Search

Background: Colorectal cancer (CRC) is the second cause of tumour mortality in Spain and Europe. To date, no studies have been conducted in Spain to evaluate the spatial and temporal distribution of the excess risk of death during hospitalisation for CRC.Methods: A cohort was constructed of all episodes of hospitalisation in Spain due to CRC (codes 153 and 154 of the International Classification of Diseases, 9th edition, Clinical Modification) during the period 2008-2014, based on the minimum basic data set published by the Ministry of Health. Mortality ratios were calculated per region for each of the years analyzed (spatial or cross-sectional analysis) and during the overall study period, for each region independently (temporal or longitudinal analysis). In the first of these analyses, particular note was taken of the regions and years in which the limits of two and three standard deviations were exceeded.Results: Two hundred and fifty eight thousand, nine hundred and twenty seven episodes of CRC were analysed. The patients were predominantly male (60.6%), with an average hospital stay of 13.16 days. Half underwent surgery during admission and on average presented more than six diagnoses at discharge. The spatial analysis revealed mortality ratios that deviated by at least three standard deviations in the following regions: Islas Canarias, Asturias, Valencia, Extremadura, País Vasco and Andalucía. The longitudinal analysis showed that most regions presented one or more years when CRC mortality was at least 15% higher than expected during the period; outstanding in this respect were Asturias, Navarra and La Rioja, where this excess risk was detected in at least 2 years.Conclusions: Geographic and temporal patterns of the distribution of the excess risk of mortality from CRC in Spain are described using SMRs. We conclude that during the study period, the geographic pattern of mortality in Spain did not coincide with the excess risk of mortality calculated using the SMR method described by Jarman and Foster. This method of risk estimation can be a useful tool for the study of mortality risk and its spatial variations. [ABSTRACT FROM AUTHOR]

Background: National indicators of cancer burden are essential information for cancer surveillance and health planning, so that in countries with partial registration coverage and geographically variable risk patterns, such as Spain, this is even more relevant. This article provides estimates of cancer incidence in Spain for all cancers combined, with the single exception of non-melanoma skin cancer, and for major cancer sites over the period 1981–2006, with projections up to 2012. [ABSTRACT FROM PUBLISHER]

In the last thirty years, grain producers in central Spain have begun a slow transition from conventional tillage (CT) to reduced tillage (RT) systems for the production of cereal crops in semiarid conditions, and nowadays most of them have adopted minimum tillage (MT) and an increasing number even no-tillage (NT) practices. The main reason underlying this shift is the cut down of the production costs through a reduction in the total energy use for crop production. The objectives of this study were to assess the crop yields, energy output and energy use efficiency for monoculture cereal and cereal-fallow rotation each managed using CT, MT and NT on a Vertic Luvisol in Alcalá de Henares, Madrid, Spain. Cropping systems included monoculture winter barley (Hordeum vulgare L.) (WB) six years; spring barley (SB) one year; monoculture winter wheat (WW) (Triticum aestivum L.) sixteen years; winter wheat-fallow rotation (F-WW), 4 years; and winter barley-fallow rotation (F-WB), 2 years. Total energy use was significantly lower in NT than in MT, and in this the latter was also significantly lower than in CT, regardless of cropping system considered. Average energy saved was 11% and 14% for MT and NT, respectively, in comparison with CT. Irrespective of cropping system, direct energy use averaged 2.68 ± 0.28 GJ ha-1 year-1 in CT; 1.97 ± 0.29 GJ ha-1 year-1 in MT; and 1.27 ± 0.27 GJ ha-1 year-1 in NT, being all these figures significantly different. Indirect energy use averaged across cropping systems was highest in NT, 5.93 ± 1.16 GJ ha-1 year-1; intermediate in CT, 5.7 ± 1.26 GJ ha-1 year-1; and lowest in MT, 5.49 ± 1.27 GJ ha-1 year-1. As all tillage systems received the same rates of seed and fertilizer, increased herbicide consumption in NT was responsible for its highest indirect energy use that was offset by its lowest direct energy use. In the cropping systems considered, no significant differences were observed between the crop yields, and crop yields per standing plant, obtained in each tillage system. Energy productivity mean values of each crop rotation were similar in NT and MT, and higher than those of CT. The pooled average energy productivity across crop rotations was 15% higher in MT than in CT, 19% higher in NT than in CT, and 3.7% higher in NT than in MT. Energy productivity of each tillage system increased linearly with the amount of rainfall from sowing to maturity. The slope of the regression lines reflects the efficiency of a tillage system in converting each millimetre of water received in energy productivity. For wheat, the largest slope corresponded to NT, intermediate to MT, and lowest to CT. For barley the largest slope was that of MT, intermediate that of NT, and the lowest that of CT. [ABSTRACT FROM AUTHOR]

