Revistas
Revista:
BIOMEDICINES
ISSN:
2227-9059
Año:
2023
Vol.:
11
N°:
2
Págs.:
238
Background: The addition of dendritic cell vaccines (DCV) to NAC could induce immune responses in those patients with residual disease (RD) by transforming the tumor microenvironment. Methods: Core diagnostic biopsies and surgical specimens from 80 patients (38 in the vaccinated group plus NAC (VG) and 42 in the control group (CG, treated only with NAC) were selected. We quantify TILs (CD8, CD4 and CD45RO) using immunohistochemistry and the automated cellular imaging system (ACIS III) in paired samples. Results: A CD8 rise in TNBC samples was observed after NAC plus DCV, changing from 4.48% in the biopsy to 6.70% in the surgical specimen, not reaching statistically significant differences (p = 0.11). This enrichment was seen in up to 67% of TNBC patients in the experimental arm as compared with the CG (20%). An association between CD8 TILs before NAC (4% cut-off point) and pathological complete response in the VG was found in the univariate and multivariate analysis (OR = 1.41, IC95% 1.05-1.90; p = 0.02, and OR = 2.0, IC95% 1.05-3.9; p = 0.03, respectively). Conclusion: Our findings suggest that patients with TNBC could benefit from the stimulation of the antitumor immune system by using DCV together with NAC.
Revista:
CIRUGÍA ESPAÑOLA
ISSN:
2173-5077
Año:
2023
Vol.:
101
N°:
5
Págs.:
333 - 340
INTRODUCTION: Laparoscopic resection of the pancreas (LRP) has been implemented to a varying degree because it is technically demanding and requires a long learning curve. In the present study we analyze the risk factors for complications and hospital readmissions in a single center study of 105 consecutive LRPs.
METHODS: We conducted a retrospective study using a prospective database. Data were collected on age, gender, BMI, ASA score, type of surgery, histologic type, operative time, hospital stay, postoperative complications, degree of severity and hospital readmission.
RESULTS: The cohort included 105 patients, 63 females and 42 males with a median age and BMI of 58 (53-70) and 25.5 (22,2-27.9) respectively. Eighteen (17%) central pancreatectomies, 5 (4.8%) enucleations, 81 (77.6%) distal pancreatectomies and one total pancreatectomy were performed. Fifty-six patients (53.3%) experienced some type of complication, of which 13 (12.3%) were severe (Clavien-Dindo > IIIb) and 11 (10.5%) patients were readmitted in the first 30 days after surgery. In the univariate analysis, age, male gender, ASA score, central pancreatectomy and operative time were significantly associated with the development of complications (P <0.05). In the multivariate analysis, male gender (OR 7.97; 95% CI 1.08-58.88)), severe complications (OR 59.40; 95% CI, 7.69-458.99), and the development of intrabdominal collections (OR 8.97; 95% CI, 1.28-63.02)) were associated with hospital readmission.
CONCLUSIONS: Age, male gender, ASA score, operative time and central pancreatectomy are associated with a higher incidence of complications. Male gender, severe complications and intraabdominal collections are associated with more hospital readmissions.
Revista:
BIOMEDICINES
ISSN:
2227-9059
Año:
2022
Vol.:
10
N°:
7
Págs.:
1753
Objectives: Immunostimulatory therapies using immune checkpoint blockers show clinical activity in a subset of glioblastoma (GBM) patients. Several inhibitory mechanisms play a relevant role in the immune response to GBM. With the objective of analyzing the tumor immune microenvironment and its clinical significance, we quantified several relevant immune biomarkers. Design: We studied 76 primary (non-recurrent) GBMs with sufficient clinical follow-up, including a subgroup of patients treated with a dendritic cell vaccine. The IDH-mutation, EGFR-amplification, and MGMT methylation statuses were determined. Several relevant immune biomarkers, including CD163, CD8, PD1, and PDL1, were quantified in representative selected areas by digital image analysis and semiquantitative evaluation. The percentage of each immune expression was calculated with respect to the total number of tumor cells. Results: All GBMs were wild-type IDH, with a subgroup of classical GBMs according to the EGFR amplification (44%). Morphologically, CD163 immunostained microglia and intratumor clusters of macrophages were observed. A significant direct correlation was found between the expression of CD8 and the mechanisms of lymphocyte immunosuppression, in such a way that higher values of CD8 were directly associated with higher values of CD163 (p < 0.001), PDL1 (0.026), and PD1 (0.007). In a multivariate analysis, high expressions of CD8+ (HR = 2.05, 95%CI (1.02-4.13), p = 0.034) and CD163+ cells (HR 2.50, 95%CI (1.29-4.85), p = 0.007), were associated with shorter survival durations. The expression of immune biomarkers was higher in the non-classical (non-EGFR amplified tumors) GBMs. Other relevant prognostic factors were age, receipt of the dendritic cell vaccine, and MGMT methylation status. Conclusions: In accordance with the inverse correlation between CD8 and survival and the direct correlation between effector cells and CD163 macrophages and immune-checkpoint expression, we postulate that CD8 infiltration could be placed in a state of anergy or lymphocytic inefficient activity. Furthermore, the significant inverse correlation between CD163 tissue concentration and survival explains the relevance of this type of immune cell when creating a strong immunosuppressive environment. This information may potentially be used to support the selection of patients for immunotherapy.
Revista:
ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH ED.)
ISSN:
2173-5786
Año:
2022
Vol.:
46
N°:
5
Págs.:
275 - 284
Objetivos
Evaluar los resultados de la prostatectomía radical asistida por robot (PRAR), y compararlos con los de la cirugía abierta (PRA) y laparoscópica (PRL). El interés no solo radica en los resultados oncológicos y funcionales de la serie, sino en la evaluación de la calidad de vida (QoL), la recuperación postoperatoria y la satisfacción personal de los pacientes con la intervención (PR), fundamentalmente.
Métodos
Se realizaron 685 PR en nuestro centro entre 2011-2018 (17,8% PRA, 22,2% PRL y 60% PRAR). Los pacientes fueron evaluados prospectivamente mediante seguimiento hasta abril de 2020, y con la realización un cuestionario múltiple a los 12 meses post-PR, que incluía ICIQ-SF, SHIM, IPSS, IQL y preguntas sobre el dolor, la recuperación postoperatoria y la satisfacción del paciente (SP). También se recogieron datos basales y postoperatorios relacionados con el paciente y el tratamiento, y se realizaron regresiones logísticas binomiales para las comparaciones 1 vs. 1 (PRA vs. PRAR y PRL vs. PRAR).
Resultados
Los pacientes tratados con PRAR tienen en general menos comorbilidades, menos agresividad tumoral, un requerimiento de mayor tiempo operatorio y un número mayor de márgenes quirúrgicos positivos que los pacientes tratados con PRA y PRL. Sin embargo, la PRAR supera a la PRA en: días de estancia hospitalaria (OR: 0,86; IC 95%: 0,80-0,94), disminución de hemoglobina (OR: 0,38; IC 95%: 0,30-0,47), tasas de transfusión (OR: 0,18; IC 95%: 0,09-0,34), complicaciones tempranas (p = 0,001), IQL (OR: 0,82; IC 95%: 0,69-0,98), función eréctil (OR: 0,41; IC 95%: 0,21-0,79), manejo del dolor (OR: 0,82; IC 95%: 0,75-0,89), recuperación postoperatoria (p < 0,001) y elección de un abordaje diferente (OR: 5,55; IC 95%: 3,14-9,80). La PRAR es superior a la PRL en: continencia urinaria (OR: 0,55; IC 95%: 0,37-0,82), IPSS (OR: 0,96; IC 95%: 0,93-0,98), IQL (OR: 0,76; IC 95%: 0,66-0,88), función eréctil (OR: 0,52; IC 95%: 0,29-0,93), recuperación posquirúrgica (p = 0,02 y 0,004), PS (p = 0,005; 0,002; y 0,03) y elección de un abordaje diferente (OR: 7,79; IC 95%: 4,63-13,13).
Conclusiones
Los hallazgos de nuestro estudio respaldan la efectividad de la PRAR sobre la PRL y/o la PRA de manera global, tanto en factores funcionales, como en la recuperación postoperatoria, la QoL y la PS. Los resultados oncológicos aún deben ser mejorados.
Revista:
MATERIALS TODAY COMMUNICATIONS
ISSN:
2352-4928
Año:
2022
Vol.:
31
Págs.:
103690
Due to the COVID19 pandemic, solutions to automate disinfection using UV-C combined with mobile robots are beginning to be explored. It has been proved that the use of these systems highly reduces the risk of contagion. However, its use in real applications is not being as rapid as it needs to be. One of the main market input barriers is the fear of degrading facilities. For this reason, it is crucial to perform a detailed study on the degradation effect of UV-C light on inert materials. This experimental study proves that, considering exposition times equivalent to several work years in hospital rooms, only the appearance of the material is affected, but not their mechanical functionalities. This relevant result could contribute to accelerate the deployment of these beneficial disinfection technologies. For that purpose, a colorimetry test, tensile strength test, and analysis of the surface microstructure were carried out. The results showed that polymers tend to turn yellow, while fabrics lose intensity depending on the color. Red is hardly affected by UV-C, but blue and green are. Thus, this study contributes to the identification of the best materials and colors to be used in rooms subjected to disinfection processes. In addition, it is shown how the surface microstructure of the materials is altered in most of the materials, but not the tensile strength of the fabrics.
