risk groups

  • 文章类型: Journal Article
    我们提出了由3个科学学会制定的关于青少年免疫计划的共识文件:西班牙儿科协会(AEP),通过其疫苗咨询委员会(CAV-AEP),西班牙青少年医学学会(SEMA)和西班牙疫苗学会(AEV)。青春期的传染病有其特殊性,例如对百日咳的易感性增加,水痘的结果较差,腮腺炎和甲型肝炎,性传播感染的高发病率或脑膜炎球菌携带的患病率增加。该文件在总体疫苗接种政策的背景下分析了青少年的时间表。它考虑将疫苗纳入健康青少年的免疫计划:针对侵袭性脑膜炎球菌病(四价ACWY和B),人类乳头瘤病毒(应该是性别中立的),针对百日咳,抗流感和抗SARS-CoV-2(在未接种疫苗的个体和高危人群中)。值得注意的是,4CMenB疫苗似乎对淋球菌感染具有一定的保护作用,这对青少年来说将是一个相当大的附加值。还需要考虑为属于危险群体或出国旅行的青少年接种疫苗,就像任何其他年龄组的情况一样。甲型肝炎疫苗接种,包括在加泰罗尼亚的常规免疫计划中,休达和梅利利亚从第二年开始,在前往流行地区的青少年中,也应将其视为优先事项。
    We present the consensus document on the immunization schedule for adolescents developed by 3 scientific societies: the Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines (CAV-AEP), the Spanish Society of Adolescent Medicine (SEMA) and the Spanish Association of Vaccinology (AEV). There are particularities in infectious disease during adolescence, such as an increased susceptibility to pertussis, poorer outcomes of chickenpox, mumps and hepatitis A, a high incidence of sexually transmitted infections or increased prevalence of meningococcal carriage. The document analyses the schedule for adolescents in the context of vaccination policy overall. It contemplates the vaccines to be included in the immunization schedule for healthy adolescents: against invasive meningococcal disease (tetravalent ACWY and B), against human papillomavirus (which should be gender-neutral), against pertussis, against influenza and against SARS-CoV-2 (in unvaccinated individuals and at-risk groups). It is worth noting that the 4CMenB vaccine appears to confer some protection against gonococcal infection, which would be a considerable added value for adolescents. The vaccination of adolescents belonging to risk groups or travelling abroad also needs to be contemplated, as is the case in any other age group. Vaccination against hepatitis A, which is included in the routine immunization schedule of Catalonia, Ceuta and Melilla from the second year of life, should also be considered a priority in adolescents traveling to endemic areas.
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  • 文章类型: Journal Article
    简介:所有流行病学研究表明,维生素D缺乏在波兰普通人群中普遍存在。由于维生素D缺乏被证明是许多疾病和全因死亡率的危险因素之一,对这个问题的关注导致我们更新了波兰以前的建议。方法:在回顾流行病学证据后,病例对照研究和随机对照试验(RCTs),一个波兰多学科小组就一般人群和患者风险组预防和治疗维生素D缺乏症的建议提出了问题.对维生素D多效性的科学证据以及小组成员的投票结果进行了审查和讨论。代表不同专业领域的34位作者准备了立场声明。共识小组,代表八个波兰/国际医学协会和八名国家专家顾问,准备了最后的波兰建议。结果:基于网络讨论,表明维生素D缺乏的总血清25-羟基维生素D浓度范围[<20ng/mL(<50nmol/L)],次优状态[20-30ng/mL(50-75nmol/L)],并确认最佳浓度[30-50ng/mL(75-125nmol/L)]。制定了将胆钙化醇(维生素D3)作为预防和治疗维生素D缺乏症的首选的实用指南。介绍了骨化二醇作为预防和治疗维生素D缺乏症的第二选择。结论:必须再次宣布改善普通人群的维生素D状况和患者风险人群的治疗作为降低疾病谱风险的医疗保健政策。本文就波兰维生素D缺乏症的预防和治疗策略提供了共识声明。
    Introduction: All epidemiological studies suggest that vitamin D deficiency is prevalent among the Polish general population. Since vitamin D deficiency was shown to be among the risk factors for many diseases and for all-cause mortality, concern about this problem led us to update the previous Polish recommendations. Methods: After reviewing the epidemiological evidence, case-control studies and randomized control trials (RCTs), a Polish multidisciplinary group formulated questions on the recommendations for prophylaxis and treatment of vitamin D deficiency both for the general population and for the risk groups of patients. The scientific evidence of pleiotropic effects of vitamin D as well as the results of panelists\' voting were reviewed and discussed. Thirty-four authors representing different areas of expertise prepared position statements. The consensus group, representing eight Polish/international medical societies and eight national specialist consultants, prepared the final Polish recommendations. Results: Based on networking discussions, the ranges of total serum 25-hydroxyvitamin D concentration indicating vitamin D deficiency [<20 ng/mL (<50 nmol/L)], suboptimal status [20-30 ng/mL (50-75 nmol/L)], and optimal concentration [30-50 ng/mL (75-125 nmol/L)] were confirmed. Practical guidelines for cholecalciferol (vitamin D3) as the first choice for prophylaxis and treatment of vitamin D deficiency were developed. Calcifediol dosing as the second choice for preventing and treating vitamin D deficiency was introduced. Conclusions: Improving the vitamin D status of the general population and treatment of risk groups of patients must be again announced as healthcare policy to reduce a risk of spectrum of diseases. This paper offers consensus statements on prophylaxis and treatment strategies for vitamin D deficiency in Poland.
