Obstetric history and mammographic density: a population-based cross-sectional study in Spain (DDM-Spain)

High mammographic density (MD) is used as a phenotype risk marker for developing breast cancer. During pregnancy and lactation the breast attains full development, with a cellular-proliferation followed by a lobular-differentiation stage. This study investigates the influence of obstetric factors on MD among pre- and post-menopausal women. We enrolled 3,574 women aged 45–68 years who were participating in breast cancer screening programmes in seven screening centers. To measure MD, blind anonymous readings were taken by an experienced radiologist, using craniocaudal mammography and Boyd’s semiquantitative scale. Demographic and reproductive data were directly surveyed by purpose-trained staff at the date of screening. The association between MD and obstetric variables was quantified by ordinal logistic regression, with screening centre introduced as a random effect term. We adjusted for age, number of children and body mass index, and stratified by menopausal status. Parity was inversely associated with density, the probability of having high MD decreased by 16% for each new birth (P value < 0.001). Among parous women, a positive association was detected with duration of lactation [>9 months: odds ratio (OR) = 1.33; 95% confidence interval (CI) = 1.02–1.72] and weight of first child (>3,500 g: OR = 1.32; 95% CI = 1.12–1.54). Age at first birth showed a different effect in pre- and post-menopausal women (P value for interaction = 0.030). No association was found among pre-menopausal women. However, in post-menopausal women the probability of having high MD increased in women who had their first child after the age of 30 (OR = 1.53; 95% CI = 1.17–2.00). A higher risk associated with birth of twins was also mainly observed in post-menopausal women (OR = 2.02; 95% CI = 1.18–3.46). Our study shows a greater prevalence of high MD in mothers of advanced age at first birth, those who had twins, those who have breastfed for longer periods, and mothers whose first child had an elevated birth weight. These results suggest the influence of hormones and growth factors over the proliferative activity of the mammary gland

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Geoarchaeology and castlescapes: heritage management case studies in Spain and the eastern Baltic

This paper promotes the application of geoarchaeology—joint studies using historical, archaeological and heritage approaches—to the conservation and management practice of castles and landscapes in the context of ‘castlescapes’. Using case studies from recent research on medieval castles in frontier regions of the eastern Baltic and Spain, it demonstrates how geoarchaeology can create synergies between on-site and off-site environments and between cultural and natural heritage and draw valuable information from soils and sediments about the changing form and function of spaces within castles, and about the links between these spaces and activities in their hinterlands. Geoarchaeological approaches can also illuminate the diachronic biographies that hide from visitors in the buried archaeology of castles, which to most visitors would be blank cavasses, but which can provide snap-shots of castle life in the context of a wider landscape. Castles are commonly publicly recognised as being important historical monuments, but from a heritage perspective they are often presented in isolation from their associated historical territories, and often (especially in frontier regions) appropriated within modern politics, which has influenced both heritage management decisions and research frameworks

Survival, causes of death, and risk factors associated with mortality in Barcelona HIV new diagnoses. 2001-2013

The antiretroviral treatment has supposed a decrease in HIV-related mortality. We assessed factors related to survival in HIV individuals. Causes of death (CoD) in HIV individuals were described. Abstract methods Deaths registered in the Census until 30.06.2013 and 2001-2012 new diagnoses from Barcelona HIV Register were included in the analysis. The CoD were obtained from Death Register. The CoD were classified in external (ICD-10: X), HIV-related (B20-B24, B44.9, C83.7 and C85.9) and non-HIV-related (other codes) causes. Mortality rate was calculated as follow-up person-year per 1000 and its 95% confidence interval (M; 95%CI). Association with mortality of socio-demographic, clinical and epidemiological variables were studied using Cox regression [hazard ratio (HR); 95%CI]. Abstract results Among 3533 new HIV diagnoses, 168 (5%) died (M:8.2; 95%CI: 6.9-9.4). CoD was available in 93 (55%). Among those, 43% died by non-HIVrelated causes (M:1.9; 95%CI:1.3-2.5); 42% by HIV-related causes (M:1.9; 95%CI:1.3-2.5), and 15% by external ones (M:0.7; 95%CI:0.3-1.0). Worse survival was observed in injecting drug users (IDU)(HR:4.7; 95%CI:2.9-7.7) and heterosexual (HTS) men (HR:2.4; 95%CI:1.4-3.9), Spaniards (HR:2.5; 95%CI:1.6-4.0), Gràcia district residents (HR:2.0; 95%CI:1.1-3.7), illiterate/primary education individuals (HR:1.5; IC95%:1.1-2.2), and <200 CD4 subjects (HR:1.8; 95%CI:1.2-3.0). HIV-related CoD were due to infections (48%): most common in men who have sex with men (MSM) (63%), followed by HTS women (60%). Non-HIV-related CoD were cancer (29%): more prevalent in men (32%), people with have secondary/university studies (39%) and HTS men (50%); cardiovascular diseases (22%): in HTS women (57%) and illiterate/primary education individuals (35%) and; liver diseases (19%): in IDU (37%). Abstract conclusion Mortality was associated with being IDU, HTS man, Spaniard, with low educational level and damaged immune system. CoD frequencies in HIVrelated and non-HIV-related were simila

Survival, causes of death, and risk factors associated with mortality in Barcelona HIV new diagnoses. 2001-2013

The antiretroviral treatment has supposed a decrease in HIV-related mortality. We assessed factors related to survival in HIV individuals. Causes of death (CoD) in HIV individuals were described. Abstract methods Deaths registered in the Census until 30.06.2013 and 2001-2012 new diagnoses from Barcelona HIV Register were included in the analysis. The CoD were obtained from Death Register. The CoD were classified in external (ICD-10: X), HIV-related (B20-B24, B44.9, C83.7 and C85.9) and non-HIV-related (other codes) causes. Mortality rate was calculated as follow-up person-year per 1000 and its 95% confidence interval (M; 95%CI). Association with mortality of socio-demographic, clinical and epidemiological variables were studied using Cox regression [hazard ratio (HR); 95%CI]. Abstract results Among 3533 new HIV diagnoses, 168 (5%) died (M:8.2; 95%CI: 6.9-9.4). CoD was available in 93 (55%). Among those, 43% died by non-HIVrelated causes (M:1.9; 95%CI:1.3-2.5); 42% by HIV-related causes (M:1.9; 95%CI:1.3-2.5), and 15% by external ones (M:0.7; 95%CI:0.3-1.0). Worse survival was observed in injecting drug users (IDU)(HR:4.7; 95%CI:2.9-7.7) and heterosexual (HTS) men (HR:2.4; 95%CI:1.4-3.9), Spaniards (HR:2.5; 95%CI:1.6-4.0), Gràcia district residents (HR:2.0; 95%CI:1.1-3.7), illiterate/primary education individuals (HR:1.5; IC95%:1.1-2.2), and &lt;200 CD4 subjects (HR:1.8; 95%CI:1.2-3.0). HIV-related CoD were due to infections (48%): most common in men who have sex with men (MSM) (63%), followed by HTS women (60%). Non-HIV-related CoD were cancer (29%): more prevalent in men (32%), people with have secondary/university studies (39%) and HTS men (50%); cardiovascular diseases (22%): in HTS women (57%) and illiterate/primary education individuals (35%) and; liver diseases (19%): in IDU (37%). Abstract conclusion Mortality was associated with being IDU, HTS man, Spaniard, with low educational level and damaged immune system. CoD frequencies in HIVrelated and non-HIV-related were simila