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Introduction: A STOP-BANG questionnaire (SBQ) score of ≥3 may detect obstructive sleep apnea (OSA) but is not well studied in primary care (PC) Aims and Objectives: Assess the ability of SBQ to predict OSA severity in PC Methods: 30 to 70 year-olds attending any of 4 PC centres in a 22-month period were randomly selected. PC physician did the SBQ. A home respiratory polygraphy (HRP) was done when scores of ≥3 were found and an attended polysomnography (PSG) when apnea-hypopnea index (AHI) was Results: Of included patients (565), 38.2% had SBQ≥3. Of these, 93.1% were diagnosed with OSA (Figure 1). All cases with SBQ≥6 had an AHI≥5/h. SBQ discriminated patients with severe OSA (AHI≥30/h)(n=70, AUC=0.697, 95% CI:0.621-0.773): moderate in women (n=23, AUC=0.733, 95% CI:0.605-0.860) and lower in men (n=47, AUC=0.679, 95% CI:0.583-0.766). In these cases, SBQ≥5 in women had a sensitivity (Sn) of 52.2%, specificity (Sp) of 85.7%, positive likelihood ratio (LR+) of 3.65 and negative likelihood ratio (LR-) of 0.56; and SBQ≥6 in men gave Sn of 44.7%, Sp of 86.7%, LH+ of 3.35 and LH- of 0.64 Conclusions: SB≥3 may adequately screen for OSA in PC. Scores of SB≥5 in women and ≥6 in men could be good opportunistic predictors of severe OSA in PC.

espanolIntroduccion: el objetivo de este estudio es comparar los resultados oncologicos (recidiva local, metastasis y supervivencia global) del Proyecto Docente del Cancer de Recto de la Asociacion Espanola de Cirujanos (Proyecto Vikingo [PV]) en Cataluna con los obtenidos en el resto de comunidades autonomas (CC. AA.). Metodos: la base de datos del PV incluye 4.508 pacientes operados con una reseccion curativa entre marzo de 2006 y diciembre de 2010 (1.163 en Cataluna y 3.345 en el resto de Espana), provenientes de los primeros 59 hospitales incluidos en el PV con un seguimiento minimo de cinco anos. Resultados: la incidencia acumulada a cinco anos de recidiva local en Cataluna fue del 8% (IC 95%: 6,4-9,9); de metastasis, del 17,7% (IC 95%: 15,4-20,2); y de supervivencia global, del 75% (IC 95%: 72,4-77,7). La incidencia de recidiva local en el resto de CC. AA. fue del 7% (IC 95%: 6,2-8,2); de metastasis, del 22,3% (IC 95%: 20,7-23,9); y de supervivencia global, del 71% (IC 95%: 69,4-72,9). La intervencion de Hartmann, la perforacion intraoperatoria y la afectacion del margen circunferencial fueron las variables asociadas con recurrencia tumoral en el PV. Conclusion: los resultados observados en el Proyecto del Cancer de Recto entre Cataluna y el resto de comunidades son homogeneos. EnglishIntroduction: the goal of this study was to compare the oncological results (local recurrence, metastasis and overall survival) obtained by the Proyecto Docente del Cancer de Recto of the Spanish Association of Surgeons (AEC) (Proyecto Vikingo, PV) in Catalonia versus the rest of Spanish autonomous communities. Methods: the PV database includes 4,508 patients who underwent a curative resection between March 2006 and December 2010, from the first 59 hospitals included in PV; 1,163 were from Catalonia and 3,345 were from the rest of Spain. There was a minimum follow-up of five years. Results: in Catalonia, the five-year cumulative incidence was 8% (95% CI: 6.4-9.9) for local recurrence, 17.7% (95% CI: 15.4-20.2) for metastasis and 75% (95% CI: 72.4-77.7) for overall survival. In the rest of autonomous communities, these figures were 7% (95% CI: 6.2-8.2) for local recurrence, 22.3% (95% CI: 20.7-23.9) for metastasis, and 71% (95% CI: 69.4-72.9) for overall survival. Variables associated with tumor recurrence in PV included Hartmann’s procedure, intraoperative perforation and circumferential margin involvement. Conclusion: the results obtained by the Proyecto Docente del Cancer de Recto were homogeneous between Catalonia and the rest of the autonomous communities.

Homocisteïna; Càncer de mama; Dieta cetogènica Homocisteína; Cáncer de mama; Dieta cetogénica Homocysteine; Breast cancer; Ketogenic diet Certain dietary interventions might improve the therapeutic index of cancer treatments. An alternative to the “drug plus diet” approach is the pharmacological reproduction of the metabolic traits of such diets. Here we explored the impact of adding metformin to an established therapeutic regimen on the systemic host metabolism of cancer patients. A panel of 11 serum metabolites including markers of mitochondrial function and intermediates/products of folate-dependent one-carbon metabolism were measured in paired baseline and post-treatment sera obtained from HER2-positive breast cancer patients randomized to receive either metformin combined with neoadjuvant chemotherapy and trastuzumab or an equivalent regimen without metformin. Metabolite profiles revealed a significant increase of the ketone body β-hydroxybutyrate and of the TCA intermediate α-ketoglutarate in the metformin-containing arm. A significant relationship was found between the follow-up levels of homocysteine and the ability of treatment arms to achieve a pathological complete response (pCR). In the metformin-containing arm, patients with significant elevations of homocysteine tended to have a higher probability of pCR. The addition of metformin to an established anti-cancer therapeutic regimen causes a fasting-mimicking modification of systemic host metabolism. Circulating homocysteine could be explored as a clinical pharmacodynamic biomarker linking the antifolate-like activity of metformin and biological tumor response. This work was supported by grants from the Ministerio de Sanidad, Servicios Sociales e Igualdad (EC10-125, Ayudas para el Fomento de la Investigación Clínica Independiente to Begoña Martin-Castillo). Work in the Menendez laboratory is supported by the Ministerio de Ciencia e Innovación (Grant SAF2016-80639-P, Plan Nacional de l+D+I, founded by the European Regional Development Fund [EU FEDER], Spain) and by an unrestricted research grant from the Fundació Oncolliga Girona (Lliga catalana d’ajuda al malalt de càncer, Girona).

