Plasma lipidome and risk of atrial fibrillation: results from the PREDIMED trial.

The potential role of the lipidome in atrial fibrillation (AF) development is still widely unknown. We aimed to assess the association between lipidome profiles of the Prevención con Dieta Mediterránea (PREDIMED) trial participants and incidence of AF. We conducted a nested case-control study (512 incident centrally adjudicated AF cases and 735 controls matched by age, sex, and center). Baseline plasma lipids were profiled using a Nexera X2 U-HPLC system coupled to an Exactive Plus orbitrap mass spectrometer. We estimated the association between 216 individual lipids and AF using multivariable conditional logistic regression and adjusted the p values for multiple testing. We also examined the joint association of lipid clusters with AF incidence. Hitherto, we estimated the lipidomics network, used machine learning to select important network-clusters and AF-predictive lipid patterns, and summarized the joint association of these lipid patterns weighted scores. Finally, we addressed the possible interaction by the randomized dietary intervention.Forty-one individual lipids were associated with AF at the nominal level (p < 0.05), but no longer after adjustment for multiple-testing. However, the network-based score identified with a robust data-driven lipid network showed a multivariable-adjusted ORper+1SD of 1.32 (95% confidence interval: 1.16-1.51; p < 0.001). The score included PC plasmalogens and PE plasmalogens, palmitoyl-EA, cholesterol, CE 16:0, PC 36:4;O, and TG 53:3. No interaction with the dietary intervention was found. A multilipid score, primarily made up of plasmalogens, was associated with an increased risk of AF. Future studies are needed to get further insights into the lipidome role on AF.Current Controlled Trials number, ISRCTN35739639.

One-year longitudinal association between changes in dietary choline or betaine intake and cardiometabolic variables in the PREvención con DIeta MEDiterránea-Plus (PREDIMED-Plus) trial.

BACKGROUND: Choline and betaine intakes have been related to cardiovascular health. OBJECTIVES: We aimed to explore the relation between 1-y changes in dietary intake of choline or betaine and 1-y changes in cardiometabolic and renal function traits within the frame of the PREDIMED (PREvención con DIeta MEDiterránea)-Plus trial. METHODS: We used baseline and 1-y follow-up data from 5613 participants (48.2% female and 51.8% male; mean ± SD age: 65.01 ± 4.91 y) to assess cardiometabolic traits, and 3367 participants to assess renal function, of the Spanish PREDIMED-Plus trial. Participants met ≥3 criteria of metabolic syndrome and had overweight or obesity [BMI (in kg/m2) ≥27 and ≤40]. These criteria were similar to those of the PREDIMED parent study. Dietary intakes of choline and betaine were estimated from the FFQ. RESULTS: The greatest 1-y increase in dietary choline or betaine intake (quartile 4) was associated with improved serum glucose concentrations (-3.39 and -2.72 mg/dL for choline and betaine, respectively) and HbA1c levels (-0.10% for quartile 4 of either choline or betaine intake increase). Other significant changes associated with the greatest increase in choline or betaine intake were reduced body weight (-2.93 and -2.78 kg, respectively), BMI (-1.05 and -0.99, respectively), waist circumference (-3.37 and -3.26 cm, respectively), total cholesterol (-4.74 and -4.52 mg/dL, respectively), and LDL cholesterol (-4.30 and -4.16 mg/dL, respectively). Urine creatinine was reduced in quartile 4 of 1-y increase in choline or betaine intake (-5.42 and -5.74 mg/dL, respectively). CONCLUSIONS: Increases in dietary choline or betaine intakes were longitudinally related to improvements in cardiometabolic parameters. Markers of renal function were also slightly improved, and they require further investigation.This trial was registered at https://www.isrctn.com/ as ISRCTN89898870.

Psychosocial risk and job satisfaction in professional drivers.

