Geographical Variability in Mortality in Urban Areas: A Joint Analysis of 16 Causes of Death.

The geographical distribution of mortality has frequently been studied. Nevertheless, those studies often consider isolated causes of death. In this work, we aim to study the geographical distribution of mortality in urban areas, in particular, in 26 Spanish cities. We perform an overall study of 16 causes of death, considering that their geographical patterns could be dependent and estimating the dependence between the causes of death. We study the deaths in these 26 cities during the period 1996-2015 at the census tract level. A multivariate disease mapping model is used in order to solve the potential small area estimation problems that these data could show. We find that most of the geographical patterns found show positive correlations. This suggests the existence of a transversal geographical pattern, common to most causes of deaths, which determines those patterns to a higher/lower extent depending on each disease. The causes of death that exhibit that underlying pattern in a more prominent manner are chronic obstructive pulmonary disease (COPD), lung cancer, and cirrhosis for men and cardiovascular diseases and dementias for women. Such findings are quite consistent for most of the cities in the study. The high positive correlation found between geographical patterns reflects the existence of both high and low-risk areas in urban settings, in general terms for nearly all the causes of death. Moreover, the high-risk areas found often coincide with neighborhoods known for their high deprivation. Our results suggest that dependence among causes of death is a key aspect to be taken into account when mapping mortality, at least in urban contexts.

[Magnitude and factors associated with the solitary death phenomenon of the elderly in the Valencian Community.] / Magnitud y factores asociados al fenómeno de la muerte solitaria del anciano en la Comunidad Valenciana.

OBJECTIVE: In the Valencian Community 23% of the elderly people live alone, representing the solitary death among aged persons an unwanted effect of aging. Our aim was to determine the magnitude of this phenomenon and its risk factors in the population over 64 years of the CV during the period 2015-2017. METHODS: Cross-sectional study was carried out. Household deaths of residents over 64 years of the CV during the 2015-2017 period were analyzed, with records on medical and judicial death certificates. Adjusted incidence rates, sociodemographic characteristics and causes of death were described. For the analysis of risk factors, a multivariate logistic regression was performed, taking the adjusted Odds Ratio (OR) as an association measure. A significance level α=0.05 and 95% confidence intervals (CI) were used. RESULTS: 417 cases were found. The adjusted rates were: in 2015, 17.3 (95% CI: 14.7-20.2); in 2016, 14.5 (95% CI: 12.1-17.2); and in 2017, 13.2 (95% CI: 11,0-15.8). The most frequent causes were circulatory (52.5%) and external (19.2%). After adjustment, gender (OR M / H: 2.40; 95% CI: 1.87-3.06), age (OR ≥76 / <76: 4.56; 95% CI: 3.53 -5.90), disability (OR No / Yes: 0.51; 95% CI: 0.31-0.85), season (ref: spring; summer OR: 2.34; 95% CI: 1.63-3 , 37) and population nucleus (rural / urban OR: 2.20; 95% CI 1.58-3.08), remained associated whit the MSA. CONCLUSIONS: The solitary death among aged persons is a phenomenon scarcely studied in our environment from public health. The magnitude in the CV is relevant, with a greater risk in men and at younger ages, as well as in summer and urban areas. Presenting disability represents a certain protection.