Revista:
EUROPEAN JOURNAL OF CLINICAL NUTRITION
ISSN:
0954-3007
Año:
2022
Vol.:
76
N°:
1
Págs.:
48 - 55
Background Dementia is projected to affect 135 million by 2050. Diet is a pertinent target for primary prevention, but firm recommendations for dementia prevention are not available yet. Our aim was to address the association between exploratory (empirically derived) dietary patterns (DP) and changes in the Spanish Telephone Interview for Cognitive Status (STICS-m, maximum score = 41 points) over 6 years. Method Information on diet was collected with a validated 136-item food-frequency questionnaire from 803 participants in the Mediterranean cohort Seguimiento Universidad de Navarra. We used principal component analysis to derive exploratory DP. The derived DP were associated with change in STICS-m scores over 6 years, through adjusted multiple linear regression models. Results Two main DP were identified. The first DP resembled a Western dietary pattern (WDP)-high in sugar, fat, processed foods, and red meat-and the second DP resembled a Mediterranean dietary pattern (MDP)-high in vegetables, fruits, nuts, fish, and olive oil. Adherence to the WDP (tertile 3 vs tertile 1) was significantly associated with negative STICS-m changes after 6 years (between-tertile difference in changes: -0.80 points; 95% confidence interval [CI] -1.51, -0.08, p value = 0.03). Meanwhile, the MDP showed a positive +0.71 point (95% CI 0.15, 1.26, p value = 0.01) between-tertile difference in changes in the STICS-m score. Conclusions A healthy, prudent, MDP was associated with less decline in cognitive function and, thus, could help to lower dementia incidence. Western-type diets were associated with a greater decline in cognitive performance and could increase dementia incidence.
Revista:
NUTRITIONAL NEUROSCIENCE
ISSN:
1028-415X
Año:
2022
Vol.:
25
N°:
3
Págs.:
612 - 620
Background:Severe cognitive decline is one of the major public health problems in developed countries. Finding modifiable risk factors could become essential to develop strategies to prevent or delay dementia progression and stop its rising incidence. Objective:Our aim was to investigate the association between hypertension and cognitive function and to assess whether better adherence to the Mediterranean diet may modify this association. Methods:A subsample of 764 participants from the 'Seguimiento Universidad de Navarra' (SUN) cohort older than 55 years was evaluated with the Spanish Telephone Interview for Cognitive Status (TICS-m) at two-time points, separated by 6 years. Multivariable-adjusted linear regression models were used to prospectively assess the association between hypertension -also according to adherence to the Mediterranean diet- and 6-y changes in cognitive function. Results:The adjusted between-group difference in the 6-year change of the TICS-m score between hypertensive participants and their non-hypertensive counterparts was -0.36 (95% CI -0.70, -0.02). This association was stronger among participants with a lower adherence to the Mediterranean diet [-0.62 (95% CI: -1.09, -0.15)] but the differences between hypertensive and non-hypertensive participants were no longer significant among participants with a higher baseline adherence to the Mediterranean diet. Conclusion:In this Mediterranean cohort, hypertension was inversely associated with cognitive function, but an attenuation of this detrimental association by a moderate/high adherence to the Mediterranean diet was suggested.
Autores:
Onambele, L.; Ortega-León, W.; Guillén-Aguinaga, S.; et al.
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2022
Vol.:
19
N°:
20
Págs.:
13146
Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children's Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9; -3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations' target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.
Revista:
JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY
ISSN:
2666-4690
Año:
2022
Vol.:
11
Págs.:
100138 - *
SARS-CoV-2 is responsible for the COVID-19 pandemic, which has caused almost 570 million infections and over six million deaths worldwide. To help curb its spread, solutions using ultraviolet light (UV) for quick virus inactivation inside buildings without human intervention could be very useful to reduce chances of contagion. The UV dose must be sufficient to inactivate the virus considering the different materials in the room, but it should not be too high, not to degrade the environment. In the present study, we have analyzed the ability of a 254nm wavelength UV-C lamp to inactivate dried samples of SARS-CoV-2 exposed at a distance of two meters, simulating a full-scale scenario. Our results showed that virus inactivation was extremely efficient in most tested materials, which included plastic, metal, wood, and textile, with a UV-C exposure of only 42s (equivalent to 10mJ/cm2). However, porous materials like medium density fibreboard, were hard to decontaminate, indicating that they should be avoided in hospital rooms and public places.
Revista:
JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE
ISSN:
2308-3425
Año:
2022
Vol.:
9
N°:
1
Págs.:
25
(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031-1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267-3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2022
Vol.:
158
N°:
11
Págs.:
543 - 546
Background and objective: We compared the efficacy and safety of standard vs. extended primary cytomegalovirus (CMV) prophylaxis in solid organ transplantation.
Materials and methods: Retrospective cohort study of CMV seronegative recipients who received CMV prophylaxis after solid organ transplantation from seropositive donor (D+/R-) (2007-2017). CMV infection in the first two years after transplantation in recipients with prophylaxis longer or shorter than 100 days were compared.
Results: CMV infection occurred in 29 of 66 patients (43.9%) with prophylaxis. Forty-five patients (68.2%) received extended prophylaxis. CMV infection and disease rates were not different between patients with extended and standard prophylaxis. However, extended prophylaxis was associated with a higher rate of myelotoxicity (68.9% vs. 42.9%, p<0.05).
Conclusions: Extending primary CMV prophylaxis over 100 days did not prevent late-onset infection but it was associated with hematological toxicity.
Autores:
Soto, A. (Autor de correspondencia); Guillén-Grima, F; Morales, G.; et al.
Revista:
GLOBAL HEART
ISSN:
2211-8160
Año:
2022
Vol.:
17
N°:
1
Págs.:
26
Background: Stroke is the second largest single cause of death and disability in Latin America and the Caribbean (LAC). There have been large overall declines in stroke mortality rates in most LAC countries in recent decades. Objective: To analyze trends in mortality caused by stroke in LAC countries in the period 1979-2015. Methods: We extracted data for age-standardized stroke mortality rates per 100,000 in LAC for the period 1979-2015 from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the annual percent change (APC) in LAC as a whole and by country. Analyses were conducted by gender, region and World Bank income classification. Results: Mortality from stroke has decreased in LAC over the study period by an average APC of -1.9%. Most countries showed significant downward trends, with the sharpest decreases in Chile, Colombia and Uruguay. We recorded statistically significant decreases of -1.4% and -2.4% in mortality rates in men and women, respectively, in the whole LAC. Southern and high-income countries showed the steepest decreases. Conclusions: Stroke mortality has decreased in LAC, in both sexes, especially in southern and high-income countries. Our results could serve as a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.
Autores:
McAlaney, J.; Dempsey, R. C.; Helmer, S. M. (Autor de correspondencia); et al.
Revista:
EUROPEAN ADDICTION RESEARCH
ISSN:
1022-6877
Año:
2021
Vol.:
27
N°:
1
Págs.:
75 - 82
Background: University students are a risk group for heavy substance use and the experience of various potentially severe negative substance use consequences which may impact on their health, social, and academic functioning. Whilst the experience of negative consequences of substance use is well understood in North American student samples, there is little data on these experiences in European students. In order to develop effective harm prevention and reduction interventions for students' substance use, there needs to be an understanding of the types of consequences experienced in European student samples. Objectives: The aim of the study was to investigate the prevalence and predictors of the experience of negative substance use-related consequences amongst university students in 7 European countries. Methods: University students (n = 4,482) in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the UK completed an online survey of their substance use behaviours and the experience of associated negative consequences. Results: European students reported that experiencing a hangover or illness, missing class, being short of money, and experiencing memory loss were the most commonly experienced negative consequences of substance use. Not living with other students and using alcohol, cannabis, sedatives, and cocaine were also associated with higher odds of experiencing these negative consequences. Conclusions: In contrast to North American data, European university students tended to experience consequences that are associated with lower level health risks rather than more severe consequences (e.g., drink-driving and physical injury). Harm prevention and reduction interventions for students should be targeted towards those consequences that are most salient to the target group to ensure feedback is relevant and potentially more effective in changing students' substance use behaviours.
Revista:
BRITISH JOURNAL OF CANCER
ISSN:
0007-0920
Año:
2021
Vol.:
124
N°:
6
Págs.:
1138 - 1149
Background Adoptive immunotherapy with tumour-infiltrating lymphocytes (TIL) may benefit from the use of selective markers, such as PD-1, for tumour-specific T-cell enrichment, and the identification of predictive factors that help identify those patients capable of rendering tumour-reactive TILs. We have investigated this in ovarian cancer (OC) patients as candidates for TIL therapy implementation. Methods PD-1(-) and PD-1(+) CD8 TILs were isolated from ovarian tumours and expanded cells were tested against autologous tumour cells. Baseline tumour samples were examined using flow cytometry, multiplexed immunofluorescence and Nanostring technology, for gene expression analyses, as well as a next-generation sequencing gene panel, for tumour mutational burden (TMB) calculation. Results Tumour-reactive TILs were detected in half of patients and were exclusively present in cells derived from the PD-1(+) fraction. Importantly, a high TIL density in the fresh tumour, the presence of CD137(+) cells within the PD-1(+)CD8(+) TIL subset and their location in the tumour epithelium, together with a baseline T-cell-inflamed genetic signature and/or a high TMB, are features that identify patients rendering tumour-reactive TIL products. Conclusion We have demonstrated that PD-1 identifies ovarian tumour-specific CD8 TILs and has uncovered predictive factors that identify OC patients who are likely to render tumour-specific cells from PD-1(+) TILs.
Autores:
Soto, A. (Autor de correspondencia); Guillén-Grima, F; Morales, G.; et al.
