Reversal of the Upward Trend of Obesity in Boys, but Not in Girls, in Spain.

(1) Background: To compare the prevalence of overweight and obesity in boys and girls and to estimate socioeconomic differences associated with obesity in Spain in 1997, 2007, and 2017. (2) Methods: Data were drawn from national health interview surveys. For each year of study, the prevalence of overweight and obesity was measured, and these results were compared by gender (boy/girl) and socioeconomic status (low/high education). (3) Results: The prevalence of overweight and obesity rose from 1997 to 2007 but then fell in 2017 in all subgroups except in girls aged 10 to 15 years. In this group, there was a steady increase in the prevalence of both overweight (1997, 14.6%; 2007, 17.7%; 2017, 19.6%) and obesity (1.1, 3.2, and 3.7%, respectively). The decrease in prevalence of overweight in both sexes and of obesity in boys, along with the increase in prevalence of obesity in girls, was of a higher magnitude in children whose parents had a lower educational level. (4) Conclusions: The apparent turnaround in the obesity epidemic in Spain should be interpreted with caution. Children's body weight is influenced by both gender and socioeconomic status-considerations that should be kept in mind when designing health promotion interventions.

Decentralization of health systems in low and middle income countries: a systematic review.

OBJECTIVES: A substantial number of low and middle income countries (LMICs) have implemented health sector reforms in the last 40 years, and the majority of them have included some degree of decentralization of the health system as part of the wider reform. This review will provide an updated and comprehensive assessment of the effects of decentralization in LMICs. METHODS: We conducted a systematic review of published and grey literature till May 2015, following standard methods. RESULTS: 54 qualitative, quantitative and mixed methods studies conducted in 26 countries were included in the review. We found positive and negative effects of decentralization of health systems in LMICs. Whereas decentralization of governance, financing and service delivery, have been shown to have positive effects on the system; decentralization of resource management has been challenging in several settings. CONCLUSIONS: Overall, lessons learned from LMICs suggest that factors such as adequate mix of technical skills at the local level to perform decentralized tasks, effective decentralization of decision-making to the periphery, and political leadership are key factors for a successful decentralization.

New strategy of tacrolimus administration in animal model based on tacrolimus-loaded microspheres.

New strategies for tacrolimus administration that conserve its immunosuppressive effect but avoiding fluctuations in tacrolimus circulating levels are needed. The aim was to analyze if subcutaneous biodegradable tacrolimus-loaded microspheres injection promoted a significant immunosuppressive response in rats. Rats received two subcutaneous tacrolimus-loaded microspheres injections at different days, the first injection was done at day 0 and the second injection was done 12 days after. Plasma circulating levels of tacrolimus, interleukin-2 (IL-2) and calcineurin phosphatase (PP2B) activity in mononuclear cells were measured. Tacrolimus plasma levels were significantly increased from the day after tacrolimus-loaded microspheres injection and remained increased during 10days. Compared to control, plasma IL-2 levels and PP2B activity in mononuclear cells were significantly decreased during ten days. At day 12, a new subcutaneous injection of tacrolimus-loaded microspheres was performed and two days after injection, tacrolimus plasma levels were again increased and both IL-2 plasma levels and PP2B activity decreased. A single subcutaneous tacrolimus-loaded microspheres injection was enough to reduce tacrolimus-related immunosuppressive parameters. These results open the possibility of new therapeutic strategies to administrate calcineurin inhibitors reducing the variability of their circulating levels related to gastrointestinal drug absorption/metabolism modifications.

BRCA2 gene mutations and coagulation-associated biomarkers.

Thromboembolic events are the second cause of death in cancer patients, although the mechanisms underlying this increased thromboembolic risk remain unclear. The aims of this study were to examine whether BRCA2 gene mutations may modify the circulating levels of thrombocoagulation biomarkers and whether breast cancer development may influence changes in such circulating biomarkers. The study was performed in 25 women with mutations in the BRCA2 gene (n=12 breast cancer, n=13 breast cancer-free) and in 13 BRCA2 non-mutant controls. Results revealed that plasma levels of fibrinogen gamma chain isotypes 2 and 3, haptoglobin isotypes 4 and 5, serotransferrin isotypes 3 and 4 and convertase C3/C5 isotypes 4 and 5 were significantly higher in BRCA2 mutation carriers compared to controls. However, plasma levels of vitamin D binding protein isotype 1 and alpha1-antitrypsin isotypes 2, 3 and 4 were significantly decreased in BRCA2 mutation carriers compared to controls. Plasma expression of PF4 and P-selectin was significantly higher in BRCA2 mutations carriers than in controls. BRCA2 truncated mutations conserving a binding region for RAD51 were associated with increased plasma levels of alpha1-antitrypsin isotypes 3 and 4 with respect to women showing BRCA2 mutations that loss the binding RD51 region to BRCA2. Only plasma levels of vitamin D binding protein isotypes 1 and 3 were significantly reduced and alpha 1-antitrypsin isotype 1 was increased in cancer-free BRCA2 mutation carriers compared to BRCA2 mutation carriers with breast cancer. The presence of BRCA2 mutations is associated with increased plasma levels of thrombo-coagulating-related proteins, which are independent to breast cancer development.