OBJETIVO: En la Comunidad Valenciana un 23% de los ancianos viven solos, representando la muerte solitaria del anciano un efecto indeseado del envejecimiento. Nuestro objetivo fue determinar la magnitud de este fenómeno y sus factores de riesgo en la población mayor de 64 años de la CV durante el período 2015-2017. METODOS: Estudio observacional, transversal. Se analizaron las defunciones domiciliarias de residentes mayores de 64 años de la CV durante el período 2015-2017, con datos de los certificados médicos y judiciales de defunción. Se describieron las tasas de incidencia ajustadas, características sociodemográficas y causas de muerte. Para el análisis de factores de riesgo se realizó una regresión logística multivariante tomando como medida de asociación la Razón de Odds (OR) ajustada. Se usó un nivel de significación α=0,05 y unos IC del 95%. RESULTADOS: Se encontraron 417 casos. Las tasas ajustadas fueron: en 2015, 17,3 (IC95%: 14,7-20,2); en 2016, 14,5 (IC95%: 12,1-17,2); y en 2017, 13,2 (IC95%: 11,0-15,8). Las causas más frecuentes fueron circulatorias (52,5%) y externas (19,2%). Los factores asociados a la MSA fueron el sexo (OR M/H: 2,40; IC95%: 1,87-3,06), edad (OR ≥76/<76: 4,56; IC95%: 3,53-5,90), discapacidad (OR No/Sí: 0,51; IC95%: 0,31-0,85), estación (ref: primavera; OR verano: 2,34; IC95%: 1,63-3,37) y núcleo de población (OR rural/urbano: 2,20; IC95%1,58-3,08). CONCLUSIONES: La magnitud de la muerte en solitario en la Comunidad Valenciana es relevante, existiendo un mayor riesgo en hombres y a edades más tempranas, así como en verano y áreas urbanas. Presentar discapacidad representa una cierta protección.

Beyond standardized mortality ratios; some uses of smoothed age-specific mortality rates on small areas studies.

BACKGROUND: Most epidemiological risk indicators strongly depend on the age composition of populations, which makes the direct comparison of raw (unstandardized) indicators misleading because of the different age structures of the spatial units of study. Age-standardized rates (ASR) are a common solution for overcoming this confusing effect. The main drawback of ASRs is that they depend on age-specific rates which, when working with small areas, are often based on very few, or no, observed cases for most age groups. A similar effect occurs with life expectancy at birth and many more epidemiological indicators, which makes standardized mortality ratios (SMR) the omnipresent risk indicator for small areas epidemiologic studies. METHODS: To deal with this issue, a multivariate smoothing model, the M-model, is proposed in order to fit the age-specific probabilities of death (PoDs) for each spatial unit, which assumes dependence between closer age groups and spatial units. This age-space dependence structure enables information to be transferred between neighboring consecutive age groups and neighboring areas, at the same time, providing more reliable age-specific PoDs estimates. RESULTS: Three case studies are presented to illustrate the wide range of applications that smoothed age specific PoDs have in practice . The first case study shows the application of the model to a geographical study of lung cancer mortality in women. This study illustrates the convenience of considering age-space interactions in geographical studies and to explore the different spatial risk patterns shown by the different age groups. Second, the model is also applied to the study of ischaemic heart disease mortality in women in two cities at the census tract level. Smoothed age-standardized rates are derived and compared for the census tracts of both cities, illustrating some advantages of this mortality indicator over traditional SMRs. In the latest case study, the model is applied to estimate smoothed life expectancy (LE), which is the most widely used synthetic indicator for characterizing overall mortality differences when (not so small) spatial units are considered. CONCLUSION: Our age-space model is an appropriate and flexible proposal that provides more reliable estimates of the probabilities of death, which allow the calculation of enhanced epidemiological indicators (smoothed ASR, smoothed LE), thus providing alternatives to traditional SMR-based studies of small areas.

Understanding Primary Ciliary Dyskinesia: Experience From a Mediterranean Diagnostic Reference Centre.

