Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.

OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Construcción y explotación de un almacén de datos para el análisis del sistema de prestaciones sociales

El objetivo principal del proyecto que se presenta a continuación es diseñar, construir y explotar un almacén de datos a partir de la información entregada por las comunidades autónomas españolas (excepto País Vasco y Navarra) y el Instituto Nacional de Estadísticas (INE) para determinar la sostenibilidad del sistema de prestaciones sociales y conocer la evolución de dichas prestaciones.

Trends in self-reported past alcoholic beverage consumption and ethanol intake from 1950 to 1995 observed in eight European countries participating in the European Investigation into Cancer and Nutrition (EPIC).

OBJECTIVE To describe the trends of self-reported past consumption of alcoholic beverages and ethanol intake from 1950 to 1995 within the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN Data on consumption of beer/cider, wine and liqueur/spirits were obtained retrospectively at age 20, 30 and 40 years to calculate average consumption and ethanol intake for the time periods 1950-1975 (at age 20), 1960-1985 (at age 30) and 1970-1995 (at age 40). Regression analysis was conducted with the time period data to assess trends in past alcoholic beverage consumption and ethanol intake with time. SETTING The EPIC project. SUBJECTS In total, 392 064 EPIC participants (275 249 women and 116 815 men) from 21 study centres in eight European countries. RESULTS Generally, increases in beer/cider consumption were observed for most EPIC centres for 1950-1975, 1960-1985 and 1970-1995. Trends in wine consumption differed according to geographical location: downward trends with time were observed for men in southern European EPIC centres, upward trends for those in middle/northern European study centres. For women, similar but less pronounced trends were observed. Because wine consumption was the major contributor to ethanol intake for both men and women in most study centres, time trends for ethanol intake showed a similar geographical pattern to that of wine consumption. CONCLUSION The different trends in alcoholic beverage consumption and ethanol intake suggest that information depicting lifetime history of ethanol intake should be included in analyses of the relationship between ethanol and chronic diseases, particularly in multi-centre studies such as EPIC.

Experiencias y cambios en los padres de niños con parálisis cerebral infantil: estudio cualitativo.

BACKGROUND The diagnosis of infant cerebral palsy (ICP) is a traumatic event that can provoke multiple effects and changes in the family. The aim of the study is to discover the difficulties that parents face in the process of parenting, especially in the initial period following diagnosis. METHODS A qualitative study was carried out through semi-structured interviews. Sixteen mothers and fathers whose children were diagnosed with cerebral palsy participated in the study. Data analysis was performed with Atlas.ti 6.2 software following a strategy of open coding. RESULTS The reception of the diagnosis is perceived as an unexpected event that makes parents change expectations and hopes related to their children. The mode of relation with the child with ICP is different from that with other children as parents are more focused on the possibility of improvement and the future evolution of their child. Changes in different aspects of the lives of these parents are shown, such as demands on time, their economic and labour situation, as well as the relationship of the couple. CONCLUSIONS In providing care for children with cerebral palsy it is necessary to take the problems of the parents into account, especially in the initial period after diagnosis. The process of parenting a child with cerebral palsy entails many changes in the family so a global perspective is needed to organize interventions.

Foto de familia, un estudio descriptivo de los recursos de información científica en las bibliotecas del Sistema Sanitario Público Español

G17+1 está integrado por: Elena Primo (Biblioteca Nacional de Ciencias de la Salud), Verónica Juan (BV Andalucía), Montserrat Salas (BV Aragón), Mercedes Corrales y Raquel Lavandera (BV Asturias), Virgili Paéz (BV Baleares), Beatriz Duque (BV Canarias), Fanny Ribes (BV Cantabria), Marisa Alonso (BV Castilla-La Mancha), Pilar Díaz Ruiz (BV Castilla y León), Pilar Roqué (BV Cataluña), Francisco Javier Moreno (BV Extremadura), Teresa Mejuto (BV Galicia), Mayra García Berges y José Manuel Estrada (BV Madrid), Enrique Aguinaga y Juan Antonio Sánchez Sánchez (BV Murcia), Idoia Gaminde (BV Navarra) y Ricardo Aróstegui y Mª Asunción García Martín (BV País Vasco).

Nutrient patterns and their food sources in an International Study Setting: report from the EPIC study.

BACKGROUND Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses. METHODOLOGY/PRINCIPAL FINDINGS We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores. CONCLUSION/SIGNIFICANCE The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term of food sources. These outcomes open research opportunities and perspectives of using nutrient patterns in future studies particularly at international level.

Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study.

BACKGROUND Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors - healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. RESULTS After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. CONCLUSIONS Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.

Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study.

BACKGROUND Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. METHODS The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. RESULTS The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. CONCLUSIONS Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

Metabolomic profiles of hepatocellular carcinoma in a European prospective cohort.

BACKGROUND Hepatocellular carcinoma (HCC), the most prevalent form of liver cancer, is difficult to diagnose and has limited treatment options with a low survival rate. Aside from a few key risk factors, such as hepatitis, high alcohol consumption, smoking, obesity, and diabetes, there is incomplete etiologic understanding of the disease and little progress in identification of early risk biomarkers. METHODS To address these aspects, an untargeted nuclear magnetic resonance metabolomic approach was applied to pre-diagnostic serum samples obtained from first incident, primary HCC cases (n = 114) and matched controls (n = 222) identified from amongst the participants of a large European prospective cohort. RESULTS A metabolic pattern associated with HCC risk comprised of perturbations in fatty acid oxidation and amino acid, lipid, and carbohydrate metabolism was observed. Sixteen metabolites of either endogenous or exogenous origin were found to be significantly associated with HCC risk. The influence of hepatitis infection and potential liver damage was assessed, and further analyses were made to distinguish patterns of early or later diagnosis. CONCLUSION Our results show clear metabolic alterations from early stages of HCC development with application for better etiologic understanding, prevention, and early detection of this increasingly common cancer.