During adipogenesis, preadipocytes' cytoskeleton reorganizes in parallel with lipid accumulation. Failure to do so may impact the ability of adipose tissue (AT) to shift between lipid storage and mobilization. Here, we identify cytoskeletal transgelin 2 (TAGLN2) as a protein expressed in AT and associated with obesity and inflammation, being normalized upon weight loss. TAGLN2 was primarily found in the adipose stromovascular cell fraction, but inflammation, TGF-β, and estradiol also prompted increased expression in human adipocytes. Tagln2 knockdown revealed a key functional role, being required for proliferation and differentiation of fat cells, whereas transgenic mice overexpressing Tagln2 using the adipocyte protein 2 promoter disclosed remarkable sex-dependent variations, in which females displayed >healthy> obesity and hypertrophied adipocytes but preserved insulin sensitivity, and males exhibited physiologic changes suggestive of defective AT expandability, including increased number of small adipocytes, activation of immune cells, mitochondrial dysfunction, and impaired metabolism together with decreased insulin sensitivity. The metabolic relevance and sexual dimorphism of TAGLN2 was also outlined by genetic variants that may modulate its expression and are associated with obesity and the risk of ischemic heart disease in men. Collectively, current findings highlight the contribution of cytoskeletal TAGLN2 to the obese phenotype in a gender-dependent manner.-Ortega, F. J., Moreno-Navarrete, J. M., Mercader, J. M., Gómez-Serrano, M., García-Santos, E., Latorre, J., Lluch, A., Sabater, M., Caballano-Infantes, E., Guzmán, R., Macías-González, M., Buxo, M., Gironés, J., Vilallonga, R., Naon, D., Botas, P., Delgado, E., Corella, D., Burcelin, R., Frühbeck, G., Ricart, W., Simó, R., Castrillon-Rodríguez, I., Tinahones, F. J., Bosch, F., Vidal-Puig, A., Malagón, M. M., Peral, B., Zorzano, A., Fernández-Real, J. M. Cytoskeletal transgelin 2 contributes to gender-dependent adipose tissue expandability and immune function., GenDiab Consortium was constituted with funds from the Ministerio de Educación y Ciencia (Grant GEN2001‐4758). This work was also supported by research funds from the Instituto de Salud Carlos III (ISCIII; PI15/01934 to J.M.F‐R., and PI18/00550 to F.J.O.) and the Ministerio de Educación y Ciencia (SAF2008‐02073 to J.M.F.‐R., SAF2009‐10461 and SAF2012‐33014 to B.P.), the Instituto de Salud Carlos III (CIBEROBN and CIBERDEM), the Pla estratègic de recerca i innovació en salut and the Govern de la Generalitat (PERIS 2016 to F.J.O.), the Agènda de Gestió d'Ajuts Universitaris de Recerca (AGAUR, FI‐DGR 2015 to J.L.), the Universidad Autónoma de Madrid (FPI‐UAM to M.G.‐S.), and the Fondo Europeo de Desarrollo Regional (FEDER). J.M.M. was supported by a Beatriu de Pinós fellowship from the AGAUR. R.B. is recipient of funding from the Agence Nationale de la Recherche (Florinflam and Floradip programs) and the Institute Nationale du Diabète.

Evidence suggests an excess of long-term mortality due to cardiovascular diseases, second tumours and other causes in patients diagnosed with invasive breast cancer (BC). Our aim was to assess this risk of death in a cohort of patients diagnosed with BC in Girona and Tarragona, northeastern Spain. Materials and methods: Using data from the cancer registries in these areas, a population-based cohort study was carried out including all the women diagnosed with BC during 1985–2004 and followed up until December 31st 2014 (N = 10,195). The standardised mortality ratios (SMRs) were calculated for causes other than BC in the cohort at 10 years (periods 1985–1994/1995–2004) and 20 years (period 1985–1994). The impact of competing causes of death in the long-term survival was evaluated through competing risk analysis. Results: The SMRs at 10 and 20 years for all-cause mortality, except BC, were 1.21 and 1.22. The main causes of mortality showing statistically significant SMR at 10 years were other tumours (colon, lung, corpus uteri, ovary, and haematological), diabetes mellitus, diseases of the nervous system, cardiovascular diseases (after BC, the second competing cause of death among patients diagnosed > 69 years) and diseases of the kidney. Globally, the 10-year SMR was higher in the first period. After 20 years of follow-up (1985–1994 cohort), there were 48.5 excess deaths per 10,000 patient-years for causes other than BC. Conclusions: Women who did not die from BC at 10 or 20 years after the BC diagnosis had 20% higher risk of dying from other causes than women without BC. This excess risk must be clinically considered during 20 years after the BC diagnosis This work was supported by (1) Instituto deSalud Carlos III through the Project PI14/01041, co-funded by FEDER funds/European Regional Development Fund (ERDF)-a way to Build Europe-//FONDOS FEDER “una manera de hacer Europa” and by (2) Agència d’Avaluació d’Universitats i Recerca (2017SGR00735) from Generalitat de Catalunya

Background: The minor allele (C) of the single-nucleotide polymorphism (SNP) rs11212617, located near the ataxia telangiectasia mutated (ATM) gene, has been associated with an increased likelihood of treatment success with metformin in type 2 diabetes. We herein investigated whether the same SNP would predict clinical response to neoadjuvant metformin in women with early breast cancer (BC). Methods: DNA was collected from 79 patients included in the intention-to-treat population of the METTEN study, a phase 2 clinical trial of HER2-positive BC patients randomized to receive either metformin combined with anthracycline/taxane-based chemotherapy and trastuzumab or equivalent regimen without metformin, before surgery. SNP rs11212617 genotyping was assessed using allelic discrimination by quantitative polymerase chain reaction. Results: Logistic regression analyses revealed a significant relationship between the rs11212617 genotype and the ability of treatment arms to achieve a pathological complete response (pCR) in patients (odds ratio [OR]genotype×arm = 10.33, 95% confidence interval [CI]: 1.29–82.89, p = 0.028). In the metformin-containing arm, patients bearing the rs11212617 C allele had a significantly higher probability of pCR (ORA/C,C/C = 7.94, 95%CI: 1.60–39.42, p = 0.011). Conversely, no association was found between rs11212617 and clinical response in the reference arm (ORA/C,C/C = 0.77, 95%CI: 0.20–2.92, p = 0.700). After controlling for tumor size and hormone receptor status, the rs11212617 C allele remained a significant predictor of pCR solely in the metformin-containing arm. Conclusions: If reproducible, the rs11212617 C allele might warrant consideration as a predictive clinical biomarker to inform the personalized use of metformin in BC patients. Trial Registration: EU Clinical Trials Register, EudraCT number 2011-000490-30. Registered 28 February 2011, https://www.clinicaltrialsregister.eu/ctr-search/trial/2011-000490-30/ES.