BACKGROUND: Due to the lack of a gold standard diagnostic test, reference centres with experienced personnel and costly procedures are needed for primary ciliary dyskinesia (PCD) diagnostics. Diagnostic flowcharts always start with clinical symptoms. Therefore, the aim of this work is to define differential clinical criteria so that only patients clinically compatible with PCD are referred to reference centres. MATERIALS AND METHODS: 18 variables from 476 Mediterranean patients with clinically suspicious PCD were collected. After analysing cilia function and ultrastructure, 89 individuals were diagnosed with PCD and 387 had a negative diagnosis. Simple logistic regression analysis, considering PCD as a dependent variable and the others as independent variables, was done. In order to define the variables that best explain PCD, a step-wise logistic regression model was defined. Aiming to classify individuals as PCD or PCD-like patients, based on variables included in the study, a classification and regression tree (CART) was designed. RESULTS AND CONCLUSIONS: Simple logistic regression analysis shows statistically significant association between age at the beginning of their symptomatology, periodicity, fertility, situs inversus, recurrent otitis, atelectasis, bronchiectasis, chronic productive cough, rhinorrea, rhinusinusitis and recurrent pneumonias, and PCD. The step-wise logistic regression model selected situs inversus, atelectasis, rhinorrea, chronic productive cough, bronchiectasis, recurrent pneumonias, and otitis as PCD predictive variables (82% sensitivity, 88% specificity, and 0.92 Area Under the Curve (AUC)). A decision tree was designed in order to classify new individuals based on pansinusitis, situs inversus, periodicity, rhinorrea, bronchiectasis, and chronic wet cough.

Prevalencia de la anticoagulación oral y calidad de su seguimiento en el ámbito de la atención primaria: estudio de la Red Centinela Sanitaria de la Comunitat Valenciana / Prevalence of oral anticoagulation and quality of its management in primary healthcare: A study by the Health Sentinel Network of the Region of Valencia (Spain)

Objetivo: Estimar la prevalencia de pacientes con terapia anticoagulante oral (TAO) en la Comunitat Valenciana (CV) y evaluar la calidad del seguimiento de la TAO con antagonistas de la vitaminaK (AVK) realizado en atención primaria. Diseño: Estudio observacional transversal realizado a través de la Red Centinela Sanitaria de la Comunitat Valenciana (RCSCV), que incluye una encuesta y el análisis retrospectivo del control de la TAO. Emplazamiento: Atención primaria (AP), Comunitat Valenciana (CV), España. Participantes: Todos los pacientes con ≥18años con TAO que consultaron durante el año 2014. La población cubierta por los 59 médicos de la RCSCV supone un 2,2% de la población adulta de la CV, y es representativa de esta. Mediciones principales: Datos demográficos, socioeconómicos, de salud y referentes a la TAO. La calidad del seguimiento de la TAO con AVK fue valorada mediante el porcentaje de tiempo dentro de rango terapéutico (TRT), calculado mediante el método Rosendaal. Resultados: Se registraron 1.144 pacientes (edad media 74,5±11años; 49,7% mujeres). La prevalencia de TAO en la CV es de 1,3 casos por 100 habitantes. El perfil característico de estos pacientes es una persona añosa, pluripatológica, con bajo nivel educativo, que vive acompañada. La fibrilación auricular es la indicación más habitual. El 82,8% de los pacientes con TAO con AVK llevaron seguimiento a través de AP. El TRT medio fue del 65,0%, y el 53,9% de pacientes presentaron un TRT ≥65%. El 74,4% de los pacientes con un control inadecuado fueron percibidos como bien controlados por el médico de AP. Conclusiones: La prevalencia de la TAO es alta y se prevé que siga aumentando. El grado de control alcanzado cumple con el estándar de calidad generalmente aceptado (TRT medio ≥ 65%) y es comparable al observado en otros estudios nacionales e internacionales. Sin embargo, hay un amplio margen de mejora. Es crucial optimizar la gestión de esta terapia de la manera más eficaz y coste-efectiva posible. Entre otras medidas, se debe mejorar el acceso de los facultativos a la información clínica de sus pacientes (AU)

