ITALIAN CANCER FIGURES - REPORT 2015: The burden of rare cancers in Italy = I TUMORI IN ITALIA - RAPPORTO 2015: I tumori rari in Italia

OBJECTIVES: This collaborative study, based on data collected by the network of Italian Cancer Registries (AIRTUM), describes the burden of rare cancers in Italy. Estimated number of new rare cancer cases yearly diagnosed (incidence), proportion of patients alive after diagnosis (survival), and estimated number of people still alive after a new cancer diagnosis (prevalence) are provided for about 200 different cancer entities. MATERIALS AND METHODS: Data herein presented were provided by AIRTUM population- based cancer registries (CRs), covering nowadays 52% of the Italian population. This monograph uses the AIRTUM database (January 2015), which includes all malignant cancer cases diagnosed between 1976 and 2010. All cases are coded according to the International Classification of Diseases for Oncology (ICD-O-3). Data underwent standard quality checks (described in the AIRTUM data management protocol) and were checked against rare-cancer specific quality indicators proposed and published by RARECARE and HAEMACARE (www.rarecarenet.eu; www.haemacare.eu). The definition and list of rare cancers proposed by the RARECAREnet "Information Network on Rare Cancers" project were adopted: rare cancers are entities (defined as a combination of topographical and morphological codes of the ICD-O-3) having an incidence rate of less than 6 per 100,000 per year in the European population. This monograph presents 198 rare cancers grouped in 14 major groups. Crude incidence rates were estimated as the number of all new cancers occurring in 2000-2010 divided by the overall population at risk, for males and females (also for gender-specific tumours).The proportion of rare cancers out of the total cancers (rare and common) by site was also calculated. Incidence rates by sex and age are reported. The expected number of new cases in 2015 in Italy was estimated assuming the incidence in Italy to be the same as in the AIRTUM area. One- and 5-year relative survival estimates of cases aged 0-99 years diagnosed between 2000 and 2008 in the AIRTUM database, and followed up to 31 December 2009, were calculated using complete cohort survival analysis. To estimate the observed prevalence in Italy, incidence and follow-up data from 11 CRs for the period 1992-2006 were used, with a prevalence index date of 1 January 2007. Observed prevalence in the general population was disentangled by time prior to the reference date (≤2 years, 2-5 years, ≤15 years). To calculate the complete prevalence proportion at 1 January 2007 in Italy, the 15-year observed prevalence was corrected by the completeness index, in order to account for those cancer survivors diagnosed before the cancer registry activity started. The completeness index by cancer and age was obtained by means of statistical regression models, using incidence and survival data available in the European RARECAREnet data. RESULTS: In total, 339,403 tumours were included in the incidence analysis. The annual incidence rate (IR) of all 198 rare cancers in the period 2000-2010 was 147 per 100,000 per year, corresponding to about 89,000 new diagnoses in Italy each year, accounting for 25% of all cancer. Five cancers, rare at European level, were not rare in Italy because their IR was higher than 6 per 100,000; these tumours were: diffuse large B-cell lymphoma and squamous cell carcinoma of larynx (whose IRs in Italy were 7 per 100,000), multiple myeloma (IR: 8 per 100,000), hepatocellular carcinoma (IR: 9 per 100,000) and carcinoma of thyroid gland (IR: 14 per 100,000). Among the remaining 193 rare cancers, more than two thirds (No. 139) had an annual IR <0.5 per 100,000, accounting for about 7,100 new cancers cases; for 25 cancer types, the IR ranged between 0.5 and 1 per 100,000, accounting for about 10,000 new diagnoses; while for 29 cancer types the IR was between 1 and 6 per 100,000, accounting for about 41,000 new cancer cases. Among all rare cancers diagnosed in Italy, 7% were rare haematological diseases (IR: 41 per 100,000), 18% were solid rare cancers. Among the latter, the rare epithelial tumours of the digestive system were the most common (23%, IR: 26 per 100,000), followed by epithelial tumours of head and neck (17%, IR: 19) and rare cancers of the female genital system (17%, IR: 17), endocrine tumours (13% including thyroid carcinomas and less than 1% with an IR of 0.4 excluding thyroid carcinomas), sarcomas (8%, IR: 9 per 100,000), central nervous system tumours and rare epithelial tumours of the thoracic cavity (5%with an IR equal to 6 and 5 per 100,000, respectively). The