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Resumen Antecedentes y objetivo Se han comparado la eficacia y seguridad de la profilaxis primaria estandar o prolongada de la infeccion por citomegalovirus (CMV) en el trasplante de organo solido. Materiales y metodos Estudio retrospectivo de los receptores CMV seronegativos de donante seropositivo (D+/R−) que recibieron profilaxis frente a CMV tras un trasplante de organo solido (2007-2017). Se comparo la frecuencia de infeccion por CMV en los 2 primeros anos postrasplante en los receptores que recibieron profilaxis durante mas o menos de 100 dias. Se evaluo asimismo la mielotoxicidad durante la profilaxis. Resultados Se analizaron 66 pacientes. De ellos el 43,9% (n = 29) presentaron infeccion por CMV. El 68,2% (n = 45) recibieron profilaxis prolongada, sin asociarse su uso con una menor tasa de infeccion (42,2 vs. 47,6%, p = 0,44) ni de enfermedad posprofilaxis (15,6 vs. 19%, p = 0,72). La profilaxis prolongada se asocio con una mayor frecuencia de mielotoxicidad (68,9 vs. 42,9%, p Conclusiones La prolongacion de la profilaxis primaria mas de 100 dias no aumenta su efectividad pero si la toxicidad hematologica.

BACKGROUND Dementia is projected to affect 135 million by 2050. Diet is a pertinent target for primary prevention, but firm recommendations for dementia prevention are not available yet. Our aim was to address the association between exploratory (empirically derived) dietary patterns (DP) and changes in the Spanish Telephone Interview for Cognitive Status (STICS-m, maximum score = 41 points) over 6 years. METHOD Information on diet was collected with a validated 136-item food-frequency questionnaire from 803 participants in the Mediterranean cohort "Seguimiento Universidad de Navarra." We used principal component analysis to derive exploratory DP. The derived DP were associated with change in STICS-m scores over 6 years, through adjusted multiple linear regression models. RESULTS Two main DP were identified. The first DP resembled a Western dietary pattern (WDP)-high in sugar, fat, processed foods, and red meat-and the second DP resembled a Mediterranean dietary pattern (MDP)-high in vegetables, fruits, nuts, fish, and olive oil. Adherence to the WDP (tertile 3 vs tertile 1) was significantly associated with negative STICS-m changes after 6 years (between-tertile difference in changes: -0.80 points; 95% confidence interval [CI] -1.51, -0.08, p value = 0.03). Meanwhile, the MDP showed a positive +0.71 point (95% CI 0.15, 1.26, p value = 0.01) between-tertile difference in changes in the STICS-m score. CONCLUSIONS A healthy, prudent, MDP was associated with less decline in cognitive function and, thus, could help to lower dementia incidence. Western-type diets were associated with a greater decline in cognitive performance and could increase dementia incidence.

AIMS: To identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL). METHODS: Continence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) and the number of pads employed in a 24-hour period (pad usage). We used the one-way ANOVA technique with posthoc pairwise comparisons according to Scheffe's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI). RESULTS: The continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using "0 pads," "1 safety pad," "1 pad," and "ICIQ score 0" definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (ρ = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between "0 pads-ICIQ score 0" (K = 0.466), but poor for "1 safety pad" and "1 pad" (K = 0.326 and 0.137, respectively). Patients with "0 pad usage" have better QoL related to urine leakage than patients with "1 safety pad" or "1 pad" (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63). CONCLUSIONS: Pad usage and the ICIQ-SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score ≤2) as it is the definition with the least impact on daily QoL.

Background: Severe cognitive decline is one of the major public health problems in developed countries. Finding modifiable risk factors could become essential to develop strategies to prevent or de...

Background Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe. Method We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords "stroke", "cerebrovascular accident", "epidemiology", "prevalence", "incidence" and "Europe". In order to evaluate the quality and risk of bias, we used the Hoy's modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity. Results The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age. Conclusion The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100,000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.

Resumen Objetivos La European Society of Mastology (EUSOMA) propone criterios de calidad en el diagnostico y tratamiento del cancer de mama y recomienda la evaluacion de las Unidades de Mama aplicando dichos criterios. En nuestro centro, coincidiendo con la acreditacion de la Unidad de Mama por la Sociedad Espanola de Senologia y Patologia Mamaria (SESPM) en el ano 2000, se asignaron 2 cirujanos a dedicacion preferente a la misma. El objetivo es evaluar la repercusion en parametros quirurgicos y los criterios de calidad relacionados con el tratamiento quirurgico tras la adscripcion de los cirujanos a la patologia mamaria. Material y metodos Estudio retrospectivo de pacientes tratadas de cancer de mama entre 1990 y 2010, distribuidas en dos periodos, A; 1990-1999 y B; 2000-2010. Se evaluan datos demograficos, diagnosticos, el tratamiento aplicado, las complicaciones postoperatorias, el seguimiento, la recidiva y 10 criterios de calidad propuestos por EUSOMA. Resultados La serie se compone de 1.881 mujeres intervenidas por cancer de mama, 671 en el periodo A y 1.210 en el B. Se han encontrado diferencias significativas entre ambos periodos en la estancia (9,8 dias vs. 2,7 dias) y complicaciones postoperatorias (17,4% vs. 10%). Existe mejoria significativa en el periodo B en 6 de los 10 criterios evaluados. Conclusiones La dedicacion preferente de los cirujanos a la patologia de la mama dentro de una Unidad de Mama ha conseguido reducir las complicaciones y la estancia hospitalaria postoperatoria, se ha obtenido mejoria en los criterios de calidad que evaluan el diagnostico completo, la indicacion y el tratamiento de los ganglios axilares y el seguimiento postoperatorio.

BackgroundThe addition of Dendritic cell vaccines (DCV) to neoadjuvant chemotherapy (NAC) could induce immune biomarker changes in those patients with residual disease (RD) by transforming tumor microenvironment.MethodsCore-diagnostic biopsies and surgical specimens from 80 patients (38 in the Vaccinated Group plus NAC (VG) and 42 in the Control Group (CG) treated only with NAC) were selected. We quantify TILs (CD8, CD4 and CD45RO) using Immunohistochemistry (IHC) and the Automated Cellular Imaging System (ACIS III) in the core-diagnostic biopsies and in the surgical specimen, to compare the amount of TILs in each group.ResultsA CD8 rise in TNBC samples was observed after NAC plus DCV, changing from 4.48% in the biopsy to 6.70% in the surgical specimen, not reaching statistically significant differences (p = 0.11). TNBC patients in the CG showed a TILs drop from 2.71% in the biopsy to 0.18% in the surgical specimen (p = 0.5). We also found that a 66.7% (4/6) of TNBC patients from VG registered an increase in TILs after treatment as compared with 20% (1/5) of TNBC patients in the CG (p=0.24). This phenomenon is not observed in the other biologic subtypes.An association between before NAC CD8 TILs (4% cut-off point ) and pathological complete response in VG was found in univariate and multivariate analysis (OR=1.41, IC95% 1.05-1.90; p=0.02, and OR=2.0, IC95% 1.05-3.9; p=0.03, respectively).ConclusionOur findings suggest that patients with TNBC especially benefit from the stimulation of the antitumor immune system by using DCV pulsed with tumor antigens.Trial registration: NCT01431196. Registred 19 May 2016. EudraCT 2009- 017402-36.

Background: we analyzed the relationship between the prevalence of schizophrenia and the season of birth and gestation during a period of an influenza pandemic. Methods: cross-sectional analysis of a prospective population-based cohort of 470,942 adults. We fitted multivariant logistic regression models to determine whether the season of birth and birth in an influenza-pandemic year (1957, 1968, 1977) was associated with schizophrenia. Results: 2077 subjects had been diagnosed with schizophrenia. Logistic regression identified a significantly greater prevalence of schizophrenia in men than in women (OR = 1.516, CI 95% = 1.388–1.665); in those born in the winter or spring than in those born in the summer or autumn (OR = 1.112, CI 95% = 1.020–1.212); and in those born in a period of an influenza pandemic (OR = 1.335, CI 95% = 1.199–1.486). The increase in risk was also significant when each influenza pandemic year was analyzed separately. However, neither month of birth nor season of birth, when each of the four were studied individually, were associated with a statistically significant increase in that risk. Conclusions: the winter–spring period and the influenza pandemics are independent risk factors for developing schizophrenia. This study contradicts many previous studies and thus revitalizes a locked debate in understanding the neurodevelopmental hypothesis of this disorder. This research was funded by grants from The Institute of Health Carlos III (ISCIII).

