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Jacques-Aviñó C, Alarcón Guitiérrez M, Barbera MJ, Fuertes I, Martin-Ezquerra G, Lopez-Contreras J, Vives Á, Rodriguez R, Ros M, Rius C, de Olalla PG. Epidemiological Characteristics and Factors Associated with Repeat Sexually Transmitted Infections in Barcelona, Spain Over a Decade. Arch Sex Behav 2024; 53:735-744. [PMID: 37875628 PMCID: PMC10844332 DOI: 10.1007/s10508-023-02711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023]
Abstract
In the last few years, the frequency of sexually transmitted infections (STI) has increased, as has the number of people with multiple infections. The aim of our study was to describe the epidemiological characteristics of persons with repeated bacterial STI and to determine the risk factors for these episodes in persons living in Barcelona during the period 2007-2018. We studied all cases of bacterial STI included in the STI registry of Barcelona. Repeated STI were defined as a diagnosis of gonorrhea, syphilis, or lymphogranuloma venereum (LGV) after a first episode of one of these infections. Analysis was stratified by sex and place of birth. The factors associated with time to reinfection were determined by Kaplan-Meier estimates, while the factors associated with risk of infection were determined by a Cox proportional hazards model. Of 9927 persons with a diagnosis of bacterial STI, 1690 (17.0%) had at least two episodes of STI during the study period. On multivariate analysis, repeat STI were independently associated with male sex assigned at birth (HR: 3.45; 95%CI 2.22-5.36), age less than 34 years (HR: 1.22; 95%CI 1.10-1.35); gay, bisexual, and other men who have sex with men, and transgender o transsexual woman (GBSMS/Trans) (HR: 4.03; 95%CI 3.24-5.03), having gonorrhea as first diagnosis (HR:1.49, 95%CI 1.34-1.66) or LGV (HR:1.75; 95%CI 1.47-2.08) and coinfection with HIV (HR:1.98; 95%CI 1.78-2.21). Sexual health programs should be strengthened to prevent STI and reinfection in key populations.
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Affiliation(s)
- Constanza Jacques-Aviñó
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Gran Via Corts Catalanes, 587, àtic, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), Bellaterra, Spain.
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.
| | - Miguel Alarcón Guitiérrez
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), Bellaterra, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - María Jesús Barbera
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Irene Fuertes
- Dermatology Department, Hospital Clinic, Barcelona, Spain
| | - Gemma Martin-Ezquerra
- Dermatology Department, Institut Hospital del Mar d'Investigacions Mèdiques, Hospital del Mar, Barcelona, Spain
| | - Joaquín Lopez-Contreras
- Infectious Diseases Unit-Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Raquel Rodriguez
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Miriam Ros
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Cristina Rius
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Patricia Garcia de Olalla
- Servei d'Epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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González-Safont L, Rebagliato M, Arregi A, Carrasco P, Guxens M, Vegas O, Julvez J, Estarlich M. Sleep problems at ages 8-9 and ADHD symptoms at ages 10-11: evidence in three cohorts from INMA study. Eur J Pediatr 2023; 182:5211-5222. [PMID: 37721582 PMCID: PMC10640481 DOI: 10.1007/s00431-023-05145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/18/2023] [Accepted: 07/30/2023] [Indexed: 09/19/2023]
Abstract
Sleep problems and attention deficit hyperactivity disorder (ADHD) are interrelated during childhood and preadolescence. The objective of this work is assessing if sleep problems at ages 8-9 represent an alarm sign for presenting ADHD problems at ages 10-11 in three cohorts from INMA Study. Participants were 1244 children from Gipuzkoa, Sabadell, and Valencia cohorts. Sleep problems were assessed (ages 8-9) with the sleep items of the Child's Behaviour Checklist (CBCL), and ADHD problems were collected through the Conner's Parent Rating Scales-Revised: Short Form (CPRS-R:S) (age 10-11). Minimally and fully adjusted negative binomial models were fitted for each CPRS-R:S scale. Linearity of the relationship was assessed with generalized additive models (cubic smoothing splines with 2, 3, and 4 knots). For sensitivity analyses, children with previous symptoms, those born preterm and small for gestational age, and cases with extreme values, were excluded. Sleep problems presented IRR (95% CI) of 1.14 (1.10-1.19), 1.20 (1.14-1.26), 1.18 (1.11-1.25), and 1.18 (1.13-1.23) for opposition, inattention, hyperactivity, and ADHD scales, respectively. Fully adjusted models slightly decreased the IRR, but the association remained similar and significant. Sensitivity analyses showed similar results to fully adjusted models with only hyperactivity shown a slight decrease on significance (p = 0.051) when ADHD cases at age 9 were excluded. Conclusion: Sleep problems are an alarm sign for later neurodevelopment problems such as ADHD. Healthcare systems could take advantage implementing policies to pay special attention on the sleep habits and sleep hygiene. This could contribute to add evidence to public health programmes such as the Healthy Child Programme.