Psychosocial work factors are implicated in the development of stress and job satisfaction. This relationship has been scarcely studied in so-called singular activities, as is the case of professional drivers. This cross-sectional study of 601 professional drivers assesses psychosocial risks and job satisfaction using Copenhagen Psychosocial Questionnaire (COPSOQ) and Overall Job Satisfaction questionnaire models. The values of the psychosocial scales of professional drivers were compared with thresholds values of the Spanish working population. The relationships of the psychosocial scales with the level of job satisfaction were examined using logistic regression models, adjusted for age, gender, length of driving license and years of experience. In general, professional drivers have an unfavorable psychosocial environment compared to the average Spanish workers. The relationship between psychosocial scales and job satisfaction is observed, with the most influential variables being the meaning and development of work, integration in the company, social relations, esteem and level of psychological demands.

Needs for International Benchmarking of Road Safety Management Based on Mobility Exposure Measures and Risk Patterns.

Each year, 1.35 million people worldwide die due to Road Traffic Injuries (RTI), highlighting the need for further research. The risk of RTI is usually estimated as the number of casualties divided by the level of exposure in a population. Identifying the most appropriate exposure measures is one of the most important current challenges in this field. This paper presents an analysis of exposure measures used in empirical studies on road accidents. The results show a large variability in the exposure measures used, ranging from more general measures (such as population figures or vehicle fleet) to more specific measures related to mobility (such as number of trips, distances or travel time). A comparison of the risk patterns found shows that there is a partial consensus on the profiles with the highest risk of road traffic injuries. In conclusion, there is a need for the international standardization of criteria and data to be recorded, at least injury severity and measures of exposure to mobility, as the travel time disaggregated by socio-demographic variables and mode of transport. Such data would provide higher-quality results on risk profiles and facilitate the implementation of more effective, knowledge-based road safety policies.

Alzheimer's Disease, Mild Cognitive Impairment and Mediterranean Diet. A Systematic Review and Dose-Response Meta-Analysis.

Alzheimer's Disease (AD) is a pathology with increasing prevalence in the context of a more long-lived society and it is the first cause of dementia in western countries. It is important to investigate factors that can be protective and may influence its development, in order to act on them trying to reduce AD incidence and its progression. The aim of this study was to conduct a systematic review and meta-analysis to determine the effects of a higher adherence to Mediterranean diet (MD) on Mild Cognitive Impairment (MCI) and AD. A literature search in PubMed, The Cochrane Library Plus and Scopus was conducted, selecting articles that analyzed associations between MD adherence and AD biomarkers (Volumetry assessed by MRI and betamiloide and Tau deposits by PET); cognitive performance in patients at risk or presenting MCI and AD; and incidence or progression from MCI to AD. Out of the 589 studies screened, 22 studies met eligibility criteria for the systematic review and qualitative synthesis. Finally, 11 studies were included in the meta-analysis (12,458 participants). Higher adherence to MD was associated with a significantly lower risk of MCI (RR = 0.91, 95%CI = 0.85-0.97) and lower risk of AD (RR = 0.89, 95% CI = 0.84-0.93). Our results enhance the importance of taking health-promoting lifestyle measures like following Mediterranean dietary patterns in order to reduce AD risk.

Effectiveness of psychological and educational interventions for the prevention of depression in the workplace: A systematic review and meta-analysis.

Objectives Psychological and educational interventions for the prevention of depression have a small-to-moderate effect. However, little is known about their effectiveness in the workplace. We aimed to evaluate the effectiveness of such interventions through a systematic review and meta-analysis of randomized controlled trials (RCT). Methods We searched PubMed, PsycINFO, EMBASE, CENTRAL, CIS-DOC and Open Grey for RCT. Search was supplemented with manual searches of reference lists of relevant meta-analyses and trials. We included RCT that assessed either the incidence of depression or the reduction of depressive symptoms, which excluded participants with baseline depression. Measurements were required to have been made using validated instruments and participants recruited in the workplace. Independent evaluators selected studies, evaluated risk bias (Cochrane Collaboration's tool) and extracted from RCT. The combined OR was estimated using the fixed-effects model. Heterogeneity was measured by I 2and Cochrane's Q. Results Of the 1963 abstracts reviewed, 69 were selected for review in fulltext. Only three RCT met our inclusion criteria, representing 1246 workers from three different countries and continents. The combined odds ratio was 0.25 [95% confidence interval (CI) 0.11-0.60, P=0.002]; I 2=0% and Q=0.389 (P=0.823). The risk of bias was low in one RCT and moderate and high in the other two, respectively. Conclusion Psychological or educational interventions in the workplace may prevent depression, although the quality of evidence was low.