Background: Alzheimer’s disease (AD) has become a concerning public health issue. We aimed to analyze the trends of hospital morbidity from AD in the European Union (EU) in the period 2000 to 2014. Methods: Data from hospital discharges of men and women over 50 years old hospitalized due to AD in the EU were extracted from Eurostat database. We tested for secular trends computing anual percent change, and identified significant changes in the linear slope of the trend. Results: Hospital morbidity from AD showed a 0.8% (95% confidence intervals −2.2 to 0.6) slight declining trend in the EU. In men and women, we recorded a −0.5% and −1.0% decrease in hospital morbidity rates, respectively. Several countries showed changing trends during the study period. Conclusion: Alzheimer’s disease hospital morbidity has slightly declined in the entire EU in the past years. Eastern European countries showed steadily increasing trends, whereas in western and Mediterranean countries the rates decreased or leveled off.

CONTEXT To study the prevalence of thyroid dysfunction in a very large unselected population. OBJECTIVE To determine the prevalence of abnormal thyroid function and evaluate potential modulatory factors. DESIGN AND SETTING The Estudio de Atencion Primaria de Navarra, The APNA Study, is a cross-sectional study conducted in northern Spain. It involved 303 883 people, of 20 years of age and older, who live in the Navarra region. Participants are covered by the public healthcare system and medical records are digitalized. MAIN OUTCOME MEASURES The information was gathered from e-registered data regarding serum thyrotropin (TSH), thyroid hormones, thyroid antibody concentration and clinical context. Measurements were logged (demographic information and potential thyroid function modulatory factors). RESULTS Serum TSH (mU/L) normal range was established at 0.7-4.28. At the time of the study, 87% of the Navarra population had a TSH level within the normal range. Mean serum TSH in euthyroid individuals was higher in women (2.15) than in men (1.96) (P

Resumen: Objetivos: Conocer los factores asociados al asma y síntomas relacionados con asma en la población infantil y adolescente en la zona rural de Navarra (España) a través de la validación del cuestionario ISAAC. Participantes y métodos: Estudio transversal mediante la realización del cuestionario ISAAC y variables adicionales por 797 niños y adolescentes, a través del cual se obtuvieron datos de prevalencia sobre síntomas de asma y factores asociados sin realizar ninguna prueba diagnóstica adicional. Emplazamiento: Marco de atención primaria. A través de las zonas básicas de salud se hizo la selección de la muestra y en los centros educativos de dichas zonas se realizó el cuestionario. Mediciones y resultados: El análisis estadístico se hizo a través de regresión logística, chi cuadrado e intervalo de confianza al 95%. La prevalencia asma referida es del 11,7% en niños y del 13,4% en adolescentes. En cuanto a los factores relacionados, según los valores de OR destacan: OR = 9,5 entre sibilancias y asma, y OR = 3,5 entre rinitis recientes y asma. Respecto a las sibilancias recientes, hallamos un OR = 11,5 entre despertares y sibilancias recientes, y un OR = 3,4 entre rinitis recientes y sibilancias recientes. Conclusiones: El asma referida es una enfermedad prevalente ligeramente superior en la adolescencia y la población femenina de los escolares de la zona rural. Rinitis y otros síntomas de asma están relacionados con el asma y con las sibilancias, así como la utilización de los servicios de urgencias en el caso del asma y la bronquitis con las sibilancias. Abstract: Objectives: To determine the factors associated with asthma and asthma-related symptoms in children and adolescents in rural areas of Navarre (Spain). Participants and methods: A cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as additional variables, was conducted on 797 children and adolescents. These provided prevalence data on asthma symptoms and associated factors without further diagnostic testing. Location: Primary Care setting, through the basic health areas and in the corresponding education centres. Measurements and results: The prevalence of referred asthma is 11.7% in children, and 13.4% in adolescents. The prevalence in the female population is 13.7% and in males it is 11.3%. As for the related factors according to the values of OR, an OR = 9.5 was found between wheezing and asthma, and an OR = 3.5 between recent rhinitis and asthma. As regards recent wheezing, an OR = 11.5 was found between awakenings due to wheezing and recent wheezing, and an OR = 3.4 between recent rhinitis and wheezing. Conclusions: Referred asthma is a prevalent disease in children and adolescents in rural areas. It is more prevalent in adolescence and in the female population. Rhinitis and other asthma symptoms are related to asthma and wheezing, as well as the use of emergency services, in the case of asthma. Palabras clave: Asma, Etiología, Niño, Adolescente, Epidemiología, Keywords: Asthma, Aetiology, Child, Adolescent, Epidemiology

Objective Assess compliance with the IDF recommendations for patients with Diabetes Type2 (DM2), and its variability, by groups of doctors and nurses who provide primary care services in Navarre (Spain). Materials and methodologies A cross-sectional study of a population of 462,568 inhabitants, aged ≥18 years in 2013, attended by 381 units of doctor/nurse (quota). Clinical data were collected retrospectively through electronic records. Using cluster analysis, we identified two groups of units according to the score for each indicator. We calculated the Odds Ratio, adjusted for age sex, BMI, socioeconomic status and smoking, for complying with each recommendation whether a patient was treated by one of the quota from the highest score to the lowest. 30,312 patients with DM2 were identified: prevalence: 6.39%; coefficient of variation between UDN: 22.8%; biggest cluster 7.7% and smallest 5.3%; OR = 1.54 (1.50–1.58). The HbA1c control at ≤8% was 82.8% (82.2–83.3) and >9% was 7.6% (7.3–8.0), with OR 1.79 (1.69–1.89) and 2.62 (2.36–2.91) respectively. Control of BP and LDL-C show significant differences between the clusters. Conclusions An important variability was identified according to the doctor treating patients. The average HbA1c control is acceptable being limited in BP and LDL-C.

Background and objective The basis for optimal resource allocation is an understanding of requirements during the diagnostic and treatment phases. Costs associated with the rising incidence of cutaneous melanoma are considerable. We undertook an up-to-date analysis of the cost of diagnosis, treatment, and follow-up according to tumor stage. Methods We constructed descriptive tables following a theoretical model of direct costs based on amounts published in directives for the Spanish national health system and in international guidelines for managing cutaneous melanoma according to stage at diagnosis and clinical course. The tables allowed us to calculate the cost of treating individual patients as well as the expected cost for all patients with tumors in the same stage. Results Individual patients would generate costs ranging from €1689 (for a stage I tumor) to €88 268 (stage IV ). The largest differences were between stages IA and IB–IIA and between stages III and IV . Costs differed greatly between patients with early-stage tumors and favorable outcomes and those with recurring tumors, which cost 50-fold more in the first year and 20-fold more after 10 years of follow-up. Conclusions The high cost of diagnosing advanced-stage cutaneous melanoma calls attention to the need to promote primary prevention and early detection. Our findings provide the knowledge base for cost-effectiveness studies in this disease.

Resumen Introduccion y objetivo El conocimiento de los recursos utilizados en cada uno de los pasos del diagnostico y tratamiento de las enfermedades es la base para poder optimizarlos. El melanoma cutaneo es un tipo tumoral en constante incremento, y con un importante coste asociado, por lo que se ha realizado un analisis actualizado de los costes de los procesos de su diagnostico, terapia y seguimiento en funcion del estadio de la enfermedad. Metodos Se han elaborado tablas descriptivas de costes directos a partir de un modelo teorico basado en directrices nacionales e internacionales de manejo de pacientes con melanoma cutaneo dependiendo del momento de diagnostico y evolucion. Estas tablas permiten saber el coste de cada paciente individual y de todos aquellos en un mismo estadio. Resultados Los costes para un paciente en el primer ano oscilan entre los 1.689 € del estadio I y los 88.268 € del estadio IV , las mayores diferencias se encuentran entre el estadio IA y el IB-IIA y entre el III y IV . Si comparamos los costes de los pacientes en estadio precoz con buena evolucion con los de aquellos que recidivaron, las diferencias son considerables: llegan a ser de hasta 50 veces mayores en el primer ano y 20 veces mayores en el seguimiento a 10 anos. Conclusiones Los elevados costes del diagnostico del melanoma cutaneo en estadio avanzado evidencian la necesidad de promocionar la prevencion primaria y los programas de deteccion precoz. Nuestros resultados serviran como base para posteriores estudios de coste-efectividad.

