Preventive Gambling Programs for Adolescents and Young Adults: A Systematic Review.

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

Agenesia de vena cava inferior infrarrenal como hallazgo casual tras apendicectomía laparoscópica / Inferior vena cava agenesis as a casual finding after laparoscopic appendectomy

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Colorectal cancer and its delayed diagnosis: have we improved in the past 25 years?

OBJECTIVE: to determine the current delay in diagnosing colorectal cancer (CRC) and establish whether there has been any improvement in the past 25 years in the same healthcare setting using the same methods. PATIENTS AND METHOD: 152 patients undergoing surgery at our unit were personally interviewed during their hospital stay to determine the delay incurred for the diagnosis and treatment of their CRC. SPSS software was used for univariate and multivariate analysis of the data obtained. RESULTS: the study population was comprised of 152 patients of mean age 71 years (SD 10; range 36 to 90 years), 82 men and 70 women (53.9 and 46.1% respectively; p > 0.05). The diagnostic delay for CRC at our unit currently runs at 7.28 months despite the fact that in 58% of patients the disease produced obvious symptoms such as rectal bleeding. Although this delay in diagnosis is reduced over that observed 25 years ago, the difference is statistically not significant in terms of both doctor-attributed or patient-attributed delay (doctor-attributed delay was 3.28 months in 1985 versus 1.89 at present and patient-attributed delay was 3.18 months versus today´s 2.75; p > 0.05). Unlike the situation 25 years ago, no link was detected between diagnostic delay and tumor stage. Paradoxically, stage D disease was diagnosed earlier (at 5.71 months) than stage A disease (at 11.16 months) (p < 0.05). CONCLUSION: the diagnostic delay for CRC at our centre is 7.28 months. This delay is excessive for a disease that produces evident symptoms in 90% of patients. Over the last 25 years little improvement has been noted in the overall delay in diagnosing CRC, al though the delay attributed to the care provider has significantly improved. No relationship was detected between diagnostic delay and disease stage upon diagnosis. We feel the high prevalence of CRC, the failure of campaigns to increase awareness of early symptoms and no real improvement in its prognosis justify the introduction of large-scale colonoscopy screening for this disease.

Cáncer colorrectal: retraso diagnóstico. ¿Hemos mejorado algo en los últimos 25 años? / Colorectal cancer and its delayed diagnosis: have we improved in the past 25 years?

Objetivo: determinar la situación actual en cuanto al retraso diagnóstico del cáncer colorrectal (CCR) y analizar si se ha producido alguna mejora con respecto a lo acontecido hace 25 años en un mismo medio sanitario y con una misma metodología. Pacientes y método: se entrevistó personalmente a 152 pacientes durante su ingreso para tratamiento quirúrgico en nuestro Servicio con el fin de determinar el retraso acumulado para el diagnóstico y tratamiento de su CCR. Se realizó un análisis estadístico univariable y mutivariable mediante el software SPSS. Resultados: se incluyeron 152 pacientes con una edad media de 71 años con una desviación típica de 10 (edad mínima 36 y máxima 90 años), con un total de 82 varones y 70 mujeres (53,9 y 46,1% respectivamente; p > 0,05). El retraso diagnóstico del cáncer colorrectal en el momento actual en nuestro medio es de 7,28 meses, a pesar de que la mayoría de los pacientes cursa con sintomatología florida, como es la rectorragia en un 58% de pacientes. Aunque el retraso es menor que hace 25 años, la diferencia no llega a ser significativa en cuanto a retraso médico ni por parte del paciente (retraso médico 3,28 meses en 1985 frente a 1,89 en el momento actual y retraso del paciente de 3,18 en 1985 frente a 2,75 en la actualidad) (p > 0,05). A diferencia de lo que acontecía hace 25 años, no se ha encontrado relación entre retraso diagnóstico y estadio anatomopatológico, con el hecho paradójico de un menor retraso en estadio D (5,71 meses) que en A (11,16 meses) (p < 0,05). Conclusión: el retraso diagnóstico en el CCR es de 7,28 meses; cifra muy elevada para una patología que presenta sintomatología en el 90% de pacientes. En los últimos 25 años apenas ha variado el retraso global, aunque ha mejorado de forma importante el atribuible al médico. En nuestro estudio no se ha encontrado relación entre retraso diagnóstico y estadio anatomopatológico. Dada la alta prevalencia del cáncer colorrectal y la insuficiencia de las campañas para diagnóstico temprano del mismo en fase sintomática, con la ausencia de mejoría en cuanto al pronóstico, creemos necesaria la potenciación de programas de screening mediante colonoscopia(AU)

Objective: to determine the current delay in diagnosing colorectal cancer (CRC) and establish whether there has been any improvement n the past 25 years in the same healthcare setting using the same methods. Patients and method: 152 patients undergoing surgery at our unit were personally interviewed during their hospital stay to determine the delay incurred for the diagnosis and treatment of their CRC. SPSS software was used for univariate and multivariate analysis of the data obtained. Results: the study population was comprised of 152 patients of mean age 71 years (SD 10; range 36 to 90 years), 82 men and 70 women (53.9 and 46.1% respectively; p > 0.05). The diagnostic delay for CRC at our unit currently runs at 7.28 months despite the fact that in 58% of patients the disease produced obvious symptoms such as rectal bleeding. Although this delay in diagnosis is reduced over that observed 25 years ago, the difference is statistically not significant in terms of both doctor-attributed or patient-attributed delay (doctor-attributed delay was 3.28 months in 1985 versus 1.89 at present and patient-attributed delay was 3.18 months versus today’s 2.75; p > 0.05). Unlike the situation 25 years ago, no link was detected between diagnostic delay and tumor stage. Paradoxically, stage D disease was diagnosed earlier (at 5.71 months) than stage A disease (at 11.16 months) (p < 0.05). Conclusion: the diagnostic delay for CRC at our centre is 7.28 months. This delay is excessive for a disease that produces evident symptoms in 90% of patients. Over the last 25 years little improvement has been noted in the overall delay in diagnosing CRC, al - though the delay attributed to the care provider has significantly improved. No relationship was detected between diagnostic delay and disease stage upon diagnosis. We feel the high prevalence of CRC, the failure of campaigns to increase awareness of early symptoms and no real improvement in its prognosis justify the introduction of large-scale colonoscopy screening for this disease(AU)

Gastric tube volume after duodenal switch and its correlation to short-term weight loss.

BACKGROUND: Bariatric operations may have a restrictive and a malabsorptive component. The restrictive component is considered key for short-term weight loss. However, there are important volume discrepancies between gastric reservoirs in different bariatric surgical techniques, which questions the real meaning of the restrictive part of the operation. We have investigated the relationship between residual gastric volume after sleeve gastrectomy in duodenal switch (DS) and weight loss over the first postoperative year. METHODS: 14 patients submitted to a modified DS and one patient submitted to a sleeve gastrectomy were studied. All patients had an abdominal CT performed between the third and the ninth postoperative month to measure residual gastric volume. Gastric tube volume was correlated to early postoperative weight loss. RESULTS: Mean excess BMI loss was 75% at 12 months. Mean gastric tube volume was 208 cc. Gastric volume was not related to preoperative weight or BMI; instead, it was directly related to patient's height. There was no statistical relation between gastric volume and weight loss at 3, 6, 9 or 12 months after the operation. CONCLUSION: After DS, gastric tube volume is not directly related to weight changes. Other factors could have influence on intake restriction, such as gastric tube compliance or different mechanisms of satiety induction, because no differences in weight loss were observed between narrow tubes and wider ones, despite important variations in volume.