Health-related quality of life and mortality in the 'Seguimiento Universidad de Navarra' prospective cohort study.

OBJECTIVE: To study the association between health-related quality of life (HRQoL) and all-cause mortality in a healthy middle-aged Mediterranean cohort. METHODS: We included 15,390 participants -mean age 42.8 years at first HRQoL ascertainment, all university graduates-. HRQoL was assessed with the self-administered Medical Outcomes Study Short Form-36 (SF-36) twice, with a 4-year gap. We used multivariable-adjusted Cox regression models to address the relation between self-reported health and Physical or Mental Component Summary (PCS-36 or MCS-36) and mortality, and their interaction with prior comorbidities or adherence to the Mediterranean diet (MedDiet). RESULTS: Over 8.7 years of median follow-up time, 266 deaths were identified. Hazard ratio (HR) for the excellent vs. poor/fair category in self-reported health was 0.30 (95 % confidence interval (CI), 0.16-0.57) in the model with repeated measurements of HRQoL. Both the PCS-36 (HRquartile4(Q4)vs.Q1 0.57 [95%CI, 0.36-0.90], ptrend < 0.001; HRper+10points: 0.64 [95%CI, 0.54-0.75]) and the MCS-36 (HRQ4vs.Q1 0.67 [95%CI, 0.46-0.97], ptrend = 0.025; HRper+10points: 0.86 [95%CI, 0.74-0.99]) were inversely associated with mortality in the model with repeated measurements of HRQoL. Previous comorbidities or adherence to the MedDiet did not modify these associations. CONCLUSIONS: Self-reported HRQoL -assessed as self-reported health, PCS-36 and MCS-36- obtained with the Spanish version of the SF-36 were inversely associated with mortality risk, regardless of the presence of previous comorbidities or adherence to the MedDiet.

Social mobility and healthy behaviours from a gender perspective in the Spanish multicase-control study (MCC-Spain).

There is evidence for the influence of socioeconomic status (SES) on healthy behaviours but the effect of social mobility (SM) is not yet well known. This study aims to analyse the influence of origin and destination SES (O-SES and D-SES) and SM on healthy behaviours and co-occurrence, from an integrated gender and age perspective. Data were obtained from the controls of MCC-Spain between 2008-2013 (3,606 participants). Healthy behaviours considered: healthy diet, moderate alcohol consumption, non-smoking and physical activity. SM was categorized as stable high, upward, stable medium, downward or stable low. Binary and multinomial logistic regression models were adjusted. Those aged <65, with a low O-SES, D-SES and stable low SM are less likely to have healthy behaviours in the case of both women (physically active: OR = 0.65 CI = 0.45-0.94, OR = 0.71 CI = 0.52-0.98, OR = 0.61 CI = 0.41-0.91) and men (non-smokers: OR = 0.44 CI = 0.26-0.76, OR = 0.54 CI = 0.35-0.83, OR = 0.41 CI 0.24-0.72; physically active: OR = 0.57 CI = 0.35-0.92, OR = 0.64 CI = 0.44-0.95, OR = 0.53 CI = 0.23-0.87). However, for those aged ≥65, this probability is higher in women with a low O-SES and D-SES (non-smoker: OR = 8.09 CI = 4.18-15.67, OR = 4.14 CI = 2.28-7.52; moderate alcohol consumption: OR = 3.00 CI = 1.45-6.24, OR = 2.83 CI = 1.49-5.37) and in men with a stable low SM (physically active: OR = 1.52 CI = 1.02-1.26). In the case of men, the same behaviour pattern is observed in those with a low O-SES as those with upward mobility, with a higher probability of co-occurring behaviours (three-to-four behaviours: OR = 2.00 CI = 1.22-3.29; OR = 3.13 CI = 1.31-7.48). The relationship of O-SES, D-SES and SM with healthy behaviours is complex and differs according to age and gender.