Potato Consumption Does Not Increase Blood Pressure or Incident Hypertension in 2 Cohorts of Spanish Adults.

Background: Potatoes have a high glycemic load but also antioxidants, vitamins, and minerals. It is unclear what mechanisms are involved in relation to their effect on blood pressure (BP) and hypertension.Objectives: This study aimed to assess the association between potato consumption, BP changes, and the risk of hypertension in 2 Spanish populations.Methods: Separate analyses were performed in PREDIMED (PREvención con DIeta MEDiterránea), a multicenter nutrition intervention trial of adults aged 55-80 y, and the SUN (Seguimiento Universidad de Navarra) project, a prospective cohort made up of university graduates and educated adults with ages (means ± SDs) of 42.7 ± 13.3 y for men and 35.1 ± 10.7 y for women. In PREDIMED, generalized estimating equations adjusted for lifestyle and dietary characteristics were used to assess changes in BP across quintiles of total potato consumption during a 4-y follow-up. Controlled BP values (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) during follow-up were also assessed. For SUN, multivariate-adjusted HRs for incident hypertension during a mean 6.7-y follow-up were calculated.Results: In PREDIMED, the total potato intake was 81.9 ± 40.6 g/d. No overall differences in systolic or diastolic BP changes were detected based on consumption of potatoes. For total potatoes, the mean difference in change between quintile 5 (highest intake) and quintile 1 (lowest intake) in systolic BP after multivariate adjustment was -0.90 mm Hg (95% CI: -2.56, 0.76 mm Hg; P-trend = 0.1) and for diastolic BP was -0.02 mm Hg (95% CI: -0.93, 0.89 mm Hg; P-trend = 0.8). In SUN, the total potato consumption was 52.7 ± 33.6 g/d, and no significant association between potato consumption and hypertension incidence was observed in the fully adjusted HR for total potato consumption (quintile 5 compared with quintile 1: 0.98; 95% CI: 0.80, 1.19; P-trend = 0.8).Conclusions: Potato consumption is not associated with changes over 4 y in blood pressure among older adults in Spain or with the risk of hypertension among Spanish adults. This trial was registered at www.controlled-trials.com as ISRCTN35739639.

Epidemiological study of mortality in epilepsy in a Spanish population.

PURPOSE: Studies concerning mortality in epilepsy have been performed primarily in Northern-Central Europe and US. The aim of this study was to provide information about mortality in people with epilepsy in Southern European countries. METHOD: We studied a Spanish prevalence and incidence cohort of 2309 patients aged ≥14 years with epilepsy who were treated in an outpatient epilepsy clinic between 2000 and 2013. The deceased were identified through Civil Registries. Causes of death were determined using death certificates, forensic autopsies, hospital reports, family practitioners, and care-givers' records. Standardised mortality ratios (SMRs) were calculated. RESULTS: In a total of 15,865 person-years of follow-up, 152 patients died, resulting in an SMR of 2.11 (95% CI 1.79-2.47), which was higher for those aged 14-24. There was also a high rate of death for symptomatic epilepsies, progressive causes (SMR=6.12, CI 3.50-9.94), and remote causes (SMR=2.62, CI 2.12-3.21). High SMRs were found for all kinds of epilepsy and for respiratory and tumoural causes. Patients who died of epilepsy itself were 12.5%. Sudden unexpected death in epilepsy incidence was 0.44:1000. Death from status epilepticus incidence was 20:100,000. SMRs for external causes were of no statistical significance. CONCLUSIONS: This is the first epidemiological study to examine rate of mortality in epilepsy in a Southern European country. The identified mortality pattern is similar to the one provided by researchers from developed countries. The similarities between our results concerning epilepsy-related deaths and those provided by population-based studies are the result of the scarcely selected character of our study cohort.

Mercury exposure and risk of cardiovascular disease: a nested case-control study in the PREDIMED (PREvention with MEDiterranean Diet) study.