Revista:
EUROPEAN JOURNAL OF NEUROLOGY
ISSN:
1351-5101
Año:
2021
Vol.:
28
N°:
1
Págs.:
182 - 191
Background and purpose Stroke is the second largest single cause of death in Europe, responsible for 9% and 13% of all deaths in men and women, respectively. There have been large overall declines in stroke mortality rates in the majority of European countries in recent decades. The aim of this study was to analyse trends in mortality caused by stroke in the 28 member countries of the European Union (EU) over the last two decades. Methods We extracted data for age-standardized stroke mortality rates per 100 000 in the EU for the period 1996-2015 from the World Health Organization database. Joinpoint regression analysis was used to analyse the trends and compute the annual percent change (APC) in the EU as a whole and by country. Analyses were conducted by gender and by European region. Results Mortality from stroke has decreased in the EU over the study period by an average APC of 4.2%. All countries showed downward trends, with the sharpest decreases in Estonia, Portugal and Austria. We recorded statistically significant decreases of 4.2% and 4.3% in mortality rates in men and women, respectively, in the whole EU. Southern and western countries showed the steepest decreases, whereas mortality has increased in northern countries in recent years. Conclusions Stroke mortality has decreased in the EU, in both sexes, especially in southern and western European countries. Our results could be a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN:
2077-0383
Año:
2021
Vol.:
10
N°:
24
Págs.:
5854
Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c >= 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C >= 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C >= 9% (HR = 1.151; 95% CI, 1.032-1.284).
Revista:
NEUROUROLOGY AND URODYNAMICS
ISSN:
0733-2467
Año:
2021
Vol.:
40
N°:
3
Págs.:
840-847
Aims To identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL). Methods Continence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) and the number of pads employed in a 24-hour period (pad usage). We used the one-way ANOVA technique with posthoc pairwise comparisons according to Scheffe's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI). Results The continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using "0 pads," "1 safety pad," "1 pad," and "ICIQ score 0" definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (rho = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between "0 pads-ICIQ score 0" (K = 0.466), but poor for "1 safety pad" and "1 pad" (K = 0.326 and 0.137, respectively). Patients with "0 pad usage" have better QoL related to urine leakage than patients with "1 safety pad" or "1 pad" (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63). Conclusions Pad usage and the ICIQ-SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score <= 2) as it is the definition with the least impact on daily QoL.
Revista:
ACTAS UROLOGICAS ESPAÑOLAS
ISSN:
0210-4806
Año:
2020
Vol.:
44
N°:
2
Págs.:
103 - 110
Introduction: Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. Material and methods: The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscate -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. Results: 135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p <.001), as well as in items 1 (p =.029), 3 (p =.002), 6 (p =.006), 7 (p =.005) and 8 (p =.025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (<0.2). 4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p =.001), F3 (p =.007) and F4 (p =.001). Significant correlation with age only in F1 and F3, but very weak (<0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p <.001). Conclusions: Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness.
Revista:
CLINICAL NUTRITION
ISSN:
0261-5614
Año:
2020
Vol.:
39
N°:
8
Págs.:
2487 - 2494
Background: Shorter telomeres are associated with several age-related diseases, and lifestyle factors could influence this relationship. The aim of this study was to examine associations between salivary telomere length (TL) and diet quality using 5 evidence-based dietary indexes in an elderly (>55 years old) Spanish population of the SUN project (n = 886).
Method: TL was measured using the quantitative real-time polymerase chain reaction. Age-adjusted TL variable through residuals methods was used for all analysis. Diet quality was assessed by the Prime Diet Quality Score (PDQS), Fat Quality Index (FQI), Mediterranean Diet Adherence Screener (MEDAS), Dietary Approaches to Stop Hypertension (DASH) index and the Alternative Healthy Eating Index (AHEI-2010).
Results: TL did differ according to sex, smoking status, and dyslipidemia in elderly subjects of the SUN study. In addition, subjects with dyslipidemia (compared to absence of dyslipidemia) had a significantly higher risk (27% vs. 18%, p = 0.015) of short telomeres (<percentile 20th). Interestingly, a lower risk of having short telomeres was observed among participants in the top tertiles of the following diet quality score PDQS, MEDAS and DASH compared to the bottom tertiles in crude and adjusted models. Moreover, FQI and AHEI-2010 scores showed an inverse association with the risk of having short telomeres after adjustment for potential confounders (model adjusted for dyslipidemia interaction, p for trend = 0.025 and 0.021, respectively; and model additionally adjusted for sex and smoking status, p for trend = 0.033 and 0.029, respectively).
Conclusion: Adherence to high quality diet is associated to longer salivary TL in our elderly Spanish population of the SUN study.
Autores:
Cordoba, I. E. (Autor de correspondencia); Acedo, P. S. ; Cabezon, J. H.; et al.
Revista:
AMERICAN JOURNAL OF SURGERY
ISSN:
0002-9610
Año:
2020
Vol.:
220
N°:
4
Págs.:
1071 - 1075
Introduction: We aimed to test the predictive ability and to compare the predictive ability of the USEM to SRS, SORT and ASA in a prospective sample. Patients and methods: A Prospective cohort of >65 year old patients undergoing urgent abdominal surgery in a Hospital. Models calibration and discrimination were evaluated using the receiver operating characteristics curves and the Hosmer-Lemeshow test. Results: A total of 500 patients with a median age of 78 years were included. The AUROC in the validation cohort was 0.824. The USEM overestimated mortality (Test Hosmer-Lemeshow p < 0.001), after recalibration the USEM provided an accurate prediction of postoperative mortality. Conclusions: After the recalibration, the USEM had good discriminant power to estimate the risk of mortality in elderly patients after urgent abdominal surgery.
Revista:
ARCHIVOS ESPAÑOLES DE UROLOGIA
ISSN:
0004-0614
Año:
2019
Vol.:
72
N°:
1
Págs.:
25 - 35
OBJECTIVES: Studying the psychosocial sphere of patients who undergo any treatment allows to have more information about its repercussion and can help the choice of an appropriate and personalized treatment. Due to the absence of specific instruments at present, the objective is to design and validate a health questionnaire regarding the treatment received with ESWL. METHODS: It was carried out in 6 phases using a sample of 50 patients treated with ESWL in 2015 in our center, whom we interviewed by telephone. In phase 1 the items were proposed based on bibliographic review, in phase 2 those that scored below 7 were eliminated according to the evaluation from 0 to 10 on the items made by specialists. In phase 3, values of 1 to 5 were assigned to each item and those with corrected correlation more than 0.2 and not significant (p>0.05) discriminant power with U-Mann Whitney were eliminated. In phase 4 the reliability of the questionnaire was checked with two indexes (Cronbach's alpha and two Guttman's halves). In phase 5, the factor analysis with Varimax rotation was performed to calculate the construct validity and in stage 6, the scores were analyzed to establish reference values. RESULTS: 50 patients (32 men, 18 women). Median age 59 years (27-79), In phase 1, 35 items were proposed, 9 of which were eliminated in phase 2. The initial questionnaire with 26 items was distributed, with 18 being eliminated in phase 3. The final questionnaire was formed with 8 items. In phase 4 the results of Cronbach's alpha and Guttman's two halves index were 0.44 and 0.323 respectively. In phase 5 after factor analysis, we found 4 factors with 2 items each (background, impact of the acute picture, post-treatment, quality of life) able to explain 71.19% of the variance. The median scores of the scale, extreme values and quartiles studied in phase 6 were respectively: P50: 17 (minimum-maximum 9-25), P25: 14 and P75: 20. CONCLUSIONS: The study carried out has provided a new instrument for assessing satisfaction after treatment with ESWL with adequate reliability and validity values. Future studies will be necessary to contrast its true clinical usefulness.
Autores:
Onambele, L.; San-Martin-Rodriguez, L.; Niu, H. (Autor de correspondencia); et al.
Revista:
ANALES DE PEDIATRIA
ISSN:
1695-4033
Año:
2019
Vol.:
91
N°:
4
Págs.:
219 - 227
BACKGROUND:
Infant mortality is an indicator of child health, and an explanatory variable to reflect the socioeconomic development of a country. We aimed to examine the changes and trends of infant mortality in the European Union (EU) and its 28 member states in the 1994-2015 period.
METHODS:
We extracted data of deaths in children aged less than one year between 1994 and 2015 from the Eurostat database. We analysed secular variation in the EU overall, by country and by geographical region using joinpoint regression analysis. We conducted additional analyses to examine neonatal and early neonatal mortality trends.
RESULTS:
Infant mortality in the EU has declined significantly from 8,3 to 3,6 per 1,000 live births (annual percent change=-3,8%; 95% confidence interval, -4,1 to -3,6). Among EU countries, we found the highest mortality rates throughout the study period in Romania and Bulgaria, and the lowest rates in Scandinavian countries (Finland, Sweden). There were significant decreasing trends in every country of the EU, which were most pronounced in former Soviet Baltic states and Eastern European countries, and least pronounced in Western European countries. Mortality rates have increased significantly in Greece in the last years, and plateaued in the United Kingdom and Ireland.
CONCLUSIONS:
Our findings, which are based on official data, provide consistent evidence that infant mortality has declined steadily in the EU and its member states in the past decades, most markedly in Eastern European countries and former Soviet Baltic states. However, rates have risen or levelled off in some western countries in the past few years.
Autores:
Cordoba, I. E. (Autor de correspondencia); Cabezon, J. H.; Acedo, P. S. ; et al.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2019
Vol.:
111
N°:
9
Págs.:
677 - 682
Introduction: an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality.The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score). Patients and methods: this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test. Results: in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85). Conclusions: a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery.