[Infection by SARS-CoV-2 in pregnancy and possibility of transmission to neonates: A systematic revision]. / Infección por SARS-CoV-2 en el embarazo y posibilidad de transmisión al neonato: una revisión sistemática.

Studies published on COVID-19, pregnancy and neonate disease until 30 April 2020 are revised. We found 33 articles including 553 pregnant women and 456 deliveries. The more frequent symptoms in the pregnant women were fever, cough and dyspnoea. About two thirds deliveries were carried out via Caesarean rate; 5.9% women were admitted in the ICU and 4% required mechanic ventilation. No maternal death was reported. Prematurity occurred in 22.3% deliveries and 38.3% neonates required admission in the ICU. Only one neonatal death was reported (0.4%) and 13 neonates (3.4%) suffered COVID-19. The available information does not allow to state whether transmission to neonates occurred transplacentarily.

Compositional analysis of dietary patterns.

Instead of looking at individual nutrients or foods, dietary pattern analysis has emerged as a promising approach to examine the relationship between diet and health outcomes. Despite dietary patterns being compositional (i.e. usually a higher intake of some foods implies that less of other foods are being consumed), compositional data analysis has not yet been applied in this setting. We describe three compositional data analysis approaches (compositional principal component analysis, balances and principal balances) that enable the extraction of dietary patterns by using control subjects from the Spanish multicase-control (MCC-Spain) study. In particular, principal balances overcome the limitations of purely data-driven or investigator-driven methods and present dietary patterns as trade-offs between eating more of some foods and less of others.

Epidemiology of traumatic brain injury in the elderly over a 25 year period. / Epidemiología del traumatismo craneoencefálico en la población mayor de 65 años a lo largo de 25 años.

OBJECTIVE: To identify the changes in the epidemiology of traumatic brain injury (TBI) in a cohort of patients older than 65 years old admitted in the Intensive care unit of a third-level hospital over a 25 year period. MATERIAL AND METHODS: A retrospective cohort study conducted on patients over 65 years-old admitted with the diagnosis of TBI into an intensive care unit of a Spanish university hospital. The demographic, clinical variables were collected at the time of admission, including comorbidities, injury mechanisms, and injuries presented, and days of stay in ICU. A statistical analysis was carried out by five-year periods. RESULTS: A total of 446 TBI in patients over 65 years were included. In the analysis, an increase was observed in the proportion of patients presenting with epidural haematoma (1.39% in the period 1990-1995 vs. 9.46% in 2010-2015), with a significant linear tendency (P=.018). Falls from own height have increased from 8.33% (1991-1995) to currently more than 70% (2011-2015), P<.001. The percentage of traffic accidents declined from 26.39% to 3.95% in the last period, P<.001. CONCLUSIONS: In the last 25 years there seems to be evidence of a change in the origins of TBI in the elderly in our field.

Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II. / Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II.

OBJECTIVE: To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU. PATIENTS AND METHODS: Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). RESULTS: We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). CONCLUSIONS: The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia.

Anti-TNF-α therapy reduces retinol-binding protein 4 serum levels in non-diabetic patients with psoriasis: a 6-month prospective study.

BACKGROUND: Retinol-binding protein-4 (RBP4), an adipokine considered as an emerging cardiometabolic risk factor, is increased in patients with moderate-to-severe psoriasis. OBJECTIVE: In this study, we aimed to establish the effect of anti-TNF-α therapy on RBP4 levels in patients with moderate-to-severe psoriasis. We also assessed if RBP4 levels correlate with metabolic syndrome features and disease severity in these patients. METHODS: Prospective study on a series of consecutive non-diabetic patients with moderate-to-severe psoriasis who completed 6 months of therapy with adalimumab. Patients with kidney disease, hypertension or body mass index ≥ 35 kg/m(2) were excluded. Metabolic and clinical evaluation was performed at the onset of treatment (time 0) and at month 6. RESULTS: Twenty-nine patients were assessed. Statistically significant reduction (P = 0.0001) of RBP4 levels was observed after 6 months of therapy (RBP4 at time 0: 55.7 ± 21.4 µg/mL, vs. 35.6 ± 29.9 µg/mL at month 6). No significant correlation between basal RBP4 levels and metabolic syndrome features or disease severity was found. Nevertheless, although RBP4 levels did not correlate with insulin resistance, a negative and significant correlation between RBP4 levels obtained after 6 months of adalimumab therapy and other metabolic syndrome features such as abdominal perimeter and body mass index were observed. At that time, a negative and significant correlation between RBP4 levels and disease activity scores and ultrasensitive CRP levels was also disclosed. CONCLUSION: Our results support an influence of the anti-TNF-α blockade on RBP4 serum levels. This finding is of potential relevance due to increased risk of cardiovascular disease in patients with psoriasis.

