Psoriasis of the external auditory canal: prevalence, clinical features and impact on quality of life.

Psoriasis of the external auditory canal (PsEAC) is often under-recognized. The aims of this study were to assess the prevalence of PsEAC, its association with a particular psoriasis subtype and its impact on quality of life (QoL). A prospective study was carried out in two Spanish university hospitals, enrolling consecutive patients who attended a consultation for psoriasis. The clinical features of psoriasis and PsEAC were recorded and the Dermatology Life Quality Index (DLQI) and Itch Numerical Rating Scale (Itch-NRS) were distributed to patients. Overall, 188 of 1000 patients (18.8%) included in the study had PsEAC, which was associated with severity of psoriasis, presence of inverse psoriasis and involvement of the scalp, nails and genitals, but not with obesity or psoriatic arthritis. PsEAC was the main reason for consultation in 27 patients, with itching being the main symptom. In this study, PsEAC had a prevalence of 18.8%. The occurrence of PsEAC was associated with poorer QoL, as measured by DLQI and Itch-NRS.

Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy.

PURPOSE: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. METHODS: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. RESULTS: During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level <3.5 g/dL, falls in the past 6 months ≥1, and weight loss >5%. Three risk groups for UH were established according to the score in all patients: 0-1: 17.5%; 2: 34%; and 3-7: 57% (p < 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67-0.77). CONCLUSION: This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatment.

Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer.

Background: Estimation of life expectancy in older patients is relevant to select the best treatment strategy. We aimed to develop and validate a score to predict early mortality in older patients with cancer. Patients and Methods: A total of 749 patients over 70 years starting new chemotherapy regimens were prospectively included. A prechemotherapy assessment that included sociodemographic variables, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and early death was examined using multivariable logistic regression. Score points were assigned to each risk factor. External validation was performed on an independent cohort. Results: In the training cohort, the independent predictors of 6-month mortality were metastatic stage (OR 4.8, 95% CI [2.4-9.6]), ECOG-PS 2 (OR 2.3, 95% CI [1.1-5.2]), ADL ≤ 5 (OR 1.7, 95% CI [1.1-3.5]), serum albumin levels ≤ 3.5 g/dL (OR 3.4, 95% CI [1.7-6.6]), BMI < 23 kg/m2 (OR 2.5, 95% CI [1.3-4.9]), and hemoglobin levels < 11 g/dL (OR 2.4, 95% CI (1.2-4.7)). With these results, we built a prognostic score. The area under the ROC curve was 0.78 (95% CI, 0.73 to 0.84), and in the validation set, it was 0.73 (95% CI: 0.67-0.79). Conclusions: This simple and highly accurate tool can help physicians making decisions in elderly patients with cancer who are planned to initiate chemotherapy treatment.

Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy.

PURPOSE: To identify risk factors for toxicity, unplanned hospitalization (UH) and early death (ED) in older patients with colorectal carcinoma (CRC) initiating chemotherapy. METHODS: 215 patients over 70 years were prospectively included. Geriatric assessment was performed before treatment, and tumor and treatment variables were collected. The association between these factors and grade 3-5 toxicity, UH and ED (<6 months) was examined by using multivariable logistic regression. Score points were assigned to each risk factor. RESULTS: During the first 6 months of treatment, 33% of patients developed grade 3-5 toxicity, 31% had UH and 23% died. Risk factors were, for toxicity, instrumental activities of daily living, creatinine clearance, weight loss and MAX2 index; for UH, Charlson Comorbidity Score, creatinine clearance, weight loss, serum albumin, and metastatic disease; and for ED, basic activities in daily living, weight loss, metastatic disease, and hemoglobin levels. Predictive scores were built with these variables. The areas under receiver operation characteristic (ROC) curves for toxicity, UH and ED were 0.70 (95% CI: 0.64-0.766), 0.726 (95% IC: 0.661-0.799) and 0.74 (95% IC: 0.678-0.809), respectively. CONCLUSION: Simple scores based on geriatric, tumor and laboratory characteristics predict severe toxicity, UH and ED, and may help in treatment planning.