Bronchiectasis; Quality of life; Respiratory disease Bronquiectasia; Calidad de vida; Enfermedad respiratoria Bronquiectàsia; Qualitat de vida; Malaltia respiratòria Cough is a main symptom in cystic fibrosis (CF). We aim to validate a Spanish version of the Leicester Cough Questionnaire (LCQ-Sp) to measure the impact of cough in CF bronchiectasis. A prospective longitudinal multicentre study was performed. Internal consistency and score changes over a 15-day period in stable state were assessed to analyse reliability. Concurrent validity was analysed by correlation with Saint George’s Respiratory Questionnaire (SGRQ) and convergent validity by assessing the association with clinical variables. Changes in scores between stable state and the first exacerbation were assessed to analyse responsiveness. 132 patients (29.73 ± 10.52 years) were enrolled in four hospitals. Internal consistency was high for the total score and good for the three domains (Cronbach’s α 0.81–0.93). The test–retest reliability showed an intraclass correlation coefficient of 0.86 for the total score. The correlation between LCQ-Sp and SGRQ scores was −0.74. The LCQ-Sp score negatively correlated with sputum volume, and the mean score decreased at the beginning of exacerbations (16.04±3.81 vs 13.91±4.29) with a large effect size. The LCQ-Sp is a reliable, repeatable and responsive instrument to assess the impact of cough in CF bronchiectasis and is responsive to change in the event of exacerbations. The author(s) received no financial support for the research, authorship, and/or publication of this article.

Metformina; Ki67; Càncer de mama Metformina; Ki67; Cáncer de mama Metformin; Ki67; Breast cancer The proliferative capacity of residual breast cancer (BC) disease indicates the existence of partial treatment resistance and higher probability of tumor recurrence. We explored the therapeutic potential of adding neoadjuvant metformin as an innovative strategy to decrease the proliferative potential of residual BC cells in patients failing to achieve pathological complete response (pCR) after pre-operative therapy. We performed a prospective analysis involving the intention-to-treat population of the (Metformin and Trastuzumab in Neoadjuvancy) METTEN study, a randomized multicenter phase II trial of women with primary, non-metastatic (human epidermal growth factor receptor 2) HER2-positive BC evaluating the efficacy, tolerability, and safety of oral metformin (850 mg twice-daily) for 24 weeks combined with anthracycline/taxane-based chemotherapy and trastuzumab (arm A) or equivalent regimen without metformin (arm B), before surgery. We centrally evaluated the proliferation marker Ki67 on sequential core biopsies using visual assessment (VA) and an (Food and Drug Administration) FDA-cleared automated digital image analysis (ADIA) algorithm. ADIA-based pre-operative values of high Ki67 (≥20%), but not those from VA, significantly predicted the occurrence of pCR in both arms irrespective of the hormone receptor status (p = 0.024 and 0.120, respectively). Changes in Ki67 in residual tumors of non-pCR patients were significantly higher in the metformin-containing arm (p = 0.025), with half of all patients exhibiting high Ki67 at baseline moving into the low-Ki67 (

To analyze the population-based survival of breast cancer (CM) diagnosed in early stages estimating the time trends of excess mortality (EM) in the long term in annual and five-year time intervals, and to determine, if possible, a proportion of patients who can be considered cured.We included women diagnosed with BC under the age of 60 years in stages I and II in Girona and Tarragona (N = 2453). The observed (OS) and relative survival (RS) were calculated up to 20 years of follow-up. RS was also estimated at annual (RSI) and in five-year intervals (RS5) to graphically assess the EM. The results are presented by age groups (≤49 and 50-59), stage (I/II) and diagnostic period (1985-1994 and 1995-2004).In stage I, OS and RS were higher during 1995-2004 compared to 1985-1994: 3.5% at 15 years of follow-up and 4.5% at 20-years of follow-up. In 1995-2004, the OS surpassed 80% in stage I patients whereas in stage II it remained below 70%. During 1995-2004, the long-term EM did not level off towards 0 (RSI1) independently of age group, stage and period of diagnosis. After 15 years of follow-up, the 5-year EM oscillated between 1 and 5% in stage I (RS5 ≥0.95) and between 5 and 10% in stage II.In our cohort, after 15 years of follow-up, it was detected that the annual EM did not disappear and the five-year EM remained between 1 and 10%. Therefore, it was not possible to determine a cure rate of BC during the study period.

Background/Aims: Obesity is characterized by the immune activation that eventually dampens insulin sensitivity and changes metabolism. This study explores the impact of different inflammatory/ anti-inflammatory paradigms on the expression of toll-like receptors (TLR) found in adipocyte cultures, adipose tissue, and blood. Methods: We evaluated by real time PCR the impact of acute surgery stress in vivo (adipose tissue) and macrophages (MCM) in vitro (adipocytes). Weight loss was chosen as an anti-inflammatory model, so TLR were analyzed in fat samples collected before and after bariatric surgery-induced weight loss. Associations with inflammatory and metabolic parameters were analyzed in non-obese and obese subjects, in parallel with gene expression measures taken in blood and isolated adipocytes/ stromal-vascular cells (SVC). Treatments with an agonist of TLR3 were conducted in human adipocyte cultures under normal conditions and upon conditions that simulated the chronic low-grade inflammatory state of obesity. Results: Surgery stress raised TLR1 and TLR8 in subcutaneous (SAT), and TLR2 in SAT and visceral (VAT) adipose tissue, while decreasing VAT TLR3 and TLR4. MCM led to increased TLR2 and diminished TLR3, TLR4, and TLR5 expressions in human adipocytes. The anti-inflammatory impact of weight loss was concomitant with decreased TLR1, TLR3, and TLR8 in SAT. Cross-sectional associations confirmed increased V/ SAT TLR1 and TLR8, and decreased TLR3 in obese patients, as compared with non-obese subjects. As expected, TLR were predominant in SVC and adipocyte precursor cells, even though expression of all of them but TLR8 (very low levels) was also found in ex vivo isolated and in vitro differentiated adipocytes. Among SVC, CD14+ macrophages showed increased TLR1, TLR2, and TLR7, but decreased TLR3 mRNA. The opposite patterns shown for TLR2 and TLR3 in V/ SAT, SVC, and inflamed adipocytes were observed in blood as well, being TLR3 more likely linked to lymphocyte instead of neutrophil counts. On the other hand, decreased TLR3 in adipocytes challenged with MCM dampened lipogenesis and the inflammatory response to Poly(I:C). Conclusion: Functional variations in the expression of TLR found in blood and hypertrophied fat depots, namely decreased TLR3 in lymphocytes and inflamed adipocytes, are linked to metabolic inflammation.