Objective: To estimate the prevalence of patients with oral anticoagulant therapy (OAT) in the Region of Valencia and to evaluate the quality of management of OAT with vitamin K antagonists (VKA) carried out in primary healthcare. Design: Observational cross-sectional study conducted through the Health Sentinel Network of the Region of Valencia, which includes a survey and the retrospective analysis of OAT monitoring. Setting: Primary healthcare, Region of Valencia, Spain. Subjects: All patients aged 18years or older on OAT who consulted during the year 2014. The population covered by the 59 doctors of the Health Sentinel Network constitutes 2.2% of the adult population of the Region of Valencia, and it is representative of it. Key measurements Demographic, socioeconomic and health data as well as information concerning OAT. Quality of OAT management with VKA was assessed by means of the percentage of time in therapeutic range (TTR), computed using the Rosendaal method. Results: A total of 1,144 patients were recorded (mean age 74.5±11 years; 49.7% women). Prevalence of OAT in the Region of Valencia is 1.3 cases per 100 population. The characteristic profile of these patients is an old person, with several comorbidities and a low level of education, who lives accompanied. Atrial fibrillation is the most common indication. 82.8% of patients on OAT with VKA were monitored in primary healthcare. The average TTR was 65.0%, and 53.9% of patients had a TTR ≥ 65%. Among inadequately controlled patients, 74.4% were perceived as well-controlled by their primary care doctor. Conclusions. Prevalence of OAT is high, and it is expected to increase. The degree of control achieved meets the generally accepted quality standard (mean TTR ≥ 65%), and it is comparable to that observed in other national and international studies. However, there is wide scope for improvement. It is crucial to optimize the management of this therapy in the most effective and cost-effective way. Among other measures, access of physicians to their patients’ clinical information should be improved (AU)

[Prevalence of oral anticoagulation and quality of its management in primary healthcare: A study by the Health Sentinel Network of the Region of Valencia (Spain)]. / Prevalencia de la anticoagulación oral y calidad de su seguimiento en el ámbito de la atención primaria: estudio de la Red Centinela Sanitaria de la Comunitat Valenciana.

OBJECTIVE: To estimate the prevalence of patients with oral anticoagulant therapy (OAT) in the Region of Valencia and to evaluate the quality of management of OAT with vitaminK antagonists (VKA) carried out in primary healthcare. DESIGN: Observational cross-sectional study conducted through the Health Sentinel Network of the Region of Valencia, which includes a survey and the retrospective analysis of OAT monitoring. SETTING: Primary healthcare, Region of Valencia, Spain. SUBJECTS: All patients aged 18years or older on OAT who consulted during the year 2014. The population covered by the 59 doctors of the Health Sentinel Network constitutes 2.2% of the adult population of the Region of Valencia, and it is representative of it. KEY MEASUREMENTS: Demographic, socioeconomic and health data as well as information concerning OAT. Quality of OAT management with VKA was assessed by means of the percentage of time in therapeutic range (TTR), computed using the Rosendaal method. RESULTS: A total of 1,144 patients were recorded (mean age 74.5±11 years; 49.7% women). Prevalence of OAT in the Region of Valencia is 1.3 cases per 100 population. The characteristic profile of these patients is an old person, with several comorbidities and a low level of education, who lives accompanied. Atrial fibrillation is the most common indication. 82.8% of patients on OAT with VKA were monitored in primary healthcare. The average TTR was 65.0%, and 53.9% of patients had a TTR ≥65%. Among inadequately controlled patients, 74.4% were perceived as well-controlled by their primary care doctor. CONCLUSIONS: Prevalence of OAT is high, and it is expected to increase. The degree of control achieved meets the generally accepted quality standard (mean TTR ≥65%), and it is comparable to that observed in other national and international studies. However, there is wide scope for improvement. It is crucial to optimize the management of this therapy in the most effective and cost-effective way. Among other measures, access of physicians to their patients' clinical information should be improved.

Applying probabilistic temporal and multisite data quality control methods to a public health mortality registry in Spain: a systematic approach to quality control of repositories.

