Extreme diurnal temperature range and cardiovascular emergency hospitalisations in a Mediterranean region.

OBJECTIVES: The impact of extreme diurnal temperature range (DTR) on cardiovascular morbidity in Mediterranean regions remains uncertain. We aimed to analyse the impact of extreme low DTR (stable temperature) or high DTR (changeable temperature) on cardiovascular hospitalisations in Catalonia (Southern Europe). METHODS: We conducted a self-controlled case series study using whole-year data from the System for the Development of Research in Primary Care database and 153 weather stations from the Catalan Meteorological Service. The outcome was first emergency hospitalisation. Monthly DTR percentiles were used to define extreme DTR as low (DTR 95th percentile). We assessed two effects: same-day (1-day exposure, coinciding with the extreme DTR episode) and cumulative (3-day exposure, adding two subsequent days). Incidence rate ratios (IRR) were calculated adjusted by age, season and air pollution. Stratified analyses by gender, age or cardiovascular type and regions are provided. RESULTS: We computed 121 206 cardiovascular hospitalisations from 2006 to 2013. The IRR was 1.032 (95% CI 1.005 to 1.061) for same day and 1.024 (95% CI 1.006 to 1.042) for cumulative effects of extreme high DTR. The impact was significant for stroke and heart failure, but not for coronary heart disease. Conversely, extreme low DTR did not increase cardiovascular hospitalisations. CONCLUSIONS: Extreme high DTR increased the incidence of cardiovascular hospitalisations, but not extreme low DTR. Same-day effects of extreme high DTR were stronger than cumulative effects. These findings contribute to better understand the impact of outdoor temperature on health, and to help defining public health strategies to mitigate such impact.

[Public funding of health research on LGTBIQ+population in Spain]. / La financiación pública de la investigación en salud LGTBIQ+ en España.

OBJECTIVE: To describe the public funding of research on LGTBIQ+health in Spain. METHOD: We conducted an observational and descriptive study. We sought research projects dealing with LGTBIQ+health funded by the research projects grant from the Instituto Carlos III from 2013 to 2019. We consulted the webpage and the FIS portal and we identified projects that included LGTB community, totally or partially. We estimated the absolute and relative frequencies of LGTBIQ+projects in relation to total funded projects; and we described the LGTBIQ+funded projects by year of funding, topics, LGTBIQ+subpopulation, or funding. RESULTS: Only 0,4% (n=16) of 4404 funded projects included -totally or partially- LGTBIQ+community, which represents only 0,3% of the funding. LGTBIQ+projects mainly focused on men who have sex with men (n=14) and the human immunodeficiency viruses (HIV) (n=11). The number of funded LGTBIQ+projects decreased from 2013 (n=6) to 2019 (n=0). CONCLUSIONS: Research projects on LGTBIQ+health are scarce in Spain. Current funding for research on LGTBIQ+health is insufficient to care for population other than HIV and men within LGTBIQ+. There is a compelling necessity to promote the LGTBIQ+health research to mitigate health disparities, to offer inclusive health services, and to improve healthcare of about 3 million LGTBIQ+people living in Spain.

Insulin resistance is associated with increased serum concentration of IGF-binding protein-related protein 1 (IGFBP-rP1/MAC25).

IGF-binding protein (IGFBP)-related protein 1 (IGFBP-rP1) has been shown to bind both IGFs and insulin, albeit with low affinity, and to inhibit insulin signaling. We hypothesized that IGFBP-rP1 is associated with insulin resistance and components of the IGF system in humans. To this aim, a cross-sectional study was conducted in 113 nondiabetic and 43 type 2 diabetic men. Insulin sensitivity (insulin sensitivity index [S(i)] from intravenous glucose tolerance tests in nondiabetic subjects, or the rate constant for disappearance of glucose [K(ITT)] from insulin tolerance tests in type 2 diabetic subjects), circulating IGFBP-rP1 (from enzyme-linked immunosorbent assay), adiponectin (from radioimmunoassay), C-reactive protein (CRP; from immunoturbidimetry), soluble tumor necrosis factor receptor 2 (sTNFR2; from enzyme-amplified sensitivity immunoassay), and IGF system parameters (IGF-I, free IGF-I, and IGFBP-1 from immunoradiometric assay) were assessed in all subjects. Among nondiabetic men, those in the highest quartile for circulating IGFBP-rP1 exhibited decreased S(i) and adiponectin (both P < 0.01) as well as increased CRP and sTNFR2 (both P < 0.05). Circulating IGFBP-rP1 was also found to be increased in previously undiagnosed type 2 diabetic patients (P = 0.01) but not in known type 2 diabetic patients receiving pharmacological therapy. Although no changes in IGF system components were evident by IGFBP-rP1 quartiles in nondiabetic subjects, independent positive associations of IGFBP-rP1 with circulating fasting IGFBP-1 were evident after adjustment for insulin resistance parameters in both nondiabetic and type 2 diabetic subjects, with IGFBP-rP1 explaining 2 and 11% of IGFBP-1 variance, respectively. In additional multivariate analyses, S(i), sTNFR2, and age stood as independent predictive variables of IGFBP-rP1 (together explaining 18% of its variance) in nondiabetic subjects, and BMI became the only independent predictive variable of IGFBP-rP1 (explaining 26% of its variance) in type 2 diabetic men. These findings show for the first time that circulating IGFBP-rP1 is increased with insulin resistance, and they also suggest novel interactions between IGFBP-rP1 and the IGF system in humans.

