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Alonso J, Vilagut G, Mortier P, Ferrer M, Alayo I, Aragón-Peña A, Aragonès E, Campos M, Cura-González ID, Emparanza JI, Espuga M, Forjaz MJ, González-Pinto A, Haro JM, López-Fresneña N, Salázar ADMD, Molina JD, Ortí-Lucas RM, Parellada M, Pelayo-Terán JM, Pérez-Zapata A, Pijoan JI, Plana N, Puig MT, Rius C, Rodríguez-Blázquez C, Sanz F, Serra C, Kessler RC, Bruffaerts R, Vieta E, Pérez-Solà V. Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey. Rev Psiquiatr Salud Ment (Engl Ed) 2021; 14:90-105. [PMID: 34127211 PMCID: PMC10068024 DOI: 10.1016/j.rpsmen.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain. METHODS All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders. RESULTS 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95). CONCLUSIONS One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.
| | - Gemma Vilagut
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Philippe Mortier
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Montse Ferrer
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Itxaso Alayo
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Andrés Aragón-Peña
- Epidemiology Unit, Regional Ministry of Health, Community of Madrid, Madrid, Spain; Fundación Investigación e Innovación Biosanitaria de Atención Primaria, Comunidad de Madrid, Madrid, Spain
| | - Enric Aragonès
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Spain
| | - Mireia Campos
- Service of Prevention of Labor Risks, Medical Emergencies System, Generalitat de Catalunya, Spain
| | - Isabel D Cura-González
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain; Department of Medical Specialities and Public Health, King Juan Carlos University, Madrid, Spain; Fundación Investigación e Innovación Biosanitaria de Atención Primaria, Comunidad de Madrid, Madrid, Spain
| | - José I Emparanza
- Hospital Universitario Donostia, San Sebastián, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Meritxell Espuga
- Occupational Health Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria João Forjaz
- National Center of Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
| | - Ana González-Pinto
- Hospital Universitario Araba-Santiago, Vitoria-Gasteiz, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
| | - Josep M Haro
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | | | - Juan D Molina
- Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain; Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Mara Parellada
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - José I Pijoan
- Hospital Universitario Cruces/OSI EEC, Bilbao, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Nieves Plana
- Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Maria Teresa Puig
- Department of Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Cristina Rius
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain; CIBER Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Carmen Rodríguez-Blázquez
- National Center of Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain; CIBER Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Ferran Sanz
- Research Progamme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain; Instituto Nacional de Bioinformatica - ELIXIR-ES, Barcelona, Spain
| | - Consol Serra
- Parc de Salut Mar PSMAR, Barcelona, Spain; CiSAL-Centro de Investigación en Salud Laboral, IMIM/UPF, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium
| | - Eduard Vieta
- Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
| | - Víctor Pérez-Solà
- Parc de Salut Mar PSMAR, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
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Mortier P, Vilagut G, Ferrer M, Serra C, Molina JD, López‐Fresneña N, Puig T, Pelayo‐Terán JM, Pijoan JI, Emparanza JI, Espuga M, Plana N, González‐Pinto A, Ortí‐Lucas RM, de Salázar AM, Rius C, Aragonès E, del Cura‐González I, Aragón‐Peña A, Campos M, Parellada M, Pérez‐Zapata A, Forjaz MJ, Sanz F, Haro JM, Vieta E, Pérez‐Solà V, Kessler RC, Bruffaerts R, Alonso J. Thirty-day suicidal thoughts and behaviors among hospital workers during the first wave of the Spain COVID-19 outbreak. Depress Anxiety 2021; 38:528-544. [PMID: 33393724 PMCID: PMC8246904 DOI: 10.1002/da.23129] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Healthcare workers are a key occupational group at risk for suicidal thoughts and behaviors (STB). We investigated the prevalence and correlates of STB among hospital workers during the first wave of the Spain COVID-19 outbreak (March-July 2020). METHODS Data come from the baseline assessment of a cohort of Spanish hospital workers (n = 5450), recruited from 10 hospitals just after the height of the coronavirus disease 2019 (COVID-19) outbreak (May 5-July 23, 2020). Web-based self-report surveys assessed 30-day STB, individual characteristics, and potentially modifiable contextual factors related to hospital workers' work and financial situation. RESULTS Thirty-day STB prevalence was estimated at 8.4% (4.9% passive ideation only, 3.5% active ideation with or without a plan or attempt). A total of n = 6 professionals attempted suicide in the past 30 days. In adjusted models, 30-day STB remained significantly associated with pre-pandemic lifetime mood (odds ratio [OR] = 2.92) and anxiety disorder (OR = 1.90). Significant modifiable factors included a perceived lack of coordination, communication, personnel, or supervision at work (population-attributable risk proportion [PARP] = 50.5%), and financial stress (PARP = 44.1%). CONCLUSIONS AND RELEVANCE Thirty-day STB among hospital workers during the first wave of the Spain COVID-19 outbreak was high. Hospital preparedness for virus outbreaks should be increased, and strong governmental policy response is needed to increase financial security among hospital workers.
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Affiliation(s)
- Philippe Mortier
- Health Services Research UnitIMIM‐Institut Hospital del Mar d'Investigacions MèdiquesBarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Gemma Vilagut
- Health Services Research UnitIMIM‐Institut Hospital del Mar d'Investigacions MèdiquesBarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Montse Ferrer
- Health Services Research UnitIMIM‐Institut Hospital del Mar d'Investigacions MèdiquesBarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain,Universitat Autònoma de Barcelona (UAB)BarcelonaSpain
| | - Consol Serra
- CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain,Parc de Salut Mar PSMARBarcelonaSpain,CiSAL‐Centro de Investigación en Salud LaboralIMIM/UPFBarcelonaSpain
| | - Juan D. Molina
- Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric ServiceHospital Universitario 12 de OctubreMadridSpain,Research Institute Hospital 12 de Octubre (i+12)MadridSpain,Faculty of Health SciencesFrancisco de Vitoria UniversityMadridSpain,CIBER Salud Mental (CIBERSAM)MadridSpain
| | | | - Teresa Puig
- Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,Department of Epidemiology and Public HealthHospital de la Santa Creu i Sant PauBarcelonaSpain,Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaSpain,CIBER Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | | | - José I. Pijoan
- CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain,Hospital Universitario Cruces/OSI EECBilbaoSpain
| | - José I. Emparanza
- CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain,Hospital Universitario DonostiaSan SebastiánSpain
| | - Meritxell Espuga
- Occupational Health ServiceHospital Universitari Vall d'HebronBarcelonaSpain
| | - Nieves Plana
- CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain,Príncipe de Asturias University HospitalAlcalá de HenaresMadridSpain
| | - Ana González‐Pinto
- CIBER Salud Mental (CIBERSAM)MadridSpain,Hospital Universitario Araba‐SantiagoVitoria‐GasteizSpain
| | - Rafael M. Ortí‐Lucas
- CIBER Salud Mental (CIBERSAM)MadridSpain,Hospital Clínic UniversitariValenciaSpain
| | | | - Cristina Rius
- CIBER Salud Mental (CIBERSAM)MadridSpain,Agència de Salut Pública de BarcelonaBarcelonaSpain
| | - Enric Aragonès
- Institut d'Investigació en Atenció Primària IDIAP Jordi GolBarcelonaSpain,Atenció Primària Camp de TarragonaInstitut Català de la SalutTarragonaSpain
| | - Isabel del Cura‐González
- Research Unit, Primary Care ManagementMadrid Health ServiceMadridSpain,Department of Medical Specialities and Public HealthKing Juan Carlos UniversityMadridSpain,Fundación Investigación e Innovación Biosanitaria de APComunidad de MadridMadridSpain
| | - Andrés Aragón‐Peña
- Fundación Investigación e Innovación Biosanitaria de APComunidad de MadridMadridSpain,Epidemiology UnitRegional Ministry of Health, Community of MadridMadridSpain
| | - Mireia Campos
- Service of Prevention of Labor RisksMedical Emergencies System, Generalitat de CatalunyaBarcelonaSpain
| | - Mara Parellada
- CIBER Salud Mental (CIBERSAM)MadridSpain,Hospital General Universitario Gregorio MarañónMadridSpain
| | | | - Maria João Forjaz
- National Center of EpidemiologyInstituto de Salud Carlos III (ISCIII)MadridSpain,Health Services Research Network on Chronic Diseases (REDISSEC)MadridSpain
| | - Ferran Sanz
- Research Progamme on Biomedical Informatics (GRIB)Hospital del Mar Medical Research Institute (IMIM)BarcelonaSpain,Department of Experimental and Health SciencesPompeu Fabra UniversityBarcelonaSpain,Instituto Nacional de Bioinformatica—ELIXIR‐ESMadridSpain
| | - Josep M. Haro
- Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,CIBER Salud Mental (CIBERSAM)MadridSpain,Parc Sanitari Sant Joan de DéuBarcelonaSpain
| | - Eduard Vieta
- CIBER Salud Mental (CIBERSAM)MadridSpain,Hospital Clínic, University of Barcelona, IDIBAPSBarcelonaSpain
| | - Víctor Pérez‐Solà
- Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,Parc de Salut Mar PSMARBarcelonaSpain,CIBER Salud Mental (CIBERSAM)MadridSpain
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Ronny Bruffaerts
- Center for Public Health PsychiatryUniversitair Psychiatrisch Centrum, KU LeuvenLeuvenBelgium
| | - Jordi Alonso
- Health Services Research UnitIMIM‐Institut Hospital del Mar d'Investigacions MèdiquesBarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain,Department of Experimental and Health SciencesPompeu Fabra UniversityBarcelonaSpain
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Castiella A, Urreta I, Zapata E, Alústiza JM, de Juan MD, Emparanza JI. Prediction of liver iron overload in the Basque country (Spain) in patients referred for hyperferritinemia. Dig Liver Dis 2021; 53:137-138. [PMID: 33191133 DOI: 10.1016/j.dld.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Agustin Castiella
- Gastroenterology Service, Donostia University Hospital, Donostia, Spain; Gastroenterology Service, Mendaro Hospital, Mendaro, Spain; Corresponding author at: Gastroenterology Service, Donostia University Hospital, Donostia, Spain..
| | - Iratxe Urreta
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, Donostia University Hospital, Donostia, Spain
| | - Eva Zapata
- Gastroenterology Service, Donostia University Hospital, Donostia, Spain; Gastroenterology Service, Mendaro Hospital, Mendaro, Spain
| | | | | | - José I Emparanza
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, Donostia University Hospital, Donostia, Spain
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Castiella A, Urreta I, Zapata E, Zubiaurre L, Alústiza JM, Otazua P, Salvador E, Letamendi G, Arrizabalaga B, Rincón ML, Emparanza JI. Liver iron concentration in dysmetabolic hyperferritinemia: Results from a prospective cohort of 276 patients. Ann Hepatol 2020; 19:31-35. [PMID: 31587985 DOI: 10.1016/j.aohep.2019.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES We aimed to study the liver iron concentration in patients referred for hyperferritinemia to six hospitals in the Basque Country and to determine if there were differences between patients with or without metabolic syndrome. PATIENTS AND METHODS Metabolic syndrome was defined by accepted criteria. Liver iron concentration was determined by magnetic resonance imaging. RESULTS We obtained the data needed to diagnose metabolic syndrome in 276 patients; a total of 135 patients (49%), 115/240 men (48%), and 20/36 women (55.6%) presented metabolic syndrome. In all 276 patients, an MRI for the determination of liver iron concentration (mean±SD) was performed. The mean liver iron concentration was 30.83±19.38 for women with metabolic syndrome, 38.84±25.50 for men with metabolic syndrome, and 37.66±24.79 (CI 95%; 33.44-41.88) for the whole metabolic syndrome group. In 141 patients (51%), metabolic syndrome was not diagnosed: 125/240 were men (52%) and 16/36 were women (44.4%). The mean liver iron concentration was 34.88±16.18 for women without metabolic syndrome, 44.48±38.16 for men without metabolic syndrome, and 43.39±36.43 (CI 95%, 37.32-49.46) for the whole non-metabolic syndrome group. Comparison of the mean liver iron concentration from both groups (metabolic syndrome vs non-metabolic syndrome) revealed no significant differences (p=0.12). CONCLUSIONS Patients with hyperferritinemia and metabolic syndrome presented a mildly increased mean liver iron concentration that was not significantly different to that of patients with hyperferritinemia and non-metabolic syndrome.