Revista:
GACETA SANITARIA
ISSN:
0213-9111
Año:
2019
Vol.:
33
N°:
5
Págs.:
415 - 420
Objective: To compare the Spanish version of the modified Telephone Interview of Cognitive Status (STICS-m) with the Mini-Mental State Examination (MMSE) and predict its ability to detect the development of dementia. Method: 106 participants in a dietary intervention trial underwent face-to-face evaluation with the MMSE, and phone interview with the STICS-m. The correlation between STICS-m and MMSE was assessed with the intraclass correlation coefficient (ICC) of consistency. Secondly, 932 participants over 55 years old from the "Seguimiento Universidad de Navarra" cohort were evaluated with the STICS-m and data on dementia diagnosis were gathered (median follow-up time of 6.5 years). A logistic regression model evaluated the association between STICS-m score or 2-year changes in STICS-m score and risk of developing dementia, adjusting for ApoE, age and years of university education. Results: The ICC between the MMSE and the STICS-m was 0.31 (95% confidence interval [95%CI]: 0.13-0.48). The adjusted odds ratio (OR) for the development of dementia for each additional point in the baseline STICS-m score was 0.85 (95%Cl: 0.72-1.02; p =0.084). When considering the 2-year change in the STICS-m score as exposure, the OR for the development of dementia was 0.79 (95%CI: 0.67-0.93; p = 0.006). Conclusions: The weak correlation between the STICS-m and the MMSE reflects moderate-low concurrent validity. Even so, the STICS-m can be regarded as an useful tool in the epidemiological setting since increasing scores appear to be able to predict a lower risk of developing dementia. (C) 2018 SESPAS. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Autores:
Orzanco-Garralda, M. R. (Autor de correspondencia); Guillén-Grima, F; Sainz-Suberviola, L.; et al.
Revista:
REVISTA DE PSICOLOGIA DEL DEPORTE
ISSN:
1132-239X
Año:
2018
Vol.:
27
N°:
1
Págs.:
135 - 144
The active transport, whether walking or cycling, contributes to increasing the level of physical activity of people. This habit could be favoured by acting on certain psychosocial factors, and by creating favourable environments. The purpose of the present study was to determine the perception of individual factors and of the nearby environment, related in a special way to each of the two modalities of active transport, in a population sample of the adults living in the metropolitan area of Pamplona. A cross-sectional study was conducted based on the methodology suggested by the International Physical Activity and the Environment Network Adult Group, which studies the relationship between environmental factors and physical activity practiced by adults. The results showed that the lack of time to practice physical activity was more likely to be associated with the group that walked less, OR 1.23 (1.08-1.40), and the lack of enjoyment of the physical activity with those who transport by bicycle less, OR 1.29 (1.04-1.61). Also, the existence of trees in the streets was associated with a greater probability of transport by walking, OR 1.23 (1.03-1.46), while the presence of signs or zebra crossings, which helped pedestrians to cross, was related to a wider use of the bycicle, OR 1.42 (1.08-1.87). In conclusion, certain characteristics of the individual and the environment are particularly associated with walking while others are with the use of the bicycle. Thus, people who spend less time walking to go from one place to another indicate lack of time as the reason that prevents them from carrying out some physical activity, while the group that uses the bicycle less to transport indicates lack of enjoyment. In addition, the presence of trees on the pavements favours and encourages people to travel by walking and the perception of intense traffic is associated with the group that dedicates less time to walking in order to go from one place to another. However, developing infrastructures that facilitate the mobility of pedestrians is associated with a greater use of the bicycle for active transport.
Autores:
Lehne, G. (Autor de correspondencia); Zeeb, H.; Pischke, C. R.; et al.
Revista:
ADDICTIVE BEHAVIORS
ISSN:
0306-4603
Año:
2018
Vol.:
87
Págs.:
17 - 23
Introduction The use of non-prescribed prescription sedatives and sleeping pills (NPPSSP) among university students has been described as an important public health issue. However, the impact of perceived social norms on students' use and attitudes towards use of NPPSSP is still unclear. Our aim was to investigate whether perceptions of peer use and approval of use are associated with students' personal use and approval of NPPSSP use. Methods: Cross-sectional data from the Social Norms Intervention for the prevention of Polydrug Use (SNIPE) project containing 4482 university students from seven European countries were analyzed to investigate self other discrepancies regarding personal use and attitudes towards NPPSSP use. Associations between personal and perceived peer use and between personal and perceived approval of use were examined using multivariable logistic regression. Results: The majority (51.0%) of students perceived their peers' NPPSSP use to be higher than their personal use. 92.6% of students perceived their peers' approval of NPPSSP use to be identical or higher than their personal approval. Students perceiving that the majority of peers had used NPPSSP at least once displayed higher odds for personal lifetime use (OR: 1.95, 95% CI: 1.49-2.55). Perceived peer approval of NPPSSP use was associated with higher odds for personal approval (OR: 5.49, 95% CI: 4.63-6.51). Conclusions: Among European university students, perceiving NPPSSP use and approval of use to be the norm was positively associated with students' personal NPPSSP use and approval of use, respectively. Interventions addressing perceived social norms may prevent or reduce NPPSSP use among university students.
Revista:
CLINICAL ENDOCRINOLOGY
ISSN:
0300-0664
Año:
2018
Vol.:
89
N°:
3
Págs.:
367 - 375
ContextTo study the prevalence of thyroid dysfunction in a very large unselected population. ObjectiveTo determine the prevalence of abnormal thyroid function and evaluate potential modulatory factors. Design and SettingThe Estudio de Atencion Primaria de Navarra, The APNA Study, is a cross-sectional study conducted in northern Spain. It involved 303883 people, of 20years of age and older, who live in the Navarra region. Participants are covered by the public healthcare system and medical records are digitalized. Main Outcome MeasuresThe information was gathered from e-registered data regarding serum thyrotropin (TSH), thyroid hormones, thyroid antibody concentration and clinical context. Measurements were logged (demographic information and potential thyroid function modulatory factors). ResultsSerum TSH (mU/L) normal range was established at 0.7-4.28. At the time of the study, 87% of the Navarra population had a TSH level within the normal range. Mean serum TSH in euthyroid individuals was higher in women (2.15) than in men (1.96) (P<.001) and higher in the obese with body mass index (BMI) 30kg/m(2) (2.12) as compared to the non-obese BMI <30kg/m(2) (2.06) (P<.001). Mean TSH for the entire population was 1.9. The native Spanish population had statistically significantly lower TSH (1.87) than non-native Spanish (2.15) (P<.001). Additionally, we observed that serum TSH levels decreased with age and an increase in the prevalence of hypothyroidism in the elderly and among people with low-income levels. The prevalence of thyroid dysfunction in Navarra was 12.3%. The prevalence of hypothyroidism (or high TSH) in the population was 8.8% (13.3% in women, 4.2% in men), and the prevalence of hyperthyroidism (or low TSH) was 4.3% (5.6% in women, 3.0% in men). ConclusionsNearly 15% of the general population suffers from biochemical thyroid dysfunction. The serum TSH level appears to be influenced by sex, BMI, age, ethnic origin and socio-economic status.
Revista:
TRANSPLANT INFECTIOUS DISEASE
ISSN:
1398-2273
Año:
2018
Vol.:
20
N°:
3
Págs.:
e12873
Background: Cytomegalovirus (CMV) is the most important viral pathogen in solid organ transplant (SOT) recipients. The role of secondary CMV prophylaxis in this population remains unclear.
Methods: Retrospective cohort study in a single center. SOT recipients treated for CMV infection from 2007 to 2014 were studied to determine the efficacy and safety of secondary prophylaxis and its impact on graft loss and mortality. The outcome variable was CMV replication in the first 3 months after the end of therapy. Secondary variables were crude mortality and graft lost censored at 5 years after transplantation. Propensity score for the use of secondary prophylaxis was used to control selection bias.
Results: Of the 126 treated patients, 103 (83.1%) received CMV secondary prophylaxis. CMV relapse occurred in 44 (35.5%) patients. The use of secondary prophylaxis was not associated with fewer relapses (34.0% in patients with prophylaxis vs. 42.9% in those without prophylaxis, p= 0.29).After a mean follow-up of 32.1 months, graft loss was not different between both groups but patient mortality was significantly lower in patients who received secondary prophylaxis (5.8% vs. 28.6%, p= 0.003).
Conclusion: Secondary prophylaxis did not prevent CMV infection relapse but it was associated with improved patient survival.
Autores:
Al-Rahamneh, M. J. (Autor de correspondencia); Al-Rahamneh, A. ; Guillén-Grima, F; et al.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN:
0213-005X
Año:
2018
Vol.:
36
N°:
6
Págs.:
342 - 351
Background: The objective of this study was to update and analyze tuberculosis (TB) mortality data in the European Union between 2000 and 2010 separately for men and women and try to detect if there have been any changes in trends in each country and the association with the economic situation and inequalities. Methods: Data were extracted for tuberculosis deaths in 2000-2010 for 29 European Union countries and for Switzerland, via the World Health Organization (WHO) European detailed mortality database (DMDB), using the Mortality tabulation list 1 (MTLI) codes for men and women separately for one age group (20-85+). We estimated age-standardised mortality rates, and analyzed data using the Joinpoint Regression Program for men and women separately in the European Union overall and by individual country for each year. Results: Between 2000 and 2010, there were 68,771 recorded tuberculosis deaths in the European Union and the mortality rates were higher for men than women in the entire study zone. Overall, TB mortality rates declined linearly for both genders, but more in women than in men (from 5.43/100,000 in 2000 to 2.59/100,000 in 2010 in men and from 1.37/100,000 in 2000 to 0.51/100,000 in 2010 in women). There was decline in both genders for the entire study period, with a significant Estimated Annual Percentage Change (EAPC) of -8.1 for women and -7 for men when alpha < 0.05 and with a 95% confidence interval (CI). A higher tuberculosis mortality was associated with lower economic resources and greater inequalities. Conclusions: TB mortality rates in the European Union decreased overall in 2000-2010 for both genders. Men have higher TB mortality rates than women in all countries. Our findings were consistent with the downward TB mortality trend in many other countries worldwide. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espariola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN:
0213-005X
Año:
2018
Vol.:
36
N°:
6
Págs.:
343-351
TB mortality rates in the European Union decreased overall in 2000-2010 for both genders. Men have higher TB mortality rates than women in all countries. Our findings were consistent with the downward TB mortality trend in many other countries worldwide.
Autores:
Niu, H. (Autor de correspondencia); Alvarez-Alvarez, I.; Aguinaga-Ontoso, I.; et al.
