[Survival analysis in multiple cancer patients in Asturias, Spain, 1975-2004]. / Análisis de la supervivencia en pacientes con cáncer múltiple, Asturias, 1975-2004.

BACKGROUND: Almost one in ten survivors of cancer suffers a second primary. Some studies try to clarify the causes, but there are few that study the time variable. Our research aim was to describe this variable in multiple cancer (MC) patients and to detect others associated with time without MC and survival. METHODS: We performed a descriptive study, and the Kaplan Meyer method and Cox Regression were used to study the patients with MC included in the tumour registry of the reference hospital of Asturias. RESULTS: Time between the first symptom and diagnosis was significantly reduced in the second tumour when compared with the first one (113 to 88 days). Time between the first two tumours (median=2.93 years) and the risk of an earlier second primary was higher in older people (RR=1.03) with: primaries diagnosed in advanced stage (RR=1.55), treated with palliative surgery (RR=2.67) or chemotherapy (RR=1.51); second neoplasm located in the prostate (RR=1.67). 60.9% survived at least 5 years after the first diagnosis and 19.1% after the second. These probabilities decreased with age (RR=1.04) and advanced stages (RR=2.48). Nevertheless, locations with good prognosis (prostate, breast or skin) and almost any treatment with surgery or radiotherapy increase survival. CONCLUSION: Physicians should be alert to new cancer symptoms in patients with previous neoplasms during the follow-up period to improve early MC diagnosis. Survival in MC patients is acceptable, and it largely depends on the location and stage of the cancer involved, but also upon the strategy of treatment.

Análisis de la supervivencia en pacientes con cáncer múltiple. Asturias, 1975-2004 / Survival analysis in multiple cancer patients in Asturias, Spain, 1975-2004

Fundamento. Casi uno de cada diez supervivientes de cáncer sufre un segundo primario. Algunos estudios intentan clarificar las causas pero escasean los que estudian la variable tiempo. Nuestro objetivo fue describir esta variable en pacientes con cáncer múltiple (CM) y detectar otras asociadas con el tiempo libre de CM y la supervivencia. Métodos. Se diseñó un estudio descriptivo y se utilizaron el método de Kaplan Meyer y la Regresión de Cox para estudiar los pacientes con CM incluidos en el registro de tumores del Hospital Central de Asturias. Resultados. El tiempo ‘primer síntoma-diagnóstico’ se redujo significativamente del primer al segundo cáncer (de 113 a 88 días). El tiempo entre los dos primeros cánceres (mediana=2,93 años) fue menor en las personas de más edad (RR=1,03), con cánceres primarios avanzados (RR=1,55), tratados con cirugía paliativa (RR=2,67) o quimioterapia (RR=1,51) y con un segundo cáncer localizado en la próstata (RR=1,67). El 60,9% sobrevivió más de 5 años desde el primer diagnóstico y el 19,1% desde el segundo. Estas probabilidades disminuyeron con la edad (RR=1,04) y estadios avanzados (RR=2,48), sin embargo, localizaciones con buen pronóstico (próstata, mama y piel) y casi cualquier tratamiento quirúrgico o radiológico aumentan la supervivencia. Conclusión. Los médicos deben estar alerta ante nuevos síntomas de cáncer en pacientes con neoplasias previas durante su periodo de seguimiento para mejorar el diagnóstico precoz del CM. La supervivencia en estos pacientes depende en gran medida de la localización y estadio del cáncer implicado, pero también del tipo de tratamiento (AU)

