Circulating immune biomarkers in peripheral blood correlate with clinical outcomes in advanced breast cancer.

Identification of the different elements intervening at the tumor microenvironment seems key to explain clinical evolution in several tumor types. In this study, a set of immune biomarkers (myeloid derived suppressor cells, regulatory T cells, and OX40 + and PD-1 + T lymphocytes counts) in peripheral blood of patients diagnosed with advanced breast cancer were analyzed along of first line antineoplastic therapy. Subsequently, a comparison between groups with clinical benefit versus progression of disease and with a healthy women cohort was executed. Results reflected that patients showed higher basal levels of myeloid derived suppressor cells (35.43, IR = 180.73 vs 17.53, IR = 16.96 cells/µl; p = 0.001) and regulatory T cells (32.05, IR = 29.84 vs 22.61, IR = 13.57 cells/µl; p = 0.001) in comparison with healthy women. Furthermore, an increase in the number of activated T lymphocytes (expressing OX40), a decrease of immune inhibitory cells (MDSCs and Tregs) and inhibited T lymphocytes (expressing PD-1) were observed along the treatment in patients with clinical benefit (p ≤ 0.001). The opposite trend was observed in the case of disease progression. These findings suggest that some critical immune elements can be easily detected and measured in peripheral blood, which open a new opportunity for translational research, as they seem to be correlated with clinical evolution, at least in ABC.

Características de las urgencias hospitalarias del Servicio Andalus de Salud durante 2012. A partir del Conjunto Mínimo Básico de Datos de urgencias / Case-mix of hospital emergencies in the Andalusian Health Service based on the 2012 Minimum Data Set. Spain

Fundamentos: La implantación de Diraya-Urgencias en los hospitales del Servicio Andaluz de Salud (SAS) y el desarrollo de un codificador automático propio ha permitido instaurar el Conjunto Mínimo Básico de Datos de Urgencias (CMBD-U). El objetivo de este artículo es describir la casuística de los servicios de urgencias hospitalarios utilizando las distintas dimensiones contenidas en el CMBD-U. Métodos: Utilizando el CMBD-U, se clasificaron 3.235.600 registros de urgencias hospitalarias de 2012 en categorías clínicas mediante el código CIE-9-MC proporcionado por el codificador automático. Se definieron reglas de validez para la explotación de los tiempos. Se realizó un análisis descriptivo obteniendo indicadores demográficos, cronológicos, tasas de hospitalización, retorno y exitus y tiempos asistenciales y de permanencia en urgencias. Resultados: Las mujeres generaron el 54,26% de las urgencias. Su edad media (39,98 años) superó a la de los hombres (37,61). El 21,49% fueron urgencias pediátricas. La máxima afluencia horaria fue de 10:00 a 13:00 y de 16:00 a 17:00. Los pacientes que no pasaron por observación (92,67%) permanecieron en urgencias 153 minutos de media. Más del 50% de las urgencias fueron generadas por lesiones e intoxicaciones, enfermedades respiratorias, osteomusculares y síntomas y signos. Entre los procesos asistenciales integrados se identificaron 79.191 casos de dolor torácico, 28.741 de insuficiencia cardiaca y 27.989 infecciones graves. Conclusiones: El CMBD-U permite analizar sistemáticamente las urgencias hospitalarias identificando la actividad desarrollada, la casuística atendida, los tiempos de respuesta asistencial y permanencia en urgencias y la calidad asistencial (AU)

Background: The implementation of digital health records in emergency departments (ED) in hospitals in theAndalusian Health Service and the development of an automatic encoder for this area have allowed us to establish a Minimum Data Set for Emergencies (MDS-ED). The aim of this article is to describe the casemix of hospital EDs using various dimensions contained in the MDS-ED. Methods: 3.235.600 hospital emergency records in 2012 were classified in clinical categories from the ICD-9-CM codes generated by the automatic encoder. Operating rules to obtain response time and length of stay were defined. A descriptive analysis was carried out to obtain demographic and chronological indicators as well as hospitalization, return and death rates and response time and length of stay in the EDs. Results:Women generated 54,26%of all occurrences and their average age (39,98 years) was higher than men’s (37,61). Paediatric emergencies accounted for 21,49% of the total. The peak hours were from 10:00 to 13:00 and from 16:00 to 17:00. Patients who did not undergo observation (92,67%) remained in the ED an average of 153 minutes. Injuries and poisoning, respiratory diseases, musculoskeletal diseases and symptoms and signs generated over 50% of all visits. 79.191 cases of chest pain, 28.741 episodes of heart failure and 27.989 episodes of serious infections were identified among the most relevant disorders. Conclusions: The MDS-ED makes it possible to address systematically the analysis of hospital emergencies by identifying the activity developed, the case-mix attended, the response times, the time spent in ED and the quality of the care (AU)

[Case-Mix of hospital emergencies in the Andalusian Health Service based on the 2012 Minimum Data Set. Spain]. / Características de las urgencias hospitalarias del Servicio Andaluz de Salud durante 2012 a partir del Conjunto Mínimo Básico de Datos de Urgencias.

