Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes.

OBJECTIVE: To investigate the association of maternal circulating 25-hydroxyvitamin D3 [25(OH)D3] concentration with pregnancy and birth outcomes. DESIGN: Prospective cohort study. SETTING: Four geographical areas of Spain, 2003-2008. POPULATION: Of 2382 mother-child pairs participating in the INfancia y Medio Ambiente (INMA) Project. METHODS: Maternal circulating 25(OH)D3 concentration was measured in pregnancy (mean [SD] 13.5 [2.2] weeks of gestation). We tested associations of maternal 25(OH)D3 concentration with pregnancy and birth outcomes. MAIN OUTCOME MEASURES: Gestational diabetes mellitus (GDM), preterm delivery, caesarean section, fetal growth restriction (FGR) and small-for-gestational age (SGA), anthropometric birth outcomes including weight, length and head circumference (HC). RESULTS: Overall, 31.8% and 19.7% of women had vitamin D insufficiency [25(OH)D3 20-29.99 ng/ml] and deficiency [25(OH)D3 < 20 ng/ml], respectively. After adjustment, there was no association between maternal 25(OH)D3 concentration and risk of GDM or preterm delivery. Women with sufficient vitamin D [25(OH)D3 ≥ 30 ng/ml] had a decreased risk of caesarean section by obstructed labour compared with women with vitamin D deficiency [relative risk (RR) = 0.60, 95% CI 0.37, 0.97). Offspring of mothers with higher circulating 25(OH)D3 concentration tended to have smaller HC [coefficient (SE) per doubling concentration of 25(OH)D3, -0.10 (0.05), P = 0.038]. No significant associations were found for other birth outcomes. CONCLUSION: This study did not find any evidence of an association between vitamin D status in pregnancy and GDM, preterm delivery, FGR, SGA and anthropometric birth outcomes. Results suggest that sufficient circulating vitamin D concentration [25(OH)D3 ≥ 30 ng/ml] in pregnancy may reduce the risk of caesarean section by obstructed labour.

Alcohol intake and the risk of coronary heart disease in the Spanish EPIC cohort study.

BACKGROUND: The association between alcohol consumption and coronary heart disease (CHD) has been widely studied. Most of these studies have concluded that moderate alcohol intake reduces the risk of CHD. There are numerous discussions regarding whether this association is causal or biased. The objective of this paper is to analyse the association between alcohol intake and CHD risk in the Spanish cohort of the European Prospective Investigation into Cancer (EPIC). METHODS: Participants from the EPIC Spanish cohort were included (15 630 men and 25 808 women). The median follow-up period was 10 years. Ethanol intake was calculated using a validated dietary history questionnaire. Participants with a definite CHD event were considered cases. A Cox regression model adjusted for relevant co-variables and stratified by age was produced. Separate models were carried out for men and women. RESULTS: The crude CHD incidence rate was 300.6/100 000 person-years for men and 47.9/100 000 person-years for women. Moderate, high and very high consumption was associated with a reduced risk of CHD in men: hazard ratio 0.90 (95% CI 0.56 to 1.44) for former drinkers, 0.65 (95% CI 0.41 to 1.04) for low, 0.49 (95% CI 0.32 to 0.76) for moderate, 0.46 (95% CI 0.30 to 0.71) for high and 0.50 (95% CI 0.29 to 0.85) for very high consumers. A negative association was found in women, with p values above 0.05 in all categories. CONCLUSIONS: Alcohol intake in men aged 29-69 years was associated with a more than 30% lower CHD incidence. This study is based on a large prospective cohort study and is free of the abstainer error.

Incidence of acute myocardial infarction in the Spanish epic cohort.

