Metformin and aspirin treatment could lead to an improved survival rate for Type 2 diabetic patients with stage II and III colorectal adenocarcinoma relative to non-diabetic patients.

Metformin, the drug of choice in the treatment of type 2 diabetes mellitus (DM2), in addition to aspirin (ASA), the drug prescribed for cardioprotection of diabetic and non-diabetic patients, have an inhibitory effect on cancer cell survival. The present population-based study conducted in the province of Trieste (Italy), aimed to investigate the prevalence of DM2 in patients with colorectal adenocarcinoma (CRC) and survival for CRC in diabetic and nondiabetic patients. All permanent residents diagnosed with a CRC between 2004 and 2007 were ascertained through the regional health information system. CRC-specific and relative survival probabilities were computed for each group of patients defined by CRC stage, presence or absence of DM2 treated with metformin, and presence or absence of daily ASA therapy. A total of 515 CRC patients without DM2 and 156 with DM2 treated with metformin were enrolled in the study. At the time of CRC diagnosis, 71 (14%) nondiabetic and 39 (25%) diabetic patients were taking ASA daily. The five-year relative survival for stage III CRC was 101% [95% confidence interval (CI)=76-126] in the 18 patients with DM2 treated with metformin and ASA, 55% (95% CI=31-78) in the 23 without DM2 treated with ASA, 55% (95% CI=45-65) in the 150 without DM2 not taking ASA, and 29% (95% CI=13-45) in the 43 with DM2 treated with metformin, however not with ASA. The findings support the hypothesis of a possible inhibitory effect of metformin and ASA on CRC cells. Randomized controlled trials are required to verify this hypothesis.

Demographic, tumor and clinical features of clinical trials versus clinical practice patients with HER2-positive early breast cancer: results of a prospective study.

BACKGROUND: Several randomized clinical trials (RCTs) have demonstrated the efficacy of trastuzumab-based adjuvant therapy in HER2-positive breast cancer (BC). However, RCT patients may not invariably be representative of patients routinely seen in clinical practice (CP). To address this issue, we compared the clinical and tumor features of RCT and CP patients with HER2-positive BC. PATIENTS AND METHODS: From January to December 2012, 650 consecutive patients with HER2-positive early BC, treated in 36 different types of Italian healthcare facilities, were enrolled in this study. Age, treatment, tumor size (T), nodes (N), grade (G), estrogen receptor (ER) and progesterone receptor (PgR) status were prospectively collected in these CP patients. The same data were extracted from the main adjuvant trastuzumab RCTs and pooled using the random-effects model of DerSimonian and Laird. RCT and CP patients were compared by using the Cochran Q statistics. RESULTS: Versus RCT patients, CP patients were more likely to be older than 50 years (65 vs. 49 %; p < 0.0001) and to have HR (ER and/or PgR)-positive (72 vs. 54 %; p < 0.0001) BC and less likely to have tumor >2 cm (T ≥ 2 cm 39 vs. 59 %; p < 0.0001), positive N (47 vs. 89 %; p < 0.0001) and a high G (61 vs. 67 %; p = 0.0241). CP patients more frequently received adjuvant endocrine therapy (70 vs. 57 %; p < 0.0003) and less frequently adjuvant chemotherapy (97 vs. 99.7 %; p < 0.0001). CONCLUSIONS: Most tumor and clinical features differed significantly between CP and RCT patients. These data raise concerns about the applicability of RCT results to CP patients.

The role of O6-methylguanine-DNA methyltransferase in a long-surviving metastatic melanoma.

BACKGROUND: Brain metastases commonly occur in patients with metastatic melanoma and are associated with a poor prognosis. Only a few chemotherapeutic agents have been shown to be potentially active. Resistance to chemotherapy is one of the main limitations to treatment. A key mechanism of resistance is O6-methylguanine-DNA methyltransferase (MGMT). The methylation of its promotor could inhibit the activity of this enzyme; consequently, it is very important to evaluate the methylation status of all available specimens. CASE REPORT: We report the case of a long-surviving patient in whom combination treatment with an alkylating agent inhibiting MGMT, such as temozolomide, was useful in clinical control of the disease.