Relationship of leptin with adiposity and inflammation and resistin with disease severity in psoriatic patients undergoing anti-TNF-alpha therapy.

BACKGROUND: Altered secretion patterns of proinflammatory adipokines may influence the increased risk of cardiovascular mortality observed in patients with chronic inflammatory diseases. OBJECTIVE: To determine whether two adipokines, leptin and resistin, correlate with metabolic syndrome features and disease severity in psoriatic patients who underwent anti-TNF-α therapy. METHODS: Prospective study of consecutive non-diabetic patients with moderate-to-severe psoriasis who completed 6 months of therapy with anti-TNF-α- adalimumab. Patients with kidney disease, hypertension or body mass index ≥35 Kg/m(2) were excluded. Metabolic and clinical evaluation was performed at the onset of anti-TNF-α treatment and at month 6. RESULTS: Twenty-nine patients were assessed. A correlation between adiposity and leptin was observed (waist circumference and leptin levels after 6 months of therapy: r = 0.43; P = 0.030). Leptin concentration also correlated with blood pressure before adalimumab onset (systolic: r = 0.48; P = 0.013 and diastolic blood pressure: r = 0.50; P = 0.010 ). A marginally significant negative correlation between insulin sensitivity (QUICKI) and leptin levels was also observed. CRP levels correlated with leptin prior to the onset of adalimumab (r = 0.45; P = 0.020) and with resistin both before (r = 0.45; P = 0.020) and after 6 months of therapy (r = 0.55; P = 0.004). A positive association between parameters of disease activity such as BSA (r = 0.60; P = 0.001) and PASI (r = 0.63; P = 0.001) prior to the onset of adalimumab therapy and resistin concentrations was also disclosed. No significant changes in leptin and resistin concentrations following the 6-month treatment with adalimumab were seen. CONCLUSION: In patients with moderate-to-severe psoriasis leptin correlates with metabolic syndrome features and inflammation whereas resistin correlate with inflammation and disease severity.

Effect of cold temperatures on mortality in Cantabria (Northern Spain): a case-crossover study.

OBJECTIVES: To determine the impact of low temperatures on mortality in a Spanish region that includes both rural and urban areas. STUDY DESIGN: Case-crossover study. METHODS: A case-crossover study was conducted on the impact of cold temperatures on mortality in Cantabria, a Spanish region which includes both rural and urban areas, in 2004-2005. Odds ratios for several cold weather indicators were estimated using conditional logistic regression, adjusting for humidity and wind speed. Zero- to 6-day lags in the temperature effect were considered. RESULTS: Temperatures lower than the 5th percentile were strongly associated with mortality compared with temperatures above the 5th percentile (OR 3.40, 95% confidence interval 2.95-3.93 for 6-day lag). All temperature indices show a negative association with mortality; for instance, the maximum temperature had ORs of 0.71, 0.58, 0.32 and 0.16 for Quintiles 2-5 (reference: Quintile 1). This effect was common to all age groups. CONCLUSION: Cold weather is strongly associated with mortality in small cities and rural areas.

[Factors associated with patient satisfaction with hospital care]. / Factores que determinan la alta satisfacción del usuario con la asistencia hospitalaria.

