Including ecosystem descriptors in current fishery data collection programmes to advance towards a holistic monitoring: Seabird abundance attending demersal trawlers.

To develop an ecosystem-based approach to fisheries management a holistic perspective is necessary that goes beyond target species management to preserve ecosystem functioning and, therefore, secure future food availability. To achieve these objectives, current fishery data collection programmes should widen their objectives to include the collection of ecosystem descriptors to effectively take advantage of funding and human resources in relation to fisheries monitoring already in place. From an ecological perspective, fishing discards are food subsidies unnaturally available that can profoundly impact the life history traits and population dynamics of seabirds, as well as community structure. In 2015, we took advantage of the Data Collection Framework (DCF) programme, monitoring the Basque trawling fleet, to monitor seabird abundance associated with trawlers as an additional task to be performed by the observers. The main objectives were (1) to develop a standard protocol from an interdisciplinary expert committee, (2) to obtain baseline information of seabird association with trawlers to be able to track changes and (3) to understand seabird abundance in relation to discard facilitation processes based on environmental and fishing parameters. Based on the developed standard protocol, more than 21 species of seabirds were recorded in 241 fishing hauls in the Bay of Biscay (ICES areas 8abd). This biogeographic area is an important migratory flyway and wintering area, where maximum number of seabirds attending trawlers were recorded between December and April (2015-2019). Based on Generalised Linear Models, seabird abundance was higher in multiple situations: harsher environmental conditions, less available discards, shallower areas, increased period of discard availability, higher number of trawlers simultaneously operating in the same fishing ground, in addition to the months of February and April. The core discarding ground was located in the outer French shelf between the latitudinal range of 44.5°N and 46°N, especially for otter trawl fishing. Our approach puts into value the seabird counts that the observers of the DCF can perform systematically, collecting relevant information on the effect of trawling on other biodiversity components such as seabirds. This information will be critical to respond to the application of the reform of the Common Fisheries Policy regarding the effect of the Landing Obligation that seeks fishing sustainability.

Low antimicrobial resistance rates of Mycobacterium tuberculosis complex between 2000 and 2015 in Gipuzkoa, northern Spain / Baja tasa de resistencia antibiótica de Mycobacterium tuberculosis complex en Gipuzkoa, norte de España, entre 2000 y 2015

OBJECTIVE: Although the incidence of tuberculosis (TB) has declined, TB drug resistance remains a major problem. The TB rate in Gipuzkoa (northern Spain) is higher than the European average. The objective of this study was to determine the antimicrobial susceptibility of 1855 Mycobacterium tuberculosis complex isolates (94.5% of confirmed cases between 2000 and 2015). METHODS: Susceptibility testing was performed using the agar proportion method and a commercial broth system (MGIT 960). In isoniazid- or rifampicin-resistant strains, we studied genetic determinants of drug resistance and genotype (MIRU-VNTR). RESULTS: The annual mean incidence of TB was 24.5 cases per 100,000 population on average, and tended to decrease. The multidrug-resistant TB rate was 0.5% (9/1855), and no extensively drug-resistant TB strains were detected. Rates of resistance to isoniazid and rifampicin were 3.9% (range, 3.4-4.3%) and 0.6% (range, 0.4-1.4%), respectively. TB resistance was more common among foreign-born individuals and those who had received previous TB treatment. Genotyping of 102 resistant strains showed predominance of the Euro-American lineage, although 4/9 multidrug-resistant strains had Eastern lineages (2 East African-Indian, and 2 East Asian (Beijing)). CONCLUSIONS: In Gipuzkoa, with a moderate incidence of TB, resistance was very low, mostly being detected among individuals who were born abroad or who had a history of TB treatment

OBJETIVO: Aunque la incidencia de tuberculosis (TB) está descendiendo, la resistencia a fármacos antituberculosos continúa siendo un grave problema. Gipuzkoa, norte de España, tiene una tasa de TB superior a la media europea. El objetivo de este trabajo fue estudiar la sensibilidad a los antibióticos de 1.855 aislamientos de Mycobacterium tuberculosis complex (94,5% de los casos confirmados entre 2000 y 2015). MÉTODOS: El estudio de susceptibilidad se realizó mediante el método de las proporciones en agar, y mediante dilución en caldo (sistema MGIT 960). En las cepas resistentes a isoniacida o rifampicina se analizaron determinantes genéticos de resistencia y el genotipo (MIRU-VNTR). RESULTADOS: La incidencia media anual de TB fue de 24,5 casos por 100.000 habitantes, con una tendencia decreciente. La tasa de multirresistencia fue del 0,5% (9/1.855), y no se detectaron cepas con resistencia extrema. Las tasas de resistencia a isoniacida y rifampicina fueron del 3,9% (rango: 3,4-4,3%) y 0,6% (rango: 0,4-1,4%), respectivamente. La TB resistente fue más frecuente entre las personas nacidas en el extranjero y entre los que recibieron tratamiento antituberculoso previo. El genotipado de 102 cepas resistentes mostró predominio del linaje Euro-Americano, aunque 4/9 cepas multirresistentes pertenecieron a linajes orientales (2 East African-Indian, y 2 East Asian (Beijing)). CONCLUSIONES: En Gipuzkoa, con una incidencia moderada de TB, la resistencia fue muy baja, y asociada especialmente a personas nacidas en el extranjero o que recibieron tratamiento antituberculoso previo

Prenatal exposure to perfluoroalkyl substances, immune-related outcomes, and lung function in children from a Spanish birth cohort study.