Background. Almost one in ten survivors of cancer suffers a second primary. Some studies try to clarify the causes, but there are few that study the time variable. Our research aim was to describe this variable in multiple cancer (MC) patients and to detect others associated with time without MC and survival. Methods. We performed a descriptive study, and the Kaplan Meyer method and Cox Regression were used to study the patients with MC included in the tumour registry of the reference hospital of Asturias. Results. Time between the first symptom and diagnosis was significantly reduced in the second tumour when compared with the first one (113 to 88 days). Time between the first two tumours (median=2.93 years) and the risk of an earlier second primary was higher in older people (RR=1,03) with: primaries diagnosed in advanced stage (RR=1.55), treated with palliative surgery (RR=2.67) or chemotherapy (RR=1.51); second neoplasm located in the prostate (RR=1.67). 60.9% survived at least 5 years after the first diagnosis and 19.1% after the second. These probabilities decreased with age (RR=1.04) and advanced stages (RR=2.48). Nevertheless, locations with good prognosis (prostate, breast or skin) and almost any treatment with surgery or radiotherapy increase survival. Conclusion. Physicians should be alert to new cancer symptoms in patients with previous neoplasms during the follow-up period to improve early MC diagnosis. Survival in MC patients is acceptable, and it largely depends on the location and stage of the cancer involved, but also upon the strategy of treatment (AU)

Escala para medir la calidad de vida en desdentados totales rehabilitados con prótesis completa mucosoportada / Scale to measure quality of life in edentulous patients rehabilitated with full tissue-supported prostheses

Introducción: El objetivo del presente artículo es valorar la utilidad de una escala especifica para medir el bienestar físico en pacientes desdentados totales. Se ha integrado esta escala en un cuestionario modular genérico para medir la Calidad de Vida Relacionada con la Salud (CVRS). Pacientes y método: Se aplicó la escala conjuntamente con el cuestionario Perfil de Calidad de Vida en Enfermos Crónicos (PECVEC). En un estudio longitudinal, se siguieron cincuenta pacientes desdentados, que asistieron a tratamiento para la colocación de una prótesis total, en las Clínicas Odontológicas, de la Universidad de Guadalajara, México. Se realizaron tres determinaciones de la CVRS. Al empezar el tratamiento, a las ocho semanas y a los seis meses. Resultados: Se obtuvo una fiabilidad media del cuestionario de 0,74 (Cronbach). La CVRS mejoró progresivamente entre la primera y la tercera medición, presentando una mayor satisfacción con la prótesis total y mejor calidad de vida. Conclusiones: Las pérdidas dentales tienen un profundo impacto sobre la CVRS. Una prótesis total, reemplazando los dientes perdidos, mejora sustancialmente la calidad de vida de los afectados. Los resultados demuestran, que el cuestionario PECVEC con la escala específica, es de gran utilidad para la evaluación de la CVRS en la rehabilitación de estos pacientes

Introduction: The objective of the present article is to evaluate the utility of a specific scale in the measurement of the physical well-being in edentulous patients. This scale has been integrated in a modular generic questionnaire to measure the Health-Related Quality of Life (HRQL). Patient and Methods: The scale was applied in combination with “Quality of Life Profile in the Chronically Ill (PLC)” questionnaire. In a longitudinal study, a follow-up of fifty edentulous patients treated with full dentures in the Dental Clinics of the University of Guadalajara, Mexico, was performed. HRQL was measured three times: upon beginning of the treatment, after eight weeks and after six months. Results: The mean reliability of the questionnaire was 0.74 (Cronbach). The HRQL improved progressively between the first and the third measurement, eventually presenting a higher level of satisfaction with the full dentures prostheses and a better quality of life. Conclusions: The loss of teeth has a deep impact on the HRQL. A full denture which replaces the missing teeth improves the quality of life of the affected patients substantially. The results demonstrate that the PLC questionnaire with the specific scale is of great utility for the evaluation of the HRQL in the rehabilitation of these patients

Escala para medir la calidad de vida en desdentados totales rehabilitados con prótesis completa mucosoportada / Scale to measure quality of life in edentulous patients rehabilitated with full tissue-supported prostheses