Resumen Introduccion La esclerosis multiple es una enfermedad cronica y degenerativa del sistema nervioso central, de base autoinmune, que cursa con clinica variable y discapacidad progresiva. El diagnostico de la enfermedad y su manejo terapeutico generan en el paciente nuevas necesidades y expectativas que requieren una asistencia sanitaria de calidad. Enfermeria, mediante una intervencion basada en el proceso enfermero, pretende detectar y dar solucion de independencia a estas necesidades hasta la obtencion del maximo nivel de automanejo, mejorando asi la calidad de vida de las personas con esclerosis multiple. Por consiguiente, el objetivo principal del presente estudio consistio en evaluar la eficacia de una intervencion enfermera basada en la adquisicion de conocimientos, habilidades y estrategias basicas de autocuidado para mejorar la calidad de vida de las personas con esclerosis multiple. Metodo Estudio clinico piloto aleatorizado de grupos paralelos. Seleccion prospectiva una vez obtenida la autorizacion del Comite de Etica e Investigacion Clinica. Se implemento una intervencion de enfermeria basada en la adquisicion de los conocimientos, habilidades y estrategias basicos de autocuidado para permitir el automanejo efectivo de los pacientes respecto a su enfermedad. La calidad de vida se evaluo mediante el cuestionario de calidad de vida Multiple Sclerosis Quality of Life-54. Los diagnosticos de enfermeria relativos a los conocimientos deficientes y la disposicion para gestionar la propia salud se evaluaron mediante los indicadores de resultado asociados. Resultados Cada grupo quedo constituido por 7 pacientes, no detectandose diferencias significativas en las variables sociodemograficas estudiadas. Se detecto una mejora significativa de la evolucion de la dimension Calidad de vida a nivel global del cuestionario (p = 0,002) y una tendencia a la significacion en la Salud fisica (p = 0,073), la Limitacion de rol por problemas emocionales (p = 0,062) y en la Percepcion de la salud (p = 0,097), mejorando todos estos parametros en el grupo experimental. En el grupo experimental se instauro un plan de cuidados, constatando una mejora estadisticamente significativa en todos los indicadores de resultado respecto al momento inicial. Conclusiones Una consulta de enfermeria especializada en esclerosis multiple, focalizada en mejorar los conocimientos y en potenciar la disposicion para mejorar la gestion de la propia salud, es util para mejorar la calidad de vida de los pacientes y se asocia a un incremento de los indicadores de resultado asociados a los diagnosticos de enfermeria.

Introduction: Diagnosing sleep apnoea syndrome (SAS) in hospital settings limits detection and is costly. We compare SAS diagnosis in primary care (PC) by respiratory polygraphy with automatic analysis (RPa) with currently validated methodology and hospital techniques. Material and methods: Random, cross-sectional, single-blind, multicentre study at four primary care centres and their reference hospital over 6 months. Patients between 30 and 70 years with high probability of SAS (STOP-BANG ≥3) who were visited at their primary care centre were included. Apnealink Air respiratory polygraphy was performed at home and read by the primary care doctor. Recorded data were sent online to the reference hospital and analysed manually by a sleep specialist. In patients with non-severe SAS (Apnoea-Hypopnoea Index Results: 76.2% (48/63) of patients completed the protocol; mean age 57.5±8.5; male sex 62.5%; BMI 30.5±5.8. 85.4% were diagnosed with RPa. Concordance between PC and hospital diagnosis was k=0.22 (Table 1). For severity, patients with SAS had a concordance of k=0.54 with a sensitivity of 45.4%; 95% CI (11.5-79.4), specificity of 100.0%; 95% CI (98.3-100.0), PPV 100.0% and NPV 83.3% (Table 2). Conclusion: RPa could be useful in diagnosing SAS in PC. Hospital diagnosis would not be needed in cases of severe SAS.

Relative survival has been used as a measure of the temporal evolution of the excess risk of death of a cohort of patients diagnosed with cancer, taking into account the mortality of a reference population. Once the excess risk of death has been estimated, three probabilities can be computed at time T: 1) the crude probability of death associated with the cause of initial diagnosis (disease under study), 2) the crude probability of death associated with other causes, and 3) the probability of absolute survival in the cohort at time T. This paper presents the WebSurvCa application (https://shiny.snpstats.net/WebSurvCa/), whereby hospital-based and population-based cancer registries and registries of other diseases can estimate such probabilities in their cohorts by selecting the mortality of the relevant region (reference population).

Introduction The objective of this observational, prospective, multicenter and multilevel study was to evaluate the oncological outcomes (local recurrence, metastasis and overall survival) of the Rectal Cancer Project of the Spanish Association of Surgeons (AEC) 10 years after its initiation, comparing the results with Scandinavian registries. Methods The AEC teaching project database includes 17 620 patients to date, of which 4508 were operated on with a potentially curative resection between March 2006 and December 2010. All of them come from the first 59 hospitals included in the project, and therefore followed for at least 5 years, and are the subject of the present study. Results The cumulative incidence of local recurrence was 7.3 (95% CI: 8.2–6.5), metastasis 21.0 (CI 95%: 22.4–19.7) and overall survival 72.3 (CI 95%: 80.3–77.6). The multilevel regression analysis with the hospital variable as a random effect, showed a significant variation among the hospitals for the cancer outcome variables: general survival, local recurrence and metastasis (δ2 = 0.053). Conclusions This study indicates that the results observed in the AEC’ Rectal Cancer Project are inferior than those observed in the Scandinavian registries that we tried to emulate and that this is attributable to the variability of practice in some centers.

Background: MicroRNAs (miRNAs) are non-coding RNAs that regulate cellular processes by controlling protein translation and mRNA degradation. Objective: We aimed to explore the miRNA signature of multiple sclerosis (MS) patients versus controls and the possibility that patients with lipid-specific oligolconal IgM bands (LS_OCMB), a predictor of a more severe disease course, may have a distinct profile. Methods: An extensive profile of 754 miRNAs was evaluated in the cerebrospinal fluid (CSF) of 14 women using TaqMan low-density arrays. Differentially expressed miRNAs together with others previously identified in the literature were validated in an extended sample of 86 MS patients (39 LS_OCMB+) and 55 controls. Results: We detected higher levels of miR-150 in MS patients and especially in those with LS_OCMB+. Other miRNAs (miR-328, miR-30a-5p and miR-645) were up-regulated in MS patients compared to controls while miR-21, miR-199a-3p, miR-191, miR-365, miR-106a and miR-146a showed down-regulated expression. Considering only patients with LS_OCMB+, we also detected up-regulation of miR-30a-5p, miR-150 and miR-645 and down-regulation of miR-191 compared to controls. Conclusion: Our study confirms the recent findings regarding the deregulated expression of miR-150 not only with MS but also with the presence of LS_OCMB. This study highlights the potential utility of miRNAs in CSF as biomarkers for MS.

Alzheimer’s disease (AD) has a high worldwide prevalence but little is known about its aetiology and risk factors. Recent research suggests environmental factors might increase AD risk. We aim to describe the association between AD mortality and the presence of highly polluting industry in small areas in Spain between 1999 and 2010. We calculated AD age-adjusted Standardized Mortality Ratio (SMR), stratified by sex, grouped by industrial pollution density, compared for each small area of Spain. In the small areas with the highest mortality, the SMR among women was at least 25% greater than the national average (18% in men). The distribution of AD mortality was generally similar to that of high industrial pollution (higher mortality in the north, the Mediterranean coast and in some southern areas). The risk of AD mortality among women was 140% higher (123% among men) in areas with the highest industrial density in comparison to areas without polluting industries. This study has identified a geographical pattern of small areas with higher AD mortality risk and an ecological positive association with the density of highly polluting industry. Further research is needed on the potential impact of this type of industry pollution on AD aetiology and mortality.