BACKGROUND: Prenatal exposure to perfluoroalkyl substances (PFASs) has been associated with impaired immune and respiratory health during childhood but the evidence is inconsistent and limited for lung function. We studied the association between prenatal PFASs exposure and immune and respiratory health, including lung function, up to age 7 years in the Spanish INMA birth cohort study. METHODS: We assessed four PFASs in maternal plasma samples collected during the 1st trimester of pregnancy (years: 2003-2008): perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorononanoate (PFNA). Mothers reported the occurrence (yes/no) of lower respiratory tract infections, wheezing, asthma, and eczema in the previous 12 months at 1.5 and 4 years of the child (n = 1188) and at 7 years (n = 1071). At ages 4 (n = 503) and 7 (n = 992) years lung function was assessed using spirometry tests. RESULTS: The most abundant PFASs were PFOS and PFOA (geometric means: 5.80 and 2.31 ng/mL, respectively). The relative risk of asthma during childhood per each doubling in PFNA concentration was 0.74 (95 CI%: 0.57, 0.96). The relative risk of eczema during childhood per every doubling in PFOS concentration was 0.86 (95 CI%: 0.75, 0.98). Higher PFOA concentrations were associated with lower forced vital capacity and lower forced expiratory volume in 1 s z-scores at 4 years [ß (95 CI %): -0.17 (-0.34, -0.01) and -0.13 (-0.29, 0.03), respectively], but not at 7 years. CONCLUSION: This longitudinal study suggests that different PFASs may affect the developing immune and respiratory systems differently. Prenatal exposure to PFNA and PFOS may be associated with reduced risk of respiratory and immune outcomes, particularly asthma and eczema whereas exposure to PFOA may be associated with reduced lung function in young children. These mixed results need to be replicated in follow-up studies at later ages.

Low antimicrobial resistance rates of Mycobacterium tuberculosis complex between 2000 and 2015 in Gipuzkoa, northern Spain.

OBJECTIVE: Although the incidence of tuberculosis (TB) has declined, TB drug resistance remains a major problem. The TB rate in Gipuzkoa (northern Spain) is higher than the European average. The objective of this study was to determine the antimicrobial susceptibility of 1855 Mycobacterium tuberculosis complex isolates (94.5% of confirmed cases between 2000 and 2015). METHODS: Susceptibility testing was performed using the agar proportion method and a commercial broth system (MGIT 960). In isoniazid- or rifampicin-resistant strains, we studied genetic determinants of drug resistance and genotype (MIRU-VNTR). RESULTS: The annual mean incidence of TB was 24.5 cases per 100,000 population on average, and tended to decrease. The multidrug-resistant TB rate was 0.5% (9/1855), and no extensively drug-resistant TB strains were detected. Rates of resistance to isoniazid and rifampicin were 3.9% (range, 3.4-4.3%) and 0.6% (range, 0.4-1.4%), respectively. TB resistance was more common among foreign-born individuals and those who had received previous TB treatment. Genotyping of 102 resistant strains showed predominance of the Euro-American lineage, although 4/9 multidrug-resistant strains had Eastern lineages (2 East African-Indian, and 2 East Asian [Beijing]). CONCLUSIONS: In Gipuzkoa, with a moderate incidence of TB, resistance was very low, mostly being detected among individuals who were born abroad or who had a history of TB treatment.

A Q Fever Outbreak with a High Rate of Abortions at a Dairy Goat Farm: Coxiella burnetii Shedding, Environmental Contamination, and Viability.