OBJECTIVE: To identify the influence of sociodemographic, care and communication factors on patient satisfaction. METHODS: Cross-sectional study by means of a telephonic survey of patients discharged during September, 2006. Instrument for measuring satisfaction: SERQVHOS questionnaire. STATISTICAL ANALYSIS: we used odds ratio (OR) and its 95% confidence interval (CI); adjustment for confusion factors was performed using multiple logistic regression. RESULTS: Response rate was 80.9%. On evaluating the influence of sociodemographic characteristics, we observed that patients whose nationality did not correspond to the European Union were more satisfied than Spanish patients (OR=3.01; 95% CI: 1.40-3.51); subjects who had only completed primary studies were more satisfied than those with university studies (OR = 2.85, 95% CI: 1.88-4.35). With respect to care factors, patients readmitted because of the same major diagnostic category had lower satisfaction (OR=0.67, bordering statistical significance). Finally, with regard to communication factors, the three aspects most associated with patient satisfaction were: correct health-care personnel identification (OR: 6.22 95% CI: 3.52-10.97), receiving enough information about his/her state of health (OR: 3.83 95% CI: 1.94-7.57), and being informed about the place and schedule for medical information (OR: 2.60, 95% CI: 1.60-4.22). CONCLUSIONS: Communication favourably affects the final perception of care, which justifies the continuity of its improvement in the health centres of our region.

[Hand hygiene: experience in two Spanish autonomous regions]. / Lavado de manos: experiencias de dos comunidades autónomas.

BACKGROUND AND OBJECTIVE: The Spanish Ministry of Health in accordance with WHO guidelines, promotes hand washing in hospitals, with the objective of reinforcing the commitment of health care workers to hand washing. In this study we described the results of the actions implemented in two communities, which were aimed at increasing hand-washing compliance among health care workers by means of a multimodal improvement programme. SETTING: Cantabrian and Murcian health services. The project was carried out in three phases. Phase I: analysis of preimplantation situation by means of an observational study in open care units, and a cross study of self-perceived compliance to hand hygiene with a questionnaire. Phase II: Implementing of training plan and promoting the use of alcohol-based solutions. Phase III: Reassessment of the results achieved by means of a post- intervention observational study. RESULTS: There has been a significant increase in frequency of hand washing adherence in both communities. 40.5% 95% CI [38.2-42.4] vs. 46.2% 95% CI [44.0-48.4] (p < .001) in Cantabria, and 43% vs. 54% in Murcia. CONCLUSIONS: The need to implement recommendations must continue to be emphasized and new interventions developed to increase health workers compliance, as well as promote educational policies and ease of access to alcohol-based solutions.

Meta-analysis of genetic variability in the beta-amyloid production, aggregation and degradation metabolic pathways and the risk of Alzheimer's disease.

BACKGROUND: Variants in genes encoding enzymes involved in production, aggregation or degradation of beta-amyloid are potential risk factors for sporadic Alzheimer's disease (AD). METHODS: Meta-analyses on AD association with BACE1 exon 5, BACE1 intron 5, FE65 intron 13, CYP46 intron 2, alpha(1)-antichymotrypsine Ala17Thr, bleomycin hydrolase I443V, lectin-like oxidized low-density lipoprotein receptor (OLR1) 3'-UTR (+1071) and (+1073), and very-low-density lipoprotein receptor (VLDLR) 5'-UTR (CGG-repeat) polymorphisms. RESULTS: In BACE1 exon 5, genotype CC+CT acts as a protective factor in Apolipoprotein E (ApoE) epsilon 4 carriers [odds ratio (OR) = 0.57; 95% confidence interval (CI): 0.38-0.88], and as a risk factor in ApoE epsilon 4 non-carriers (OR = 1.33; 95% CI: 1.00-1.78). OLR1 3'-UTR (+1073) allele C is associated with increased risk (OR = 1.23; 95% CI: 1.01-1.50). VLDLR 5'-UTR genotype 2 is associated with increased risk (OR = 1.70; 95% CI: 1.09-2.63) in the Asian population and is protective (OR = 0.48; 95% CI: 0.26-0.86) in the non-Asian population. Other studied polymorphisms are not associated with AD. CONCLUSIONS: The overall impact on AD risk of the genes for which meta-analyses are now available is rather limited. Additional meta-analyses of other different genes encoding for A beta production, aggregation and degradation mediators might help in determining the risk profile for AD.