remaining (rare male genital tumours, IR: 4 per 100,000; tumours of eye, IR: 0.7 per 100,000; neuroendocrine tumours, IR: 4 per 100,000; embryonal tumours, IR: 0.4 per 100,000; rare skin tumours and malignant melanoma of mucosae, IR: 0.8 per 100,000) each constituted <4% of all solid rare cancers. Patients with rare cancers were on average younger than those with common cancers. Essentially, all childhood cancers were rare, while after age 40 years, the common cancers (breast, prostate, colon, rectum, and lung) became increasingly more frequent. For 254,821 rare cancers diagnosed in 2000-2008, 5-year RS was on average 55%, lower than the corresponding figures for patients with common cancers (68%). RS was lower for rare cancers than for common cancers at 1 year and continued to diverge up to 3 years, while the gap remained constant from 3 to 5 years after diagnosis. For rare and common cancers, survival decreased with increasing age. Five-year RS was similar and high for both rare and common cancers up to 54 years; it decreased with age, especially after 54 years, with the elderly (75+ years) having a 37% and 20% lower survival than those aged 55-64 years for rare and common cancers, respectively. We estimated that about 900,000 people were alive in Italy with a previous diagnosis of a rare cancer in 2010 (prevalence). The highest prevalence was observed for rare haematological diseases (278 per 100,000) and rare tumours of the female genital system (265 per 100,000). Very low prevalence (<10 prt 100,000) was observed for rare epithelial skin cancers, for rare epithelial tumours of the digestive system and rare epithelial tumours of the thoracic cavity. COMMENTS: One in four cancers cases diagnosed in Italy is a rare cancer, in agreement with estimates of 24% calculated in Europe overall. In Italy, the group of all rare cancers combined, include 5 cancer types with an IR>6 per 100,000 in Italy, in particular thyroid cancer (IR: 14 per 100,000).The exclusion of thyroid carcinoma from rare cancers reduces the proportion of them in Italy in 2010 to 22%. Differences in incidence across population can be due to the different distribution of risk factors (whether environmental, lifestyle, occupational, or genetic), heterogeneous diagnostic intensity activity, as well as different diagnostic capacity; moreover heterogeneity in accuracy of registration may determine some minor differences in the account of rare cancers. Rare cancers had worse prognosis than common cancers at 1, 3, and 5 years from diagnosis. Differences between rare and common cancers were small 1 year after diagnosis, but survival for rare cancers declined more markedly thereafter, consistent with the idea that treatments for rare cancers are less effective than those for common cancers. However, differences in stage at diagnosis could not be excluded, as 1- and 3-year RS for rare cancers was lower than the corresponding figures for common cancers. Moreover, rare cancers include many cancer entities with a bad prognosis (5-year RS <50%): cancer of head and neck, oesophagus, small intestine, ovary, brain, biliary tract, liver, pleura, multiple myeloma, acute myeloid and lymphatic leukaemia; in contrast, most common cancer cases are breast, prostate, and colorectal cancers, which have a good prognosis. The high prevalence observed for rare haematological diseases and rare tumours of the female genital system is due to their high incidence (the majority of haematological diseases are rare and gynaecological cancers added up to fairly high incidence rates) and relatively good prognosis. The low prevalence of rare epithelial tumours of the digestive system was due to the low survival rates of the majority of tumours included in this group (oesophagus, stomach, small intestine, pancreas, and liver), regardless of the high incidence rate of rare epithelial cancers of these sites. This AIRTUM study confirms that rare cancers are a major public health problem in Italy and provides quantitative estimations, for the first time in Italy, to a problem long known to exist. This monograph provides detailed epidemiologic indicators for almost 200 rare cancers, the majority of which (72%) are very rare (IR<0.5 per 100,000). These data are of major interest for different stakeholders. Health care planners can find useful information herein to properly plan and think of how to reorganise health care services. Researchers now have numbers to design clinical trials considering alternative study designs and statistical approaches. Population-based cancer registries with good quality data are the best source of information to describe the rare cancer burden in a population