Inspired by a previous study showing a striking geographical mortality clustering, not attributable to chance, in the south-western region of Spain in 1987-1995, the authors have conducted an ecological study of time trends in all-cause mortality risk between 1987-1995 and 1996-2004 in 2,218 small areas of Spain. To identify high-risk areas, age-adjusted relative risks for each area, stratified by sex and time period, were computed using a Bayesian approach. Areas of high-risk in both periods, or in the second period only, were identified. Annual excess mortality and percentage of people living in these high-risk areas, again stratified by sex and time period, were estimated. The cluster of high mortality risk areas identified in the southwest of Spain during 1987-1995 persisted in the period 1996-2004 with an increase in the number of high-risk areas and in annual excess of mortality. These increases showed a gender difference, being more pronounced in women.

No placebo controlled clinical trials evaluating airway clearance techniques have been performed in BC. We evaluate short and long-term efficacy of ELTGOL in BC in a randomized control trial with placebo (Clinical Trial Registration NCT01578681). Non-cystic fibrosis BC adult patients in stable state with >10ml sputum/day not practising regular chest physiotherapy were randomized to perform ELTGOL or a placebo exercise twice daily. Patients were assessed at 7 visits (V) over one year. Primary endpoint: sputum volume during the procedure at V2 and 24-h post treatment. Secondary endpoints: sputum volume during the procedure at V7 and 24-h post treatment; Leicester Cough Questionnaire (LCQ), Saint George9s Respiratory Questionnaire (SGRQ). Results: 44 patients were randomized (22 ELTGOL group and 22 placebo group; mean age 63.04±13.48 and 67.72±9.08). Sputum volume during the procedure at V2 and 24-h post treatment were higher in the ELTGOL group (12.27±11.92ml vs. 0ml and 47.75±31.6ml vs. 12.04±9.86ml, p Conclusions: The ELTGOL technique is effective in airway clearance both in the short and long term, improves quality of life and reduces the impact of daily cough in non-cystic fibrosis BC adult patients. Funding: SEPAR, SOCAP, CFC, ACMG, Fiss PI12/01551.

Aims and Background Bayesian survival analysis was applied to assess the long-term survival and probability of death due to breast cancer (BC) in Girona, the Spanish region with the highest BC incidence. Methods A Bayesian autoregressive model was implemented to compare survival indicators between the periods 1985–1994 and 1995–2004. We assessed the long-term excess hazard of death, relative survival (RS), and crude probability of death due to BC (PBC) up to 20 years after BC diagnosis, reporting the 95% credible intervals (CI) of these indicators. Results Patients diagnosed from 1995 onwards showed lower 20-year excess hazards of death than those diagnosed earlier (RS during 1985–1994: local stage: 76.6%; regional stage: 44.9%; RS during 1995–2004: local stage: 85.2%; regional stage: 57.0%). The PBC after 20 years of BC diagnosis for patients diagnosed in 1995 and after might reach 14.4% (95% CI: 8.9%–21.2%) in local stage and 41.0% (95% CI: 36.1%–47.1%) in regional stage. Conclusions The method presented could be useful when dealing with population-based survival data from a small region. Better survival prospects were found in patients diagnosed after 1994, although we detected a non-decreasing long-term excess hazard of death, suggesting that these patients have higher mortality than the general population even 10 years after the diagnosis of BC.

Background Changes in the burden of cancer mortality are expected to be observed among Spanish women. We predict those changes, in Spain, for breast cancer (BC), colorectal cancer (CRC), lung cancer (LC) and pancreatic cancer (PC) from 2013 to 2022. Methods Bayesian age–period–cohort modeling was used to perform projections of the cancer burden in 2013–2022, extrapolating the trend of cancer mortality data from 1998 to 2012. We assessed the time trends of the crude rates (CRs) during 1998–2012, and compared the number of cancer deaths between the periods 2008–2012 and 2018–2022 to assess the contribution of demographic changes and changes in the risk factors for cancer. Results During 1998–2012, CRs of cancer decreased for BC (0.3% per year) and increased for LC (4.7%), PC (2%) and CRC (0.7%). During 2013–2022, CRs might level off for CRC, whereas the time trends for the remaining cancers might continue at a similar pace. During 2018–2022, BC could be surpassed by CRC as the most frequent cause of cancer mortality among Spanish women, whereas LC could be the most common cause of cancer mortality among women aged 50–69 years (N/year = 1960 for BC versus N/year = 1981 for LC). Comparing 2018–2022 and 1998–2012, changes in the risk factors for cancer could contribute 37.93% and 18.36% to the burden of LC and PC, respectively, and demographic shifts – mainly due to ageing (19.27%) – will drive the burden of CRC. Conclusions During 2018–2022, demographic changes (ageing) and changes in risk factors could have a different impact on the lifetime risk of cancer among Spanish women.

The Leicester Cough Questionnaire (LCQ) has been validated in non-cystic fibrosis bronchiectasis (NCFBC). The present study aimed to create and validate a Spanish version of the LCQ (LCQ-Sp) in NCFBC. The LCQ-Sp was developed following a standardized protocol. For reliability, we assessed internal consistency and the change in score over a 15-day period in stable state. For responsiveness, we assessed the change in scores between visit 1 and the first exacerbation. For validity, we evaluated convergent validity through correlation with the Saint George’s Respiratory Questionnaire (SGRQ) and discriminant validity. Two hundred fifty-nine patients (118 mild bronchiectasis, 90 moderate bronchiectasis and 47 severe bronchiectasis) were included. Internal consistency was high for the total scoring and good for the different domains (Cronbach’s α: 0.86–0.91). The test–retest reliability shows an intraclass correlation coefficient of 0.87 for the total score. The mean LCQ-Sp score at visit 1 decreased at the beginning of an exacerbation (15.13 ± 4.06 vs. 12.24 ± 4.64; p < 0.001). The correlation between LCQ-Sp and SGRQ scores was −0.66 ( p < 0.01). The differences in the LCQ-Sp total score between the different groups of severity were significant ( p < 0.001). The LCQ-Sp discriminates disease severity, is responsive to change when faced with exacerbations and is reliable for use in bronchiectasis.