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Affiliation(s)
- Llúcia González-Safont
- Nursing and Chiropody Faculty of Valencia University, Nineteenth of Menéndez Pelayo St., 46010, Valencia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain
| | - Marisa Rebagliato
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain
- Predepartamental Unit of Medicine of Universitat Jaume I, Faculty of Health Sciences of Jaume I University, Sos Baynat Av, 12071, Castelló, Spain
| | - Ane Arregi
- University of the Basque Country, UPV/EHU, 48940, Leioa, Spain
- Biodonostia Health Research Institute, Dr. Beguiristain Av, 20014, San Sebastian, Spain
| | - Paula Carrasco
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain.
- Predepartamental Unit of Medicine of Universitat Jaume I, Faculty of Health Sciences of Jaume I University, Sos Baynat Av, 12071, Castelló, Spain.
| | - Mònica Guxens
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- ISGlobal, Barcelona, Biomedical Research Park (PRBB), Eighty-Eighth Doctor Aiguader Av, 08003, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Oscar Vegas
- University of the Basque Country, UPV/EHU, 48940, Leioa, Spain
- Biodonostia Health Research Institute, Dr. Beguiristain Av, 20014, San Sebastian, Spain
| | - Jordi Julvez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- ISGlobal, Barcelona, Biomedical Research Park (PRBB), Eighty-Eighth Doctor Aiguader Av, 08003, Barcelona, Spain
| | - Marisa Estarlich
- Nursing and Chiropody Faculty of Valencia University, Nineteenth of Menéndez Pelayo St., 46010, Valencia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Fifth of Monforte Lemos St., 28029, Madrid, Spain
- JRU in Epidemiology, Environment and Health FISABIO-UJI-UV, Valencia, Spain
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Arias de la Torre J, Ronaldson A, Serrano-Blanco A, Martín V, Bellón JÁ, Valderas JM, Alonso J. Population health surveys and screening tools for depressive disorders: aims and uses. BMJ Ment Health 2023; 26:e300757. [PMID: 37364931 PMCID: PMC10577754 DOI: 10.1136/bmjment-2023-300757] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Jorge Arias de la Torre
- Care in Long Term Conditions Research Division, King's College London, London, UK
- CIBER Epidemiology and Public Health, CIBERESP, Barcelona, Spain
- Universidad de León, Leon, Spain
| | - Amy Ronaldson
- Health Services and Policy Research Department, King's College London, London, UK
| | - Antoni Serrano-Blanco
- CIBER Epidemiology and Public Health, CIBERESP, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Vicente Martín
- CIBER Epidemiology and Public Health, CIBERESP, Barcelona, Spain
- Universidad de León, Leon, Spain
| | - Juan Ángel Bellón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- Prevention and Health Promotion Research Network (redIAPP), Madrid, Spain
- Biomedical Research Institute of Málaga (IBIMA-Bionand platform), Malaga, Spain
- El Palo Health Centre, Andalusian Health Service (SAS), Málaga, Spain
- Department of Public Health and Psychiatry, Universidad de Malaga, Malaga, Spain
| | - Jose M Valderas
- Department of Medicine, National University of Singapore, Singapore
- Department of Family Medicine, National University Health System, Singapore
- Centre for Research in Health Systems Performance (CRiHSP), National University Health System, Singapore
| | - Jordi Alonso
- CIBER Epidemiology and Public Health, CIBERESP, Barcelona, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Dept. of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
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Arias de la Torre J, Ronaldson A, Alonso J, Dregan A, Mudway I, Valderas JM, Vineis P, Bakolis I. The relationship between air pollution and multimorbidity: Can two birds be killed with the same stone? Eur J Epidemiol 2023; 38:349-353. [PMID: 36645629 PMCID: PMC9841484 DOI: 10.1007/s10654-022-00955-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 01/17/2023]