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Affiliation(s)
- Agustin Castiella
- Gastroenterology Service, Mendaro Hospital, Mendaro, Spain; Gastroenterology Service, Donostia University Hospital, Donostia, Spain.
| | - Iratxe Urreta
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, Donostia University Hospital, Donostia, Spain
| | - Eva Zapata
- Gastroenterology Service, Mendaro Hospital, Mendaro, Spain; Gastroenterology Service, Donostia University Hospital, Donostia, Spain
| | | | | | - Pedro Otazua
- Gastroenterology Service, Mondragon Hospital, Mondragon, Spain
| | | | | | | | | | - José I Emparanza
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, Donostia University Hospital, Donostia, Spain
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Aguinagalde B, Zabaleta J, Lopez I, Izquierdo JM, Redin JA, Lopez D, Fernandez-Monge A, Emparanza JI. P-089MANUAL VERSUS DIGITAL ASPIRATION FOR FIRST-LINE TREATMENT OF PRIMARY SPONTANEOUS PNEUMOTHORAX: THE AMVADI STUDY, A RANDOMIZED CLINICAL TRIAL. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Castiella A, Alústiza JM, Zapata E, Zubiaurre L, Otazua P, Emparanza JI. Dysmetabolic iron overload syndrome: The need for an accurate liver iron concentration determination by magnetic resonance imaging. Hepatology 2017; 65:2119. [PMID: 28066930 DOI: 10.1002/hep.29030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | | | - Eva Zapata
- Gastroenterology Service, Mendaro Hospital, Mendaro, Spain
| | | | - Pedro Otazua
- Gastroenterology Service, Mondragon Hospital, Mondragon, Spain
| | - José I Emparanza
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, Donostia University Hospital, Donostia, Spain
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Abstract
BACKGROUND Oxygen (O2) is widely used in people with acute myocardial infarction (AMI). Previous systematic reviews concluded that there was insufficient evidence to know whether oxygen reduced, increased or had no effect on heart ischaemia or infarct size. Our first Cochrane review in 2010 also concluded there was insufficient evidence to know whether oxygen should be used. Since 2010, the lack of evidence to support this widely used intervention has attracted considerable attention, prompting further trials of oxygen therapy in myocardial infarction patients. It is thus important to update this Cochrane review. OBJECTIVES To assess the effects of routine use of inhaled oxygen for acute myocardial infarction (AMI). SEARCH METHODS We searched the following bibliographic databases on 6 June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO) and Web of Science (Thomson Reuters). LILACS (Latin American and Caribbean Health Sciences Literature) was last searched in September 2016. We also contacted experts to identify eligible studies. We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials in people with suspected or proven AMI (ST-segment elevation myocardial infarction (STEMI) or non-STEMI) within 24 hours after onset, in which the intervention was inhaled oxygen (at normal pressure) compared to air, regardless of co-therapies provided to participants in both arms of the trial. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the titles and abstracts of identified studies to see if they met the inclusion criteria and independently undertook the data extraction. We assessed the quality of studies and the risk of bias according to guidance in the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was death. The measure of effect used was the risk ratio (RR) with a 95% confidence interval (CI). We used the GRADE approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro) to import data from Review Manager 5 and create 'Summary of findings' tables. MAIN RESULTS The updated search yielded one new trial, for a total of five included studies involving 1173 participants, 32 of whom died. The pooled risk ratio (RR) of all-cause mortality in the intention-to-treat analysis was 0.99 (95% CI 0.50 to 1.95; 4 studies, N = 1123; I2 = 46%; quality of evidence: very low) and 1.02 (95% CI 0.52 to 1.98; 4 studies, N = 871; I2 = 49%; quality of evidence: very low) when only analysing participants with confirmed AMI. One trial measured pain directly, and two others measured it by opiate usage. The trial showed no effect, with a pooled RR of 0.97 for the use of opiates (95% CI 0.78 to 1.20; 2 studies, N = 250). The result on mortality and pain are inconclusive. There is no clear effect for oxygen on infarct size (the evidence is inconsistent and low quality). AUTHORS' CONCLUSIONS There is no evidence from randomised controlled trials to support the routine use of inhaled oxygen in people with AMI, and we cannot rule out a harmful effect. Given the uncertainty surrounding the effect of oxygen therapy on all-cause mortality and on other outcomes critical for clinical decision, well-conducted, high quality randomised controlled trials are urgently required to inform guidelines in order to give definitive recommendations about the routine use of oxygen in AMI.
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Affiliation(s)
- Juan B Cabello
- Hospital General Universitario de AlicanteDepartment of Cardiology & CASP SpainPintor Baeza 12AlicanteAlicanteSpain03010
| | - Amanda Burls
- City University LondonSchool of Health SciencesMyddleton StreetLondonUKEC1V 0HB
| | - José I Emparanza
- Hospital Universitario DonostiaUnidad de Epidemiología Clínica. CASPe. CIBERESPPaseo del Doctor Begiristain, 107‐115San SebastiánSpain20014
| | - Susan E Bayliss
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Tom Quinn
- Kingston University and St George's University of LondonFaculty of Health, Social Care and EducationGrosvenor WingCranmer TerraceLondonUKSW17 0RE
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Undabeitia J, Torres-Bayona S, Samprón N, Arrázola M, Bollar A, Armendariz M, Torres P, Ruiz I, Caballero MC, Egaña L, Querejeta A, Villanua J, Pardo E, Etxegoien I, Liceaga G, Urtasun M, Michan M, Emparanza JI, Aldaz P, Matheu A, Úrculo E. Indirect costs associated with glioblastoma: Experience at one hospital. Neurologia 2016; 33:85-91. [PMID: 27449154 DOI: 10.1016/j.nrl.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/27/2016] [Accepted: 05/04/2016] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. MATERIAL AND METHOD We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. RESULTS We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was €11 080 762 (2015). Mean indirect cost per patient was €111 926 (2015). DISCUSSION Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease.
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Affiliation(s)
- J Undabeitia
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España.
| | - S Torres-Bayona
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España
| | - N Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España
| | - M Arrázola
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Departamento de Cirugía y Radiología y Medicina Física, Universidad del País Vasco, Donostia, España
| | - A Bollar
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España
| | - M Armendariz
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España
| | - P Torres
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España
| | - I Ruiz
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Anatomía Patológica, Hospital Universitario Donostia, Donostia, España
| | - M C Caballero
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Anatomía Patológica, Hospital Universitario Donostia, Donostia, España
| | - L Egaña
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Oncología Médica, Hospital Universitario Donostia, Donostia, España
| | - A Querejeta
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Oncología Radioterápica, Hospital Universitario Donostia, Donostia, España
| | - J Villanua
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Neurorradiología, Osatek, Hospital Universitario Donostia, Donostia, España
| | - E Pardo
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Radiología, Hospital Universitario Donostia, Donostia, España
| | - I Etxegoien
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Radiología, Hospital Universitario Donostia, Donostia, España
| | - G Liceaga
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Farmacología, Hospital Universitario Donostia, Donostia, España
| | - M Urtasun
- Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Servicio de Neurología, Hospital Universitario Donostia, Donostia, España
| | - M Michan
- Servicio de Medicina Interna, Hospital Universitario Donostia, Donostia, España
| | - J I Emparanza
- Servicio de Epidemiología Clínica, Hospital Universitario Donostia, Donostia, España
| | - P Aldaz
- Grupo de Neuro-oncología, Instituto de Investigación Sanitaria Biodonostia, Donostia, España
| | - A Matheu
- Grupo de Neuro-oncología, Instituto de Investigación Sanitaria Biodonostia, Donostia, España
| | - E Úrculo
- Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, España; Comité de Neurooncología, Hospital Universitario Donostia, Donostia, España; Departamento de Cirugía y Radiología y Medicina Física, Universidad del País Vasco, Donostia, España
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Krawczyk M, Jiménez-Agüero R, Alustiza JM, Emparanza JI, Perugorria MJ, Bujanda L, Lammert F, Banales JM. PNPLA3 p.I148M variant is associated with greater reduction of liver fat content after bariatric surgery. Surg Obes Relat Dis 2016; 12:1838-1846. [PMID: 27576208 DOI: 10.1016/j.soard.2016.06.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/30/2016] [Accepted: 06/29/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Obesity is the major trigger of nonalcoholic fatty liver disease (NAFLD). NAFLD is further favored by the patatin-like phospholipase domain-containing 3 (PNPLA3) p.I148M, transmembrane 6 superfamily member 2 (TM6SF2) p.E167K, and membrane-bound O-acyltransferase domain containing 7 (MBOAT7) rs641738 variants. OBJECTIVES To investigate the relationship between the PNPLA3, TM6SF2, and MBOAT7 genotypes and the outcomes of bariatric surgery. SETTING University hospital. METHODS Prospectively we monitored 84 obese individuals (body mass index 35-64 kg/m2) scheduled for bariatric surgery. The PNPLA3 p.I148M, TM6SF2 p.E167K, and MBOAT7 rs641738 variants were genotyped using restriction fragment length polymorphism analysis and TaqMan assays. Hepatic steatosis was determined before surgery using analysis of liver biopsy samples and a novel magnetic resonance imaging-based equation. One year later, steatosis was reevaluated by magnetic resonance imaging. RESULTS The presence of the PNPLA3 allle [M] was associated with increased hepatic triglyceride content (P = .03), steatosis detected by magnetic resonance imaging (P = 0.04), and decreased serum glucose concentrations (P = .04). Neither variant TM6SF2 nor MBOAT7 increased hepatic steatosis (all P>.05); however, the MBOAT7 polymorphism was associated with increased triglyceride, total cholesterol, low density lipoprotein, and serum glucose levels (all P<.05). Patients carrying the prosteatotic PNPLA3 allele [M] lost more weight (P<.01) and liver fat (P = .04) one year after surgery, as compared to individuals having the common genotype. The PNPLA3 genotype and initial grade of steatosis, but not the TM6SF2 or MBOAT7 variants, were independent predictors of NAFLD improvement (P = .03 and P<.01, respectively). CONCLUSION In obese patients, the presence of the PNPLA3 p.I148M allele might be associated with greater improvement of hepatic steatosis after bariatric surgery in comparison to carriers of PNPLA3 wild-type alleles.