Decompressive craniectomy (DC) has been sporadically used in cases of infectious encephalitis with brain herniation. Like for other indications of DC, evidence is lacking regarding the beneficial or detrimental effects for this pathology. We reviewed all the cases of viral and bacterial encephalitis treated with decompressive craniectomy reported in the literature. We also present one case from our institution. These data were analyzed to determine the relation between clinical and epidemiological variables and outcome in surgically treated patients. Of 48 patients, 39 (81.25 %) had a favorable functional recovery and 9 (18.75 %) had a negative course. Only two patients (4 %) died after surgical treatment. A statistically significant association was found between diagnosis (viral and bacterial encephalitis) and outcome (GOS) in surgically treated patients. Viral encephalitis, usually caused by herpes simplex virus (HSV), has a more favorable outcome (92.3 % with GOS 4 or 5) than bacterial encephalitis (56.2 % with GOS 4 or 5). Based on this literature review, we consider that, due to the specific characteristics of infectious encephalitis, especially in case of viral infection, decompressive craniectomy is probably an effective treatment when brain stem compression threatens the course of the disease. In patients with viral encephalitis, better prognosis can be expected when surgical decompression is used than when only medical treatment is provided.

Resumen Fundamento y objetivo La vigilancia epidemiologica del cancer de cervix (CC) deberia extenderse desde el cribado hasta la mortalidad. El objetivo de este trabajo es proporcionar una vision global del CC en la provincia de Girona entre 1990-2004. Se trata de un estudio longitudinal que incluye la incidencia de carcinoma in situ (CISC) e invasor (CIC), mortalidad, supervivencia e historial de cribado (HdC) en 1/3 de las afectadas. Pacientes y metodo Se han calculado las tasas anuales y quinquenales de incidencia cruda y ajustada por edad de CISC, de CIC y de mortalidad, asi como la supervivencia relativa a los 5 anos. Se han utilizado modelos de regresion Joinpointpara estimar el porcentaje de cambio anual (PCA) y cambios de tendencia. Se han revisado las citologias de cribado. Resultados Se diagnosticaron 373 casos incidentes de CIC y 1.093 de CISC. Tras un ascenso inicial en la incidencia de ambos tipos, la tasa ajustada de CISC se estabilizo alrededor de los 28 casos por 100.000 y la de CIC descendio hasta 5,8 casos por 100.000 en el periodo 2000-2004. La mortalidad se ha mantenido estable y la supervivencia ha aumentado, aunque de forma no significativa. En los casos con HdC un 50% de las mujeres con CIC no tenia citologia previa, en contraste con el alto porcentaje de mujeres con CISC que disponian de esta (92% en 2000-2004). Conclusiones La incidencia de cancer de cervix esta descendiendo en Girona, aunque los datos sobre HdC sugieren que esta podria reducirse aun mas.

Keeping airways clear of mucus by airway clearance techniques seems essential in bronchiectasis treatment, although no placebo-controlled trials or any studies lasting longer than 3 months have been conducted. We evaluate the efficacy of the ELTGOL (slow expiration with the glottis opened in the lateral posture) technique over a 1-year period in bronchiectasis patients with chronic expectoration in a randomised placebo-controlled trial.Patients were randomised to perform the ELTGOL technique (n=22) or placebo exercises (n=22) twice-daily (ClinicalTrials.gov,NCT01578681). The primary outcome was sputum volume during the first intervention and 24 h later. Secondary outcomes included sputum volume during the intervention and 24 h later at month 12, exacerbations, quality of life, sputum analyses, pulmonary function, exercise capacity, systemic inflammation, treatment adherence, and side effects.Sputum volume during intervention and 24 h later was higher in the ELTGOL group than in the placebo group both at the beginning and end of the study. Patients in the ELTGOL group had fewer exacerbations (p=0.042) and a clinically significant improvement in the St George's Respiratory Questionnaire score (pTwice-daily ELTGOL technique over 1 year in bronchiectasis patients facilitated secretion removal and was associated with fewer exacerbations, improved quality of life, and reduced cough impact.

// Begona Martin-Castillo 1, 2 , Eugeni Lopez-Bonet 2, 3 , Maria Buxo 2, 4, 5 , Joan Dorca 6 , Francesc Tuca-Rodriguez 7 , Miguel Alonso Ruano 7 , Ramon Colomer 8, 9 , Javier A. Menendez 2, 10 1 Unit of Clinical Research, Catalan Institute of Oncology, Girona, Catalonia, Spain 2 Girona Biomedical Research Institute (IDIBGI), Molecular Oncology Group, Girona, Catalonia, Spain 3 Department of Anatomical Pathology, Dr. Josep Trueta Hospital of Girona, Girona, Catalonia, Spain 4 Epidemiology Unit and Cancer Registry of Girona (UERCG), Catalan Cancer Plan, Catalan Health Government, Girona, Catalonia, Spain 5 Department of Nursing, Universitat de Girona (UdG), Girona, Catalonia, Spain 6 Medical Oncology Department, Catalan Institute of Oncology, Girona, Catalonia, Spain 7 Department of Gynecology, Dr. Josep Trueta Hospital of Girona, Girona, Catalonia, Spain 8 Breast Cancer Clinical Research Unit, CNIO-Spanish National Cancer Research Center, Madrid, Spain 9 Medical Oncology Department, Hospital La Princesa, Madrid, Spain 10 Translational Research Laboratory, Catalan Institute of Oncology (ICO), Girona, Catalonia, Spain Correspondence to: Javier A. Menendez, e-mail: jmenendez@iconcologia.net , jmenendez@idibgi.org Keywords: Breast cancer, HER2, basal-like, trastuzumab, cytokeratins Received: December 22, 2014 Accepted: January 08, 2015 Published: January 29, 2015 ABSTRACT There is an urgent need to refine the prognostic taxonomy of HER2+ breast carcinomas and develop easy-to-use, clinic-based prediction algorithms to distinguish between good- and poor- responders to trastuzumab-based therapy. Building on earlier studies suggesting that HER2+ tumors enriched with molecular and morpho-immunohistochemical features classically ascribed to basal-like tumors are highly aggressive and refractory to trastuzumab, we investigated the prognostic and predictive value of the basal-HER2+ phenotype in HER2-overexpressing tumors. Our retrospective cohort study of a consecutive series of 152 HER2+ primary invasive ductal breast carcinomas first confirmed the existence of a distinct subgroup co-expressing HER2 protein and basal cytokeratin markers CK5/6, the so-called basal-HER2+ phenotype. Basal-HER2+ phenotype (≥10% of cells showing positive CK5/6 staining), but not estrogen receptor status, was significantly associated with inferior overall survival by univariate analysis and predicted worsened disease free survival after accounting for strong prognostic variables such as tumor size at diagnosis in stepwise multivariate analysis. In the sub-cohort of HER2+ patients treated with trastuzumab-based adjuvant/neoadjuvant therapy, basal-HER2+ phenotype was found to be the sole independent prognostic marker for a significantly inferior time to treatment failure in multivariate analysis. A CK5/6-based immunohistochemical fingerprint may provide a simple, rapid, and accurate method for re-classifying women diagnosed with HER2+ breast cancer in a manner that can improve prognosis and therapeutic planning in patients with clinically aggressive basal-HER2+ tumors who are not likely to benefit from trastuzumab-based therapy.

