) fue el único predictor independiente de peor respuesta a procinéticos. Conclusiones: en los pacientes con DF atendidos por médicos de Atención Primaria, el sexo femenino y el síntoma de saciedad precoz se relacionaron con la prescripción de procinéticos. Las tasas de eficacia sintomática precoz con procinéticos o antisecretores fueron altas (85 por ciento). Los pacientes con dispepsia del tipo inespecífico o sintomatología de larga evolución presentaron respuesta terapéutica menos favorable a procinéticos (AU)

Validación de la versión española de la Glasgow Dyspepsia Severity Score / Validation of the Spanish version of the Glasgow Dyspepsia Severitiy Score

Objetivo: traducir, adaptar y validar al castellano la Glasgow Dysepsia Severity Score (GDSS).Método: la traducción y adaptación del cuestionario al castellano fue realizada por personal especializado en traducción médica. Se estudió la comprensibilidad de la escala por dos evaluadores independientes y por el equipo investigador. La GDSS está compuesta por ocho ítems y fue cumplimentada en una ocasión por 40 sujetos sanos (grupo control) y en dos ocasiones por 131 pacientes con dispepsia funcional. Tras la primera valoración de la escala se prescribía a los pacientes tratamiento con un bloqueante H2 (roxatidina) durante 2 meses. A los 6 meses del inicio del tratamiento se realizó la segunda evaluación. Resultados: la comprensibilidad del cuestionario fue buena. El cuestionario mostró una consistencia interna aceptable tanto para el grupo control (0,6) como para los pacientes en la valoración durante la inclusión (0,6) y buena para los pacientes a los 6 meses de seguimiento (0,8). Después del tratamiento, la puntuación total de la escala disminuyó en los pacientes casi a la mitad (p< 0,0001) confirmando la bondad del tratamiento 4 meses después de finalizado, aunque la puntuación seguía siendo superior a la del grupo control (p< 0,001).Conclusiones: los resultados sugieren el interés de incorporar el cuestionario GDSS en los protocolos de registro de sintomatología dispéptica ya que permite estimar con aceptable objetividad y de forma rápida y sencilla el grado de afectación de la sintomatología dispéptica, la percepción de bienestar y la eficacia de una determinada terapia (AU)

Valoración de la eficacia y seguridad de ibuprofeno retard en procesos reumatológicos agudos y crónicos / Assessment of the safety and efficacy of ibuprofen retard in acute and chronic rheumatologic conditions

Se realizó un estudio epidemiológico, observacional, prospectivo y multicéntrico en el que se incluyeron datos de 489 pacientes afectos de trastornos crónicos y agudos que cursaban con dolor. Un 28,6 por ciento de los pacientes demandaron asistencia médica por procesos crónicos y el 71,4 por ciento restante por procesos agudos. El 16 por ciento de los pacientes recibieron 1 comprimido de 600 mg de ibuprofeno retard al día, frente al 84 por ciento restante que recibió 2 comprimidos al día. Los pacientes permanecieron en tratamiento por un período de 14,7 ñ 6,1 días. El grado de satisfacción fue ligeramente superior en los pacientes con procesos agudos frente a los crónicos. Sólo 38 pacientes presentaron efectos secundarios mayoritariamente de carácter leve (87,8 por ciento) y de tipo gastrointestinal (76,2 por ciento). Únicamente un 1,4 por ciento de los participantes en el estudio abandonaron el tratamiento. Ibuprofeno retard presentó una elevada efectividad en el tratamiento de procesos agudos y crónicos con una excelente tolerabilidad (AU)

An exploratory multivariate approach to drug consumption patterns in young people based on primary socialization theory.

Drug consumption patterns and their psychosocial conditioning factors are explored on the basis of Primary Socialization Theory (PST), through the application of a questionnaire to a representative sample (N= 650) of the young population (age 15 to 29 years) in the Madrid Region. Cluster analysis identifies five consumption groups. Discriminant analysis, including indicators about subject's integration in primary socialization environments, beliefs about the effects of drugs, indicators of psychosocial wellbeing, and variables related to leisure time, allows 67.45% of correct consumption group prediction. Complex associations between drug use, socialization environments and psychosocial wellbeing are found, calling into question approaches establishing cumulative or unidimensional relationships between posited "risk factors" and drug consumption.