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Affiliation(s)
- Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany; Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Raúl Jiménez-Agüero
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute-Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - José M Alustiza
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute-Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), San Sebastián, Spain; Osatek SA, San Sebastián, Spain
| | - José I Emparanza
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, Biodonostia Health Research Institute-HUD, San Sebastián, Spain
| | - María J Perugorria
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute-Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), San Sebastián, Spain; Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Luis Bujanda
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute-Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), San Sebastián, Spain; Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Jesús M Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute-Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), San Sebastián, Spain; Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain.
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Castiella A, Zapata E, Zubiaurre L, Iribarren A, Alústiza JM, Otazua P, Salvador E, Emparanza JI. Liver iron concentration is not raised in patients with dysmetabolic hyperferritinemia. Ann Hepatol 2016; 15:540-544. [PMID: 28869748 DOI: 10.5604/16652681.1202947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Background &amp;amp;amp; aims. Hyperferritinemia (HF) is frequently present in patients with metabolic syndrome (MS). MS associated with HF is named dysmetabolic hyperferritinemia (DH). There are some publications that propose that DH is associated with a raised liveriron concentration (LIC). We studied the LIC in patients referred for HF to a secondary hospital to determine if there are differences between patients with or without MS. MATERIAL AND METHODS We conducted a prospective study of 132 consecutive patients with HF from January to December 2010. The MS was defined by the International Diabetes Federation criteria (2005). LIC was determined by Magnetic resonance imaging (MRI). RESULTS The number of patients for which there was enough data to determine MS was 97, out of which 54 had MS and 43 had no MS (NMS). In 54/97 patients, MRI for LIC determination was performed. From the MS group, 44 were men (27 underwent MRI) and 10 women (9 MRI). The mean LIC was 27.83 ± 20.90 ?mol/g for the MS group. In the NMS group, 36 were men (13 MRI), and 7 women (5 MRI). In 18 patients from the NMS group, LIC was determined by MRI. The mean LIC was 33.16 ± 19.61 ?mol/g in the NMS group. We compared the mean values of LIC from both groups (MS vs. NMS) and no significant differences were found (p = 0.067). CONCLUSION Patients with DH present a mean LIC within normal values and their values do not differ from those of patients with HF but without MS.
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Affiliation(s)
| | - Eva Zapata
- Gastroenterology Service, Mendaro Hospital, Mendaro, Spain
| | | | | | | | - Pedro Otazua
- Gastroenterology Service, Mondragon Hospital, Mondragon, Spain
| | | | - José I Emparanza
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, Donostia University Hospital, Donostia, Spain
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Alústiza JM, Emparanza JI, Castiella A, Casado A, Garrido A, Aldazábal P, San Vicente M, Garcia N, Asensio AB, Banales J, Salvador E, Moyua A, Arozena X, Zarco M, Jauregui L, Vicente O. Measurement of liver iron concentration by MRI is reproducible. Biomed Res Int 2015; 2015:294024. [PMID: 25874207 PMCID: PMC4385637 DOI: 10.1155/2015/294024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/14/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE The objectives were (i) construction of a phantom to reproduce the behavior of iron overload in the liver by MRI and (ii) assessment of the variability of a previously validated method to quantify liver iron concentration between different MRI devices using the phantom and patients. MATERIALS AND METHODS A phantom reproducing the liver/muscle ratios of two patients with intermediate and high iron overload. Nine patients with different levels of iron overload were studied in 4 multivendor devices and 8 of them were studied twice in the machine where the model was developed. The phantom was analysed in the same equipment and 14 times in the reference machine. RESULTS FeCl3 solutions containing 0.3, 0.5, 0.6, and 1.2 mg Fe/mL were chosen to generate the phantom. The average of the intramachine variability for patients was 10% and for the intermachines 8%. For the phantom the intramachine coefficient of variation was always below 0.1 and the average of intermachine variability was 10% for moderate and 5% for high iron overload. CONCLUSION The phantom reproduces the behavior of patients with moderate or high iron overload. The proposed method of calculating liver iron concentration is reproducible in several different 1.5 T systems.
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Affiliation(s)
- José María Alústiza
- 1Osatek, Donostia Universitary Hospital, P. Dr. Beguiristain 109, 20014 Donostia/San Sebastián, Spain
- *José María Alústiza:
| | - José I. Emparanza
- 2Clinical Epidemiology, Donostia Universitary Hospital, P. Dr. Beguiristain 117, 20080 Donostia/San Sebastián, Spain
| | - Agustín Castiella
- 3Gastroenterology, Mendaro Hospital, Mendarozabal s/n, Mendaro, Spain
| | - Alfonso Casado
- 4Basque Country University, Avenida Tolosa 54, 20018 Donostia/San Sebastián, Spain
| | - Adolfo Garrido
- 5Biochemical Laboratory, Donostia Universitary Hospital, P. Dr. Beguiristain 117, 20080 Donostia/San Sebastián, Spain
| | - Pablo Aldazábal
- 6Experimental Department, Donostia Universitary Hospital, P. Dr. Beguiristain 117, 20080 Donostia/San Sebastián, Spain
| | - Manuel San Vicente
- 1Osatek, Donostia Universitary Hospital, P. Dr. Beguiristain 109, 20014 Donostia/San Sebastián, Spain
| | - Nerea Garcia
- 6Experimental Department, Donostia Universitary Hospital, P. Dr. Beguiristain 117, 20080 Donostia/San Sebastián, Spain
| | - Ana Belén Asensio
- 6Experimental Department, Donostia Universitary Hospital, P. Dr. Beguiristain 117, 20080 Donostia/San Sebastián, Spain
| | - Jesús Banales
- 7Liver Diseases Unit, Biodonostia Research Institute, P. Dr. Beguiristain s/n, 20014 Donostia/San Sebastián, Spain
| | - Emma Salvador
- 1Osatek, Donostia Universitary Hospital, P. Dr. Beguiristain 109, 20014 Donostia/San Sebastián, Spain
| | - Aranzazu Moyua
- 8Policlínica Gipúzkoa, Paseo Miramón 174, 20014 Donostia/San Sebastián, Spain
| | - Xabier Arozena
- 9Radiology, Quirón Donostia Hospital, Alkolea Parkea 7, 20012 Donostia/San Sebastián, Spain
| | - Miguel Zarco
- 9Radiology, Quirón Donostia Hospital, Alkolea Parkea 7, 20012 Donostia/San Sebastián, Spain
| | - Lourdes Jauregui
- 10Onkologikoa, P. Dr. Beguiristain s/n, 20011 Donostia/San Sebastián, Spain
| | - Ohiana Vicente
- 10Onkologikoa, P. Dr. Beguiristain s/n, 20011 Donostia/San Sebastián, Spain
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Jiménez-Agüero R, Emparanza JI, Beguiristain A, Bujanda L, Alustiza JM, García E, Hijona E, Gallego L, Sánchez-González J, Perugorria MJ, Asensio JI, Larburu S, Garmendia M, Larzabal M, Portillo MP, Aguirre L, Banales JM. Novel equation to determine the hepatic triglyceride concentration in humans by MRI: diagnosis and monitoring of NAFLD in obese patients before and after bariatric surgery. BMC Med 2014; 12:137. [PMID: 25164060 PMCID: PMC4145227 DOI: 10.1186/s12916-014-0137-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/23/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is caused by abnormal accumulation of lipids within liver cells. Its prevalence is increasing in developed countries in association with obesity, and it represents a risk factor for non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Since NAFLD is usually asymptomatic at diagnosis, new non-invasive approaches are needed to determine the hepatic lipid content in terms of diagnosis, treatment and control of disease progression. Here, we investigated the potential of magnetic resonance imaging (MRI) to quantitate and monitor the hepatic triglyceride concentration in humans. METHODS A prospective study of diagnostic accuracy was conducted among 129 consecutive adult patients (97 obesity and 32 non-obese) to compare multi-echo MRI fat fraction, grade of steatosis estimated by histopathology, and biochemical measurement of hepatic triglyceride concentration (that is, Folch value). RESULTS MRI fat fraction positively correlates with the grade of steatosis estimated on a 0 to 3 scale by histopathology. However, this correlation value was stronger when MRI fat fraction was linked to the Folch value, resulting in a novel equation to predict the hepatic triglyceride concentration (mg of triglycerides/g of liver tissue = 5.082 + (432.104 * multi-echo MRI fat fraction)). Validation of this formula in 31 additional patients (24 obese and 7 controls) resulted in robust correlation between the measured and estimated Folch values. Multivariate analysis showed that none of the variables investigated improves the Folch prediction capacity of the equation. Obese patients show increased steatosis compared to controls using MRI fat fraction and Folch value. Bariatric surgery improved MRI fat fraction values and the Folch value estimated in obese patients one year after surgery. CONCLUSIONS Multi-echo MRI is an accurate approach to determine the hepatic lipid concentration by using our novel equation, representing an economic non-invasive method to diagnose and monitor steatosis in humans.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jesús M Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute, Donostia University Hospital (HUD), University of the Basque Country (UPV/EHU), San Sebastian, Spain.
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Sardón O, Corcuera P, Aldasoro A, Korta J, Mintegui J, Emparanza JI, Pérez-Yarza EG. Alveolar nitric oxide and its role in pediatric asthma control assessment. BMC Pulm Med 2014; 14:126. [PMID: 25090994 PMCID: PMC4124482 DOI: 10.1186/1471-2466-14-126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/29/2014] [Indexed: 11/17/2022] Open
Abstract
Background Nitric oxide can be measured at multiple flow rates to determine proximal (maximum airway nitric oxide flux; JawNO) and distal inflammation (alveolar nitric oxide concentration; CANO). The main aim was to study the association among symptoms, lung function, proximal (maximum airway nitric oxide flux) and distal (alveolar nitric oxide concentration) airway inflammation in asthmatic children treated and not treated with inhaled glucocorticoids. Methods A cross-sectional study with prospective data collection was carried out in a consecutive sample of girls and boys aged between 6 and 16 years with a medical diagnosis of asthma. Maximum airway nitric oxide flux and alveolar nitric oxide concentration were calculated according to the two-compartment model. In asthmatic patients, the asthma control questionnaire (CAN) was completed and forced spirometry was performed. In controls, differences between the sexes in alveolar nitric oxide concentration and maximum airway nitric oxide flux and their correlation with height were studied. The correlation among the fraction of exhaled NO at 50 ml/s (FENO50), CANO, JawNO, forced expiratory volume in 1 second (FEV1) and the CAN questionnaire was measured and the degree of agreement regarding asthma control assessment was studied using Cohen’s kappa. Results We studied 162 children; 49 healthy (group 1), 23 asthmatic participants without treatment (group 2) and 80 asthmatic patients treated with inhaled corticosteroids (group 3). CANO (ppb) was 2.2 (0.1-4.5), 3 (0.2-9.2) and 2.45 (0.1-24), respectively. JawNO (pl/s) was 516 (98.3-1470), 2356.67 (120–6110) and 1426 (156–11805), respectively. There was a strong association (r = 0.97) between FENO50 and JawNO and the degree of agreement was very good in group 2 and was good in group 3. There was no agreement or only slight agreement between the measures used to monitor asthma control (FEV1, CAN questionnaire, CANO and JawNO). Conclusions The results for CANO and JawNO in controls were similar to those found in other reports. There was no agreement or only slight agreement among the three measure instruments analyzed to assess asthma control. In our sample, no additional information was provided by CANO and JawNO.
