[Medicine consumption as a factor associated with the state of fragility of the elderly patient in Spain]. / El consumo de medicamentos como factor asociado al estado de fragilidad en personas mayores de 65 años en España.

INTRODUCTION: Frailty in the elderly is a concept in constant evolution, with a significant impact on the morbidity and mortality of patients. We assessed the associative strength of the Timed Up and Go test (TUG) and medication consumption in frailty and associated risk using various methods. MATERIAL AND METHODS: Observational, cross-sectional, multicenter study carried out in 128 Primary Care Centers distributed throughout Spain, has a total sample of 2422 patients over 65 years of age, estimating the prevalence of frailty with the TUG test. Descriptive analysis of the categorical variables and associative strength of TUG for frailty and medication consumption was performed with distribution of absolute and relative frequencies and multinomial logistic regression. SPSS 22.0 was used, considering statistical significance p=0.05. RESULTS: The prevalence of frailty in the sample was 13.7%, accepting as frailty those subjects who obtained a score >20s in performing the TUG test. A third of these subjects classified as frail took more than 30s to complete the test and 32.5% of those studied would be classified as "pre-frail". We found a slight difference in the prevalence of frailty if we analyze the data according to sex, being 10.8% in men compared to 15.8% in women. Regarding pharmacological consumption, 72.8% of the subjects consume 5 or more drugs daily with similar proportions by sex, and with an average consumption of 6.57 drugs. The drugs with the greatest association with the degree of frailty were drugs used for dementia (40% of individuals who consumed them were considered frail), antiparkinsonian drugs (38%), antipsychotics (34%), antianemics (26.2%), anticoagulants (22.2%) and antiepileptics (21.1%). CONCLUSIONS: The incidence of frailty in elderly patients in Spain is initially notable, being present in 13.7% through the application of the TUG test. The age variable is the one that is most significantly associated with the frailty of the elderly patient. An association was demonstrated between the degree of frailty and total medication consumption. The prevalence of frailty was 4.7% in the non-polypharmacy group compared to 15.4% in the polypharmacy group and reaching 23.4% in the extreme polypharmacy group. The drugs with a greater association with the patient's degree of frailty were those used in the neurological/psychiatric sphere (antidementia, antiparkinsonian, antipsychotic or antiepileptic drugs).

Associations of accumulated persistent organic pollutants in breast adipose tissue with the evolution of breast cancer after surgery.

Chronic exposure to persistent organic pollutants (POPs) is suspected to contribute to the onset of breast cancer, but the impact on the evolution of patients after diagnosis is unclear. We aimed to analyze the contribution of long-term exposure to five POPs to overall mortality, cancer recurrence, metastasis, and development of second primary tumors over a global follow-up of 10 years after surgery in breast cancer patients in a cohort study. Between 2012 and 2014, a total of 112 newly diagnosed breast cancer patients were recruited from a public hospital in Granada, Southern Spain. Historical exposure to POPs was estimated by analyzing their concentrations in breast adipose tissue samples. Sociodemographic data were collected through face-to-face interviews, while data on evolution tumor were retrieved from clinical records. Statistical analyses were performed using Cox regression (overall survival, breast cancer recurrence or metastasis) and binary logistic regression models (joint outcome variable). We also tested for statistical interactions of POPs with age, residence, and prognostic markers. The third vs first tertile of hexachlorobenzene concentrations was associated with a lower risk of all-cause mortality (Hazard Ratio, HR = 0.26; 95 % Confidence Interval, CI = 0.07-0.92) and of the appearance of any of the four events (Odds Ratio = 0.37; 95 % CI = 0.14-1.03). Polychlorinated biphenyl 138 concentrations were significantly and inversely associated with risk of metastasis (HR = 0.65; 95 % CI = 0.44-0.97) and tumor recurrence (HR = 0.69; 95 % CI = 0.49-0.98). Additionally, p,p'-dichlorodiphenyldichloroethylene showed inverse associations with risk of metastasis in women with ER-positive tumors (HR = 0.49; 95 % CI = 0.25-0.93) and in those with a tumor size <2.0 cm (HR = 0.39; 95 % CI = 0.18-0.87). The observed paradoxical inverse associations of POP exposure with breast cancer evolution might be related to either a better prognosis of hormone-dependent tumors, which have an approachable pharmacological target, or an effect of sequestration of circulating POPs by adipose tissue.