Bone marrow (BM) aspirates used for flow-cytometry (FCM) studies are usually obtained from a second aspiration, as the primary aspirate is used for morphological assessment. For this reason, the FCM samples unavoidably contain some blood; although, good-quality samples contain only a small amount. It is of utmost importance to assess the quality of samples prior to FCM analysis; yet, contamination with peripheral blood (PB) is not evaluated in most laboratories, possibly because the methods available are either qualitative or too complex for daily practice. Here, we propose a simple FCM method to quantitatively evaluate PB contamination in BM aspirates, by analyzing the percentage of plasma cells and CD34+ cells - two cell populations nearly absent from PB - and CD10+ granulocytes, which comprise the majority of the PB granulocyte population. We analyzed these three populations in 122 BM aspirates from subjects without hematological disease, and identified samples with PB contamination by performing a hierarchical cluster analysis. A discriminant analysis yielded a function, which we named the PB contamination index (PBCI). This index value gives a quantitative indication about the degree of hemodilution of a given sample. A threshold was identified that discriminates low-quality samples. The method and the threshold proved to be useful in BM aspirates infiltrated with malignant cells, with the exception of cases where hematological disease altered two of the three parameters included in the index. We have easily implemented the PBCI calculation in our daily routine, and find it very helpful for an accurate interpretation of FCM results in a large proportion of BM specimens. Limitations of the technique are discussed.

Background: University students are a risk group for heavy substance use and the experience of various potentially severe negative substance use consequences which may impact on their health, social, and academic functioning. Whilst the experience of negative consequences of substance use is well understood in North American student samples, there is little data on these experiences in European students. In order to develop effective harm prevention and reduction interventions for students’ substance use, there needs to be an understanding of the types of consequences experienced in European student samples. Objectives: The aim of the study was to investigate the prevalence and predictors of the experience of negative substance use-related consequences amongst university students in 7 European countries. Methods: University students (n = 4,482) in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the UK completed an online survey of their substance use behaviours and the experience of associated negative consequences. Results: European students reported that experiencing a hangover or illness, missing class, being short of money, and experiencing memory loss were the most commonly experienced negative consequences of substance use. Not living with other students and using alcohol, cannabis, sedatives, and cocaine were also associated with higher odds of experiencing these negative consequences. Conclusions: In contrast to North American data, European university students tended to experience consequences that are associated with lower level health risks rather than more severe consequences (e.g., drink-driving and physical injury). Harm prevention and reduction interventions for students should be targeted towards those consequences that are most salient to the target group to ensure feedback is relevant and potentially more effective in changing students’ substance use behaviours.

Mortality due to cardiovascular disease (CVD), including cerebrovascular disease (CED) and ischaemic heart disease (IHD), was considerably different in eight municipalities of the province of Castell&oacute, n, Community of Valencia (Spain) during the period of 1991&ndash, 2011. In addition, these villages showed differences in agricultural practices and production. Since high vegetable consumption has been linked to decreased all-cause, CVD, and CED mortalities, we hypothesized that the diversity in vegetable and artichoke production, used as proxies for their consumption, could be associated with the diversity of mortality rates. In order to test our hypothesis, we estimated the smoothed standardized mortality ratios (SMRs) of CVD, CED, and IHD mortalities and a directed, age-adjusted mortality rate (AMR). We used a multilevel linear regression analysis to account for the ecological nature of our study. After adjustment, the CVD and CED SMRs were inversely associated with vegetable and artichoke production, with a reduction in SMRs for CVD: &minus, 0.19 (95% Confidence Interval [CI] &minus, 0.31 to &minus, 0.07) and &minus, 0.42 (95% CI &minus, 0.70 to &minus, 0.15) per hectare/103 inhabitants, respectively. The SMRs for CED also decreased: &minus, 0.68 (95% CI &minus, 1.61 to &minus, 0.19) and &minus, 1.47 (95% CI &minus, 2.57 to &minus, 0.36) per hectare/103 inhabitants, respectively. The SMRs for IHD were not associated with vegetal and artichoke production. When the directed AMR was used, CED mortality was consistent with the previous results, whereas the CVD mortality association was lost. Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities.

We aimed to test the predictive ability and to compare the predictive ability of the USEM to SRS, SORT and ASA in a prospective sample.A Prospective cohort of65-year-old patients undergoing urgent abdominal surgery in a Hospital. Models calibration and discrimination were evaluated using the receiver operating characteristics curves and the Hosmer-Lemeshow test.A total of 500 patients with a median age of 78 years were included. The AUROC in the validation cohort was 0.824. The USEM overestimated mortality (Test Hosmer-Lemeshow p 0.001), after recalibration the USEM provided an accurate prediction of postoperative mortality.After the recalibration, the USEM had good discriminant power to estimate the risk of mortality in elderly patients after urgent abdominal surgery.

Shorter telomeres are associated with several age-related diseases, and lifestyle factors could influence this relationship. The aim of this study was to examine associations between salivary telomere length (TL) and diet quality using 5 evidence-based dietary indexes in an elderly (55 years old) Spanish population of the SUN project (n = 886).TL was measured using the quantitative real-time polymerase chain reaction. Age-adjusted TL variable through residuals methods was used for all analysis. Diet quality was assessed by the Prime Diet Quality Score (PDQS), Fat Quality Index (FQI), Mediterranean Diet Adherence Screener (MEDAS), Dietary Approaches to Stop Hypertension (DASH) index and the Alternative Healthy Eating Index (AHEI-2010).TL did differ according to sex, smoking status, and dyslipidemia in elderly subjects of the SUN study. In addition, subjects with dyslipidemia (compared to absence of dyslipidemia) had a significantly higher risk (27% vs. 18%, p = 0.015) of short telomeres (percentile 20th). Interestingly, a lower risk of having short telomeres was observed among participants in the top tertiles of the following diet quality score PDQS, MEDAS and DASH compared to the bottom tertiles in crude and adjusted models. Moreover, FQI and AHEI-2010 scores showed an inverse association with the risk of having short telomeres after adjustment for potential confounders (model adjusted for dyslipidemia interaction, p for trend = 0.025 and 0.021, respectively; and model additionally adjusted for sex and smoking status, p for trend = 0.033 and 0.029, respectively).Adherence to high quality diet is associated to longer salivary TL in our elderly Spanish population of the SUN study.

Resumen Introducción: la inactividad física constituye el cuarto factor de riesgo más importante de mortalidad en todo el mundo y los estudiantes universitarios presentan en un alto nivel este factor de riesgo. Objetivos: determinar la modificación de la actividad física de los estudiantes universitarios en Navarra durante los tres primeros años de universidad. Métodos: estudio observacional prospectivo de una cohorte de universitarios que participaron en el estudio en primer curso y dos años después, en tercer curso. Las cohortes fueron constituidas por 454 estudiantes que respondieron a un cuestionario de autocumplimentación voluntario y anónimo con variables sociodemográficas y relacionadas con la actividad física. Los datos se analizaron con el SPSS v21.0. Resultados: un 67,4% (n = 306) fueron mujeres y un 32,6% (n = 148) fueron hombres. El 61,6% de los estudiantes de primer curso realizaban más de 150 minutos a la semana de actividad física y se incrementó el porcentaje de estudiantes activos físicamente en un 2,7%. Entre quienes realizaban actividad física mínimo tres veces a la semana se observó un incremento del 6,1%, hasta alcanzar el 30,5% de estudiantes. Conclusiones: el periodo universitario no desempeña un papel significativo en la promoción de la actividad física, ya que se observan modificaciones mínimas en su práctica. A futuro, convendría plantearse los motivos que dificultan la actividad física y diseñar programas según las recomendaciones actuales. Abstract Introduction: physical inactivity is the fourth most important risk factor for mortality worldwide and university students present this risk factor at a high level. Objective: to determine the changes in the physical activity of university students in Navarra during the first three years of college. Methods: prospective observational study of a cohort of university students. They participated in the first year, and two years later in the third year. The cohorts were comprised of 454 students who answered a voluntary and anonymous self-completion questionnaire with sociodemographic and physical activity related variables. Data were analyzed with SPSS v21.0. Results: of the participants, 67.4% (n = 306) were women and 32.6% (n = 148) were men. In the first year, 61.6% of students performed more than 150 minutes of physical activity per week. This percentage increased by 2.7%. The frequency of physical activity at least three times a week increased 6.1%, reaching 30.5% of students. Conclusions: university does not play a significant role in the promotion of physical activity, finding minimal modifications. In the future, it would be convenient to consider the reasons that hinder physical activity and design programs according to current recommendations.