Background: The overall intake of energy and nutrients in the Granada EPIC-cohort (European Prospective Investigation into Cancer and Nutrition) is examined in order to assess compliance with the Spanish Nutritional Objectives (NO) and the Recommended Intakes (RI). Methods: During recruitment (1992-1996), 7,789 participants, aged 35-69, were asked about diet through a validated diet history questionnaire. Nutrient intake is compared to the NO and RI that were valid at that time. Risk of inadequate intake is estimated as the percentage of the sample with intakes: ≤ 1/3 RI (high risk), ≤ 2/3 RI-> 1/3 RI (moderate risk), ≤ RI- > 2/3 RI, > RI. Differences in intakes have been analyzed by sex and age, and by smoking status and BMI. Results: The daily intake of nutrients did not meet the NO as the total contribution of energy from proteins and fats exceeded these guidelines. Whilst intake of most nutrients was above the RI, the amount of iron, magnesium and vitamins D and E provided by the diet was not enough to meet the RI: in women aged 20-49 years, about 55% were at moderate risk for iron inadequacy, and a 20% of women for magnesium. Both sexes were at high risk of inadequacy for vitamin D, although sunlight exposure may supply adequate amounts. Never smokers showed a higher compliance to the NO. Conclusion: At recruitment, the nutrient profile of the diet was unbalanced. The observed nutrient inadequacy for iron, magnesium and vitamin E might be attributed to inappropriate dietary habits, and may have implications for future disease risk. [ABSTRACT FROM AUTHOR]

Background: Although prostate cancer has recently registered increasing incidence and decreasing mortality in Spain, no analysis has yet been made of these two indicators to ascertain the magnitude of and reasons for these trends. [ABSTRACT FROM PUBLISHER]

Background: This study provides estimates of population-based relative survival in Spain for nine major cancers and reports results on cancer survival by region, gender and age group. [ABSTRACT FROM PUBLISHER]

Objective: To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service., Methods: Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses., Results: Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case., Conclusions: The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Despite major advances, multiple myeloma remains an incurable disease. Epidemiological data from high-quality population-based registries are needed to understand the heterogeneous landscape of the disease., Methods: Incidence, mortality and survival in multiple myeloma were comprehensively analyzed in the Girona and Granada population-based cancer registries, over a 23-year study (1994-2016), divided into three periods (1994-2001, 2002-2009 and 2010-2016). Joinpoint regression analysis was used to estimate the annual percentage change in incidence and mortality. Age-standardized net survival was calculated with the Pohar-Perme method., Results: 1957 myeloma patients were included in the study, with a median age of 72 years. Age-standardized incidence and mortality rates decreased over time in both sexes and both rates were higher in males. Five-year age-standardized net survival by period was 27.4% (1994-2001), 38.8% (2002-2009), and 47.4% (2010-2016). Survival improved for all age groups: 32.4%, 74.1% and 78.5% for patients aged 15-49; 27.5%, 44.6%, and 58.5% for those aged 50-69; finally, 24.8%, 25.5%, and 26.3% for the older group., Conclusion: Incidence remained overall stable throughout the study, with only a small increase for men. Mortality was progressively decreasing in both sexes. Both incidence and mortality were higher in men. Age plays a critical role in survival, with impressive improvement in patients younger than 70 years, but only a minor benefit in those older than 70.