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Affiliation(s)
- Olaia Sardón
- Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, Avda, Dr, Beguiristain número 118, San Sebastian, Guipúzcoa CP 20014, Spain.
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Abraira V, Muriel A, Emparanza JI, Pijoan JI, Royuela A, Plana MN, Cano A, Urreta I, Zamora J. Reporting quality of survival analyses in medical journals still needs improvement. A minimal requirements proposal. J Clin Epidemiol 2013; 66:1340-6.e5. [DOI: 10.1016/j.jclinepi.2013.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
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Castiella A, Alústiza JM, Zapata E, Emparanza JI. Is MRI becoming the new gold standard for diagnosing iron overload in hemochromatosis and other liver iron disorders? ACTA ACUST UNITED AC 2013. [DOI: 10.2217/iim.13.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
BACKGROUND Oxygen (O₂) is widely used in people with acute myocardial infarction (AMI) although it has been suggested it may do more harm than good. Previous systematic reviews have concluded that there was insufficient evidence to know whether oxygen reduced, increased or had no effect on heart ischaemia or infarct size, as did our original Cochrane review on this topic in 2010. The wide dissemination of the lack of evidence to support this widely-used intervention since 2010 may stimulate the needed trials of oxygen therapy, and it is therefore important that this review is updated regularly. OBJECTIVES To review the evidence from randomised controlled trials to establish whether routine use of inhaled oxygen in acute myocardial infarction (AMI) improves patient-centred outcomes, in particular pain and death. SEARCH METHODS The following bibliographic databases were searched last in July 2012: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO) and Web of Science (ISI). LILACS (Latin American and Caribbean Health Sciences Literature) and PASCAL were last searched in May 2013. We also contacted experts to identify any studies. We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials of people with suspected or proven AMI (ST-segment elevation myocardial infarction (STEMI) or non-STEMI), less than 24 hours after onset, in which the intervention was inhaled oxygen (at normal pressure) compared to air and regardless of cotherapies provided these were the same in both arms of the trial. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the titles and abstracts of identified studies to see if they met the inclusion criteria, and independently undertook the data extraction. The quality of studies and the risk of bias were assessed according to guidance in the Cochrane Handbook. The primary outcomes were death, pain and complications. The measure of effect used was the risk ratio (RR) with a 95% confidence interval (CI). MAIN RESULTS The updated search identified one new trial. In total, four trials involving 430 participants were included and 17 deaths occurred. The pooled RR of death was 2.05 (95% CI 0.75 to 5.58) in an intention-to-treat analysis and 2.11 (95% CI 0.78 to 5.68) in participants with confirmed AMI. While suggestive of harm, the small number of deaths recorded means that this could be a chance occurrence. Pain was measured by analgesic use. The pooled RR for the use of analgesics was 0.97 (95% CI 0.78 to 1.20). AUTHORS' CONCLUSIONS There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in people with AMI. A definitive randomised controlled trial is urgently required, given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines.
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Affiliation(s)
- Juan B Cabello
- Department of Cardiology & CASP Spain, Hospital General Universitario de Alicante, Pintor Baeza 12, Alicante, Alicante, Spain, 03010
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Burls A, Emparanza JI, Quinn T, Cabello JB. Oxygen use in acute myocardial infarction: an online survey of health professionals' practice and beliefs. Emerg Med J 2012; 27:283-6. [PMID: 20385680 DOI: 10.1136/emj.2009.077370] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION There is growing interest in the safety of oxygen therapy in emergency patients. A Cochrane review of oxygen versus air for patients with acute myocardial infarction (AMI) showed a potentially important, but statistically non-significant, increase in mortality (RR 3.03 (95% CI 0.93 to 9.83)) and concluded a definitive randomised controlled trial (RCT) was needed. OBJECTIVE To explore the feasibility of conducting an RCT of oxygen versus air in AMI, by exploring the beliefs of UK professionals who treat patients with AMI about oxygen's benefits, and to establish a baseline of reported practice by asking about their use of oxygen. Method A cross-sectional online survey of UK emergency department, cardiology and ambulance staff. RESULT 524 responses were received. All specialities had over 100 respondents. 98.3% said they always or usually use oxygen. 80% reported having local guidelines that recommended the routine use of oxygen. 55% believed oxygen definitely or probably significantly reduces the risk of death, while only 1.3% reported that they thought 'it may even increase the risk of death.' There were only minor differences across specialities and grades. CONCLUSION Widespread belief in the benefit of oxygen in AMI may make it difficult to persuade funders of the importance of this issue and health professionals to participate in enrolling patients into a trial in which oxygen would be withheld from half their patients.
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Affiliation(s)
- Amanda Burls
- Division of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Alústiza JM, Emparanza JI, Aldazábal P, Garrido A, García N, Salvador E, San Vicente M. [Standardization of the quantification of iron concentration in the liver by magnetic resonance imaging]. Radiologia 2011; 54:149-54. [PMID: 22079139 DOI: 10.1016/j.rx.2010.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To calibrate 1.5 tesla magnetic resonance scanners for the quantification of the concentration of iron in the liver. MATERIAL AND METHODS We analyzed twenty-eight 1.5 tesla magnetic resonance scanners using a phantom with four tubes containing different concentrations of iron (III) chloride and one tube without iron. The phantom represented two typical patients: one with moderate iron overload and one with high iron overload. We measured the signal intensity ratio between each iron-containing tube and the tube without iron; then we calculated the theoretical levels of iron concentration in each scanner according to the model for the two levels of overload. We compared the results of each scanner with those of the reference scanner in which the model and the phantom had been designed, and we calculated the percentage of difference between the two scanners. RESULTS The mean difference in the ratios compared to the reference center was 11% (0.3-39). The mean concentration of iron was 71 μmol Fe/g for moderate overload and 193 μmol Fe/g for high overload. The mean difference was 6% (1.2- 7%) and 3.4% (0-16%). respectively. In two scanners, we applied a correction factor so that the difference was below 25% in all cases. CONCLUSION We calibrated twenty-eight 1.5 tesla scanners for the concentration of iron in the liver and achieved variability less than 25%.
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Abstract
BACKGROUND Oxygen (O(2)) is widely recommended for patients with myocardial infarction yet a narrative review has suggested it may do more harm than good. Systematic reviews have concluded that there was insufficient evidence to know whether oxygen reduced, increased or had no effect on the heart ischaemia or infarct size. OBJECTIVES To review the evidence from randomised controlled trials to establish whether routine use of inhaled oxygen in acute myocardial infarction (AMI) improves patient-centred outcomes, in particular pain and death. SEARCH STRATEGY The following bibliographic databases were searched (to the end of February 2010): Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, MEDLINE In-Process, EMBASE, CINAHL, LILACS and PASCAL, British Library ZETOC, Web of Science ISI Proceedings. Experts were also contacted to identify any studies. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials of people with suspected or proven AMI, less than 24 hours after onset, in which the intervention was inhaled oxygen (at normal pressure) compared to air and regardless of co-therapies provided these were the same in both arms of the trial. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the titles and abstracts of identified studies to see if they met the inclusion criteria and independently undertook the data extraction. The quality of studies and the risk of bias were assessed according to guidance in the Cochrane Handbook. The primary outcomes were death, pain and complications. The measure of effect used was the relative risk (RR). MAIN RESULTS Three trials involving 387 patients were included and 14 deaths occurred. The pooled RR of death was 2.88 (95% CI 0.88 to 9.39) in an intention-to-treat analysis and 3.03 (95% CI 0.93 to 9.83) in patients with confirmed AMI. While suggestive of harm, the small number of deaths recorded meant that this could be a chance occurrence. Pain was measured by analgesic use. The pooled RR for the use of analgesics was 0.97 (95% CI 0.78 to 1.20). AUTHORS' CONCLUSIONS There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with acute AMI. A definitive randomised controlled trial is urgently required given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines.
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Affiliation(s)
- Juan B Cabello
- Departamento de Cardiologia & CASP Spain, Hospital General Universitario de Alicante, Pintor Baeza 12, Alicante, Alicante, Spain, 03010
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Sardón-Prado O, Korta-Murua J, Valverde-Molina J, Fernández-Paredes JJ, Mintegui J, Corcuera-Elosegui P, Emparanza JI, Pérez-Yarza EG. Association among lung function, exhaled nitric oxide, and the CAN questionnaire to assess asthma control in children. Pediatr Pulmonol 2010; 45:434-9. [PMID: 20425850 DOI: 10.1002/ppul.21144] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association among a validated symptom-based questionnaire for asthma control in children (CAN), forced expiratory volume in 1 sec (FEV(1)), and fractional exhaled nitric oxide (FE(NO)). METHODS Observational cross-sectional study was performed in a consecutive sample of asthmatic children aged between 7 and 14 years old from December 2007 to February 2008. FE(NO) was measured with a portable electrochemical analyzer and forced spirometry was performed according to American Thoracic Society/European Respiratory Society. The CAN questionnaire was completed by the parents (aged <9 years old) or by the children (> or = 9 years old). The strength of the association among FEV(1), FE(NO), and CAN questionnaire was studied using Spearman's rho, and the degree of agreement for asthma control among FEV(1), FE(NO), and CAN questionnaire, with classification of these variables according to values of normality, was studied using Pearson's chi(2) test and Cohen's kappa (KC). RESULTS We studied 268 children, mean age 9.7 +/- 2.1 years. Significant correlations were found between FE(NO) and CAN (r = 0.2), between FEV(1) and CAN (r = -0.3), and between FE(NO) and FEV(1) (r = -0.12). On classifying the variables according to values of normality, no agreement was found to establish the degree of asthma control between FE(NO) and CAN (KC = 0.18, chi(2) Pearson = 9.63); between FEV(1) and CAN (KC = 0.29, chi(2) = 38.5); or between FE(NO) and FEV(1) (KC = 0.07, chi(2) = 4.9). CONCLUSIONS The association among the three measurement instruments used to assess asthma control (FEV(1), FE(NO), and CAN) was weak. These are instruments that quantify variables that influence asthma in different ways, in this sense, none can be used instead of another in asthma management although they are complementary.
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Affiliation(s)
- O Sardón-Prado
- Department of Pediatrics, Division of Respiratory Medicine, Donostia Children's Hospital, San Sebastián, Spain.