Background: Sugar-sweetened beverages (SSB) and artificially-sweetened beverages (ASB) have been inconsistently associated with declines in cognitive function. Because of their low caloric content ...

Resumen Objetivo La gripe constituye un importante problema de salud publica. El objetivo del estudio es conocer la cobertura vacunal y los factores motivadores de la vacunacion en profesionales sanitarios de atencion primaria y hospitalaria en Navarra. Metodologia Estudio analitico multicentrico con diseno de cuestionario a partir de 3 fuentes: Kraut, CIBERESP y estudio cualitativo en universitarios. El cuestionario con las razones de vacunacion consta de 29 items, remitido por correo electronico, con datos profesionales, antecedentes de vacunacion, situacion actual e intencion en el futuro. Se estudia el Ji cuadrado, odds ratio (OR), regresion logistica y pruebas no parametricas (Kruskall-Wallis y U de Mann-Whitney). Resultados Se obtienen 1.178 cuestionarios con tasas de cumplimentacion del 27 y 24,7% en atencion primaria y hospitalaria respectivamente. Tasa de vacunacion global del 31,8%. Los factores predictores significativos de vacunacion son: antecedentes de vacunacion previa (ORa: 190,99), ser medico (ORa: 2,28) y trabajar en servicio de pediatria (ORa: 3,47). El item con media mas alta (4,3) en vacunados es «la vacuna es eficaz para prevenir la gripe y sus complicaciones» y en no vacunados (3,3) es « he decidido que no me interesa» en escala Likert. Los sanitarios estiman que los companeros de profesion y de trabajo se vacunan en cifras situadas en la zona media de la escala y con diferencias significativas entre vacunados y no vacunados (p Conclusion Potenciar la informacion de las ventajas personales, familiares y profesionales de la vacunacion e informar del coste social de la vacunacion pueden aumentar las tasas de vacunacion.

Objective Flu represents an important problem for public health. The objective of the study is to establish the vaccination cover and the motivating factors of health professionals from the hospitals and primary healthcare in Navarra. Method Multi health centre analytical study by means of a questionnaire using 3 sources. Kraut, CIBERESP and a qualitative study in universities. The questionnaire with the reasons for vaccinations is made up of 29 items, sent by email with professional data of the healthcare workers, vaccination history information, current situation and future intentions. A study of the Ji square, odd ratio (OR), logistical regression, non parameter tests (Kruskall–Wallis and U of Mann–Whitney). Results 1178 questionnaires are obtained with a 27% and a 24.7% completion rate in primary healthcare and hospitals respectively. Global vaccination rate of 31.8%. The predicting indicating factors for vaccinations are: history of previous vaccination (ORa: 190.99), be a doctor (ORa: 2.28) and workers in paediatric services (ORa: 3.47). From the those vaccinated the item with the highest average (4.3) is that “the vaccination is efficient for the prevention of flu and the resulting complications” and from those not vaccinated (3.3) is “I’ve decided that I’m not interested” on the Likert scale. Healthcare workers are of the opinion that their fellow professionals and health care colleagues vaccinate in numbers that would be the average on the scale with significant differences between those vaccinated and those not (p Conclusion Improve information on the personal, family and professional benefits of vaccination and inform that the social cost (effect) of the vaccination can increase the rates of vaccination.

Objectives To determine the prevalence of sleep disorders in children with attention-deficit/hyperactivity disorder (ADHD) and in a control population. To examine the relationship between sleep disorders and symptoms of inattention, hyperactivity/impulsiveness and executive dysfunction. Materials and methods We studied 126 children with ADHD and 1036 control children aged between 5 and 18 years old. Caregivers completed the Pediatric Sleep Questionnaire and the ADHD Rating Scale (ADHD-RS). Children with ADHD were subsequently assessed for executive function with the Conner's Continuous Performance Test (CPT) or with AULA Nesplora. Results Children with ADHD slept less at night and were more likely to display sleep-related rhythmic movements. Children in the ADHD group who were under 12 years old and who had total ADHD-RS scores over the 90th percentile had more difficulty falling asleep than other children; there was also a relationship between total ADHD-RS scores over the 90th percentile and certain parasomnias in the control population. There was a correlation between shorter duration of night-time sleep and omission errors in children who were 12 or older and who were under pharmacological treatment for ADHD. Bedtime resistance and difficulty falling sleep were more frequent in children with ADHD whose symptoms were not treated pharmacologically, than in children receiving treatment. Interpretation Symptoms of inattention and hyperactivity are correlated with impaired sleep duration and quality; specifically, there is an association between ADHD symptoms and problems falling asleep and parasomnias, however, the current study does not address the nature and direction of causality. Children with ADHD and receiving methylphenidate had fewer sleep disorders, suggesting that, at least in some children, stimulant treatment is associated with improvement of some aspects of sleep. Shorter sleep duration in adolescents under pharmacological treatment for ADHD tended to result in more errors of omission, suggesting that it is important to promote good sleep habits in this population.

There is a lack of large, randomized, double-blind studies that address antihistamine updosing for chronic spontaneous urticaria (CSU). The objective of this systematic review is to explore and analyse available data to provide clinical evidence for the efficacy of antihistamine updosing. We searched the literature in Medline, Scopus, Google Scholar, Embase, Web of Science and Cochrane databases using the keywords 'chronic, urticaria, antihistamines' to identify studies published between January 1990 and November 2014. We assessed quality using the Jadad score that evaluates quality of randomization, double-blinding and losses to follow-up. We identified 1042 articles and 15 articles were included in the final evaluation. We performed two meta-analyses, one that included studies that analysed treatment response among groups receiving different antihistamine dosages vs. placebo, and another that analysed antihistamine updosing in those patients who did not respond to standard dosages. Only five articles obtained a high quality level score. We did not find significant differences in response rates or number of weals in those patients who received a standard dosage vs. a high dosage. We found a significant improvement only in the pruritus variable of the Urticaria Activity Score scale. The estimated relative risk for improvement by increasing the antihistamine dosage was 2·27 [95% confidence interval (CI) 1·68-3·06]; however, there was significant heterogeneity. The proportion of nonrespondent patients with CSU who responded to antihistamine updosing was 63·2% (95% CI 57-69·6). We found that updosing antihistamines significantly improved control of pruritus but not weal number. However, the relative weakness of the studies and the significant heterogeneity among them made it difficult to reach a final conclusion.

Fundamento . El sentido de coherencia interna (SOC), concepto central del modelo salutogenico descrito por Aaron Antonovsky, se ha empleado como predictor de medidas de salud percibida y objetiva, se relaciona fuerte y positivamente con comportamientos saludables, y se desarrolla principalmente en la juventud y en la epoca de estudiante. Los universitarios son un grupo de jovenes diana para aplicar medidas promotoras de salud en funcion de su nivel SOC, siendo necesario comprobar la calidad de la medicion de la escala. El objetivo es validar y estudiar las propiedades psicometricas de la escala SOC en los estudiantes de la Universidad de Navarra, y conocer su evolucion temporal. Sujetos y metodo. Se analizaron los estudiantes de nuevo acceso de la Universidad de Navarra. Estudio de cohortes con seguimiento a los tres anos. Los instrumentos utilizados fueron el cuestionario de orientacion a la vida (OLQ-13), la Escala del Estres Percibido (EEP) y el Indice de malestar. Se estudiaron la calidad de los datos y viabilidad, asunciones escalares, estabilidad temporal, fiabilidad, validez de criterio concomitante y clinica, y estructura factorial y analisis confirmatorio de los datos obtenidos. Se utilizaron los paquetes estadisticos SPSS v. 19 y Amos v.7. Resultados. La muestra estudiada ha sido de 508 estudiantes, 33,5% varones y el 65,9% mujeres. Fiabilidad alta (Alfa de Cronbach de 0,814). Adecuada validez convergente con la EEP. Inadecuada validez clinica. Analisis de componentes principales con tres factores que explican el 50,73% de la varianza. Conclusiones. Instrumento valido que permite proponerlo como herramienta para aplicar medidas promotoras de salud en jovenes.