Abstract
Air pollution and multimorbidity are two of the most important challenges for Public Health worldwide. Although there is a large body of evidence linking air pollution with the development of different single chronic conditions, the evidence about the relationship between air pollution and multimorbidity (the co-occurrence of multiple long-term conditions) is sparse. To obtain evidence about this relationship could be challenging and different aspects should be considered, such as its multifaceted and complex nature, the specific pollutants and their potential influence on health, their levels of exposure over time, or the data that could be used for its study. This evidence could be instrumental to inform the development of new recommendations and measures to reduce harmful levels of air pollutants, as means to prevent the development of multimorbidity and reduce its burden.
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Affiliation(s)
- Jorge Arias de la Torre
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Centre for Implementation Science, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK.
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Institute of Biomedicine (IBIOMED), University of Leon, Leon, Spain.
| | - Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Centre for Implementation Science, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Jordi Alonso
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medical and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Alex Dregan
- Psychological Medicine Department. Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Ian Mudway
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, London, UK
- NIHR-HPRU Environmental Exposures and Health, School of Public Health, Imperial College London, London, UK
| | - Jose M Valderas
- Centre for Research in Health Systems Performance, National University Health System, Singapore, Singapore
| | - Paolo Vineis
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, London, UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Centre for Implementation Science, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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5
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Humanes-Navarro AM, Herrador Z, Redondo L, Cruz I, Fernández-Martínez B. Estimating human leishmaniasis burden in Spain using the capture-recapture method, 2016-2017. PLoS One 2021; 16:e0259225. [PMID: 34714890 PMCID: PMC8555825 DOI: 10.1371/journal.pone.0259225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Leishmaniasis is endemic and a mandatory reporting disease in Spain since 1982. However, between 1996 and 2014, surveillance on public health was decentralized and only some autonomous regions monitored the disease. The aim of this study is to estimate the incidence of leishmaniasis and to evaluate the extent of underreporting in Spain. A capture-recapture (CRC) study was conducted to calculate the incidence of human leishmaniasis using reports from the National Surveillance Network (RENAVE) and the Hospital Discharge Records of the National Health System (CMBD) for 2016 and 2017. During the study period, 802 cases were reported to RENAVE and there were 1,149 incident hospitalizations related to leishmaniasis. The estimated incidence rates through the CRC study were 0.79 per 100,000 inhabitants for visceral leishmaniasis (VL), 0.88 (cutaneous leishmaniasis (CL)) and 0.12 (mucocutaneous leishmaniasis (MCL)) in 2016 and 0.86 (VL), 1.04 (CL) and 0.12 (MCL) in 2017. An underreporting of 14.7-20.2% for VL and 50.4-55.1% for CL was found. The CRC method has helped us to assess the sensitivity and representativeness of leishmaniasis surveillance in Spain, being a useful tool to assess whether the generalization of leishmaniasis surveillance throughout the Spanish territory achieves a reduction in underreporting.