OBJECTIVE: To assess the variability in data distributions among data sources and over time through a case study of a large multisite repository as a systematic approach to data quality (DQ). MATERIALS AND METHODS: Novel probabilistic DQ control methods based on information theory and geometry are applied to the Public Health Mortality Registry of the Region of Valencia, Spain, with 512 143 entries from 2000 to 2012, disaggregated into 24 health departments. The methods provide DQ metrics and exploratory visualizations for (1) assessing the variability among multiple sources and (2) monitoring and exploring changes with time. The methods are suited to big data and multitype, multivariate, and multimodal data. RESULTS: The repository was partitioned into 2 probabilistically separated temporal subgroups following a change in the Spanish National Death Certificate in 2009. Punctual temporal anomalies were noticed due to a punctual increment in the missing data, along with outlying and clustered health departments due to differences in populations or in practices. DISCUSSION: Changes in protocols, differences in populations, biased practices, or other systematic DQ problems affected data variability. Even if semantic and integration aspects are addressed in data sharing infrastructures, probabilistic variability may still be present. Solutions include fixing or excluding data and analyzing different sites or time periods separately. A systematic approach to assessing temporal and multisite variability is proposed. CONCLUSION: Multisite and temporal variability in data distributions affects DQ, hindering data reuse, and an assessment of such variability should be a part of systematic DQ procedures.

Seguridad de las vacunas antigripales en grupos de riesgo: análisis de las sospechas de reacciones adversas notificadas en Comunidad Valenciana entre 2005 y 2011 / Safety of influenza vaccines in risk groups: analysis of adverse events following immunization reported in Valencian Community from 2005 to 2011

Objetivo. Evaluar las notificaciones de sospechas de reacciones adversas a las vacunas administradas frente a la gripe, por sexo, grupos de riesgo y por grupos de edad en la Comunidad Valenciana desde el año 2005 a 2011. Métodos. Se ha realizado un estudio farmacoepidemiológico de diseño observacional descriptivo y transversal, basado en las notificaciones de sospechas de reacciones adversas a las vacunas (NRAV) frente a la gripe, registradas a través del Sistema de Información Vacunal (SIV) de la Comunidad Valenciana, de 1 de enero de 2005 hasta 31 de diciembre de 2011. Resultados. Durante el periodo de estudio se registraron 5.107.790 dosis de vacuna frente a la gripe, con una tasa de notificación de NRAV de 1,94 por 100.000 (IC95% 1,59-2,36) y 228.094 dosis de vacuna de gripe A(H1N1)pdm09 (tasa 96,45 por 100.000; IC95% 84,52-110,06). El 70,71% (70) y el 64,55% (142), respectivamente, de las NRAV correspondieron a mujeres. El grupo de riesgo de trabajadores sociosanitarios presentó una mayor tasa de notificación para la gripe estacional (25,35 por 100.000; IC95%: 17,65-36,40) así como para gripe A(H1N1)pdm09 (864,13 por 100.000; IC95% 714,38-1044,93) durante el periodo de estudio. Conclusiones. Las vacunas frente a la gripe administradas durante el periodo de estudio muestran un elevado perfil de seguridad tanto en población con patología de riesgo como en otros grupos diana susceptibles de la vacunación. Las reacciones registradas durante el estudio coinciden en su mayoría con las descritas en las fichas técnicas de las vacunas (AU)

Objective. To evaluate reports of adverse events following influenza immunization by sex, risk and age groups in Valencian Community from 2005 to 2011. Methods. A pharmacoepidemiological descriptive cross-sectional observational study based on the reports of adverse events following immunization (AEFI) against influenza, registered through the Vaccination Information System (SIV) of Valencian Community from 1 January 2005 until 31 December 2011 was done. Results. During the study period 5,107,790 doses of vaccine against influenza were reported, with an AEFI incidence of 1.94 per 100,000 (95% CI 1.59 to 2.36), and 228,094 doses of vaccine for influenza A (H1N1) pdm09 (96.45 per 100,000, 95%CI 84.52-110.06). The 70.71% (70) and 64.55% (142), respectively, of AEFI were in women. The healthcare workers group had a higher reporting rate for seasonal influenza (25.35 per 100,000; 95%CI: 17.65-36.40) and for influenza A(H1N1) pdm09 (864.13 per 100,000; 95%CI 714.38-1044.93) during the study period. Conclusions. Vaccines against influenza administered during the study had a high safety profile in both populations with disease risk and other susceptible target groups of vaccination. Adverse reactions reported during the study mostly coincide with those described in the summary of product characteristics of vaccines (AU)

