Expected-value bias in mid-trimester preterm birth screening.

OBJECTIVES: Cervical length (CL) measurement ≤ 25 mm on mid-trimester ultrasound scan is a known risk factor for preterm birth, for which vaginal progesterone is recommended. The aims of this study were to evaluate whether CL measurement is affected by observer bias and to assess the impact on short cervix prevalence of masking CL measurement during routine mid-trimester ultrasound scan. METHODS: This was a flash study designed for a 2-month period (October and November 2018) at Cruces University Hospital (Bizkaia, Spain), in which all CL measurements from routine mid-trimester scans were masked. During the study period, there was no modification of the routine screening method, and women with a short cervix were prescribed 200 mg vaginal progesterone daily as per usual. The control group included women examined in a 2-month period (April and May 2018) prior to the study, in which CL measurements were taken as usual by a non-blinded operator. The primary outcome was the prevalence of short cervix in each group. RESULTS: A total of 983 CL measurements were analyzed, including 457 in the blinded group and 526 in the control group. The prevalence of short cervix was 2.7% in the non-blinded group and 5.5% in the blinded group (P = 0.024). We identified a statistically significant difference in the incidence of CL of 24-25 mm between the two groups, with a lower prevalence in the non-blinded vs blinded group (0.6% vs 2.4%; P < 0.005). Moreover, the distribution of CL values was normal in the blinded group, in contrast to the non-blinded group, which was characterized by skewed distribution of CL values. CONCLUSIONS: Expected-value bias exists and should be taken into account when measuring CL in mid-trimester preterm birth screening. Blinding has demonstrated to be an effective strategy to improve the performance of CL screening in clinical practice. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Coffee consumption and mortality from all causes of death, cardiovascular disease and cancer in an elderly Spanish population.

PURPOSE: The effect of coffee consumption on mortality has been scarcely investigated in the elderly. We assessed the association between coffee consumption and mortality from all-cause, cardiovascular disease (CVD) and cancer, in an elderly population of Spain. METHODS: We studied 903 individuals (511 women) aged 65 years and older from two population-based studies, the EUREYE-Spain study and the Valencia Nutritional Survey. Coffee consumption and diet were assessed using a validated food frequency questionnaire. Information on education, anthropometry, sleeping time, smoking, alcohol intake, physical activity and pre-existing disease was collected at baseline. Deaths were ascertained during a 12-year follow-up period, and Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HR). RESULTS: There were 403 deaths during the 12-year period (40% from CVD), 174 of which occurred during the first 6 years. We observed evidence of a lower CVD mortality among coffee drinkers in the first 6 years of follow-up. Drinkers of ≤1 cup of coffee/day and > 1 cup/day showed lower CVD mortality than non-drinkers of coffee, HR 0.82 (95% CI 0.46-1.44) and HR 0.38 (0.15-0.96), respectively (p trend = 0.04). This association of coffee with CVD mortality attenuated after 12 years of follow-up. No significant association was observed with all-cause or cancer mortality, neither for caffeinated and decaffeinated coffee. CONCLUSIONS: In this study, coffee consumption was associated with lower CVD mortality in elderly. Although this association should be further investigated, coffee consumption appears to be safe for the elderly since no increased mortality was observed in coffee drinkers.

Predictive performance of PAMG-1 vs fFN test for risk of spontaneous preterm birth in symptomatic women attending an emergency obstetric unit: retrospective cohort study.

