The risk of incident depression when assessed with the Lifestyle and Well-Being Index.

OBJECTIVES: Novel findings indicate links between unhealthy lifestyles and depression based on active inflammatory processes. Thus, identifying participants with poor habits could reveal differences in trends of incident depression. This study aimed to examine the association between an objective lifestyle assessment, as measured by the Lifestyle and Well-Being Index (LWB-I), and incident depression in healthy participants of a Spanish cohort. STUDY DESIGN: This was a longitudinal analysis of a subsample of 10,063 participants from the Seguimiento Universidad de Navarra cohort study. METHODS: Group comparisons and Cox proportional hazard models were conducted using the LWB-I, which categorizes the sample into groups with healthy and unhealthy lifestyles and well-being. The main outcome was incident depression as well as secondary outcomes. RESULTS: Those classified to the transition category of LWB-I were associated with a hazard ratio of 0.67 (95% confidence interval: 0.52-0.87), and those in the excellent category showed a hazard ratio of 0.44 (95% confidence interval: 0.33-0.58), which in both groups reflects a significantly lower risk of incident depression compared with the group including those classified in the poor LWB-I level. Moreover, the available sensitivity analyses concerning time of depression diagnosis or antidepressant treatment further supported the role of nutrition and physical activity on incident depression. Interestingly, throughout the follow-up, incident depression was inversely related to healthier daily habits as measured by the LWB-I. CONCLUSIONS: A global assessment of lifestyles such as the LWB-I provides valuable insight into the complex relationship between lifestyle factors and their link to depression risk.

Impact of the 2005 and 2010 Spanish smoking laws on hospital admissions for tobacco-related diseases in Valencia, Spain.

OBJECTIVES: This study aimed to assess the impact of the latest smoke-free legislation on hospital admission rates due to smoking-related diseases in Spain. STUDY DESIGN: A retrospective cohort study was conducted to evaluate changes in hospital admission rates for cardiovascular, respiratory diseases, and smoking-related cancer in Valencia, Spain, during the period 1995-2013. Law 28/2005 and then law 42/2010 prohibited smoking in bars and restaurants as well as playgrounds and access points to schools and hospitals. METHODS: General population data by age and sex were obtained from the National Institute of Statistics census. Data on hospital admissions were obtained from the Minimum Basic Data Set. Diagnoses were codified according to the International Classification of Diseases-9th revision. Data from all hospitals of the Valencian Community from 1995 to 2013 were analysed. Trend analyses in the periods before and after the approval of the 2005 law were conducted using least-squares linear regression models. RESULTS: Adjusted hospital admission rates per 100,000 inhabitants for cardiovascular diseases significantly decreased after the 2005 Law (from 550.0/100,000 in 2005 to 500.5/100,000 in 2007), with a further decrease (to 434.6/100,000) in 2013, after the 2010 Law. Reductions in hospital admissions were seen in men and women, although declining trends were more marked in men. Hospital admission rates for respiratory diseases showed a reduction of a lower magnitude, whereas for smoking-related cancer admissions there was a slight decline only among men. CONCLUSIONS: The Spanish comprehensive smoking ban resulted in a remarkable reduction of the adjusted rate of hospital admissions mainly associated to cardiovascular diseases. The decrease in the number of persons requiring in-patient care is relevant and may be viewed as an improvement of the public's health.

Total polyphenol intake, polyphenol subtypes and incidence of cardiovascular disease: The SUN cohort study.

BACKGROUND AND AIMS: Polyphenol-rich diets have been associated with reduced risk of cardiovascular disease (CVD). However, few prospective epidemiological studies have examined the relationship between classes of ingested polyphenols and risk of CVD. Our aim was to evaluate the association between polyphenol intake and risk of major cardiovascular events in a prospective Spanish cohort. METHODS AND RESULTS: We included 17,065 university graduates (60.7% women, mean age: 37.2 years, age range: 20-89) followed-up for a mean of 10.1 years. Polyphenol intake was assessed at baseline using a validated semi-quantitative 136-item food frequency questionnaire and matching food consumption data with the Phenol-Explorer database. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for incident cardiovascular events (myocardial infarction, stroke or cardiovascular death). Cherries, chocolate, coffee, apples, and olives were the major sources of variability in polyphenol intake. Participants with higher flavonoids intake (fifth quintile) had a 47% lower incidence of cardiovascular events compared to those in the lowest quintile (HR: 0.53, 95% CI: 0.29-0.98; P for trend = 0.09) after adjusting for potential confounders. The results were non-significant for other polyphenol types. CONCLUSION: The intake of flavonoids showed an inverse association with risk of cardiovascular events in a prospective cohort of Spanish middle-aged adult university graduates. REGISTRATION NUMBER FOR CLINICAL TRIALS: NCT02669602 in Clinical Trials.