Correlation of phytoplankton satellite observations and radiological doses in molluscs.

In this work data of salinity, temperature, suspended particulate matter (SPM), chlorophyll-a, and phytoplankton concentration in the Gibraltar Strait coast, in the confluence of the Mediterranean Sean and the Atlantic Ocean, were analyzed together with 210Po, 40K, 210Pb and 234Th activity concentration in different types of bivalve molluscs at the same time-period. The physicochemical parameters were evaluated using the Copernicus Marine Environment Monitoring Service (CMEMS) products based on satellite observations. A multivariate statistical analysis, including contrasted natural radioactivity contents, allowed the discrimination of bivalve molluscs from Atlantic and Mediterranean coasts. Additionally, a cluster analysis determined a highly significant negative correlation 210Po concentration in molluscs and phytoplankton concentration suggesting that phytoplankton concentration in the water column is a determinant factor to regulate 210Po concentration in those animals. These results introduce a useful tool to calculate the radiological doses in seafood from chlorophyll satellite image.

Fluorescent perylenylpyridine complexes: an experimental and theoretical study.

The perylene derivative 2-(3-perylenyl)-4-methylpyridine (HPerPy) was prepared and used to synthesize [Ag(HPerPy)(PPh3)(OClO3)], with the perylene ligand bonded to the metal centre only by the pyridine nitrogen. The treatment of HPerPy with [Pd(OAc)2] in methanol or acetic acid led to acetate bridged dimers (µ-OOCCH3)2[Pd(PerPy)]2, six-membered or five-membered cycled at the perylenyl fragment. Substitution reactions afforded mononuclear compounds [Pd(PerPy)(acac)] (six-member or five-member cycled) and [Pd(PerPy)(S2COMe)] (six-member or five-member cycled). The reaction of HPerPy with a platinum(ii) fragment led to a five-membered cyclometallated Pt(ii) complex [Pt(PerPy)(acac)]. The oxidative addition with MeI gave the corresponding cyclometallated Pt(iv) compound [Pt(PerPy)(acac)MeI]. X-ray single crystal studies of compounds [Ag(HPerPy)(PPh3)(OClO3)], (µ-OOCCH3)2[Pd(PerPy)]2-five-membered, [Pd(PerPy)(acac)]-six-membered, [Pd(PerPy)(S2COMe)]-five-membered, [Pt(PerPy)(acac)]-five-membered, and [Pt(PerPy)(acac)MeI]-five-membered confirmed the proposed structures. The UV-Vis spectra show one intense absorption with vibronic coupling in the visible region with maxima in the range of 448-519 nm. DFT calculations were carried out for the absorption spectra of the HPerPy molecule and representative complexes [M(PerPy)(acac)] (M: Pd, Pt; five and six-membered isomers) and [Pt(PerPy)(acac)MeI], showing that the lowest energy most intense transition in the complexes corresponds to the HOMO → LUMO transition in the perylene moiety, although affected by the metallacycle size and the metal nature. All the compounds are fluorescent in solution, due to the perylene fragment. The emission spectra display maxima in the range of 468-549 nm, with quantum yields from 1.1 to 82%. The attenuation of the intensity of fluorescence by the presence of heavy atoms and the formation of metallacycles has been experimentally determined and sequenced.

[Risk of falls and drug use in patients over 65 years of age. The PYCAF study]. / Riesgo de caídas y consumo de fármacos en los pacientes mayores de 65 años. Estudio PYCAF.