Background: The prevalence of arterial hypertension (AHT), a well-known risk factor for cardiovascular disease, has considerably increased over last decades. Non-persistent environmental pollutants (npEPs) are a group of ubiquitous chemicals, widely used in consumer products such as food packaging and cosmetics, which have been identified as endocrine disrupting chemicals and obesogens. The aim of this study was to assess the potential associations of serum levels of three groups of npEPs with the risk of incident AHT., Methods: Cohort study within a sub-cohort of Granada EPIC-Spain center (n = 670). We quantified serum concentrations of three groups of npEPs, i.e., bisphenol A (BPA), four parabens: methylparaben (MP), ethylparaben (EP), propylparaben (PP) and butylparaben (BP), and two benzophenones: benzophenone 1 (BP1), benzophenone 3 (BP3), in samples collected at recruitment. Statistical analyses were performed by means of Cox Proportional Hazard Models., Results: Median follow-up time was 23 years. BPA and MP were found in >80% of the study population. Individuals within the 4th PP quartile (0.53-9.24 ng/ml) showed a statistically significant increased risk of AHT (HR = 1.40, p = 0.015). No associations were found for the rest of pollutants., Conclusions: Overall, we evidenced no associations of most npEPs with AHT risk, with the exception of an increased risk in the highest PP percentiles. Considering the limitations of using one spot serum sample for exposure characterization, further research on the potential contribution of npEPs on the development of AHT risk is warranted., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The natural and forced mobilization of lead, cadmium and arsenic in zinc hydrometallurgy waste is studied with the purpose of establishing potentially environmentally damaging levels and associated risks in uncontrolled situations. Differential X-Ray diffraction is used to study, in simulated environmental situations, the relevant role played by several mineralogical and amorphous phases. The study of potential mobility shows that all the samples considered are susceptible of releasing a significant amount of potentially toxic elements (PTEs) depending of the particular environmental conditions. Two situations can be considered the most problematic: the natural mobilization of the released cadmium and zinc as a result of rain, and a change in the redox conditions caused by an anoxic environment (flooding and/or incorporation of organic matter). The presence of massive quantities of soluble salts increases the hazard potential of these residues, mobilizing the PTEs and creating a potential carcinogenic risk caused by a possible oral intake for both children and adults., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Mortality from malignant cutaneous melanoma increased alarmingly during the second half of the 20th century in Spain and other European countries., Objective: The aim was to analyse sex- and age-specific trends in melanoma mortality in Spain in the period 1982-2016., Methods: European age-standardized melanoma mortality rates during the period 1982-2016 were calculated from mortality figures provided by the National Statistics Institute. Joinpoint regressions were used to identify significant points of change in trends and to compute average annual per cent change (AAPC). Age-cohort-period models were fitted to explore the effect of these variables on mortality., Results: During the period 1982-2016, age-standardized melanoma mortality rates increased in Spain from 0.90 to 1.80 deaths per 100 000 people in men and from 0.64 to 1.11 per 100 000 in women, rising noticeably from 1982 to 1995 in both sexes and in all age groups. From the mid-90s different trends were observed depending on sex and age: there was a decrease in mortality in the population younger than 45 years (AAPC -2 in both sexes) and aged 45-64 years (AAPC -1 among men and -0.2 among women), but in the group over 64 years rates continued to increase (AAPC 1.7 and 0.2, respectively, for men and women). The mortality sex ratio decreased in the younger population but increased in older individuals. A cohort effect was observed with lower mortality in the cohorts born after 1943 in men and 1956 in women. There was also a period effect with decreased mortality rates at the beginning of the 1990s., Conclusions: Melanoma mortality rates in Spain increased during the last decades of the 20th century; however, later they stabilized in women and began to decrease in younger cohorts and middle-aged men. Promotion of primary and secondary prevention measures should continue, with particular emphasis on males over 65 years., (© 2019 European Academy of Dermatology and Venereology.)