This study describes a Q fever outbreak in a herd of 77 Alpine goats which suffered a high rate of abortions (81% [58/72]) in January 2017 and presents the results of monitoring the contamination and viability of Coxiella burnetii in the farm environment several months after the outbreak. Over the course of 7 months, we studied bacterial shedding by 35 dams with abortions to monitor C. burnetii infection dynamics and the duration of excretion. The highest bacterial shedding load was observed in vaginal mucus, followed by in feces and in milk. Conversely, the duration of C. burnetii shedding was longer through feces (5 months after abortion) than milk (3 months). C. burnetii DNA was detected throughout the study in aerosol samples periodically collected indoors and outdoors from the animal premises. Mouse inoculation and culture in Vero cells demonstrated the presence of viable isolates in dust collected from different surfaces inside the animal facilities during the period of time with the highest number of abortions but not in dust collected 2, 3, and 4 months after the last parturition. Some workers and visitors were affected by Q fever, with attack rates of 78% (7/9) and 31% (4/13), respectively. Affected people mostly showed fever and seroconversion, along with myalgia and arthralgia in two patients and pneumonia in the index case. The genotype identified in animal and environmental samples (SNP1/MST13) turned out to be very aggressive in goats but caused only moderate symptoms in people. After the diagnosis of abortion by Q fever in goats, several control measures were implemented at the farm to prevent contamination inside and outside the animal facilities.IMPORTANCE This work describes a 7-month follow-up of the excretion by different routes of Coxiella burnetii genotype SNP1/MST13 in a herd of goats that suffered high rate of abortions (81%), generating high environmental contamination. Some of the workers and visitors who accessed the farm were infected, with fever as the main symptom but a low incidence of pneumonia. The detected strain (SNP1/MST13 genotype) turned out to be very aggressive in goats. The viability of C. burnetii was demonstrated in the environment of the farm at the time of abortions, but 2 months after the last parturition, no viable bacteria were detected. These results highlighted the importance of implementing good biosafety measures at farms and avoiding the entrance of visitors to farms several months after the end of the kidding period.

Prenatal exposure to mercury and longitudinally assessed fetal growth: Relation and effect modifiers.

BACKGROUND: Prenatal mercury exposure has been related to reductions in anthropometry at birth. Levels of mercury have been reported as being relatively elevated in the Spanish population. OBJECTIVE: To investigate the relation between prenatal exposure to mercury and fetal growth. METHODS: Study subjects were pregnant women and their newborns (n:1867) participating in a population-based birth cohort study set up in four Spanish regions from the INMA Project. Biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and estimated fetal weight (EFW) were measured by ultrasounds at 12, 20, and 34 weeks of gestation. Size at and growth between these points were assessed by standard deviation (SD) scores adjusted for constitutional characteristics. Total mercury (T-Hg) was determined in cord blood. Associations were investigated by linear regression models, adjusted by sociodemographic, environmental, nutritional - including four seafood groups - and lifestyle-related variables in each sub-cohort. Final estimates were obtained using meta-analysis. Effect modification by sex, seafood intake and polychlorinated biphenyl (PCB) congener 153 concentration was assessed. RESULTS: Geometric mean of cord blood T-Hg was 8.2µg/L. All the estimates of the association between prenatal Hg and growth from 0 to 12 weeks showed reductions in SD-scores, which were only statistically significant for BPD. A doubling of cord blood T-Hg was associated with a 0.58% reduction in size of BPD at week 12 (95% confidence interval -CI-: - 1.10, - 0.07). Size at week 34 showed estimates suggestive of a small reduction in EFW, i.e., a doubling of T-Hg levels was associated with a reduction of 0.38% (95% CI: - 0.91, 0.15). An interaction between PCB153 and T-Hg was found, with statistically significant negative associations of T-Hg with AC and EFW in late pregnancy among participants with PCB153 below the median. CONCLUSIONS: Exposure to mercury during pregnancy was associated with early reductions in BPD. Moreover, an antagonism with PCB 153 was observed with noteworthy reductions late in pregnancy in AC and EFW in the group with lower PCB153.

Prenatal Exposure to Perfluoroalkyl Substances and Cardiometabolic Risk in Children from the Spanish INMA Birth Cohort Study.

BACKGROUND: Perfluoroalkyl substances (PFAS) may affect body mass index (BMI) and other components of cardiometabolic (CM) risk during childhood, but evidence is scarce and inconsistent. OBJECTIVES: We estimated associations between prenatal PFAS exposures and outcomes relevant to cardiometabolic risk, including a composite CM-risk score. METHODS: We measured perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) in maternal plasma (first trimester). We assessed weight gain from birth until 6 mo. At 4 and 7 y, we calculated the age- and sex-specific z-scores for BMI, waist circumference (WC), and blood pressure (BP) (n≈1,000). At age 4, we calculated the age-, sex-, and region-specific z-scores for cholesterol, triglycerides (TGs), high-density (HDL-C), and low-density lipoprotein cholesterol (LDL-C) (n=627). At age 4, we calculated a CM-risk score (n=386) as the sum of the individual age-, sex-, and region-specific z-scores for WC, BP, HDL-C, and TGs. We used the average between the negative of HDL-C z-score and TGs z-score to give similar weight to lipids and the other components in the score. A higher score indicates a higher cardiometabolic risk at age 4. RESULTS: PFOS and PFOA were the most abundant PFAS (geometric mean: 5.80 and 2.32 ng/mL, respectively). In general, prenatal PFAS concentrations were not associated with individual outcomes or the combined CM-risk score. Exceptions were positive associations between prenatal PFHxS and TGs z-score [for a doubling of exposure, ß=0.11; 95% confidence interval (CI): 0.01, 0.21], and between PFNA and the CM-risk score (ß=0.60; 95% CI: 0.04, 1.16). There was not clear or consistent evidence of modification by sex. CONCLUSIONS: We observed little or no evidence of associations between low prenatal PFAS exposures and outcomes related to cardiometabolic risk in a cohort of Spanish children followed from birth until 7 y. https://doi.org/10.1289/EHP1330.

