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1.
Infect Dis Poverty ; 9(1): 16, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32029005

RESUMEN

BACKGROUND: Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa. The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid, Spain. METHODS: A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid, Spain, a reference center, over 19 years. Categorical variables were expressed as frequency counts and percentages. Continuous variables were expressed as the mean and standard deviation (SD) or median and interquartile range (IQR: Q3-Q1). Chi-square tests were used to assess the association between categorical variables. The measured outcomes were expressed as the odds ratio (OR) with a 95% confidential interval. Continuous variables were compared by Student's t-tests or Mann-Whitney U tests. Binary logistic regression models were used. P <  0.05 was considered a statistically significant difference. RESULTS: One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified. Forty-nine patients were male (37.4%). The migrants' mean age (±SD) was 42.3 ± 17.3 years, and 124 (94.7%) were from Equatorial Guinea. The median time (IQR) between arrival in Spain and the first consultation was 2 (1-7) months. One hundred fifteen migrants had eosinophilia, and one hundred thirteen had hyper-IgE syndrome. Fifty-seven patients had pruritus (43.5%), and thirty patients had Calabar swelling (22.9%). Seventy-three patients had coinfections with other filarial nematodes (54.2%), and 58 migrants had only Loa loa infections (45.8%). One hundred two patients (77.9%) were treated; 45.1% (46/102) patients were treated with one drug, and 54.9% (56/102) patients were treated with combined therapy. Adverse reactions were described in 14 (10.7%) migrants. CONCLUSIONS: Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. However, considering that 72.5% of the patients had only positive microfilaremia without any symptoms, we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.


Asunto(s)
Loiasis/epidemiología , Adulto , Anciano , Antihelmínticos/uso terapéutico , Eosinofilia/diagnóstico , Eosinofilia/epidemiología , Eosinofilia/etiología , Guinea Ecuatorial/etnología , Femenino , Humanos , Loiasis/diagnóstico , Loiasis/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Migrantes , Adulto Joven
2.
BMC Infect Dis ; 20(1): 80, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31992207

RESUMEN

BACKGROUND: In addition to outbreaks of nosocomial influenza, sporadic nosocomial influenza infections also occur but are generally not reported in the literature. This study aimed to determine the epidemiologic characteristics of cases of nosocomial influenza compared with the remaining severe cases of severe influenza in acute hospitals in Catalonia (Spain) which were identified by surveillance. METHODS: An observational case-case epidemiological study was carried out in patients aged ≥18 years from Catalan 12 hospitals between 2010 and 2016. For each laboratory-confirmed influenza case (nosocomial or not) we collected demographic, virological and clinical characteristics. We defined patients with nosocomial influenza as those admitted to a hospital for a reason other than acute respiratory infection in whom ILI symptoms developed ≥48 h after admission and influenza virus infection was confirmed using RT-PCR. Mixed-effects regression was used to estimate the crude and adjusted OR. RESULTS: One thousand seven hundred twenty-two hospitalized patients with severe laboratory-confirmed influenza virus infection were included: 96 (5.6%) were classified as nosocomial influenza and more frequently had > 14 days of hospital stay (42.7% vs. 27.7%, P < .001) and higher mortality (18.8% vs. 12.6%, P < .02). The variables associated with nosocomial influenza cases in acute-care hospital settings were chronic renal disease (aOR 2.44 95% CI 1.44-4.15) and immunodeficiency (aOR 1.79 95% CI 1.04-3.06). CONCLUSIONS: Nosocomial infections are a recurring problem associated with high rates of chronic diseases and death. These findings underline the need for adherence to infection control guidelines.


Asunto(s)
Infección Hospitalaria/epidemiología , Gripe Humana/epidemiología , Adolescente , Adulto , Anciano , Infección Hospitalaria/tratamiento farmacológico , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Síndromes de Inmunodeficiencia/epidemiología , Síndromes de Inmunodeficiencia/virología , Control de Infecciones , Gripe Humana/tratamiento farmacológico , Gripe Humana/virología , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estaciones del Año , España/epidemiología , Adulto Joven
3.
Aten. prim. (Barc., Ed. impr.) ; 52(1): 3-13, ene. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-185978