[Background]: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet. [Objective]: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts., [Design]: We assessed 18,566 participants in the “Seguimiento Universidad de Navarra” (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the “PREvencion con DIeta MEDiterránea” (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality., [Results]: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%–32%, for the highest vs lowest category of DII)., [Conclusion]: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively., Supported by the official funding agency for biomedical research of the Spanish Government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial (RTIC G03/140, to R.E.; RTIC RD 06/0045, to Miguel A. Martínez-González) and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (Proyecto de Investigación (PI) 04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505, PI13/00462, PI13/00615, PI13/01090, PI14/01668, PI14/01798, PI14/01764), Ministerio de Ciencia e Innovación (Recursos y teconologia agroalimentarias(AGL)-2009-13906-C02 and AGL2010-22319-C03 and AGL2013-49083-C3-1- R), Fundación Mapfre 2010, the Consejería de Salud de la Junta de Andalucía (PI0105/2007), the Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (Generalitat Valenciana Ayuda Complementaria (GVACOMP) 06109, GVACOMP2010-181, GVACOMP2011-151), Conselleria de Sanitat y, PI14/01764 AP; Atención Primaria (CS) 2010-AP-111, and CS2011-AP-042), and Regional Government of Navarra (P27/2011).). Drs. Shivappa and Hébert were supported by grant number R44DK103377 from the United States National Institute of Diabetes and Digestive and Kidney Diseases.

Background: Infant mortality is an indicator of child health, and an explanatory variable to reflect the socioeconomic development of a country. We aimed to examine the changes and trends of infant mortality in the European Union (EU) and its 28 member states in the 1994-2015 period. Methods: We extracted data of deaths in children aged less than one year between 1994 and 2015 from the Eurostat database. We analysed secular variation in the EU overall, by country and by geographical region using joinpoint regression analysis. We conducted additional analyses to examine neonatal and early neonatal mortality trends. Results: Infant mortality in the EU has declined significantly from 8,3 to 3,6 per 1,000 live births (annual percent change=-3,8%; 95% confidence interval, -4,1 to -3,6). Among EU countries, we found the highest mortality rates throughout the study period in Romania and Bulgaria, and the lowest rates in Scandinavian countries (Finland, Sweden). There were significant decreasing trends in every country of the EU, which were most pronounced in former Soviet Baltic states and Eastern European countries, and least pronounced in Western European countries. Mortality rates have increased significantly in Greece in the last years, and plateaued in the United Kingdom and Ireland. Conclusions: Our findings, which are based on official data, provide consistent evidence that infant mortality has declined steadily in the EU and its member states in the past decades, most markedly in Eastern European countries and former Soviet Baltic states. However, rates have risen or levelled off in some western countries in the past few years. Introducción: La mortalidad infantil es un indicador de la salud infantil y una variable explicativa del desarrollo socioeconómico. Nuestro objetivo fue examinar los cambios y tendencias de la mortalidad infantil en la Unión Europea (UE) y sus 28 países miembros en el período 1994-2015. Métodos: Se recopilaron datos de muertes de niños menores de un año entre 1994 y 2015 de la base de datos Eurostat. Estudiamos las tendencias en la UE, por países y regiones, utilizando el análisis de regresión joinpoint. Se condujeron análisis adicionales para estudiar las tendencias de mortalidad neonatal y neonatal precoz. Resultados: La mortalidad infantil en la UE ha disminuido significativamente de 8.3 a 3.6 por 1.000 (porcentaje de cambio anual = −3.8%, intervalos de confianza del 95% −4.1; −3.6). Las tasas de mortalidad más altas se registraron en Rumanía y Bulgaria, y las tasas más bajas en países escandinavos (Finlandia, Suecia). Se encontraron tendencias descendentes significativas en los países de la UE, más pronunciadas en los países bálticos exsoviéticos y países de Europa oriental, mientras que los países de Europa occidental mostraron los descensos menos pronunciados. La mortalidad infantil ha aumentado significativamente en Grecia en los últimos años, mientras que en el Reino Unido e Irlanda las tasas se han estabilizado. Conclusiones: La mortalidad infantil ha disminuido en la UE y sus países en las últimas décadas, más pronunciadamente en los países de Europa oriental y los países bálticos exsoviéticos, mientras que en varios países de Europa occidental las tasas aumentaron o se han estabilizado en los últimos anos.

Introduction: an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality. The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score). Patients and methods: this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test. Results: in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85). Conclusions: a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery.

Objetivo: Estudiar la correlación de la Telephone Interview for Cognitive Status modificada en español(STICS-m) con el Mini-Mental State Examination (MMSE) y predecir la capacidad de la primera para detectar el desarrollo de demencia. Método: Ciento seis sujetos de un estudio de intervención dietética fueron evaluados personalmente con el MMSE y por teléfono con la STICS-m. La correlación entre ambos se midió con el coeficiente de correlación intraclase (CCI) de consistencia. Además, 932 participantes mayores de 55 años de la cohorte 'Seguimiento Universidad de Navarra' fueron evaluados con la STICS-m. Durante una mediana de seguimiento de 6,5 años, se recogió información sobre el desarrollo de demencia. Mediante regresión logística se estudió la asociación entre la puntuación de la STICS-m o el cambio a 2 años en la puntuación y el riesgo de desarrollar demencia, ajustando por apolipoproteína E, edad y años de educación universitaria. Resultados: El CCI entre el MMSE y la STICS-m fue de 0,31 (intervalo de confianza del 95% [IC95%]:0,13-0,48). La odds ratio (OR) ajustada para el desarrollo de demencia para cada punto adicional en la puntuación basal de la STICS-m fue de 0,85 (IC95%: 0,72-1,02; p = 0,084). Al considerar el cambio en la puntuación a los 2 años como variable independiente, la OR fue de 0,79 (IC95%: 0,67-0,93; p = 0,006). Objective: To compare the Spanish version of the modified Telephone Interview of Cognitive Status(STICS-m) with the Mini-Mental State Examination (MMSE) and predict its ability to detect the development of dementia. Method: 106 participants in a dietary intervention trial underwent face-to-face evaluation with the MMSE, and phone interview with the STICS-m. The correlation between STICS-m and MMSE was assessed with the intraclass correlation coefficient (ICC) of consistency. Secondly, 932 participants over 55 years old from the ‘Seguimiento Universidad de Navarra’ cohort were evaluated with the STICS-m and data ondementia diagnosis were gathered (median follow-up time of 6.5 years). A logistic regression model evaluated the association between STICS-m score or 2-year changes in STICS-m score and risk of developing dementia, adjusting for ApoE, age and years of university education. Results: The ICC between the MMSE and the STICS-m was 0.31 (95% confidence interval [95%CI]: 0.13-0.48). The adjusted odds ratio (OR) for the development of dementia for each additional point in the baseline STICS-m score was 0.85 (95%CI: 0.72-1.02; p = 0.084). When considering the 2-year change inthe STICS-m score as exposure, the OR for the development of dementia was 0.79 (95%CI: 0.67-0.93; p = 0.006). Conclusions: The weak correlation between the STICS-m and the MMSE reflects moderate-low concurrent validity. Even so, the STICS-m can be regarded as an useful tool in the epidemiological setting since increasing scores appear to be able to predict a lower risk of developing dementia. The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045, CIBER-OBN, Grants PI10/02658, PI10/02293, PI13/00615,PI14/01668, PI14/01798, PI14/01764, and G03/140), the Navarra Regional Government (45/2011, 122/2014), and the University of Navarra. The PREDIMED Plus-NAVARRA trial has received fundingfrom the European Research Council (Advanced Research Grant2013-2018; 340918) granted to MAMG, the Instituto de Salud Carlos III (PI13/01090, PI16/01522).