Los retos presentes y futuros de las agencias de medios en España

La revolución tecnológica en la que estamos inmersos está afectando a los consumidores, a las marcas y muy especialmente a los medios de comunicación, lo que obliga a las agencias de medios a reformular tanto susestructuras organizativas como los servicios que ofrecen a los anunciantes. En un momento además caracterizado por una grave crisis económica que hace que las inversiones publicitarias de hoy en día estén retrocediendo hasta niveles de hace cinco años atrás.En esta investigación realizaré un análisis retrospectivo de este tipo de agencias desde los años 70 hasta nuestros días, analizando los factores que han impulsado a que las agencias de medios estén cambiando, continuando de este modo con la línea de investigación abierta por el Dr. Francisco Javier Pérez-Latre de la Universidad de Navarra y autor de la tesis “Centrales deCompra de Medios”.

Análisis de viabilidad técnica-económica del parque eólico Altos de Peralta

RESUMEN La energia eolica se considera una forma indirecta de energia solar. Entre el 1 y 2% de la energia proveniente del sol se convierte en viento, debido al movimiento del aire ocasionado por el desigual calentamiento de la superficie terrestre. La energia cinetica del viento puede transformarse en energia util, tanto mecanica como electrica. La energia eolica, transformada en energia mecanica ha sido historicamente aprovechada, pero su uso para la generacion de energia electrica es mas reciente, en respuesta a la crisis del petroleo y a los impactos ambientales derivados del uso de combustibles. El objetivo principal de este trabajo es hacer un analisis de viabilidad desde un punto de vista tecnico y economico de un parque eolico situado en el municipio de Barasoain (Navarra). Desde el punto de vista tecnico se han estudiado los aspectos constructivos del parque considerando sus diferentes infraestructuras de obra civil y electrica asi como los niveles de recurso eolico. En el ambito economico y financiero se han analizado los aspectos y ratios mas relevantes que definen un proyecto de estas caracteristicas asi como el modelo de financiacion elegida basada en el Project- Finance. Entre las conclusiones mas destacadas de este proyecto cabe destacar la contribucion de la construccion del parque al desarrollo social y economico de la zona donde queda ubicado contribuyendo a la creacion de puestos de trabajo, tanto en la fase de construccion como de explotacion y una perfecta armonia con condicionantes medioambientales de la zona. El analisis tecnico realizado nos indica la viabilidad tecnica del parque tanto desde el punto de vista de recurso eolico como la idoneidad para poder evacuar la energia producida. Por otro lado, los resultados obtenidos cumplen perfectamente con los estandares requeridos por los financiadores de los parques y resultando ser muy atractivos para sus accionistas

Inserció laboral dels titulats en Biblioteconomia i Documentació per la Universitat de Barcelona

[eng] The article presents the results of a study regarding job placement of University of Barcelona LIS alumni -of the 3-year (diplomatura) degree measured over the past 5 graduating classes and of the Bachelor degree (llicenciatura) between 2000-June 2003. Twelve years after the first study on this topic, this study demonstrates that the labour market continues to expand and steadily absorb the LIS graduates.

Imatge i ús dels serveis d'informació en els alumnes de l'Escola Universitària de Biblioteconomia i Documentació Jordi Rubió i Balaguer (II)

Aquesta és la segona part de l'article aparegut en el número 20 d'ítem. En aquella es presentaven les conclusions de l'estudi realitzat sobre els hàbits en l'ús dels serveis d'informació dels alumnes de primer de l'Escola del curs Í996-Í997. En aquesta segona es pretén veure quin és el punt de vista dels alumnes de segon i tercer curs, per tal d'analitzar els canvis soferts a mesura que van aprofundint en el coneixement dels centres i veure fins a quin punt aquests canvis poden atribuir-se al procés currícular dels alumnes.

Nous jaciments laborals per a diplomats: anàlisi dels convenis de cooperació educativa de la Facultat de Biblioteconomia i Documentació (UB), 1998-2002

A partir de les ofertes de col·laboració d'empreses privades amb finalitat de lucre rebudes a la Facultat de Biblioteconomia i Documentació de la Universitat de Barcelona entre setembre de 1998 juny de 2002, es presenten i analitzen els resultats pel que fa a tres aspectes que s'han cregut especialment destacables: el sector d'activitat de les empreses, les tasques per a les quals se sol·liciten els estudiants i, en darrer lloc, els coneixements i actituds que se'ls requereix. La informació recollida permet fer algunes propostes d'actuació i definir línies de treball tant pel que fa a la formació acadèmica dels alumnes com a la seva orientació professional.

Imatge i ús dels serveis d'informació en els alumnes de l'Escola Universitària Jordi Rubió i Balaguer de Biblioteconomia i Documentació

Es pretén mostrar quins són els hàbits informatius dels alumnes de l'Escola com també la imatge que tenen sobre la professió bibliotecària en el moment d'iniciar els seus estudis universitaris i de quina manera aquesta opinió es modifica a mesura que la seva vida acadèmica avança.