[Safety of influenza vaccines in risk groups: analysis of adverse events following immunization reported in Valencian Community from 2005 to 2011]. / Seguridad de las vacunas antigripales en grupos de riesgo: análisis de las sospechas de reacciones adversas notificadas en Comunidad Valenciana entre 2005 y 2011.

OBJECTIVE: To evaluate reports of adverse events following influenza immunization by sex, risk and age groups in Valencian Community from 2005 to 2011. METHODS: A pharmacoepidemiological descriptive cross-sectional observational study based on the reports of adverse events following immunization (AEFI) against influenza, registered through the Vaccination Information System (SIV) of Valencian Community from 1 January 2005 until 31 December 2011 was done. RESULTS: During the study period 5,107,790 doses of vaccine against influenza were reported, with an AEFI incidence of 1.94 per 100,000 (95% CI 1.59 to 2.36), and 228,094 doses of vaccine for influenza A (H1N1) pdm09 (96.45 per 100,000, 95%CI 84.52-110.06). The 70.71% (70) and 64.55% (142), respectively, of AEFI were in women. The healthcare workers group had a higher reporting rate for seasonal influenza (25.35 per 100,000; 95%CI: 17.65-36.40) and for influenza A(H1N1) pdm09 (864.13 per 100,000; 95%CI 714.38-1044.93) during the study period. CONCLUSIONS: Vaccines against influenza administered during the study had a high safety profile in both populations with disease risk and other susceptible target groups of vaccination. Adverse reactions reported during the study mostly coincide with those described in the summary of product characteristics of vaccines.

Inequalities in perinatal mortality rates among immigrant and native population in Spain, 2005-2008.

We compared perinatal mortality rates (PMRs) and the risk from certain causes among immigrant and native population in the Valencian Community (Spain). Using data from the Perinatal Mortality Registry, crude and age standardized mortality ratios were obtained in the different groups of mothers. Mortality rate ratios were calculated to compare the causes of death resulting from prematurity, congenital anomalies, infectious diseases and Sudden Infant Death Syndrome between Spanish and foreign women. PMRs were higher among all the immigrant groups compared with the native population, with a statistical significance in Eastern European and sub-Saharan mothers. Neonatal mortality rates in North African and Latin American mothers were similar to those of native women. Babies of immigrant mothers were at a significant higher risk of dying from late infectious diseases and from causes resulting from being premature. More research is needed on the risk factors which contribute to generating differences in our setting.

Association between pre-transplant dialysis modality and patient and graft survival after kidney transplantation.

BACKGROUND: Previous studies have found inconsistent associations between pre-transplant dialysis modality and subsequent post-transplant survival. We aimed to examine this relationship using the instrumental variable method and to compare the results with standard Cox regression. METHODS: We included 29 088 patients (age >20 years) from 16 European national or regional renal registries who received a first kidney transplant between 1 January 1999 and 31 December 2008 and were on dialysis before transplantation for a period between 90 days and 10 years. Standard multivariable Cox regression examined the association of individually assigned pre-transplant dialysis modality with post-transplant patient and graft survival. To decrease confounding-by-indication through unmeasured factors, we applied the instrumental variable method that used the case-mix adjusted centre percentage of peritoneal dialysis (PD) as predictor variable. RESULTS: Standard analyses adjusted for age, sex, primary renal disease, donor type, duration of dialysis, year of transplantation and country suggested that PD before transplantation was associated with better patient [hazard ratio, HR (95% CI) = 0.83 (0.76-0.91)] and graft survival (HR (95% CI) 0.90 (0.84-0.96)) when compared with haemodialysis (HD). In contrast, the instrumental variable analysis showed that a 10% increase in the case-mix adjusted centre percentage of patients on PD was neither associated with post-transplant patient survival [HR (95% CI = 1.00 (0.97-1.04)] nor with graft survival [HR (95% CI) = 1.01 (0.98-1.04)]. CONCLUSIONS: The instrumental variable method failed to confirm the associations found in standard Cox regression between pre-transplant dialysis modality and patient and graft survival after transplantation. The lack of association in instrumental variable analysis may be due to better control of residual confounding.

