Fundación Andaluza Beturia para la Investigación en Salud

Improvements in breast cancer survival rate have been achieved through a variety of multimodal therapeutic approaches, which play a key role in the patients' healthcare pathway and their Patient-Reported Outcomes (PROs) from a Value-Based Healthcare (VBHC) perspective. This paper analyses differences in PROs of patients diagnosed with breast cancer according to their healthcare pathway. A cohort of 690 patients diagnosed with breast cancer between 2018 and 2020 at six European sites was used. PROs were assessed at baseline and 6 months using the International Consortium for Health Outcome Measures standard set. Archetypes defined by patient characteristics and treatment trajectories served as the basis for comparison. Multivariate linear regression models were used to analyse differences in PROs across archetypes. Functional scores generally worsened over 6 months, particularly in physical functioning, whereas emotional functioning improved. Archetypes undergoing mastectomy, with or without reconstruction, showed significant decreases in body image perception and satisfaction with breasts. Pain, fatigue, and peripheral symptoms were prevalent in most archetypes, with those receiving chemotherapy reporting the greatest symptom burden. Patients with in situ carcinoma and patients undergoing conservative surgery plus radiotherapy showed minimal deterioration. The use of PROs in a real-world setting enables the identification of differences across patient archetypes based on their therapeutic pathways. This information provides valuable insights for refining patient-centred care guiding VBHC strategies in oncology, developing of personalized care solutions, and facilitating Shared-Decision Making.

Postpartum depression (PPD) is one of the most common disorders following childbirth. This systematic review and meta-analysis (SR/MA) aimed to assess the effectiveness of psychological interventions in preventing PPD in non-depressed women. PRISMA guidelines were followed. MEDLINE (Ovid and PubMed), PsycINFO, Web of Science, Scopus, CINAHL, CENTRAL, OpenGrey, Australian New Zealand Clinical Trial Registry and clinicaltrial.gov were searched. Randomized controlled trials (RCTs) conducted with pregnant or postpartum (up to 12 months) women who were non-depressed at baseline were selected. The outcomes were the incidence of PPD and/or the reduction of postpartum depressive symptoms. The standardized mean difference (SMD) using random-effect models was calculated. Sensitivity, sub-group and meta-regression analyses were performed. 17 RCTs were included in the SR and 15 in the MA, representing 4958 participants from four continents. The pooled SMD was -0.175 [95% confidence interval (CI) -0.266 to -0.083; p < 0.001] and sensitivity analyses confirmed the robustness of this result. Heterogeneity was low (I2 = 21.20%) and was fully explained by a meta-regression model including one variable (previous deliveries). The meta-regression model and MA stratified by previous deliveries indicated that interventions focused on primiparous women are more effective. There was no evidence of publication bias. Few RCTs had an overall low risk of bias. According to GRADE, the quality of evidence was moderate. Psychological interventions have very little effectiveness in preventing PPD in non-depressed women, although this effectiveness is greater in interventions focused on primiparous women. Further RCTs with a low risk of bias and more effective interventions are needed.

Background: A high burden of kidney diseases, including acute kidney injury (AKI), has been reported among agricultural workers, mainly male workers in tropical areas. Dehydration caused by strenuous work at high temperatures and other related working conditions have been associated with AKI. The aim on this study was to estimate the incidence of AKI and study related risk factors among female agricultural workers in south of Spain working in crops under plastic, where temperatures can be similar to those observed in tropical latitudes.Methods: A hundred female agricultural workers were enrolled in south Spain (Huelva) during the summer months. For each participant we estimated (i) cross-shift incidence of AKI based on serum creatinine values according to the KDIGO definition; and (ii) presence of heat stress during work shift based on external temperature, activities conducted and clothing, according to international standard ISO 7933:2005. We also collected information on other occupational risk factors, clinical history, life-style factors and anthropometric measurements. We used logistic regression models to assess if heat stress is a risk factors for AKI among this population and explore other potential risk factors.Results and conclusions: Seven per cent of participants presented cross-shift AKI. Heat stress was not associated with AKI incidence [OR (95%CI) =0.37 (0.04,3.19)]. The only risk factor associated with AKI was lower mean estimated glomerular filtration rate (eGFR) prior to work-shift [(104.7 (16.3) versus 102.2 (20.2)], suggesting that previous kidney conditions were the main risk factor for AKI. These results are being validated with additional measurements of kidney function and injury such as cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) urine levels (results will be available before the conference). Results suggest that previous kidney conditions were the main risk factor for AKI in this population of female agricultural workers.