BACKGROUND: There is some evidence that Mediterranean diet reduces risk of ischemic heart disease, and this is to be investigated in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). In this paper we present the incidence of acute myocardial infarction (AMI) in four EPIC Spanish cohorts. METHOD: Incidence cases were ascertained in EPIC cohort during the follow up period (from recruitment to the end of 2004), by means of self-report questionnaires, hospital morbidity and mortality registries, and population AMI registries. Analysis was restricted to aged 45 to 74. The present study included data from 13,704 women and 19,410 men, after excluding a priori participants with prevalent AMI. Age standardized incidence rate for each cohort was estimated and compared with the available population rates. RESULTS: The Median duration of follow-up was 9.3 years, yielding a total of 297,704 person-years. 391 men and 99 women presented AMI in the four cohorts studied. Age standardized AMI rates in men of the EPIC cohorts go from the lowest 302 (CI: 268-335) per 100.000 person-year of Gipuzkoa to the highest 330 (CI: 293-367) of Navarra. Women in Navarra presented the lowest AMI incidence with 60 (CI: 43-77) per 100,000 and the highest was observed in Murcia (114, CI: 91-137). The AMI incidence in all EPIC centres are close to the population incidence rates and in any case these are within the EPIC 95% CI. CONCLUSIONS: The comparison of incidence in EPIC with population rates shows very good agreement for acute myocardial infarction.

Incidencia de infarto agudo de miocardio en la cohorte EPIC España / Incidence of acute myocardial infarction in the Spanish epic cohort

Background. There is some evidence that Mediterraneandiet reduces risk of ischemic heart disease, and this is to beinvestigated in the Spanish cohort of the European ProspectiveInvestigation into Cancer and Nutrition (EPIC). In thispaper we present the incidence of acute myocardial infarction(AMI) in four EPIC Spanish cohorts.Method. Incidence cases were ascertained in EPIC cohortduring the follow up period (from recruitment to the end of2004), by means of self-report questionnaires, hospital morbidityand mortality registries, and population AMI registries.Analysis was restricted to aged 45 to 74. The presentstudy included data from 13,704 women and 19,410 men,after excluding a priori participants with prevalent AMI. Agestandardized incidence rate for each cohort was estimatedand compared with the available population rates.Results. The Median duration of follow-up was 9.3 years, yieldinga total of 297,704 person-years. 391 men and 99 womenpresented AMI in the four cohorts studied. Age standardizedAMI rates in men of the EPIC cohorts go from the lowest 302(CI: 268-335) per 100.000 person-year of Gipuzkoa to the highest330 (CI: 293-367) of Navarra. Women in Navarra presentedthe lowest AMI incidence with 60 (CI: 43-77) per 100,000 andthe highest was observed in Murcia (114, CI: 91-137). The AMIincidence in all EPIC centres are close to the population incidencerates and in any case these are within the EPIC 95% CI.Conclusions. The comparison of incidence in EPIC with populationrates shows very good agreement for acute myocardial infarction(AU)

Antedecentes. Existen evidencias que sugieren que la dietamediterránea reduce el riesgo de enfermedad cardiaca isquémicay esta asociación va a ser investigada en la cohorteespañola del “Estudio europeo sobre cáncer y nutrición”(EPIC). En este artículo se presenta la incidencia de infartoagudo de miocardio (IAM) en 4 de las cohortes españolas.Método. Los casos incidentes de IAM fueron identificadosen la cohorte EPIC durante el periodo de seguimiento (delreclutamiento a finales de 2004), mediante un cuestionarioautorreportado, el registro de altas hospitalarias y de mortalidady registros poblacionales de IAM. El análisis se centróen el grupo de 45 a 74 años de edad. El estudio incluyó cuatrocohortes compuestas de 13.704 mujeres and 19.410 hombres,tras la exclusión a priori de participantes con IAM prevalentes.Se estimó la tasa de incidencia ajustada por edad paracada cohorte, y se comparó con las tasas poblacionales disponibles.Resultados. La duración mediana del seguimiento fue de9,3 años, que aportó un total de 297.704 personas-año. 391hombres and 99 mujeres presentaron IAM en las 4 cohortesestudiadas. Las tasas ajustadas por edad de IAM, en hombres,en las cohortes EPIC se movieron entre los 302 (CI:268-335) casos por 100.000 personas-año de Gipuzkoa, lamenor tasa observada, hasta los 330 (CI: 293-367) de Navarra.Las mujeres navarras presentaron las tasas más bajasde IAM con unas cifras de 60 (CI: 43-77) casos por 100.000,mientras que las mujeres murcianas presentaron las tasasmás altas (114, CI: 91-137). La incidencia de IAM en todaslas regiones EPIC fué similar a la incidencia poblacional conocidade dichas regiones, o bien se mantienen dentro delintervalo de confianza la 95%.Conclusiones. La incidencia de la cohorte EPIC muestragran concordancia con las tasas poblaciones disponiblespara el IAM(AU)

Female breast cancer in Gipuzkoa: prognostic factors and survival.