Cost-Utility Analysis of Magnetic Resonance Imaging Management of Patients with Acute Ischemic Stroke in a Spanish Hospital.

INTRODUCTION: Stroke has a high rate of long-term disability and mortality and therefore has a significant economic impact. The objective of this study was to determine from a social perspective, the cost-utility of magnetic resonance imaging (MRI) compared to computed tomography (CT) as the first imaging test in acute ischemic stroke (AIS). METHODS: A cost-utility analysis of MRI compared to CT as the first imaging test in AIS was performed. Economic evaluation data were obtained from a prospective study of patients with AIS ≤12 h from onset in one Spanish hospital. The measure of effectiveness was quality-adjusted life-years (QALYs) calculated from utilities of the modified Rankin Scale. Both hospital and post-discharge expenses were included in the costs. The incremental cost-effectiveness ratio (ICER) was calculated and sensitivity analysis was carried out. The costs were expressed in Euros at the 2004 exchange rate. RESULTS: A total of 130 patients were analyzed. The first imaging test was CT in 87 patients and MRI in 43 patients. Baseline variables were similar in the two groups. The mean direct cost was €5830.63 for the CT group and €5692.95 for the MRI group (P = not significant). The ICER was €11,868.97/QALY. The results were sensitive when the indirect costs were included in the analysis. CONCLUSION: Total direct costs and QALYs were lower in the MRI group; however, this difference was not statistically significant. MRI was shown to be a cost-effective strategy for the first imaging test in AIS in 22% of the iterations according to the efficiency threshold in Spain.

Association of ADIPOR2 with liver function tests in type 2 diabetic subjects.

OBJECTIVE: Adiponectin protects against liver dysfunction in insulin-resistant states such as obesity and type 2 diabetes (T2DM), but the role of adiponectin receptors in this disorder is largely unknown. We studied whether common single-nucleotide polymorphisms (SNPs) in ADIPOR1 and ADIPOR2 are associated with liver function tests (LFTs) in human subjects with various degrees of insulin resistance. METHODS AND PROCEDURES: Serum alanine (ALT) and aspartate (AST) aminotransferases, homeostasis model assessment of insulin resistance (HOMA-IR), -8503 G/A (rs6666089) and +5843 C/T (rs1342387) SNPs in ADIPOR1, -64,241 T/G (rs1029629) and +33447 C/T (rs1044471) SNPs in ADIPOR2 were assessed in 700 white subjects from a population-based study. RESULTS: In nondiabetic subjects, the at-risk alleles for the common -64,241 T/G and +33447 C/T SNPs in ADIPOR2 were associated with increased circulating adiponectin (P < 0.05 to P < 0.005), but not with LFT. Conversely, in T2DM subjects (who are at risk for liver dysfunction), the same alleles were associated with increased serum ALT and AST (P < 0.05 to P < 0.0001), but not with circulating adiponectin. No significant associations with these parameters were evident for the common -8503 G/A and +5843 C/T SNPs in ADIPOR1. In a replication study, the -64,241 T/G and +33447 C/T SNPs in ADIPOR2 were associated with ALT and AST (P < 0.05 to P < 0.0001) in pooled obese and T2DM subjects. DISCUSSION: Common SNPs in ADIPOR2 are associated with LFT in T2DM subjects, which suggests a possible role of this receptor in liver dysfunction associated with insulin resistance.