BACKGROUND: Substantial evidence suggests that consuming 1-2 servings of fish per week, particularly oily fish (e.g., salmon, herring, sardines) is beneficial for cardiovascular health due to its high n-3 polyunsaturated fatty acid content. However, there is some concern that the mercury content in fish may increase cardiovascular disease risk, but this relationship remains unclear. METHODS: The PREDIMED trial included 7477 participants who were at high risk for cardiovascular disease at baseline. In this study, we evaluated associations between mercury exposure, fish consumption and cardiovascular disease. We randomly selected 147 of the 288 cases diagnosed with cardiovascular disease during follow-up and matched them on age and sex to 267 controls. Instrumental neutron activation analysis was used to assess toenail mercury concentration. In-person interviews, medical record reviews and validated questionnaires were used to assess fish consumption and other covariates. Information was collected at baseline and updated yearly during follow-up. We used conditional logistic regression to evaluate associations in the total nested case-control study, and unconditional logistic regression for population subsets. RESULTS: Mean (±SD) toenail mercury concentrations (µg per gram) did not significantly differ between cases (0.63 (±0.53)) and controls (0.67 (±0.49)). Mercury concentration was not associated with cardiovascular disease in any analysis, and neither was fish consumption or n-3 fatty acids. The fully-adjusted relative risks for the highest versus lowest quartile of mercury concentration were 0.71 (95% Confidence Interval [CI], 0.34, 1.14; ptrend = 0.37) for the nested case-control study, 0.74 (95% CI, 0.32, 1.76; ptrend = 0.43) within the Mediterranean diet intervention group, and 0.50 (95% CI, 0.13, 1.96; ptrend = 0.41) within the control arm of the trial. Associations remained null when mercury was jointly assessed with fish consumption at baseline and during follow-up. Results were similar in different sensitivity analyses. CONCLUSIONS: We found no evidence that mercury exposure from regular fish consumption increases cardiovascular disease risk in a population of Spanish adults with high cardiovascular disease risk and high fish consumption. This implies that the mercury content in fish does not detract from the already established cardiovascular benefits of fish consumption. TRIAL REGISTRATION: ISRCTN35739639 .

Mediterranean diet and risk of heart failure: results from the PREDIMED randomized controlled trial.

AIMS: The aim of this study was to evaluate the effect of the Mediterranean diet (MedDiet) on the incidence of heart failure (HF), a pre-specified secondary outcome in the PREDIMED (PREvención con DIeta MEDiterránea) primary nutrition-intervention prevention trial. METHODS AND RESULTS: Participants at high risk of cardiovascular disease were randomly assigned to one of three diets: MedDiet supplemented with extra-virgin olive oil (EVOO), MedDiet supplemented with nuts, or a low-fat control diet. Incident HF was ascertained by a Committee for Adjudication of events blinded to group allocation. Among 7403 participants without prevalent HF followed for a median of 4.8 years, we observed 29 new HF cases in the MedDiet with EVOO group, 33 in the MedDiet with nuts group, and 32 in the control group. No significant association with HF incidence was found for the MedDiet with EVOO and MedDiet with nuts, compared with the control group [hazard ratio (HR) 0.68; 95% confidence interval (CI) 0.41-1.13, and HR 0.92; 95% CI 0.56-1.49, respectively]. CONCLUSION: In this sample of adults at high cardiovascular risk, the MedDiet did not result in lower HF incidence. However, this pre-specified secondary analysis may have been underpowered to provide valid conclusions. Further randomized controlled trials with HF as a primary outcome are needed to better assess the effect of the MedDiet on HF risk. TRIAL REGISTRATION: ISRCTN35739639.

Health-related quality of life in young people at risk of exclusion in Melilla (Spain) / Calidad de vida relacionada con la salud en jóvenes en riesgo de exclusión en Melilla

No disponible

Glycemic index, glycemic load and invasive breast cancer incidence in postmenopausal women: The PREDIMED study.