BACKGROUND: Cytomegalovirus (CMV) is the most important viral pathogen in solid organ transplant (SOT) recipients. Prolongation of CMV prophylaxis from 3 to 6 months has been associated with a long-term reduction in CMV infection in high-risk renal recipients It has been recommended in this group of patients and, by extension, in other SOT recipients. PURPOSE: To assess the efficacy and safety of CMV prophylaxis in SOT recipients, as well as comparing the efficacy of extended versus standard CMV prophylaxis. MATERIAL AND METHODS: Cases of SOT patients from 2007 to 2014 were retrospectively studied. Patient demographics, transplant type, donor and recipient CMV serostatus, immunosuppressive therapy and data of CMV prophylaxis were collected from electronic patient files. CMV replication after prophylaxis was monitored according to SOT protocols (at least monthly from 3 to 6 months after SOT, and then when clinically indicated). CMV infection after prophylaxis was reviewed in order to evaluate the efficacy of prophylaxis. Outcome was compared between the groups of patients with standard prophylaxis (length 100 days). Safety analysis was based on the evaluation of myelotoxicity, according to the National Cancer Institute Common Toxicity Criteria scale Version 4. 0. RESULTS: Of the 438 SOT patients, 60 (13.7%) received CMV prophylaxis (37 renal, 15 hepatic and eight cardiac) for a median of 122 days. The main CMV serostatus was D+/R- (70.0%). Thirty-four of the 60 patients (56.7%) received extended prophylaxis. After a mean of 48 months of follow-up, 16 patients (26.7%) developed CMV infection after the end of prophylaxis (10 asymptomatic infections, two viral syndromes and four invasive diseases). Mean time to CMV replication was 52 days. Extended prophylaxis was not associated with fewer CMV infections (26.9% vs. 26.5% with standard prophylaxis). Thirty (50%) patients developed haematological toxicity, mainly neutropaenia (38.3%). Length of prophylaxis was independently associated with toxicity (OR 1.01, 95% CI: 1.00 to 1.02, p

To evaluate some methodological and ethical quality variables of clinical trials (CTs) published in 10 family medicine journals.Quality descriptive study of 10 family medicine journals including CTs in humans published since 2010 to 2013. We obtained 141 CT and 2447 were excluded.CTs parallels controlled in 92.9% (95% confidence interval [95% CI]: 92.0-93.9). Masked randomization in 72.3% (95% CI: 71.7-73.1), decentralized in 51.8% (95% CI: 51.4-52.4) and using as control an active treatment in 82.2% (95% CI: 81.5-83.1). Wrote informed consent in 48.9% (95% CI: 48.5-49.5) and it was not withdrawn in 56.0% of cases (95% CI: 55.5-56.7). Approval by clinical research ethics committee (CREC) in 134, and there was no conflict of interest in 117 CTs. Average κ was 0.96 (95% CI: 0.93-0.99).We observe an increase in some quality variables like masked randomization (19.6%) and approval by CREC (75%) post CONSORT, in CTs published in 10 family medicine journals (2010-2013).Evaluar algunas variables sobre la calidad metodológica y ética de los ensayos clínicos publicados en 10 revistas de medicina de familia.Estudio descriptivo de calidad sobre 10 revistas de medicina de familia incluyendo ensayos clínicos en humanos publicados entre 2010 y 2013. Obtuvimos 141 ensayos clínicos y fueron excluidos 2447.Ensayos clínicos controlados paralelos en el 92,9% (intervalo de confianza del 95% [IC 95%]: 92.0-93.9). Aleatorización enmascarada en el 72.3% (IC 95%: 71.7-73.1), descentralizada en el 51.8% (IC 95%: 51.4-52…4) y utilizando como control un tratamiento activo el 82.2% (IC 95%: 81.5-83.1). Consentimiento informado escrito en el 48.9% (IC 95%: 48.5-49.5) y no fue retirado en el 56.0% (IC 95%: 55.5-56.7). En 134 ensayos clínicos se contó con la aprobación por un comité ético de investigación clínica (CEIC), y en 117 no hubo conflicto de intereses. Se obtuvo un κ medio de 0,96 (IC 95%: 0.93-0.99).Observamos, tras considerar las normas CONSORT, un aumento en algunas variables de calidad, como la aleatorización enmascarada (19.6%) y la aprobación por un CEIC (75%), en los ensayos clínicos publicados en 10 revistas de medicina de familia (2010-2013).

ContextThe natural history of advanced thyroid malignancies is largely unknown. The outcome of patients included in the placebo arm of clinical trials could be reflective of their therapy-free evolution.ObjectiveTo analyze the response rate, symptoms and adverse effects of locally advanced or metastatic differentiated (DTC) and medullary thyroid cancer (MTC) in patients treated with placebo in clinical trials.DesignPubMed (MEDLINE) and SCOPUS databases were searched through September 2015 to identify high-quality randomized controlled clinical trials. We included studies that recruited patients with DTC or MTC with a placebo arm.MethodsWe conducted a meta-analysis for each category of response rate, adherence to treatment, and adverse events. An empirical Bayesian random-effect model was used.ResultsWe identified five clinical trials. DTC and MTC were independently analyzed. In the placebo arm, no complete response was observed; partial response occurred in 1.6% (0.6–3) and 6.4% (3.4–10.3) of DTC and MTC respectively; stable disease was described in 40.5% (34.6–46.9) and 53.9% (44.3–64.4) of DTC and MTC respectively. DTC reached a disease control rate of 42.3% (36.2–48.9) and MTC of 60.2 (50.1–71.4). Treatment discontinuation rate was 3.5% (1.9–5.5) in DTC and 5.7% (3.0–9.4) in MTC. Rate of dose reduction was 7.3% (4.8–10.5) in DTC and 6.2% (3.3–10.0) in MTC.ConclusionsThis meta-analysis provides extensive data on the response rate and adverse effects of locally advanced or metastatic DTC and MTC in patients treated with placebo. These results may be used for comparisons with results from clinical trials without a placebo arm.

Resumen Objetivo La gripe constituye un importante problema de salud publica, a pesar de contar con una vacuna eficaz. El objetivo del estudio es conocer la cobertura vacunal y los factores motivadores de la vacunacion en algunos colectivos sociales, como policias, bomberos, docentes y cuidadores de residencias geriatricas en Navarra. Metodologia Estudio analitico con diseno de cuestionario, remitido por correo electronico, con datos profesionales, de vacunacion (anos previos, presente e intencion para el futuro) y actitud ante la vacunacion antigripal clasificada en escala Likert. Se estudia el ji cuadrado, la odds ratio (OR), la regresion logistica y las pruebas no parametricas (Kruskal-Wallis y U de Mann-Whitney). El cuestionario con las razones de vacunacion se ha disenado a partir del disenado por Kraut y por el centro CIBERESP. Consta de un total de 29 items. Resultados Se obtienen 390 cuestionarios con una tasa global de vacunacion del 15%. El unico factor predictor (OR: 327,3) de vacunacion es la vacunacion en anos anteriores. La percepcion sobre vacunacion en colectivos sociales es 3 veces mayor a los datos obtenidos en nuestro estudio, con diferencias (Kruskal-Wallis) significativas. El item con la media mas alta en vacunados es la «experiencia positiva en vacunaciones previas», y en no vacunados es «he decidido que no me interesa». Conclusion Proporcionar mas informacion sobre la eficacia y la seguridad de la vacunacion, asi como sobre la potencial gravedad de la enfermedad, puede favorecer nuestra actitud vacunal.

espanolObjetivo: Evaluar algunas variables sobre la calidad metodologica y etica de los ensayos clinicos publicados en 10 revistas de medicina de familia. Metodos: Estudio descriptivo de calidad sobre 10 revistas de medicina de familia incluyendo ensayos clinicos en humanos publicados entre 2010 y 2013. Obtuvimos 141 ensayos clinicos y fueron excluidos 2447. Resultados: Ensayos clinicos controlados paralelos en el 92,9% (intervalo de confianza del 95% [IC 95%]: 92.0-93.9). Aleatorizacion enmascarada en el 72.3% (IC 95%: 71.7-73.1), descentralizada en el 51.8% (IC 95%: 51.4-52...4) y utilizando como control un tratamiento activo el 82.2% (IC 95%: 81.5-83.1). Consentimiento informado escrito en el 48.9% (IC 95%: 48.5-49.5) y no fue retirado en el 56.0% (IC 95%: 55.5-56.7). En 134 ensayos clinicos se conto con la aprobacion por un comite etico de investigacion clinica (CEIC), y en 117 no hubo conflicto de intereses. Se obtuvo un κ medio de 0,96 (IC 95%: 0.93-0.99). Conclusiones: Observamos, tras considerar las normas CONSORT, un aumento en algunas variables de calidad, como la aleatorizacion enmascarada (19.6%) y la aprobacion por un CEIC (75%), en los ensayos clinicos publicados en 10 revistas de medicina de familia (2010-2013). EnglishObjective: To evaluate some methodological and ethical quality variables of clinical trials (CTs) published in 10 family medicine journals. Methods: Quality descriptive study of 10 family medicine journals including CTs in humans published since 2010 to 2013. We obtained 141 CT and 2447 were excluded. Results: CTs parallels controlled in 92.9% (95% confidence interval [95% CI]: 92.0-93.9). Masked randomization in 72.3% (95% CI: 71.7-73.1), decentralized in 51.8% (95% CI: 51.4-52.4) and using as control an active treatment in 82.2% (95% CI: 81.5-83.1). Wrote informed consent in 48.9% (95% CI: 48.5-49.5) and it was not withdrawn in 56.0% of cases (95% CI: 55.5-56.7). Approval by clinical research ethics committee (CREC) in 134, and there was no conflict of interest in 117 CTs. Average κ was 0.96 (95% CI: 0.93-0.99). Conclusions: We observe an increase in some quality variables like masked randomization (19.6%) and approval by CREC (75%) post CONSORT, in CTs published in 10 family medicine journals (2010-2013).