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

Background: Lymphoma is the third most common malignancy in children (0-14 years) and the first in adolescents (15-19 years). This population-based study-the largest ever done in Spain-analyses incidence and survival of lymphomas among Spanish children and adolescents., Patients and Methods: 1664 lymphoma cases (1983-2007) for incidence and 1030 for survival (1991-2005) followed until 31/12/2010, were provided by 11 cancer registries. Age-adjusted incidence rates (ASRw) to the world standard population were obtained; incidence trends were modelled using the Joinpoint programme, observed survival (OS) was estimated with Kaplan-Meier and trends tested with a log-rank test. Results are presented according to the International Classification of Childhood Cancer-3., Results: In Spain, the ASRw 0-14 for lymphomas was 17.5 per 1.000.000 child-years and 50.0 the specific rate for adolescents. Overall incidence increased significantly during 1983-1997 with no increases thereafter. Patients over 9 years old showed significant rising trends for all subtypes, except for Burkitt lymphoma (BL) in adolescents. During 2001-2005 (age 0-19 years), 5-year OS was 94 (90-98), 73 (64-83) and 86 (78-94) for Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL) and BL, respectively. No improvement in survival was found. The incidence in Spain was higher than overall European rates, but within the range of that in Southern Europe. Comparing OS in Spain 1991-1995 and 2001-2005 with results for Europe of the Automated Childhood Cancer Information System (ACCIS) (1988-1997) and the European cancer registry-based study on survival and care of cancer patients (EUROCARE) (2000-2007), it was similar for HL and lower for NHL and BL., Conclusions: Systematic monitoring and analysis of lymphoma paediatric data would provide clinical and epidemiological information to improve the health care of these patients and the outcomes for these malignancies in Spain.

Background/objectives: High intakes of unprocessed red or processed meat may increase the risk of stroke. We aimed to examine the association between unprocessed red meat, processed meat and total red meat consumption and risk of total stroke and ischaemic stroke., Subjects/methods: Cox proportional hazards regression analyses were conducted based on the data for 41,020 men and women aged 29-69 years at baseline., Results: During a mean follow-up of 13.8 years, 674 incident cases of stroke (531 ischaemic strokes, 79 haemorrhagic strokes, 42 subarachnoid haemorrhages and 22 mixed or unspecified events) were identified. After multiple adjustment, unprocessed red meat, processed meat and total red meat consumption were not correlated with incidence of total stroke or ischaemic stroke in either men or women. The hazard ratios (HRs) for unprocessed red meat and processed meat and risk of total stroke comparing the highest with the lowest quintiles were, respectively, 0.81 (95% confidence interval (CI) 0.54-1.21; P-trend=0.15) and 0.92 (95% CI 0.64-1.32; P-trend=0.82) in men and 1.21 (95% CI 0.79-1.85; P-trend=0.10) and 0.81 (95% CI 0.51-1.27; P-trend=0.17) in women. The HRs for unprocessed red meat and processed meat and risk of ischaemic stroke were, respectively, 0.80 (95% CI 0.51-1.25; P-trend=0.51) and 0.86 (95% CI 0.57-1.29; P-trend=0.77) in men and 1.24 (95% CI 0.74-2.05; P-trend=0.13) and 0.82 (95% CI 0.47-1.42; P-trend=0.31) in women., Conclusions: In the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, unprocessed red meat and processed meat consumption were not associated with risk of stroke in men or women.

