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Azagra R.,Autonomous University of Barcelona | Azagra R.,International University of Catalonia | Roca G.,Autonomous University of Barcelona | Martin-Sanchez J.C.,International University of Catalonia | And 6 more authors.
Medicina Clinica | Year: 2015

Background and objective To detect FRAX® threshold levels that identify groups of the population that are at high/low risk of osteoporotic fracture in the Spanish female population using a cost-effective assessment.Patients and methods This is a cohort study. Eight hundred and sixteen women 40-90 years old selected from the FRIDEX cohort with densitometry and risk factors for fracture at baseline who received no treatment for osteoporosis during the 10 year follow-up period and were stratified into 3 groups/levels of fracture risk (low < 10%, 10-20% intermediate and high > 20%) according to the real fracture incidence.Results The thresholds of FRAX® baseline for major osteoporotic fracture were: low risk < 5; intermediate ≥ 5 to < 7.5 and high ≥ 7.5. The incidence of fracture with these values was: low risk (3.6%; 95% CI 2.2-5.9), intermediate risk (13.7%; 95% CI 7.1-24.2) and high risk (21.4%; 95% CI12.9-33.2). The most cost-effective option was to refer to dual energy X-ray absorptiometry (DXA-scan) for FRAX® ≥ 5 (Intermediate and high risk) to reclassify by FRAX® with DXA-scan at high/low risk. These thresholds select 17.5% of women for DXA-scan and 10% for treatment. With these thresholds of FRAX®, compared with the strategy of opportunistic case finding isolated risk factors, would improve the predictive parameters and reduce 82.5% the DXA-scan, 35.4% osteoporosis prescriptions and 28.7% cost to detect the same number of women who suffer fractures.Conclusions The use of FRAX ® thresholds identified as high/low risk of osteoporotic fracture in this calibration (FRIDEX model) improve predictive parameters in Spanish women and in a more cost-effective than the traditional model based on the T-score ≤ -2.5 of DXA scan. © 2013 Elsevier España, S.L.U. All rights reserved.


PubMed | Institute for Predictive and Personalized Medicine of Cancer IMPPC, University of Arkansas for Medical Sciences, Institute Dinvestigacio En Ciencies Of La Salut Germans Trias I Pujol, Autonomous University of Barcelona and 4 more.
Type: Journal Article | Journal: PloS one | Year: 2016

Efforts to develop vaccines that can elicit mucosal immune responses in the female genital tract against sexually transmitted infections have been hampered by an inability to measure immune responses in these tissues. The differential expression of adhesion molecules is known to confer site-dependent homing of circulating effector T cells to mucosal tissues. Specific homing molecules have been defined that can be measured in blood as surrogate markers of local immunity (e.g. 47 for gut). Here we analyzed the expression pattern of adhesion molecules by circulating effector T cells following mucosal infection of the female genital tract in mice and during a symptomatic episode of vaginosis in women. While CCR2, CCR5, CXCR6 and CD11c were preferentially expressed in a mouse model of Chlamydia infection, only CCR5 and CD11c were clearly expressed by effector T cells during bacterial vaginosis in women. Other homing molecules previously suggested as required for homing to the genital mucosa such as 41 and 47 were also differentially expressed in these patients. However, CD11c expression, an integrin chain rarely analyzed in the context of T cell immunity, was the most consistently elevated in all activated effector CD8+ T cell subsets analyzed. This molecule was also induced after systemic infection in mice, suggesting that CD11c is not exclusive of genital tract infection. Still, its increase in response to genital tract disorders may represent a novel surrogate marker of mucosal immunity in women, and warrants further exploration for diagnostic and therapeutic purposes.