OBJECTIVE: To compare the performance of the placental alpha microglobulin-1 (PAMG-1) and fetal fibronectin (fFN) tests for the prediction of spontaneous preterm delivery in patients presenting to an emergency obstetric unit with threatened preterm labor, by conducting a retrospective audit of patient medical records from separate 1-year periods during which either fFN or PAMG-1 was used as the standard-of-care biochemical test. METHODS: This was a retrospective cohort study based on chart review of electronic medical records of women with threatened preterm labor presenting at a level-III maternity hospital over two different periods: (1) the 'baseline' period (year 2012), during which the qualitative fFN test with a cut-off of 50 ng/mL was used as the standard-of-care biochemical test for the risk assessment of preterm delivery, and (2) the 'comparative' period (year 2016), during which the PAMG-1 test with a cut-off of 1 ng/mL was used as the standard-of-care biomarker test. Patients with a singleton pregnancy between 24 + 0 and 34 + 6 weeks' gestation with symptoms of early preterm labor, clinically intact membranes and cervical dilatation < 3 cm, who did not have a medically indicated preterm delivery within 14 days of testing, were selected for chart review and included in the analysis. Key parameters used for the analysis were biochemical test results, time of testing and time of delivery. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for the prediction of spontaneous preterm delivery ≤ 7 and ≤ 14 days of presentation were calculated for the PAMG-1 and fFN tests. RESULTS: Four hundred and twenty patients were identified as having presented with threatened preterm labor during the baseline period, of whom 378 (90.0%) met the eligibility criteria. Of these, 38 (10.1%) were fFN positive and 10 (2.6%) had spontaneous preterm delivery ≤ 7 days of presentation. PPV, NPV, LR+ and LR- of fFN were 7.9%, 97.9%, 3.2 and 0.8, respectively, for spontaneous preterm delivery ≤ 7 days. Four hundred and ten patients were identified as having presented with threatened preterm labor during the comparative period and 367 (89.5%) subjects met the eligibility criteria. Of these, 17 (4.6%) were PAMG-1 positive and 12 (3.3%) had spontaneous preterm delivery ≤ 7 days of presentation. PAMG-1 PPV and NPV were 35.3% and 98.3%, respectively, and LR+ and LR- were 16.1 and 0.5, respectively, for spontaneous preterm delivery ≤ 7 days. CONCLUSIONS: Before switching to PAMG-1, fFN was the standard-of-care test for the risk assessment of spontaneous preterm delivery. This retrospective audit of each test's performance over separate 1-year periods shows that we were more than twice as likely to get a positive fFN test than a positive PAMG-1 test, while the rate of discharging women who ultimately delivered spontaneously within 14 days of testing was not affected. Furthermore, a positive PAMG-1 test was more than four times more reliable than a positive fFN test in predicting imminent spontaneous preterm delivery. The use of a more reliable biomarker that is associated with fewer false-positive results could lead to a reduction in unnecessary admissions, interventions and use of hospital resources. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Self-rated health and mortality: a follow-up study of a Spanish population.

OBJECTIVES: Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population. STUDY DESIGN: Longitudinal study. METHODS: A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations. RESULTS: Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability. CONCLUSIONS: SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

Retinal neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy.

In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers.

[Place of death of people with conditions needing palliative care in the different regions of Spain]. / Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España.

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (O-H/H) and in a nursing home vs. at home (O-N/H), and odds ratio (OR-H/H and OR-N/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O-H/H higher than 1 and O-N/H lower than 1 were observed in all AC, except Catalonia. Oncological causes made O-H/H lower than 1 in almost 50% of AC, while O-N/H continue to be lower than 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999-2008.

Spain's immigrant population has increased 380% in the last decade, accounting for 13.1% of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999-2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (-17.8% for men and -16.6% for women) as well as in the foreign-born one (-45.9% for men and -35.7% for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España / Place of death of people with conditions needing palliative care in the different autonomous communities (regions) of Spain

FUNDAMENTO: Conocer el lugar de fallecimiento por causas susceptibles de cuidados paliativos de personas residentes en España de 15 o más años de edad según la comunidad autónoma (CA), y cómo influyen las causas (oncológicas y no oncológicas). MÉTODO: Estudio transversal de base poblacional con análisis de los certificados médicos de defunción entre 2012 y 2015. Los efectos ajustados de las variables sociodemográficas, la CA y las causas sobre el lugar de fallecimiento se estimaron mediante las odds de fallecimiento en hospital frente a domicilio (OH/D) y en residencia frente a domicilio (OR/D), y las odds ratio (ORH/D y ORR/D) obtenidas por regresión logística multinomial. RESULTADOS: Se produjeron 1.611.767 muertes de las que 64,8% correspondieron a la población diana. La defunción en hospital fue un 77% más frecuente que en domicilio, y en residencia un 53% menor. Sexo masculino, menor edad, bajo nivel de estudios, lugar de nacimiento fuera de España, tamaño de municipio grande y estado civil no casado se asociaron a fallecimiento en hospital, y las mismas excepto sexo femenino y mayor edad a residencia. Las OH/D ajustadas fueron > 1 en todas las CA y las OR/D < 1, excepto Cataluña. Para las causas oncológicas, las ORH/D ajustadas disminuyeron y fueron significativamente <1 en casi la mitad de CA, y todas las ORR/D permanecieron <1. CONCLUSIONES: El fallecimiento se produjo mayoritariamente en hospital y menos en residencia, aunque las causas oncológicas aumentan la probabilidad de fallecer en domicilio en vez de en hospital (efecto ajustado)

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (OH/H) and in a nursing home vs. at home (ON/H), and odds ratio (ORH/H and ORN/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted OH/H > 1 and ON/H < 1 were observed in all AC, except Catalonia. Oncological causes made OH/H < 1 in almost 50% of AC, while ON/H continue to be < 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect)

[Size of breast cancer at the time of initial diagnosis]. / Extensión del cáncer de mama en el momento del diagnóstico inicial.