RESUMEN

Objetivo: Determinar la fracción atribuible poblacional (FAP) de los factores de riesgo (FR) clásicos para la aparición de la enfermedad cardiovascular en una cohorte poblacional de Extremadura, a fin de recomendar intervenciones preventivas prioritarias. Métodos: Diseño: estudio de cohortes. Emplazamiento: Muestra poblacional representativa de un área de salud de Extremadura (España). Participantes: Dos mil ochocientos treinta y tres individuos, de 25 a 79 años, seleccionados aleatoriamente e incluidos entre 2007 y 2009. Se registraron antecedentes y se midieron parámetros clínicos, siendo seguidos hasta el 31 de diciembre de 2015. Mediciones: Variables explicativas: edad, sexo, obesidad, tabaquismo, hipertensión arterial (HTA), diabetes mellitus (DM) e hipercolesterolemia. Variable resultado: Primer evento de la variable combinada de infarto de miocardio, angina de pecho, ictus, isquemia de miembros inferiores y muerte cardiovascular. Se calcularon las hazard ratio mediante regresión de Cox, totalmente ajustadas y las FAP mediante la fórmula de Levin. Resultados: Se analizaron 2.669 sujetos de la cohorte inicial, al ser excluidos 103 por antecedentes de enfermedad cardiovascular y 61 por pérdidas. El seguimiento fue de 6,9 años (RI: 6,5-7,5). Se documentaron 134 eventos. Tasa de incidencia 7,42/1.000 personas-año. Las hazard ratio ajustadas (IC 95%) fueron: HTA 2,26 (1,40-3,67), hipercolesterolemia 2,23 (1,56-3,18), DM 1,79 (1,24-2,58), tabaquismo 1,72 (1,11-2,69). Las FAP (IC 95%) fueron HTA 31,1 (12,4-48,8), hipercolesterolemia 27,0% (14,8-40,6), tabaquismo 18,8% (3,3-35,0), DM 7,9% (2,6-15,2). Conclusiones: La HTA es el FR con mayor impacto en la salud cardiovascular de la población extremeña, seguido de hipercolesterolemia y tabaquismo, constituyendo objetivos prioritarios para una estrategia preventiva poblacional


Objective: To determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health. Methods: Design, Cohort study. Location: Representative population sample of a health area of Extremadura (Spain). Participants: 2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done. Measurements: Explanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia. Outcome variable: First event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula. Results: 2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3-35.0) and DM 7.9% (2.6-15.2). Conclusions: Hypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy


Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Anciano , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo , Estudios de Cohortes , Prevención de Enfermedades , Riesgo Atribuible a la Población , Evaluación de Resultados de Acciones Preventivas , Obesidad , Tabaquismo , Hipertensión , Diabetes Mellitus , Hipercolesterolemia , España/epidemiología
4.
Aten. prim. (Barc., Ed. impr.) ; 52(1): 29-37, ene. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-185981

RESUMEN

Objetivos: Evaluar la prevalencia, severidad y factores de riesgo asociados a la retinopatía diabética (RD) en Cantabria. Diseño: Estudio transversal de base poblacional. Emplazamiento: Centro de salud de Cantabria. Participantes: Muestra aleatoria de 442 pacientes con diabetes mellitus tipo 2. Mediciones principales: Retinografía no midriática, clasificándolas según la International Clinical Diabetic Retinopathy Disease Severity Scale. Los factores de riesgo estudiados: edad, sexo, edad diagnóstico, años de evolución de la diabetes, grado de control glucémico (HbA1c), tratamiento de la diabetes, control de la tensión arterial, control lipídico, obesidad, tabaquismo, hematocrito bajo, embarazo, déficit de vitamina D, nefropatía y eventos cardiovasculares. Resultados: Prevalencia de RD del 8,56% (IC: 5,81-11,32). RD no proliferativa leve: 5,07% (IC: 2,89-7,25); RD no proliferativa moderada: 1,38% (IC: 0,17-2,60); RD no proliferativa severa: 0,27% (IC: 0,006-1,28); RD proliferativa: 1,84% (IC: 0,46-3,22); edema macular diabético: 2,30% (IC: 0,77-3,83). Edad media: 70 años, edad de diagnóstico 58,97 años; índice de masa corporal 29,86; hipertensos 78,40%; dislipidemia 67,30% y HbA1c mediana 6,76%. El déficit de 25 (OH) D fue del 77%. En el análisis multivariante los factores independientes fueron tratamiento de la diabetes mellitus tipo 2, índice de masa corporal, años de evolución y control de la diabetes. Conclusiones: La prevalencia de RD ha disminuido hasta el 8,56%; esta disminución se asocia a la mejora en el control de los factores de riesgo modificables. Los factores de riesgo asociados de forma independiente fueron: tratamiento, índice de masa corporal, años de evolución y control de la diabetes. Las variables control hipertensión arterial, eventos cardiovasculares y nefropatía también mostraron capacidad predictiva para la RD