Patients with mantle cell lymphoma (MCL) have an adverse outcome after relapse. Bendamustine has demonstrated a good efficacy and toxicity profile in previously reported trials. In this study, we present a retrospective analysis of the Spanish experience in relapsed/refractory MCL treated with bendamustine in combination or alone with the objective of knowing the efficacy and toxicity profile of this treatment in our current clinical practice. Fifty eight patients were registered: 67 % male with median age of 71 years, and 2 is the median number of previous lines. The most frequent bendamustine regimen was bendamustine plus rituximab (83 %). The median number of cycles was 5 (range 1-8). The overall response rate was 84 % with 53 % of complete response/unconfirmed complete response (CR/uCR). Median progression-free survival (PFS) was 16 months (95 % confidence interval (CI) 13.3-18.8), and for patients who achieved CR/uCR, it was 33 months (95 % CI 11.1-54.2). Median overall survival (OS) was 30 months (95 % CI 25.6-34.9). For PFS, only blastoid histology and not achieving CR after bendamustine had a significant negative impact on the univariate and multivariate analyses (p < 0.05). Nevertheless, for OS, only an elevated lactate dehydrogenase (LDH) had negative impact on both, univariate and multivariate analyses (p < 0.05). Only one case of treatment-related mortality in a 79-year-old patient with very bad performance status was reported. In 280 cycles, 12 (4 %) hospitalizations for febrile neutropenia were reported. In our population, bendamustine has been a good salvage treatment with a favorable toxicity profile in a non selected and heavily pretreated population of patients with MCL.

Lung cancer incidence is decreasing worldwide among men but rising among women due to recent changes in smoking patterns in both sexes. In Europe, the smoking epidemic has evolved different rates and times, and policy responses to it, vary substantially between countries. Differences in smoking prevalence are much more evident among European women reflecting the heterogeneity in cancer incidence rates. Other factors rather than smoking and linked to sex may increase women's susceptibility to lung cancer, such as genetic predisposition, exposure to sex hormones and molecular features, all of them linked to epidemiologic and clinical characteristics of lung cancer in women. However, biological bases of sex-specific differences are controversial and need further evaluation. This review focuses on the epidemiology and outcome concerning non-small cell lung cancer in women, with emphasis given to the Spanish population.

Background and Aims: The evidence about the benefits of omega-3 fatty acid intake on coronary heart disease (CHD) is not consistent. We thus aimed to assess the relation between dietary intake of total omega-3 fatty acids (from plant and marine foods) and marine polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on the risk of CHD in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)., Methods and Results: The analysis included 41,091 men and women aged 20-69 years, recruited from 1992 to 1996 and followed-up until December 2004. Omega-3 fatty acid intake was estimated from a validated dietary questionnaire. Only participants with definite incident CHD event were considered as cases. Cox regression models were used to assess the association between the intake of total omega-3 fatty acids, EPA or DHA and CHD. A total of 609 participants (79% men) had a definite CHD event. Mean intakes of total omega-3 fatty acids, EPA and DHA were very similar in the cases and in the cohort, both in men and women. In the multivariate adjusted model, omega-3 fatty acids, EPA and DHA were not related to incident CHD in either men or women. The hazard ratios (HR) for omega-3 were 1.23 in men (95% CI 0.94-15.9, p = 0.20); and 0.77 in women (95% CI 0.46-1.30, p = 0.76)., Conclusion: In the Spanish EPIC cohort, with a relatively high intake of fish, no association was found between EPA, DHA and total omega-3 fatty acid intake and risk of CHD., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: The objective of this study is to analyze the distribution, clinicopathological features, relative survival rate and excess risk of death among females diagnosed with invasive breast cancer and classified by molecular subtype from ten Spanish cancer registries., Method: Three thousand four hundred and eighty incident cases of women - mostly diagnosed in 2005 - were classified into five molecular subtypes according to immunohistochemical status of hormonal receptors and HER2 (human epidermal growth factor receptor 2): estrogen receptor (ER) and/or progesterone receptor (PR)+ and HER2-, ER+ and/or PR+ and HER2+, HER2-overexpressed (ER-, PR- and HER2+), triple negative (ER, PR and HER2-) and unclassified (hormonal receptor or/and HER2 unknown). Relative survival rates at 1, 3 and 5years and relative excess risks (RER) of death adjusting for molecular subtype, age, stage and histological grade were estimated., Results: Marked differences in clinicopathological characteristics and relative survival rate were observed between molecular subtypes. Compared with women with ER+ and/or PR+ and HER2-, ER+ and/or PR+ and HER2+ cases had an RER of 1.00 (95% CI: 0.66 to 1.52) after adjusting for age, stage and histological grade, whereas HER2-overexpressed, triple negative and women with unclassified subtypes presented an RER of 1.72 (95% CI: 1.15 to 2.57), 3.16 (95% CI: 2.26 to 4.41) and 2.55 (95% CI: 1.96 to 3.32), respectively., Conclusion: The prognostic value of molecular subtype persists when adjusting for age, stage and histological grade. Hormone receptor-positive tumors were associated with a better prognosis when compared with HER2-overexpressed and triple negative subtypes. Further research is required to improve triple negative prognosis., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Survival in the case of lung cancer patients not only remains poor and decreases with advancing age at diagnosis, but recent European studies also report that it differs by sex. Our study sought to describe sex-related differences in lung cancer survival in Spain, and evaluate the role played by histologic type. Our analysis covered seven Spanish regions with population-based cancer registries. Cases diagnosed with lung cancer during the period 1995-1999 were followed up until December 31, 2004. To ascertain possible sex differences we performed multiple regression analysis. Age-standardized 5-year relative survival proved significantly higher in women (11.8%) than in men (9.2%), and among the youngest patients relative survival at 5 years conditional on surviving 1 year, was 1.74 times significantly higher in women than in men. The regression analysis showed that men had a higher relative excess risk of dying (RER) than did women (1.1 [95% CI 1.03-1.18]), with this being particularly marked among the 15-54 age group (1.42 [1.24-1.64]). Analysis by histologic type showed that in small cell carcinoma, men had a higher RER than women (1.29 [1.02-1.61]); in squamous cell carcinoma, men had a significantly lower RER than women during the first and fifth years; and in large cell carcinoma and adenocarcinoma, the RER displayed no significant sex-related differences. Lung cancer survival rates in Spain are poor, with better prognosis in women, especially among patients aged under 55 years at diagnosis, or those with small cell carcinoma., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: There is some evidence that Mediterranean diet reduces risk of ischemic heart disease, and this is to be investigated in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). In this paper we present the incidence of acute myocardial infarction (AMI) in four EPIC Spanish cohorts., Method: Incidence cases were ascertained in EPIC cohort during the follow up period (from recruitment to the end of 2004), by means of self-report questionnaires, hospital morbidity and mortality registries, and population AMI registries. Analysis was restricted to aged 45 to 74. The present study included data from 13,704 women and 19,410 men, after excluding a priori participants with prevalent AMI. Age standardized incidence rate for each cohort was estimated and compared with the available population rates., Results: The Median duration of follow-up was 9.3 years, yielding a total of 297,704 person-years. 391 men and 99 women presented AMI in the four cohorts studied. Age standardized AMI rates in men of the EPIC cohorts go from the lowest 302 (CI: 268-335) per 100.000 person-year of Gipuzkoa to the highest 330 (CI: 293-367) of Navarra. Women in Navarra presented the lowest AMI incidence with 60 (CI: 43-77) per 100,000 and the highest was observed in Murcia (114, CI: 91-137). The AMI incidence in all EPIC centres are close to the population incidence rates and in any case these are within the EPIC 95% CI., Conclusions: The comparison of incidence in EPIC with population rates shows very good agreement for acute myocardial infarction.

Susceptibility to erythromycin and clindamycin was determined in 860 consecutive clinical isolates of beta-haemolytic streptococci belonging to groups A (GAS, n = 134), B (GBS, n = 689), C (GCS, n = 19) and G (GGS, n = 18). Erythromycin resistance was 26.1% in GAS, 15.7% in GBS, 5.3% in GCS and 33.3% in GGS. The highest rate of clindamycin resistance (33.3%) was in GGS, followed by GBS (15.8%), GCS (15.8%) and GAS (5.2%). The M phenotype was predominant in GAS (80%), the constitutive MLS(B) phenotype was predominant in GBS (75%), and all GGS isolates showed the inducible MLS(B) phenotype. The uncommon erythromycin-susceptible and clindamycin-resistant phenotype was found in four GBS and two GCS isolates.

The major risks due to metal pollution of sediments consist of leaching to groundwater and potential toxicity to animals and/or plants. The objective of this study was to evaluate by means of an ecotoxicological approach the effects of the addition of cutting marble sludges on the mobile metal fraction of sediments polluted with heavy metals. The study was carried out on two sediments derived from mining activities in Portman Bay (SE, Spain) polluted by heavy metals. These sediments were mixed with sludges left after the cutting of marble. The results obtained by leaching experiments showed that the addition of marble cutting sludge, consisting mainly of carbonates, to a heavy-metal polluted sediment produces a decrease of available metal forms. The carbonate content seems to play a role in chemical stabilisation of metals and in a decrease of toxicity of sediments. The leached solutions have a non-toxic effect. The mild remediation by addition of sludge has moreover effects to long term.

Introduction: This study aims to assess the validity of self reported diagnoses of cancer by persons recruited for the Spanish EPIC (European prospective investigation into cancer and nutrition) cohort study and to identify variables associated with correctly reporting a diagnosis of cancer., Methods: 41 440 members of EPIC were asked at the time of recruitment whether they had been diagnosed with cancer and the year of diagnosis and site. The process of validating self reported diagnoses of cancer included comparison of the cohort database with the data from the population based cancer registries. Cancer diagnostic validity tests were calculated. The association between a correct report and certain sociodemographic, tumour related, or health related variables were analysed by logistic regression., Results: The overall sensitivity of self reported diagnoses of cancer is low (57.5%; 95% CI: 51.9 to 63.0), the highest values being shown by persons with a higher level of education or with a family history of cancer and the lowest values by smokers. Breast and thyroid cancers are those with the highest diagnostic validity and uterus, bladder, and colon-rectum those with the lowest. In both sexes the variables showing a significant association with a correct report of cancer are: higher education level, number of previous pathologies, invasive tumour, and, in women, a history of gynaecological surgery., Conclusions: The overall sensitivity of self reported diagnoses of cancer is comparatively low and it is not recommended in epidemiological studies for identifying tumours. However, self reported diagnoses might be highly valid for certain tumour sites, malignant behaviour, and average to high levels of education.

Cancer of the oral cavity and oropharynx is a major public health problem in Spain. Tobacco and alcohol have been identified as the two major risk factors for oral cancer in most western populations. Other risk factors include diets low in fruits and vegetables, but the impact of dietary habits on the risk of these cancers has never been assessed in Spain. The objective of this study was to elucidate the role of dietary habits in oral and oropharyngeal cancer, a multicentric case-control study was conducted in three areas of Spain (Barcelona, Granada and Sevilla) between 1996 and 1999. Cases were 375 patients (71 women), with incident, histologically confirmed cancer of the oral cavity or oropharynx, and controls were 375 subjects (71 women) admitted to hospitals for conditions unrelated to smoking or alcohol drinking. Data were analysed using multivariate logistic regression procedures. After allowance for education, tobacco and alcohol use, a significant inverse association with the risk of oral and oropharyngeal cancer was found for total consumption of total green vegetables (OR 0.54, 95% CI = 0.34-0.87) and total fruit (OR 0.52, 95% CI = 0.34-0.79) with significant trends in risk. We found that the protective effect of each of these food items was consistently larger among current smokers and among heavy alcohol drinkers, following a multiplicative effect model. In conclusion, this study provides further support to the beneficial effect of high intake of vegetables and fruits on the risk of developing cancers of the oral cavity and oropharynx in Spain, particularly among current smokers and heavy alcohol drinkers.