BACKGROUND: In Gipuzkoa, screening for breast cancer was initiated in 1997 and in this paper we present breast cancer characteristics and survival for women diagnosed during the pre-screening period. METHODS: All cases diagnosed during 1995-1996 were included and the tumour characteristics were analysed. One-, five- and ten-year observed and relative survival (RS) were estimated overall, as well as by age and tumour characteristics. Multiple regression models were used to evaluate the effect of tumour characteristics on ten-year RS. RESULTS: Six hundred and twenty-two cases with a mean age of 60.7+/-15 years were included. The mean follow-up was 7.5 years (max. 10) with a mortality of 40.5%. Ductal carcinoma accounted for 78% of all cases; almost 50% had good or moderate differentiation and 28% were positive for both hormone receptors studied. Nearly 80% of cases were diagnosed in stage I or II and breast-conserving surgery was employed more often than mastectomy. Age-standardised RS was 77% (95% CI 72.1-82.3) and 68% (95% CI 60.4-74.6), five and ten years after diagnosis respectively. The relative excess risk of death was significantly different only for age, stage and degree of differentiation. DISCUSSION: This study shows an increase in survival compared to previous studies in the region. This could be explained by advances in diagnosis and treatment, as demonstrated by younger age and earlier stage at diagnosis and by the therapy profiles. Age and stage were shown to be major predictors of survival in our study and adjustment for the other factors had only limited effects on the risk of death for these two variables.

Female breast cancer in Gipuzkoa: prognostic factors and survival

BACKGROUND: In Gipuzkoa, screening for breast cancer was initiated in 1997 and in this paper we present breast cancer characteristics and survival for women diagnosed during the pre-screening period. METHODS: All cases diagnosed during 1995-1996 were included and the tumour characteristics were analysed. One-, five- and ten-year observed and relative survival (RS) were estimated overall, as well as by age and tumour characteristics. Multiple regression models were used to evaluate the effect of tumour characteristics on ten-year RS. RESULTS: Six hundred and twenty-two cases with a mean age of 60.7+/-15 years were included. The mean follow-up was 7.5 years (max. 10) with a mortality of 40.5%. Ductal carcinoma accounted for 78% of all cases; almost 50% had good or moderate differentiation and 28% were positive for both hormone receptors studied. Nearly 80% of cases were diagnosed in stage I or II and breast-conserving surgery was employed more often than mastectomy. Age-standardised RS was 77% (95% CI 72.1-82.3) and 68% (95% CI 60.4-74.6), five and ten years after diagnosis respectively. The relative excess risk of death was significantly different only for age, stage and degree of differentiation. DISCUSSION: This study shows an increase in survival compared to previous studies in the region. This could be explained by advances in diagnosis and treatment, as demonstrated by younger age and earlier stage at diagnosis and by the therapy profiles. Age and stage were shown to be major predictors of survival in our study and adjustment for the other factors had only limited effects on the risk of death for these two variables (AU)

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Guía de actuación ante Staphylococcus aureus resistente a meticilina (SARM) en centros gerontológicos, sociosanitarios y unidades de media-larga estancia / Practice guidelines in methicillin-resistant Staphylococcus aureus in gerontological centres, nursing homes and medium to long-term care units