The objective of this study was to evaluate the prospective associations between dietary glycemic index (GI) and glycemic load (GL) and the risk for invasive breast cancer incidence in postmenopausal women at high cardiovascular disease (CVD) risk. This study was conducted within the framework of the PREvención con DIeta MEDiterránea (PREDIMED) study, a nutritional intervention trial for primary cardiovascular prevention. We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease. Dietary information was collected using a validated 137-item food frequency questionnaire. We assigned GI values using the International Tables of GI and GL values. Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index. Only cases confirmed by results from cytology tests or histological evaluation were included. We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models. We repeated our analyses using yearly repeated measures of GI/GL intakes. No associations were found between baseline dietary GI/GL and invasive breast cancer incidence. The multivariable hazard ratio and 95% confidence interval (CI) for the top tertile of dietary GI was 1.02 (95% CI: 0.42-2.46) and for dietary GL was 1.00 (95% CI: 0.44-2.30) when compared with the bottom tertile. Repeated-measures analyses yielded similar results. In sensitivity analyses, no significant associations were observed for women with obesity or diabetes. Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk.

Psychiatric Status across Body Mass Index in a Mediterranean Spanish Population.

BACKGROUND: Mental and body weight disorders are among the major global health challenges, and their comorbidity may play an important role in treatment and prevention of both pathologies. A growing number of studies have examined the relationship between psychiatric status and body weight, but our knowledge is still limited. OBJECTIVE: The present study aims to investigate the cross-sectional relationships of psychiatric status and body mass index (BMI) in Málaga, a Mediterranean city in the South of Spain. MATERIALS AND METHODS: A total of 563 participants were recruited from those who came to his primary care physician, using a systematic random sampling, non-proportional stratified by BMI categories. Structured clinical interviews were used to assess current Axes-I and II mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). BMI was calculated as weight (Kg) divided by square of height in meters (m2). Logistic regression was used to investigate the association between BMI and the presence of any mental disorder. BMI was introduced in the models using restricted cubic splines. RESULTS: We found that high BMI values were directly associated with mood and adjustment disorders, and low BMI values were directly associated with avoidant and dependent personality disorders (PDs). We observed an inverse relationship between low BMI values and cluster A PDs. There were not significant relationships between anxiety or substance-related disorders and BMI. CONCLUSION: Psychiatric status and BMI are related in a Mediterranean Spanish population. A multidisciplinary approach to both pathologies becomes increasingly more necessary.

Entorno psicosocial y estrés en trabajadores sanitarios de la sanidad pública: diferencias entre atención primaria y hospitalaria / Psychosocial stress environment and health workers in public health: Differences between primary and hospital care

OBJETIVOS: Describir el entorno psicosocial de los profesionales sanitarios de la sanidad pública en atención primaria y hospitalaria, compararlo con el de la población asalariada española y valorar el efecto de los factores de riesgos psicosociales sobre síntomas relacionados con el estrés percibido. DISEÑO: Estudio observacional transversal, con muestreo aleatorio estratificado. Emplazamiento: Trabajadores de atención sanitaria de la provincia de Granada, distribuidos en 5 centros hospitalarios y 4 distritos sanitarios. PARTICIPANTES: Se invitó a 738 empleados (personal facultativo y de enfermería) del Servicio Andaluz de Salud (SAS). MEDICIONES PRINCIPALES: Cuestionario CopSoQ/Istas21, desarrollado para el análisis del ambiente psicosocial en el trabajo de forma multidimensional. Los síntomas de estrés se midieron con el cuestionario Stress Profile. RESULTADOS: La tasa de respuesta fue del 67,5%. En comparación con la población laboral española, nuestra muestra mostró altos niveles de exigencias psicológicas cognitivas, emocionales y sensoriales, posibilidades de desarrollo personal y sentido de su trabajo. El personal facultativo de atención primaria es el que presenta un ambiente psicosocial más desfavorable, aunque todos los grupos mostraron niveles elevados de síntomas relacionados con el estrés percibido. El análisis multivariante mostró que las variables asociadas con el estrés percibido fueron menor edad y posibilidades de relación social, el conflicto de rol, y mayores exigencias psicológicas emocionales e inseguridad en el trabajo. CONCLUSIONES: Nuestros hallazgos muestran que el ambiente psicosocial de los trabajadores sanitarios difiere del de la población asalariada española, siendo más desfavorable en el colectivo de facultativos/as de atención primaria

OBJECTIVE: To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. DESIGN: Cross-sectional study with stratified random sampling. SETTING: Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. PARTICIPANTS: A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. MAIN MEASUREMENTS: CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. RESULTS: The response rate was 67.5%.compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. CONCLUSIONS: Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners

[Psychosocial stress environment and health workers in public health: Differences between primary and hospital care]. / Entorno psicosocial y estrés en trabajadores sanitarios de la sanidad pública: diferencias entre atención primaria y hospitalaria.