[Evaluation of the research performed in Spanish hospitals]. / Valoración de la investigación que se realiza en los hospitales españoles.

OBJECTIVES: No study that analyzes how the investigators who work in the Spanish hospitals perceived and evaluate the current research system has been performed. This work, carried out by the Scientific Forum of the Lilly Foundation, aims to improve the level of information on the research activity performed in the hospitals. SUBJECTS AND METHODS: By means of a «self-administered¼ interview made up of 34 items and aimed at physicians and other research professionals who work in the Spanish hospitals (272 surveyed), 3 questions were analyzed: a) general situation of biomedical research in Spain; b) administration of available resources: need for better resources, and c) evaluation and giving priority to biomedical research. RESULTS: The use of the data has shown strengths in the system such as the initiatives to promote research through contracts with FIS and post-residency (7.6/10 points); the beneficial effects of research and care quality (7.3/10); or support of the pharmaceutical industry through the sponsoring of clinical trials (6.9/10). However, it has also shown that there are some weaknesses in the organization of the centers, as for example, those referring to the differentiated allocation of the care cost of the research activity (5.1/10); to the coordination between them and the health care centers (2.8/10); to the integration and organization among care, teaching and research (3.6/10); and to decide the priorities (5.2/10) and evaluation (5.2/10) of the research activities. Furthermore, the value of the research as a fundamental activity of the hospitals is emphasized (4.7/10). CONCLUSIONS: The investigators surveyed consider that biomedical research in recent decades in the hospital setting has significantly improved and has had a positive effect in the number of publications. The subjects surveyed consider that research should have greater institutional support and recognition, and a more translational orientation, which would be translated into better quality of life of the citizens and registry of patents.

[Adverse events related to medication in hospitals from the Valencian Community. EPIDEA Study 2005-2013]. / Eventos adversos relacionados con la medicación en los hospitales de la Comunidad Valenciana. Estudio EPIDEA 2005-2013.

OBJECTIVE: To determine the prevalence of Adverse Events related to Medication (AEM) in hospitals of the Valencian Community in the 2005-2013 study period, and to describe the associated risk factors and their impact. METHODS: This study is based on data and methodology of the Study of Prevalence of Adverse Events in hospitals (EPIDEA), since its inception in 2005 until 2013. AEM produced in each year were analyzed. RESULTS: We identified 344 AEM that occurred in 337 patients, among 35,103 patients studied, giving a prevalence of patients with AEM of 0.96% (IC95% 0.89-1.07). The most prevalent intrinsic risk factors for AEM were hypertension, diabetes and cancer. The most prevalent extrinsic risk factors were peripheral venous catheter, urinary catheter and central venous catheter. Therapeutic groups most frequently involved were systemic antibiotics, cardiovascular drugs and antineoplastics. The 61.17% of AEM was classified as moderate, followed by 27.18% as mild and 11.65% as severe. The 33.99% of EAM caused increase of the patient's stay and 39.90% of EAM caused the re-entry of patient. The 58.5% of AEM were avoidable. Mild AEM were avoidable in 46.3%, moderate AEM were avoidable in 60.3% and severe AEM were in 75% (p = 0.013). CONCLUSIONS: The prevalence of patients with AEM in hospitals of the Community of Valencia for the period 2005- 2013 was 0.96%. More than half of AEM were preventable, and preventability increases significantly with the severity of the event.

Serum alpha-tocopherol concentration in relation to subsequent colorectal cancer: pooled data from five cohorts.