BACKGROUND: The implementation of digital health records in emergency departments (ED) in hospitals in the Andalusian Health Service and the development of an automatic encoder for this area have allowed us to establish a Minimum Data Set for Emergencies (MDS-ED). The aim of this article is to describe the case mix of hospital EDs using various dimensions contained in the MDS-ED. METHODS: 3.235.600 hospital emergency records in 2012 were classified in clinical categories from the ICD-9-CM codes generated by the automatic encoder. Operating rules to obtain response time and length of stay were defined. A descriptive analysis was carried out to obtain demographic and chronological indicators as well as hospitalization, return and death rates and response time and length of stay in the Eds. RESULTS: Women generated 54,26% of all occurrences and their average age (39,98 years) was higher than men's (37,61). Paediatric emergencies accounted for 21,49% of the total. The peak hours were from 10:00 to 13:00 and from 16:00 to 17:00. Patients who did not undergo observation (92,67%) remained in the ED an average of 153 minutes. Injuries and poisoning, respiratory diseases, musculoskeletal diseases and symptoms and signs generated over 50% of all visits. 79.191 cases of chest pain, 28.741 episodes of heart failure and 27.989 episodes of serious infections were identified among the most relevant disorders. CONCLUSIONS: The MDS-ED makes it possible to address systematically the analysis of hospital emergencies by identifying the activity developed, the case-mix attended, the response times, the time spent in ED and the quality of the care.

Oral and dental health of non-institutionalized elderly people in Spain.

With aging of the populations, the oral health and hygiene of elderly people has become an important public health issue. In this cross-sectional study we investigated the prevalence of tooth decay and other periodontal diseases in a representative cohort of 480 non-institutionalized adults ≥65 years from the province of Valencia, Spain. Using a World Health Organization standard for an adult oral survey methodology, we obtained data on remnant teeth with the decayed, missing and filled teeth (DMFT) index, a Community Periodontal Index of Treatment Needs (CPTIN), attachment loss, and temporo-mandibular articulation (TMA) status. The prevalence of these conditions were compared by age and gender, using the Chi-square, and Student's t-, and ANOVA statistical tests. The mean number of remaining teeth were 17.1 in the total sample, which was higher for women (17.9 versus 15.7 in men; p=0.04). This mean number decreased as age increased (p<0.05). The overall DMFT index was 19%, showing a persistent increase with age from 14% (65-69-year) to 23% (≥80-year) (p=0.118). Only 6% of participants had no periodontal pathology, while 26% had bleeding gums and 57% had calculus, while attachment loss was observed in 31%. TMA malfunction with a click was present in 6%, was painful in 5%, and was associated with reduced mouth-opening in 2%. The prevalence of oral health pathologies was high among these elderly people, who would benefit from optimal oral health care.

[Infant, neonatal and postneonatal mortality trends in Andalucía, Spain, 1975-1989]. / Evolución de la mortalidad infantil, neonatal y postneonatal en andalucía, 1975-1998.

BACKGROUND: Infant mortality and its neonatal and postneonatal aspects are important health indicators and thus warrant regular analysis even in developed countries where the rates thereof have dropped considerably. This study is aimed at describing the changes recorded in these rates in Andalusia over the past twenty-five years. METHODS: The annual infant, early and late neonatal and postneonatal mortality rates have been calculated for the 1975-1998 period. Poisson regression was used to estimate the annual percentages of change in the rates for the 1975-1986 and 1987-1998 periods, as well as for the entire 1975-1998 period. An analysis was also made of the proportional mortality rate due to infectious, respiratory, congenital causes, disorders having arisen during the perinatal period and all other causes, as well as the ratio for mortality rates due to disorders having arisen in the perinatal period and for all causes as a whole for the 1994-1998 four-year period as compared to the 1975-1979 period, in infant, neonatal (early and late) and postnatal periods. RESULTS: The greatest percentage drops were in early (6.38%) and late (4.6%) neonatal mortality. The ratio for mortality rates due to disorders having arisen in the perinatal period for the 1994-1998 and 1975-1975 periods is 10 for the postneonatal mortality rate, whilst it is under 1 for the late (0.63) and early (0.33) neonatal and infant (0.30) mortality. CONCLUSIONS: Mortality during the infant, early and late neonatal and postneonatal periods dropped sharply during the 1975-1998 period. The risk of death due to disorders arising during the perinatal period among children ranging from four weeks to one year of age (postneonatal period) rose tenfold during the 1975-1979 and 1994-1998 periods.