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Affiliation(s)
| | - Zaida Herrador
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain
| | - Lidia Redondo
- Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain
- National Centre for Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Beatriz Fernández-Martínez
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Alemany S, Avella-García C, Liew Z, García-Esteban R, Inoue K, Cadman T, López-Vicente M, González L, Riaño Galán I, Andiarena A, Casas M, Margetaki K, Strandberg-Larsen K, Lawlor DA, El Marroun H, Tiemeier H, Iñiguez C, Tardón A, Santa-Marina L, Júlvez J, Porta D, Chatzi L, Sunyer J. Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts. Eur J Epidemiol 2021; 36:993-1004. [PMID: 34046850 PMCID: PMC8542535 DOI: 10.1007/s10654-021-00754-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/20/2021] [Indexed: 12/05/2022]
Abstract
The potential etiological role of early acetaminophen exposure on Autism Spectrum Conditions (ASC) and Attention-Deficit/Hyperactivity Disorder (ADHD) is inconclusive. We aimed to study this association in a collaborative study of six European population-based birth/child cohorts. A total of 73,881 mother-child pairs were included in the study. Prenatal and postnatal (up to 18 months) acetaminophen exposure was assessed through maternal questionnaires or interviews. ASC and ADHD symptoms were assessed at 4-12 years of age using validated instruments. Children were classified as having borderline/clinical symptoms using recommended cutoffs for each instrument. Hospital diagnoses were also available in one cohort. Analyses were adjusted for child and maternal characteristics along with indications for acetaminophen use. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis. The proportion of children having borderline/clinical symptoms ranged between 0.9 and 12.9% for ASC and between 1.2 and 12.2% for ADHD. Results indicated that children prenatally exposed to acetaminophen were 19% and 21% more likely to subsequently have borderline or clinical ASC (OR = 1.19, 95% CI 1.07-1.33) and ADHD symptoms (OR = 1.21, 95% CI 1.07-1.36) compared to non-exposed children. Boys and girls showed higher odds for ASC and ADHD symptoms after prenatal exposure, though these associations were slightly stronger among boys. Postnatal exposure to acetaminophen was not associated with ASC or ADHD symptoms. These results replicate previous work and support providing clear information to pregnant women and their partners about potential long-term risks of acetaminophen use.
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Affiliation(s)
- Silvia Alemany
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Claudia Avella-García
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Hospital Sagrat Cor, Martorell, Spain
| | - Zeyan Liew
- Departmen of Environmental Health Sciences, Yale School of Public Health, New Haven, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, USA
| | - Raquel García-Esteban
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kosuke Inoue
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Tim Cadman
- MRC Integrative Epidemiology Unit (IEU) and School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Science, Bristol, UK
| | - Mònica López-Vicente
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Llúcia González
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Isolina Riaño Galán
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo and ISPA, Oviedo, Spain
| | - Ainara Andiarena
- Faculty of Psychology, University of the Basque Country, Gipuzkoa, Spain
- Health Research Institute, Biodonostia, San Sebastian, Spain
| | - Maribel Casas
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Katrine Strandberg-Larsen
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit (IEU) and School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Science, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
- Department of Pediatrics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, USA
| | - Carmen Iñiguez
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Department of Statistics and Computational Research, Universitat de València, València, Spain
| | - Adonina Tardón
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Health Research Institute of the Principality of Asturias (ISPA), IUOPA, University of Oviedo, Oviedo, Spain
| | - Loreto Santa-Marina
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Health Research Institute, Biodonostia, San Sebastian, Spain
- Public Health Division of Gipuzkoa, Basque Government, Gipuzkoa, Spain
| | - Jordi Júlvez
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus, Catalonia, Spain
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Leda Chatzi
- Department of Preventive Medicine, University of Southern California, University Park Campus, Los Angeles, USA
| | - Jordi Sunyer
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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7
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Aznar-Lou I, Zabaleta-Del-Olmo E, Casajuana-Closas M, Sánchez-Viñas A, Parody-Rúa E, Bolíbar B, Iracheta-Todó M, Bulilete O, López-Jiménez T, Pombo-Ramos H, Martín Miguel MV, Magallón-Botaya R, Maderuelo-Fernández JÁ, Motrico E, Bellón J, Martí-Lluch R, Rubio-Valera M, Serrano-Blanco A. Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study). Int J Behav Nutr Phys Act 2021; 18:88. [PMID: 34215275 PMCID: PMC8254273 DOI: 10.1186/s12966-021-01144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. METHODS An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. RESULTS The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. CONCLUSION The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. TRIAL REGISTRATION Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 - Retrospectively registered.
