sábado, 22 de octubre de 2016

Possible Association between Underarm Deodorants/Antiperspirants Use and Breast Cancer Risk?

BREAST CANCER AND DEODORANTS/ ANTIPERSPIRANTS: A SYSTEMATIC REVIEW

Mohamed Farouk Allam (1,2)
1. Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Cordoba, Cordoba, Spain.
2. Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

SUMMARY
Background: Over the last decade, the possible association between underarm deodorants/antiperspirants use and breast cancer risk has raised important interest in the scientific community. The objective of our systematic review is to estimate the pooled risk of deodorants/antiperspirants use for breast cancer.
Methods: All observational studies that evaluated the association between breast cancer risk and deodorants/antiperspirants use were reviewed. We have only identified two case-control studies, carried out between 2002 and 2006.
Results: The first study was conducted in the USA and investigated the possible relationship between the use of products applied for underarm perspiration and the risk for breast cancer in women aged 20–74 years. This population-based case-control study gathered information by in-person interview. The second study was conducted in Iraq and investigated the possible relationship between the use of antiperspirants and the risk for breast cancer in women attending a teaching hospital. This study also gathered information by in-person interview. There was no risk of antiperspirants use in the pooled risk (odds ratio 0.40, 95% confidence interval 0.35–0.46).
Conclusion: Our comprehensive search has identified an insufficient number of studies to conduct a quantitative review and obtain reliable results. Further prospective studies are strongly needed.

KEYWORDS: Cancer; antiperspirants; breast; case-control; cohort; deodorants; meta-analysis; systematic review

PMID:b27755864
DOI: 10.21101/cejph.a4475 [PubMed - in process] 

http://apps.szu.cz/svi/cejph/show_en.php?kat=archiv/2016-3-15  

sábado, 15 de octubre de 2016

La Diferencia entre la Investigación Cuantitativa y la Investigación Cualitativa

El Principito: A los adultos les gustan los números. Cuando uno les habla de un nuevo amigo, nunca preguntan sobre lo esencial. Nunca te dicen: "Cómo es el sonido de su voz? Cuáles son los juegos que prefiere? Colecciona mariposas?" Te preguntan: "Qué edad tiene? Cuántos hermanos tiene? Cuánto pesa? Cuánto gana su padre?" Sólo entonces creen conocerlo. Si uno dice a los adultos: "Vi una bella casa de ladrillos rosas, con geranios en las ventanas y palomas en el techo..." no logran imaginársela. Hay que decirles: "Vi una casa de cien mil francos." Entonces exclaman: "Qué lindo !"

sábado, 1 de octubre de 2016

International pooled study on diet and bladder cancer

International pooled study on diet and bladder cancer: the bladder cancer, epidemiology and nutritional determinants (BLEND) study: design and baseline characteristics.

Arch Public Health. 2016 Jul 6;74:30. doi: 10.1186/s13690-016-0140-1. eCollection
2016.

Goossens ME(1), Isa F(2), Brinkman M(3), Mak D(2), Reulen R(2), Wesselius A(4),
Benhamou S(5), Bosetti C(6), Bueno-de-Mesquita B(7), Carta A(8), Allam MF(9),
Golka K(10), Grant EJ(11), Jiang X(12), Johnson KC(13), Karagas MR(14), Kellen E(15), La Vecchia C(16), Lu CM(17), Marshall J(18), Moysich K(18), Pohlabeln H(19), Porru S(8), Steineck G(20), Stern MC(12), Tang L(18), Taylor JA(21), van
den Brandt P(22), Villeneuve PJ(23), Wakai K(24), Weiderpass E(25), White E(26),
Wolk A(27), Zhang ZF(28), Buntinx F(29), Zeegers MP(30).