Gerenciamento participativo em saúde do trabalhador: uma experiência na atividade de controle de vetores / Participative management in workers' health: an experience in the vector control activity

Este artigo apresenta a experiência de implantação de um sistema de gestão em Saúde do Trabalhador implantado na Superintendencia de Controle de Endemias (SUCEN), no período de 1998 a 2002, que operava na atividade de controle químico de vetores no Estado de São Paulo. OBJETIVO: Descrever o sistema de gestão participativa, as ações desenvolvidas e os principais resultados alcançados. MÉTODO: Relato da experiência vivenciada pela equipe usando abordagem qualitativa, análise de documentos e apresentação de dados quantitativos. RESULTADOS: Foram eleitas 11 Comissões de Saúde e Trabalho (COMSAT's) que em conjunto com a equipe técnica iniciaram a identificação dos riscos e de propostas para prevenção e controle dos riscos no trabalho. O mapeamento de riscos resultou em 650 recomendações, 45,7 por cento das quais foram executadas. Foram identificadas como doenças relacionadas ao trabalho: reações alérgicas aos pesticidas, lesões por esforços repetitivos, distúrbios auditivos e patologias de coluna vertebral. Participaram dos cursos básicos de saúde do trabalhador 1.003 servidores (76,3 por cento do total de servidores), sendo que 90,8 por cento dos participantes os consideraram ótimos ou bons. CONCLUSÕES: O sistema de gerenciamento participativo coloca em prática os princípios de gestão democrática do Sistema Único de Saúde (SUS); incorpora, por meio do mapeamento de riscos, o saber do trabalhador; inclui os trabalhadores como sujeitos do processo de negociação e mudanças; pratica o direito à informação. As COMSAT's revelaram-se espaços adequados para a negociação das melhorias nas condições de trabalho. A aprovação do sistema de gestão culminou na validação legal por meio de um acordo tripartite assinado em março de 2002.(AU)

Gerenciamento participativo em saúde do trabalhador: uma experiência na atividade de controle de vetores / Participative management in workers' health: an experience in the vector control activity

Este artigo apresenta a experiência de implantação de um sistema de gestão em Saúde do Trabalhador implantado na Superintendencia de Controle de Endemias (SUCEN), no período de 1998 a 2002, que operava na atividade de controle químico de vetores no Estado de São Paulo. OBJETIVO: Descrever o sistema de gestão participativa, as ações desenvolvidas e os principais resultados alcançados. MÉTODO: Relato da experiência vivenciada pela equipe usando abordagem qualitativa, análise de documentos e apresentação de dados quantitativos. RESULTADOS: Foram eleitas 11 Comissões de Saúde e Trabalho (COMSAT's) que em conjunto com a equipe técnica iniciaram a identificação dos riscos e de propostas para prevenção e controle dos riscos no trabalho. O mapeamento de riscos resultou em 650 recomendações, 45,7 por cento das quais foram executadas. Foram identificadas como doenças relacionadas ao trabalho: reações alérgicas aos pesticidas, lesões por esforços repetitivos, distúrbios auditivos e patologias de coluna vertebral. Participaram dos cursos básicos de saúde do trabalhador 1.003 servidores (76,3 por cento do total de servidores), sendo que 90,8 por cento dos participantes os consideraram ótimos ou bons. CONCLUSÕES: O sistema de gerenciamento participativo coloca em prática os princípios de gestão democrática do Sistema Único de Saúde (SUS); incorpora, por meio do mapeamento de riscos, o saber do trabalhador; inclui os trabalhadores como sujeitos do processo de negociação e mudanças; pratica o direito à informação. As COMSAT's revelaram-se espaços adequados para a negociação das melhorias nas condições de trabalho. A aprovação do sistema de gestão culminou na validação legal por meio de um acordo tripartite assinado em março de 2002.