BACKGROUND: Vitamin E is an antioxidant that inhibits mutagenesis and cell transformation. Previous findings in five prospective epidemiologic studies suggested that the level of serum alpha-tocopherol, the predominant form of vitamin E in the blood, was lower in subjects who subsequently developed colorectal cancer than in control subjects. However, the difference was neither obvious nor statistically significant in any one of these five studies. PURPOSE: To evaluate in greater detail the association between serum alpha-tocopherol concentration and risk of colorectal cancer, we pooled and analyzed the original data from the five studies. Our analyses were designed to (a) test the hypothesis with greater statistical power, (b) examine the association after adjustment for serum cholesterol levels, and (c) evaluate the association after uniform exclusion of cases diagnosed shortly after blood specimens were drawn. METHODS: Data for individual subjects were analyzed. To make the design of the component investigations uniformly nested case-control studies with individual matching, we matched controls to cases in two of the cohorts. Subjects were categorized according to study-specific quartile of serum alpha-tocopherol level within the study. The pooled analysis included 289 cases of colorectal cancer and 1267 matched controls. RESULTS: For cancers of the colon and rectum combined, the matched odds ratio (OR) for the highest quartile of serum alpha-tocopherol concentration compared with the lowest was 0.6 (95% confidence interval [CI] = 0.4-1.0). Adjustment for serum cholesterol level attenuated the OR to 0.7 (95% CI = 0.4-1.1). CONCLUSION: The results suggest that serum alpha-tocopherol concentration may be inversely related to risk of colorectal cancer. It is unclear whether an association exists, however, because the association between serum alpha-tocopherol level and decreased risk of colorectal cancer was modest, the CIs were wide, and, overall, the tests for trend in effect were not significant. IMPLICATIONS: Larger observational studies with concurrent dietary data are needed to determine whether vitamin E has a modest but potentially important protective effect against colorectal cancer.

Tissue stores of individual monounsaturated fatty acids and breast cancer: the EURAMIC study. European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer.

The strongest evidence that monunsaturated fat may influence breast cancer risk comes from studies of southern European populations, in whom intake of oleic acid sources, particularly olive oil, appears protective. No previous study has examined the relation of adipose tissue fatty acid content to breast cancer in such a population. We used adipose biopsies with diverse fat intake patterns gathered in 5 European centers, including southern Europe (Malaga, Spain), to test the hypothesis that stores of oleic acid or other monounsaturates are inversely associated with breast cancer. Gluteal fat aspirates were obtained from 291 postmenopausal incident breast cancer patients and 351 control subjects, frequency-matched for age and catchment area. Logistic regression was used to model breast cancer by monounsaturates, with established risk factors controlled for. Oleic acid showed a strong inverse association with breast cancer in the Spanish center. The odds ratio for the difference between 75th and 25th percentiles was 0.40 (95% CI: 0.28, 0.58) in Malaga and 1.27 (0.88, 1.85) in all other centers pooled, with a peak at 2.36 (1.01, 5.50) for Zeist. Palmitoleic and myristoleic acids showed evidence of an inverse association outside Spain, and cis-vaccenic acid showed a positive association in 3 centers. These data do not support the hypothesis that increasing tissue stores of oleic acid are protective against breast cancer in non-Spanish populations. This finding implies that the strong protective associations reported for olive oil intake in dietary studies may be due to some other protective components of the oil and not to the direct effect of oleic acid uptake. Alternatively, high olive oil intake may indicate some other protective aspect of the lifestyle of these women.

Tissue antioxidants and postmenopausal breast cancer: the European Community Multicentre Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC).

Antioxidants may protect against free radical mediated carcinogenesis. Epidemiological studies have not confirmed this hypothesis for breast cancer, possibly because of methodological limitations. Time-integrated exposure of alpha-tocopherol and beta-carotene in adipose tissue, and selenium in toenails was investigated in a case-control study among postmenopausal women, ages 50-74 years, from five European countries. The study group comprised 347 incident breast cancer cases and 374 controls. Mean antioxidant levels, adjusted for age and center, did not significantly differ for alpha-tocopherol (cases were 4.5% higher than controls), beta-carotene (3.0% lower), or selenium (1.8% lower). Odds ratios for highest versus lowest tertiles of exposure, adjusted for potential confounders, were 1.15 (95% confidence interval, 0.75-1.77), 0.74 (0.45-1.23), and 0.96 (0.63-1.47), respectively, without evidence for a decreasing trend. No statistically significant interactions were observed. Moreover, a provisional antioxidant score, indicating whether concentrations were above the median for zero, one, two, or all three antioxidants, yielded odds ratios of 1.00 (reference; all below median), 1.58, 1.58, and 1.21, respectively (chi2 for association = 4.00; P = 0.26). These results do not support the hypothesis that antioxidants are important determinants of this hormone-related malignancy among postmenopausal women.