Valores de hormona antimülleriana (HAM) y recuento de folículos antrales (RFA) en casos con fallo reproductivo previo / Anti-Müllerian hormone values and antral follicle count in patients with prior reproductive failure

Objetivo. Determinar si la HAM y el RFA pueden emplearse para predecir reserva ovárica. Sujetos y métodos. Se compara el RFA y los valores de la HAM en FIV/ICSI: bajas, normo y altas respondedoras, las primeras con fallos de TRA previos (un FIV/ICSI). El RFA se llevó a cabo con US 3D con modos superficie, inverso y AVC. Resultados. Existió correlación entre HAM y RFA. Ambos reflejan la reserva ovárica. Las diferencias entre normo y bajas respondedoras fueron significativas. RFA, HAM y edad mostraron ser los mejores parámetros. Las diferencias entre normo y altas respondedoras fueron igualmente significativas, mostrando ser predictivos de hiperestimulación. El grupo de número de ovocitos recuperados (<=5 vs >5) mostró ser predictivo de maduración, no de calidad embrionaria ni de pronóstico reproductivo. Conclusiones. La determinación de HAM y RFA no permite negar un nuevo intento FIV, pero obligan a informar a la pareja de las bajas probabilidades de éxito. Valores de HAM y RFA superiores a 27,21pmol/L y 15 folículos son riesgo de hiperestimulación. El pronóstico reproductivo muestra alto índice de cancelaciones (22% de ciclos iniciados) muy bajo de gestaciones (16,7%), con solo un 6,2% de embarazos evolutivos. Valores bajos de HAM (<9,28pmol/L) predicen mal pronóstico con un 72,7 y 64,5% de sensibilidad y especificidad. La mejor aproximación predictiva es la combinación HAM más RFA, con un área bajo la curva de 82% (AU)

Objective. To determine whether anti-Müllerian hormone (AMH) and antral follicle count (AFC) could be used as predictors of ovarian reserve. Subjects and methods. We compared AFC and AMH values in IVF/ICSI in low, normal and high responders. Low responders had undergone previous assisted reproduction technologies (ART) and had experienced at least one IVF failure.AFC was carried out with US 3D surface, inverse mode, and automatic volume calculation. Results. AMH and AFC were correlated and reflected the actual ovarian reserve. Differences between normal and low responders were significant. The best predictors of ovarian reserve were AMH, AFC and age. Differences between normal and high responders were also significant and were predictors of hyperstimulation. Grouping patients according to oocyte recovery (<= vs. >5) was predictive of maturation but was not predictive of embryo quality or reproductive outcome. Conclusions. Low AMH values (<9.28pmol/L) predicted poor outcomes with a sensitivity and specificity of 72.7% and 64.5%. The best predictive approach was the combination of AMH plus AFC, resulting in an area under the curve of 82.2%. AMH and AFC above 27.21pmol/L and 15 follicles indicated a high risk of hyperstimulation. The reproductive outcome showed a very high cancelation rate (22% of initiated cycles), very low pregnancy rates (16.7%) and only 6.2% of ongoing pregnancies. Determination of AMH and AFC levels should not be used to reject candidates for IVF treatment but to inform patients with low levels of the very poor probability of success and the use of other alternatives (AU)

Factors associated with childhood obesity in Spain. The OBICE study: a case-control study based on sentinel networks.

OBJECTIVE: To estimate the association strength of dietary behaviour and sedentary habits in relation to childhood obesity in Spain. DESIGN: A matched case-control study was carried out using data collected by sentinel network paediatricians in general practices. SETTING: Five Spanish autonomous communities. SUBJECTS: Cases were 437 children (2-14 years old) with BMI >95th percentile according to Spanish reference tables. Controls were 751 children (2-14 years old; two paired per case) with BMI <84th percentile. Data were collected in two phases: individual (questionnaires filled in by sentinel paediatricians) and family (self-administered questionnaires filled in a family environment). Crude OR and adjusted OR (ORc and adj OR) for the given variables were calculated using a simple and multiple conditional logistic regression analysis. RESULTS: The factors with the greatest effect on obesity were family history of obesity: both parents (adj OR = 11.2), mother but not father (adj OR = 9.1), father but not mother (adj OR = 6.1), siblings (adj OR = 2.7); and eating between meals (adj OR = 2.5) and consumption of sweets and soft drinks >2 times/week (adj OR = 2.0). The highest protection effect was found for five meals per day (adj OR = 0.5), the regular consumption of breakfast (adj OR = 0.5) and for eating fruit for dessert (adj OR = 0.6). Factors related to sedentary habits did not appear as noteworthy. CONCLUSIONS: We have determined the association between certain dietary behaviour and family history with childhood obesity in several Spanish regions.

Efficacy of Neoseiulus californicus and Phytoseiulus persimilis in suppression of Tetranychus urticae in young clementine plants.

Tetranychus urticae is one of the most damaging tetranychid mites affecting clementine orchards in Spain, where natural control is insufficient. Furthermore, in clementine nurseries, tender foliage is highly susceptible to attack and natural enemies are almost always absent. Therefore, acaricides are often used indiscriminately. Alternative control measures are necessary, both in commercial orchards and clementine nurseries. In order to assess the efficacy of inoculative releases of N. californicus and P. persimilis to reduce T. urticae populations in young Spanish clementine plants, a semi-field experiment was conducted and repeated in three seasons (spring, summer and autumn). Phytoseiulus persimilis was highly effective in reducing both T. urticae infestations and the damage level inflicted on plants at both release rates evaluated (40 and 80 phytoseiids/plant) and all three periods considered. By contrast, N. californicus demonstrated low performance under certain conditions. The results of this study could be adapted and transferred to nurseries and young citrus plantations.

Assessment of the diversity and dynamics of Plum pox virus and aphid populations in transgenic European plums under Mediterranean conditions.

The molecular variability of Plum pox virus (PPV) populations was compared in transgenic European plums (Prunus domestica L.) carrying the coat protein (CP) gene of PPV and non-transgenic plums in an experimental orchard in Valencia, Spain. A major objective of this study was to detect recombination between PPV CP transgene transcripts and infecting PPV RNA. Additionally, we assessed the number and species of PPV aphid vectors that visited transgenic and non-transgenic plum trees. Test trees consisted of five different P. domestica transgenic lines, i.e. the PPV-resistant C5 'HoneySweet' line and the PPV-susceptible C4, C6, PT6 and PT23 lines, and non-transgenic P. domestica and P. salicina Lind trees. No significant difference in the genetic diversity of PPV populations infecting transgenic and conventional plums was detected, in particular no recombinant between transgene transcripts and incoming viral RNA was found at detectable levels. Also, no significant difference was detected in aphid populations, including viruliferous individuals, that visited transgenic and conventional plums. Our data indicate that PPV-CP transgenic European plums exposed to natural PPV infection over an 8 year period caused limited, if any, risk beyond the cultivation of conventional plums under Mediterranean conditions in terms of the emergence of recombinant PPV and diversity of PPV and aphid populations.