Undertreatment and overtreatment in older patients treated with chemotherapy.

BACKGROUND: Inconsistent doses and schemes are commonly used in older patients receiving cancer chemotherapy. We performed this study in patients with cancer and age ≥ 70 years to determine the frequency of undertreatment and overtreatment as well as factors influencing the decision to modify chemotherapy doses. PATIENTS AND METHODS: Patients aged ≥70 years starting new chemotherapy regimens were prospectively included in a multicentre study. The schedule and drug doses were determined by the treating oncologist. Pre-chemotherapy assessment included sociodemographics, treatment details and geriatric assessment (GA) variables. Association between these factors and undertreatment (use of less intensive cancer treatment [LICT] in a fit patient) or overtreatment (use of standard cancer treatment in an unfit older patient) were examined by multivariate logistic regression. RESULTS: Three- hundred ninety-seven patients were included, 43% of whom received LICT. If not adjusted for GA, toxicity did not differ between those receiving LICT (38%) or standard doses of chemotherapy (37%). If the dose of chemotherapy was analyzed according to the results of GA 61 (15%) patients had been undertreated and 133 (34%) had been overtreated. Undertreatment was related with increasing age and decreased renal function. Factors related with overtreatment were younger age, curative intention of treatment, prescription of G-CSF as primary prophylaxis and adequate cognitive status. Overtreated patients had more grade 3-4 toxicity than those receiving treatment adapted to fragility (42% vs 31%; p < 0.05). CONCLUSIONS: The use of chemotherapy without considering GA leads to overtreatment more commonly than undertreatment in older patients with cancer. Oncologists should take into account the results of GA to stratify patients and to avoid under or overtreatment.

Ustekinumab Drug Survival in Patients with Psoriasis: A retrospective Study of Real Clinical Practice.

Background and objectives: The efficacy and safety of ustekinumab have been proved in clinical trials. In daily clinical practice, knowing the factors that determine survival differences of biological drugs allows psoriasis treatment to be optimized as a function of patient characteristics. The main objectives of this work are to understand ustekinumab drug survival in patients diagnosed with plaque psoriasis in the Hospital Universitario Central de Asturias (HUCA Dermatology Department, and to identify the predictors of drug discontinuation. Materials and Methods: A retrospective hospital-based study, including data from 148 patients who were receiving ustekinumab (Stelara®) between 1 February 2009 and 30 November 2019, were collected. Survival curves were approximated through the Kaplan-Meier estimator and compared using the log-rank test. Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. Results: The average duration of the treatment before discontinuation was 47.57 months (SD 32.63 months; median 41 months). The retention rates were 82% (2 years), 66% (5 years), and 58% (8 years). Median survival was 80 months (95% confidence interval. CI 36.9 to 123.01 months). The survival study revealed statistically significant differences between patients with arthritis (log-rank test, p < 0.001) and those who had previously received biological treatment (log-rank test, p = 0.026). The five-year prevalence in patients still under treatment was 80% (those without arthritis) and 54% (arthritis patients). In the multivariate analysis, only the patients with arthritis had a lower rate of drug survival. No statistically significant differences were observed for any of the other comorbidities studied. The first and second most frequent causes of discontinuation were secondary failure and arthritis inefficacy, respectively. Conclusion: Ustekinumab is a biological drug conferring high survival in plaque psoriasis patients. Ustekinumab survival is lower in patients with arthritis.

Predicting Chemotherapy Toxicity in Older Patients with Cancer: A Multicenter Prospective Study.