Serum biomarkers in uncontrolled no heart-beating donors may identify kidneys that will never work after transplantation.

BACKGROUND/AIMS: Kidneys from uncontrolled non heart-beating donors achieve a good level of renal function after transplantation. However, a number of them will never function in the recipient. Our aim was to determine if serum biomarkers associated with platelet activity, inflammation and the nitric oxide system in uncontrolled non heart-beating donors may help to predict no renal function recovery after renal transplantation. METHODS: Serum levels of interleukin (IL)-6, IL-10, intercellular cell adhesion molecule-1 (ICAM-1), cyclic guanosine monophosphate (cGMP), nitrite + nitrate and platelet factor-4 (PF4) were measured using enzyme-linked immunosorbent assay (ELISA) kits in 88 uncontrolled non heart-beating donors divided according to the renal functionality achieved in the recipients into functional (n = 76) and non functional (n = 12). RESULTS: Kidneys from donors with higher IL-6 levels (>900 pg/ml) were functional after transplantation. Serum cGMP levels below 372.3 fmol/l were also associated with kidneys that recovered the renal function. However, serum levels of PF4 showed the best correlation with recovery of renal functional in the recipients since they were significantly lower in the donors whose kidneys functioned after transplantation. CONCLUSIONS: Serum PF4 levels in uncontrolled non heart-beating donors may be a good predictor for kidneys that never will reach functional recovery. Some serum cGMP, IL-6 and IL-10 levels may simply help identify kidneys that will function after transplantation.

New circulating biomarkers for predicting cardiovascular death in healthy population.

There is interest to analyse newer biomarkers to identify healthy individuals at risk to develop cardiovascular disease (CVD) incidents and death. To determine in healthy individuals new circulating protein biomarkers, whose systemic levels may be associated with the risk of future development of CVD incidents and death. The study was performed in 82 individuals from the Malmö Diet and Cancer study cohort, free from CVD of whom 41 developed CVD and 41 did not. Plasma proteins related to inflammation and thrombo-coagulating processes were analysed. α1-antitrypsin isotype 3 plasma levels were significantly higher while apolipoprotein J plasma levels were lower in participants that developed CVD incidents than those that did not develop acute cardiovascular episode. Of 82 participants, 17 died by CVD causes. There were proteins whose expression in plasma was significantly higher in participants suffering CVD death as compared with those that did not die by CVD. These proteins included: fibrinogen ß-chain isotypes 1 and 3, fibrinogen-γ-chain isotype 2, vitamin D-binding protein isotypes 1, 2 and 3, α1-antitrypsin isotypes 3 and 6, haptoglobin isotypes 3,4,5 and 5, haemopexin isotypes 1 and 2, and Rho/Rac guanine nucleotide exchange factor 2. Moreover, apolipoprotein J plasma levels were found lower in participants that died by cardiovascular cause. Association between plasma levels of proteins and CVD death was independent of age, gender, conventional risk factors and plasma C-reactive protein levels. Several protein plasma levels and protein isotypes related to inflammation and thrombo-coagulating phenomena were independently associated with the risk of future CVD death.

[Seroprevalence of measles, rubella, mumps and varicella in health workers in the Community of Madrid]. / Seroprevalencia de sarampión, rubéola, paperas y varicela en los trabajadores de un área sanitaria de la Comunidad de Madrid.

BACKGROUND: The vaccination of health workers has a large repercussion on the health of the workers, the patients and the population in general. Due to this, we proposed to discover the serological status for varicella, rubella, mumps and measles in the workers of a tertiary hospital in Madrid. METHODS: We have conducted a retrospective epidemiological study of 1060 health workers, obtaining information such as age, sex, service area, employment status, pre-exposure vaccination and post-vaccination serology and vaccination status. RESULTS: In the population studied, 90.1% were protected against varicella, 65.6% against mumps, 95.6% against rubella and 92.9% against measles. There is no better protection against these illnesses for workers who treat patients directly, workers who treat immunosuppressed patients or for workers in services or units with a higher risk of infection. CONCLUSION: There is no better protection against varicella, rubella, mumps and measles for the workers who have higher risk of infection at work; and the workers who treat patients, that if they suffer these diseases, this could put their health at risk.

Influenza vaccination coverage rates among diabetes sufferers, predictors of adherence and time trends from 2003 to 2010 in Spain.