Socioeconomic differences in incidence and relative survival after a first acute myocardial infarction in the Basque Country, Spain

Objective To estimate the incidence and 28-day and 5-year survival rates after a first acute myocardial infarction (AMI) in relation to socioeconomic status in the Basque Country (Spain) between 1999 and 2000.MethodsData from a population-based registry of AMI were used. The study included 3,619 patients to calculate age-standardized incidence by the direct method and 2,003 patients (out-of-hospital deaths were excluded) to calculate observed and relative survival using the Kaplan-Meier and Hakulinen methods, respectively. Socioeconomic status was quantified using a deprivation index ecologically assigned to each patient according to the census tract of residence at diagnosis of AMI and was categorized into quintiles. Results Among men, the risk of AMI was higher in the lowest socioeconomic group than in the highest socioeconomic group (RR=1.17; 95%CI: 1.02-1.34). In men, a higher risk of death was observed in the middle (Q3; HR=1.60; 95%CI: 1.02-2.51) and low (Q5; HR=1.65; 95%CI: 1.02-2.69) quintiles compared with the least deprived group for age-adjusted survival during the acute phase. In the fully adjusted model, this effect was attenuated and no significant differences were observed in long-term survival. Among women, no significant differences were observed either in incidence or in short- and long-term survival. Conclusions Socioeconomic inequalities were only observed in men in incidence and in survival during the acute phase after an AMI (AU)

Objetivo Estimar la incidencia y la supervivencia a 28 días y 5 años tras un primer infarto agudo de miocardio (IAM) según la posición socioeconómica en el País Vasco entre 1999 y 2000.MétodosUtilizando datos de un registro poblacional de IAM se incluyeron 3.619 pacientes para estimar la incidencia ajustada por edad por el método directo, y 2003 (excluidas las muertes extrahopitalarias) para la supervivencia observada y relativa con el método de Kaplan-Meier y el de Hakulinen, respectivamente. El nivel socioeconómico se definió por un índice de privación ecológicamente asignado a cada paciente según la sección censal de residencia al diagnóstico del IAM, y se categorizó en quintiles. Resultados Los hombres del nivel socioeconómico más bajo tuvieron un mayor riesgo de IAM que los del más alto (RR=1,17; IC95%: 1,02-1,34). En la supervivencia en la fase aguda ajustada por edad, los hombres de los quintiles medio (Q3; HR=1,60; IC95%: 1,02-2,51) y bajo (Q5; HR=1,65; IC95%: 1,02-2,69) presentaron un mayor riesgo de muerte en comparación con el grupo más favorecido. Este efecto se vio atenuado en los modelos completamente ajustados, y no hubo diferencias significativas en la supervivencia a largo plazo. En la mujeres no se hallaron diferencias significativas en la incidencia ni en la supervivencia a corto y largo plazo. Conclusiones Sólo se han observado desigualdades socioeconómicas en los hombres en la incidencia y la supervivencia durante la fase aguda (AU)

Socioeconomic differences in incidence and relative survival after a first acute myocardial infarction in the Basque Country, Spain.

OBJECTIVE: To estimate the incidence and 28-day and 5-year survival rates after a first acute myocardial infarction (AMI) in relation to socioeconomic status in the Basque Country (Spain) between 1999 and 2000. METHODS: Data from a population-based registry of AMI were used. The study included 3,619 patients to calculate age-standardized incidence by the direct method and 2,003 patients (out-of-hospital deaths were excluded) to calculate observed and relative survival using the Kaplan-Meier and Hakulinen methods, respectively. Socioeconomic status was quantified using a deprivation index ecologically assigned to each patient according to the census tract of residence at diagnosis of AMI and was categorized into quintiles. RESULTS: Among men, the risk of AMI was higher in the lowest socioeconomic group than in the highest socioeconomic group (RR=1.17; 95%CI: 1.02-1.34). In men, a higher risk of death was observed in the middle (Q3; HR=1.60; 95%CI: 1.02-2.51) and low (Q5; HR=1.65; 95%CI: 1.02-2.69) quintiles compared with the least deprived group for age-adjusted survival during the acute phase. In the fully adjusted model, this effect was attenuated and no significant differences were observed in long-term survival. Among women, no significant differences were observed either in incidence or in short- and long-term survival. CONCLUSIONS: Socioeconomic inequalities were only observed in men in incidence and in survival during the acute phase after an AMI.

Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain).