OBJECTIVE: To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. DESIGN: Cross-sectional study with stratified random sampling. SETTING: Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. PARTICIPANTS: A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. MAIN MEASUREMENTS: CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. RESULTS: The response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. CONCLUSIONS: Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners.

Weight status and psychological distress in a Mediterranean Spanish population: a symmetric U-shaped relationship.

Psychological disorders in people with extreme weight (low weight or obesity) should be taken into consideration by health professionals in order to practice an effective treatment to these patients. This study evaluates the association between body mass index (BMI) and psychological distress in 563 inhabitants of Málaga (South of Spain). Participants were classified in four categories of BMI: Underweight (BMI <18.5 Kg/m2), Normal weight (BMI 18.5-24.99 Kg/m2), Overweight (BMI 25.0-29.99 Kg/m2) and Obesity (BMI >30 Kg/m2). Psychological distress was measured with the Spanish version of the Derogatis' Symptoms Checklist Revised (SCL-90-R). We observed a symmetric U-shaped relationship between weight status and psychological distress in all SCL-90-R dimensions (p for quadratic trend <0.001) for both men and women. Participants with extreme weight showed the worst psychological status, and participants with normal weight exhibited the best. We found no statistically significant differences between underweight and obese participants in 9 of the 10 SCL-90-R dimensions analyzed among men, and in 8 of the 10 dimensions among women. Underweight and obese participants showed no gender differences in psychological distress levels. Psychological treatment of Mediterranean people with extreme weight, should consider underweight and obese patients at the same level of psychological distress.

Iron: protector or risk factor for cardiovascular disease? Still controversial.

Iron is the second most abundant metal in the Earth's crust. Despite being present in trace amounts, it is an essential trace element for the human body, although it can also be toxic due to oxidative stress generation by the Fenton reaction, causing organic biomolecule oxidation. This process is the basis of numerous pathologies, including cardiovascular diseases (CVD). The relationship between iron and cardiovascular disease was proposed in 1981 by Jerome Sullivan. Since then, numerous epidemiological studies have been conducted to test this hypothesis. The aim of this review is to present the main findings of the chief epidemiological studies published during the last 32 years, since Sullivan formulated his iron hypothesis, suggesting that this element might act as a risk factor for cardiovascular disease. We have analyzed 55 studies, of which 27 supported the iron hypothesis, 20 found no evidence to support it and eight were contrary to the iron hypothesis. Our results suggest that there is not a high level of evidence which supports the hypothesis that the iron may be associated with CVD. Despite the large number of studies published to date, the role of iron in cardiovascular disease still generates a fair amount of debate, due to a marked disparity in results.

[Clear cells cervical adenocarcinoma in a girl no exposed to dietiletilbestrol]. / Adenocarcinoma de células claras de cérvix en niña no expuesta a dietiletilbestrol.

BACKGROUND: the clear cell adenocarcinoma (CCA) in cervix is a rare disease. It represents only 2 to 7 % of whole adecocarcinomas of cervix. Its histological pattern seems identical to their counterparts elsewhere in the female genital tract, including the vagina, endometrial and ovary. The CCA is constituted by cells with a clear cytoplasm in tack that are arranged in a solid pattern, tubu-locystic, papillary, or mixed. CLINICAL CASE: an eleven year old girl with sporadic and intermittent transvaginal bleeding, and who felt in severe anemia due to hiperpolimenorrea treated with athinyl estradiol deso-gestrel was attended. She had not history of exposition in utero to diethyletilbestrol. Hysteroscopy showed an ectocervical exophytic lesion in a barrel of 7 × 3 × 3 cm, located predominantly in the posterior lip. A frozen section of the lesion was reported as a poorly differentiated malignant tumor compatible with cervical carcinoma. She underwent to simple trachelectomy. CONCLUSIONS: diagnostic difficulty was the age of the patient and the lack exposition in utero to DES, the differential diagnosis included the age group tumors and rhabdomyosarcoma botryoides and extragonadal endodermic origen with papillary and reticular pattern. Another was a metastatic CCA.