Randomized trial of a multidisciplinary lifestyle intervention in HIV-infected patients with moderate-high cardiovascular risk

OBJECTIVE

To assess the impact of a multidisciplinary lifestyle intervention on cardiovascular risk and carotid intima-media thickness (c-IMT) in HIV-infected patients with Framingham scores (FS) > 10%.

DESIGN

Randomized pilot study; follow-up 36 months.

METHODS

Virologically suppressed adult HIV-1-infected patients with FS >10% were randomized 1:1 to the intervention group (multidisciplinary lifestyle intervention) or control group (routine care). At baseline and months 12, 24 and 36, lipid parameters were analyzed and carotid ultrasound was performed to determine c-IMT and presence of plaques. Biomarkers were measured at baseline and month 36. The primary endpoints were lipid and FS changes at 36 months.

RESULTS

Fifty-four patients were included, 27 in each arm. Median age was 50.5 years, all patients but one were men, and FS was 16.5%. Relative to controls, total and LDL cholesterol had significantly decreased in the intervention group at 24 months (p = 0.039, p = 0.011, respectively). However, no differences between groups were found at month 36 in lipid variables, neither in FS. Tobacco use decreased in the intervention group (p = 0.031). At baseline, 74.5% of patients had subclinical atherosclerosis, and at month 36, we observed a progression in c-IMT that was greater in the intervention group (p = 0.030). D-dimer increased (p = 0.027) and soluble intercellular adhesion molecule-1 decreased (p = 0.018) at 36 months.

CONCLUSIONS

In this cohort of HIV-infected patients with FS>10% and a high percentage of subclinical atherosclerosis, a multidisciplinary lifestyle intervention resulted in a slight improvement in some cardiovascular risk factors and the FS during the first 2 years, but did not prevent c-IMT progression.

Timing of hepatitis B vaccination: its effect on vaccine response in health care workers

We assessed the effect of timing and other biological variables on immune response among health care workers (HCW) vaccinated with hepatitis B vaccine. A total of 2.058 HCW received three doses and were tested for anti-HBs within 6 months. 92.2% of the HCW had evidence of seroprotection. Multivariable analysis showed that controlling for age, the estimated non-response OR associated with a delayed second dose was 2.16 (95% CI: 1.46, 3.18, p=0.004). We found a decreasing response rate with increasing age. Particular attention should be given to those HCW who are late for the second vaccine dose and to older subjects.

Prognostic factors for tobacco consumption reduction after relapse

INTRODUCTION

It is not properly estimated the cigarette consumption after a relapse compared with the consumption before a smoking cessation therapy. The aim of this study was to know if tobacco consumption among relapsed smokers that visited a smoking cessation unit is higher or lower than consumption preceding dishabituation therapy and the related factors to this consumption change.

SUBJECTS AND METHODS

1,516 smokers who received a multicomponent program for smoking cessation have been studied. The percentage of reduction after the relapse in relation to previous consumption and the consumption difference with regard to basal variables among 994 relapsed smokers has been calculated. A logistic regression model was used in order to analyze the predictors to reduce more than 50% of previous cigarette consumption.

RESULTS

Relapsed patients smoked 20.4% less than before the smoking cessation therapy. Smokers with chronic obstructive pulmonary disease, and with the age of 50 years or more, had the highest rate of reduction consumption. The best predictors for cigarette reduction were those of low nicotine dependence and being heavy smokers.

CONCLUSIONS

Heavy smokers or low nicotine dependence smokers have a higher probability to reduce their cigarette consumption. Other predictor variables are age of more than 50 years, high previous consumption or previous abstinence period of more than 6 months.

Optical coherence tomography analysis of a randomized study combining photodynamic therapy with intravitreal triamcinolone

BACKGROUND

The objective of the study was to analyze optical coherence tomography (OCT) scan differences between patients with predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with only photodynamic therapy (PDT) and patients treated with PDT combined with intravitreal triamcinolone acetonide (IVTA).