Objetivo: Determinar la prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la nutrición materna. Materiales y métodos: Estudio transversal descriptivo de prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la alimentación de la madre se recolecto la información a través del cuestionario del International Study of Asthma and Allergies in Childhood el cual es empleado para describir el comportamiento epidemiológico de las enfermedades como asma, rinitis y eccema en niños y jóvenes, este fue resuelto por los padres de los menores previa firma y entrega del consentimiento informado, el cuestionario arrojo una confiabilidad del 0,78 en el alfa de cronbach, a las categorías de interés de este estudio se les hizo análisis de proporción, el contraste de hipótesis se realizó mediante diferencia de proporciones con intervalo de confianza en un nivel del 95%, y cálculo de error aceptado. Resultados: Teniendo en cuenta los resultados sobre el consumo de alimentos de la madre en etapa de gestación y la presencia de síntomas de alergia en los menores se concluye que: Valor-P= 0,0 Valor-Zα/2= -34,6241 No se acepta la H0 para un α/2= 0,025, se encontró en el estudio que aunque las madres refirieron haber consumido mayormente alimentos saludables, sus hijos presentaron síntomas de enfermedades alérgicas, asociados a asma, rinitis y eccema. Conclusiones: No existe un consenso sobre si la dieta materna influye positivamente en la disminución de alergias en los neonatos, se sugiere continuar con las recomendaciones de los expertos en lo referente a una nutrición balanceada que culmine en un óptimo estado de salud de la gestante y el feto. Objective: To establish the prevalence of allergies in boys and girls of 6 and 7 years old and their relation with maternal nutrition. Methods and materials: Descriptive transversal study of prevalence of allergies in boys and girls of 6 and 7 years old and their relation with theirs mother´s nutrition, information that was collected through the International Study of Asthma and Allergies in Childhood questionnaire, which is used to describe the epidemiological behavior of diseases like asthma, rhinitis and eczema in kids and youths. It was resolved by theirs parents before their signature and delivery of informed consent. It was made a questionnaire throw one reliability of 0,78 in the α of Cronbach, an analysis of proportion to the categories of interest of this study and a contrast of hypothesis was made by the differences of proportions with the interval of confidence in a level of 95% Results: Given the results of the consumption of mother´s food in the gestation age and the presence of symptom of allergies in kids, it includes that: Value-P: 0,05 Value –Za/2: -34,6241, it´s not accepted the Ho for a α/2= 0,025. It was found in the study although mothers reported having consumed mainly healthy food, these children felt and showed symptom of allergic diseases, associated with asthma, rhinitis and eczema. Conclusions: This study as well as others, does not present a consensus looking if the maternal diet influences positively in the reduction of allergies in neonates.

BACKGROUND Cytomegalovirus (CMV) is the most important viral pathogen in solid organ transplant (SOT) recipients. The role of secondary CMV prophylaxis in this population remains unclear. METHODS Retrospective cohort study in a single center. SOT recipients treated for CMV infection from 2007 to 2014 were studied to determine the efficacy and safety of secondary prophylaxis and its impact on graft loss and mortality. The outcome variable was CMV replication in the first 3 months after the end of therapy. Secondary variables were crude mortality and graft lost censored at 5 years after transplantation. Propensity score for the use of secondary prophylaxis was used to control selection bias. RESULTS Of the 126 treated patients, 103 (83.1%) received CMV secondary prophylaxis. CMV relapse occurred in 44 (35.5%) patients. The use of secondary prophylaxis was not associated with fewer relapses (34.0% in patients with prophylaxis vs 42.9% in those without prophylaxis, P = .29). After a mean follow-up of 32.1 months, graft loss was not different between both groups but patient mortality was significantly lower in patients who received secondary prophylaxis (5.8% vs 28.6%, P = .003). CONCLUSION Secondary prophylaxis did not prevent CMV infection relapse but it was associated with improved patient survival.

Introducción: existe una amplia evidencia en población adulta de que un alto nivel de actividad física y un bajo nivel de sedentarismo se asocian de forma independiente con una reducción de los factores de riesgo cardiometabólico (FRCM). Esta asociación ha sido poco estudiada en población joven y los resultados no son concluyentes. Objetivo: estimar la asociación entre FRCM, actividad física y sedentarismo en estudiantes universitarios chilenos. Métodos: estudio de corte transversal. Muestra de 326 estudiantes matriculados el año 2014 en la Universidad de La Frontera, Temuco, Chile, seleccionados en forma aleatoria, estratificada según facultad, carrera y sexo. Se evaluó antropometría, presión arterial, perfil lipídico, glicemia, insulinorresistencia, consumo de tabaco y alcohol. Estas variables se asociaron con los niveles de actividad física (NAF) y sedentarismo, de acuerdo al cuestionario IPAQ. Resultados: los estudiantes con un NAF bajo tuvieron mayor probabilidad de tener obesidad abdominal (Odds ratio [OR]: 4,68; IC 95% 1,86-11,73), síndrome metabólico (OR: 3,80; IC 95% 1,23-11,73) y triglicéridos elevados (OR: 2,61 IC95%; 1,18-5,75), en comparación con aquellos estudiantes que realizaban NAF moderados o vigorosos (p < 0,05). No se observó asociación entre FRCM y sedentarismo, incluso después de ajustar por actividad física. Conclusión: encontramos asociación entre FRCM y NAF, que fue independiente del sedentarismo. Es de suma importancia implementar programas de actividad física efectivos en las universidades, motivando a los estudiantes a incrementar los NAF a rangos moderado y vigoroso, con el fin de reducir el riesgo cardiovascular. Consideramos que es necesario seguir investigando la asociación entre sedentarismo y FRCM. Introduction: There is a huge evidence in adults, that a high level of physical activity and a low level of sedentariness are associated independently with a reduction of cardiometabolic risk factors (CMRF). This association has been poor evaluated in young people and the results are not conclusive. Objective: To estimate the association between CMRF, physical activity and sedentariness in Chilean university students. Methods: Cross-sectional study. Sample of 326 students who enrolled at University of La Frontera, Temuco, Chile, in 2014. They were selected randomly and stratified according to faculty, career and gender. We measured anthropometry, blood pressure, lipidic profile, glycemia, insulin resistance, tobacco and alcohol consumption. These variables were associated with physical activity level (PAL) and sedentariness using the IPAQ questionnaire. Results: The students with a low PAL had a higher probability of abdominal obesity (OR: 4.68; IC 95% 1.86-11.73), metabolic syndrome (OR: 3.80; IC 95% 1.23-11.73) and triglycerides elevated (OR: 2.61 IC 95%; 1.18-5.75), compared with students with moderate and vigorous PAL (p < 0.05). There were no association between CMRF and sedentariness, even after fit by physical activity. Conclusions: We found an association between CMRF and PAL which was independent of sedentatiness. We believe it is very important to implement effective physical activity programs at universities. It is necesary to encourage students in order to increase the physical activity level to a moderate and vigorous range with the purpose of decreasing their cardiovascular risk. We consider it is recommendable to keep studying the association between sedentariness and CMRF. Proyecto de investigación DIUFRO DI15-0034.

BACKGROUND Breast reduction is a procedure with a high rate of patient satisfaction. Many techniques can be used for this type of surgery; patient satisfaction can vary from one technique to another. The main aim of this study was to use Breast-Q for initial evaluation of patient satisfaction after breast reduction by either vertical or inverted-T technique and then determine if the quantity of breast tissue removed had any influence on patient satisfaction. METHODS Eighty-four out of 288 patients operated on between 2000 and 2013 anonymously completed the post-operative version of Breast-Q Reduction/Mastopexy. Inverted T technique: 55 patients; vertical technique: 29 patients. Statistical significance was set at p

Objective Some recent studies have related autoimmune thyroid dysfunction and gestational diabetes (GD). The common factor for both conditions could be the existence of pro-inflammatory homeostasis. The study objective was therefore to assess whether the presence of antithyroid antibodies is related to the occurrence of GD. Material and methods Fifty-six pregnant women with serum TSH levels ≥ 2.5 mU/mL during the first trimester were retrospectively studied. Antithyroid antibodies were measured, and an O'Sullivan test was performed. GD was diagnosed based on the criteria of the Spanish Group on Diabetes and Pregnancy. Results Positive antithyroid antibodies were found in 21 (37.50%) women. GD was diagnosed in 15 patients, 6 of whom (10.71%) had positive antibodies, while 9 (16.07%) had negative antibodies. Data were analyzed using exact logistic regression by LogXact-8 Cytel; no statistically significant differences were found between GD patients with positive and negative autoimmunity (OR = 1.15 [95%CI = 0.28–4.51]; P = 1.00). Conclusions The presence of thyroid autoimmunity in women with TSH above the recommended values at the beginning of pregnancy is not associated to development of GD. However, GD prevalence was higher in these patients as compared to the Spanish general population, suggesting the need for closer monitoring in pregnant women with TSH levels ≥ 2.5 mU/mL.

Resumen Objetivo Recientemente varios trabajos han relacionado la disfuncion tiroidea autoinmune con la diabetes gestacional (DG). El hipotetico nexo de union seria el desarrollo de la homeostasis proinflamatoria. Por ello nos propusimos estudiar si la presencia de anticuerpos antitiroideos se relaciona con la aparicion de DG. Material y metodos Se estudiaron retrospectivamente 56 gestantes con valores de TSH ≥ 2,5 μU/ml en el primer trimestre. Se midieron anticuerpos antitiroideos y se realizo la prueba de O'Sullivan. Para el diagnostico de DG se llevo a cabo una sobrecarga oral de glucosa (100 g) y se siguieron los criterios recomendados por el Grupo Espanol de Diabetes y Embarazo. Resultados Se constato anticuerpos antitiroideos elevados en 21 (37,50%) mujeres. Se diagnostico DG en 15 (26,79%) pacientes, de las que 6 (10,71%) tenian anticuerpos positivos y 9 (16,07%) tenian anticuerpos negativos. Los datos fueron analizados mediante regresion logistica exacta por LogXact-8 Cytel, no encontrandose diferencias significativas entre las pacientes diagnosticadas de DG con anticuerpos antitiroideos positivos y con autoinmunidad negativa (OR = 1,15 [IC 95% = 0,28-4,51]; p = 1,00). Conclusiones La presencia de autoinmunidad tiroidea en mujeres con TSH por encima de los valores recomendados al inicio de la gestacion no se asocia con el desarrollo de DG. No obstante, la prevalencia de DG en estas pacientes es superior a la documentada en la poblacion general espanola, lo que sugiere la necesidad de un seguimiento mas estrecho en gestantes con TSH ≥ 2,5 μU/ml.

Thyroid dysfunction is one of the leading endocrine disorders. Previous data show that about half of the population with thyroid dysfunction remains undiagnosed.Our objective was to estimate epidemiologic data on thyroid dysfunction in Europe.PubMed, EMBASE, and SCOPUS databases were searched to identify studies that evaluated the prevalence and/or incidence of thyroid dysfunction in Europe published between 1975 and 2012.Of the 541 identified abstracts examined, 178 were considered for evaluation and 17 were included. Studies were excluded if they included participants with an underlying disease or were limited by age or gender.Results were grouped into 3 categories: 1) prevalence of undiagnosed thyroid dysfunction, 2) prevalence of thyroid dysfunction, and 3) incidence of thyroid dysfunction. Extraction was conducted independently by 2 investigators.An empirical Bayesian random-effects model was used. The prevalence of undiagnosed thyroid dysfunction was assessed in 7 studies with a mean result of 6.71% (95% credibility interval, 6.49%-6.93%): 4.94% (4.75%-5.13%) and 1.72% (1.66%-1.88%) for undiagnosed hypothyroidism and hyperthyroidism, respectively. The prevalence of both previously diagnosed and undiagnosed thyroid dysfunction was assessed in 9 studies with a mean result of 3.82% (3.77%-3.86%): 3.05% (3.01%-3.09%) and 0.75% (0.73%-0.77%) for hypothyroidism and hyperthyroidism, respectively. The incidence rate of thyroid dysfunction was assessed in 7 studies with a mean result of 259.12 (254.39-263.9) per 100 000 per year: 226.2 (222.26-230.17) and 51 (49.23-52.88) per 100 000 per year for hypothyroidism and hyperthyroidism, respectively.This meta-analysis provides extensive data on the prevalence and incidence of thyroid dysfunction in Europe.

Fundamento. La calidad de los servicios en un sistema sanitario está relacionada con el nivel de satisfacción de sus profesionales. El objetivo de este trabajo es conocer la satisfacción laboral y jerarquizar aquellos factores capaces de mejorarla, en profesionales de atención primaria. Metodología. Estudio descriptivo realizado en 2010 en Navarra. Se remitió por correo un cuestionario validado a la población de estudio: médicos, pediatras y enfermería de atención primaria. Se recogen variables de datos sociodemográficos y autocalificación de su satisfacción laboral en escala de 1 a 10. Se solicita la jerarquización de 10 factores que puedan mejorar la satisfacción previa señalada. Se realizó comparación de medias y análisis bivariante mediante el test de la Chi cuadrado, estudiando la asociación entre variables mediante la Odds Ratio (OR). El análisis ajustado se realizó mediante regresión logística no condicional. Resultados. Se recogieron 432 cuestionarios (77,5%). La satisfacción media fue 6,7 (escala 1 a 10), más alta en enfermería. Las mujeres presentaron una media superior a los hombres (6,90: 6,34). Los trabajadores de centros de salud urbanos (OR:1,71; IC:1,10-2,65) presentaron un mayor riesgo de insatisfacción respecto a los profesionales de centros rurales. Las actividades formativas de los profesionales es el ítem más valorado, seguido de razones económicas y de presión asistencial, no encontrándose diferencias por profesión. Conclusión. La satisfacción laboral es una dimensión de la gestión de calidad en atención primaria y su estudio permite identificar problemas u oportunidades de mejora con impacto en la calidad de los servicios que se ofertan Background. The quality of services in a health system is related to the level of satisfaction of its professionals. The aim of this article is to determine job satisfaction in primary care professionals and rank those factors capable of improving it. Methodology. Descriptive study carried out in Navarre in 2010. A validated questionnaire was sent by post to the population of the study: primary care doctors, pediatricians and nurses. Variables on socio-demographic data were collected and job satisfaction was self-evaluated on a scale of 1 to 10. Respondents were asked to rank 10 factors that could improve the previously mentioned satisfaction. Averages were compared and bivariate analysis was carried out using the chi-square test, studying the association between variables through the Odds Ratio (OR). The adjusted analysis was realized through unconditional logistic regression. Results. We collected 432 questionnaires (77.5%). Average satisfaction was 6.7 (scale of 1 to 10), higher in nursing. Women showed a higher average than men (6.90:6.34). The workers at urban health centers (OR: 1.71; CI: 1.10- 2.65) showed a higher risk of dissatisfaction with respect to professionals at rural centers. The training activities of the professional is the most highly valued item, followed by economic questions and questions of care pressure, with no differences found by profession. Conclusion. Job satisfaction is a dimension of quality management in primary care and its study enables identification of problems or opportunities for improvement with an impact on the quality of the services offered

Objective The peroxisome proliferator-activated receptor gamma 2 (PPARG2) gene has been intensively studied with relation to obesity and metabolic disorders. Indeed, a large number of studies assessing the association between the PPARG2 polymorphism Pro12Ala (rs1801282) and body mass index (BMI) have been published with some controversial results. In this meta-analysis, the effects of Pro12Ala polymorphism of the PPARG2 gene on BMI were investigated. Design and Methods Externally published data were collected and we included our own novel data from a study in the elderly participants (>55 years) of a Mediterranean cohort, the SUN (“Seguimiento Universidad de Navarra”) Project (n = 972). A total of 75 independent studies with 49,092 subjects (39,806 with the genotype Pro12Pro and 9,286 carrier subjects of the Ala allele) were included. Results The meta-analysis revealed a higher BMI with an overall estimation of +0.065 kg/m2 (95%CI = 0.026-0.103, P = 0.001) for homo-/heterozygous carriers of the Ala allele of the PPARG2 gene in comparison to non-carriers. The analysis also showed that there was heterogeneity (P for heterogeneity