Staphylococcus aureus es una bacteria muy ubicua que se encuentra en las fosas nasales de hasta en un 30 por ciento de adultos sanos y con frecuencia coloniza también la piel (especialmente los pliegues cutáneos). Es capaz de causar gran cantidad de infecciones, sobre todo en la piel y las partes blandas (infección de heridas quirúrgicas, abscesos, etc.). La patogenicidad de las cepas de S. aureus resistente a meticilina (SARM) es muy similar a las no resistentes. En los centros gerontológicos de Gipuzkoa, la mitad de los estafilococos aislados fueron SARM en el año 2002.El mecanismo de transmisión más frecuente es a través de las manos contaminadas del personal sanitario/auxiliar que no hace un correcto lavado de éstas entre la atención a diferentes residentes. El lavado de manos es la medida más importante y eficaz para reducir los riesgos de transmisión, y debe aplicarse en el manejo de todos los residentes. El uso de guantes no suple dicha medida. No está justificado el rechazo de una persona colonizada por SARM en ningún centro o recurso social, ya que su presencia no supone en la práctica un riesgo de contagio para el resto de las personas, si se siguen unas medidas higiénicas adecuadas. La persona colonizada por SARM (excepto si es de alto riesgo: con úlceras importantes, alteraciones de la conducta o colonización respiratoria) puede compartir habitación con otro residente con el mismo microorganismo multirresistente (sin agrupar los de localización dérmica con los de localización respiratoria), o con otra persona no colonizada que no tenga úlceras, heridas, catéteres, drenajes ni sondas. La persona colonizada por SARM puede utilizar áreas comunes, debiendo guardar una higiene adecuada. Si es incontinente, se recomienda la colocación de un pañal limpio antes de la utilización de dicho espacio. En caso de heridas o úlceras colonizadas, éstas deben estar cubiertas con un apósito seco. No hay que tratar con antibióticos a las personas colonizadas por SARM. No se consigue la erradicación ni se reduce la transmisión, ni tampoco la enfermedad ni la mortalidad. Sin embargo, se selecciona un mayor número de resistencias antibióticas. La persona infectada por SARM será trasladada, a criterio médico, a un centro sanitario. La persona infectada por SARM o colonizada de alto riesgo (con úlceras importantes, alteraciones de la conducta o colonización respiratoria), si no es trasladada a un centro sanitario, puede compartir habitación con otra con la misma infección (excepto si es de localización respiratoria) o, en última instancia, con otra persona no colonizada que no tenga úlceras ni heridas, catéteres, drenajes, sondas ni esté inmunodeprimida. Sin embargo, no debería utilizar áreas comunes y las visitas serán restringidas. No es necesario realizar controles sistemáticos entre el personal sanitario que atiende a las personas colonizadas/infectadas por SARM. El personal dedicado al traslado de éstas deberá aplicar las precauciones estándar (AU)

Interruption of measles transmission in Gipuzkoa (Basque Country), Spain.

Measles vaccine was introduced in Gipuzkoa (Basque country, Spain) in 1978 and was replaced by the measles, mumps, and rubella (MMR) vaccine for children aged 12-15 months in 1981. A second dose of the MMR vaccine was introduced in 1992. Both doses of the MMR vaccine were well accepted by the population and high coverage was achieved (95% and 91% for the first and second doses respectively for the period 1993-2002). Measles virus circulation was interrupted in the second half of the 1990s: no cases of indigenous measles were notified between 1998 and 2003, and only imported cases have been confirmed during this period. These data indicate that the measles vaccination programme implemented has been effective. Nevertheless, to avoid measles outbreaks following viral introduction, high MMR vaccine coverage levels for the two doses have to be maintained (>95%).

Interruption of measles transmission in Gipuzkoa (Basque Country), Spain.

Measles vaccine was introduced in Gipuzkoa (Basque country, Spain) in 1978 and was replaced by the measles, mumps, and rubella (MMR) vaccine for children aged 12-15 months in 1981. A second dose of the MMR vaccine was introduced in 1992. Both doses of the MMR vaccine were well accepted by the population and high coverage was achieved (95% and 91% for the first and second doses respectively for the period 1993-2002). Measles virus circulation was interrupted in the second half of the 1990s: no cases of indigenous measles were notified between 1998 and 2003, and only imported cases have been confirmed during this period. These data indicate that the measles vaccination programme implemented has been effective. Nevertheless, to avoid measles outbreaks following viral introduction, high MMR vaccine coverage levels for the two doses have to be maintained (>95%).

Mumps outbreak in vaccinated children in Gipuzkoa (Basque Country), Spain.

A mumps outbreak occurred in a group of vaccinated children aged 3-4 years in San Sebastián (Gipuzkoa, Basque Country, Spain) in 2000 during the same period as a revaccination campaign against measles-mumps-rubella (MMR) was performed. The clinical cases were confirmed by viral culture, detection of viral RNA and/or specific IgM. Eighty-eight percent of the children had been vaccinated with the Rubini strain and the remainder with the Jeryl-Lynn strain. The attack rate was 47.9% (35 cases in 73 school-attending children of this age). The outbreak was caused by an H genotype strain of mumps virus which was circulating at the same time as a D genotype strain that caused sporadic cases. By sequencing the small hydrophobic (SH) gene, the strains of the clinical cases were identified as wild-type mumps virus with heterologous genotypes in comparison to the vaccine strains used in our area.