INTRODUCTION: The paper shows the implementation experience of a management system in occupational health that took place at SUCEN (Superintendence for Endemic Control), from 1998 to 2002, which worked on the activity of chemical control of vectors in the State of São Paulo.OBJECTIVE: To describe the participative management system, the actions that were taken and the main accomplished results. METHODS: Report on what was experienced by the team using qualitative approach, document analysis and report on quantitative data.RESULTS: Eleven COMSAT's (Workers Health Committees) were elected, which, together with the technical team, started to identify the occupational risks and proposals to prevent and control them. The investigation resulted in 650 suggestions, 45.7% of which were carried out. Work-related diseases were identified as allergic reactions to pesticides, muscular pain linked to repetitive movements, hearing disorders and back pain caused by excessive weight carrying. A total of 1003 workers participated in the basic courses on workers health, 90.8% of whom classified them as good or excellent. CONCLUSIONS: The participative management system puts into practice the democratic management principles of SUS (Brazil's National Health System); by means of risk mapping, it incorporates workers' experiences; it regards workers as agents in the change and negotiation process; it puts into practice the right to information. The COMSAT's proved to be adequate places for negotiating improvements in working conditions. The approval of the Management System ended up in legal validation through a three-party agreement signed in March 2002.

Mental adaptation to cancer: depression and blood platelet monoamine oxidase activity in breast cancer patients.

BACKGROUND: Stress and depression were reported as negative prognostic factors in breast cancer patients and monoamine oxidase (MAO) activity was considered a marker of mental suffering. MATERIALS AND METHODS: MAO activity in platelets was determined in a group of newly diagnosed breast cancer patients, after the communication of diagnosis and surgery, using the Mental Adjustment to Cancer (MAC) and Hospital Anxiety and Depression scales (HADS). RESULTS: The analysis of regression indicated that hopelessness-helplessness positively correlated with depression, anxiety and anxious preoccupation. Monoamine oxidase (MAO) activity displayed a positive regression coefficient with depression score. At follow-up, Cox analysis of survival indicated that MAO activity was a marginally significant risk factor. CONCLUSION: Further research in a larger group of patients may support the present results, showing that MAO activity is a biological marker of difficulties in mental adaptation to cancer and is a risk factor for survival.

Life events and benign paroxysmal positional vertigo: a case-controlled study.

CONCLUSIONS: Within the poorly understood mechanisms implicated in the aetiology of benign paroxysmal positional vertigo (BPPV), the results of this trial provide clinical evidence of a potential role of emotional stress connected to adverse life events as a trigger of otoconial dysfunction. High levels of anxiety, depression and somatization were recorded and considered psychogenic precursors of BPPV, thus emphasizing the role of psychological distress in precipitating peripheral vestibular disorders. Therefore, appraisal of life stress and psychological attitudes may have potential implications in the clinical assessment of this labyrinthine vertigo and its frequent relapses. OBJECTIVES: BPPV is one of the most common peripheral vestibular disorders, and although it has been the subject of several studies and debates, its aetiology still remains unknown in most cases. Because it has been shown that emotional stress is related to the onset or worsening of other inner ear dysfunctions such as Ménière's disease and sudden hearing loss, this study investigated the hypothesis that life events, mood and psychological attitudes may have a causal relationship with BPPV. PATIENTS AND METHODS: Fifty patients (40 females and 10 men; mean age 43.5+/-10.1 years, range 30-65 years) were recruited and compared with 50 healthy volunteers matched for sex, age and socio-demographic variables. Patients were selected among dizzy patients who were referred to the ENT Clinic of the University of Modena and Reggio Emilia from the emergency unit with a primary diagnosis of 'positional vertigo' and enrolled in the study only if they had a paroxysmal positional nystagmus as diagnosed by Dix-Hallpike and Semont's manoeuvres. Patients with a history of recurrent vertigo and additional otoneurological diseases were excluded. The Paykel Life Events Scale, Spielberger State-Trait Anxiety Inventory, Symptom Check List-90 Revisited and Hamilton Depression Scale were the psychometric questionnaires used to complete the audiological and vestibular examinations. RESULTS: Patients with BPPV reported significantly more life events than control subjects in the year preceding the onset of vertigo (p<0.005). Negative life events, objective negative impact and a poor degree of control were also significantly more frequent in patients compared with controls (p<0.005). There were no significant differences between groups concerning positive life events (p>0.05). Psychometric questionnaires recorded significantly higher levels of anxiety, depression and somatization in the pathological sample (p<0.005), as well as an increased obsessive-compulsive attitude (p<0.05).