OBJECTIVE: To evaluate the risk of falls and its relationship with the multiple drug use in the non-institutionalised elderly. MATERIALS AND METHODS: The PYCAF study (Prevalence and Characteristics of the Fragile Elderly) is a cross-sectional, descriptive and multicentre study in patients> 65 years of age. A fall was considered high risk when it took more than 20seconds to perform the Timed Up and Go test. Consuming between 5 and 9 drugs is considered multiple drug (MD) use, and extreme multiple drug (EMD) use the consumption of 10 or more drugs. Adjusted logistic regression models evaluated the association between multiple drug use and EMD and the risk of falls. RESULTS: A total of 2,461 patients (57.9% women), with a mean age (SD) 76.0 (± 7.0) years, were included in the study. The mean consumption of medications was 6.6 ± 3.7, range 0-23. Multiple drug use was present in 50.6%, and EMD in 19.2% of patients. A high risk of falls was observed in 13.7% of patients. The prevalence of high risk of falls was more than 2times higher in patients with EMD (ORa = 2.07, 95% CI = 1.27 - 3.38) and MD (ORa = 1.95, 95% CI = 1.26 - 2.99). CONCLUSIONS: MD and EMD are associated with a high risk of falls in patients over 65 years of age. The risk of falls in elderly patients should be assessed before prescribing medication.

A lysimeter study under field conditions of nitrogen and phosphorus leaching in a turf grass crop amended with peat and hydrogel.

Golf courses represent an agricultural activity wherein grass is intensively cultivated using large quantities of fertilizers. In the present study, nitrogen and phosphorus leaching was analyzed over two years in an experimental green under actual field conditions. The green contained four plots with distinct amendments (P1: hydrogel + peat, P2: peat, P3: hydrogel, and P4: no amendment). The applied doses of nitrogen ranged from 5 to 103 kg/ha and of phosphorus from 9 to 31 kg/ha. The irrigation level varied as a function of the rainfall regime and the water requirements of grass; overall water intake varied from 1550 to 2080 mm/year. Daily, leached water volume was calculated, and samples were taken for chemical analysis. Nitrogen and phosphorus mass balances were calculated for different periods based on the collected data. The plot amended with peat and hydrogel (P1) had reduced water flow; the percentage of drainage water varied from 8.4 to 29%. As a result, the dissolution and leaching of nitrogen (N) and phosphorus (P) were the lowest in comparison to the other plots. According to the calculated mass balances, the lowest leaching values were also recorded in this plot (P1), ranging from 0.5 to 6.3% for N and from 0.8 to 20.9% for P. The plot without amendment (P4) drained the most water (25.9-44.8%) and leached the highest quantities of N and P, ranging from 9.1-45.7%, and 6-35.9%, respectively. The use of double amendments (hydrogel and peat) therefore represented optimal operating conditions for the green. Moreover, a relationship was found between increasing rates of fertilization and increasing percentages of N and P leaching as well as between higher irrigation levels and greater leaching.

Patient, tumor, and healthcare factors associated with regional variability in lung cancer survival: a Spanish high-resolution population-based study.

PURPOSE: The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain. METHODS: A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain. RESULTS: There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis. CONCLUSIONS: The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.

Disposable sputtered-bismuth screen-printed sensors for voltammetric monitoring of cadmium and lead in atmospheric particulate matter samples.

We report here the use of commercial screen-printed disposable sensors comprising a sputtered bismuth working electrode, a silver pseudo reference electrode and a carbon auxiliary electrode (whole set referred as BispSPE), as a new and advantageous alternative for reliable and convenient monitoring of Cd and Pb in atmospheric particulate matter (PM10 fraction) by anodic stripping voltammetry after acid digestion. After a detailed exploration of surface composition and depth profiles of the BispSPE by SEM, EDX, XPS and EIS, chemical and instrumental variables have been optimized to develop a reliable method capable of measuring Cd and Pb with detection limits of 11.8ngmL-1 and 6.1ngmL-1 respectively. These detection limits are useful for pollution monitoring of these elements in ambient air under the requirements of international health and environmental protection standards. The accuracy of the method was assessed by voltammetric measurements of Cd and Pb in ERM®-CZ120 Fine dust (PM10-like) and ERM® 1648a Urban Particulate Matter certified reference materials. The applicability of the method to Cd and Pb determination in real samples was demonstrated by analysis of PM10 samples from the air quality network in Extremadura, with a good correlation respect to the standard ICP-MS methodology. Our work constitutes the first reference about the use of disposable sensors based on BispSPE for the determination of heavy metals in atmospheric particulate matter samples.