PubMed | IMIM Institute Hospital del Mar dInvestigacions Biomediques, Hospital Universitario Germans Trias i Pujol, Institute Catala Of La Salut Ics, Autonomous University of Barcelona and Subdireccio de Promocio de la Salut
Type: | Journal: Anales de pediatria (Barcelona, Spain : 2003) | Year: 2016

To update the literature review on the effectiveness of clinical interventions on childhood obesity, proposed in Clinical Practice Guidelines, excluding prevention and pharmacological and surgical treatments.A systematic review was carried out in electronic databases of the Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE, and SCOPUS, replicating the search for the Clinical Practice Guidelines, from 2009 to 2014. The Clinical Practice Guidelines of National Institute for Health and Care Excellence were taken as a reference. Systematic reviews were given priority, and the quality of the studies was assessed.Out of a total of 3,703 documents initially identified, 48 were finally included. Studies showed great heterogeneity in the type and duration of interventions, and in outcome measures. Adherence to treatment was, in general, low. Multi-component interventions including diet, physical activity, sedentary lifestyle, and behaviour changes, involving the family, and starting at early ages, were the most effective for reducing body mass index. There is no consensus on criteria for referral to specialised care.It is recommended to implement multi-component programs conducted by professionals with previous training, involving the family, and addressing behavioural, individual and socio-demographic aspects. Lack of adherence is one of the reasons for failure of interventions. Diagnostic and referral criteria, the outcome measures, and the type and duration of interventions need to be improved and standardised.


PubMed | Institute Catala Of La Salut Ics, Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol, Autonomous University of Barcelona and Hospitalet Of Llobregat
Type: Journal Article | Journal: BMJ open | Year: 2015

The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers.A systematic review of randomised and non-randomised controlled trials was undertaken.Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish.We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted.Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences.Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results.


Almirall J.,Autonomous University of Barcelona | Serra-Prat M.,Hospital Of Mataro | Bolibar I.,Autonomous University of Barcelona | Palomera E.,Hospital Of Mataro | And 7 more authors.
BMJ Open | Year: 2014

Objective: To assess whether passive smoking exposure at home is a risk factor for communityacquired pneumonia (CAP) in adults. Setting: A population-based case-control study was designed in a Mediterranean area with 860 000 inhabitants >14 years of age. Participants: 1003 participants who had never smoked were recruited. Primary and secondary outcome measures: Risk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. Methods: A population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis. Results: The study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases×10-3 inhabitants in passive smokers and 0.90×10-3 in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants ≥65 years of age, this incidence was 2.50×10-3 in passive smokers and 1.69×10-3 in nonpassive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively ( p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45). Conclusions: Passive smoking at home is a risk factor for CAP in older adults (65 years or more).


PubMed | EAP Sant Marti ICS, Unitat Docent de Medicina Familiar i Comunitaria, EAP Doctor Vilaseca Can Mariner, EAP Poblenou ICS and 9 more.
Type: Journal Article | Journal: European psychiatry : the journal of the Association of European Psychiatrists | Year: 2015

The aim of this randomized clinical trial follow-up at three months was to evaluate the effectiveness of an educational intervention with a focus on diet and physical activity (PA) to change the amount of PA, body mass index (BMI) and the waist circumference (WC) in patients with severe mental illness.We recruited 332 outpatients with severe mental disorders undergoing treatment with antipsychotic medication from Mental Healthcare Centers of Barcelona. They were randomly assigned to an intervention or a control group. The patients in the intervention group participated in a group PA and diet educational program. The blinded measurements at 0 and 3 months were: the level of PA (IPAQ questionnaire), BMI, WC, blood pressure, dietary habits (PREDIMED questionnaire), quality of life (SF-36 questionnaire) and laboratory parameters (cholesterol, triglycerides, glucose).The average age was 46.7 years and 55% were males. Schizophrenia had been diagnosed in 67.1% of them. At 3 months, the average weekly walking METs rose significantly in the IG 266.05 METs (95%CI: 16.86 to 515.25; P=0.036). The total MET average also rose although not significantly: 191.38 METs (95%CI: 1.38 to 381.38; P=0.086). However, the BMI decreased significantly more in the CG, by 0.26kg/m(2) (95%CI: 0.02 to 0.51; P=0.038), than in the IG. There were no significant differences in the WC.The short-term results suggest that the intervention increases the level of PA, but does not improve physical or laboratory parameters.Clinicaltrials.gov NCT01729650 (effectiveness of a physical activity and diet program in patients with psychotic disorder [CAPiCOR]).