BACKGROUND: To observe whether patients with breast cancer of an epithelial strain consult physician with a less advanced disease, the patients attended by the Valencian Interhospital Group were studied between January 1981 and December 1990. METHODS: The same diagnosis of disease spread (anamnesis, physical examination, blood analysis and imaging techniques of the thorax, bones and liver) was carried out in all cases. Surgical techniques and histopathologic criteria were homogenous throughout the study. The classification used was that of the International Union Against Cancer of 1987. Histopathologic correlations were studied. RESULTS: Seven hundred seventy-nine patients with a mean age of 57.3 years (range: 24-85) were studied. A statistically significant (S) progressive reduction in the size of the tumor was observed (p less than 0.003) with the percentage of stage II progressively increasing and stage IIIa (more advanced disease than stage II) parallelly diminishing (p less than 0.0019) (S). In patients over the age of 55 this diminution was not observed. To the contrary, more advanced stages (stage IIIb--locally advanced, and stage IV--metastatic disease) were presented than in younger women (p = 0.000) (S). There is a direct correlation between the size of the tumor, the degree of tumoral differentiation and lymphatic metastases. CONCLUSIONS: Patients under the age of 55 spontaneously and progressively consult the physician with a less advanced breast cancer. This is expected to have beneficial effects on survival. It is suggested that primary medicine may play a fundamental role in making women more aware of breast cancer, particularly those over 55 years of age regardless of early detection campaigns.

Neurodegeneración retiniana en pacientes diabéticos tipo 2 sin retinopatía diabética / Retinal neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy

La retinopatía diabética (RD) tradicionalmente se ha considerado parte de un proceso vascular. Investigaciones recientes sugieren que la degeneración de la retina en la diabetes mellitus (DM) podría ser causada también por una neuropatía y que la neurodegeneración retiniana precedería a las alteraciones microvasculares. El presente artículo revisa la bibliografía existente sobre neurodegeneración en pacientes con DM tipo 2 (DM2) sin RD. En los pacientes con DM2 no severa, temprana, con buen control metabólico y sin RD, las pruebas de función visual muestran anormalidades precoces que anteceden a la aparición de la RD clínica (la que diagnosticamos con una exploración oftalmológica convencional). Utilizando la tomografía de coherencia óptica (OCT) se observa que en estos pacientes existe una disminución en el espesor de distintas capas de la retina, tanto en el área macular como peripapilar. Recientes estudios sugieren que las complicaciones sistémicas (especialmente la isquemia) y una posible alteración microvascular contribuyen a la neurodegeneración retiniana, lo que abre la puerta a nuevos estudios que incluyan nuevas técnicas de evaluación de la microvascularización de las capas internas de la retina como la angio-OCT (AU)

In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers (AU)

Impact of a mammography screening programme on the breast cancer population of the Region of Valencia (Spain)

OBJECTIVE: Randomised clinical trials with a control arm of non-screened patients are nowadays ethically impossible. The aim of this study was to establish the impact of mammography screening on a non-selected population. PATIENTS AND METHODS: Between January 1993 and December 2002, 3662 patients were included, 2313 in the screened group and 1349 in the unscreened group. RESULTS: 55.3% of the screened patients were diagnosed in stage I vs. 26.1% in the non-screened group. The proportion of stage III-IV was 4.6% and 19.8% for the screened and unscreened groups respectively (p<0.001). 48.8% in the screening group were submitted to mastectomy vs. 66.4% of the unscreened patients (p<0.001). Overall survival was superior for the prevalent cases in the screening group, with a relative risk of 0.49, and was not significant for the incident cases. CONCLUSIONS: Diagnosis of breast cancer in the mammography screening programme of the Region of Valencia significantly increases conservative surgery rates and suggests an improvement in survival in prevalent cases. The increased rate of early stages in these patients could be the main reason of this benefit (AU)

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