O lugar ocupado pela assistência fisioterapêutica: representações sociais de trabalhadores com DORT

INTRODUÇÃO: Os distúrbios osteomusculares relacionados ao trabalho (DORT) articulam-se diretamente à realização de atividades ocupacionais e às condições de trabalho. OBJETIVO: O artigo origina-se de uma pesquisa qualitativa que analisou as representações sociais da assistência fisioterapêutica entre trabalhadores portadores de Distúrbios Osteomusculares Relacionados ao Trabalho (DORT), frequentadores do Centro de Referência em Saúde do Trabalhador (CEREST), pelo Departamento de Saúde do Trabalhador (DSAT), Juiz de Fora (MG). MATERIAIS E MÉTODOS: O recurso de apreensão das informações foi a entrevista semiestruturada, realizada com 12 trabalhadoras com idades entre 29 e 55 anos. RESULTADOS: As informações submetidas à análise temática apontaram que a assistência fisioterapêutica recebida repercute em períodos longos de tratamento e na insatisfação dos resultados, por meio de uma prática curativista, segmentada e pouco resolutiva, na qual prevalece a utilização de equipamentos em detrimento das manobras corporais e holísticas. CONCLUSÃO: Diante dos relatos, verificamos a necessidade de uma atenção humanizada, integral e equânime com responsabilização e vínculo, além da valorização dos trabalhadores e usuários, promovendo melhor qualidade de vida. É imprescindível a realização de novos estudos que possibilitem melhor compreensão e aprofundamento teórico e prático da relação entre a atuação do fisioterapeuta e as representações sociais envolvidas

Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. Objective: To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. Methods: This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Results: Fifty-one patients were randomized — 26 to the HCTZ group and 25 to the placebo group. There was a trend towards additional weight reduction in the HCTZ group (HCTZ: -1.78 ± 1.08 kg/day vs placebo: -1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: -0.74 ± 0.47 kg/40 mg vs placebo: -0.33 ± 0.80 kg/40 mg; p = 0.032) - figure. There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes - table. Conclusion: There was a trend towards greater daily weight reduction in the HCTZ group. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a synergistic effect on weight loss. Study outcomesOutcomeHCTZPlacebop-valuePrimaryWeight change/day-1.78 ± 1.08-1.05 ± 1.510.062SecondaryLength of stay (days)9 ± 88 ± 90.37Change in creatinine (mg/dL)0.50 ± 0.370.27 ± 0.400.05Need for vasoactive drugs (%)19.212.00.70Congestion score-5.4 ± 4.6-4.8 ± 4.60.68Change in dyspnea scale-4.7 ± 2.7-3.2 ± 3.60.14Thirst scale-1.7 ± 4.50.5 ± 3.80.21Change in natriuretic peptides (%)-11.1 ± 100.3-33.3 ± 50.90.83Plus–minus values are means ± standard deviation.Abstract Figure. Diuretic response </jats:sec

Afastamento do trabalho e os percursos terapêuticos de trabalhadores acometidos por LER/Dort

O estudou objetivou investigar os percursos terapêuticos de trabalhadores em situação de afastamento do trabalho por Lesões por Esforços Repetitivos/Distúrbios Osteomusculares Relacionados ao Trabalho (LER/Dort) atendidos em um serviço de saúde. Ocorreu análise de prontuários clínicos e seleção de sujeitos para entrevistas semiestruturadas, que foram gravadas para análise de conteúdo temática. Participaram das entrevistas dez trabalhadores, de ambos os gêneros e diferentes profissões. Os sujeitos passaram por condutas clínicas embasadas no modelo biomédico, pelo desamparo da empresa e do Instituto Nacional do Seguro Social (INSS), gerando sofrimento. Concluiu-se que ainda há necessidade de melhorias nas ações intersetoriais e interdisciplinares em casos de doenças crônicas e no modelo integral de saúde

Perfil dos pacientes e características do tratamento fisioterapêutico aplicado aos trabalhadores com LER/DORT em Juiz de Fora, MG

INTRODUÇÃO: A reestruturação do processo produtivo verificada nas últimas décadas implicou alterações diretas na saúde do trabalhador, modificando o perfil de adoecimento e sofrimento desses indivíduos. Dentro desse contexto, observa-se um aumento significativo dos casos de Lesões por Esforços Repetitivos (LER) e dos Distúrbios Osteomusculares Relacionados ao Trabalho (DORT). OBJETIVO: Conhecer o perfil dos trabalhadores com LER/DORT e a assistência fisioterapêutica aos quais são submetidos. METODOLOGIA: Pela aplicação de um questionário estruturado, foram entrevistados 80 trabalhadores, usuários do SUS, inseridos no Programa de Reabilitação Física do Centro de Referência em Saúde do Trabalhador (Cerest), por meio do Departamento de Saúde do Trabalhador (DSAT), Prefeitura Municipal de Juiz de Fora, Secretaria de Saúde (SS). RESULTADOS: Há um predomínio de casos de DORT no sexo feminino, e em 83,8% dos casos a renda pessoal não passa de um salário mínimo. Das ocupações encontradas, 76 (95%) estavam relacionadas com o trabalho braçal, e quanto ao tempo de trabalho em uma mesma função, a média foi de 16 anos. Setenta e oito (97,5%) trabalhadores afirmaram impossibilidades na realização das atividades de vida diária (AVDs). Quanto ao tratamento fisioterapêutico, 30 (37,6%) relataram realizar algum tipo de cinesioterapia. CONCLUSÃO: A visão estritamente fisiopatológica, baseada no modelo unidirecional e curativista, não mostram resultados satisfatórios e eficazes. Isso implica a não resolução dos quadros álgicos, favorecendo períodos extensos de tratamento fisioterapêutico, sobrecarga do serviço público de saúde e repercussões no âmbito emocional e sócio-econômico desses trabalhadores