Associations of persistent organic pollutants in serum and adipose tissue with breast cancer prognostic markers.

This study aimed to evaluate associations between exposure to a group of persistent organic pollutants, measured in both adipose tissue and serum samples from breast cancer patients, and a set of tumor prognostic markers. The study population comprised 103 breast cancer patients recruited in Granada, Southern Spain. Data for tumor prognostic markers were retrieved from hospital clinical records and socio-demographic information was gathered by questionnaire. Persistent organic pollutants were quantified by gas chromatography with electron capture detection. Exposure levels were categorized in quartiles, and associations were evaluated using unconditional logistic regression. Adipose tissue HCB concentrations were associated positively with ER and PR expression (p-trends=0.044 and 0.005, respectively) and negatively with E-Cadherin and p53 expression (p-trends=0.012 and 0.027, respectively). PCB-180 adipose tissue concentrations were positively associated with HER2 expression (p-trend=0.036). Serum PCB-138 concentrations were positively associated with ER and PR expression (p-trends=0.052 and 0.042, respectively). The risk of p53 expression was higher among women in the lowest quartile of serum PCB-138 concentrations, but no significant trend was observed (p-trend=0.161). These findings indicate that human exposure to certain persistent organic pollutants might be related to breast cancer aggressiveness. We also highlight the influence on exposure assessment of the biological matrix selected, given that both serum and adipose tissue might yield relevant information on breast cancer prognosis.

Trends in lung cancer incidence by histologic subtype in the south of Spain, 1985-2012: a population-based study

Purpose: To analyze and interpret age- and sex-specific incidence trends of lung cancer in Granada over the period 1985–2012 and to further analyze these trends by histologic subtype. Methods: Incidence data were obtained from the population-based cancer registry located in Granada (Southern Spain). All cases with newly diagnosed primary lung cancer over the period 1985–2012 (n = 8658) and defined by International Classification of Diseases 10th Revision (codes C33–C34) were included. Joinpoint regression analysis of age-standardized incidence rates was used to estimate the annual percent change (APC) and 95 % confidence intervals. Results are presented overall and by sex, age groups (0-34, 35-54, 55-64, 65-74, C75 years) and histologic subtypes. Results: Temporal trends of incidence rates by sex, over the period 1985–2012, showed a distinct pattern. A significant change point of the trend was observed in males in 1994 (APC: ?2.5 %; 95 % CI 0.7-4.4 from 1985 to 1994 and -1.4 %; 95 % CI -2.0 to -0.7 from 1994 onward). This general change was mainly caused by the age group 65-74 years and by the higher incidence of squamous cell carcinoma histologic subtype. In females, lung cancer incidence increased over the entire study period by +4.2 % per year (95 % CI 3.1-5.4); this trend was mainly caused by the age group 55-64 years (APC = +7 %) and by adenocarcinoma incidence between women (APC = +6.8 %). Conclusion: Male lung cancer incidence rates have decreased in Granada, while female rates have increased overall especially in younger women. These trends may reflect the increased consumption of cigarettes in women especially during younger ages. Lung cancer prevention through tobacco control policies are therefore of utmost importance (AU)

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Trends in lung cancer incidence by histologic subtype in the south of Spain, 1985-2012: a population-based study.