A descriptive cross-sectional study was conducted for adults (aged ≥ 50 y) with diabetes. Data was obtained from the 2009 European Health Interview Survey for Spain and the 2003 and 2006 Spanish National Health Surveys. To assess influenza vaccination status, we considered the response (yes or no) to the question "Have you received the influenza vaccine in the previous season?" Both dependent and independent variables were based on the survey questionnaires. The independent variables analyzed included socio-demographic characteristics, health-related variables and use of health care services. The coverage among adults with diabetes in 2010 was 65.0% (95% CI: 62.1-67.7) compared with 41.2% (95% CI 40.0-42.4) for those without diabetes (p<0.01) adjusted OR 1.67 (95% CI: 1.40-1.99). The positive predictors of vaccine uptake among diabetic adults were: higher age, being male, the presence of associated chronic conditions and physician visits in the last 2 wk. The vaccine uptake among adults with diabetes was 61.4% (95% CI: 57.9-64.8) in 2003 and 63.8% (95% CI: 60.7-66.8) in 2006.The adjusted OR of having been vaccinated in 2010 with respect to 2003 was not significant 1.18 (95% CI: 0.97-1.44). We conclude that the levels of influenza vaccination coverage are below desirable levels among adults with diabetes. Furthermore, trend analysis in influenza vaccination coverage indicates that influenza vaccination rates in adults with diabetes have not improved in recent years. Urgent strategies for increasing vaccination coverage among diabetes sufferers are necessary especially for those aged 50-59, women, those without chronic conditions and those who are not frequent users of health care services.

Influenza vaccination coverage and uptake predictors among Spanish adults suffering COPD.

The aim of this study is to compare influenza vaccination coverage among Spaniards aged 40 y or over who suffer from chronic obstructive pulmonary disease (COPD) with those without this illness to identify the factors that influence vaccination uptake among patients with COPD. Data was extracted from the European Health Survey performed in Spain in 2009/10, and analyzed data on 15,355 Spaniards (≥ 40 y of age), of whom 1,309 (8.2% 95%CI 7.7-8.7) had COPD was used. We considered the answer (yes/no) to the question about whether or not the interviewed person had been vaccinated against influenza in the previous flu season. We used the answer to this question as the dependent variable. For independent variables, we analyzed social demographic characteristics, health related variables, and the utilization of health care services. Vaccination coverage among patients with COPD is 49.4% (95% CI: 46.3-52.5%) and 21.3% (95% CI: 20.7-21.9) among people without (p < 0.001). The probability of being vaccinated is three times greater for COPD patients (crude OR = 3.0, 95% CI: 2.6-3.5). Among COPD patients the uptake of vaccination increased with age. Other factors associated with an increase in vaccination coverage were: being male, perceiving one's health as fair or poor, not smoking, and having seen a doctor during the previous month. The rate of flu vaccination among adult Spaniards with COPD is lower than desired. Urgent strategies for increasing vaccination coverage are necessary for COPD sufferers aged under 65 of age and those with unhealthy lifestyles.

Predictors of contraceptive methods among adolescents and young women residing in Spain.

INTRODUCTION: Preventing unwanted pregnancy is considered one of the main preventive measures of a developed health system. AIMS: The aim of the study were to determine the prevalence of contraceptive methods and identify factors associated with the use of contraception by adolescents and young women residents in Spain. METHODS: Descriptive cross-sectional epidemiologic study on the factors determining use of a contraceptive method among sexually active adolescents and young women aged 16-29 years, living in Spain. As the dependent variable, we took the answer to the questions "During the last 12 months, what contraceptive method have you generally used in your sexual relations?" Independent variables were socio-demographic factors, sexual habits, and variables associated with perception of sexual health. Using logistic multivariate regression models, we have estimated the independent effect of each of these variables on the contraceptive methods use. MAIN OUTCOME MEASURES: We used secondary individualized data drawn from the first National Sexual Health Survey conducted in Spain. RESULTS: The male condom seems to be the most widely used (56.7%). The likelihood of using a condom is greater to those who have more than two sexual partners (adjusted odds ratio [AOR]=3.11; 95% confidence interval [CI], 1.72-5.60). Predictors of use of oral contraceptives as the only method are age and having a positive view of one's sexual health (AOR=2.65; 95% CI, 1.28-5.45). Young women with two or more sexual partners were three times likelier to use the double method (AOR=3.83; 95% CI, 1.52-9.65). CONCLUSIONS: The number of sexual partners, information on and importance of sexuality in one's life predicted the use of the condom as the only method. The factors associated with use of oral contraceptives were having a stable sexual partner and good perception of sexual health. The variable most strongly associated with use of the double method was number of sexual partners.