SAFETY OF A FORMULA SUPPLEMENTED WITH GALACTO-OLIGOSACCHARIDES IN TERM INFANTS

Infant formula design aims at achieving the same beneficial effects on physical and physiological development seen in breast-fed infants. The objective of this study was to evaluate the safety of an infant milk formula supplemented with GOS (0.4g/100mL) in terms of growth and incidence of adverse effects. This was a double blind, multicenter, parallel group, randomized clinical trial. Weight (g), length (cm), and occipito-frontal head circumference (cm) were measured. The incidence of adverse events (AEs) and infants acceptance and tolerance of the study formula were evaluated. A total of 199 breast fed infants and 163 formula fed (80 in the control and 83 in the study group) were recruited. All three groups showed appropriate physical development throughout the period. Length was significantly associated with breastfeeding. Diarrhea was comparably present in all groups. GOS supplemented formula stimulated infants’ growth and prevented AEs similarly to human milk

Parâmetros acústicos do contraste de sonoridade das plosivas no desenvolvimento fonológico típico e no desviante Acoustic parameters of the voicing contrast of plosives in typical phonological development and phonological disorder

OBJETIVO: Investigar se as crianças com desvio fonológico apresentam características acústicas distintas de sons plosivos surdos e sonoros das crianças com desenvolvimento fonológico típico. MÉTODOS:Participaram do estudo 11 crianças com desenvolvimento fonológico típico e cinco com desvio fonológico e dificuldade na aquisição do traço [+voz] das consoantes plosivas. Por meio de palavras (['papa], ['baba], ['tata], ['dada], ['kaka] e ['gaga]) inseridas em frases-veículo, mediu-se o voice onset time, a duração da vogal, a amplitude do burst e a duração da oclusão de cada plosivo. Foram comparados todos os registros acústicos de plosivos surdos e sonoros intra e intergrupo, por meio de testes estatísticos. RESULTADOS: As crianças com desenvolvimento fonológico típico apresentaram resultados significativos, principalmente, na diferenciação dos parâmetros de voice onset time, duração da vogal e oclusão de plosivos surdos e sonoros, diferentemente do observado para as crianças com desvio fonológico. A comparação entre os dois grupos mostrou diferenças quanto à produção de voice onset time e duração da oclusão dos plosivos sonoros. Com relação aos demais parâmetros analisados, os valores foram aproximados entre os grupos, sem diferença estatística. CONCLUSÃO: A marcação do contraste de sonoridade do grupo desviante mostra-se distinta em relação ao grupo de crianças com desenvolvimento fonológico típico, principalmente no que se refere ao voice onset time e à duração da oclusão dos segmentos sonoros.<br>PURPOSE: To investigate if children with phonological disorder present different acoustic characteristics of voiceless and voiced plosives from children with typical phonological development. METHODS: Participants were 11 children with typical phonological development and five children with phonological disorder and difficulty to establish the distinctive feature [+voice] of plosives. Through words (['papa], ['baba], ['tata], ['dada], ['kaka] and ['gaga]) inserted into carrier phrases, we measured voice onset time, vowel length, burst amplitude, and occlusion length of each plosive. The acoustic parameters of voiceless and voiced plosives were compared between and within groups through statistical analysis. RESULTS: The subjects within typical phonological development presented significant results mainly in distinguishing the parameters voice onset time, vowel length, and occlusion of voiceless and voiced stops, which was different from what was observed for children with phonological disorder. The comparison between groups showed differences related to the production of voice onset time and the occlusion length of voiced plosives. Regarding the other analyzed parameters, the values were similar between groups, with no statistical differences. CONCLUSION: The marking of the voicing contrast of the group with phonological disorder is different from the group with typical phonological development, especially regarding the voice onset time and the occlusion length of the voiced segments