Evolución de la mortalidad infantil, neonatal y postneonatal en Andalucía, 1975-1998 / Infant, neonatal and postneonatal mortality trends in Andalucía, Spain, 1975-1989

Fundamento: La mortalidad infantil, y sus componentes neonatal y postneonatal, son importantes indicadores de salud, lo cual justifica su análisis periódico incluso en países desarrollados donde sus tasas han descendido considerablemente. El objetivo de este estudio es describir las modificaciones registradas en dichas tasas en Andalucía en el último cuarto de siglo. Métodos: Se han calculado las tasas anuales de mortalidad infantil, neonatal precoz y tardía, así como post-neonatal en 1975-1998. Mediante regresión de Poisson se han estimado los porcentajes anuales de cambio de las tasas en los dos intervalos de 1975-1986 y 1987-1998 así como en el periodo completo 1975-1998. Se ha analizado también la mortalidad proporcional por causas infecciosas, respiratorias, congénitas, afecciones originadas en el periodo perinatal y el resto de causas, así como la razón de tasas de mortalidad por afecciones originadas en el periodo perinatal y para el total de causas, en el quinquenio 1994-98 respecto al quinquenio 1975-79, en los periodos infantil, neonatal (precoz y tardío) y postneonatal. Resultados: Los mayores descensos porcentuales se han producido en la mortalidad neonatal precoz (6,38 por ciento) y tardía (4,6 por ciento). La razón de tasas de mortalidad por afecciones originadas en el periodo perinatal entre 1994-98 y 1975-79 es 10 para la mortalidad postneonatal mientras que es inferior a 1 para la mortalidad neonatal tardía (0,63), precoz (0,33) e infantil (0,30). Conclusiones: La mortalidad en los periodos infantil, neonatal precoz, tardío y post-neonatal ha descendido acusadamente entre 1975 y 1998. El riesgo de fallecer por afecciones originadas en el periodo perinatal de los niños con más de 4 semanas y menos de 1 año de vida (periodo postneonatal) se ha multiplicado por diez entre 1975-79 y 1994-98 (AU)

Salud oral de los escolares de Ceuta. Influencias de la edad, el género, la etnia y el nivel socioeconómico / Oral health of schoolchildren in Ceuta. Influences of age, sex, ethnic background and socioeconomic level

Fundamento: La caries dental tiene una etiología multifactorial en la que intervienen características del huésped (saliva y esmalte dental), de la flora bucal (placa bacteriana) y del substrato sobre el que ésta se desarrolla (higiene oral y dieta). El objetivo de este trabajo es medir la prevalencia de caries, enfermedad periodontal y maloclusión en la población escolar de Ceuta, y su distribución según edad, género, etnia y nivel socioeconómico (NSE) -medido a través de la ocupación paterna-.Métodos: Se realizó una exploración física de la cavidad bucal a una muestra de escolares de 7, 12 y 14 años (n=347) del distrito sanitario de Ceuta con el fin de calcular los índices cao -dentición temporal-, CAO -dentición definitiva-, CPITN y de maloclusión. La selección de la muestra se realizó de forma aleatoria, estratificada polietápica. Se valoró la significación estadística de las diferencias encontradas aplicando las pruebas de Chi-cuadrado, T de Student. y F de Snedecor. Se calcularon las razones de ventaja (Odds Ratio), según sexo, etnia y NSE, de un índice CAO superior a la mediana de la distribución en escolares de 12 y 14 años.Resultados: El índice cao (piezas cariadas, ausentes y obturadas en dentición temporal) es 3,02 a los 7 años y el índice CAO (piezas cariadas, ausentes y obturadas en dentición definitiva) es 3,91 a los 12 años y 4,46 a los 14 años. Las razones de ventaja (OR) de un índice CAO> 4 a los 12-14 años y sus intervalos de confianza (IC) son los siguientes: 2,26 según género (IC95 por ciento= 1,27-4,05), 2,17 según etnia (IC95 por ciento=1,18-3,99) y 1,80 según NSE (IC95 por ciento=0,85-3,81). En el estrato de bajo NSE la OR por etnia es 1,38 (IC95 por ciento= 0,28-7,0). No se observan diferencias significativas en la distribución de maloclusión ni de enfermedad periodontal -excepto por edad-.Conclusiones: Los valores del índice CAO en escolares de Ceuta son más elevados que el promedio nacional y superiores al objetivo marcado por la OMS para el año 2000. El riesgo de índice CAO superior a la mediana es en niñas 2,3 veces mayor que en niños, en musulmanes 2,17 veces mayor que en no musulmanes y en escolares con bajo nivel socioeconómico -padres desempleados- 1,8 veces mayor que en escolares con padres activos. El aumento de riesgo asociado a etnia está influenciado por el nivel socioeconómico (AU)

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