PURPOSE: To analyze and interpret age- and sex-specific incidence trends of lung cancer in Granada over the period 1985-2012 and to further analyze these trends by histologic subtype. METHODS: Incidence data were obtained from the population-based cancer registry located in Granada (Southern Spain). All cases with newly diagnosed primary lung cancer over the period 1985-2012 (n = 8658) and defined by International Classification of Diseases 10th Revision (codes C33-C34) were included. Joinpoint regression analysis of age-standardized incidence rates was used to estimate the annual percent change (APC) and 95% confidence intervals. Results are presented overall and by sex, age groups (0-34, 35-54, 55-64, 65-74, ≥75 years) and histologic subtypes. RESULTS: Temporal trends of incidence rates by sex, over the period 1985-2012, showed a distinct pattern. A significant change point of the trend was observed in males in 1994 (APC: +2.5%; 95% CI 0.7-4.4 from 1985 to 1994 and -1.4%; 95% CI -2.0 to -0.7 from 1994 onward). This general change was mainly caused by the age group 65-74 years and by the higher incidence of squamous cell carcinoma histologic subtype. In females, lung cancer incidence increased over the entire study period by +4.2% per year (95% CI 3.1-5.4); this trend was mainly caused by the age group 55-64 years (APC = +7%) and by adenocarcinoma incidence between women (APC = +6.8%). CONCLUSION: Male lung cancer incidence rates have decreased in Granada, while female rates have increased overall especially in younger women. These trends may reflect the increased consumption of cigarettes in women, especially during younger ages. Lung cancer prevention through tobacco control policies are therefore of utmost importance.

Serum and adipose tissue as matrices for assessment of exposure to persistent organic pollutants in breast cancer patients.

The aim of this study was to assess differences between two biological matrices (serum and breast adipose tissue) in the evaluation of persistent organic pollutant (POP) exposure in breast cancer patients. The study population consisted of 103 women undergoing surgery for newly diagnosed breast carcinoma in a public hospital in Granada, Southern Spain. Independent variables were gathered from questionnaires and clinical records. POP concentrations were quantified in breast adipose tissue and serum samples. Spearman correlation tests were performed between pairs of POP concentrations and stepwise multivariable linear regression analyses were conducted to assess predictors of concentrations in the two matrices. p,p'- Dichlorodiphenyldichloroethylene (p,p'-DDE) showed the the highest median concentration in both matrices (194.34 and 173.84 ng/g lipid in adipose tissue and serum, respectively). Median wet-basis adipose tissue:serum ratios ranged from 109.34 to 651.62, while lipid-basis ratios ranged from 0.88 to 4.34. In general, we found significant positive correlation coefficients between pairs of POPs in adipose tissue and in serum, which were always higher in adipose tissue. We found positive and statistically significant correlations between serum and adipose tissue concentrations of p,p'-DDE and hexachlorobenzene (HCB) but not of polychlorinated biphenyls (PCBs). Age was positively associated with most POPs in adipose tissue and serum, while the body mass index was positively associated with adipose tissue HCB concentrations and negatively associated with serum PCB-153 and PCB-138 concentrations. Recent weight loss was inversely associated with POP residues in adipose tissue and positively associated with POP residues in serum. Serum HCB and PCB-180 concentrations were lower in patients who had received preoperative chemotherapy. According to our results, serum and adipose tissue POP concentrations in breast cancer patients may be differentially affected by external predictors. Taken together, these findings indicate the need to take account of the individual POP(s) under study and the biological matrix used when relating internal POP exposure to breast cancer disease and to make a careful selection of covariates for adjusting the model.

Higher fluorescence in platinum(iv) orthometallated complexes of perylene imine compared with their platinum(ii) or palladium(ii) analogues.