Author information:
(1)Department of General Practice, Katholieke Universiteit Leuven, ACHG-KU
Leuven, Kapucijnenvoer 33, Blok J, bus 7001, 3000 Leuven, Belgium. (2)Department of Public Health, Epidemiology and Biostatistics, University of Birmingham,Birmingham, UK. (3)The Cancer Council Victoria, Melbourne, Australia. (4)NUTRIM School for Nutrition and Translational Research in Metabolism, University of Maastricht, Maastricht, The Netherlands. (5)INSERM U946, Variabilite Genetique et Maladies Humaines, Fondation Jean Dausset / CEPH, Paris, France. (6)Laboratory of General Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. (7)Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands ; Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands ; Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK ; Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. (8)Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Public Health and Human Sciences, University of Brescia, Brescia, Italy. (9)Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Cordoba, Cordoba, Spain. (10)Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany. (11)Department of Epidemiology Radiation Effects Research Foundation, Hiroshima, Japan. (12)Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA. (13)Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON Canada. (14)Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH USA. (15)Leuven University Centre for Cancer Prevention (LUCK), Leuven, Belgium. (16)Department of Clinical Medicine and Community Health, University of Milan, Milan, Italy. (17)Department of Urology, Buddhist Dalin Tzu Chi General Hospital, Dalin Township, 62247 Chiayi County Taiwan. (18)Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY USA. (19)Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. (20)Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Hospital, Stockholm, Sweden. (21)Epidemiology Branch, and Epigenetic and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC USA. (22)Department of Epidemiology, Schools for Oncology and Developmental
Biology and Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands. (23)Population Studies Division Health Canada, Ottawa, ON Canada. (24)Department of Preventive medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. (25)Department of Medical Epidemiology and Biostatistics, Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden ; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway ; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland ; Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. (26)Fred Hutchinson Cancer Research Center, Seattle, WA USA. (27)Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. (28)Departments of Epidemiology, UCLA Center for Environmental Genomics, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA USA. (29)Department of General Practice, Katholieke Universiteit Leuven, ACHG-KU Leuven, Kapucijnenvoer 33, Blok J, bus 7001, 3000 Leuven, Belgium ; CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands. (30)NUTRIM School for Nutrition and Translational Research in Metabolism, University of Maastricht, Maastricht, The Netherlands ; CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands ; School of Cancer Sciences, University of Birmingham, Birmingham, UK.

BACKGROUND: In 2012, more than 400,000 urinary bladder cancer cases occurred worldwide, making it the 7(th) most common type of cancer. Although many previous studies focused on the relationship between diet and bladder cancer, the evidence related to specific food items or nutrients that could be involved in the development of bladder cancer remains inconclusive. Dietary components can either be, or be activated into, potential carcinogens through metabolism, or act to prevent carcinogen damage.
METHODS/DESIGN: The BLadder cancer, Epidemiology and Nutritional Determinants (BLEND) study was set up with the purpose of collecting individual patient data from observational studies on diet and bladder cancer. In total, data from 11,261 bladder cancer cases and 675,532 non-cases from 18 case-control and 6 cohort studies from all over the world were included with the aim to investigate the association between individual food items, nutrients and dietary patterns and risk of developing bladder cancer.
DISCUSSION: The substantial number of cases included in this study will enable us to provide evidence with large statistical power, for dietary recommendations on the prevention of bladder cancer.

DOI: 10.1186/s13690-016-0140-1
PMCID: PMC4933992
PMID: 27386115  [PubMed]

lunes, 26 de septiembre de 2016

GUÍAS DE PRÁCTICA CLÍNICA

Definición:
Las Guías de Práctica Clínica (GPC) son “conjunto de recomendaciones basadas en una revisión sistemática de la evidencia y en la evaluación de los riesgos y beneficios de las diferentes alternativas, con el objetivo de optimizar la atención sanitaria a los pacientes”.