BACKGROUND: Standard oncology tools are inadequate to distinguish which older patients are at higher risk of developing chemotherapy-related complications. MATERIALS AND METHODS: Patients over 70 years of age starting new chemotherapy regimens were prospectively included in a multicenter study. A prechemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and the development of grade 3-5 toxicity was examined by using logistic regression. RESULTS: A total of 551 patients were accrued. Chemotherapy doses (odds ratio [OR] 1.834; 95% confidence interval [CI] 1.237-2.719) and creatinine clearance (OR 0.989; 95% CI 0.981-0.997) were the only factors independently associated with toxicity. Only 19% of patients who received reduced doses of chemotherapy and had a creatinine clearance ≥40 mL/minute had grade 3-4 toxicity, compared with 38% of those who received standard doses or had a creatinine clearance <40 mL/minute (p < .0001). However, no satisfactory multivariate model was obtained using different selection approaches. CONCLUSION: Chemotherapy doses and renal function were identified as the major risk factors for developing severe toxicity in the older patient. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up in these patients. IMPLICATIONS FOR PRACTICE: Older patients are more vulnerable to chemotherapy toxicity. However, standard tools are inadequate to identify who is at higher risk of developing chemotherapy-related complications. Chemotherapy doses (standard vs. reduced) and renal function were identified as the major risk factors for developing severe toxicity in the elderly. These factors should be considered when planning to initiate a new chemotherapy regimen and should also lead to a closer follow-up.

Redefinindo o significado da atividade profissional para as mulheres: o caso das pequenas empresárias / Women who run small enterprises: redifining the importance of professional activity / Redefinindo la actividad profesional: el caso de las pequeñas empresarias

Este artigo apresenta parte dos resultados de um estudo que investigou como pequenas empresárias do Estado do Rio de Janeiro percebem a atividade profissional, a maternidade e a conciliação trabalho-família. Nossos resultados apontam para o fato de que, se antes a maternidade definia a vida da mulher, agora, apesar de ser vista como essencial para a completa realização da mulher, ela parece já não ser suficiente para sua plena satisfação pessoal. Desenvolver uma atividade profissional é, para elas, não apenas fonte de sustento, mas, em especial, algo extremamente importante em suas vidas, e que se fez presente, inclusive, nos projetos e planos por elas traçados. Assim, estas duas esferas de atuação, a família e o trabalho, que, num primeiro momento, parecem mutuamente excludentes, acabam por ser vividas e assumidas concomitantemente no cotidiano, o que traz conseqüências importantes para a vida da mulher atual.(AU)

Este texto presenta parte de los resultados de un estudio sobre como pequeñas empresarias de Rio de Janeiro perciben la actividad profesional, la maternidad y la conciliación entre casa y trabajo, entre otras cosas. Los resultados evidenciaron que, aunque la maternidad otrora definía la vida de una mujer, hoy ella ya no parece suficiente para su satisfacción personal. Para estas empresarias, desarrollar una actividad profesional constituye, no apenas fuente de sustento, sino, principalmente, algo de extrema importancia en sus vidas, algo que siempre estuvo presente, incluso, en sus proyectos y planos de vida. No obstante, la maternidad sigue siendo vista por ellas como esencial para la completa realización de una mujer. Así, estas dos esferas de acción, que, en un primer momento parecen mutuamente excluyentes, resultan por ser vividas y asumidas concomitantemente en lo cotidiano, algo que trae consecuencias importantes para la vida de la mujer de hoy.(AU)

This article presents part of the results of a study that investigated how small entrepreneurs from Rio de Janeiro see professional activity, motherhood, and the conciliation of work and family, among other things. Ours results point to the fact that, although maternity used to define the life of a woman, nowadays it does not seem sufficient for their personal satisfaction. For these entrepreneurs, the development of a professional activity, despite bringing them financial support, is mainly a fundamental part of their lives, something that was always present in life projects and plans. Despite that, maternity continues to be seen as essential for the full realization of a woman. Thus, these two spheres of action, house and work, which, at a first glance, seem mutually excluding, end up by being lived and adopted concomitantly in daily life, something that brings important consequences for the life of women nowadays.(AU)

Redefinindo o significado da atividade profissional para as mulheres: o caso das pequenas empresárias / Women who run small enterprises: redifining the importance of professional activity / Redefinindo la actividad profesional: el caso de las pequeñas empresarias