Revista:
AMERICAN JOURNAL OF ALZHEIMERS DISEASE AND OTHER DEMENTIAS
ISSN:
1533-3175
Año:
2018
Vol.:
33
N°:
7
Págs.:
440 - 449
Background: Alzheimer's disease (AD) has become a concerning public health issue. We aimed to analyze the trends of hospital morbidity from AD in the European Union (EU) in the period 2000 to 2014. Methods: Data from hospital discharges of men and women over 50 years old hospitalized due to AD in the EU were extracted from Eurostat database. We tested for secular trends computing anual percent change, and identified significant changes in the linear slope of the trend. Results: Hospital morbidity from AD showed a 0.8% (95% confidence intervals -2.2 to 0.6) slight declining trend in the EU. In men and women, we recorded a -0.5% and -1.0% decrease in hospital morbidity rates, respectively. Several countries showed changing trends during the study period. Conclusion: Alzheimer's disease hospital morbidity has slightly declined in the entire EU in the past years. Eastern European countries showed steadily increasing trends, whereas in western and Mediterranean countries the rates decreased or leveled off.
Revista:
GACETA MEDICA DE MEXICO
ISSN:
0016-3813
Año:
2018
Vol.:
154
N°:
1
Págs.:
92 - 104
Objective: To evaluate some methodological and ethical quality variables of clinical trials (CTs) published in 10 family medicine journals. Methods: Quality descriptive study of 10 family medicine journals including CTs in humans published since 2010 to 2013. We obtained 141 CT and 2447 were excluded. Results: CTs parallels controlled in 92.9% (95% confidence interval [95% CI]: 92.0-93.9). Masked randomization in 72.3% (95% CI: 71.7-73.1), decentralized in 51.8% (95% CI: 51.4-52.4) and using as control an active treatment in 82.2% (95% CI: 81.5-83.1). Wrote informed consent in 48.9% (95% CI; 48.5-49.5) and it was not withdrawn in 56.0% of cases (95% CI: 55.5-56.7). Approval by clinical research ethics committee (CREC) in 134, and there was no conflict of interest in 117 CTs. Average K was 0.96 (95% CI: 0.93-0.99). Conclusions: We observe an increase in some quality variables like masked randomization (19.6%) and approval by CREC (75%) post CONSORT, in CTs published in 10 family medicine journals (2010-2013).
Revista:
TECNOHOSPITAL
ISSN:
1645-9431
Año:
2017
Vol.:
79
Págs.:
18-20
Revista:
JOURNAL OF IMMUNOLOGICAL METHODS
ISSN:
0022-1759
Año:
2017
Vol.:
442
Págs.:
54 - 58
Bone marrow (BM) aspirates used for flow-cytometry (FCM) studies are usually obtained from a second aspiration, as the primary aspirate is used for morphological assessment. For this reason, the FCM samples unavoidably contain some blood; although, good-quality samples contain only a small amount. It is of utmost importance to assess the quality of samples prior to FCM analysis; yet, contamination with peripheral blood (PB) is not evaluated in most laboratories, possibly because the methods available are either qualitative or too complex for daily practice. Here, we propose a simple FCM method to quantitatively evaluate PB contamination in BM aspirates, by analyzing the percentage of plasma cells and CD34 + cells - two cell populations nearly absent from PB - and CD10 + granulocytes, which comprise the majority of the PB granulocyte population. We analyzed these three populations in 122 BM aspirates from subjects without hematological disease, and identified samples with PB contamination by performing a hierarchical cluster analysis. A discriminant analysis yielded a function, which we named the PB contamination index (PBCI). This index value gives a quantitative indication about the degree of hemodilution of a given sample. A threshold was identified that discriminates low-quality samples. The method and the threshold proved to be useful in BM aspirates infiltrated with malignant cells, with the exception of cases where hematological disease altered two of the three parameters included in the index. We have easily implemented the PBCI calculation in our daily routine, and find it very helpful for an accurate interpretation of FCM results in a large proportion of BM specimens. Limitations of the technique are discussed.
Revista:
JOURNAL OF PLASTIC SURGERY AND HAND SURGERY
ISSN:
2000-6764
Año:
2017
Vol.:
51
N°:
6
Págs.:
14-19
Both techniques were similar regarding satisfaction. In this study, patients with large resection and high BMI more often had the inverted T technique and were just as happy as those with smaller resections, who more often had the vertical techniques.
Autores:
Gómez Roig, MD; Mazarico, E; Ferrero,S; et al.
Revista:
JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH
ISSN:
1341-8076
Año:
2017
Vol.:
43
N°:
7
Págs.:
1145-1151
Mothers of SGA fetuses had a different nutritional intake and cigarette smoking habits compared with mothers of AGA fetuses. No other differentiating lifestyle habits were observed between the groups. Thus, intrauterine growth conditions might be improved by the endorsement of certain dietary habits during pregnancy.
Revista:
NEUROLOGIA
ISSN:
0213-4853
Año:
2017
Vol.:
32
N°:
8
Págs.:
523 - 532
Background: A disease of unknown aetiology, Alzheimer's disease (AD) is the most common type of dementia. As the elderly population grows worldwide, the number of patients with AD also increases rapidly. The aim of this meta-analysis is to evaluate the prevalence and incidence of AD in Europe. Methodology: We conducted a literature search on Medline, Scopus, and CINAHL Complete using the keywords Alzheimer, Alzheimer's disease, and AD combined with prevalence, incidence, and epidemiology. A Bayesian random effects model with 95% credible intervals was used. The 12 statistic was applied to assess heterogeneity. Results: The prevalence of Alzheimer's disease in Europe was estimated at 5.05% (95% CI, 4.73-5.39). The prevalence in men was 3.31% (95% CI, 2.85-3.80) and in women, 7.13% (95% CI, 6.56-7.72), and increased with age. The incidence of Alzheimer's disease in Europe was 11.08 per 1000 person-years (95% CI, 10.30-11.89). Broken down by sex, it was 7.02 per 1000 person-years (95% CI, 6.06-8.05) in men and 13.25 per 1000 person-years (95% CI, 12.05-14.51) in women; again these rates increased with age. Conclusions: The results of our meta-analysis allow a better grasp of the impact of this disease in Europe. (C) 2016 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.
Revista:
ALLERGOLOGIA ET IMMUNOPATHOLOGIA
ISSN:
0301-0546
Año:
2017
Vol.:
45
N°:
3
Págs.:
227 - 233
Background
The objective of the study was to examine the relationship between asthma and overweight¿obesity in Spanish children and adolescents and to determine whether this relationship was affected by gender and atopy.
Methods
The study involves 8607 Spanish children and adolescents from the International Study of Asthma and Allergies in Childhood phase III. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between asthma symptoms and overweight¿obesity in the two groups. Afterwards, it was stratified by sex and rhinoconjunctivitis.
Results
The prevalence of overweight and obesity in 6¿7-year-old children was 18.6% and 5.2% respectively and in 13¿14 year-old teenagers was 11.4% and 1.1% respectively. Only the obese children, not the overweight children, of the 6¿7 year old group had a higher risk of any asthma symptoms (wheezing ever: OR 1.68 [1.15¿2.47], asthma ever: OR 2.29 [1.43¿3.68], current asthma 2.56 [1.54¿4.28], severe asthma 3.18 [1.50¿6.73], exercise-induced asthma 2.71 [1.45¿5.05]). The obese girls had an increased risk of suffering any asthma symptoms (wheezing ever: OR 1.73 [1.05¿2.91], asthma ever: OR 3.12 [1.67¿5.82], current asthma 3.20 [1.65¿6.19], severe asthma 4.83[1.94¿12.04], exercise-induced asthma 3.68 [1.67¿8.08]). The obese children without rhinoconjunctivitis had a higher risk of asthma symptoms.
Conclusions
Obesity and asthma symptoms were associated in 6¿7 year-old children but not in 13¿14 year-old teenagers. The association was stronger in non-atopic children and obese girls.
Revista:
FAMILY MEDICINE & MEDICAL SCIENCE RESEARCH
ISSN:
2327-4972
Año:
2016
Vol.:
5
N°:
200
Págs.:
-
Introduction: At present, the quality of the publication of Control Trials (CTs) in medical journals improved due to the inclusion of the CONSORT (CONsolidated Standards of Reporting Trials) standards and the Declaration of Helsinki. The aim is to analyse methodological and ethical quality of published CTs in Annals of Family Medicine journal.
Material and methods: We use a 133-item checklist divided into 11 sections based on CONSORT and the Declaration of Helsinki. The Confidence Interval of 95% (95% CI) of Clopper-Pearson for ¿ average is calculated.
Results: We found 35 CTs in a literature review (2010-2013) on March 25, 2014 according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis). CT was mentioned in all heading/subheadings; CT controlled parallels in 80%; cluster type 45.7%. The most observed method was masked, active-controlled, decentralized randomization. The most frequently found category was an open CT assessing a medical intervention, with a positive significant result surveyed. The most common Informed Consent (IC) was in writing, not clearly voluntary, without prior knowledge and doubtful. It was not withdrawn in 45.7% of cases. A grant/scholarship was found to be the most frequent incentive for researchers. In 28 CTs there was no conflict of interest. The ¿ average was 0.93 (95% CI, 0.90-0.96).
Conclusions: CT published ¿standard¿ characteristic are indicated. Following the CONSORT standards publication, it has increased the overall quality of the CTs published. But there are some areas for improvement in the methodological and ethical quality of the CTs published from 2010 to 2013 in Annals of Family Medicine.
Revista:
EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY
ISSN:
1090-3798
Año:
2016
Vol.:
20
N°:
6
Págs.:
925 - 937
Symptoms of inattention and hyperactivity are correlated with impaired sleep duration and quality; specifically, there is an association between ADHD symptoms and problems falling asleep and parasomnias, however, the current study does not address the nature and direction of causality. Children with ADHD and receiving methylphenidate had fewer sleep disorders, suggesting that, at least in some children, stimulant treatment is associated with improvement of some aspects of sleep. Shorter sleep duration in adolescents under pharmacological treatment for ADHD tended to result in more errors of omission, suggesting that it is important to promote good sleep habits in this population.