Introducción: El objetivo del presente artículo es valorar la utilidad de una escala especifica para medir el bienestar físico en pacientes desdentados totales. Se ha integrado esta escala en un cuestionario modular genérico para medir la Calidad de Vida Relacionada con la Salud (CVRS). Pacientes y método: Se aplicó la escala conjuntamente con el cuestionario Perfil de Calidad de Vida en Enfermos Crónicos (PECVEC). En un estudio longitudinal, se siguieron cincuenta pacientes desdentados, que asistieron a tratamiento para la colocación de una prótesis total, en las Clínicas Odontológicas, de la Universidad de Guadalajara, México. Se realizaron tres determinaciones de la CVRS. Al empezar el tratamiento, a las ocho semanas y a los seis meses. Resultados: Se obtuvo una fiabilidad media del cuestionario de 0,74 (Cronbach). La CVRS mejoró progresivamente entre la primera y la tercera medición, presentando una mayor satisfacción con la prótesis total y mejor calidad de vida. Conclusiones: Las pérdidas dentales tienen un profundo impacto sobre la CVRS. Una prótesis total, reemplazando los dientes perdidos, mejora sustancialmente la calidad de vida de los afectados. Los resultados demuestran, que el cuestionario PECVEC con la escala específica, es de gran utilidad para la evaluación de la CVRS en la rehabilitación de estos pacientes (AU)

Introduction: The objective of the present article is to evaluate the utility of a specific scale in the measurement of the physical well-being in edentulous patients. This scale has been integrated in a modular generic questionnaire to measure the Health-Related Quality of Life (HRQL). Patient and Methods: The scale was applied in combination with “Quality of Life Profile in the Chronically Ill (PLC)” questionnaire. In a longitudinal study, a follow-up of fifty edentulous patients treated with full dentures in the Dental Clinics of the University of Guadalajara, Mexico, was performed. HRQL was measured three times: upon beginning of the treatment, after eight weeks and after six months. Results: The mean reliability of the questionnaire was 0.74 (Cronbach). The HRQL improved progressively between the first and the third measurement, eventually presenting a higher level of satisfaction with the full dentures prostheses and a better quality of life. Conclusions: The loss of teeth has a deep impact on the HRQL. A full denture which replaces the missing teeth improves the quality of life of the affected patients substantially. The results demonstrate that the PLC questionnaire with the specific scale is of great utility for the evaluation of the HRQL in the rehabilitation of these patients (AU)

[Measuring psychosocial stress at work in Spanish hospital's personnel. Psychometric properties of the Spanish version of Effort-Reward Imbalance model]. / Evaluación del estrés laboral en trabajadores de un hospital público español. Estudio de las propiedades psicométricas de la versión española del modelo Desequilibrio Esfuerzo-Recompensa.

BACKGROUND AND OBJECTIVE: Two main models are currently used to evaluate the psychosocial factors at work: the Demand-Control (or job strain) model developed by Karasek and the Effort-Reward Imbalance model, developed by Siegrist. A Spanish version of the first model has been validated, yet so far no validated Spanish version of the second model is available. The objective of this study was to explore the psychometric properties of the Spanish version of the Effort-Reward Imbalance model in terms of internal consistency, factorial validity, and discriminate validity. SUBJECTS AND METHODS: A cross-sectional study on a representative sample of 298 workers of the Spanish public hospital San Agustin in Asturias was performed. The Spanish version of Effort-Reward Imbalance Questionnaire (23 items) was obtained by a standard forward/backward translation procedure, and the information was gathered by a self-administered application. Exploratory factor analysis were performed to test the dimensional structure of the theoretical model. Cronbach's alpha coefficient was calculated to estimate the internal consistency reliability. Information on discriminate validity is given for sex, age and education. Differences were calculated with the t-test for two independent samples or ANOVA, respectively. RESULTS: Internal consistency was satisfactory for the two scales (reward and intrinsic effort) and Cronbach's Alpha coefficients higher than 0.80 were observed. The internal consistency for the scale of extrinsic effort was lower (alpha = 0.63). A three-factor solution was retained for the factor analysis of reward as expected, and these dimensions were interpreted as a) esteem, b) job promotion and salary and c) job instability. A one-factor solution was retained for the factor analysis of intrinsic effort. The factor analysis of the scale of extrinsic effort did not support the expected one-dimension structure. The analysis of discriminate validity displayed significant associations between measures of Effort-Reward Imbalance and the variables of sex, age and education level. CONCLUSIONS: This study is the first one supporting satisfactory psychometric properties of the Spanish version of the Effort-Reward Imbalance model. However, the factorial validity of the extrinsic effort could be questioned.

