Hospital Universitario de Valme

Anal cancer mortality has increased across high-income countries, yet subnational patterns remain poorly characterized. This study provides the first comprehensive, sex-stratified, spatiotemporal analysis of anal cancer (ICD-10 C21) mortality in Spain from 1999 to 2023. We conducted an ecological, descriptive, province-level analysis of mortality using data from the National Institute of Statistics. Sex-stratified Bayesian hierarchical models were applied to estimate smoothed relative risks (RRs) by province and year, incorporating spatial, temporal, and interaction effects. Model selection was guided by the Deviance Information Criterion and Widely Applicable Information Criterion. Posterior probabilities (PP) were used to identify high-risk provinces (PP > 0.95). Among 160 candidate models, optimal structures differed by sex: males showed intrinsic Conditional Autoregressive (iCAR) spatial prior with RW1 temporal prior and Type IV interaction; females showed iCAR with RW2 temporal prior and Type III interaction. Mortality rose in both sexes: male RR increased steadily to 1.39 in 2023; female RR followed a nonlinear trajectory with delayed surge to 1.30. Variance decomposition indicated male mortality was mainly temporal (80.2%), female mortality largely spatial (58.1%). Male hotspots clustered in southern/insular provinces (e.g., Las Palmas RR=1.22, Cádiz 1.18, Valencia 1.18); female hotspots were more dispersed (e.g., Las Palmas 1.34, Málaga 1.33, Barcelona 1.26). Anal cancer mortality in Spain is rising, revealing persistent sex-specific and geographic inequalities beyond national temporal trends. Precision prevention-via gender-neutral HPV vaccination, targeted screening, and prioritization of hotspot provinces-is urgently needed.

The primary objective of this study is to identify opportunities to improve clinical and comprehensive support of patients diagnosed with gynaecological cancers in Spain. Secondary objectives included identifying the unmet needs regarding awareness and access to screening strategies of gynaecological cancers in Spain. A mixed-methods design was used, combining qualitative and quantitative research in 235 participants. The qualitative component comprised semi-structured interviews and focus groups with 12 patients with gynaecological cancer, 6 caregivers, and 11 healthcare professionals. The quantitative component included anonymous surveys from 44 women with gynaecological cancer and 162 women from the general population. Descriptive statistics were applied. The qualitative study revealed needs in prevention, early diagnosis, emotional support, nutrition, physical activity, and sexual health. Among surveyed patients, the mean knowledge of gynaecological cancer before diagnosis was low (2.3/6). Substantial limitations were reported after diagnosis in physical activity (59%), diet (43%), and sexual life (70%), and 55% experienced psychological consequences. Fifty-six percent reported insufficient non-pharmacological information from their healthcare team, and 59% sought support from patient associations. In the general population, 40% of women had never received information on gynaecological cancer. Improving care for women with gynaecological cancers in Spain requires action at two levels: (1) strengthened early detection through awareness and screening strategies, and (2) expanded supportive services including nutrition, psycho-oncology, physical activity programmes, and sexual health interventions. Addressing taboos around women's sexuality and leveraging patient associations and preferred communication channels should be priorities.

Abstract Background There are no "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) programs in the management of embolic event prevention after a severe bleeding (SB) in anticoagulated patients with atrial fibrillation (AF). Purpose Our main objective was to investigate the frequency of LAAC in anticoagulated AF patients surviving a SB event and to describe the differential features of these patients versus those medically managed in Andalusia (South of Spain). Methods All consecutive patients discharged alive from January 1st, 2021 to December 31st, 2022, after an intracranial or gastrointestinal severe haemorrhage, who were previously anticoagulated for AF, in all public Andalusian hospitals with LAAC program, and who could be eligible either for LAAC or direct anticoagulant treatment were included in a retrospective, multicentre study. The frequency of a percutaneous LAAC strategy in the follow-up was registered. A comparative analysis of baseline features between those patients treated with LAAC and those medically managed was performed. Results Among a reference population of 7119044 inhabitants in 15 hospitals, 1403 patients were included in the study. Median age was 81 years [p25-75, 76-87 years] with 51.6% male patients. A LAAC procedure was performed in 114 patients (8.13%) at a median time of 5 [2-10] months after discharge. After adjusting for confounding variables in a logistic regression model, LAAC closure was independently associated with intracranial hemorrhage (ICH), previous bleeding events, at least moderate valvular disease, leukemia and aspirin use at admission; and was more infrequently performed in patients aged >80 years, with dementia, uncontrolled blood pressure, vitamin K antagonist use at admission and interventional treatment of the bleeding event (Table). Variables with univariate association with LAAC (p<0.10) but excluded in backward stepwise regression after showing no significant independent association were hypercholesterolemia (rate of LAAC 9.5% vs 6.5% in non-hypercholesterolemia, p=0.04), diabetes mellitus (9.6% vs 7.2%, p=0.096), ischemic heart disease (11.9% vs 7.4%, p=0.02), heart failure or left ventricular dysfunction (9.9% vs 7.1%, p=0.06), connective tissue disease (0.0% vs 8.3%, p=0.09), chronic obstructive pulmonary disease (5.3% vs 8.7%, p=0.08), peptic ulcer disease (11.9% vs 7.7%, p=0.09), baseline heart rate (70[64-80] vs 75[66-87] bpm, p=0.003) and platelet count (201[158-244] vs 212[166-269]/nL, p=0.08). Conclusions In anticoagulated patients with AF who survived a SB event in all public hospitals with LAAC program in a large European region in 2021-2022, and who were also eligible for anticoagulation with DOAC, only 8.13% were managed with a LAAC strategy. Several baseline features were independently associated with higher or lower frequency of this approach.Table