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21
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Olaciregui I, Hernández U, Muñoz JA, Emparanza JI, Landa JJ. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child 2009; 94:501-5. [PMID: 19158133 DOI: 10.1136/adc.2008.146530] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate potential markers of serious bacterial infection (SBI) in infants under 3 months of age presenting with fever of unknown origin. MATERIAL AND METHODS We retrospectively studied all infants under 3 months of age seen in the emergency department between January 2004 and December 2006 for a febrile syndrome with no identifiable focus. Clinical data, procalcitonin (PCT), C reactive protein (CRP) and leucocyte count were evaluated for their ability to discriminate between SBI and non-SBI; receiver operating characteristic (ROC) curves were constructed for the laboratory markers and analysis was performed by multivariate logistic regression. RESULTS The sample comprised 347 patients (23.63% with SBI). Mean PCT, CRP, leucocyte and neutrophil count were significantly higher in the group with SBI unlike the other criteria studied. The area under the ROC curve (AUC) for PCT was 0.77 (95% CI 0.72 to 0.81) and 0.79 for CRP (95% CI 0.75 to 0.84); both these variables were stronger predictors than leucocyte count (0.67, 95% CI 0.63 to 0.73). In the 15 infants with more invasive bacterial infections (sepsis, bacteraemia, bacterial meningitis), the diagnostic value of PCT (AUC 0.84, 95% CI 0.79 to 0.88) was higher than CRP (AUC 0.68, 95% CI 0.63 to 0.73). In infants who had been febrile for under 12 h, the differences between PCT, CRP and leucocyte count were statistically significant in both SBI and non-SBI groups, with increasing predictive value of PCT and decreasing value of CRP. CONCLUSIONS PCT, CRP, and leucocyte count have intrinsic predictive value for SBI in febrile infants under 3 months of age. The diagnostic value of PCT is greater than CRP for more invasive bacterial infections and for fever of short duration.
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Affiliation(s)
- I Olaciregui
- Department of Pediatrics, Division of Emergency Department, Donostia Hospital, San Sebastian, Spain.
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22
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Goicoechea M, Cía F, San José C, Asensio A, Emparanza JI, Gil AG, López de Cerain A, Aldazabal P, Azpitarte M, Otaegui D, López de Munain A. Minimizing creatine kinase variability in rats for neuromuscular research purposes. Lab Anim 2008; 42:19-25. [PMID: 18348763 DOI: 10.1258/la.2007.06006e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rat serum or plasma creatine kinase (CK) activity is widely used to evaluate myopathic processes, to test the myotoxicity of different drugs, or to analyse the benefits of emerging gene therapies in some neuromuscular disorders. However, great variability is found in this determination. The aim of this study has been to control some factors of variation in order to reduce variability and increase the reproducibility of analytical data. 8-10-week-old Wistar-Han rats were used. The study consisted of four sequential phases. Phase I aimed to analyse the effect of ether and isoflurane as anaesthetic drugs. The objective of Phase II was to evaluate bleeding rats via retro-orbital sinus vs. tail vein. Phases III and IV were designed as two separate, repeated measure experiments on two factors: habituation to laboratory handling procedures in Phase III and gender in Phase IV. The repeated factor was the storage temperature of blood sample prior to centrifugation. Ether did not significantly increased the CK value. Using isoflurane, getting rats accustomed to laboratory handling procedures and whole blood refrigeration prior to centrifugation and serum separation resulted in statistically significant reduction in CK value and variability. Male rats showed significantly higher values than female rats. In the light of our findings, CK value and variability in rats may be minimized by choosing tail vein as site of bleeding, getting rats accustomed to laboratory handling procedures and maintaining whole blood refrigerated until centrifugation and serum separation.
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Affiliation(s)
- M Goicoechea
- Unidad Experimental, Laboratorio Unificado, Hospital Donostia, San Sebastián, Spain.
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Otaegui D, Ruíz-Martínez J, Olaskoaga J, Emparanza JI, López de Munain A. Influence of CCR5-Δ32 genotype in Spanish population with multiple sclerosis. Neurogenetics 2007; 8:201-5. [PMID: 17351762 DOI: 10.1007/s10048-007-0085-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 02/28/2007] [Indexed: 10/23/2022]
Abstract
A number of association studies have explored the relationship between the CCR5-Delta32 allele and the risk of developing multiple sclerosis (MS), with varying results. In light of the results of several studies that have analyzed the role of the allele in MS, it has been proposed that the allele is involved in the etiopathogeny of the disease. Our study revealed a statistically significant difference between the study group and the control group for the carriers of at least one deleted allele (P = 0.027). The allele was more frequent in the control group, which suggests a possible protective effect of this deletion against MS. When ethnic origin was taken into account in the same analysis, we saw that the bulk of the difference was attributable to the Basque group, although the trend was also visible in the control group. Consideration of ethnic origin is therefore essential for the analysis of our sample. CCR5-Delta32 allele distribution was higher in the Basque control population than in the Basque MS population, which suggests that it confers a protective effect against MS. Relevant values were a P value of 0.008 and an odds ratio of 0.168 (95% confidence interval, 0.038 to 0.737).
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Affiliation(s)
- D Otaegui
- Unidad Experimental, Hospital Donostia, San Sebastian, Spain.
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Oñate E, González Pérez-Yarza E, de la Paz AF, Aldasoro A, Aramendi JF, Bardagi S, Emparanza JI. [The shuttle run test is not valid for the detection of asthma in school physical education programs]. Arch Bronconeumol 2007; 42:564-8. [PMID: 17125690 DOI: 10.1016/s1579-2129(06)60588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Certain sporting activities may trigger asthma exacerbations of varying intensity in children. Such exacerbations may lead to limitations in and rejection of such activities. During school hours, teachers are in a good position to observe these phenomena. The aim of the present study was to evaluate the shuttle run, a test of physical fitness used in school physical education programs, as a way of detecting asthma. PATIENTS AND METHODS We carried out a cross-sectional observational study of school children between the ages of 6 and 12 years using the asthma symptom questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), a shuttle run test, and a free running test at maximum effort in order to study bronchial hyperresponsiveness. The principal measure of bronchial hyperresponsiveness used in both physical fitness tests was peak expiratory flow rate as measured with a peak flow meter. In comparing the results of the shuttle run test with those of the free running test and the ISAAC questionnaire we used the chi(2) test to measure association and the Cohen kappa coefficient to measure agreement. RESULTS We distributed the ISAAC questionnaire (n=919) to 460 (50.1%) boys and 459 (49.9%) girls between the ages of 6 and 12 years. All the tests were completed by 826 children. The level of agreement between the shuttle run test and free running test was positive but low for decreases in peak expiratory flow rate compared to baseline of 15% (chi(2)=5.6; P< .05; kappa=0.093; SE, 0.042) and of 20% (chi(2)=4.5; P< .05; kappa=0.08; SE, 0.046). For 10% decreases association was not significant and agreement was low (kappa=0.05; SE, 0.04). There was no agreement between the ISAAC questionnaire and the shuttle run test (kappa=0.095; SE, 0.63). CONCLUSIONS The shuttle run test using peak expiratory flow rate as the principal measure of bronchial hyperresponsiveness is not valid for the detection of asthma in schoolchildren.
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Affiliation(s)
- Eider Oñate
- Unidad de Neumología Infantil, Hospital Donostia, San Sebastián, Guipúzcoa, España.
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Oñate E, González Pérez-Yarza E, de la Paz AF, Aldasoro A, Francisco Aramendi J, Bardagi S, Emparanza JI. La prueba course-navette no es válida para detectar asma en programas de educación física escolar. Arch Bronconeumol 2006. [DOI: 10.1157/13094322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Blázquez L, De Juan D, Ruiz-Martínez J, Emparanza JI, Sáenz A, Otaegui D, Sistiaga A, Martínez-Lage P, Lamet I, Samaranch L, Buiza C, Etxeberria I, Arriola E, Cuadrado E, Urdaneta E, Yanguas J, López de Munain A. Genes related to iron metabolism and susceptibility to Alzheimer's disease in Basque population. Neurobiol Aging 2006; 28:1941-3. [PMID: 17011669 DOI: 10.1016/j.neurobiolaging.2006.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 07/28/2006] [Accepted: 08/22/2006] [Indexed: 10/24/2022]
Abstract
Alzheimer's disease (AD) is the most common dementing disorder and presents with a progressive and irreversible cognitive decline of gradual onset. To date, several reports have involved iron in AD physiopathology. In this study, we have analysed TFC2 variant and HFE mutations (H63D and C282Y) in 211 AD patients and 167 controls recruited from an area of the Basque Country. Furthermore, we have studied APOE genotype as it is a well-known risk factor for AD. APOE epsilon 4 allele was associated with an increased risk of AD and an earlier age at onset, whereas no association was found between TFC2 or HFE C282Y mutation and disease susceptibility. The frequency of H63D mutation was higher in control population (29.9%) than in AD patients (18%), suggesting a protective role of this allele on AD either due to the presence of the mutation itself or through the effect of other related genes in the ancestral haplotype in which it is included.
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Affiliation(s)
- L Blázquez
- Experimental Unit, Donostia Hospital, San Sebastián, Spain.
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Blázquez L, Otaegui D, Sáenz A, Paisán-Ruiz C, Emparanza JI, Ruiz-Martinez J, Moreno F, Martí-Massó JF, López de Munain A. Apolipoprotein E epsilon4 allele in familial and sporadic Parkinson's disease. Neurosci Lett 2006; 406:235-9. [PMID: 16904828 DOI: 10.1016/j.neulet.2006.07.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 07/14/2006] [Accepted: 07/18/2006] [Indexed: 11/16/2022]
Abstract
Parkinson's disease (PD) is the second most common age-related neurodegenerative disease after Alzheimer's disease (AD). Common risk factors for both diseases have been explored to study potential etiologic interactions between these two neurodegenerative disorders. The APOE epsilon4 allele, previously associated with AD, has also been associated with risk of PD and with the presence of some clinical features in PD patients. However, the role of APOE epsilon4 allele in risk of PD remains unclear. We studied the distribution of APOE alleles in 276 unrelated familial and sporadic PD patients and in 212 controls. Patients and controls were classified by ethnicity. No genetic heterogeneity between Basques and people from other regions of Spain was found. No significant differences in APOE allele distribution between PD patients and controls were found; however, lower epsilon4 allele frequency was observed when the sporadic PD group was analyzed separately. By contrast, an increase in epsilon4 allele frequency was found in familial PD patients with cognitive decline. We conclude that the APOE epsilon4 allele may be associated with the risk of developing PD in isolated cases and that it is linked to the presence of cognitive decline in familial PD in our sample.
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Affiliation(s)
- L Blázquez
- Experimental Unit, Donostia Hospital, San Sebastián, Spain.
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Zubillaga P, Garrido A, Mugica I, Ansa J, Zabalza R, Emparanza JI. Effect of vitamin D and calcium supplementation on bone turnover in institutionalized adults with Down's Syndrome. Eur J Clin Nutr 2005; 60:605-9. [PMID: 16391575 DOI: 10.1038/sj.ejcn.1602357] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the status of vitamin D and the effects of calcium and vitamin D3 supplementation on the bone metabolism in a group of adults with Down's syndrome (DS). DESIGN Randomized, parallel, controlled and open clinical trial. SETTING Institution for mentally handicapped: Fundación Uliazpi, Diputación Foral de Guipúzcoa, San Sebastián, Spain. SUBJECTS A total of 23 persons with DS, residents at the Uliazpi Foundation were recruited and all completed the study. INTERVENTION In all, 12 participants were randomly allocated to receive 1 g of calcium and 800 IU of vitamin D once daily for 1 year while 11 were assigned to the control group, receiving no supplementation. RESULTS We found no differences between groups regarding serum calcium and phosphorous levels. The remaining parameters showed differences between the two groups consistent with a beneficial effect of the intervention: serum levels of parathyroid hormone, osteocalcin and crosslaps diminished while serum 25 OH vitamin D3 level increased. CONCLUSIONS The results obtained allow to include people with DS as a risk group with regards to vitamin D deficit, which that can be corrected with vitamin D and calcium supplementation, and giving rise to an improvement of the biochemical markers related to the phospho-calcium metabolism and bone remodelling.