Este artigo apresenta parte dos resultados de um estudo que investigou como pequenas empresárias do Estado do Rio de Janeiro percebem a atividade profissional, a maternidade e a conciliação trabalho-família. Nossos resultados apontam para o fato de que, se antes a maternidade definia a vida da mulher, agora, apesar de ser vista como essencial para a completa realização da mulher, ela parece já não ser suficiente para sua plena satisfação pessoal. Desenvolver uma atividade profissional é, para elas, não apenas fonte de sustento, mas, em especial, algo extremamente importante em suas vidas, e que se fez presente, inclusive, nos projetos e planos por elas traçados. Assim, estas duas esferas de atuação, a família e o trabalho, que, num primeiro momento, parecem mutuamente excludentes, acabam por ser vividas e assumidas concomitantemente no cotidiano, o que traz conseqüências importantes para a vida da mulher atual.

Este texto presenta parte de los resultados de un estudio sobre como pequeñas empresarias de Rio de Janeiro perciben la actividad profesional, la maternidad y la conciliación entre casa y trabajo, entre otras cosas. Los resultados evidenciaron que, aunque la maternidad otrora definía la vida de una mujer, hoy ella ya no parece suficiente para su satisfacción personal. Para estas empresarias, desarrollar una actividad profesional constituye, no apenas fuente de sustento, sino, principalmente, algo de extrema importancia en sus vidas, algo que siempre estuvo presente, incluso, en sus proyectos y planos de vida. No obstante, la maternidad sigue siendo vista por ellas como esencial para la completa realización de una mujer. Así, estas dos esferas de acción, que, en un primer momento parecen mutuamente excluyentes, resultan por ser vividas y asumidas concomitantemente en lo cotidiano, algo que trae consecuencias importantes para la vida de la mujer de hoy.

This article presents part of the results of a study that investigated how small entrepreneurs from Rio de Janeiro see professional activity, motherhood, and the conciliation of work and family, among other things. Ours results point to the fact that, although maternity used to define the life of a woman, nowadays it does not seem sufficient for their personal satisfaction. For these entrepreneurs, the development of a professional activity, despite bringing them financial support, is mainly a fundamental part of their lives, something that was always present in life projects and plans. Despite that, maternity continues to be seen as essential for the full realization of a woman. Thus, these two spheres of action, house and work, which, at a first glance, seem mutually excluding, end up by being lived and adopted concomitantly in daily life, something that brings important consequences for the life of women nowadays.

Atenuando conflitos?: pequenas empresárias buscam conciliar casa e trabalho

O presente estudo busca investigar a vida de seis mulheres empresárias, casadas e com filhos, que encontram em sua atividade empresarial uma nova maneira de conciliar sua vida profissional e familiar da melhor forma possível. Foram coletadas as histórias de vida dessas mulheres, que relataram um pouco do seu cotidiano, de suas escolhas pessoais e das dificuldades decorrentes de tais escolhas. Os textos resultantes da transcrição das histórias de vida foram submetidos a uma análise de discurso. Veremos que o fato de serem empresárias parece reacender a discussão acerca do problema enfrentado por muitas mulheres profissionais, que é a dupla jornada de trabalho. Apesar das mulheres empresárias fazerem uso de estratégias de conciliação que não estão disponíveis às mulheres que trabalham em empresa privada - horário flexível, acesso dos filhos ao ambiente de trabalho e mudança do endereço da empresa para melhor atender à família - isto não parece significar que a conciliação entre trabalho e família ficou menos árdua e difícil. A identidade de empresária, repousando sobre as identidades de mãe e esposa parece ser um dos fatores que mais torna difícil a conciliação de todas as áreas de sua vida. Além disso, a permanência de um discurso tradicional que dita as regras do que é ser uma 'boa mãe' parece dificultar uma mudança efetiva do ambiente doméstico e das relações no seio da família, o que possibilitaria à mulher fazer suas escolhas, tanto pela vida profissional quanto pela maternidade, com menos culpa e desgaste excessivo (AU)