[Prevention of nosocomial infection of fungal origin: verification of the environmental biosafety in surgery rooms]. / Prevención de la infección nosocomial de origen fúngico: verificación de la bioseguridad ambiental en quirófanos.

The biodiversity and concentration of environmental fungi in the hospital surgical area was monitored for 36 months. A total of 120 measures were made, 70% of which had fungal growth, a single genus being identified in 62%. Nine different genus were isolated (Penicillium, Aspergillus, Acremonium, Dactylaria, Fusarium, Cladophialophora, Alternaria, Candida and Rodothorula) with a clear predominance of Cladophialophora. Aspects that still must be resolved are discussed. These are: periodicity of the sample obtention, definition of the area of risk, interpretation of the counts and species considered pathogenic. At present, in spite of the large gaps in knowledge, the maintenance of continuous registry system of the environmental biosafety levels is fundamental, since the cause cannot be identified in most of the times when elevated fungal count is detected.

[Comparison between several standard populations for age-adjusting]. / Comparación entre varias poblaciones estándar para el ajuste por edades.

BACKGROUND: To analyse the effect the choice of reference population has on different indicators derived from mortality rates age-adjusting. METHODS: The mortality rates for different causes of death in Spain from 1971 to 1992 were adjusted by using four reference populations: Spanish populations from 1971 and 1992, the Standard European population and the standard world population. The results obtained with the four populations were compared by applying three indicators: difference between the rates of 1992 and 1971, ratio between the rates of 1992 and 1971 and annual percentage change between 1971 and 1992. RESULTS: In the majority of the causes of death studied, including the total, ischemic heart disease and almost all of the tumours, the ratio between the rates and the percentage of annual change are similar regardless of the standard population used. However, the difference in rates is very noticeable in relation to the reference population. In the infectious diseases and testis cancer, the opposite occurs: the different in rates is steadfast while the ratio between the rates varies with the standard population. Finally, the mortality due to pneumonia, Parkinson's disease and encephalic cancer show changes all three indicators used. CONCLUSIONS: An analysis of the specific rates by age must be made before proceeding with their adjustment. This analysis will enable us to ascertain whether the adjustment by age is correct and which indicator (difference, ratio or percentage change) will be appropriate for making comparisons.

[Comparison of 2 methods for calculating uncertainty in laboratory analysis]. / Comparación de dos métodos para el cálculo de la incertidumbre en los análisis de laboratorio.

OBJECTIVE: To compare two methods in the estimation of the uncertainty in laboratory quality control. METHODS: A computerized simulation is performed to compare the delta method (suggested by the International Organization for Standardization and the Entidad Nacional de Acreditación) and a bootstrap-based method. The simulation includes several situations with different environmental conditions and different relationships between the analyzed variables. RESULTS: The mean in the coverage obtained by the estimated confidence intervals is higher and closer to the nominal using the bootstrap than using the delta method. The most important differences are observed in the coverage percent distribution: while using the bootstrap, a great number of simulations obtain coverage near the nominal of 95%; using the delta method the coverage are more dispersed, including coverage of 100% in some occasions and lesser than 80% in others. The bootstrap offers very similar results under different conditions, including in the presence of unknown and unmeasured variables or when the analyzed variables are correlated. The delta method shows poorer results in both situations. CONCLUSION: The uncertainty in the laboratory quality control can be estimated more accurately with bootstrapping than with the delta method.