Adipose tissue trans fatty acids and breast cancer in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer.

To investigate the relationship between trans fatty acids and postmenopausal breast cancer in European populations differing greatly in their dietary fat intakes, a case control study using adipose tissue stores of trans fatty acids as a biomarker of exposure was conducted. Subjects included 698 postmenopausal incident cases of primary breast cancer and controls randomly drawn from local population and patient registries, ages 50-74 Concentrations of individual trans fatty acids in gluteal fat biopsies were measured in these women. The adipose concentration of trans fatty acids showed a positive association with breast cancer. The covariate-adjusted association with breast cancer. The covariate-adjusted OR was 1.40 (95% confidence interval: 1.02, 1.93) for the difference between the 75th and 25th percentiles of total adipose trans. The adjusted OR for trans in the lowest tertile of polyunsaturated fatty acid reached 3.6 (2.2, 6.1). These associations were not attributable to differences in age, body mass index, exogenous hormone use, or socioeconomic status. These findings suggest an association of adipose stores of trans fatty acids with postmenopausal breast cancer in European women. They require confirmation in other populations, with concomitant consideration of the potential roles of dietary saturated and monounsaturated fats.

Recent transmission of tuberculosis in Madrid: application of capture-recapture analysis to conventional and molecular epidemiology.

BACKGROUND: Population-based studies using a combination of molecular techniques and conventional epidemiological methods have been used to study the dynamics of tuberculosis (TB) transmission but the relative utility of each technique has not yet been established. METHODS: A prospective population-based molecular and epidemiological study of patients diagnosed with TB was conducted in three urban districts of Madrid (Spain) during 1997-1999. Analysis was performed using the capture-recapture method including covariates in which conventional epidemiological data and the information on clustered cases obtained by DNA fingerprinting were regarded as independent and complementary procedures. RESULTS: The estimate obtained by molecular analysis alone, that 31.6% of TB cases were due to recent transmission, was revised to 44.8% (95% CI: 31.4-58.2) using the capture-recapture method. The estimated completeness of the combined databases for identification of recent transmission was 59.2%. Underestimation of the true prevalence of recent transmission was higher with conventional epidemiology than molecular analysis, particularly for patients <35 years old and those with a history of imprisonment. CONCLUSIONS: In this study, use of the capture-recapture technique allowed us to combine epidemiological information obtained by conventional and molecular methods to quantify the number of cases of recently transmitted TB in the community and identify specific populations at high risk of disease. This information is clearly important because such groups are a prime target for improved TB control measures. In the long term, this combination of techniques may contribute significantly to control the spread of TB.

Development and validation of a food frequency questionnaire in Spain.

To create a suitable instrument to estimate intakes of total calories, protein, carbohydrate, fats (saturated, mono and polyunsaturated), alcohol, cholesterol, fibre, vitamin A and vitamin C in epidemiological studies conducted in Spain, a food frequency questionnaire was developed and tested. In particular, the questionnaire was designed to be used in a large population-based case-control study of dietary factors in relation to breast and colorectal cancer among women from different Spanish regions. After identifying the most important food sources of the relevant nutrients in the study population, the final version of the questionnaire asked about consumption of 118 food items. Its reproducibility and validity were tested among 147 Spanish women aged 18-74 years. These subjects were asked to complete the questionnaire before and after completing four 4-day food records. The records were obtained at 3-month intervals designed to represent daily and seasonal changes (between 1990 and 1991). Using the information available from standard Spanish food composition tables, an ad hoc computer program was created to translate food consumption into nutrient intake. The reproducibility of the questionnaire was assessed by means of estimating correlations between nutrient scores measured with the same instrument twice, with a period of 1 year between estimates. Pearson correlation coefficients ranged from 0.51 for saturated fat to 0.88 for alcohol. In the validity study, correlation coefficients between diet records and the first and second questionnaires ranged between r = 0.20 for vitamin A and r = 0.88 for alcohol.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical assay of N-duopropenide alcohol solution on hand application in newborn and pediatric intensive care units: control of an outbreak of multiresistant Klebsiella pneumoniae in a newborn intensive care unit with this measure.