Objetive: To assess the prevalence and risk factors associated with diabetic retinopathy (DR) in Cantabria. Design: Cross-sectional population based study. Location: Health center of Cantabria. Particiants: A random sample of 442 patients with type 2 diabetes. Main measurements: Non-mydiatric retinography, classifying them according to the International Clinical Diabetic Retinopathy Disease Severity Scale. The analyzed risk factors were: age, gender, age at diabetes onset, duration of diabetes, glycated haemoglobin levels (A1C), treatment of diabetes, blood pressure (systolic and diastolic), serum lipids concentration, body mass index, smoking status, hematocrit, pregnancy, serum vitamin D (25 OH D) levels, nephropathy and cardiovascular events. Results: The prevalence of DR was 8.56% (CI: 5.81-11.32): Mild non-proliferative DR: 5.07% (CI: 2.89-7.25); Moderate non-proliferative DR: 1.38% (CI: 0.17-2.60); Severe non-proliferative DR: 0.27% (CI: 0.006-1.28); proliferative DR: 1.84% (CI: 0.46-3.22). Diabetic macular oedema: 2.30% (CI: 0.77-3.83). Mean age: 70 years, mean diagnostic age: 58.97 years, mean body mass index 29.86, 78.40% patients with hypertension, 67.30% dyslipidemia and median A1C: 6.7%. A deficit of 25 (OH) D was identified in 77% of patients. In the multivariate analysis, treatment of type 2 diabetes, body mass index, duration of diabetes and metabolic control of glycaemia were identified as independent risk factors. Conclusions: The prevalence of DR, compared with former studies, has decreased to 8.56%; this decrease is associated with the improvement in the control of modifiable risk factors. The associated independent risk factors were: treatment, body mass index, duration and control of diabetes. The variables antihypertensive treatment, cardiovascular events and nephropathy showed predictive value for DR


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Retinopatía Diabética/epidemiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , España/epidemiología , Estudios Transversales , Centros de Salud , Glucemia , Deficiencia de Vitamina D , Nefropatías Diabéticas/epidemiología , Diabetes Mellitus Tipo 2/epidemiología
5.
Arthritis Care Res (Hoboken) ; 72(2): 216-224, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31529686

RESUMEN

OBJECTIVE: To estimate the incidence and analyze any cancer-associated factors in patients with systemic lupus erythematosus (SLE), differentiating between hormone-sensitive (HS) and non-HS cancers. METHODS: This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post-SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non-HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built. RESULTS: A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI] 1.15-1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84-2.91]). The SIR in women with HS versus non-HS cancer was 1.02 (95% CI 0.13-1.91) and 1.93 (95% CI 0.98-2.89). In HS versus non-HS cancers, SLE diagnostic age (odds ratio [OR] 1.04 [P = 0.002] versus 1.04 [P = 0.019]), and period of disease evolution (OR 1.01 [P < 0.001] versus 1.00 [P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (OR 1.27 [P = 0.022]) and angiotensin-converting enzyme (ACE) inhibitor prescriptions (OR 2.87 [P = 0.048]) were associated with non-HS cancers. CONCLUSION: Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non-HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed.


Asunto(s)
Hormonas/sangre , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/epidemiología , Neoplasias/sangre , Neoplasias/epidemiología , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Estudios Retrospectivos , España/epidemiología , Adulto Joven
6.
BJOG ; 127(3): 377-387, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31631477

