Summary Background Population studies on the prevalence of thyroid dysfunctions are costly. The pharmacy dispensing (PDR) and diagnosis (DR) registers allow us to study the epidemiology of these pathologies in a simpler way. Our aims: 1/Estimate the prevalence of thyroid dysfunction in Catalonia based on data from the PDR and the DR, 2/to evaluate the concordance of the results obtained by both strategies. Methods The population studied was the one registered with the public health system in Catalonia(Catsalut). In the PDR analysis, the information obtained through the Pharmaceutical Provision file (during 2012, 2013, 2014) was used regarding the number of patients under treatment (NPT) (levothyroxine and antithyroid medication). The DR analysis (2014) was performed by ICD‐9 codes (hyperthyroidism 242 and hypothyroidism 243, 244). Results According to the NPT in the PDR analysis, the prevalence of treated hypothyroidism increased over 3 years: 2.81%(2012), 2.92%(2013) and 3.07%(2014) (P < .00001). The prevalence of hyperthyroidism in treatment was 0.14%(2012), 0.13%(2013) and 0.14%(2014). According to the DR analysis in 2014, the prevalence of hypothyroidism was 2.54% and 0.35% for hyperthyroidism. The PDR analysis estimated a higher hypothyroidism prevalence compared to that estimated by the DR (P < .0001) and vice versa in the case of hyperthyroidism. Conclusion Both PDR and DR prevalence estimations of thyroid dysfunction show some degree of discordance probably due to undercoding bias in the case of DR and the absence of subclinical pathology in the case of PDR. However, both approaches are valid and complementary for estimating the prevalence of thyroid dysfunction.
IntroducciónLa diseminación peritoneal constituye uno de los principales patrones de recaída tras cirugía en los tumores de localización abdominal y pélvica. Ha sido considerada clásica-mente como un signo de enfermedad generalizada, tratada de forma paliativa y de desenlace inevitablemente fatal. En un reciente estudio multicéntrico en el que se incluían pacientes con carcinomatosis de origen no ginecológico, la supervivencia media era de 3.1 meses 1 . En estudios en los que se ha tratado con quimioterapia sistémica, se han obtenido buenas respuestas tumorales, aunque sin mejoría en la supervivencia.La diseminación de las células tumorales en el peritoneo puede ser espontánea o producirse durante la cirugía, por mecanismos como la formación de émbolos tumorales por presión, la fuga de células malignas al cortar los vasos linfá-ticos o la siembra de las mismas en la cavidad peritoneal durante la disección quirúrgica. Va seguida habitualmente de la invasión o perforación de la serosa.Una vez extirpado el tumor primario, los factores de crecimiento celular involucrados en la cicatrización estimulan el crecimiento de las células malignas viables atrapadas o en coágulos sanguíneos intraabdominales, o por la fibrina en superficies peritoneales traumatizadas. Paralelamente, el atrapamiento de dichas células dificulta el acceso a ellas de la quimioterapia sistémica, disminuyendo o anulando su eficacia 2,3 . Desde 1980 han aparecido en la literatura nuevas propuestas para el tratamiento de los pacientes afectos de diseminación tumoral peritoneal, un grupo de difícil manejo terapéutico y emocional, derivado de la perspectiva de fracaso terapéutico con perdida rápida y progresiva de la calidad de vida 4 . La administración de drogas antitumorales por vía intraperitoneal, la inmunoterapia intracavitaria, la terapia fotodinámica o la quimioterapia e hipertermia intraperitoneal constituyen una muestra de las líneas de trabajo en esta dirección 4 . La perfusión intraperitoneal con quimioterapia e hipertermia ha ofrecido hasta el momento resultados esperanzadores. Consiste en realizar la cirugía de exéresis máxima o debulking, seguida de dosis altas de quimioterapia regional en perfusión hipertérmica durante el mismo acto operatorio. En ocasiones se completa la técnica con la administración de dosis altas de quimioterapia en la cavidad peritoneal los dí-as posteriores a la cirugía, a través de catéteres provisionales implantados a tal efecto.La cirugía posibilita la reducción de la enfermedad peritoneal a un tamaño mínimo y libera todas las adherencias, creando las condiciones óptimas para obtener mayor eficacia de los citostáticos. Estos son potenciados por el calor, que también tiene un efecto citotóxico por sí mismo, se elimina el atrapamiento celular, y se consiguen niveles altos de fármaco en la zona a tratar, imposibles de lograr por vía sistémica debido a su toxicidad [5][6][7][8] . Debido a la barrera peritoneo-plasmática, las sustancias de alto peso molecular como mitomicina C, 5-fluorouracilo, cisplatino o doxorubici...
Background Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). Objectives To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. Design Observational, cross‐sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day‐care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. Methods Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. Results Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0–8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). Conclusions Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. Patient contribution Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life.
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