Revista:
EUROPEAN PSYCHIATRY
ISSN:
0924-9338
Año:
2016
Vol.:
32
Págs.:
55 - 60
BACKGROUND:
The association between body mass index (BMI) and depression is complex and controversial. The present study examined the relationship between BMI and new-onset depression during 7 years of follow-up in 20,212 adult women attending Primary Health Care Centres in Navarra, Spain.
METHODS:
The Atención Primaria de Navarra (APNA) study is a dynamic prospective cohort study. A total of 20,212 women aged 18-99 years (mean age: 50.7±18.5 years) without depression at baseline were selected from 2004 to 2011. We estimated the incidence of depression. We used the Kaplan-Meier analysis to predict the survival curve. The risk of depression onset according to different measures of BMI at baseline was assessed using Cox regression analyses.
RESULTS:
During the 7 years of follow-up, depression appeared in 8.9% (95% CI 8.5-9.3). The highest rates of depression incidence at follow-up occurred in underweight and obese women (9.8% [95% CI 7.3-12.9] and 10.3% [95% CI 9.5-11.1] respectively). The distribution of depression incidence by weight category was U-shaped. The risk of depression increased over time with an observed Kaplan-Meier estimation of 6.67. After adjusting for age, underweight and obese women at baseline have increased risk of depression onset during the follow-up period compared with normal weight women (HR=1.48, 95% CI=1.09-2.00 and HR=1.14, 95% CI=1.01-1.29 respectively).
CONCLUSIONS:
In this 7-year prospective study in the APNA women population, depression emerged in 8.9%. Being underweight or obese (not overweight) at baseline is significantly associated with future onset of depression.
Autores:
Guillén-Aguinaga, S.; Jáuregui Presa, I.; Aguinaga-Ontoso, E.; et al.
Revista:
BRITISH JOURNAL OF DERMATOLOGY
ISSN:
0007-0963
Año:
2016
Vol.:
175
N°:
6
Págs.:
1153-1165
There is a lack of large, randomized, double-blind studies that address antihistamine updosing for chronic spontaneous urticaria (CSU). The objective of this systematic review is to explore and analyse available data to provide clinical evidence for the efficacy of antihistamine updosing. We searched the literature in Medline, Scopus, Google Scholar, Embase, Web of Science and Cochrane databases using the keywords 'chronic, urticaria, antihistamines' to identify studies published between January 1990 and November 2014. We assessed quality using the Jadad score that evaluates quality of randomization, double-blinding and losses to follow-up. We identified 1042 articles and 15 articles were included in the final evaluation. We performed two meta-analyses, one that included studies that analysed treatment response among groups receiving different antihistamine dosages vs. placebo, and another that analysed antihistamine updosing in those patients who did not respond to standard dosages. Only five articles obtained a high quality level score. We did not find significant differences in response rates or number of weals in those patients who received a standard dosage vs. a high dosage. We found a significant improvement only in the pruritus variable of the Urticaria Activity Score scale. The estimated relative risk for improvement by increasing the antihistamine dosage was 2·27 [95% confidence interval (CI) 1·68-3·06]; however, there was significant heterogeneity. The proportion o
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2016
Vol.:
39
N°:
2
Págs.:
237 - 248
Background. The sense of coherence (SOC), the central concept of the salutogenesis model described by Aaron Antonovsky, has been employed as a predictor of measures of perceived and objective health. It is strongly and positively related to healthy behaviour and is mainly developed while young and studying. University students are a target youth group for applying measures promoting health according to their SOC level; it is therefore necessary to check the quality of the scale's measurement. The goal is to validate and study the psychometric properties of the SOC scale in students at the University of Navarre and determine their temporal evolution.
Methods. Newly enrolled students at the University of Navarre were analysed. Cohort study with a 3 year follow-up. The instruments used were the Orientation to Life Questionnaire (OLQ-13), Perceived Stress Scale (PSS) and the Discomfort Index. The following were studied: the quality and viability of the data, scale assumptions, temporal stability, reliability, concurrent and clinical validity, as well as factorial structure and confirmatory analysis of the data obtained. SPSS v. 19 and Amos v.7 statistical software were used.
Results. The study sample consisted of 508 students, 33.5% male and 65.9% female. High reliability (Cronbach Alpha 0.814). Adequate validity converging with the PSS. Inadequate clinical validity. Analysis of main components with three factors that explain 50.73% of the variation.
Conclusions. A valid instrument that makes it possible to propose it as a tool for applying measures promoting health in young people.
Autores:
Soto Ruiz, M. N. (Autor de correspondencia); Marin Fernández, M.; Aguinaga Ontoso, I.; et al.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2015
Vol.:
31
N°:
5
Págs.:
2269 - 2275
Introduction: Current models of beauty represent an extreme thinness in the women and a muscular body in the men. The body image perception will condition the search of ideal beauty through different behaviors and can be transform in eating disorders. The university students, with the changes typical of youth and university transition, are a vulnerable group.
Objective: The purpose of this study was to evaluate the body image perception of university students in Navarra.
Methods: The study included 1162 subjects of which 64.2% were female. Students asked for a self-managed questionnaire and they were weighted and heighted to calculate the body mass index (BMI). Their body image perception were obtained asking the students to select a picture, according to their perception which corresponded to their current body image from nine different silhouettes for men and women. Their BMI were calculated and compared with their perceived BAIL
Results: 43.03% of students, overestimated their body image (10.65% in males and 59.69% in females) and 10.20% of students underestimated it. 46.75% of students had concordance between BMI and body image perception.
Discussion: There were more cases the alterations in the body image perception in women. In general, women saw themselves as being fatter than really were while men saw themselves as being thinner than they really were. The results shown that the women were more worried about their weight and body image than the men.
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2015
Vol.:
30
N°:
4
Págs.:
251 - 262
Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient to meet the palliative care needs of the population.
Autores:
Soto Ruiz, M. N. (Autor de correspondencia); Aguinaga, I.; Canga, N; et al.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2015
Vol.:
31
N°:
6
Págs.:
2400 - 2406
Introduction: one of the strategies for the prevention of the obesity is the identification of critical periods of gain weight. Some studies confirm gain weight during the university period.
Objective: the purpose of the present study was to determine the changes in the body weight of the university students in Navarre.
Methods: prospective cohort study. Public University of Navarre and the University of Navarre, in Pamplona. Study examined weight change among 452 students attending at university in Pamplona, during first and third course. Four hundred and fifty two students completed the questionnaire. Weight and height were measures and body mass index was calculated.
Results: the mean body weight increased 0,600 kg, 1,8 kg for males and no change in body weight was observed in female. 44,7 % of students gained weight (60,8 % of men and 36,8 % of women), and the gain weight was of 3,4 kg.
Discussion: university years are a critical factor for the gain weight, particularly males. Consideration of this, is necessary the development of effective weight gain prevention strategies during the university.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2014
Vol.:
30
N°:
3
Págs.:
519-525
La obesidad en niños esta relacionada con los síntomas de asma. Las niñas obesas presentan un mayor riesgo y mayor gravedad de síntomas de asma que los niños.
Revista:
NEUROPSYCHOLOGIA
ISSN:
0028-3932
Año:
2014
Vol.:
58
Págs.:
14 - 22
Objectives: We hypothesize that time perception and executive functions are interrelated and share neuroanatomical basis, and that fluctuations in levels of cognitive effort play a role in mediating that relation. The main goal of this study was to identify brain structures activated both by increases in cognitive activity and during time perception tasks.
Methods: We performed a multimodal meta-analysis to identify common brain regions in the findings of (a) an SDM meta-analysis of neuroimaging studies assessing the brain response to increasing levels of cognitive difficulty, and (b) an ALE meta-analysis on neuroimaging of time perception (Ortuño, Guillén-Grima, López-García, Gómez, & Pla, 2011).
Results and Conclusions: Consistent with results of previous, separate meta-analyses, the current study supports the hypothesis that there exists a group of brain regions engaged both in time perception tasks and during tasks requiring cognitive effort. Thus, brain regions associated with working memory and executive functions were found to be engaged during time estimation tasks, and regions associated with time perception were found to be engaged by an increase in the difficulty of non-temporal tasks. The implication is that temporal perception and cognitive processes demanding cognitive control become interlinked when there is an increase in the level of cognitive effort demanded.
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1873-734X
Año:
2014
Vol.:
45
N°:
5
Págs.:
1118
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2014
Vol.:
9
N°:
2
Págs.:
e89747
Background: Palonosetron is a potent second generation 5-hydroxytryptamine-3 selective antagonist which can be administered by either intravenous (IV) or oral routes, but subcutaneous (SC) administration of palonosetron has never been studied, even though it could have useful clinical applications. In this study, we evaluate the bioavailability of SC palonosetron. Patients and Methods: Patients treated with platinum-based chemotherapy were randomized to receive SC or IV palonosetron, followed by the alternative route in a crossover manner, during the first two cycles of chemotherapy. Blood samples were collected at baseline and 10, 15, 30, 45, 60, 90 minutes and 2, 3, 4, 6, 8, 12 and 24 h after palonosetron administration. Urine was collected during 12 hours following palonosetron. We compared pharmacokinetic parameters including AUC(0-24h), t(1/2), and C-max observed with each route of administration by analysis of variance (ANOVA). Results: From October 2009 to July 2010, 25 evaluable patients were included. AUC0-24h for IV and SC palonosetron were respectively 14.1 and 12.7 ng x h/ml (p = 0.160). Bioavalability of SC palonosetron was 118% (95% IC: 69-168). C-max was lower with SC than with IV route and was reached 15 minutes following SC administration. Conclusions: Palonosetron bioavailability was similar when administered by either SC or IV route. This new route of administration might be specially useful for outpatient management of emesis and for administration of oral chemotherapy.