The reaction of 3-perylenylmethylen-4'-ethylaniline () with [Pt2Me4(µ-SMe2)2] (and subsequent addition of PPh3) or with [Pt2(η(3)-C4H7)2(µ-Cl)2] produced cyclometallated Pt(II) complexes [Pt(C^N)Me(PPh3)] () and, respectively, [Pt2(C^N)2(µ-Cl)2] () (HC^N = 3-C20H11CH[double bond, length as m-dash]NC6H4-p-C2H5), with Pt bound to the ortho site of the perylenyl fragment. From the mononuclear complexes [Pt(C^N)L2] (L2 = acac (); S2COMe (); S2CNEt2 () are easily formed. Oxidative addition of methyl iodide to the square-planar Pt(II) complexes , , and gave the corresponding cyclometallated Pt(IV) compounds [Pt(C^N)L2MeI] , and . The X-ray structures of , , and show that the perylenyl fragment remains essentially flat in and and slightly twisted in . Comparison of the optical properties of these Pt(II) complexes with those reported for similar Pd(II) derivatives reveals that the change of metal exerts a notable influence on the UV-vis spectra. In solution at room temperature, all the Pt complexes exhibit fluorescence associated with the perylene fragment with low emission quantum yields for the Pt(II) complexes (<1%) and remarkably higher emission values for the Pt(IV) complexes: up to 29%, with emission lifetimes of 1-5 ns. Time-dependent density functional theory (TD-DFT) calculations were performed on the perylene imine and on representative complexes [M(C^N)(acac)] (M = Pd, Pt) and [Pt(C^N)(acac)MeI] to analyse the absorption spectra. These calculations support a perylene-dominated intraligand π-π*emissive state based on the HOMO and LUMO orbitals of the perylene chromophore, and a ligand-to-ligand charge-transfer (more intense for the Pt(II) complex) that explains the observed influence of the metal on the absorption properties.

Highly fluorescent complexes with 3-isocyanoperylene and N-(2,5-di-tert-butylphenyl)-9-isocyano-perylene-3,4-dicarboximide.

The perylene derivatives 3-isocyanoperylene (Per-N≡C) (4a) and N-(2,5-di-tert-butylphenyl)-9-isocyano-perylene-3,4-dicarboximide (PMI-N≡C) (4b) were prepared and used to synthesize gold complexes [AuX(CNR)] (X = C6F5 (5a,b), C6F4-O(n)Bu-p (6b)). The reaction of 5b and 6b with HNEt2 led to the carbene complexes [AuX{C(NEt2)(NHR)}] (7b, 8b), respectively. The molecular structure of complexes 7b and 8b have been determined by X-ray diffraction analysis showing intermolecular π-stacking of the perylene groups and C6F5 rings and no Au···Au interactions. The derivative compounds [M(CO)5(CNR)] (M = Cr (9a,b), Mo (10a,b) or W (11a,b)) and trans-[Pd(CNR)2(C6F3Cl2)2] (12a,b) were also prepared. All complexes exhibit fluorescence associated with the perylene fragment with emission quantum yields, in solution at room temperature, in the range 0.05-0.93 and emission lifetimes ~ 4 ns. DFT calculations were performed of the absorption spectra of the ligands Per-N≡C and PMI-N≡C and representative complexes [Au(C6F5)(CNR)], [Cr(CO)5(CNR)], showing a perylene-dominated intraligand π-π* emissive state, from the HOMO and LUMO orbitals of the perylene chromophore, but with significantly different absorption maxima by the influence of the metal fragment, particularly significant in the Per-N≡C derivatives.

Impacts of urbanization on groundwater hydrodynamics and hydrochemistry of the Toluca Valley aquifer (Mexico).

The Toluca Valley is located on the high plains of Mexico, where there are significant industrial zones and large populations. Water needs are almost exclusively met by groundwater, which has brought about intense exploitation of the aquifer and indication of some contamination. The present study investigates the effect of urbanization, related to industrialization of the region, on groundwater in the central portion of the Toluca Valley aquifer--a zone with high population density and where the largest industrial park is located. A general decline in the groundwater level has been found over the years, at a rate of as much as 2.5 m/year. The appearance of a large drawdown cone was identified, indicating changes in the direction of groundwater flow. Also identified was the presence of several ground fissures, the location of which coincided with the drawdown cone. In hydrochemical terms, the water type is sodium-magnesium bicarbonate and this characteristic has not changed over time, although it has been possible to detect the presence of larger quantities of sulfates (up to 117 mg/L) and nitrates (up to 47 mg/L) in recent years, likely associated with contamination from industrial and urban wastewater. Factor analysis made it possible to identify ions that would characterize natural processes involving the acquisition of salts (HCO3 (-), Na(+), Mg(2+), and Si), as well as anthropic activities (SO4 (2-), NO3 (-), Cl(-), Ca(2+), and K(+)).