Outbreaks of gram-negative colonization (generally by antibiotic-resistant enterobacteria) are common in newborn intensive care units (NICUs), and control methods are not always effective. We studied the effectiveness of an alcohol solution of N-duopropenide (NDP) in vivo (germicidal effect on flora of teams in the NICU and the pediatric intensive care unit vs handwashing with nonantiseptic soap) and its effect on the control of a multiresistant (MR) Klebsiella pneumoniae outbreak in our NICU that had persisted for 13 months, despite the use of classic control measures. For educational purposes, we also performed 4 prevalence studies of microbial hand flora in NICU staff (two before and two after introducing NDP). The alcohol solution of NDP was highly germicidal in vivo, destroying microorganisms better than classic handwashing on the hands of 69 health care staff of our NICU and PICU. The flora in both units was reduced from an average of 63% to an average of 95%. Application of this disinfectant to the hands of health care workers after handling newborns helped to eliminate the MR Klebsiella strain in our NICU, (relative risk compared with the period preceding use of the disinfectant: 8.6, with 95% confidence intervals, 4.8-145.5). Four prevalence studies of hand microbial contamination, before and after NDP introduction in the NICU, showed a significant reduction of enterobacteriaceae, mainly MR K pneumoniae, in health care workers. In conclusion, NDP in alcohol was very effective in vivo. It proved to be a useful complementary measure to handwashing and reduced exogenous microorganism transmission in a unit with a heavy patient-care workload.

Determinants of self assessed health among Spanish older people living at home.

STUDY OBJECTIVE: To identify the main determinants of self assessed health among community dwelling elderly. PARTICIPANTS AND SETTING: A representative sample of 677 people aged 65 and over of the city of Madrid, Spain. DESIGN: Cross sectional study. Information was collected through personal interviews at the homes of the selected subjects. The five category dependent variable was grouped into two categories: good and poor self assessed health. Age, sex, social class, use of physician services, number of chronic conditions, and functional capacity, were included as main explanatory factors. Adjusted odds ratios were estimated through multiple logistic regression models. MAIN RESULTS: A total of 49.5% of subjects rated their health as good or very good. Those aged 85 and over rated their health higher than those aged 65-74 (adjusted odds ratio (OR): 0.37; 95% confidence intervals (CI): 0.18, 0.77). The adjusted OR for an increase of three chronic conditions was 3.48 (95% CI: 2.49, 4.85). Functional capacity also showed a strong independent effect (OR: 3.64; 95% CI: 1.89, 7.02). Social class was one of the main determinants for the youngest group, with those in the upper class reporting a better health perception (OR: 3.28 95% CI: 1.70, 6.35), but showed no effect in the oldest old (OR: 1.05; 95% CI: 0.57, 1.96). CONCLUSIONS: Age, chronic conditions, and functional status were the main determinants of perceived health among Spanish elderly. The effect of social class on perceived health markedly decreases with age. This study may contribute to a better utilisation and interpretation of self ratings in research and in general practice.

Spanish children's diet: compliance with nutrient and food intake guidelines.

OBJECTIVE: To compare the diet of Spanish children against the nutrient and food intake guidelines. To calculate an index of overall diet quality and check its validity against nutrient intake. DESIGN AND SETTING: Cross-sectional study in four cities in Spain, where information on food and nutrient intake was obtained from schoolchildren through a food frequency questionnaire. PARTICIPANTS: The sample included 1112 children (overall response rate of 85%) attending public and private schools and aged 6-7 y. Children were selected through random cluster sampling in schools, and stratified by sex and socioeconomic level. MAIN OUTCOME MEASURES: Mean nutrient intake, number of food servings, and the percentage of children who meet recommended nutrient and food-serving intake levels. The overall dietary quality was assessed using the Healthy Eating Index (HEI). RESULTS: Mean micronutrient intake exceeded 100% of the recommended dietary allowances, except for vitamin B6, which registered a mean intake of 77.1%. For almost all children, intake of saturated fat was above, and that of carbohydrate below, the recommended level, in contrast to the relatively high compliance with the recommendations for poly- and monounsaturated fatty acid, salt and fiber intake (69.7, 43.7, 40.7, and 30.1%, respectively). Consumption of food servings for each of the five American pyramid food groups came close to or exceeded USDA guidelines, with the exception of cereals, with 5.4 servings per day. The mean score obtained in the HEI was 64.6. Children who complied with all the food guide pyramid recommendations registered a higher dietary variety and a healthier nutritional profile. CONCLUSIONS: Children aged 6-7 y show scant compliance with the macronutrient goals for healthy eating. Micronutrient intake is adequate in general, yet there are small groups of children with risk of deficient intake of vitamins B6 and D. While Spanish children's eating habits are reasonably in line with American food guide pyramid guidelines, consumptions of cereals and fruit should be improved.