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  • 文章类型: Journal Article
    非肌肉浸润性膀胱癌(NMIBC)的欧洲泌尿外科协会(EAU)预后因素风险组用于提供经尿道膀胱肿瘤电切术(TURBT)后患者治疗的建议。他们没有,然而,考虑到广泛使用的世界卫生组织(WHO)2004/2016分级分类,并基于1980年代接受治疗的患者。
    使用WHO1973和2004/2016分级分类更新EAU预后因素风险组,并确定进展概率最低和最高的患者。
    从EAUNMIBC指南小组成员的机构收集原发性NMIBC患者的个体患者数据。
    患者接受TURBT,然后根据医生的判断进行膀胱内滴注。
    将多变量Cox比例风险回归模型拟合到主要终点,进展为肌肉浸润性疾病或远处转移的时间。患者分为四个风险组:低,中介-,high,一个新的,高危人群。使用Kaplan-Meier曲线估计进展的概率。
    共纳入3401例接受TURBT±膀胱内化疗的患者。从多变量分析中,肿瘤分期,世卫组织1973/2004-2016年级,伴随原位癌,肿瘤的数量,肿瘤大小,和年龄被用来形成四个风险组,5岁时进展的概率从<1%到>40%不等。局限性包括回顾性收集数据和缺乏中央病理学审查。
    本研究提供了更新的EAU预后因素风险组,可用于告知患者治疗和随访。纳入世卫组织2004/2016年和1973年的分级分类,一个新的,已经确定了非常高危人群,泌尿科医师应在必要时及时评估和调整其治疗策略.
    最新的欧洲泌尿外科协会非肌层浸润性膀胱癌预后因素风险组提供了一个改进的基础,为推荐患者的治疗和随访时间表。
    The European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder cancer (NMIBC) are used to provide recommendations for patient treatment after transurethral resection of bladder tumor (TURBT). They do not, however, take into account the widely used World Health Organization (WHO) 2004/2016 grading classification and are based on patients treated in the 1980s.
    To update EAU prognostic factor risk groups using the WHO 1973 and 2004/2016 grading classifications and identify patients with the lowest and highest probabilities of progression.
    Individual patient data for primary NMIBC patients were collected from the institutions of the members of the EAU NMIBC guidelines panel.
    Patients underwent TURBT followed by intravesical instillations at the physician\'s discretion.
    Multivariable Cox proportional-hazards regression models were fitted to the primary endpoint, the time to progression to muscle-invasive disease or distant metastases. Patients were divided into four risk groups: low-, intermediate-, high-, and a new, very high-risk group. The probabilities of progression were estimated using Kaplan-Meier curves.
    A total of 3401 patients treated with TURBT ± intravesical chemotherapy were included. From the multivariable analyses, tumor stage, WHO 1973/2004-2016 grade, concomitant carcinoma in situ, number of tumors, tumor size, and age were used to form four risk groups for which the probability of progression at 5 yr varied from <1% to >40%. Limitations include the retrospective collection of data and the lack of central pathology review.
    This study provides updated EAU prognostic factor risk groups that can be used to inform patient treatment and follow-up. Incorporating the WHO 2004/2016 and 1973 grading classifications, a new, very high-risk group has been identified for which urologists should be prompt to assess and adapt their therapeutic strategy when necessary.
    The newly updated European Association of Urology prognostic factor risk groups for non-muscle-invasive bladder cancer provide an improved basis for recommending a patient\'s treatment and follow-up schedule.
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  • 文章类型: Journal Article
    在这项研究中,683例子宫内膜癌(EC)患者经综合手术分期后分为低(LR)四个风险组,中间体(IR),高中间(HIR)和高风险(HR),根据最近的共识风险分组。疾病局限于子宫的患者,≥50%的子宫肌层浸润(MI)和/或3级组织学接受阴道近距离放射治疗(VBT)。患有II期疾病的患者,手术切缘阳性/闭合或子宫外扩张采用外束放疗(EBRT)±VBT治疗。中位随访时间为56个月。总生存期(OS)在LR和HR组之间有显著差异,LR组和HIR组之间存在趋势。无复发生存期(RFS)在LR和HIR之间有显著差异,LR和HR和IR和HR组。HIR组和HR组之间的OS和RFS率没有显着差异。在HR患者中,与III期和非子宫内膜样组织学相比,IB期-3级和II期的OS和RFS率显著较高,两个子宫局限期之间以及III期和非子宫内膜样组织学之间没有任何差异.当前的风险分组没有明确区分HIR和IR组。在综合手术分期的患者中,需要进一步的风险分组来区分真正的HR组.子宫内膜癌(EC)的标准治疗方法是手术,根据危险因素推荐辅助放疗(RT)和/或化疗。最近的欧洲医学肿瘤学会(ESMO),欧洲妇科肿瘤学会(ESGO)和欧洲放射治疗和肿瘤学会(ESTRO)指南引入了一个新的风险组。然而,风险分组仍然相当异构。这项研究的结果补充了什么?这项研究表明,ESMO-ESGO-ESTRO推荐的当前风险分组没有明确区分中等风险(IR)和高中等风险(HIR)组。这些发现对临床实践和/或进一步研究有什么意义?基于本研究的结果,在综合手术分期的患者中,可以进行新的风险分组,明确区分HIR和IR组.
    In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statementWhat is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging.
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