Una experiencia interesante en el uso de la información y de las bases de datos poblacionales / An interesting experience on the use of information and population data bases

Introducción. El adecuado funcionamiento de nuestro sistema sanitario requiere de bases de datos y sistemas de información de calidad para basar sus decisiones y analizar los resultados. Sin embargo, pese a los tenaces esfuerzos de recogida de datos llevados a cabo, la utilización de este tipo de bases es escasa, poco sistematizada y con excesivas cortapisas para lograr acceder a ellas. Material y métodos. Describimos en esta revisión la experiencia del Institute for Clinical Evaluative Science (ICES, Ontario, Canadá) como modelo eficiente y que puede servir de referente en nuestro país para mejorar la utilización de los sistemas de información. Resultados. El ICES está legalmente capacitado para, bajo condiciones estrictas de confidencialidad y seguridad, utilizar numerosas bases de datos poblacionales estatales para elaborar informes y proyectos de investigación. Su estructura de funcionamiento (con un nivel administrativo y un nivel científico) constituye un marco de trabajo interesante ya que garantiza su autonomía de criterio y económica. Discusión. Hasta la fecha su nivel de producción científica ha sido elevado, sobre áreas de conocimiento muy diversas y abierta a los intereses y puntos de vista de muchos profesionales de la salud (asistenciales y gestores), para los cuales la calidad de la investigación es a la postre el criterio de mayor importancia para acceder a estos recursos(AU)

Introduction. In order to support decisions and analyze outcomes, the Spanish Health System has shown a great interest in developing data bases and high quality information systems. Nevertheless the use of these data bases are limited, not very systematized and, some times, their accessibility may be difficult. Material and methods. We describe in this review the experience in using the Institute for Clinical Evaluative Science (ICES, Ontario, Canada) as an efficient model to improve the usefulness of these data bases. Results. Under restrictive conditions of confidentiality and privacy, the ICES has the legal capacity to use several population based data bases, for research projects and reports. ICES's functional structure (with an administrative and scientific level) is an interesting framework since it guarantees its independent and economic assessment. Discussion. To date, its scientific production has been high in many areas of knowledge and open to those interested, with points of view of many health care professionals (including management), for whom the quality of research is of the ultimate importance, to be able to access these resources(AU)

[An interesting experience on the use of information and population data bases]. / Una experiencia interesante en el uso de la información y de las bases de datos poblacionales.

INTRODUCTION: In order to support decisions and analyze outcomes, the Spanish Health System has shown a great interest in developing data bases and high quality information systems. Nevertheless the use of these data bases are limited, not very systematized and, some times, their accessibility may be difficult. MATERIAL AND METHODS: We describe in this review the experience in using the Institute for Clinical Evaluative Science (ICES, Ontario, Canada) as an efficient model to improve the usefulness of these data bases. RESULTS: Under restrictive conditions of confidentiality and privacy, the ICES has the legal capacity to use several population based data bases, for research projects and reports. ICES's functional structure (with an administrative and scientific level) is an interesting framework since it guarantees its independent and economic assessment. DISCUSSION: To date, its scientific production has been high in many areas of knowledge and open to those interested, with points of view of many health care professionals (including management), for whom the quality of research is of the ultimate importance, to be able to access these resources.

Predictors of the total effective xenoestrogen burden (TEXB) in human adipose tissue. A pilot study.