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Affiliation(s)
- P Zubillaga
- Fundacion Uliazpi, Portu-Etxe 53, 20018 San Sebastián, Gipuzkoa, Spain.
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Abstract
BACKGROUND Current recommendations for obtaining blood from neonates advise avoidance of the midline area of the heel and are based on postmortem studies. OBJECTIVE Because of the potential pain and tissue damage from repeated heel pricking in the same area, to investigate using ultrasonography whether the distance from skin to calcaneus is less at the midline than at the borders. METHODS One hundred consecutive healthy preterm and 105 consecutive healthy term neonates were studied 48-72 hours after delivery. The skin to perichondrium distance (SPD) was measured on two occasions by ultrasound at the external, midline, and internal areas of the heel. FINDINGS Mean SPD was 0.2 mm less at the midline than at the other sites. The proportion of measurements <3 mm at any of the three sites was the same. Depth was <3 mm in less than 3% of the term and approximately 20% of the preterm infants. The SPD correlated only with gestational age. Of children <33 weeks gestational age, 38% had an SPD <3 mm compared with 8% of older preterm infants. The proportions of preterm infants of > or = 33 weeks gestation and term infants with an SPD <3 mm were similar (8% v 3%). INTERPRETATION With the use of automated lancets of 2.2 mm length or less, the whole heel plantar surface is safe for obtaining blood in term and preterm infants of > or = 33 weeks gestation. This means that soft tissue damage and pain from repeated pricking in the same area can be reduced.
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Affiliation(s)
- J Arena
- Basque Country Newborn Screening Programme, Neonatal Unit, Hospital Donostia, San Sebastian, Spain
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Otaegui D, Sáenz A, Martínez-Zabaleta M, Villoslada P, Fernández-Manchola I, Alvarez de Arcaya A, Emparanza JI, López de Munain A. Mitochondrial haplogroups in Basque multiple sclerosis patients. Mult Scler 2005; 10:532-5. [PMID: 15471369 DOI: 10.1191/1352458504ms1069oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous studies have suggested that mitochondrial metabolism and/or mitochondrial DNA (mtDNA) could be, in conjunction with other genetic or environmental factors, a risk factor for the development of multiple sclerosis (MS). One of these studies establishes that mitochondrial haplogroup JT is a risk factor for developing the disease, in particular the visual manifestations [optic neuritis (ON)]. Nevertheless, as distribution of these haplogroups varies between populations, the observed association may be due to a slanted sample with no physiopathological value. This hypothesis was checked with MS patients, originals from Basque country (this population has peculiar genetic characteristics) and from other Spanish regions. We concluded that such an association does not exist. By contrast, a decrease could be seen in the frequency of the JT haplogroup in the ON group and in the MS-Basque group. That trend could be a protective effect, which needs to be verified in further investigations.
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Affiliation(s)
- D Otaegui
- Experimental Unit, Hospital Donostia, San Sebastián, Spain.
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Alústiza JM, Artetxe J, Castiella A, Agirre C, Emparanza JI, Otazua P, García-Bengoechea M, Barrio J, Mújica F, Recondo JA. MR quantification of hepatic iron concentration. Radiology 2004; 230:479-84. [PMID: 14668426 DOI: 10.1148/radiol.2302020820] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the accuracy of magnetic resonance (MR) imaging in the quantification of hepatic iron concentration. MATERIALS AND METHODS Between April 1999 and June 2001, 112 patients were recruited prospectively. All had undergone liver biopsy and hepatic iron concentration quantification with spectrophotometry, followed by MR imaging. MR imaging involved use of four gradient-echo sequences and one spin-echo sequence. Signal intensity (SI) was measured on images obtained with each sequence by means of regions of interest placed in the liver and paraspinal muscle to obtain the liver-to-muscle SI ratio. The relationship between hepatic iron concentration and SI ratio for each sequence was analyzed with multiple linear regression. Receiver operating characteristic analysis was performed to find the diagnostic thresholds. RESULTS Sixty-eight patients had normal hepatic iron levels (<36 micromol/g), 23 had hemosiderosis (36-80 micromol/g), and 21 had hemochromatosis (>80 micromol/g). With all sequences, an inverse linear relationship between iron concentration and SI ratio was apparent. The authors generated a mathematic model to estimate the iron concentrations from MR imaging data (r = 0.937). For estimated concentrations of more than 85 micromol/g, the positive predictive value for hemochromatosis was 100%; for those less than 40 micromol/g, the negative predictive value for hemochromatosis was 100%. For estimated concentrations of more than 58 micromol/g, the positive predictive value for iron overload was 100%; for those less than 20 micromol/g, the negative predictive value for iron overload was 100%. CONCLUSION MR imaging is a useful and noninvasive diagnostic tool for quantification of hepatic iron concentration.
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Affiliation(s)
- José M Alústiza
- OSATEK, Alta Tecnología Sanitaria S.A., Paseo Dr Beguiristain 109, 20014 San Sebastián, Basque Country, Spain.
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Areses R, Arruebarrena D, Urbieta MA, Alzueta MT, Eizaguirre I, Rodríguez F, Ubetagoyena M, Emparanza JI. [Severe primary vesicoureteral reflux in infants. A follow-up of 203 cases]. Nefrologia 2004; 24:131-41. [PMID: 15219088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE The aim of our study is to analyze the clinic characteristics and evolution of the primary reflux in infants. METHODS We studied retrospectively 203 infants in our hospital, diagnosed of severe primary renal reflux. Renal ecography and cyclic mictional cystography were practiced in all cases. DMSA was carried out in 181 patients. RESULTS Renal reflux was unilateral in the 23% of the patients, and bilateral in the remaining cases; 72% of the renal reflux were grade IV and 28% grade V. The renal injuries affected to male infants and reflux grade V. The renal injury was focal (27%), global (44%) and atrophic (29%). The 79% of the patients had conservative treatment, while 21% had surgical treatment. 100% infants with surgical treatment and 94.2% infants with conservative treatment were recovered (Test of Kaplan-Meier). The 27% of patients developed one or several urinary infections, but progression of old renal injuries or formation of new ones, were exceptional (3 cases): While the time the study lasted none of the patients developed chronic renal failure nor arterial hypertension. CONCLUSIONS 1) The fetal severe primary reflux of the patients was characterized by the following features: to be bilateral reflux, to affect mainly to male infants and to be associated in 33% of cases with a severe renal injury of congenital origin (renal displasia) most of them unilateral. 2) The natural evolution of the reflux goes to spontaneous recovery, so treatment must be conservative. 3) Some patients underwent urinary infections, but progression or formation of new renal injuries were inusual. None of the patients had terminal renal failure nor hypertension and 4) Risk patients would be male infants with bilateral injuries although these are infrequent.
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Affiliation(s)
- R Areses
- Sección de Nefrología Pediátrica, Hospital Donostia, San Sebastián
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Pérez-Yarza EG, Arranz L, Alustiza J, Azkunaga B, Uriz J, Sarasua A, Mendiburu I, Emparanza JI. [Hospital admissions for varicella complications in children aged less than 15 years old]. An Pediatr (Barc) 2003; 59:229-33. [PMID: 12975114 DOI: 10.1016/s1695-4033(03)78170-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The complications of varicella are one of the arguments in favor of universal vaccination programs in children. OBJECTIVE To describe the complications of varicella requiring hospital admission in a well-defined population (Gipuzkoa, Spain) and to compare the incidence of hospitalization with that reported in other series. MATERIAL AND METHODS Observational, retrospective, multicenter study of admissions for varicella. The medical histories codified as varicella (minimum data set, CIE-0, codes 952.0-052.9) from 1 January 1993 to 31 December 2002 were reviewed. Calculation of hospitalization rates was based on emergency department visits and population data. The pediatric population of Gipuzkoa seeking medical attention at one of the four Basque Country Health Service hospitals in the area: Hondarribia, Mendaro, San Sebastian and Zumarraga. The mean coverage in Gipuzkoa is 54,999 children aged less than 15 years/year. All the children aged 0-15 years old admitted for more than 24 h with a discharge diagnosis of varicella complications. The variables studied are: age, gender, personal history, varicella immunization, immune status, fever, chest X-ray, complementary investigations, length of hospital stay, treatment, discharge diagnosis, clinical course, complications and sequelae at discharge. RESULTS Seventy-one children were hospitalized. None had been vaccinated against the varicella-zoster virus. Eighty percent were aged less than 5 years and three were immunocompromised. Fifty-six percent had bacterial superinfection and invasive forms were found in seven patients. The mean length of admission was 6.5 days +/- 5.1. No deaths or sequelae were reported. CONCLUSIONS The annual incidence rate of admissions longer than 24 hours due to varicella complications was 12.9 cases per 100,000 children aged less than 15 years, representing 0.31% of all annual admissions in this age group.
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Affiliation(s)
- E-G Pérez-Yarza
- Servicio de Pediatría, Hospital Donostia, San Sebastián, España.
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Abstract
STUDY OBJECTIVE We sought to validate the Ottawa Knee Rules for determining the need for radiography in patients with acute knee injury. METHODS A prospective cohort study was performed in emergency departments of 11 hospitals of the Osakidetza-Basque Country Health Service. The patient population was composed of a convenience sample of 1,522 eligible adults of 2,315 patients with acute knee injuries. The attending emergency physicians assessed each patient for standardized clinical variables and determined the need for radiography according to the decision rule. Radiography was performed in each patient, irrespective of the determination of the rule, after clinical evaluation findings were recorded. The rule was assessed for the ability to correctly identify fracture of the knee. RESULTS The decision rule had a sensitivity of 1.0 (95% confidence interval [CI] 0.96 to 1.0), identifying 89 patients with clinically important fractures. The potential reduction in use of radiography was estimated to be 49%. The probability of fracture, if the decision rules were negative, is estimated to be 0% (95% CI 0% to 0.5%). CONCLUSION Prospective validation has shown the Ottawa Knee Rules to be 100% sensitive for identifying fractures of the knee and to have the potential to allow physicians to reduce the use of radiography in patients with acute knee injuries.
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Affiliation(s)
- J I Emparanza
- Clinical Epidemiology Unit, Hospital Aránzazu, CHDO, San Sebastian, Basque Country, Spain.
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Graham ID, Stiell IG, Laupacis A, McAuley L, Howell M, Clancy M, Durieux P, Simon N, Emparanza JI, Aginaga JR, O'connor A, Wells G. Awareness and use of the Ottawa ankle and knee rules in 5 countries: can publication alone be enough to change practice? Ann Emerg Med 2001; 37:259-66. [PMID: 11223761 DOI: 10.1067/mem.2001.113506] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVES We evaluate the international diffusion of the Ottawa Ankle and Knee Rules and determine emergency physicians' attitudes toward clinical decision rules in general. METHODS We conducted a cross-sectional, self-administered mail survey of random samples of 500 members each of the American College of Emergency Physicians, Canadian Association of Emergency Physicians, British Association for Accident and Emergency Medicine, Spanish Society for Emergency Medicine, and all members (n=1,350) of the French Speaking Society of Emergency Physicians, France. Main outcome measures were awareness of the Ottawa Ankle and Knee Rules, reported use of these rules, and attitudes toward clinical decision rules in general. RESULTS A total of 1,769 (57%) emergency physicians responded, with country-specific response rates between 49% (United States and France) and 79% (Canada). More than 69% of physicians in all countries, except Spain, were aware of the Ottawa Ankle Rules. Use of the Ottawa Ankle Rules differed by country with more than 70% of all responding Canadian and United Kingdom physicians reporting frequent use of the rules compared with fewer than one third of US, French, and Spanish physicians. The Ottawa Knee Rule was less well known and less used by physicians in all countries. Most physicians in all countries viewed decision rules as intended to improve the quality of health care (>78%), a convenient source of advice (>67%), and good educational tools (>61%). Of all physicians, those from the United States held the least positive attitudes toward decision rules. CONCLUSION This constitutes the largest international survey of emergency physicians' attitudes toward and use of clinical decision rules. Striking differences were apparent among countries with regard to knowledge and use of decision rules. Despite similar awareness in the United States, Canada, and the United Kingdom, US physicians appeared much less likely to use the Ottawa Ankle Rules. Future research should investigate factors leading to differences in rates of diffusion among countries and address strategies to enhance dissemination and implementation of such rules in the emergency department.