METHODS

In this prospective study, 61 patients were randomized to receive PDT (n = 30) or PDT combined with IVTA (n = 31). They were evaluated every 3 months with a refraction protocol for best-corrected visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, fluorescein angiography (FA), and OCT. When measuring foveal thickness on OCT scans, neuroretinal foveal thickness (NFT) was differentiated from outer high reflectivity band thickness (OHRBT). The main outcome measures were mean change in OCT measurements and correlation of VA and angiographic area of the lesion with OCT measurements.

RESULTS

At the 12-month follow-up, the mean change in NFT was not significantly reduced (P = 0.9), but the mean change in OHRBT was significantly lower (P = 0.004) in the group of patients who received combined therapy. There was no correlation between final VA and NFT in either patient group (P = 0.2). The final VA was significantly worse in eyes with a thicker OHRBT (P = 0.04) in the group of patients treated with only PDT. There was no correlation between angiographic area and NFT and OHRBT in either patient group (P > 0.3). There was a statistically significant difference between the pre-treatment angiographic area of the lesion and VA at the 12-month follow-up in the combined therapy group (P = 0.01), and more eyes treated with only PDT presented with intraretinal fluid at the last follow-up (P = 0.01).

CONCLUSION

Combined PDT+IVTA therapy was more effective than PDT alone at reducing OHRBT. This OCT measurement seems to be have a greater effect on VA than NFT.

Effects of partner smoking status and gender on long term abstinence rates of patients receiving smoking cessation treatment

AIMS

To assess the effect of partner smoking status on the success of a cessation program.

DESIGN

Prospective cohort.

SETTING

Smoking Cessation Unit in Hospital of Bellvitge (Hospitalet de Llobregat, Barcelona).

PARTICIPANTS

A total of 1516 smokers of 10 or more cigarettes who started a smoking cessation program between January 1995 and December 2001 were included.

MEASUREMENTS

All patients gave information about smoking history and smoking partner status. Abstinence was determined by carbon monoxide exhaled.

FINDINGS

Significant differences were found in the abstinence rates at 12 months by smoking partner status: abstinence was achieved by 28.3% of patients with smoking partner, and by 46.5% of patients without smoking partner (p<0.001). Subjects whose partner was smoking at the beginning of the program appear to be more likely to relapse than subjects without smoking partners (p<0.001) and this is more pronounced in women than in men. However no significant gender differences were found in any group of smoking partner status.

CONCLUSIONS

Having a smoking partner is a determinant of relapse 1 year after the beginning of the cessation program. Interacting not just with the smoker, but also with his or her partner, could neutralize interpersonal influences making smokers more accessible to behavioural and pharmacological techniques.

Photodynamic Therapy with Intravitreal Triamcinolone in Predominantly Classic Choroidal NeovascularizationOne-Year Results of a Randomized Study

PURPOSE

To determine whether intravitreal triamcinolone acetonide (IVTA) improves the efficacy of photodynamic therapy (PDT) with verteporfin in predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

DESIGN

Prospective randomized study.

PARTICIPANTS

Sixty-one patients with predominantly classic subfoveal CNV secondary to AMD.

METHODS

Patients were randomized to receive PDT (n = 30) or PDT followed by approximately 11 mg IVTA (n = 31), with retreatment every 3 months when leakage was documented by fluorescein angiography. At baseline and each follow-up visit, best-corrected visual acuity (VA) was measured with Early Treatment Diabetic Retinopathy Study charts by a certified examiner masked to the patient's treatment, lesion size on fluorescein angiography, and foveal thickness on optical coherence tomography.

MAIN OUTCOME MEASURES

Mean change in VA (logarithm of the minimum angle of resolution [logMAR]) from baseline, percentage of patients losing fewer than 15 letters (3 lines) of VA, mean change in lesion size, mean change in foveal thickness, and retreatment rate.

RESULTS

At the 12-month follow-up, VA (mean logMAR change from baseline) was significantly better (P = 0.001) in the group of patients who received combined therapy. Seventy-four percent of patients treated with combined therapy compared with 61% treated with verteporfin alone lost fewer than 15 letters of VA (P = 0.78). Reduction in lesion size (P = 0.001) and in foveal thickness (P = 0.03) was significantly greater with combined therapy than with verteporfin. Retreatment rate was significantly lower (P = 0.04) in the combined therapy group. Triamcinolone-related adverse events included glaucoma (25.8%) and cataract progression (32%).