Dietary patterns among children aged 6-7 y in four Spanish cities with widely differing cardiovascular mortality.

OBJECTIVE: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING: Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES: Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP: This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.

EURAMIC Study: antioxidants, myocardial infarction and breast cancer. Design and main hypotheses.

Epidemiological studies have not given sufficient evidence yet for the role of antioxidant nutrients in the prevention of cardiovascular disease. As regards cancer, an inverse association between beta-carotene intake and specific types of cancer, especially lung cancer, has been shown. For other cancer sites and other antioxidants, the association is less clear. The EURAMIC Study, an EC Concerted Action, is a case-control study conducted in 11 countries, in which the combined effect of vitamin E, beta-carotene and selenium, in relation to fatty acid intake, will be examined. The disease endpoints are acute myocardial infarction and early-stage breast cancer. The broad range of antioxidant intake, the use of biomarkers of exposure, and the analysis of pooled data will allow an estimate of the strength of the putative beneficial effect. In this paper the background and design of the study will be introduced.

Alcohol intake and risk of breast cancer: the euramic study.

To evaluate the association of alcohol intake with the risk of breast cancer in post-menopausal women, we analyzed the data from an international case-control study conducted in five European countries (FRG, Switzerland, Northern Ireland, the Netherlands and Spain). Information on alcohol intake was available in 315 cases and 364 controls. Medians for the tertiles of alcohol intake among current drinkers were 1.7, 6.0, and 20.0 g/day. Adjusted relative risks (and 95% confidence intervals) of breast cancer for each tertile of intake in current drinkers, compared to never drinkers, were 1.00 (0.60-1.67), 1.01 (0.60-1.73), and 1.18 (0.69-2.03). The adjusted relative risk for ex-drinkers was 1.73 (1.07-2.79). Among both current drinkers and ex-drinkers, the relative risk was higher for those with body mass index above the median compared to those with body mass index below the median. These results do not support a dose-response effect of alcohol on breast cancer risk, although consumption levels were too low to exclude increased risk with high regular intake. Further research is necessary to evaluate the risk of developing breast cancer among ex-drinkers and the potential interaction between body mass index and alcohol drinking.

[Methods of investigation in clinical cardiology. VIII. Meta-analysis and systematic reviews in cardiology]. / Métodos de investigación en cardiología clínica (VII). Metaanálisis y revisiones sistemáticas en cardiología.

Over the last 20 years, the development of meta-analysis has been aimed at obtaining objective synthesis of the available results on specific research questions. The main achievements of meta-analysis include the application of techniques to perform systematic literature searches and to obtain unbiased selection of studies, data extraction and pooled estimates of effect. This paper discusses the methodologic steps to follow when conducting a meta-analysis, with emphasis on study selections, data collection and statistical methods to combine the results from individual studies. We also present a set of guided questions as an aid to critically evaluate the conclusions of published meta-analyses. The application of meta-analytic techniques to cardiology is illustrated using a meta-analysis of the randomized controlled trials of angioplasty versus bypass surgery in the management of patients with ischemic heart disease.

[Meta-analysis: its role in clinical decision making in cardiology]. / Metaanálisis: su importancia en la toma de decisiones clínicas en cardiología.

Clinical decision-making in cardiology requires accurate estimates of the efficacy of diagnostic and therapeutic procedures. Defined as the quantitative integration of results from different studies on the same scientific question, meta-analyses are well-suited to summarize the evidence on the efficacy of clinical interventions. Meta-analyses aim at obtaining combined estimates of effect using all relevant information in a systematic fashion, complementing narrative reviews and expert committee reports. In this paper, the advantages and limitations of meta-analyses and their usefulness in clinical decision making in cardiology are illustrated using three recent examples in the literature--i.e., use of beta-blockers in secondary prevention of ischemic heart disease, intravenous streptokinase in acute myocardial infarction and fish intake in primary prevention of cardiovascular mortality. The steps to follow when conducting a meta-analysis are also discussed. Finally, a list of the most important meta-analyses in cardiology published to date is included for easy reference.