RESUMEN

OBJECTIVE: To assess the long-term risk factors predicting residual/recurrent cervical intraepithelial neoplasia (CIN 2-3) and time to recurrence after large loop excision of the transformation zone (LLETZ). DESIGN: Retrospective study. SETTING: Colposcopy clinic. POPULATION: 242 women with CIN 2-3 treated between 1996 and 2006 and followed up until June 2016. METHODS: Age, margins, and high-risk human papillomavirus (HR-HPV) were estimated using Cox proportional hazard and unconditional logistic regression models. The cumulative probability of treatment failure was estimated by Kaplan-Meier analysis. MAIN OUTCOME MEASURE: Histologically confirmed CIN 2-3, HR-HPV, margins, age. RESULTS: CIN 2-3 was associated with HR-HPV (HR = 30.5, 95% confidence interval [CI] = 3.80-246.20), age >35 years (HR = 5.53, 95% CI = 1.22-25.13), and margins (HR = 7.31, 95% CI = 1.60-33.44). HR-HPV showed a sensitivity of 88.8% and a specificity of 80%. Ecto+ /endocervical+ (16.7%), uncertain (19.4%) and ecto- /endocervical+ margins (9.1%) showed a higher risk of recurrence (odds ratio [OR] = 13.20, 95% CI = 1.02-170.96; OR = 15.84, 95% CI = 3.02-83.01; and OR = 6.60, 95% CI = 0.88-49.53, respectively). Women with involved margins and/or who were HR-HPV positive had more treatment failure than those who were HR-HPV negative or had clear margins (P-log-rank <0.001). CONCLUSIONS: HR-HPV and margins seem essential for stratifying post-LLETZ risk, and enable personalised management. Given that clear margins present a lower risk, a large excision may be indicated in older women to reduce the risk. TWEETABLE ABSTRACT: After LLETZ for CIN 2-3, recurrences appear more often in women with positive HR-HPV and involved margins and aged over 35.


Asunto(s)
Neoplasia Intraepitelial Cervical , Efectos Adversos a Largo Plazo , Márgenes de Escisión , Recurrencia Local de Neoplasia/diagnóstico , Neoplasia Residual/diagnóstico , Infecciones por Papillomavirus , Traquelectomía , Neoplasias del Cuello Uterino , Transformación Celular Neoplásica , Neoplasia Intraepitelial Cervical/epidemiología , Neoplasia Intraepitelial Cervical/patología , Neoplasia Intraepitelial Cervical/cirugía , Cuello del Útero/patología , Cuello del Útero/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Efectos Adversos a Largo Plazo/diagnóstico , Efectos Adversos a Largo Plazo/epidemiología , Persona de Mediana Edad , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Estudios Retrospectivos , Medición de Riesgo/métodos , España/epidemiología , Traquelectomía/efectos adversos , Traquelectomía/métodos , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía
7.
Phytopathology ; 110(1): 49-57, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31524081

RESUMEN

Mixed viral infections are common in plants, and the evolutionary dynamics of viral populations may differ depending on whether the infection is caused by single or multiple viral strains. However, comparative studies of single and mixed infections using viral populations in comparable agricultural and geographical locations are lacking. Here, we monitored the occurrence of pepino mosaic virus (PepMV) in tomato crops in two major tomato-producing areas in Murcia (southeastern Spain), supporting evidence showing that PepMV disease-affected plants had single infections of the Chilean 2 (CH2) strain in one area and the other area exhibited long-term (13 years) coexistence of the CH2 and European (EU) strains. We hypothesized that circulating strains of PepMV might be modulating the differentiation between them and shaping the evolutionary dynamics of PepMV populations. Our phylogenetic analysis of 106 CH2 isolates randomly selected from both areas showed a remarkable divergence between the CH2 isolates, with increased nucleotide variability in the geographical area where both strains cocirculate. Furthermore, the potential virus-virus interaction was studied further by constructing six full-length infectious CH2 clones from both areas, and assessing their viral fitness in the presence and absence of an EU-type isolate. All CH2 clones showed decreased fitness in mixed infections and although complete genome sequencing indicated a nucleotide divergence of those CH2 clones by area, the magnitude of the fitness response was irrespective of the CH2 origin. Overall, these results suggest that although agroecological cropping practices may be particularly important for explaining the evolutionary dynamics of PepMV in tomato crops, the cocirculation of both strains may have implications on the genetic variability of PepMV populations.


Asunto(s)
Variación Genética , Lycopersicon esculentum , Potexvirus , Genética de Población , Lycopersicon esculentum/virología , Filogenia , Enfermedades de las Plantas/virología , Potexvirus/genética , España/epidemiología
8.
Rev Esp Cardiol (Engl Ed) ; 73(1): 43-52, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31521574