Evaluación del estrés laboral en trabajadoresde un hospital público español. Estudio de laspropiedades psicométricas de la versión españoladel modelo "Desequilibrio Esfuerzo-Recompensa" / Measuring psychosocial stress at work in Spanish hospital's personnel. Psychometric properties of the Spanish version of Effort-Reward Imbalance model

FUNDAMENTO Y OBJETIVO: Actualmente se usan dos modelos para evaluar los factores psicosociales en el trabajo: el modelo Demand-Control (DC), de Karasek, y el modelo Effort-Reward Imbalance (ERI), de Siegrist. El modelo DC ha sido adaptado al español, no así el modelo ERI. El objetivo de este trabajo es explorar las propiedades psicométricas de la versión española del modelo ERI en términos de consistencia interna, de validez de construcción y discriminante. SUJETOS Y MÉTODO: Estudio descriptivo de corte transversal en una muestra representativa (n = 298) de los trabajadores del hospital comarcal de Avilés (Asturias). La versión española del cuestionario ERI (23 ítems) se obtuvo por el método de traducción-contratraducción y se aplicó autoadministrado. El análisis factorial exploratorio investigó la validez de construcción y el cálculo del coeficiente alfa de Cronbach, la consistencia interna. La validez discriminante por sexo, edad y nivel educativo se estableció mediante la prueba de la t para grupos independientes y el ANOVA, respectivamente. RESULTADOS: El análisis factorial de la escala "Esfuerzo extrínseco" extrae dos factores, no confirmando la estructura unidimensional esperada. En las escalas "Recompensa" y "Sobreimplicación" se extraen tres factores (estima, estatus financiero y seguridad en el trabajo) y un factor, respectivamente, como era de esperar. La consistencia interna fue satisfactoria, con un coeficiente alfa de Cronbach mayor de 0,80, excepto en la escala "Esfuerzo extrínseco" ( = 0,63). En cuanto al sexo, la edad y el nivel educativo se han podido reproducir diferencias. CONCLUSIONES: La evaluación de las propiedades psicométricas de la versión española del modelo ERI es satisfactoria. La estructura factorial de la escala "Esfuerzo extrínseco" no pudo ser reproducida, lo que obliga a una aplicación más extensa del cuestionario (AU)

Categorización de factores psicosociales asociados al cumplimiento farmacológico antihipertensivo / Categorization of psychosocial factors associated with adherence to antihypertensive drugs

Este estudio intenta categorizar los determinantes del cumplimiento farmacológico antihipertensivo en el modelo psicosocial A.S.E. (actitud, influencia social y autoeficacia). Es un estudio cualitativo, realizado mediante entrevista semiestructurada y grabada, con 44 pacientes (25 cumplidores y 19 incumplidores). Dos investigadores independientes realizaron un análisis temático de las respuestas, siguiendo el método de Burnand. El método se valió mediante el Índice de Kappa. La información de los pacientes sugiere que los programas educativos deberían resaltar las ventajas del tratamiento, enseñar las habilidades que mejoran la adherencia, prever las dificultades y efectos secundarios, y enseñar a soslayarlos o manejarlos. Dichos programas deberían ser impartidos por sanitarios convencidos de la eficacia del tratamiento, buenos comunicadores y dispuestos a compartir responsabilidad con el paciente y a integrar en el programa a las personas influyentes de su entorno próximo. La información obtenida es útil para la ecuación a medida y para el diseño de cuestionarios cuantitativos (AU)

This qualitative study tries to categorize the determinants of adherence to antihypertensive drugs in the A.S.E. model (attitude, social influence and self-efficacy). Data were obtained from the information of 44 patients (25 compliant and 19 noncompliant), by means of a semi-structured, recorded interview. Two independent investigators carried out a thematic analysis of the answers, following Burnard’s method. The method was validated using the Kappa Index. The information from the patients suggests that educational programs should emphasize the advantages of treatment, teach the skills that improve adherence, foresee the barriers and secondary effects, and teach avoiding or managing them. These programs should be developed by health workers convinced of the effectiveness of the treatment, who are good communicators and willing to share responsibility with patients and to integrate in the program significant people in their personal environment. The information obtained is useful for tailor made education and to elaborate quantitative questionnaires (AU)

[Evaluation of the implementation of the FAPACAN programme to prevent cancer behavioral risk in primary care users in the North of Spain]. / Evaluación de la implementación del programa FAPACAN para prevenir el riesgo conductual de cáncer en usuarios de atención primaria del norte de España.