Epidemiological studies show that adherence to a Mediterranean diet (MD) increases longevity; however, few studies are restricted to Mediterranean populations or explore the effect of a MD pattern that directly incorporates olive oil. Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The EPIC-Spain analysis included 40 622 participants (37·7 % males) aged 29-69 years who were recruited from five Spanish regions in 1992-1996. During a mean follow-up of 13·4 years, 1855 deaths were documented: 913 from cancer, 399 from CVD, 425 from other causes and 118 from unknown causes of death. Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD (rMED) score, measured using an 18-unit scale incorporating nine selected dietary components. A high compared with a low rMED score was associated with a significant reduction in mortality from all causes (hazard ratio (HR) 0·79; 95 % CI 0·69, 0·91), from CVD (HR 0·66; 95 % CI 0·49, 0·89), but not from overall cancer (HR 0·92; 95 % CI 0·75, 1·12). A 2-unit increase in rMED score was associated with a 6 % (P < 0·001) decreased risk of all-cause mortality. A high olive oil intake and moderate alcohol consumption contributed most to this association. In this Spanish cohort, following an olive oil-rich MD was related to a significant reduction in all-cause mortality, and reduced the risk of mortality from CVD. These results support the important role that the MD pattern has on reducing mortality in Mediterranean countries.

Concentración de trihalometanos y de ácidos haloacéticos en el agua de consumo y estimación de su ingesta durante el embarazo en la cohorte INMA-Guipúzcoa (España) / Trihalomethane and haloacetic acid concentrations in drinking water and their estimated intake during pregnancy in the INMA cohort (Guipúzcoa, Spain)

ObjetivosDescribir la concentración de trihalometanos (THM) y ácidos haloacéticos (AHA) del agua de consumo, valorar su variación espacio-temporal y estimar las ingestas individuales en el embarazo.MétodosEn los años 2006–2008 se analizó el agua en 33 puntos representativos de las redes de abastecimiento de los 25 municipios del área de estudio. Los hábitos de consumo de agua se obtuvieron mediante cuestionario.ResultadosLa media (desviación estándar) fue de 16,9μg/l (7,9) para el total de THM y de 10,9μg/l (4,9) para la suma de las concentraciones de cinco: monocloroacético, dicloroacético, tricloroacético, monobromoacético y dibromoacético (AHA5). Las concentraciones fueron menores en las aguas de manantial, sólo cloradas, que en las de embalse, sometidas a tratamiento completo de potabilización: 8,8μg/l frente a 19,1μg/l (p<0,01) y 8,2μg/l frente a 11,7μg/l (p<0,01). Los valores aumentan significativamente con el número de depósitos de la red y con la recloración, y son mayores en verano y en otoño. La ingesta media del total de THM y de AHA5 es menor en las mujeres que se abastecen de agua de manantial. Hay diferencias en la ingesta según el embalse de abastecimiento.ConclusionesEl origen del agua, la estructura de la red de distribución y la estación del año condicionan la cantidad de productos derivados de la desinfección en el agua. Las ingestas medias varían según el origen del agua, y para todos los productos están muy por debajo de los valores establecidos por la OMS (AU)

ObjectivesTo report trihalomethane (THM) and haloacetic acid (HAA) concentrations in drinking water, assess variations in these concentrations depending on source and over time, and estimate individual intake during pregnancy.MethodsWater taken from 33 representative points of the water supply network of the 25 municipalities in the study area was analyzed from 2006–2008. Water drinking habits were recorded using a questionnaire.ResultsMean total THM concentrations were 16.9μg/L (standard deviation, 7.9), while the mean value for the sum of concentrations of five HAA (monochloroacetic, dichloroacetic, tricholoroacetic, monobromoacetic, and dicromoacetic acids) was 10.9μg/L (standard deviation, 4.9). Concentrations were lower in spring waters, which were only chlorinated, compared with dam waters, which were subject to a complete purification treatment: 8.8μg/L vs 19.1μg/L (p<0.01) and 8.2μg/L vs 11.7μg/L (p<0.01). Concentrations significantly increased with the number of deposits in the network and with their rechlorination and were higher in the summer and fall. Mean intakes of total THM and of the five HAA were lower in women supplied with spring water. Intakes differed depending on supply reservoir.ConclusionsDisinfection by-products in water are affected by water source, supply network structure, and annual season. The mean intake of these products varies depending on the source of drinking water. Mean intakes of all products were much lower than values recommended by the World Health Organization (AU)

Sex differences in relative survival and prognostic factors in patients with a first acute myocardial infarction in Guipuzcoa, Spain.

INTRODUCTION AND OBJECTIVES: To determine 28-day and 5-year survival rates in patients who have experienced a first acute myocardial infarction and to identify prognostic factors for survival. METHODS: This study involved 1,677 patients with a first acute myocardial infarction who were treated at a hospital in Guipuzcoa, Spain between 1997 and 2000. RESULTS: Women were approximately 10 years older than men, presented more often with diabetes and hypertension, were in a less favorable clinical condition, and consumed fewer medical resources, but were less likely to smoke. Survival rates at 28 days and 5 years were higher in men over 60 years of age. In the period from 29 days to 5 years, the relative survival rate was higher in men from all age groups. Factors associated with short- and long-term survival varied between the sexes. Disease severity in the acute phase and, later on, age were associated with survival in both men and women, whereas the effect of other variables differed between the sexes. CONCLUSIONS: Myocardial infarction is a condition associated with high mortality in the acute phase. There is an interaction between sex and age that affects survival after an acute myocardial infarction. A number of factors are associated with poor short- and long-term prognoses in both sexes.