Revista:
NUTRICION HOSPITALARIA
ISSN:
0212-1611
Año:
2014
Vol.:
30
N°:
3
Págs.:
519 - 525
Objectives: The objective of this study is to determine the prevalence of asthma symptoms and overweight-obese in children aged 6-7 years and adolescents aged 13-14 years within the metropolitan area of Pamplona, and analyse the risk of asthma within the age groups and the influences if sex on this relationship.
Methods: The study is based on data of asthma symptoms and body mass index of 4,413 children and adolescents obtained from the International Study of Asthma and Allergies phase III questionnaire. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for overweight-obesity and asthma symptoms in both groups, taking as reference the group of normal weight. Afterwards, it was stratified by sex.
Results: The prevalence of overweight-obesity in the group aged 6-7 years was 23.9% and in the group of teenagers was 11.5%. The prevalence of asthma symptoms in both age groups was lower than the Spanish average. The obese children aged 6-7 years had a higher risk of asthma symptoms. When it was stratified by sex, an increased risk in all asthma symptoms was observed only in obese girls. No relationship between obesity and asthma was observed n the adolescents group.
Conclusions: Obesity in children is related to asthma symptoms. Obese girls have an increased risk and more severe asthma symptoms than boys.
Revista:
ENDOCRINOLOGIA Y NUTRICION
ISSN:
1575-0922
Año:
2014
Vol.:
61
N°:
7
Págs.:
377-381
The presence of thyroid autoimmunity in women with TSH above the recommended values at the beginning of pregnancy is not associated to development of GD. However, GD prevalence was higher in these patients as compared to the Spanish general population, suggesting the need for closer monitoring in pregnant women with TSH levels ¿ 2.5 mU/mL.
Revista:
METAS DE ENFERMERIA
ISSN:
1138-7262
Año:
2013
Vol.:
16
N°:
8
Págs.:
20-25
El paciente afectado de disfagia puede alimentarse mediante la gastrostomía
radiológica percutánea (GRP).
Objetivos: determinar el nivel de dependencia para las actividades básicas
de la vida diaria (ABVD) de los pacientes portadores de GRP, describir
el perfil del cuidador y evaluar la capacidad para la realización
del autocuidado y la relación existente entre estos factores.
Material y métodos: estudio descriptivo mediante encuesta de 48 pacientes
sometidos a recambio de sonda de GRP, entre el 1 de enero y el
30 de septiembre de 2010. Se recogieron características del paciente:
edad, sexo, patología causante de la disfagia, complicaciones relacionadas
con la GRP y número de recambios de sonda e índice de Barthel
(IB) y realización del autocuidado del estoma, la sonda y la administración
de la nutrición enteral. Características del cuidador: formal o informal,
sexo, edad y relación de parentesco con el paciente. Para el análisis
de los datos se utilizó la estadística descriptiva, el test exacto de
Fisher, la prueba U Mann-Whitney, y para el análisis multivariante la regresión
lineal múltiple.
Resultados: población de 65,81 años de media, femenina (60,41%) y
afectados de disfagia neurológica (85,41%), con tasa de complicaciones
mayores del 4,1% y media de recambios de 9,52. IB medio de 25,94.
Cuidador formal en 14 pacientes e informal en 20 (familiar directo, mujer
y de edad superior a los 50 años). 13/48 pacientes han realizado el autocuidado.
El 77,8% del número de recambio
Revista:
GENES AND NUTRITION
ISSN:
1555-8932
Año:
2013
Vol.:
8
N°:
1
Págs.:
61 - 67
Genetic factors may interact with lifestyle factors to modify obesity risk. FTO and PPARG2 are relevant obesogenes. Our aim was to explore the effect of Pro12Ala (rs1801282) of PPARG2 and rs9939609 of FTO on obesity risk and to examine their interaction with lifestyle factors in an elderly population. Subjects (n = 978; aged 69 ± 6) were recruited from the SUN (Seguimiento Universidad de Navarra) Project. DNA was obtained from saliva, and lifestyle and dietary data were collected by validated self-reported questionnaires. Genotyping was assessed by RT-PCR plus allele discrimination. Subjects carrying the Ala allele of PPARG2 gene had a significantly increased obesity risk compared to non-carrier (Pro12Pro) subjects (OR, 1.66; 95 % CI, 1.01-2.74; p = 0.045). Greater obesity risk was also found in inactive or high carbohydrate intake subjects with the Ala12 allele of PPARG2 gene. Interestingly, subjects carrying the Ala allele of the PPARG2 gene and with a high CHO (>246 g/day) intake had an increased obesity risk compared to Pro12Pro subjects (OR, 2.67; 95 % CI, 1.3-5.46; p = 0.007; p for [CHO × PPARG2] interaction = 0.046). Moreover, in subjects with a high CHO intake, the co-presence of the Ala allele of PPARG2 gene and one minor A allele (rs9939609) of FTO gene did increase obesity risk (OR, 3.26; 95 % CI, 1.19-8.89; p = 0.021) when compared to non-carrier (Pro12Pro/TT) subjects. In conclusion, it appears that lifestyle factors may act as effect modifiers for obesity risk linked to Ala12 allele of the PPARG2 gene and the minor A allele of FTO gene in an elderly population.
Revista:
OBESITY
ISSN:
1469-3259
Año:
2013
Vol.:
21
N°:
7
Págs.:
1486-1495
The meta-analysis revealed a higher BMI with an overall estimation of +0.065 kg/m(2) (95%CI = 0.026-0.103, P = 0.001) for homo-/heterozygous carriers of the Ala allele of the PPARG2 gene in comparison to non-carriers. The analysis also showed that there was heterogeneity (P for heterogeneity <0.001), but funnel plots did not suggest apparent publication bias. Furthermore, the association between the Pro12Ala polymorphism of the PPARG2 gene and increased BMI was stronger in Caucasian. Thus, carriers of the Ala allele had significantly higher BMI than non-carriers in a subsample of 6,528 Caucasian male subjects (standardized mean difference = 0.090, 95%CI=0.032-0.148, P = 0.002, P for heterogeneity = 0.121).
CONCLUSION: This updated meta-analysis showed that carriers of the Ala12 allele of the PPARG2 gene had a higher average BMI.
Revista:
JOURNAL OF INFECTION
ISSN:
0163-4453
Año:
2012
Vol.:
65
N°:
4
Págs.:
302-309
The clinical value of information provided by the Microbiology Laboratory may be reduced by the time it takes to generate results for healthcare providers. The aim of this study was to measure the clinical and economic impact associated with rapid reporting of microbiological results. Methods: 574 hospitalized patients with a bacterial clinical infection confirmed by culture were evaluated. 284 hospitalized patients were included in the historical control group (results available the day following the analysis) and 290 in the intervention group (results available the same day of the analysis). The Vitek (R) 2 system (bioMerieux) was used for identification and antimicrobial susceptibility testing in both groups. Results: Faster reporting of microbiological results enabled the clinician to optimize the antibiotic treatment sooner (P < 0.001). This reduction in turnaround time (17.6 h) was associated with improved clinical outcome, a significant reduction in the length of hospitalization and the number of microbiological and biochemical tests performed. Intubation requirements were significantly lower in the intervention group. Mortality rates did not differ significantly between the two groups. Costs incurred for patients in the intervention group were significantly lower than those in the control group, including costs for Microbiology Laboratory testing, antibiotic costs, length of hospitalization and other patient care costs. Conclusions: Rapid microbiological information was associated with quality improvement seen in earlier changes in antibiotic use, an improved clinical outcome and financial benefits. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Revista:
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY AND INFECTIOUS DISEASES
ISSN:
0934-9723
Año:
2012
Vol.:
31
N°:
9
Págs.:
2245-252
Inappropriate antibiotic prescriptions are associated with an increase in healthcare costs and a decrease in the quality of care. The aim of this study was to measure the clinical and economic impact of rapid microbiological reporting on the specimens most frequently processed by the Microbiology Laboratory. The Vitek® 2 system (bioMérieux) was used for identification and susceptibility testing. Only hospitalized patients with bacterial infections were included. Two groups were established, a historical control group (results available the day following the analysis) and an intervention group (results available the same day of the analysis). Specimens studied and the median length of time from the introduction of the microorganism in the Vitek® 2 until microbiological report were as follows: wound and abscess (control¿=¿23.5 h, intervention¿=¿9.5 h, p¿<¿0.001), blood (control¿=¿23.5 h, intervention¿=¿9.2 h, p¿<¿0.001), and urine (control¿=¿23.4 h, intervention¿=¿9.3 h, p¿<¿0.001). Outcome parameters were hospital stay and mortality rates. Hospital costs were calculated. The mortality rates did not differ significantly between the two groups. Faster reporting of identification and antimicrobial susceptibility results was associated with a significant reduction in hospital stay and in overall costs for those patients from whom wound, abscess, and urine specimens were analyzed. However, the antimicrobial results of blood culture isolates did not lead to significant clinical or f
Revista:
JOURNAL OF NUTRITION
ISSN:
0022-3166
Año:
2012
Vol.:
142
N°:
9
Págs.:
1672-8
The available large prospective studies supporting an inverse association between better adherence to the Mediterranean diet and lower mortality have mainly included older adults. It is not clear whether this inverse association is also present among younger individuals at lower mortality risk. Our aim was to assess the association between adherence to the Mediterranean diet and total mortality in middle-aged adults from the Seguimiento Universidad de Navarra (SUN) Project. We followed 15,535 Spanish university graduates for a mean of 6.8 y. Their mean age was 38 ± 12 y, 59.6% were females, and all were initially free of cardiovascular disease, cancer, and diabetes. A validated FFQ was used to assess dietary habits. Adherence to the Mediterranean diet was categorized into 3 groups according to the Mediterranean Diet Score (low, 0-2 points; moderate, 3-5 points; and high, 6-9 points). The outcome variable was total mortality. Cox proportional hazards models were used to estimate HR and 95% CI. We adjusted the estimates for sex, age, years of university education, BMI, smoking, physical activity, television watching, history of depression and baseline hypertension, and hypercholesterolemia. We observed 125 deaths during 105,980 person-years of follow-up. The fully adjusted HR for moderate and high adherence were 0.58 (95% CI: 0.34, 0.99; P = 0.05) and 0.38 (95% CI: 0.21, 0.70; P = 0.002), respectively. For each 2-point increment in the Mediterranean Diet Score, the HR of death
Revista:
CHRONOBIOLOGY INTERNATIONAL
ISSN:
1525-6073
Año:
2012
Vol.:
29
N°:
10
Págs.:
1397-1404
Genetic factors may interact with physical activity levels to modify obesity risk. Our aim was to explore the influence of rs1801260 single-nucleotide polymorphism (SNP) (3111T/C) of CLOCK gene on obesity risk, and to examine its potential interaction with lifestyle factors in an elderly population within the SUN ("Seguimiento Universidad de Navarra") Project. Subjects (n¿=¿903, aged 69¿±¿6 yrs) were recruited from the SUN Project. DNA was obtained from saliva, whereas lifestyle and dietary data were collected by validated self-report questionnaires. Genotype was assessed by reverse transcriptase-polymerase chain reaction (RT-PCR) plus allele discrimination. A significant interaction was observed between the 3111T/C SNP of CLOCK gene and sex for overweight/obesity risk (p for sex¿×¿CLOCK interaction <.001). Our results showed that women carrying the C allele of CLOCK gene had a marginally significant lower risk of overweight/obesity compared with noncarrier-TT-subjects (odds ratio [OR]: .61, 95% confidence interval [CI]: .36-1.04; p¿=¿.069). Moreover, this association of the C allele with a decreased overweight/obesity risk might be enhanced in those women with a high physical activity level. Women practicing more than 16.8 metabolic equivalent tasks (hours per week) had a significantly lower overweight/obesity risk (OR: .36, 95% CI: .17-.79; p¿=¿.011). Furthermore, a significant interaction between the 3111T/C gene variant and physical activity (PA) for overweight/obesity risk was observed but only in women (p for PA¿×¿CLOCK interaction <.050). In conclusion, it appears that physical activity levels may act by modifying the association of the 3111T/C SNP (rs1801260) of the CLOCK gene with overweight/obesity risk in elderly women in the SUN Project.