The estrogenicity of biological extracts tested by appropriate bioassay is a standard method to evaluate the total effective xenoestrogen burden (TEXB). Information has been published on the combined effect of xenoestrogens after removing endogenous hormones. The main goal of the present study was to investigate the combined estrogenicity of endogenous and xenoestrogens in human adipose tissue samples with and without HPLC fractionation. The results suggest that both approaches may be useful to study interaction between xenoestrogens and endogenous hormones. TEXB of the whole extract provides information about the overall estrogenicity to which humans are exposed, useful to assess the potential contribution to health outcomes. Additionally, it is possible to identify the source and potency of the estrogenicity by using the method with fractionation, distinguishing the effect of organohalogenated chemicals (alpha-fraction) from that of endogenous hormones and more polar xenoestrogens (beta-fraction). Both methods are an integrative measure of internal estrogen load.

Predicción de uso de consultas en el anciano a partir de las variables de género, edad, comorbilidad y visita previa / Prediction of use of consultations in the elderly from the variables of gender, age, comorbidity and prior visit

Introducción. En el anciano se conocen numerosas variables asociadas a la utilización de consultas, si bien hay discrepancias sobre su efecto como predictoras de nuevas visitas. El objetivo del estudio ha sido conocer la capacidad predictiva de un modelo de uso de consultas en población >= 65 años atendida en AP. Material y métodos. Se estudian 207 pacientes. Las variables de resultado son «Visitas al centro de salud» y «Visitas a urgencias del hospital», analizadas asimismo como predictiva una de otra. Otras variables predictivas son la edad, el género y la comorbilidad. Mediante regresión múltiple se elaboran 14 modelos multivariantes, expresándose el valor del coeficiente R2, la reducción de la varianza que aporta cada variable y su significación estadística. Resultados. La capacidad predictiva mejora al estratificar, alcanzando el máximo rendimiento en el modelo «Visitas a urgencias en pacientes sin comorbilidad» (R2=0,251,p<0,000). Ambos tipos de visitas se correlacionan significativamente con la edad, la comorbilidad y entre ambas. Son las variables más predictivas, con una capacidad explicativa que llega al 17,6%, mientras que la comorbilidad alcanza el 11,8%. Conclusiones. Aunque los modelos son precisos, las variables analizadas son insuficientes para predecir el uso de consultas en el anciano, pues tan sólo explican un 25% de la variabilidad final. Dentro de esa capacidad explicativa, se observa que una visita previa es un potente predictor de una visita futura, especialmente en 3 estratos: mujeres, < 75 años y pacientes sin comorbilidad. La edad y la comorbilidad son más predictoras de futuras visitas en hombres que en mujeres (AU)

Introduction. Several variables associated with the use of health services by the elderly are already known, although there is disagreement on their effect as predictors of new visits. The aim of this study was to determine the prediction power of a model of use of consultations in people ¡Ý 65years attended in primary care. Material and methods. A total of 207 patients of both genders were studied. Outcome variables were visits to the primary care centre and visits to hospital emergency services, both also analysed as predictive of one another. Other predictive variables were age, gender and comorbidity. A multiple regression analysis was performed using 14 multivariate models. Results. The predictive ability improved with stratification and reached the highest performance in the model ¡°Visits to hospital emergency services in patients without comorbidity¡± (R2=0,251, P<.000). Both types of visits were significantly correlated with age, comorbidity, and between themselves. These were the most predictive variables (up to 17.6%), whereas comorbidity contributed up to 11.8%. Conclusions. Despite the accuracy of the models, these variables are insufficient to predict new consultations in the elderly, because they hardly explain 25% of the final variability. Within the predictive ability, it was shown that a prior visit is a powerful predictor of a future visit, particularly in three strata: women, < 75years and patients without comorbidity. Age and comorbidity are stronger predictors of future visits in men than in women (AU)

[Study of the nutritional status of elders in Cantabria]. / Estudio del estado nutricional de los ancianos de Cantabria.

INTRODUCTION: Population ageing is a main concern under the biosanitary point of view. AIM: To assess the nutritional status of people 65 year-old and older in Cantabria (Spain) METHOD: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%). RESULTS: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65). We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. CONCLUSION: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency.