Meta-Análisis: Aportación metodológica en la investigación de resultados en salud

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Pública, y Microbiología. Fecha 19 de Julio de 201

Physical disease in schizophrenia: a population-based analysis in Spain

<p>Abstract</p> <p>Background</p> <p>Physical disease remains a challenge in patients with schizophrenia. Our objective was to determine the epidemiological characteristics and burden of physical disease in hospitalized patients with schizophrenia.</p> <p>Methods</p> <p>We analyzed the 2004 Spanish National Hospital Discharge Registry, identified records coded for schizophrenia (295.xx) and characterized the physical diseases using the ICD-9 system and the Charlson Index. We also calculated standardized mortality ratios (SMRs) versus the general population adjusted by age and calendar time.</p> <p>Results</p> <p>A total of 16, 776 cases (mean age: 43 years, 65% males) were considered for analysis. Overall, 61% of cases had at least one ICD-9 physical code and 32% had more than one ICD-9 code. The Charlson index indicated that 20% of cases had a physical disease of known clinical impact and prognostic significance. Physical disease appeared early in life (50% of cases were 15-31 years of age) and increased rapidly in incidence with age. Thus, for patients aged 53 years or more, 84% had at least one physical ICD-9 code. Apart from substance abuse and addiction, the most prevalent diseases were endocrine (16%), circulatory (15%), respiratory (15%), injury-poisoning (11%), and digestive (10%). There were gender-related differences in disease burden and type of disease. In-hospital mortality significantly correlated with age, the Charlson Index and several ICD-9 groups of physical disease. Physical disease was associated with an overall 3.6-fold increase in SMRs compared with the general population.</p> <p>Conclusions</p> <p>This study provides the first nationally representative estimate of the prevalence and characteristics of physical disease in hospitalized patients with schizophrenia in Spain. Our results indicate that schizophrenia is associated with a substantial burden of physical comorbidities; that these comorbidities appear early in life; and that they have a substantial impact on mortality. This information raises concerns about the consequences and causes of physical disorders in patients with schizophrenia. Additionally, it will help to guide the design and implementation of preventive and therapeutic programs from the viewpoint of clinical care and in terms of health-care service planning.</p

Prevalence of asthma and rhinitis symptoms in a Coruña (Spain)

Ponencia presentada en el IV Congreso de la Sociedad de Pediatría de Galicia, Verín, 2004[Resumen] Introducción. El asma y la rinitis son dos enfermedades con elevada prevalencia en la infancia, con tendencia a incrementarse en los últimos años. En ambas es frecuente el infradiagnóstico. Objetivo. Verificar la prevalencia de síntomas de asma y rinitis en la población infantil. Material y métodos. Hemos realizado, mediante cuestionario escrito, un estudio transversal siguiendo la metodología del International Study of Asthma and Allergies in Childhood (ISAAC), de prevalencia de sintomatología de asma y rinitis en el área de A Coruña. Resultados. Han sido incluidos 3.017 niños y niñas de 6 y 7 años (tasa de respuesta del 73,9%), y 2.981 de 13 y 14 años (tasa de respuesta del 93,6%). Refirieron haber presentado sibilancias alguna vez el 25,3% de los niños y niñas de 13 y 14 años y el 37,2% de los de 6 y 7 años. Han presentado asma en alguna ocasión el 18,5% de los adolescentes y el 13,7 % del grupo de menor edad. La prevalencia de rinitis alguna vez fue del 30,4% a los 6 y 7 años y del 47,3% a los 13 y 14 años. La mayor prevalencia de rinitis se produjo en el otoño. Conclusiones. El asma y la rinitis son especialmente frecuentes en nuestra población, superior a la observada en la mayoría de poblaciones españolas estudiadas.[Abstract] Introduction. The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. Objective. To asses the prevalence of asthma and rhinitis symptoms in childhood. Material and methods. We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. Results. A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of “wheezing at some time” was 25.3% in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of “asthma at some time” was 18.5% in adolescents and 13.7% in children. The prevalence of “rhinitis at some time” was 30.4% in the group aged 6-7 years and 47.3% in the group of adolescents. The prevalence of rhinitis was highest in autumn. Conclusions. The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied

High p27 protein levels in chronic lymphocytic leukemia are associated to low Myc and Skp2 expression, confer resistance to apoptosis and antagonize Myc effects on cell cycle

This is an open-access article distributed under the terms of the Creative Commons Attribution License.-- et al.Myc (c-Myc) counteracts p27 effects, and low p27 usually correlates with high Myc expression in human cancer. However there is no information on the co-expression of both genes in chronic lymphocytic leukemia (CLL). We found a lack of correlation between RNA and protein levels of p27 and Myc in CLL cells, so we determined the protein levels by immunoblot in 107 cases of CLL. We observed a high p27 protein expression in CLL compared to normal B cells. Ectopic p27 expression in a CLL-derived cell line resulted in cell death resistance. Surprisingly, Myc expression was very low or undetectable in most CLL cases analyzed, with a clear correlation between high p27 and low Myc protein levels. This was associated with low Skp2 expression, which is consistent with the Skp2 role in p27 degradation and with SKP2 being a Myc target gene. High Myc expression did not correlate with leukemia progression, despite that cell cycle-related Myc target genes were upregulated. However, biochemical analysis showed that the high p27 levels inhibited cyclin-Cdk complexes even in Myc expressing CLL cells. Our data suggest that the combination of high p27 and low Myc is a marker of CLL cells which is mediated by Skp2.The work has been funded by grants SAF11-23796 from MINECO and RD12/0036/0033 (to JL), and RD12/0036/0004 (to DC) and RD12/0036/0060 (to MAP) from Instituto Carlos III. These funding was co-sponsored by the European Union FEDER program. JC was recipient of a Fellowship from Fundación Marqués de Valdecilla and from the University of Cantabria.Peer Reviewe

Premature mortality excess related to influenza in Spain during an interpandemic period

BACKGROUND: The indicator of Potential Years of Life Lost (PYLL) has been frequently used to analysis of premature mortality and recently has been used to estimate the impact of the last influenza A(H1N1)pdm09 pandemic. The aim of this study was to estimate the excess deaths from pneumonia and influenza (P&I) in Spain and the PYLL during the period 1980-2008, measuring the mortality attributable to influenza regarding the type/subtype of influenza dominant in each season. METHODS: Monthly excess deaths were calculated with cyclical regression models. The PYLL calculation was performed as the product of the number of excess deaths and the difference between life expectancy at birth and years lived for each age group. The analysis of the variation between P&I excess deaths and PYLL, depending on the predominant influenza virus type/subtype was carried out with a Poisson regression analysis. RESULTS: In seasons dominated by influenza virus A(H3) the average P&I excess deaths was estimated at 1,348, and for PYLL in 5.297, while in seasons dominated by A(H1) or B the average P&I excess deaths was 648, and for PYLL 2.885. The adjusted rate ratios of excess (2.11, CI-95%=2.05-2.16) and PYLL (1.86, CI-95%=1.83-1.88) indicate that the relative frequencies for both indicators are significantly larger in seasons dominated by influenza virus A(H3). CONCLUSIONS: Excess deaths and PYLL doubled when comparing seasons predominantly subtype A(H3) and other influenza viruses.Programa de Investigación de la Gripe A (H1N1), Instituto de Salud Carlos III (GR09/0018

Successful Direct Acting Antiviral Therapy in ChronicHepatitis C Normalizes IFN and IL2 Production in T Cells Together with TLR8 Expression and Functionality in Peripheral Blood Mononuclear Cells

Chronic hepatitis C infection (HCV) activates a systemic cell-mediated immune response characterized by the production of IFN? and an innate immune response addressed by the activation of TLR signaling. We aimed to investigate whether HCV eradication by direct acting antivirals (DAA) leads to a recovery in cell-mediated immune response and TLR expression and functionality. Blood samples were obtained in HCV infected patients before DAA treatment and at week +48 after the end of treatment. Results were compared to healthy controls. Cell surface expression of TLR8 was assessed on peripheral blood mononuclear cells (PBMCs) by flow cytometry. Freshly isolated PBMCs were cultured with specific TLR8 agonists and intracellular production of cytokines was determined by flow-cytometry after ex vivo TLR8 activation with ssRNA 40. Production of IFN?, IL2 and IL17 was assessed by flow cytometry in T cells after polyclonal activation. Included were 50 HCV-infected patients and 15 controls. TLR8 expression in PBMCs was significantly increased before treatment and recovered normal levels at week +48. Production of IL1b, IL6 and TNF? dependent on the activation of TLR8 in PBMCs was also increased in patients before DAA treatment, with a significant reduction at week +48. Combined expression of IFN? and IL2 in CD4+ T cells in HCV-infected patients was significantly increased compared to controls and recovered normal levels at week +48. DAA-mediated clearance of HCV is associated with a decreased expression and activation of TLR8 in PBMCs until healthy control levels which is accompanied by a reduction in the Th1 response.This research was funded by the Instituto de Salud Carlos III (ISCIII), grant number PIE15/00079

Avance de los datos recogidos por el Sistema de Información Microbiológica durante el primer semestre del año 2016

[ES] Se presentan los datos provisionales para las cuatro patologías con mayor número de casos notificados al Sistema de Información Microbiológica (SIM) por 77 laboratorios de 10 Comunidades Autónomas: 9.418 infecciones por el virus de la gripe, 4.042 casos de campilobacteriosis, 2.593 casos de diarrea por rotavirus y 2.012 infecciones de transmisión sexual por Chlamydia trachomatis y linfogranuloma venéreo (LGV). En total suponen el 69,4% de los casos recogidos en las primeras 26 semanas de 2016. [EN] The current work offers a preliminary overview of data collected for the four pathologies with the highest number of cases reported by 77 laboratories from 10 Autonomous Communities to the Microbiological Information System (SIM): influenza (9418), campilobacteriosis (4042), rotavirus diarrhea (2593) and sexually transmitted infection by Chlamydia trachomatis (2012) account for 69.4% of all data notified (26039)

Obesity and asthma: an association modified by age

[Abstract] Background. Some studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. Methods. A cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6–7 year-old children (n = 7485) and 13–14 year-old adolescents (n = 8496). The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals. Results. Obesity was associated with an increase in wheezing ever (OR: 1.35) and exercise-induced asthma (OR: 1.62) in the 6–7 year-old group. No significant relationship was observed in the adolescent population. Conclusion. Obesity was associated with a higher prevalence of asthma in young children, but not in adolescents