CONCLUSIONS

Combined PDT and IVTA therapy seemed to be more effective than PDT alone for managing predominantly classic subfoveal lesions secondary to AMD. The triamcinolone-related adverse events included glaucoma and cataract progression.

Functional outcomes of elderly patients after the first hospital admission for decompensated heart failure (HF)

Congestive HF is one of the most common discharge medical diagnoses in elderly hospitalized patients. We evaluate prospectively the usefulness of a global geriatric assessment to identify changes in the functional status of patients who experience their first hospitalization for a new diagnosis of HF. The Barthel Index (BI), the Older Americans Resource Scale (OARS), the Short Portable Mental Status Questionnaire (SPMSQ), and the short form of the Mini Nutritional Assessment (short-MNA) were used to estimate functional, cognitive, and nutritional status. The Charlson score (CS) was used to measure comorbidity. Eighty-eight patients (mean age 79 years; 57% women) were finally included; their median CS score was 2.1. Prior to the index admission, their mean BI score was 91, OARS 9.8, SPMSQ 1.8 errors, and short-MNA 10.7. Twenty-four patients (27%) died during the first year of follow-up. Low preadmission BI scores were predictive of mortality (p=0.02), but not of readmission (p=0.9). After one-year of follow-up BI scores remained lower than preadmission values in 64% of the surviving patients; for OARS scores the figure was 67%. In conclusion, a previous low functional capacity is associated with higher mortality but not with HF-related hospital readmission. Admission because of a new onset HF is often followed by a sustained functional decline both for the performance of basic and instrumental activities of the daily living.

Social class, education, and smoking cessation: Long-term follow-up of patients treated at a smoking cessation unit

Our objective was to examine social class and educational differences in long-term smoking cessation success among a cohort of smokers attending a specialized smoking clinic. We studied sustained abstinence after cessation among 1,516 smokers (895 men and 621 women) treated for smoking cessation between 1995 and 2001 at a university teaching hospital in the metropolitan area of Barcelona, Spain. We calculated 1-year and long-term (up to 8-year) abstinence probabilities by means of Kaplan-Meier curves and the hazard ratio of relapse by means of Cox regression, after adjusting for other predictors of relapse. Overall abstinence probability was .277 (95% CI = .254-.301). Men and women in social classes IV-V had significant hazard ratios of relapse after long-term follow-up (men: 1.36, 95% CI = 1.07-1.72; women: 1.60, 95% CI = 1.24-2.06), as compared with patients in social classes I-II. The same independent effect was observed for education: Men and women with primary or less than primary studies had higher hazard ratios of relapse (men: 1.75, 95% CI = 1.35-2.25; women: 1.92, 95% CI = 1.51-2.46), as compared with patients with a university degree. Similar estimates were obtained after adjustment for stage of change, Fagerström score for nicotine dependence, and type of treatment. Patients of lower socioeconomic status are at higher risk of relapse, and this association is independent of other well-known predictors of relapse. Social differences have to be taken into account in the clinical setting when tailoring specific actions to treat smoking dependence.

Factores favorecedores de la aparición de cuadro confusional agudo en pacientes mayores de 84 años con fractura de fémur

BACKGROUND AND OBJECTIVE

Our objective was to analyze those factors predisposing to delirium in patients older than 84 years who were admitted because of hip fracture. We also compared the prevalence of delirium in this population with a younger group.

PATIENTS AND METHOD

One hundred and thirty patients (mean age 91.8 years) and 50 controls aged 65 to 84 years were included.

RESULTS

Forty-three patients (33%) developed delirium. A poor previous functional capacity was the best marker identifying those at risk for developing delirium. Although the prevalence of delirium was higher in those older than 84 years, statistically significant differences were not reached.

CONCLUSIONS

Disability prior to admission is the main risk factor predisposing to delirium during hospitalization in patients older than 84 years who are admitted because of hip fracture.

A comparison of five questionnaires to assess alcohol consumption in a Mediterranean population

OBJECTIVE

To evaluate the reliability of alcohol consumption measured by five different dietary methods in the Catalan Nutrition Survey (1992-1993).

DESIGN

The different questionnaires used were: (1) two 7-day food records, (2) five items addressing alcoholic beverages in a 76-item food-frequency questionnaire, (3) a 1-week recall of 13 alcoholic beverages, (4) a 13-item alcoholic beverages frequency questionnaire and (5) two 24-hour recalls.

SUBJECTS

Ninety-three of the 120 adults (aged 20 to 70 years) initially recruited completed the questionnaires and provided a peripheral blood sample.

RESULTS

Mean daily alcohol intakes as assessed by the questionnaires were very similar. Beer was the alcoholic beverage most frequently consumed, followed by wine and liquor. Eighty-two per cent of the study population consumed less than 20 g of alcohol per day. No biochemical parameters were significantly correlated with alcohol intake estimated from the questionnaires.

CONCLUSIONS

We found a satisfactory level of reproducibility and validity in the pattern of alcohol consumption across different levels and types of alcoholic beverage intake. We also found that the self-administered 13-item questionnaire and the 1-week recall were the best techniques to measure moderate or low alcohol consumption, suggesting that the two methods are the most suitable to assess overall alcohol intake in the general population.

[Prevalence of malnutrition in the elderly Spanish population]

BACKGROUND

Malnutrition in elderly has become an important problem of health, and is associated with an increase of morbidity and mortality in this age group. The aim of this study was to determine the prevalence of malnutrition in the Spanish institutionalized and living home elderly people.

SUBJECTS AND METHOD

A sample of 3,460 representative Spanish subjects older than 65 years old were studied (response rate of 96%). Nutritional status was gathered by Mini Nutritional Assessment questionnaire.

RESULTS

The prevalence of malnutrition was 3,3% among elderly living at home and 7,7% among institutionalized people. Malnutrition was more prevalent in women and people with a lower income. Increase of malnutrition with age was observed.

CONCLUSIONS

The observed prevalence of malnutrition in Spanish non-institutionalized elderly people was similar to observed in another populations. Sex, age and income were associated with a risk of malnutrition

Nutritional status in patients with rheumatoid arthritis

BACKGROUND

Some chronic diseases have been associated to an impairment of nutritional status.

OBJECTIVE

To analyze nutritional status and its relation to dietary intake, disease activity and treatment in rheumatoid arthritis.

PATIENTS AND METHODS

We have included 93 patients (43 men and 50 women) and 93 age- and sex-matched healthy controls. The assessment of nutritional status included anthropometric (body mass index, tricipital skin fold and midarm muscular circumference) and biochemical (serum albumin, prealbumin and retinol binding protein) parameters. Dietary intake was calculated from a food frequency questionnaire. As a measure of disease activity, we used the Health Assessment Questionnaire, Ritchie index, tender and swollen joint count and C-reactive protein. Statistical analysis was performed in the whole series and in every functional class.

RESULTS

In the whole series, midarm muscular circumference and serum albumin were significantly lower in patients than in controls. All anthropometric parameters and serum albumin were significantly lower in patients in functional class IV than in their respective controls. The dietary intake of energy, carbohydrates, vegetal proteins and lipids was higher in patients than in controls. Midarm muscular circumference and serum albumin had a significant inverse relation with disease activity parameters; body mass index, midarm muscular circumference and serum albumin correlated inversely with the cumulative dose of glucocorticoids.

CONCLUSIONS

Patients with rheumatoid arthritis in functional class IV have an impairment of nutritional status without a deficient dietary intake. The differences found in other functional classes are explained by rheumatoid arthritis itself. Nutritional parameters are related to disease activity and glucocorticoid treatment.

The impact of donor age on liver transplantation: influence of donor age on early liver function and on subsequent patient and graft survival

BACKGROUND

The urgent need to increase the organ donor pool has led to the expansion of criteria for donor selection. The aim of this study was to analyze the influence of donor age on early graft function, subsequent graft loss, and mortality after liver transplantation (LT).

METHODS

Data on LT were evaluated retrospectively in a population-based cohort of 400 LTs in 348 patients. Of these, 21 (5%) were from donors >70 years old. Pretransplantation donor and recipient characteristics and the evolution of recipients were analyzed. The influence of donor age as a risk factor was assessed using univariate and multivariate analyses.

RESULTS

Actuarial graft survival was 89% at 1 month after LT, 81% after 6 months, and 59% after 60 months. Multivariate analysis demonstrated that only donor age (>70 years old) was associated with a higher risk of long-term graft loss (relative risk [RR]=1.4, 95% confidence interval [CI]=1-1.9; P=0.03) and mortality (RR=1.7, 95% CI=1.2-2.3; P=0.01). Graft survival of septuagenarian livers was 80% at 1 month after LT, 56% after 6 months, and 25% after 54 months. Actuarial survival analysis (Kaplan-Meier curves) also demonstrated worse evolution in recipients of livers from old donors (log-rank test, P<0.001).

CONCLUSIONS

Advanced donor age is associated with lower graft and recipient survival.

[Food consumption and nutrient intake in relation to smoking]

BACKGROUND

It is well known that smoking and some nutritional habits are two of the most important risk factors for the development of certain cancers and cardiovascular diseases. The purpose of this study is to assess the food and nutrient consumption in relation to smoking in the Catalan population, Spain.

SUBJECTS AND METHOD

A representative sample of the Catalan population of 1774 people aged 18 to 64 years from both sexes. Nutritional status was evaluated using selected anthropometrical indexes, and food consumption with two 24-hour recall. Questionnaires about smoking consumption and a semiquantitative frequency questionnaire about alcohol consumption were also administered.

RESULTS

Male non smokers consumed more dairy products than smokers, and more fruits and nuts than smokers and ex-smokers. Female non-smokers consumed more chicken, fruits and less sweets than smokers and ex-smokers. In both genders, smokers consumed more alcohol. With respect to nutrients, smokers consumed less fiber than non smokers and more energy from lipids and saturated and monounsaturated fatty acids.

CONCLUSIONS

The diet of smokers is less healthy than that of non smokers and ex-smokers, which indicates a higher risk for the incidence of certain cancers and cardiovascular diseases.

Dietary fat intake and prostate cancer risk: a case-control study in Spain

OBJECTIVES

Epidemiological evidence suggests that dietary factors can play a role in the etiology of prostate cancer. Results from several case-control and cohort studies on nutrient intake and prostate cancer have been unclear. The authors examined the effect of lipid intake on the risk of prostate cancer.

METHODS

In order to assess associations between lipid intake and prostate cancer risk, a case-control study was conducted between May 1994 and March 1998 in the Barcelona metropolitan area, Spain. Two hundred seventeen incident cases with histologically confirmed diagnosis of prostate cancer were matched to 434 hospital and community controls by age and residence. Information about food intake was gathered by a semiquantitative food-frequency questionnaire. Unconditional logistic regression was used for the analysis.

RESULTS AND CONCLUSIONS

Animal fat intake was associated with prostate cancer with an estimated OR for highest quartile of 2.0 (95% CI 1.2-3.2). Vitamin C intake was inversely associated with prostate cancer (OR = 0.6; 95% CI 0.3-0.9). The prostate cancer risk increased in proportion to alpha-linolenic acid intake. In the analysis adjusting for energy and major covariables the estimated OR for upper quartile of alpha-linolenic acid was 3.1 (95% CI 1.1-3.8). In conclusion, the association between fat intake and prostate cancer may be correlated with alpha-linolenic acid, although the specific mechanism has to be determined.

Secretion and dual regulation between epidermal growth factor and transforming growth factor-beta1 in MDA-MB-231 cell line in 42-hour-long cultures

MDA-MB-231 is a breast cancer cell line which possesses large quantities of epidermal growth factor (EGF) receptors and specific high-affinity transforming growth factor-beta1 (TGF-beta1) receptors. We have established that these cells secrete constitutively measurable levels of EGF and TGF-beta1 in conditioned medium. The constitutive secretion of EGF decreased over time in culture (42 h), while the constitutive secretion of TGF-beta1 remained constant. TGF-beta1 secretion in EGF-treated cells was lower than in controls (P < 0.0001), but EGF concentrations were not modified after TGF-beta1 supplement. We postulate that in MDA-MB-231 cell line there is a dual regulation between both growth factors.

Analysis of the discontinuation of protease inhibitor therapy in routine clinical practice

We evaluated the frequency of and reasons for discontinuation of protease inhibitor therapy in a cohort of HIV-infected patients in a prospective observational study. We included 230 HIV-infected patients who had started protease inhibitor therapy between November 1996 and July 1997. Mean baseline CD4 count was 138 cells/microl and HIV-RNA 4.5 log10. Forty-five percent of patients had prior AIDS and 77% had been treated with nucleoside analogues. Saquinavir-treated patients were at a less advanced stage of HIV disease. Overall, 41.3% of patients discontinued therapy, and their last HIV-RNA measured higher than that of patients who continued therapy: 4.07 vs. 2.70 log10 (p < 0.0001). Reasons for discontinuation of therapy were poor adherence (including abandonment) (18.6%), drug intolerance (12.1%), virological failure (7%) and physician decision (3.5%). In a multivariate model, factors associated with drug discontinuation were not taking indinavir (OR 0.26, 95% CI 0.12-0.59) and being pretreated with nucleoside analogues (OR 3.42, 95% CI 1.58-7.42). We concluded that in routine clinical practice a high proportion of patients discontinued protease inhibitors during the first 6 months of therapy, the main reason being the patient's own decision (abandonment or poor adherence). Psychological support and counselling are warranted in patients when initiating protease inhibitor therapy.

Growth of MDA-MB-231 cell line: different effects of TGF-beta(1), EGF and estradiol depending on the length of exposure

The human cell line MDA-MB-231 is a prototype for the study of hormone-independent breast cancer. Modification of cell growth behaviour has been observed after treating these cells with growth factors. EGF is a typical stimulatory growth factor for many cell types, whereas transforming growth factor beta(1)(TGF-beta(1)) acts with inhibitory character. Here we observed cell growth inhibition after EGF as well as after TGF-beta(1)treatments. Nevertheless, in the 42-h experiments, EGF-treated cultures grew before (18 hours) respect to the TGF-beta(1)and E(2)-treated cultures (24 h), and in the 11-day experiments, EGF-treated cultures started growing (7 days) after TGF-beta(1)-treated cultures (5 days). Estradiol inhibited the proliferation of these cells only after several days of treatment.

Compliance with dietary guidelines in the Spanish population. Results from the Catalan Nutrition Survey

The aim of the present study was to analyse the different food and nutrition profiles of the section of the Spanish population having either a low or a high intake of energy, fat, saturated fatty acids (SFA) and fibre in order to analyse the compliance with dietary guidelines. Analyses were made from the Catalan Nutrition Survey, comprising a random sample of 1600 people aged 18 to 60. Dietary information was obtained by means of two 24 h recall, and food and energy intake was categorized according to the quartiles of fat, SFA and fibre intake. The results show the food consumption patterns that distinguish low versus high fat, SFA and fibre eaters in the Spanish population, and facilitate the establishment of food-based dietary guidelines in Spain and other Mediterranean countries.

Ductal carcinoma in situ of the breast: correlation between histologic classifications and biologic markers

The expression of hormone receptors (estrogen and progesterone), c-erb-B2 (neu), p53, and Ki-67) was studied by immunohistochemical analysis in a series of 94 carcinomas in situ of the breast. The tumors were classified in two (high grade vs. low grade) and three (high grade vs. intermediate grade vs. low grade) categories. High-grade carcinomas were well defined by biologic markers showing statistically significant differences for all of the parameters tested. No clear biologic distinction, however, between low-grade and intermediate-grade cancers could be obtained. Negative progesterone receptors and a high proliferative index are the best discriminant parameters for the final assignment of doubtful cases.