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Affiliation(s)
- I D Graham
- Department of Medicine, Faculty of Medicine, University of Ottawa, Canada.
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Abstract
BACKGROUND Strategies for reducing breast cancer mortality in western countries have focused on screening, at least for women aged 50 to 69 years. One of the requirements of any community screening program is to achieve a high participation rate, which is related to methods of invitation. Therefore, it was decided to systematically review the scientific evidence on the different strategies aimed at improving women's participation in breast cancer screening programs and activities. OBJECTIVES To assess the effectiveness of different strategies for increasing the participation rate of women invited to community (population-based) breast cancer screening activities or mammography programs. SEARCH STRATEGY MEDLINE (1966-2000), CENTRAL (2000), and EMBASE (1998-1999) searches for 1966 to 1999 were supplemented by reports and letters to the European Screening Breast Cancer Programs (Euref Network). SELECTION CRITERIA Both published and unpublished trials were eligible for inclusion, provided the women had been invited to a community breast screening activity or program and had been randomised to an intervention group or a control group with no active intervention. DATA COLLECTION AND ANALYSIS We identified 151 articles, which were reviewed independently by two people. The discrepancies were resolved by a third reviewer in order to reach consensus. Thirty-four studies were excluded because they lacked a control group; 58 of the other 117 articles were considered as opportunistic and not community-based; 59 articles, which reported 70 community-based randomised controlled trials or clinical controlled trials, were accepted. In 24 of these, the control group had not been exposed to any active intervention, but 8 of the 24 had to be excluded because the denominator for estimating attendance was unknown. At the end, 16 studies constituted the material for this review, although two studies were further excluded because their groups were not comparable at baseline. Data from all but one study were based on or converted to an intention-to-treat analysis. Attendance in response to the mammogram invitation was the main outcome measure. MAIN RESULTS The evidence favoured five active strategies for inviting women into community breast cancer screening services: letter of invitation (OR 1.66, 95% CI 1.43 to 1.92), mailed educational material (OR 2.81, 95% CI 1.96 to 4.02), letter of invitation plus phone call (OR 2.53, 95% CI 2.02 to 3.18), phone call (OR 1.94, 95% CI 1.70 to 2.23), and training activities plus direct reminders for the women (OR 2.46, 95% CI 1.72 to 3.50). Home visits did not prove to be effective (OR 1.06, 95 % CI 0.80 to 1.40) and letters of invitation to multiple examinations plus educational material favoured the control group (OR 0.62, 95 % CI 0.32 to 1.20). REVIEWER'S CONCLUSIONS Most active recruitment strategies for breast cancer screening programs examined in this review were more effective than no intervention. Combinations of effective interventions can have an important effect. Some costly strategies, as a home visit and a letter of invitation to multiple screening examinations plus educational material, were not effective. Further reviews comparing the effective interventions and studies that include cost-effectiveness, women's satisfaction and equity issues are needed.
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Affiliation(s)
- X Bonfill
- Centro Cochrane Iberoamericano., Hospital de la Santa Creu i Sant Pau, Casa de Convalescència, Sant Antoni M. Claret 171, Barcelona, Catalonia, Spain, 08041.
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Querejeta R, Varo N, López B, Larman M, Artiñano E, Etayo JC, Martínez Ubago JL, Gutierrez-Stampa M, Emparanza JI, Gil MJ, Monreal I, Mindán JP, Díez J. Serum carboxy-terminal propeptide of procollagen type I is a marker of myocardial fibrosis in hypertensive heart disease. Circulation 2000; 101:1729-35. [PMID: 10758057 DOI: 10.1161/01.cir.101.14.1729] [Citation(s) in RCA: 244] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study was designed to investigate whether the serum concentration of the carboxy-terminal propeptide of procollagen type I (PIP), a marker of collagen type I synthesis, is related to myocardial fibrosis in hypertensive patients. METHODS AND RESULTS The study was performed in 26 patients with essential hypertension in which ischemic cardiomyopathy was excluded after a complete medical workup. Right septal endomyocardial biopsies were performed in hypertensive patients to quantify collagen content. Collagen volume fraction (CVF) was determined on picrosirius red-stained sections with an automated image analysis system. The serum concentration of PIP was measured by specific radioimmunoassay. Compared with normotensives, both serum PIP and CVF were increased (P<0.001) in hypertensives. A direct correlation was found between CVF and serum PIP (r=0.471, P<0.02) in all hypertensives. Histological analysis revealed the presence of 2 subgroups of patients: 8 with severe fibrosis and 18 with nonsevere fibrosis. Serum PIP was higher (P<0.05) in patients with severe fibrosis than in patients with nonsevere fibrosis. Using receiver operating characteristic curves, we observed that a cutoff of 127 microg/L for PIP provided 78% specificity and 75% sensitivity for predicting severe fibrosis with a relative risk of 4.80 (95% CI, 1.19 to 19.30). CONCLUSIONS These results show a strong correlation between myocardial collagen content and the serum concentration of PIP in essential hypertension. Although preliminary, these findings suggest that the determination of PIP may be an easy and reliable method for the screening and diagnosis of severe myocardial fibrosis associated with arterial hypertension.
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Affiliation(s)
- R Querejeta
- Division of Cardiology, Nuestra Señora de Aránzazu Hospital, San Sebastian, Spain
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Abstract
The aim of this study was to design and test a pressure ulcer severity score based on assessment by experienced clinicians. Fifty pressure ulcers were each evaluated independently by seven experienced clinicians, using a scale that ranged from 0 (mildest damage) to 10 (most severe). Ulcer characteristics were analysed to determine which factors related to the assessments. A second set of 50 ulcers was used to test the validity of the resulting scoring system. Inter- and intra-observer reliability were tested in a further 10 pressure ulcers. A multivariate linear model was produced, based on the following three variables: colour (CO-matched-matched) in the wound base; depth (DE) of the ulcer; and mean diameter (D) of the wound ('CODED'). The coefficients for each variable were rounded to yield points in an additive equation, the CODED score. This score had a high correlation (r = 0.92, P < 0.001) with the second set of evaluations, used to test the score performance. The CODED score is a simple and valid tool to quantify the progress of a pressure ulcer. It has a high correlation with the severity assessment of experienced clinicians and is reliable when used by non-experienced observers.
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Affiliation(s)
- J I Emparanza
- Clinical Epidemiology Unit, Hospital Aranzazu, Osakidetza-Servicio Vasco de Salud, San Sebastian, Spain
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Poza JJ, Martínez A, Emparanza JI, López de Munain A, Martí Massó JF. [Sleep apnea syndrome and cerebral infarction]. Neurologia 2000; 15:3-7. [PMID: 10730060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES To analyze the relationship between snoring and sleep apnea with brain infarction. METHODS We studied 79 consecutive patients of both sexes with cerebral infarction and 248 age and sex matched controls. We obtained data reflecting arterial hypertension, diabetes mellitus, hypercholesterolemia, smoking and drinking habits, coronary heart disease, cardiopathy, snoring, respiratory pauses during sleep and daytime sleepiness, by using a standard questionnaire to interview every subject and his/her spouse. RESULTS 53% of patients and 46% of controls snored often or always (p = 0.27). Snoring was significantly more frequent in men. Thirty four percent of patients and 27% of controls were snorers and suffered apnea during sleep (p = 0.19). Nineteen per cent of patients and 11% of controls presented snoring, respiratory pauses during sleep and daytime sleepiness simultaneously, suggesting obstructive sleep apnea syndrome (OSAS) (p = 0.06). However, by separately analyzing people younger than 65 years, the frequency of OSAS was significantly higher in patients (29%) than in controls (7%) (p = 0.006). Finally, 10% of patients and 3% of controls presented snoring, respiratory pauses during sleep and moderate or severe daytime sleepiness simultaneously, suggesting moderate-severe OSAS (p = 0.01). A multiple logistic regression analysis confirmed the independent contribution of moderate-severe OSAS as a risk factor for ischemic stroke, with an adjusted odds ratio of 4.54. In people younger than 65 years, OSAS, regardless of its severity, was also an independent risk factor for ischemic stroke, with an adjusted odds ratio of 5.78. CONCLUSIONS Clinically diagnosed obstructive sleep apnea syndrome is an independent risk factor for ischemic stroke, especially in people younger than 65 years.
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Affiliation(s)
- J J Poza
- Servicio de Neurología, Hospital Nuestra Señora de Aránzazu, San Sebastián.
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Barrio J, García-Bengoechea M, Emparanza JI, Arenas JI. [The prevalence of hepatitis C virus infection]. Gastroenterol Hepatol 1998; 21:260-1. [PMID: 9644884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gónzález Pérez-Yarza E, Mintegui J, Garmendia A, Callén M, Reguilón MJ, Garrido A, Emparanza JI. [The excretion of free cortisol in the urine in healthy children and in asthmatics treated with long-term inhaled glucocorticoids]. An Esp Pediatr 1996; 44:531-536. [PMID: 8796962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To assess urinary free cortisol (UFC) excretion in 24 hour urine samples collected from asthmatic children treated with inhaled glucocorticoids (IGC). PATIENTS AND METHODS A retrospective cohort study was performed on a group of 358 children between the ages of 3 and 14 years. The children were divided into two groups, a normal population (n = 108) and an asthma group (n = 250). These children were treated uninterruptedly with IGC (mean dose 676 micrograms/day) during 17 +/- 8 months with budesonide (n = 221) or beclomethasone (n = 29) in dry powder (n = 167) or MDI with spacer chamber (n = 83). We considered the 24 hour urine sample valid when creatinine levels in blood and urine, as well as creatinine clearance, were normal. We determined UFC with a specific direct radioimmunoassay after cortisol extraction with dichloromethane. We performed a short ACTH test to assess the subnormal adrenocortical function when UC excretion in AG was less than -1SD. RESULTS UFC excretion was 81.98 +/- 32.12 nmol/m2/day in the asthma group. There was no correlation between UFC and the mean dose of IGC, total dose given, device used for inhalation, time of treatment or oral glucocorticoid series. The subgroup treated with beclomethasone presented UF rates lower than the subgroup treated with budesonide. Except for two cases, the ACTH test performed in the AG had normal adrenocortical responses. CONCLUSION 1) We established the normal values for UFC excretion in our pediatric population. 2) The long term asthma treatment with glucocorticoids at mean doses of 650 micrograms l/m2/day decrease physiologically the UFC excretion since the adrenocortical response remains within the normal range.