Notas Históricas:
David Sackett (1985): Son una propuesta que apoya la decisión del médico en la elección de procedimientos y conductas que se ha de seguir ante un paciente en circunstancias clínicas específicas, para mejorar la calidad de la atención médica, reducir el uso de intervenciones innecesarias, ineficaces o dañinas, facilitar el tratamiento de los pacientes con el máximo beneficio y disminuir al mínimo el riesgo de daño.” Universidad de McMaster (Ontario, Canadá).

Cochrane Collaboration: Desde 1992
Trusted Evidence. Informed Decisions. Better Health

Centre for Reviews and Dissemination (University of York NIH): Desde 1994.
NHS Economic Evaluation Database (EED).
The Database of Abstracts of Reviews of Effects (DARE).

National Institute for Health and Care Excellence (NICE): Desde 1999.

En España, se puso en marcha el Catálogo de GPC en el 2004 y el Programa de GPC en el Sistema Nacional de Salud en el 2006.

Objetivos
1.    Mejorar la práctica médica.
2.    Promover el uso eficiente de los recursos.

Fuentes
-       Centre for Reviews and Dissemination (University of York NIH).
-       National Institute for Health and Care Excellence (NICE).
-       GuíaSalud España.
-       Guías de Practicas Clínica México.
-       La Colaboracion Cochrane.
-       Fiesterra.
-       Essential Evidence PLUS.

Catálogo de GPC
Catálogo de Guías de Práctica Clínica del Sistema Nacional de Salud.

Catálogo Maestro de Guías de Práctica Clínica en México.

Calidad de GPC
Criterios de  Valoración.
Instrumento AGREE (Appraisal of Guidelines Research and Evaluation).
Preguntas incluidas en el instrumento AGREE en el apartado de “Rigor en la elaboración” relacionados con la formulación de recomendaciones:
1.    ¿Los métodos para formular las recomendaciones están claramente descritos?
2.    ¿Al formular las recomendaciones, los beneficios de salud, efectos secundarios y los riesgos, han sido considerados?
3.    ¿Hay una relación clara entre cada una de las recomendaciones y las evidencias en las que se basan?

El sistema GRADE
El sistema GRADE tiene algunos aspectos diferenciales que se pueden resumir en tres.
1) Categoriza los desenlaces de interés y su importancia relativa.
2) Evalúa la calidad de la evidencia en cuatro categorías para cada uno de los desenlaces para después obtener una calidad global de evidencia.
3) Gradúa la fuerza de las recomendaciones.

Clasificación de la importancia relativa de los desenlaces de interés
1-3: desenlace no importante. Estos desenlaces no juegan un papel importante en la formulación de las recomendaciones y no se incluyen en la tabla de evaluación de la calidad o de los resultados.
4-6: desenlace importante pero no clave para la toma de decisiones.
7-9: desenlace clave para la toma de decisiones.

En la propuesta GRADE los estudios se clasifican de forma que los ECAs corresponden de entrada a "calidad alta" y los observacionales a "calidad baja"; Alta, Moderada, Baja y Muy Baja.

El sistema GRADE considera dos categorías en relación a la fuerza de las recomendaciones: Recomendación fuerte y Recomendación débil.

STARD (Standards for Reporting of Diagnostic Accuracy).

The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.


STROBE Statement. 

sábado, 3 de septiembre de 2016

Crimean-Congo Hemorrhagic Fever - Spain: (Castile and Leon)

The Spain Report. September 01 2016
One Dead, One In Isolation After Two Cases Of Crimean-Congo Hemorrhagic Fever Confirmed In Madrid.

Madrid regional health authorities confirmed two cases of Crimean-Congo hemorrhagic fever had been detected in the Spanish capital, after receiving the results of tests from the National Microbiology Centre. Regional health authorities said in a statement that it was the first home-grown, non-imported case of Crimean-Congo hemorrhagic fever in Western Europe.
https://www.thespainreport.com/articles/883-160901142820-one-dead-one-in-isolation-after-two-cases-of-crimean-congo-hemorrhagic-fever-confirmed-in-madrid