Diferencias por sexo en la supervivencia relativa y los factores pronósticos de pacientes con un primer infarto agudo de miocardio en Guipúzcoa / Sex differences in relative survival and prognostic factors in patients with a first acute myocardial infarction in Guipuzcoa, Spain

Introducción y objetivos. Estimar la supervivencia a los 28 días y a los 5 años y los factores pronósticos asociados en personas que han sufrido un primer infarto agudo de miocardio. Métodos. Se estudió a 1.677 pacientes con un primer infarto agudo de miocardio que accedieron a un hospital de Guipúzcoa entre 1997 y 2000. Resultados. Las mujeres eran unos 10 años mayores, presentaron más diabetes mellitus e hipertensión y un cuadro clínico más desfavorable y recibieron menos recursos terapéuticos, aunque eran menos fumadoras que los varones. La supervivencia fue superior entre los varones mayores de 60 años a los 28 días y a los 5 años. En el periodo de 29 días a 5 años, los varones de todos los grupos de edad presentaron una supervivencia relativa más larga. Los factores relacionados con la supervivencia a corto y largo plazo difirieron entre uno y otro sexo. La gravedad de la enfermedad en la fase aguda y la edad en la fase tardía fueron factores relacionados con la supervivencia de varones y mujeres y en el resto de las variables el comportamiento fue distinto entre uno y otro sexo. Conclusiones. El infarto es una enfermedad con una elevada mortalidad en la fase aguda. Existe una interacción entre el sexo y la edad que afecta a la supervivencia tras un infarto agudo de miocardio. Varios factores se asocian a un peor pronóstico precoz y tardío en ambos sexos (AU)

Introduction and objectives. To determine 28-day and 5-year survival rates in patients who have experienced a first acute myocardial infarction and to identify prognostic factors for survival. Methods. This study involved 1,677 patients with a first acute myocardial infarction who were treated at a hospital in Guipuzcoa, Spain between 1997 and 2000. Results. Women were approximately 10 years older than men, presented more often with diabetes and hypertension, were in a less favorable clinical condition, and consumed fewer medical resources, but were less likely to smoke. Survival rates at 28 days and 5 years were higher in men over 60 years of age. In the period from 29 days to 5 years, the relative survival rate was higher in men from all age groups. Factors associated with short- and long-term survival varied between the sexes. Disease severity in the acute phase and, later on, age were associated with survival in both men and women, whereas the effect of other variables differed between the sexes. Conclusions. Myocardial infarction is a condition associated with high mortality in the acute phase. There is an interaction between sex and age that affects survival after an acute myocardial infarction. A number of factors are associated with poor short- and long-term prognoses in both sexes (AU)

[Trihalomethane and haloacetic acid concentrations in drinking water and their estimated intake during pregnancy in the INMA cohort (Guipúzcoa, Spain)]. / Concentración de trihalometanos y de ácidos haloacéticos en el agua de consumo y estimación de su ingesta durante el embarazo en la cohorte INMA-Guipúzcoa (España).

OBJECTIVES: To report trihalomethane (THM) and haloacetic acid (HAA) concentrations in drinking water, assess variations in these concentrations depending on source and over time, and estimate individual intake during pregnancy. METHODS: Water taken from 33 representative points of the water supply network of the 25 municipalities in the study area was analyzed from 2006-2008. Water drinking habits were recorded using a questionnaire. RESULTS: Mean total THM concentrations were 16.9 µg/L (standard deviation, 7.9), while the mean value for the sum of concentrations of five HAA (monochloroacetic, dichloroacetic, tricholoroacetic, monobromoacetic, and dicromoacetic acids) was 10.9 µg/L (standard deviation, 4.9). Concentrations were lower in spring waters, which were only chlorinated, compared with dam waters, which were subject to a complete purification treatment: 8.8 µg/L vs 19.1 µg/L (p<0.01) and 8.2 µg/L vs 11.7 µg/L (p<0.01). Concentrations significantly increased with the number of deposits in the network and with their rechlorination and were higher in the summer and fall. Mean intakes of total THM and of the five HAA were lower in women supplied with spring water. Intakes differed depending on supply reservoir. CONCLUSIONS: Disinfection by-products in water are affected by water source, supply network structure, and annual season. The mean intake of these products varies depending on the source of drinking water. Mean intakes of all products were much lower than values recommended by the World Health Organization.

Esa corporeidad mortal y rosa»: análisis del tiempo libre de enfermedad del cáncer de mama en Gipuzkoa en presencia de riesgos competitivos / That deadly and pink corporeity’: Analysis of disease-free survival analysis in breast cancer in Gipuzkoa (Spain) in the presence of competing risks

Objetivo: Analizar el tiempo de supervivencia libre de enfermedad y la supervivenciare lativa en mujeres diagnosticadas de c ancer de mama en la provincia de Gipuzkoa en un contexto de riesgos competitivos, valorando las diferencias en contradas entre el uso directo del estimador de Kaplan-Meiery el me todo de decrementos multiples por un lado y la supervivencia relativa porotro (..) (AU)

Objective: To analyze time of disease-free survival and relative survival in women diagnosed with breast cancer in the province of Gipuzkoa with in the context of competing risks by assessing differences between the direct use of the Kaplan (..) (AU)

Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study.