Revista:
CLINICAL AND TRANSLATIONAL ONCOLOGY
ISSN:
1699-048X
Año:
2012
Vol.:
14
N°:
11
Págs.:
835-41
The management of operable locally advanced N2 non-small cell lung cancer (NSCLC) is a controversial topic. Concurrent chemoradiation (CT-RT) is considered the standard of care for inoperable or unresectable patients, but the role of trimodality treatment remains controversial. We present our institution's experience with the management of stage III (N2) NSCLC patients, analyzing whether the addition of surgery improves survival when compared with definitive CT-RT alone.
METHODS:
From 1996 to 2006, 72 N2 NSCLC patients were treated. Thirty-four patients received cisplatin-based induction chemotherapy, followed by paclitaxel-cisplatin CT-RT, and 38 patients underwent surgery preceded by induction and/or followed by adjuvant therapy. Survival curves were estimated by Kaplan-Meier analysis, and the differences were assessed with the log-rank test.
RESULTS:
Most of the patients (87 %) were men. The median age was 59 years. A statistically significant association between T3-T4c and definitive CT-RT as well as between T1-T2c and surgery was noted (p < 0.0001). After a median follow-up period of 35 months, the median overall survival (OS) was 42 months for the surgery group versus 41 months for the CT-RT patients (p = 0.590). The median progression-free survival (PFS) was 14 months after surgery and 25 months after CT-RT (p = 0.933). Responders to radical CT-RT had a better OS than non-responders (43 vs. 17 months, respectively, p = 0.011). No significant differences were found in
Revista:
LARYNGOSCOPE
ISSN:
0023-852X
Año:
2011
Vol.:
121
N°:
8
Págs.:
1810 - 1817
We have identified four distinct profiles of patients with definite Menière's disease that we consider as "mildly active elderly," "mildly active young," "active compensated," and "active uncompensated." We have demonstrated that only in a restricted popu
Revista:
RISK ANALYSIS
ISSN:
0272-4332
Año:
2011
Vol.:
31
N°:
3
Págs.:
466 - 474
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1010-7940
Año:
2011
Vol.:
40
N°:
4
Págs.:
e146 -e151
Our results support the view of surgical sympathectomy as the gold-standard treatment in severe cases of Hh and Fb. Radiofrequency sympathicolysis is useful as a second-treatment choice for Hh patients. Fb patients do not benefit from radiofrequency sympathicolysis.
Revista:
Otology & Neurotology
ISSN:
1531-7129
Año:
2011
Vol.:
32
N°:
3
Págs.:
4661 - 4665
Revista:
Palliative Medicine
ISSN:
0269-2163
Año:
2010
Vol.:
24
N°:
8
Págs.:
812 - 819
Revista:
OBESITY
ISSN:
1930-7381
Año:
2010
Vol.:
18
N°:
7
Págs.:
1443 - 1448
This study included 11,825 participants of a Spanish dynamic prospective cohort based on former students from University of Navarra, registered professionals from some Spanish provinces, and university graduates from other associations, followed-up for 6.1 years. We aimed to assess the association between childhood or young adult overweight/obesity and the risk of depression. Participants were asked to select which of nine figures most closely represented their body shape at ages 5 and 20 years. Childhood and young adult overweight/obesity was defined as those cases in which participants reported body shape corresponding to the figures 6¿9 (more obese categories) at age 5 or 20, respectively. A subject was classified as incident case of depression if he/she was initially free of depression and reported physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of biannual follow-up questionnaires. The association between childhood and young adult overweight/obesity and incidence of depression was estimated by multiple-adjusted hazard ratio (HR) and its 95% confidence interval (95% CI). Overweight/obesity at age 5 years predicted an increased risk for adult depression (HR = 1.50, 95% CI = 1.06¿2.12), and a stronger association was observed at age 20 years ((HR = 2.22, 95% CI = 1.22¿4.08), (subjects younger than 30 years at recruitment were excluded from this last analysis)). Childhood or young adult overweight/obesity was associated with elevated risk of adult depression. These results, if causal and confirmed in other prospective studies, support treating childhood and young adult overweight/obesity as part of comprehensive adult depression prevention efforts.
Revista:
CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
ISSN:
0174-1551
Año:
2010
Vol.:
34
N°:
5
Págs.:
911 - 917
Revista:
AURIS NASUS LARYNX
ISSN:
0385-8146
Año:
2010
Vol.:
37
N°:
4
Págs.:
409 - 414
Objective: To evaluate the value of different variables of the clinical history, auditory and vestibular tests and handicap measurements to define intractable or disabling Meniere's disease. Methods: This is a prospective study with 212 patients of which 155 were treated with intratympanic gentamicin and considered to be suffering a medically intractable Meniere's disease. Age and sex adjustments were performed with the 11 variables selected. Discriminant analysis was performed either using the aforementioned variables or following the stepwise method. Results: Different variables needed to be sex and/or age adjusted and both data were included in the discriminant function. Two different mathematical formulas were obtained and four models were analyzed. With the model selected, diagnostic accuracy is 77.7%, sensitivity is 94.9% and specificity is 52.8%. Conclusion: After discriminant analysis we found that the most informative variables were the number of vertigo spells, the speech discrimination score, the time constant of the VOR and a measure of handicap, the "dizziness index". (C) 2009 Elsevier Ireland Ltd. All rights reserved.
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1010-7940
Año:
2010
Vol.:
5
N°:
37
Págs.:
1205 - 1208
Revista:
EUROPEAN JOURNAL OF OPHTHALMOLOGY
ISSN:
1120-6721
Año:
2010
Vol.:
20
N°:
2
Págs.:
442 - 450
Purpose. To estimate the prevalence and causes of bilateral blindness and visual impairment in an urban institutionalized population aged 65 years and older.
Methods. A total of 392 nursing home residents completed a standardized eye examination, including measurement of visual acuity (VA), intraocular pressure, lens opacity grading, indirect ophthalmoscopy, and photography of the macular area. The major causes of vision loss identified for all participants were blindness and visual impairment.
Results. The average subject age was 82 years (65¿97); women outnumbered men 263 to 129. The prevalence of bilateral blindness (VA ¿1.0 logarithm of the minimum angle of resolution [logMAR]) was 14.9% (43/288); the prevalence of visual impairment (VA ¿0.5 and 1.0 logMAR) was 31.9% (92/288). Blindness and visual impairment increased significantly with age (p<0.05), odds ratio (OR) 1.047 and 1.088, respectively. Cataract was the most common cause of bilateral blindness and visual impairment (27.9% and 44.6%, respectively) followed by pathologic myopia (23.3%) and age-related macular degeneration (AMD) (20.9%) for blindness, and by AMD (27.2%) and pathologic myopia (12%) for visual impairment. Fifty percent of subjects with visual loss had the potential for improved vision with medical or surgical intervention.
Conclusions. Although the prevalences were high, these data are important since it is difficult for epidemiologic studies to include aged, institutionalized individuals, although their numbers are increasing. Recognition of the predominant causes of visual loss dependent on age is fundamental for early diagnosis and treatment of ocular diseases. Many cases of low vision can be treated with appropriate ophthalmologic care.
Revista:
WORLD JOURNAL OF UROLOGY
ISSN:
0724-4983
Año:
2010
Vol.:
28
N°:
6
Págs.:
681-686