PubMed | Hospital Of Mataro, Hospital Nostra Senyora Of Meritxell, Autonomous University of Barcelona, Institute Catala Of La Salut Ics and 3 more.
Type: Journal Article | Journal: BMJ open | Year: 2014

To assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults.A population-based case-control study was designed in a Mediterranean area with 860000 inhabitants >14years of age.1003 participants who had never smoked were recruited.Risk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period.A population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis.The study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases10(-3) inhabitants in passive smokers and 0.9010(-3) in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants 65years of age, this incidence was 2.5010(-3) in passive smokers and 1.6910(-3) in non-passive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively (p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45).Passive smoking at home is a risk factor for CAP in older adults (65years or more).


Azagra R.,Autonomous University of Barcelona | Azagra R.,Health Center Badia del Valles | Azagra R.,International University of Catalonia | Lopez-Exposito F.,Autonomous University of Barcelona | And 10 more authors.
Osteoporosis International | Year: 2014

Summary: Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. Introduction: The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. Methods: Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). Results: There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2) over 10 years, the crude incidence rate/100,000 inhabitant/year increased an average of 2.3 %/year in men and 1.4 % in women. After adjustment, the rate increased an average of 0.4 %/year in men (p<0.0001), but decreased 0.2 %/year in women (p<0.0001). In men, younger than 85, the decrease was not significant except in 70-74 years, and from 80 years, the adjusted rate increases significantly (p<0.0001). In women under 80 years of age, the decrease in adjusted rate was significant; there was no change in 80-84 years, and the adjusted rate increased significantly in individuals 85 years and older (p<0.0001). Mortality rates declined by 22 % in both sexes, and the index of overaging population rises 30.1 % in men and 25.2 % in women. Conclusions: This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.


PubMed | Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol and Institute Catala Of La Salut Ics
Type: Journal Article | Journal: Atencion primaria | Year: 2016

To estimate the prevalence of occult renal failure (RF) in DM2, by comparing two formulas for estimating glomerular filtration rate (GFR): Modification of Diet in Renal Disease 4 (MDRD-4) and Cockcroft-Gault (CG), as well as their associated clinical variables.Multicentre analytical cross-sectional.Two basic Primary Care areas in Terres de lEbre, in North-Eastern Spain.A total of 493 DM2 patients with age >18years with an assigned doctor in the areas studied. There was a loss of 9 and 11 cases in each formula due to lack of variables necessary for the GFR.Estimated GFR using the two formulas, plasma creatinine values, classification of patients with established RF, occult RF and without RF, and possible clinical-pathological variables associated with RF.Of the total, 45.2% were men, the mean age was 70.4 years, and mean time since onset of diabetes of 7.5 years. The prevalence of occult RF with MDRD-4 was 18%, and 22.6% with CG. The cases detected by GC and not by MDRD-4 were higher, and with lower weight. In both formulas, occult RF patients had more chronic diseases, hypertension, and cardiovascular events (CV) than those without RF. Risk factors associated with occult RF were female, increasing age, and LDL cholesterol.The prevalence of occult RF was 20% in DM2, independently of the formula. A poorer control of cardiovascular risk factors was observed, which makes them a group at higher risk of suffering a CV event.


Jardi M.,University Pompeu Fabra | Fabregas P.,Hospital Duran i Reynals | Sagarra-Tio M.,Institute Catala Of La Salut Ics | Perez-Lucena M.J.,Institute Catala Of La Salut Ics | Felez J.,Institute Catala Of La Salut Ics
Journal of Biomedicine and Biotechnology | Year: 2012

The NB4 promyelocytic cell line exhibits many of the characteristics of acute promyelocytic leukemia blast cells, including the translocation (15: 17) that fuses the PML gene on chromosome 15 to the RARα gene on chromosome 17. These cells have a very high fibrinolytic capacity. In addition to a high secretion of urokinase, NB4 cells exhibit a 10-fold higher plasminogen binding capacity compared with other leukemic cell lines. When tissue-type plasminogen activator was added to acid-treated cells, plasmin generation was 2026-fold higher than that generated by U937 cells or peripheral blood neutrophils, respectively. We found that plasminogen bound to these cells can be detected by fluorescence-activated cell sorting using an antiplasminogen monoclonal antibody that specifically reacts with this antigen when it is bound to cell surfaces. All-trans retinoid acid treatment of NB4 cells markedly decreased the binding of this monoclonal antibody. This cell line constitutes a unique model to explore plasminogen binding and activation on cell surfaces that can be modulated by all-trans retinoid acid treatment. © 2012 Mercè Jardí et al.

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