The one-step nucleic acid amplification (OSNA) assay is a molecular procedure that can identify deposits of breast cancer (BC) cells in the sentinel lymph node (SLN). We examined the consistency of the OSNA assay with a classic hematoxylin-eosin (H&E)-based immunohistochemistry (IHC) study and evaluated how OSNA-based axillary staging might impact the therapeutic management of BC patients. SLN biopsy results were considered to be positive in 60 patients (40%) in the OSNA group (N = 148) and in 43 (28%) patients in the IHC cohort (N = 153, p = 0.023). There was no difference in the macrometastasis (22% for OSNA, 15% for H&E, p = 0.139) or micrometastasis (19% for OSNA, 13% for H&E, p = 0.166) rates, but we found statistically significant differences in the number of isolated tumor cells (1% for OSNA, 11% for H&E, p < 0.001). There were no differences in the administration rate of adjuvant systemic therapy between the OSNA (66% in the SLN+ patients) and the H&E (74% in the SLN+ patients) groups (p = 0.159). The OSNA assay allows for the detection of SLN metastases more precisely than conventional pathologic methods but does not alter the therapeutic management of SLN+ BC patients.

10.1007/s12094-013-1060-y PURPOSE: To describe time trends of cancer in Catalonia, Spain, during the period 1993-2007. METHODS/PATIENTS: Data have been provided by two population-based cancer registries, Girona and Tarragona, and the Catalan mortality registry. Cancer incidence in Catalonia has been estimated through modeling methods using data from these health structures. RESULTS: During 2003-2007, there were 20,042 cancer cases and 9,842 deaths per year among men and 13,673 new cancer cases and 5,882 deaths among women. The most frequent incident cancers among men were prostate (N = 4,258), lung (N = 3,021), colorectal (N = 3,007) and bladder (N = 2,238), whereas among women they were breast (N = 3,907), colorectal (N = 2,088), corpus uteri (N = 734) and lung (N = 527). During 1993-2007, age-standardized incidence rates (ASIRs) rose 1.2 % per year among men [prostate (6.3 %), testis (5.7 %), kidney (2.9 %), liver (2.2 %) and colorectal (2.1 %)]. ASIRs decreased for stomach (-2.9 %), oral cavity and pharynx (-2.8 %), larynx (-2.7 %) and esophagus (-2 %). Among women, ASIRs only rose for lung (5.2 %), kidney (3.1 %), oral cavity and pharynx (2.6 %) and thyroid (1.6 %). ASIRs decreased for corpus uteri (-2.3 %), stomach (-1.7 %) and ovary (-1.6 %). Cancer mortality decreased -1.3 % per year among men and -2.1 % among women during the same period. CONCLUSION: Among men, the decrease of incidence/mortality of tobacco-related tumors was related to a reduction of smoking prevalence. Among women, the stabilization of breast cancer incidence and the rise of lung cancer incidence are similar to that observed in most European regions. These results allow assessing the effectiveness of public health strategies and they pose new frontiers for cancer control in Catalonia.

OBJECTIVE Overexpression of fatty acid synthase (FASN), the enzyme involved in the de novo synthesis of fatty acids, has been reported in several human carcinomas, including breast cancer, and has been related to poor prognosis. Our aim was to analyze the association of FASN tumor tissue expression with clinicopathological and anthropometrical features in early-stage breast cancer patients. METHODS We prospectively studied 53 women with early-stage breast cancer who were treated with surgical operation and postoperative chemotherapy. RESULTS Menopause status and age were strongly associated with higher levels of FASN tumor expression (P < 0.005 and P = 0.038, respectively). Body mass index and pathological stage were also related to FASN tumor expression. CONCLUSIONS Our findings suggest that FASN could be a potential therapeutic target in postmenopausal breast cancer patients. However, further studies are needed.

To predict the burden of cancer in Catalonia by 2020 assessing changes in demography and cancer risk during 2010–2020. Data were obtained from Tarragona and Girona cancer registries and Catalan mortality registry. Population age distribution was obtained from the Catalan Institute of Statistics. Predicted cases in Catalonia were estimated through autoregressive Bayesian age-period-cohort models. There will be diagnosed 26,455 incident cases among men and 18,345 among women during 2020, which means an increase of 22.5 and 24.5 % comparing with the cancer incidence figures of 2010. In men, the increase of cases (22.5 %) can be partitioned in three components: 12 % due to ageing, 8 % due to increase in population size and 2 % due to cancer risk. In women, the role of each component was 9, 8 and 8 %, respectively. The increased risk is mainly expected to be observed in tobacco-related tumours among women and in colorectal and liver cancers among men. During 2010–2020 a mortality decline is expected in both sexes. The expected increase of cancer incidence, mainly due to tobacco-related tumours in women and colorectal in men, reinforces the need to strengthen smoking prevention and the expansion of early detection of colorectal cancer in Catalonia.

The authors describe the major methods and sources of information used in the EMCONET study for researching global, employment-related health inequalities. A systematic review of the literature provides valuable knowledge for research in this area. However, the limited number of studies, the poor quality of methods used, and a lack of theories or concepts have produced inconsistent results. To minimize bias from these limitations and to reach a comprehensive understanding of the complexity and health effects of global employment conditions, this article outlines key strategies for a synthetic, comprehensive, participatory approach: adapting transdisciplinary knowledge acquisition, building a theoretical model, employing multiple sources for data collection, and using a variety of methods (qualitative/quantitative studies and narrative knowledge). This approach provides solutions to important research and policy needs regarding the global context of key employment relations, social mechanisms, and health inequalities. The strategies are adapted to synthesize input from several disciplines (epidemiology, sociology, and political science), social actors, and institutions. The study's main sources of information are a variety of digital, bibliographic databases; the authors reviewed the scientific literature from 1985 to 2008 and books, reports, and other documents from 2000 to 2008.

Comparison of mortality amenable to medical intervention (avoidable mortality) in small geographical areas provides a useful tool to analyse quality of health care services. Currently there are no studies that analyse avoidable mortality by geographical distribution in small areas for the whole of Spain. The aim of this study is to describe the geographical distribution of avoidable and non-avoidable mortality in small areas in Spain by sex for the period 1990-2001.The 2.218 small areas considered consisted of municipalities or aggregated municipalities in the entirety of the Spanish territory. Avoidable deaths were analysed for the period 1990-2001. Empirical Bayes model-based estimates of age-adjusted relative risk were displayed in small-area maps for each group of causes of death by sex.There is an heterogeneous geographical distribution of avoidable mortality for both sexes. Areas with greater mortality are located in the south and northwest of Spain. Especially for hypertension, cerebrovascular disease and ischaemic heart disease in men there is a clear aggregation of deaths in these areas. Geographical distribution of non avoidable mortality in both sexes is similar to that described for these three causes.Geographical study of avoidable mortality in small areas for the whole of Spain permits the identification of areas with elevated mortality. Further research is necessary to clarify those factors related to avoidable mortality distribution.

e12579 Background: Individuals at high risk of developing breast cancer benefit from an annual surveillance with contrast enhanced breast magnetic resonance imaging (CEMRI). However, this technique...