RESUMEN

INTRODUCTION AND OBJECTIVES: To describe, for the first time, reference values for the cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (BA-PWV), carotid-femoral pulse wave velocity (CF-PWV), and the central augmentation index and to establish their association with cardiovascular risk factors in the Spanish adult population aged 35 to 75 years without cardiovascular disease. METHODS: We conducted a cross-sectional study. Through random sampling stratified by age and sex, we included 501 participants without cardiovascular disease. The mean age was 55.9 years and 50.3% were women. The measurements were taken using the SphigmoCor and Vasera VS-1500 devices. RESULTS: Values for all measures, except those for the central augmentation index, were higher in men and increased with age and blood pressure. The mean values were as follows: CAVI, 8.01±1.44; BA-PWV, 12.93±2.68m/s; CF-PWV, 6.53±2.03 m/s, and central augmentation index, 26.84±12.79. On multiple regression analysis, mean blood pressure was associated with the 4 measures, glycated hemoglobin was associated with all measures except the central augmentation index, and body mass index showed an inverse association with CAVI. The explanatory capacity of age, sex, and mean blood pressure was 62% for BA-PWV, 49% for CF-PWV 49%, 54% for the CAVI, and 38% for the central augmentation index. On logistic regression, hypertension was associated with the CAVI (OR=3.45), VOP-BT (OR=3.44), VOP-CF (OR=3.38) and with the central augmentation index (OR=3.73). CONCLUSIONS: All arterial stiffness measures increased with age. The CAVI and CF-PWV were higher in men and the central augmentation index was higher in women, with no differences in BA-PWV. This study is registered at ClinicalTrials.gov. Identifier NCT02623894.


Asunto(s)
Enfermedades Cardiovasculares/fisiopatología , Vigilancia de la Población , Rigidez Vascular/fisiología , Adulto , Anciano , Índice Tobillo Braquial , Índice de Masa Corporal , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Grosor Intima-Media Carotídeo , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Valores de Referencia , Factores de Riesgo , España/epidemiología
9.
Sci Total Environ ; 703: 135538, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-31759725

RESUMEN

The purpose of this study was to assess the impact to human health of air pollutants, through the integration of different technics: data statistics (spatial and temporal trends), population attributable fraction using AIRQ+ model developed by the WHO, and burden of disease using Disability-Adjusted Life Years (DALYs). The levels of SO2, NO, NO2, O3, H2S, benzene, PM10, PM2.5, CO, benzo(a)pyrene and metals, obtained between 2005 and 2017 from the air quality monitoring network across Camp de Tarragona County, were temporally and spatially determined. Health impacts were evaluated using the AIRQ+ model. Finally, the burden of disease was assessed through the calculation of Years of Lost life (YLL) and Years Lost due to Disability (YLD). In general terms, air quality was good according to European quality standards, but it did not fulfil the WHO guidelines, especially for O3, PM10 and PM2.5. Several decreasing (NO, NO2, SO2, PM10 and benzene) and an increasing (O3) temporal trend were found. Correlation between unemployment rate and air pollutant levels was found, pointing that the economic crisis (2008-2014) was a factor influencing the air pollutant levels. Reduction of air pollutant levels (PM2.5) to WHO guidelines in the Camp de Tarragona County would decrease the adult mortality between 23 and 297 cases per year, which means between 0.5 and 7% of all mortality in the area. In this County, for lung cancer, ischemic heart disease, stroke, and chronic obstructive pulmonary disease due to levels of PM2.5 above the WHO threshold limits, DAYLs were 240 years. This means around 80 DALYs for 100,000 persons every year -between 2005 and 2017. Population attributable fraction (PAF) and burden of disease (DALYs) methodologies are suitable tools for regional and national policymakers, who must take decisions to prevent and to control air pollution and to analyse the cost-effectiveness of interventions.


Asunto(s)
Contaminación del Aire/estadística & datos numéricos , Costo de Enfermedad , Exposición a Riesgos Ambientales/estadística & datos numéricos , Adulto , Contaminantes Atmosféricos/análisis , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Masculino , Isquemia Miocárdica/epidemiología , Material Particulado/análisis , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , España/epidemiología , Accidente Cerebrovascular/epidemiología
10.
J Forensic Sci ; 65(1): 160-165, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31343744

RESUMEN

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.


Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Prisioneros/psicología , Prisiones , Adulto , Coinfección , Femenino , Infecciones por VIH/epidemiología , Hepatitis C Crónica/epidemiología , Humanos , Estudios Longitudinales , Masculino , Polifarmacia , Estudios Prospectivos , Psicotrópicos/uso terapéutico , España/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
11.
Radiol Med ; 125(3): 272-279, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31784927

RESUMEN

OBJECTIVE: The purpose of this study is to investigate the role of cervical radiography in the study of patients with vertigo and dizziness. PATIENTS: This is a retrospective single-institution case series study of 493 patients suffering from vertigo and dizziness who were referred (from January 2011 to December 2012) to the hospital to study those symptoms. METHODS: We studied cervical radiographies, CT and MRI of the cervical spine made in the sample and the radiological findings. We analyzed demographic characteristics, presence of psychiatric pathology and emergency assistance due to vertigo in patients who have undergone cervical study. RESULTS: A total of 57% of patients had cervical radiography made; this was more frequent in women, Spanish people, with psychiatric pathology and who have gone to the emergency department for vertigo (p < 0.05). Degenerative changes were found in 74.1% of the patients with radiography made, more frequently at an older age, osteophytes in 49.5% and abnormal cervical lordosis in 37.1%. CONCLUSIONS: There are sociodemographic factors that influence in the request for cervical radiographs in patients with vertigo and dizziness. Given the suspicion of cervical vertigo, we do not consider that the findings in the radiographs help in the diagnosis. In our opinion, an excessive use of cervical radiography is made in patients with vertigo and dizziness.


Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Mareo , Imagen por Resonancia Magnética/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Vértigo , Análisis de Varianza , Distribución de Chi-Cuadrado , Mareo/epidemiología , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , España/epidemiología , Vértigo/epidemiología
13.
Rev Esp Cardiol (Engl Ed) ; 73(1): 14-20, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31160265

RESUMEN

INTRODUCTION AND OBJECTIVES: To compare the long-term results of direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) in real-world-patients with nonvalvular atrial fibrillation (NVAF) in a nationwide, prospective study. METHODS: The FANTASIIA registry prospectively included outpatients with AF anticoagulated with DOAC or VKA (per protocol, proportion of VKA and DOAC 4:1), consecutively recruited from June 2013 to October 2014 in Spain. The incidence of major events was analyzed and compared according to the anticoagulant treatment received. RESULTS: A total of 2178 patients were included in the study (mean age 73.8±9.4 years), and 43.8% were women. Of these, 533 (24.5%) received DOAC and 1645 (75.5%) VKA. After a median follow up of 32.4 months, patients receiving DOAC vs those receiving VKA had lower rates of stroke-0.40 (95%CI, 0.17-0.97) vs 1.07 (95%CI,0.79-1.46) patients/y, P=.032-, severe bleedings-2.13 (95%CI, 1.45-3.13) vs 3.28 (95%CI, 2.75-3.93) patients/y; P = .044-, cardiovascular death-1.20 (95%CI, 0.72-1.99) vs 2.45 (95%CI, 2.00-3.00) patients/y; P = .009-, and all-cause death-3.77 (95%CI, 2.83-5.01) vs 5.54 (95%CI, 4.83-6.34) patients/y; P = .016-. In a modified Cox regression model by the Andersen-Gill method for multiple events, hazard ratios for patients receiving DOAC were: 0.42 (0.16-1.07) for stroke; 0.47 (0.20-1.16) for total embolisms; 0.76 (0.50-1.15) for severe bleedings; 0.67 (0.39-1.18) for cardiovascular death; 0.86 (0.62-1.19) for all-cause death, and 0.82 (0.64-1.05) for the combined event consisting of stroke, embolism, severe bleeding, and all-cause death. CONCLUSIONS: Compared with VKA, DOAC is associated with a trend to a lower incidence of all major events, including death, in patients with NVAF in Spain.


Asunto(s)
Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control , Vitamina K/antagonistas & inhibidores , Administración Oral , Anciano , Fibrilación Atrial/complicaciones , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Pacientes Ambulatorios , Pronóstico , Estudios Prospectivos , España/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Tasa de Supervivencia/tendencias , Factores de Tiempo
14.
Rev Esp Cardiol (Engl Ed) ; 73(1): 35-42, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31122784

RESUMEN

INTRODUCTION AND OBJECTIVES: This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. METHODS: This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. RESULTS: Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The darly strategy showed a nonsignificant inverse tendency in patients with GRACE score <140. CONCLUSIONS: In high-risk (GRACE score≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.


