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Arrebola J.P.,University of Granada | Arrebola J.P.,CIBER ISCIII | Fernandez M.F.,University of Granada | Fernandez M.F.,CIBER ISCIII | And 6 more authors.
Environmental Research | Year: 2015

The aim of this study was to assess the influence of adipose tissue concentrations of a group of persistent organic pollutants (POPs) on the risk of hypertension in an adult cohort of residents of Granada (Southern Spain) over a 10-year follow-up. No chemical was significantly associated with the risk of hypertension in the overall population or when models were stratified by sex or median age. However, we found positive associations between log-transformed POP concentrations and hypertension risk in participants with body mass index (BMI) above the median value of 26.3kg/m2, which were statistically significant for hexachlorobenzene (HR=1.26, 95% CI=1.03-1.56), β-hexachlorocyclohexane (HR=1.25, 95% CI=1.03-1.51), and polychlorinated biphenyl congeners -138 (HR=1.32, 95% CI=1.04-1.69) and -153 (HR=1.36, 95% CI=1.00-1.84). Inverse associations were observed in the subgroup with BMI≤26.3kg/m2, but none was statistically significant. More research and a longer follow-up period are warranted to verify these associations and elucidate the role of obesity as a potential effect modifier. Given the elevated worldwide frequency of POP exposure and hypertension, the public health impact of this relationship may be substantial. © 2015 Elsevier Inc. Source

Pino Sanchez F.I.,Hospital Universitario Virgen Of Las Nieves | Ballesteros Sanz M.A.,Servicio de Medicina Intensiva | Cordero Lorenzana L.,Complexo Hospitalario Universitario runa | Guerrero Lopez F.,Hospital Universitario Virgen Of Las Nieves | Guerrero Lopez F.,Institute Investigacion Biosanitaria Ibsgranada
Medicina Intensiva | Year: 2015

Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. © 2014 Elsevier España, S.L.U. and SEMICYUC. Source

Fernandez Mondejar E.,Hospital Universitario Virgen Of Las Nieves | Fernandez Mondejar E.,Institute Investigacion Biosanitaria Ibsgranada | Alvarez F.J.,University of Valladolid
Medicina Intensiva | Year: 2014

The mortality of trauma patients has improved significantly in recent decades due to a combination of factors: medical care, educational campaigns and structural changes. Generalization of out-of hospital emergence medical services and the hospital care in specific centers for traumatized has undoubtedly contributed to this decline, but other factors such as periodic campaigns to prevent workplace and traffic accidents, as well as improvements in the road network have played a key role.The challenge now is to continue to decrease mortality, for which is essential an analysis of the situation to detect potential areas of improvement.The application of diagnostic or therapeutic actions with scientific evidence is associated with lower mortality, but as in other areas of medicine, the application of scientific evidence in trauma patients is barely 50%. Moreover, nearly 90% of trauma deaths occur in the crash site or in the first 72. h of hospitalization, the vast majority as a result of injuries incompatible with life. In these circumstances it is clear that prevention is the most cost-effective activity. As medical practitioners, our role in prevention is mainly focused on the secondary prevention to avoid recidivism, for which it is necessary to identify risk factor (frequently alcohol, illegal drugs, psychotropic medication etc.) and implement a brief motivational intervention. This activity can reduce recidivism by nearly 50%. In Spain, the activity in this field is negligible therefore measures should be implemented for dissemination of secondary prevention in trauma. © 2014 Elsevier España, S.L. and SEMICYUC. Source

Garrido F.,Hospital Universitario Virgen Of Las Nieves | Garrido F.,Institute Investigacion Biosanitaria Ibsgranada | Garrido F.,University of Granada | Romero I.,Hospital Universitario Virgen Of Las Nieves | And 5 more authors.
International Journal of Cancer | Year: 2016

Intratumor heterogeneity among cancer cells is promoted by reversible or irreversible genetic alterations and by different microenvironmental factors. There is considerable experimental evidence of the presence of a variety of malignant cell clones with a wide diversity of major histocompatibility class I (MHC-I) expression during early stages of tumor development. This variety of MHC-I phenotypes may define the evolution of a particular tumor. Loss of MHC-I molecules frequently results in immune escape of MHC-negative or -deficient tumor cells from the host T cell-mediated immune response. We review here the results obtained by our group and other researchers in animal models and humans, showing how MHC-I intratumor heterogeneity may affect local oncogenicity and metastatic progression. In particular, we summarize the data obtained in an experimental mouse cancer model of a methylcholanthrene-induced fibrosarcoma (GR9), in which isolated clones with different MHC-I expression patterns demonstrated distinct local tumor growth rates and metastatic capacities. The observed "explosion of diversity" of MHC-I phenotypes in primary tumor clones and the molecular mechanism ("hard"/irreversible or "soft"/reversible) responsible for a given MHC-I alteration might determine not only the metastatic capacity of the cells but also their response to immunotherapy. We also illustrate the generation of further MHC heterogeneity during metastatic colonization and discuss different strategies to favor tumor rejection by counteracting MHC-I loss. Finally, we highlight the role of MHC-I genes in tumor dormancy and cell cycle control. © 2014 UICC. Source

Garcia-Calvente M.M.,Escuela Andaluza de Salud Publica | Garcia-Calvente M.M.,Institute Investigacion Biosanitaria Ibsgranada | Ruiz-Cantero M.T.,University of Alicante | Ruiz-Cantero M.T.,CIBER ISCIII | And 6 more authors.
Gaceta Sanitaria | Year: 2015

Objective: To analyse gender inequalities in research on public health and epidemiology in Spain for the period 2007-2014. Method: A descriptive study was conducted by sex of leadership positions in the Centre for Biomedical Research Network (CIBER), especially in the subject area of epidemiology and public health (CIBERESP) in 2014; scientific societies of public health (SESPAS) and epidemiology (SEE) 2009-2014; research projects requested (13,320) and financed (4,699), and monetary amounts of calls for Strategic Action in Health (AES), 2007-2013. Results: Women were clearly under-represented in positions of leadership and in research excellence in public health (CIBER), with a predominance of men in decision-making positions. Although research projects led by women in AES increased slightly between 2007 and 2013, among proposed projects this figure was less than 50%, with the exception of the public health commission. The gender gap was even greater in funded projects. Projects led by men were more likely to be funded, representing 29% in public health. There was also a persistence of horizontal gender segregation in positions of scientific recognition in the SESPAS and SEE Congresses. Conclusions: The overrepresentation of male leaders in public health research in Spain can be understood as an indicator and a consequence of androcentrism in scientific societies and professional groups. This sexist situation threatens the existence of innovative products and services from a gender perspective that respond to the needs and demands of society as a whole. More women are needed in research incorporating this perspective. © 2015 SESPAS. Source

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