No known cohort study has investigated whether the Mediterranean diet can reduce incident coronary heart disease (CHD) events in a Mediterranean population. This study examined the relation between Mediterranean diet adherence and risk of incident CHD events in the 5 Spanish centers of the European Prospective Investigation into Cancer and Nutrition. Analysis included 41,078 participants aged 29-69 years, recruited in 1992-1996 and followed up until December 2004 (mean follow-up:10.4 years). Confirmed incident fatal and nonfatal CHD events were analyzed according to Mediterranean diet adherence, measured by using an 18-unit relative Mediterranean diet score. A total of 609 participants (79% male) had a fatal or nonfatal confirmed acute myocardial infarction (n = 468) or unstable angina requiring revascularization (n = 141). After stratification by center and age and adjustment for recognized CHD risk factors, high compared with low relative Mediterranean diet score was associated with a significant reduction in CHD risk (hazard ratio = 0.60, 95% confidence interval: 0.47, 0.77). A 1-unit increase in relative Mediterranean diet score was associated with a 6% reduced risk of CHD (95% confidence interval: 0.91, 0.97), with similar risk reductions by sex. Mediterranean diet adherence was associated with a significantly reduced CHD risk in this Mediterranean country, supporting its role in primary prevention of CHD in healthy populations.

Supervivencia relativa en cáncer de mama después de la primera recidiva y factores pronóstico asociados / Breast cancer relative survival after the first recurrence and related prognostic factors

Fundamento y objetivo: Es variable la información existente sobre la incidencia y el pronóstico de las mujeres que tienen una recidiva del cáncer de mama. El objetivo fue medir la incidencia de recidivas locorregionales y a distancia y la supervivencia y sus determinantes después de la primera recidiva. Pacientes y método: Todas las mujeres residentes en Guipúzcoa, a las que durante los años 1995 y 1996 se les diagnosticó cáncer de mama invasivo y no diseminado, identificadas mediante el Registro de Cáncer de Gipúzcoa. Se midieron retrospectivamente las recidivas ocurridas hasta diciembre de 2004 y en 2007 se cruzó con el Índice Nacional de Defunciones para conocer la mortalidad. Se calculó la supervivencia relativa mediante el método de Hakulinen. Resultados: Se incluyeron 561 mujeres con tumores en estadios i a iii. Un 42,6% fue tratado con cirugía conservadora más radioterapia, y en un 46,7% se realizó mastectomía. La mediana de seguimiento para la recidiva fue de 8 años. La incidencia de recidivas locorregionales fue del 5,7%, y la incidencia de recidivas a distancia fue del 23%. La mediana de seguimiento tras la recidiva fue de 6,1 años para las vivas y de 1,04 años para las fallecidas. La supervivencia a los 3 años fue del 54% (intervalo de confianza [IC] del 95%: 0,31 a 0,78) después de las recidivas locorregionales, y del 18% (IC del 95%: 0,09 a 0,28) tras recidiva a distancia. En el análisis multivariado, los factores que permanecen como predictores independientes de la supervivencia tras una recidiva locorregional son el tiempo hasta la recidiva, la edad y el grado de diferenciación del tumor inicial. La edad, el tiempo hasta la recidiva y la afectación ganglionar se han asociado a la supervivencia después de una recidiva a distancia (AU)

Background and objectives: Information regarding the incidence and prognosis of women who have suffered a recurrence of breast cancer is very variable. The aim of the present study was to determine the incidence of locoregional (LR) and distant recurrence and the survival and its determining factors after first recurrence.Patients and methods: We included all women resident in Guipuzkoa who were diagnosed with invasive, non-disseminated breast cancer during 1995 and 1996 identified via Guipuzkoa's Cancer Registry. Recurrences that occurred up to December 2004 were determined retrospectively and compared with the National Death Registry of 2007 to determine the mortality. Relative survival was calculated by the Hakulinen method.Results: Five hundred and sixty one women with tumours in stages I–III were included, 90% of whom were treated with conservative surgery+radiation therapy, or mastectomy. The median follow-up for recurrence was eight years, with 5,7% of these recurrences being LR and 23% distant metastases. The median follow-up after recurrence was 6,1 years for live patients and 1,04 years for dead ones. The three-year survival was 54% (95% CI: 0,31–0,78) after LR recurrence and 18% (95% CI: 0,09–0,28) after distant recurrence. Multivariate analysis showed that the factors that remained as independent predictors of survival after LR recurrence were time to recurrence, age and degree of differentiation of the initial tumour. Age, time to recurrence and nodal involvement were associated with survival after distant recurrence.Conclusions: Women younger than 54 at initial diagnosis with short disease-free periods and poorly differentiated tumours with nodal involvement have worse prognosis, which should be taken into account when deciding the therapeutic strategy to be followed upon recurrence (AU)

["That flesh, pink and perishable": analysis of disease-free survival analysis in breast cancer in Gipuzkoa (Spain) in the presence of competing risks]. / "Esa corporeidad mortal y rosa": análisis del tiempo libre de enfermedad del cáncer de mama en Gipuzkoa en presencia de riesgos competitivos.