Asunto(s)
Infarto del Miocardio sin Elevación del ST/cirugía , Intervención Coronaria Percutánea/métodos , Puntaje de Propensión , Sistema de Registros , Causas de Muerte/tendencias , Angiografía Coronaria , Electrocardiografía , Estudios de Seguimiento , Humanos , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/mortalidad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Tasa de Supervivencia/tendencias , Factores de Tiempo
15.
Accid Anal Prev ; 134: 105251, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31402051

RESUMEN

Powered two-wheelers (PTWs) are growing globally each year as they are considered an attractive alternative to cars (flexible, small, affordable, fast and easy to park), especially on congested traffic situations. However, PTWs represent an important challenge for road safety. In fact, in 2016, Spain ranked fifth in terms of PTW fatalities among EU 28. For this reason, this paper aims to investigate which are the patterns among crash characteristics contributing to PTW crashes in Spain. Data from 78,611 crashes involving PTWs occurred in Spain in the period 2011-2013 were analyzed. The analysis was performed by using classification trees and rules discovery which are suitable models aimed at extracting knowledge and identifying valid and understandable patterns from large amounts of data previously unknown and indistinguishable. The response variables assessed in this study were severity and crash type. As a result, several combinations of road, environmental and drivers' characteristics associated with severity and typology of PTW crashes in Spain were identified. Based on the analysis results, several countermeasures to solve or mitigate the safety issues identified in the study were proposed. From the methodological point of view, study results show that both the classification trees and the a priori algorithm were effective in providing non-trivial and unsuspected relations in the data. Classification trees structure allowed a simpler understanding of the phenomenon under study while association discovery provided new information which was previously hidden in the data. Given that the results of the two different techniques were never contradictory, we recommend using classification trees and association discovery as complementary approaches since their combination is effective in exploring data providing meaningful insights about PTW crash characteristics and their interdependencies.


Asunto(s)
Accidentes de Tránsito/mortalidad , Minería de Datos/métodos , Motocicletas/estadística & datos numéricos , Algoritmos , Humanos , Curva ROC , España/epidemiología
16.
Gut ; 69(1): 112-121, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30981990

RESUMEN

BACKGROUND AND AIMS: Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC). International guidelines recommend surveillance intervals of 1-2 years. However, yearly surveillance likely leads to overtreatment for many. We prospectively assessed a surveillance protocol aiming to safely reduce the burden of colonoscopies. METHODS: Between 2013 and 2018, we enrolled SPS patients from nine Dutch and Spanish hospitals. Patients were surveilled using a protocol appointing either a 1-year or 2-year interval after each surveillance colonoscopy, based on polyp burden. Primary endpoint was the 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance. RESULTS: We followed 271 SPS patients for a median of 3.6 years. During surveillance, two patients developed CRC (cumulative 5-year incidence 1.3%[95% CI 0% to 3.2%]). The 5-year AN incidence was 44% (95% CI 37% to 52%), and was lower for patients with SPS type III (26%) than for patients diagnosed with type I (53%) or type I and III (59%, p<0.001). Most patients were recommended a 2-year interval, and those recommended a 2-year interval were not at increased risk of AN: AN incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year recommendation (OR 0.57, p=0.08). CONCLUSION: Risk stratification substantially reduced colonoscopy burden while achieving CRC incidence similar to previous studies. AN incidence is considerable in SPS patients, but extension of surveillance intervals was not associated with increased AN in those identified as low-risk by the protocol. We identified SPS type III patients as low-risk group that might benefit from even less frequent surveillance. TRIAL REGISTRATION NUMBER: The study was registered on http://www.trialregister.nl; trial-ID NTR4609.


Asunto(s)
Poliposis Adenomatosa del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Poliposis Adenomatosa del Colon/epidemiología , Poliposis Adenomatosa del Colon/cirugía , Anciano , Estudios de Cohortes , Colonoscopía/métodos , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Persona de Mediana Edad , Países Bajos/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Estudios Prospectivos , Factores de Riesgo , España/epidemiología
17.
Maturitas ; 131: 72-77, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31787150

RESUMEN

OBJECTIVES: To determine the effects of a multicomponent physical exercise program on cognitive and affective functioning among nursing home residents and to clarify whether there are any changes in serum levels of brain-derived neurotrophic factor (BDNF) among participants. STUDY DESIGN: This was a single-blind randomized controlled trial in ten nursing homes in Gipuzkoa, Spain. The study included 112 men and women. Participants in the control group engaged in routine activities while those in the intervention group participated in a six-month individualized, progressive, multicomponent physical exercise program focused on strength, balance, and walking. MAIN OUTCOME MEASURES: Cognitive and affective functions were assessed at baseline and at six months. Serum BDNF levels were assessed via ELISA. RESULTS: After six months, a group by time interaction in favor of the intervention group was observed on the Montreal Cognitive Assessment (MOCA), symbol search and De Jong-Gierveld Loneliness Scale (P < 0.05). The control group scored more poorly on the MOCA, WAIS-IV (coding and symbol search), verbal fluency, and semantic fluency tests after six months (P < 0.05) than they did at baseline. The intervention group showed poorer results on the coding test (P < 0.05). Loneliness perception was reduced in the intervention group (P < 0.05). No changes in serum BDNF were observed (group x time and within groups, P > 0.05). CONCLUSION: A six-month individualized, progressive, multicomponent physical exercise intervention is effective at maintaining cognitive function and decreasing perceptions of loneliness among nursing home residents. Blood levels of BDNF were not affected by the intervention.