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Affiliation(s)
- Ignacio Aznar-Lou
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain.
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
| | - Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Departament d'Infermeria, Facultat d'Infermeria, Universitat de Girona, Girona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
| | - Alba Sánchez-Viñas
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Elizabeth Parody-Rúa
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Bonaventura Bolíbar
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
| | - Montserrat Iracheta-Todó
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
| | - Oana Bulilete
- Primary Care Research Unit, Mallorca, Balearic Public Health Service, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Haizea Pombo-Ramos
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | - Rosa Magallón-Botaya
- IIS-Aragón Grupo b21-17R, Universidad de Zaragoza, Zaragoza, Spain
- CS Arrabal.Servicio Aragonés de Salud, Zaragoza, Spain
| | - Jose Ángel Maderuelo-Fernández
- Primary Health Care Research Unit of Salamanca (APISAL), Health Service of Castilla y León (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Emma Motrico
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
- Universidad Loyola Andalucía, Sevilla, Spain
| | - Juan Bellón
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
- Centro de Salud El Palo, Málaga, Spain
- Department of Preventive Medicine, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
| | - Ruth Martí-Lluch
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
- Biomedical Research Institute, Girona (IdIBGi), ICS, Girona, Catalonia, Spain
| | - Maria Rubio-Valera
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Antoni Serrano-Blanco
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
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8
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Arroyo E, Cabrera-León A, Renart G, Saurina C, Serra Saurina L, Daponte A, Saez M. Did psychotropic drug consumption increase during the 2008 financial crisis? A cross-sectional population-based study in Spain. BMJ Open 2019; 9:e021440. [PMID: 30674485 PMCID: PMC6347932 DOI: 10.1136/bmjopen-2017-021440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES AND SETTING Although psychotropic drugs are used to treat mental health disorders, little evidence analyses the effects the 2008 economic downturn had on psychotropic drug consumption in the case of Spain. We analyse these effects, considering both gender and employment situation. PARTICIPANTS We used the microdata from the face-to-face cross-sectional population-based Spanish National Health Survey for two periods: 2006-2007 (n=28 954) and 2011-2012 (n=20 509). Our samples included adults (>15 years old). METHODS The response variables are consumption (or not) of antidepressants or sedatives and the explanatory variables are the year of the survey, gender and employment status. Covariates are mental health problems, mental health index General Health Questionnaire (GHQ-12) and self-reported health outcome variables such as self-rated health, chronic diseases, smoking behaviour, sleeping hours, body mass index, physical activity in the workplace, medical visits during the past year, age, region of residence (autonomous communities), educational level, marital status and social class of the reference person. Finally, we include interactions between time period, gender and employment status. We specify random effects logistic regressions and use Bayesian methods for the inference. RESULTS The economic crisis did not significantly change the probability of taking antidepressant drugs (OR=0.56, 95% CI 0.18 to 2.56) nor sedatives (OR=1.21, 95% CI 0.26 to 5.49). In general, the probability of consuming antidepressants among men and women decreases, but there are differences depending on employment status. The probability of consuming sedatives also depends on the employment status. CONCLUSIONS While the year of the financial crisis is not associated with the consumption of antidepressants nor sedatives, it has widened the gap in consumption differences between men and women. Although antidepressant use dropped, the difference in consumption levels between men and women grew significantly among the retired, and in the case of sedatives, risk of women taking sedatives increased in all groups except students.