OBJECTIVE: To analyze time of disease-free survival and relative survival in women diagnosed with breast cancer in the province of Gipuzkoa within the context of competing risks by assessing differences between the direct use of the Kaplan-Meier estimator and the multiple decrement method on the one hand, and relative survival on the other. METHODS: All registered breast cancer cases in Gipuzkoa in 1995 and 1996 with stages other than stage IV were included. An 8-year follow-up for recurrence and a 10-year follow-up for survival were performed. Time of disease-free survival was studied by the multiple decrement model. Observed survival and survival corrected by the expected mortality in the population (relative survival) were also studied. RESULTS: Estimation of the probability of recurrence at 8 years with the multiple decrement method was 8.8% lower than that obtained with the Kaplan-Meier method. The difference between the observed and relative survival rates at 10 years was 10.8%. Both results show how, in this case, the Kaplan-Meier estimator overestimates both the probability of recurrence and that of mortality from the disease. CONCLUSIONS: Two issues are often overlooked when performing survival analyses: firstly, because of the lack of independence between survival time and censoring time, the results obtained by the Kaplan-Meier estimator are uninterpretable; secondly, it is an incontrovertible fact that one way or another, everyone causes failures. In this approach, survival analyses must take into account the probability of failure in the general population of reference. The results obtained in this study show that superficial use of the Kaplan Meier estimator overestimates both the probability of recurrence and that of mortality caused by the disease.

[Breast cancer relative survival after the first recurrence and related prognostic factors]. / Supervivencia relativa en cáncer de mama después de la primera recidiva y factores pronóstico asociados.

BACKGROUND AND OBJECTIVES: Information regarding the incidence and prognosis of women who have suffered a recurrence of breast cancer is very variable. The aim of the present study was to determine the incidence of locoregional (LR) and distant recurrence and the survival and its determining factors after first recurrence. PATIENTS AND METHODS: We included all women resident in Guipuzkoa who were diagnosed with invasive, non-disseminated breast cancer during 1995 and 1996 identified via Guipuzkoa's Cancer Registry. Recurrences that occurred up to December 2004 were determined retrospectively and compared with the National Death Registry of 2007 to determine the mortality. Relative survival was calculated by the Hakulinen method. RESULTS: Five hundred and sixty one women with tumours in stages I-III were included, 90% of whom were treated with conservative surgery+radiation therapy, or mastectomy. The median follow-up for recurrence was eight years, with 5,7% of these recurrences being LR and 23% distant metastases. The median follow-up after recurrence was 6,1 years for live patients and 1,04 years for dead ones. The three-year survival was 54% (95% CI: 0,31-0,78) after LR recurrence and 18% (95% CI: 0,09-0,28) after distant recurrence. Multivariate analysis showed that the factors that remained as independent predictors of survival after LR recurrence were time to recurrence, age and degree of differentiation of the initial tumour. Age, time to recurrence and nodal involvement were associated with survival after distant recurrence. CONCLUSIONS: Women younger than 54 at initial diagnosis with short disease-free periods and poorly differentiated tumours with nodal involvement have worse prognosis, which should be taken into account when deciding the therapeutic strategy to be followed upon recurrence.

[Gender differences in early reperfusion treatment after myocardial infarction]. / Diferencias de género en el tratamiento de revascularización precoz del infarto agudo de miocardio.

BACKGROUND AND OBJECTIVE: Clinical variability in myocardial infarction (MI) regarding age, comorbidities and atypical symptoms could determine gender differences in inhospital care. This study analyzes the magnitude and determinants of differences between men and women in early reperfusion therapy in people hospitalized after MI. PATIENTS AND METHOD: 2,836 patients who arrived to hospital with MI were studied (IBERICA-Basque Country study). The relative risk (RR) of receiving early reperfusion for men versus women, adjusted by age, clinical characteristics, risk factors, and pre-hospital delay was estimated. The effect decomposition methodology and the log binomial regression were applied. RESULTS: 29% of patients were women with a median age of 77 years. The RR of revascularization in men compared to women was different according to age. When factors such as hypertension diabetes, Killip III-IV at admission and atypical symptoms were taken into account, statistically significant differences between sexes were not detected at 45 years old (RR=0.91; 95% CI=0.77-1.07). However, for 64 years old and over, the RR of reperfusion was 1.24 (95% CI=1.05-1.47). Both the differences by sex and the sex-age interaction were no longer statistically significant after adjusting by pre-hospital delay. CONCLUSIONS: The delay to receive medical care in elderly women is responsible of gender differences in early reperfusion. It is necessary to analyze the reasons for treatment-seeking delay.