Asunto(s)
Factor Neurotrófico Derivado del Encéfalo/sangre , Cognición/fisiología , Terapia por Ejercicio/métodos , Hogares para Ancianos , Casas de Salud , Anciano , Anciano de 80 o más Años , Ensayo de Inmunoadsorción Enzimática , Ejercicio/psicología , Femenino , Estado de Salud , Humanos , Masculino , Calidad de Vida , Método Simple Ciego , España/epidemiología , Resultado del Tratamiento , Caminata
18.
J Laryngol Otol ; 134(1): 24-28, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31858917

RESUMEN

OBJECTIVE: To ascertain the distribution of Ménière's disease phenotype subgroups in a US-based cohort, based on a recently introduced classification scheme utilising a Spanish and Portuguese cohort. METHODS: A retrospective, cross-sectional, single-institutional chart review was conducted. The electronic medical records of Ménière's disease patients were identified using International Classification of Diseases codes at a tertiary referral centre and reviewed to extract subgroup-defining features. Patients with definite Ménière's disease as per American Academy of Otolaryngology-Head and Neck Surgery criteria were categorised into one of five subgroups, for unilateral and bilateral Ménière's disease. RESULTS: Eighty-one patients with definite Ménière's disease were identified. Seventy-two cases of unilateral Ménière's disease were observed: 52.8 per cent were type 1, 20.8 per cent were type 2, 4.2 per cent were type 3, 18.1 per cent were type 4, and 4.2 per cent were type 5. This cohort differed significantly in distribution to a comparison Mediterranean cohort (p < 0.01). Nine cases of bilateral Ménière's disease were observed. CONCLUSION: The distribution of unilateral Ménière's disease subtypes in this US population was different from that observed in a European population.


Asunto(s)
Enfermedad de Meniere/epidemiología , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Estudios Retrospectivos , España/epidemiología , Centros de Atención Terciaria , Estados Unidos/epidemiología
19.
BMC Infect Dis ; 19(1): 1030, 2019 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-31801482

RESUMEN

BACKGROUND: Cytomegalovirus infection dramatically decreased with the introduction of antiretroviral therapy. Whether incidence, clinical characteristics and prognosis of cytomegalovirus in HIV infected patients, has changed over time is. scarcely known. METHODS: Retrospective single-center study. Patients included in this study were all HIV infected patients that went to our center for any disease, and were diagnosed with cytomegalovirus, during the period 2004-2015. epidemiological, clinical and laboratory patients variables were collected in a clinical database. Clinical characteristics, incidence of cytomegalovirus and predictors of mortality during the study were assessed. Results were considered statistically significant when p < 0.05. All statistical analyses were calculated by SPSS version 20.0 (Chicago, IL,USA). RESULTS: Fifty-six cases of cytomegalovirus infection, in HIV infected patients were identified during the study period (incidence rate-1.7 cases per 1000 persons/year). The most frequent presentation was systemic illness in 43% of cases. Of note,no patients presented with ophthalmic manifestations. The 30-days mortality was 18%. Predictors of mortality were, in the univariate analysis, admission to the intensive care unit OR 32.4 (3.65-287.06) p = 0.0001, and mechanic ventilation 84 OR (8.27-853.12) p = 0.0001, and ART OR 4.1 (0.97-17.31) p = 0.044. These variables were assessed by multivariate analysis, and only mechanical ventilation was statistically significant (p < 0.05) CONCLUSION: Incidence of cytomegalovirus infection was higher than described in the antiretroviral therapy era. Clinical presentation has changed. Mechanic ventilation predicted mortality.


Asunto(s)
Infecciones por Citomegalovirus/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Adulto , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/mortalidad , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Humanos , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Estudios Retrospectivos , España/epidemiología , Carga Viral
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