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Affiliation(s)
- Elena Arroyo
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Andrés Cabrera-León
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Publica, EASP, Granada, Spain
| | - Gemma Renart
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carme Saurina
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Serra Saurina
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Center for Research in Occupational Health (CiSAL), Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
- Center for Research in Occupational Health (CiSAL), Experimental and Health Sciences, IMIM (Hospital del Mar Medical Research Institute) Parc de Salut Mar, Barcelona, Spain
| | - Antonio Daponte
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Publica, EASP, Granada, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública (EASP), Granada, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
- CIBER of Epidemiology and Public Health, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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9
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Mena M, Lloveras B, Tous S, Bogers J, Maffini F, Gangane N, Kumar RV, Somanathan T, Lucas E, Anantharaman D, Gheit T, Castellsagué X, Pawlita M, de Sanjosé S, Alemany L, Tommasino M. Development and validation of a protocol for optimizing the use of paraffin blocks in molecular epidemiological studies: The example from the HPV-AHEAD study. PLoS One 2017; 12:e0184520. [PMID: 29036167 PMCID: PMC5642890 DOI: 10.1371/journal.pone.0184520] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022] Open
Abstract
Worldwide use of formalin-fixed paraffin-embedded blocks (FFPE) is extensive in diagnosis and research. Yet, there is a lack of optimized/standardized protocols to process the blocks and verify the quality and presence of the targeted tissue. In the context of an international study on head and neck cancer (HNC)-HPV-AHEAD, a standardized protocol for optimizing the use of FFPEs in molecular epidemiology was developed and validated. First, a protocol for sectioning the FFPE was developed to prevent cross-contamination and distributed between participating centers. Before processing blocks, all sectioning centers underwent a quality control to guarantee a satisfactory training process. The first and last sections of the FFPEs were used for histopathological assessment. A consensus histopathology evaluation form was developed by an international panel of pathologists and evaluated for four indicators in a pilot analysis in order to validate it: 1) presence/type of tumor tissue, 2) identification of other tissue components that could affect the molecular diagnosis and 3) quality of the tissue. No HPV DNA was found in sections from empty FFPE generated in any histology laboratories of HPV-AHEAD consortium and all centers passed quality assurance for processing after quality control. The pilot analysis to validate the histopathology form included 355 HNC cases. The form was filled by six pathologists and each case was randomly assigned to two of them. Most samples (86%) were considered satisfactory. Presence of >50% of invasive carcinoma was observed in all sections of 66% of cases. Substantial necrosis (>50%) was present in <2% of samples. The concordance for the indicators targeted to validate the histopathology form was very high (kappa > 0.85) between first and last sections and fair to high between pathologists (kappa/pabak 0.21-0.72). The protocol allowed to correctly process without signs of contamination all FFPE of the study. The histopathology evaluation of the cases assured the presence of the targeted tissue, identified the presence of other tissues that could disturb the molecular diagnosis and allowed the assessment of tissue quality.
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Affiliation(s)
- Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in primary and secondary prevention of viral induced cancers (CIBERONC), Madrid, Spain
| | - Belen Lloveras
- Department of Pathology. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Sara Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in primary and secondary prevention of viral induced cancers (CIBERONC), Madrid, Spain
| | - Johannes Bogers
- Laboratory of cell biology and histology, University of Antwerp, Antwerp, Belgium
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | - Nitin Gangane
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India
| | | | | | - Eric Lucas
- International Agency for Research on Cancer, Lyon, France
| | - Devasena Anantharaman
- International Agency for Research on Cancer, Lyon, France
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, India
| | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
| | - Xavier Castellsagué
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Michael Pawlita
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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