Objective: To study the incidence and prevalence of breast-feeding and to determine the factors that influence the mother's decision to breast-feed or to use adapted milk., Material and Methods: Two hundred families were included in a survey in the hospital's maternity department. Those who breast-fed were followed up by means of a telephone call on days 15, 30, 90, and 180., Results: On leaving hospital 78% of the neonates were receiving breast milk only. After 15 days, 89.7% of the neonates continued to receive breast milk and at 6 months this figure was 39%. Breast-feeding was discontinued after a mean of 2.5 months. The mean age of mothers who breast-fed was 30.2 years and that of mothers using adapted milk was 27.9 years (p,0.05). Mothers decided on the type of feeding before pregnancy (52.5%). This decision was unchanged by prenatal information except in the case of information provided by the family, especially if both parents were breast-fed (p,0.05). Doctors provided little information. The mother's level of education did not influence the decision to breast-feed although the higher the mother's education, the greater the tendency to breast-feed (74.7% with primary education vs 81.5% with higher education). Being in paid employment did not influence the decision to breast-feed (76% of mothers worked vs 79% of mothers who did not). The main reasons for discontinuance were hypogalactia, "feeling hungry", and work. In general, giving up breast-feeding was the mother's decision., Conclusions: The information pregnant women receive on breast-feeding should be based on unified criteria. The implementation of joint protocols between primary and hospital care as well as breast-feeding support groups help mothers to begin and continue breast-feeding.

The hospital mortality rate in our centre es 2.34% (264 deaths from a total of 11,336 discharges between 1991 and 1993). The most frequent causes are acute myocardial infarction and cerebrovascular accidents, followed in descending order by pneumonia, chronic bronchitis, congestive heart failure, upper GI haemorrhage, GI tumours, liver cirrhosis, lung tumours and arrhythmias. Our analysis reflects a mortality pattern of a rural population with an age pyramid in which 52% of the patients are older than 45 years. The pattern also reflects the little impact of accidents on our mortality. A 87% of the deaths were older than 65 years with a male to female ratio of 1, 6 and a Swaroop index of 93% and 94% for males and females respectively.

Objective: The objective of the study was to relate the symptoms attributed to motor-sensitive diabetic polyneuropathy to the findings in the exploration of osteo-tendinous reflexes and vibrative sensibility., Design: We carried out an observation prospective study of a crossover type, where the method of selection was simple random., Setting: The study was performed in the Carranque Health Centre, Málaga., Patients: The sample consisted of those patients with type II Diabetes and over 40 when first recorded, who were seen by one of five general medical practices over a one-year period. There were 120 in all., Measurements and Main Results: Average age was 65.7 (SD = 9.5). There were 47 men and 73 women. Paraesthesia was reported in 40 cases (33.3%), muscular spasms in 41 (34.1%) and pain in 31 (25.8%). The findings were: lack of Achilles reflex in 65 cases (54.1%) and vibrative anaesthesia in 55 cases (45.8%). Lack of Achilles reflex showed a statistically significant association with nocturnal muscular spasms (p = 0.04) and vibrative anaesthesia (p = 0.001). Vibrative anaesthesia showed a prevalence which was directly proportional to age (p = 0.0003)., Conclusions: We concluded that lack of Achilles reflex and vibrative anaesthesia in diabetic patients are good indicators of the existence of motor-sensitive Polyneuropathy, although vibrative anaesthesia was found to be related to other factors such as age.

We show the case of a patient suffering from a chronic renal failure in hemodialysis. He had a ischemic necrosis that was quickly progressive in his fingers and toes. It was necessary to amputate them. Diffuse vascular calcifications were recorded so radiologically than pathologically. PTH and phosphocalcic product were raised. Parathyroidectomy was practised with a quick initial improvement but immediately new distal ischemic lesions and keratotic papules with histologic perforation, that became necrosed, appeared in his buttocks and inferior extremities. The coexistence of acquired perforating disease and calciphylaxis in uremic patients has not been reported until now.