1588 Background: Excess of risk of several second primary malignancies after treatment for breast cancer (BC) has been reported. This risk can be related with shared risk factors, cancer susceptibility genes or prior treatments received. Hormonal factors and hormone therapy are known to be risk factors for both BC and some gynecological malignancies. The aim of this study was to asses gynecological cancer risk as a second neoplasm among BC patients in our population. Methods: Patients diagnosed with invasive BC (CIE10: C50.0-C50.9) and registered in the Girona Cancer Registry from 1980 to 2006 were included in our study. We analyzed their incidence of second gynaecological malignancies except for contralateral BC. Standardized Incidence Ratios (SIR) and absolute excess of risk (AER) of these patients compared to general population were calculated. Results: 6.209 patients were diagnosed of invasive BC in this period, with median age at diagnosis 62 years, median follow-up 4 years. 84 of them developed a second malignancy of gynaecological origin (SIR 1,98 CI 95% 1,59-2,44; AER 104,01/100.000 person-year). We observed 4 uterine cervix (SIR 0.64 IC95% 0,20-1,54), 3 vulvar-vaginal (SIR 0,96 IC95% 0,24-2,60), 13 ovarian (SIR 1,13 IC95% 0,63-1,89) and 63 uterine corpus neoplasms (UC), as well as 1 genital female tract neoplasm unspecified. High and statistically significant SIR was observed for gynecological malignancies in general and specifically for UC(SIR 3.14 IC 95% 2,44-4,00). With this finding, histology of UC cases was reviewed. 12 out of 63 were malignant histologies, not otherwise specified. Among the remaining 51, there were 8 type II (1 clear cell and 7 serous adenocarcinoma, 15.7%), 34 type I (endometrioid adenocarcinoma, 66.7%) and 6 carcinosarcomas (11.8%). There were also 2 adenosarcomas (3.9%) and 1 mucinous adenocarcinoma (1.9%). Conclusions: Women with previous BC have an elevated risk of developing a second primary gynecological malignancy compared with general population, particularly for UC. These patients should be followed up for its early detection. We detected a slight increase in unfavourable uterine carcinoma histologies respect to the general population. Further investigation of this finding is warranted.

ResumenObjetivoLa comparación de la mortalidad que puede ser evitada por intervención médica (mortalidad evitable) en áreas geográficas pequeñas proporciona una herramienta útil para analizar con detalle la calidad de los servicios sanitarios. No hay estudios que analicen para toda España la distribución geográfica de la mortalidad evitable en áreas pequeñas. El objetivo de este estudio es describir la distribución geográfica de la mortalidad evitable y no evitable en áreas pequeñas según el sexo para el período 1990–2001.MétodosSe consideraron 2.218 áreas pequeñas formadas por municipios o municipios agregados de todo el territorio español. Se analizaron las muertes evitables producidas en 1990–2001. Se estimó el riesgo relativo de muerte ajustado por edad utilizando un modelo bayesiano empírico. Los riesgos relativos se representaron en mapas para cada grupo de causas de muerte según el sexo.ResultadosLa distribución geográfica de la mortalidad evitable en ambos sexos es heterogénea. Se observan áreas de mayor riesgo de mortalidad en el sur y el noroeste de España. Esta distribución se presenta claramente diferenciada, principalmente en hombres, para las causas de hipertensión, enfermedades y enfermedad isquémica del corazón. La distribución geográfica de la mortalidad no evitable, en ambos sexos, es similar a la de las tres causas mencionadas.ConclusionesLa descripción de la mortalidad evitable en áreas pequeñas de toda España ha permitido identificar zonas geográficas con una elevada mortalidad. Para determinar los factores asociados a la distribución cerebrales vasculares de la mortalidad evitable se deberían realizar estudios más detallados.AbstractObjectiveComparison of mortality amenable to medical intervention (avoidable mortality) in small geographical areas provides a useful tool to analyse quality of health care services. Currently there are no studies that analyse avoidable mortality by geographical distribution in small areas for the whole of Spain. The aim of this study is to describe the geographical distribution of avoidable and non-avoidable mortality in small areas in Spain by sex for the period 1990–2001.MethodsThe 2.218 small areas considered consisted of municipalities or aggregated municipalities in the entirety of the Spanish territory. Avoidable deaths were analysed for the period 1990–2001. Empirical Bayes model-based estimates of age-adjusted relative risk were displayed in small-area maps for each group of causes of death by sex.ResultsThere is an heterogeneous geographical distribution of avoidable mortality for both sexes. Areas with greater mortality are located in the south and northwest of Spain. Especially for hypertension, cerebrovascular disease and ischaemic heart disease in men there is a clear aggregation of deaths in these areas. Geographical distribution of non avoidable mortality in both sexes is similar to that described for these three causes.ConclusionsGeographical study of avoidable mortality in small areas for the whole of Spain permits the identification of areas with elevated mortality. Further research is necessary to clarify those factors related to avoidable mortality distribution.

Background: Developing effective cancer control programmes requires information on the future cancer burden in an ageing population. In our study we predicted the burden of cancer in Catalonia from 2015 to 2025. Methods: Bayesian age-period-cohort models were used to predict the burden of cancer from 2015 to 2025 using incidence data from the Girona and Tarragona cancer registries and cancer mortality data from the Catalan mortality registry. Using the Bashir-Estève method, we divided the net change in the number of cases between 2015 and 2025 into changes due to population size (S), cancer risk (R) and age (A) distribution. Results: By 2025, there will be 21,743 new cancer cases in men (40% aged > 74 years) and 17,268 in women (37% aged > 74 years). More than 40% of the new cases will be diagnosed among population aged 74 and older in prostate, colorectal, lung, bladder, pancreatic and stomach cancers in men, and in colorectal, pancreatic and bladder cancers and leukaemia in women. During 2015-2025, the number of new diagnoses will increase by 5.5% in men (A + R + S = 18.1% − 13.3% + 0.7% = 5.5%) and 11.9% in women (A + R + S = 12.4% − 1.1% + 0.6% = 11.9%). Overall cancer mortality rates will continue to decrease during 2015-2025. Lung cancer will be the most lethal cancer among men (N = 2705) and women (N = 1174). Conclusions: The increase in the number of cancer cases in Catalonia from 2015 to 2025 will mostly affect the elderly, prompting the need for increased collaboration between geriatricians and oncologists.