Determinants of the nutritional status of vitamin E in a non-smoking Mediterranean population. Analysis of the effect of vitamin E intake, alcohol consumption and body mass index on the serum alpha-tocopherol concentration

OBJECTIVE

Study was conducted in order to investigate the association of vitamin E intake and other factors with plasma alpha-tocopherol concentration in a non-smoking Mediterranean population.

DESIGN

A cross-sectional study was conducted in a subsample of a representative sample of the Catalan population.

SUBJECTS

Sample size was 143 men and women, aged between 18 and 75 y, and final response rate reached 61.9% of the initial sample.

INTERVENTIONS

Serum alpha-tocopherol concentration standardized by serum total lipids was used as a proxy of the nutritional status of vitamin E. Vitamin E intake and alcohol consumption were estimated by a replicated 24 h recall method. Dietary data were collected in two different periods, winter and summer, in order to account for seasonal variation in nutrient intake, and were corrected for random within-person variability in order to account for day-to-day variation in nutrient intake. Multivariate linear regression models were fitted in order to estimate the determinants of serum alpha-tocopherol concentration.

RESULTS

In this population study, for each one mg increase in vitamin E intake, serum alpha-tocopherol concentration increased, on average, 0.66 micromol/L, after adjusting for age, gender, Body Mass Index (BMI), alcohol consumption and energy intake. BMI also influenced significantly serum alpha-tocopherol concentration, whereas alcohol intake, age and gender did not show significant associations with serum alpha-tocopherol.

CONCLUSIONS

The study showed that vitamin E nutritional status was associated to vitamin E intake and BMI in non-smokers.

Low-dose intramuscular revaccination against hepatitis B

Little research has been conducted on low booster doses in adults and only intradermal (i.d.) inoculation has been used with high rates of adverse reactions among subjects i.d. revaccinated. The present study compare a low intramuscular dose of recombinant hepatitis B vaccine with standard 20 micrograms revaccination. We studied 122 hospital workers 5 years after vaccination with recombinant hepatitis B vaccine who were randomly allocated to either the study group or control group. The study group received revaccination with 0.1 ml (2 micrograms) of recombinant hepatitis B vaccine and the control group 1.0 ml (20 micrograms). Two micrograms of i.m. vaccine was as effective as 20 micrograms i.m. in inducing antibody response and the antibody decrease after revaccination between groups was similar (P > 0.05) and independent of the initial concentration of anti-HBs after revaccination and dose (20 micrograms vs 2 micrograms). In conclusion, in subjects who had received a standard hepatitis B vaccination and had showed anti-HBs titres higher or equal than 10 mIU ml-1 after vaccination, low i.m. booster doses of vaccine give a rapid anamestic response similar to standard revaccination with less adversal reactions than low i.d. administered dose and would be an effective and less expensive alternative to revaccination against HBV of populations at high risk.

Age at first full-term pregnancy, lactation and parity and risk of breast cancer: a case-control study in Spain

A case-control study was carried out in Spain to assess associations between parity, lactation and age at first full-term pregnancy and breast cancer. From November 1989 to February 1992, 184 incident breast cancer histologically confirmed cases were interviewed and matched by age and residence to 184 hospitalized patients and 184 community controls selected by random digit dialing. Multiple logistic regression was used to assess the independent influence of each factor on the risk of breast cancer in relation to other factors included in the model. Age at first full-term pregnancy was associated with breast cancer risk with an estimated odds ratio of 3.5 (95% CI 1.41-9.83) for women with their first birth after 30 years in comparison with those whose first birth was before age 21. Breast cancer risk decreased with increasing number of full-term pregnancies, OR 0.3 (95% CI 0.16-0.78) for women who had had more than 3 full-term pregnancies in comparison with nulliparous women. Among parous women, the estimated OR for women with more than 3 children was 0.4 (95% CI 0.13-0.81) after allowance for age at first childbirth and lactation. The estimated OR was 2.6 (95% CI 1.4-4.7) for women with a positive history of breast cancer in first-degree relatives. Breast cancer was not associated with total duration of lactation. The study indicates that parity is an independent risk factor associated to breast cancer and that the women with a late age at first full-term pregnancy constitute a high-risk group.