BACKGROUND: The evaluation of the process is an essential condition to correctly measure the impact of educational interventions on behaviour, its psychosocial determinants and the state of change, in the context of health promotion. The aim was to evaluate the quality of the implementation of the FAPACAN Programme, designed to prevent behavioural risk of cancer in Primary Care, and to improve its psychosocial determinants in the A.S.E. Model and the state of change according to Prochaska and DiClemente Theory. METHODS: The quality of implementation was measured by means of a visit to the health centre, by filling in a checklist 'in situ', and a phone survey with the patient. Centralisation and association measures were found (Pearson and Spearman's coefficient). A multiple regression model was obtained with the score made by the patient (range of 0 to 8) and the covariables: gender, age, level of education, locality and family history of cancer. RESULTS: The quality scores obtained oscillate between 72% and 81% of optimum quality. Significant differences were found owing to the administrator (better with fewer years of exercise) and the patient (better with higher level of study). CONCLUSIONS: In general, the quality of implementation was more than sufficient, in spite of the poor provision by the health system.

Estado funcional y calidad de vida en mayores de setenta años / Functional status and quality of life over seventy years old

Estudio descriptivo transversal, realizado en el Centro de Salud de Mieres-Sur. Selección aleatoria (n=300, a =5 por ciento, E=5 por ciento) de personas de 70 años o más, valorando: nivel cognitivo, actividades básicas (ABVD) e instrumentales (AIVD) de la vida diaria, calidad de vida y aspectos clínicos y socio-económicos. Participaron 273 ancianos (91 por ciento; 55 por ciento mujeres, 45 por ciento varones). El 63 por ciento con menos de 7 años de escolarización. El 11 por ciento presentaba deterioro cognitivo, 21 por ciento vivían solos, y 26 por ciento consideraba sus ingresos insuficientes. Existía depresión en un 31 por ciento (21 por ciento de diagnóstico nuevo), y 80 por ciento presentaban pluripatología. La independencia en las ABVD y AIVD fue del 66 por ciento y del 39 por ciento. En las láminas COOPWONCA, el 78, 65 y 46 por ciento tenían buen nivel físico, de actividad diaria y estado general, un 49 por ciento de sentimientos y 78 por ciento de actividades sociales. La capacidad funcional y calidad de vida de la mayoría son fácilmente medibles desde la Atención Primaria. La elevada prevalencia de depresión exige un elevado índice de sospecha en este ámbito (AU)

Epidemiologic sectional descriptive study, at a Primary Health Care Attention Unit in Mieres-Sur (Asturias, Spain). Random Selection (n = 300, a = 5%, E = 5%), among the over 70 population. We have investigated: Primary Sociobiological Functions (PSF), Self-Maintaining and Instrumental Activities of Daily Living (SIADL), Quality of Life, and another clinical and socioeconomical aspects. We have investigated 273 over 70 people (91% of random sample, 55% women, 45% men). The 63% were people with less than seven years on enrolment in a school. The 11% were people with cognitive default impairment, 21% were people who lived alone, 26% were people who considered their incomes not enough. In 31% were people with depression (21% incidence) and 80% were people with a tipe of multiple pathology. We have obtained a result of independency of 66% and 39 in the PSF and SIADL scales. In Charts WONCA the results were: 78% good fisical level, 65% good daily activity, 46% general condition, 49% good sentiments level and 78% good social activities. In Primary Health Care quality of life and geriatric assessment are easily measuring. The big proportion of depression has neccesary been suspected at this level of care (AU)