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López de Munain A, Cobo AM, Poza JJ, Navarrete D, Martorell L, Palau F, Emparanza JI, Baiget M. Influence of the sex of the transmitting grandparent in congenital myotonic dystrophy. J Med Genet 1995; 32:689-91. [PMID: 8544186 PMCID: PMC1051667 DOI: 10.1136/jmg.32.9.689] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To analyse the influence of the sex of the transmitting grandparents on the occurrence of the congenital form of myotonic dystrophy (CDM), we have studied complete three generation pedigrees of 49 CDM cases, analysing: (1) the sex distribution in the grandparents' generation, and (2) the intergenerational amplification of the CTG repeat, measured in its absolute and relative values, between grandparents and the mothers of CDM patients and between the latter and their CDM children. The mean relative intergenerational increase in the 32 grandparent-mother pairs was significantly greater than in the 56 mother-CDM pairs (Mann-Whitney U test, p < 0.001). The mean expansion of the grandfathers (103 CTG repeats) was also significantly different from that seen in the grandmothers' group (154 CTG repeats) (Mann-Whitney U test, p < 0.01). This excess of non-manifesting males between the CDM grandparents' generation with a smaller CTG length than the grandmothers could suggest that the premutation has to be transmitted by a male to reach the degree of instability responsible for subsequent intergenerational CTG expansions without size constraints characteristic of the CDM range.
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Affiliation(s)
- A López de Munain
- Neurology Department, Hospital Ntra Sra de Aránzazu, San Sebastián, Basque Country, Spain
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García-Bengoechea M, Emparanza JI, Sarriugarte A, Cortés A, Vega JL, González F, Arenas JI. Antibodies to hepatitis C virus: a cross-sectional study in patients attending a trauma unit or admitted to hospital for elective surgery. Eur J Gastroenterol Hepatol 1995; 7:237-41. [PMID: 7538032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To assess the prevalence of hepatitis C virus (HCV) antibodies in patients attending a trauma unit or admitted to hospital for elective surgery, and to identify risk factors for acquiring HCV infection. DESIGN A cross-sectional study. SETTING The emergency room of a Department of Orthopaedic Surgery and a hospital for elective (non-digestive) surgery. PATIENTS A study population of 1824 subjects (mean age 40.1 +/- 18.1 years) and sera from a control group of 4703 blood donors giving their first donation. INTERVENTIONS Serum samples were screened for HCV antibodies by second-generation enzyme-linked immunosorbent assays and recombinant immunoblot assays. MAIN OUTCOME MEASURES HCV serostatus and the relationship between anti-HCV-positivity and age, intravenous drug use, tattoos, blood transfusion, a history of hepatitis and exposure to a contact who had had hepatitis. RESULTS The overall prevalence of anti-HCV antibodies was 2.85% in the study population and 0.5% among blood donors (chi 2 = 64.5; P < 0.0001). Anti-HCV-positivity was more common in men (3.8 versus 1.9%; P < 0.05) and in subjects with history of hepatitis (13.5 versus 2.0%; P < 0.001), exposure to a contact who had had hepatitis (12.5 versus 1.9%; P < 0.001), blood transfusion (7.8 versus 2.3%; P < 0.001), tattoos (36 versus 2.4%; P < 0.001) and intravenous drug use (85.7 versus 1.9%; P < 0.001). However, one third of subjects had no risk factors for HCV infection. The logistic regression analysis confirmed a statistically significant association (P < 0.05) between anti-HCV-positivity and intravenous drug use, tattoos, blood transfusion, a history of hepatitis and exposure to a contact who had had hepatitis. CONCLUSIONS These results show almost a five-fold higher prevalence of anti-HCV among patients attending a trauma unit or admitted to hospital for elective surgery than among blood donors.
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Affiliation(s)
- M García-Bengoechea
- Department of Gastroenterology, Hospital Nuestra Señora de Aránzazu, San Sebastián, Spain
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Cobo AM, Poza JJ, Martorell L, López de Munain A, Emparanza JI, Baiget M. Contribution of molecular analyses to the estimation of the risk of congenital myotonic dystrophy. J Med Genet 1995; 32:105-8. [PMID: 7760317 PMCID: PMC1050229 DOI: 10.1136/jmg.32.2.105] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A molecular analysis of the maternal and child CTG repeat size and intergenerational amplification was performed in order to estimate the risk of having a child with congenital myotonic dystrophy (CMD). In a study of 124 affected mother-child pairs (42 mother-CMD and 82 mother-non-CMD) the mean maternal CTG allele in CMD cases was three times higher (700 repeats) than in non-CMD cases (236 repeats). When the maternal allele was in the 50-300 repeats range, 90% of children were non-CMD. In contrast, when the maternal allele was greater than 300 repeats, 59% inherited the congenital form. Furthermore, the risk of having a CMD child is also related to the intergenerational amplification, which was significantly greater in the mother-CMD pairs than in the mother-non-CMD pairs. Although the risk of giving birth to a CMD child always exists for affected mothers, our data show that such a risk is considerably higher if the maternal allele is greater than 300 repeats.
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Affiliation(s)
- A M Cobo
- Neurology Department, Hospital Ntra Sra de Aránzazu, Basque Country, Spain
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Soto B, Rodrigo L, Garcia-Bengoechea M, Sanchez-Quijano A, Riestra S, Arenas JI, Andreu J, Rodriguez M, Emparanza JI, Torres Y. Heterosexual transmission of hepatitis C virus and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 423 pairings. J Intern Med 1994; 236:515-9. [PMID: 7964427 DOI: 10.1111/j.1365-2796.1994.tb00838.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To define the role that sexual transmission plays in the spread of hepatitis C virus (HCV) infection, and to examine the influence of coexistent human immunodeficiency virus (HIV) infection on this mode of transmission. DESIGN A multicentre, seroprevalence study of anti-HCV performed in the stable heterosexual partners (SHP) of index cases reactive for anti-HCV. SETTING Department of Internal Medicine and Section of Gastroenterology of three University Hospitals, Spain. SUBJECTS A total of 423 stable heterosexual partners of index cases reactive for anti-HCV. This included a group of 142 intravenous drug users (IVDU), 120 of whom were coinfected with HIV. Additionally, 2886 first-time voluntary blood donors selected at random were included to compare the prevalence of anti-HCV. MAIN OUTCOME MEASURES Serum samples were screened for anti-HCV by a commercially available, second-generation enzyme-linked immunoassay. Tests repeatedly reactive for anti-HCV were analysed by a four-antigen, recombinant immunoblot assay. Anti-HIV was tested by enzyme immunoassay and Western blot was used for confirmation of positive cases. RESULTS The prevalence of anti-HCV, was 7.1% in SHP and 1.2% in random donors (P < 0.001). This prevalence was higher in SHP of index cases coinfected with HIV in comparison with that shown in the SHP of index cases only reactive for the anti-HCV (9.1 vs. 6.3%; P = 0.2), particularly when a younger and more homogeneous group such as the SHP of IVDU index cases was considered alone (9.2 vs. 0%; P = 0.1). However, the SHP of IVDU index cases coinfected with HIV were almost three times more likely to be infected with HIV than HCV (24.2 vs. 9.2%). CONCLUSIONS These data suggest that HCV infection may be sexually transmitted but with low efficiency, and this could be increased in the presence of coexistent HIV infection in the index case.
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Affiliation(s)
- B Soto
- Viral Hepatitis and AIDS Study Group, Virgen del Rocio University Hospital, Seville, Spain
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López de Munain A, Blanco A, Emparanza JI, Martí Massó JF, Cobo A, Basauri B, Martorell L, Baiget M, Martínez Lage JM. Anticipation in myotonic dystrophy: a parental-sex-related phenomenon. Neuroepidemiology 1994; 13:75-8. [PMID: 8190210 DOI: 10.1159/000110362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We report anticipation in an extensive sample of myotonic dystrophy (MyD) kindreds taken from an epidemiological survey recently conducted in Guipúzcoa, Spain. Analysis of the parent-child pairs ascertained showed a mean anticipation of 2.86 decades (range 0-6). Greater anticipation occurred when the transmissor parent was the mother. These results suggest a possible sex-related effect in the transmission of the MyD gene, and are in agreement with recent discoveries at the molecular level.
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Affiliation(s)
- A López de Munain
- Department of Neurology, Hospital Ntra. Sra de Aránzazu, San Sebastián, Guipúzcoa, Spain
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García-Bengoechea M, Cortés A, López P, Vega JL, Emparanza JI, Sarriugarte A, Santos E, Arenas JI. Intrafamilial spread of hepatitis C virus infection. Scand J Infect Dis 1994; 26:15-8. [PMID: 7514809 DOI: 10.3109/00365549409008584] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We assessed the prevalence of antibodies to hepatitis C virus (anti-HCV) among 401 household contacts of 161 persons with chronic hepatitis C (index patients). None of the index patients had antibodies against HIV. The overall prevalence of anti-HCV was 3.2% (2.5% in the absence of previous parenteral exposure). Sexual partners had a seroprevalence of 4.7% and non-sexual contacts, 2.5%. Among non-sexual contacts, parents showed the highest rate (4.2%). The mean duration of exposure in the anti-HCV-positive sexual partners was 17.3 +/- 8.5 years, vis-à-vis 9.2 +/- 7.4 years in the anti-HCV-negative sexual partners. We conclude that there is little risk of HCV infection through household contact. Although the form of transmission is not well identified, the duration of sexual activity suggests that the time needed to become infected is long.
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Affiliation(s)
- M García-Bengoechea
- Service of Gastroenterology, Hospital Nuestra Señora de Aránzazu, San Sebastián, Basque Country, Spain
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García Bengoechea M, Emparanza JI, González F, Arenas JI. [The control group and the groups with risk of hepatitis C]. Med Clin (Barc) 1993; 101:795. [PMID: 8114542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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López de Munain A, Blanco A, Emparanza JI, Poza JJ, Martí Massó JF, Cobo A, Martorell L, Baiget M, Martínez Lage JM. Prevalence of myotonic dystrophy in Guipúzcoa (Basque Country, Spain). Neurology 1993; 43:1573-6. [PMID: 8351014 DOI: 10.1212/wnl.43.8.1573] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Prevalence figures for inherited neuromuscular disorders are important both for health care planning purposes and for evaluating the need for DNA diagnostic services for eugenic approaches. We screened for the prevalence of myotonic dystrophy (MyD) through extensive inquiry of neurologic and primary health services of Guipúzcoa (Basque Country, northern Spain) between 1989 and 1991. Typical adult-onset and neonatal cases and relatives at risk; suffering from a partial syndrome, were included. In the latter, molecular typing was performed with DNA probes close to the MyD gene to demonstrate the MyD gene carrier status. The high prevalence detected (26.5 cases per 100,000 population) could be explained by methodological factors, but intrinsic factors, such as a possible founder genetic effect or the quick growth of the Guipúzcoa population since the last century may contribute to one of the highest MyD prevalence in the world. In the future, the methodological basis for epidemiologic surveys of MyD must combine molecular technology with more-extensive family inquiries.
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Affiliation(s)
- A López de Munain
- Department of Neurology, Hospital Ntra. Sra. de Aránzazu, San Sebastián, Spain
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