Mortality trends and past and current dietary factors of breast cancer in Spain

Spain had one of the lowest breast cancer mortality (BCM) rates in Europe a decade ago but this is no longer the case. A study of the trends of breast cancer mortality in Spain during the last 30 years, and an analysis, at the ecological level, of the current and past dietary patterns associated with breast cancer mortality have been conducted. Age standardized rates and standardized mortality rates (SMR) for this period were calculated. Dietary information about 20 different groups of foods for the 50 Spanish provinces was obtained from two National Household Budget and Expenditure Surveys, conducted in 1964-1965 and 1980-1981. Simple correlation coefficients were calculated, and multiple regression (dependent variables: BCM and breast cancer SMR) with a stepwise procedure was performed. Trends of breast cancer mortality in Spain for the last 35 years indicated a 100% increase in the 35-64 years group. Results indicate important changes in food consumption patterns in Spain, departure from the traditional Spanish diet, and the association of breast cancer mortality with past (15 years period) consumption of beef and total meat and the current consumption of vegetable oils, among other features of interest. Past consumption of meat and particularly beef meat seems to be associated with current breast cancer mortality rates in Spain. However, results at ecological level need to be confirmed in individuals.

The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis

The aim of this study was to analyze the donor risk factors associated with second orthotopic liver transplantation (reOLT) and graft loss after OLT within 1 month. A total of 649 OLTs performed in 11 centers in Spain during the period from 1992 to 1993 were analyzed retrospectively. Eleven donor and recipient variables were studied. Biochemical evolution of the OLT, biliary and arterial complications, patient status (alive, retransplanted, or dead), and follow-up were also recorded. Bivariate study demonstrated that extended preservation ( > 12 hr) was associated with increased biliary complications (P = 0.02), and lower prothrombin time (P = 0.04). In a logistic model regression for biliary complications, ischemia > 12 hr was an independent risk factor (odds ratio = 2.2, 95% confidence interval [CI] = 1.1-4.3). The multivariate Cox proportional model of potential risk factors showed that only urgent reOLT (relative risk [RR] = 2.7, 95% CI = 1.4-5.4) was independently associated with higher 30-day mortality. Donor plasma sodium > 155 mmol/L (RR = 1.4, 95% CI = 1.0-2.2) and incompatible ABO graft (RR = 3.2, 95% CI = 1.3-7.9) were independently associated with increased rate of reOLT before 30 days. Donor plasma sodium > 155 mmol/L (RR = 2, 95% CI = 1.1-3.6) and incompatible graft (RR = 3.3, 95% CI = 1.4-8.2) were independently associated with graft loss (death or reOLT) before 1 month. We conclude that cold ischemia should be kept less than 12 hr in order to avoid biliary complications. Donors over 60 years old or with plasma sodium > 155 should be carefully evaluated before OLT.

Risk for occupational transmission of HIV infection among health care workers. Study in a Spanish hospital

The aim of this study was to evaluate the HIV seroconversion rate associated with different types of occupational exposures in health care workers. A longitudinal study was conducted from January 1986 to October 1992 in a teaching hospital in Spain, where HIV infection is prevalent among patients. Each health care worker was asked to complete a questionnaire regarding age, sex, staff category, lace of exposure, other exposures, type of exposure, body fluid, infected material and HIV status of source patient. These health care workers were then followed up at 6 weeks, 3 months, 6 months and 12 months with repeated test for HIV antibody. Four hundred twenty three reports of occupational exposure were analysed. Nursing was the profession with more exposures (42.8%). Ninety five percent of total exposures were percutaneous, 4% mucous membrane contacts and 1% skin contacts, 88.3% were described as blood contact and 71.8% had resulted from needlestick and suture needles. Exposures from HIV-positive patients comprised 23.2% of occupational exposures. There was a significant difference in the length of follow-up in physicians (p = 0.00009) and nurses (p = 0.00001), when we compared HIV-positive patients with patients in whom the HIV status was unknown or negative. The HIV seroconversion rate was 0.00%. We consider that the risk of acquiring HIV infection via contact with a patient is low, but not zero. Well documented cases of seroconversion have been published.(ABSTRACT TRUNCATED AT 250 WORDS)