[Trends in the risk of late fetal mortality, prematurity and low birth weight associated with advanced maternal age in Spain [1996-2005]].

OBJECTIVES: To describe trends in fertility, fetal death rate, prematurity and low birth weight, as well as their association with advanced maternal age, in Spain from 1996 to 2005. METHODS: We performed an ecological study. The association between low birth weight and prematurity with maternal age was analyzed through contingency tables. The pattern of fetal mortality rate was analyzed through direct standardization. To study the risk of late fetal mortality, adjusted by age and prematurity, a Poisson regression model was used. RESULTS: The rates of fertility and late fetal mortality increased in women aged more than 35 years, especially in women aged more than 45 years. The risk of late fetal mortality was 2.7 times higher in women aged 45 years and above (rate ratio, 2.7; 95%CI: 1.8-3), with an etiological fraction of exposure of 69% (95%CI: 55.2-78.6). The prevalence rate of prematurity and low birth weight was three times higher in this age group, with a prevalence rate of prematurity of 2.9 (95%CI: 2.7-3.1) and of low birth weight of 3.1 (95%CI: 2.9-3.3). CONCLUSIONS: The high risk found in women aged more than 45 years is explained by the increase in the proportion of pregnancies within this age group during the period analyzed. Further studies in perinatal epidemiology that analyze the impact of assisted reproduction techniques in pregnancies in older women are required, as well as a national registry of assisted reproduction techniques

[Fertility in Spain, 1996-2006: foreign versus Spanish women].

OBJECTIVES: To determine fertility trends in Spain and whether women's specific fertility rates differ by age and nationality during the period 1996-2006. METHODS: We performed a population-based, cross-sectional study. Direct standardization was used to compare fertility rates by nationality. Foreign versus Spanish women's fertility rates by age and the period under review were compared by a generalized linear model. The trend by nationality was described by time plots and was analyzed by simple linear regression models. RESULTS: Foreign women had more children (total fertility rate: 2 versus 1.2) and at younger age. The upward trend observed in the fertility of Spanish women (p<0.001) was primarily due to increased fertility in older mothers (35 years and older). The fertility of foreign women aged < or =19 was six times higher than that of Spanish women (rate ratio: 6.00, 95% CI: 2.60-13.86). CONCLUSIONS: The fertility pattern of foreign women differs from that of Spanish women and is mainly characterized by higher fertility, especially in younger women (< or =19 years). This pattern may be associated with social and cultural differences. Prevention and sexual educational policies should be reformulated to take into account the specific sociocultural characteristics of this group and to adapt prevention messages to their cultural context

[Frequency of sexually transmitted infections and related factors in Pweto, Democratic Republic of Congo, 2004].

OBJECTIVES: To estimate the prevalence of genital ulcer and urethral discharge in Pweto, Democratic Republic of Congo, and to analyze the association between the estimated prevalence and age, marital status, profession, and number of sexual partners. METHODS: We performed a descriptive cross-sectional study through a survey conducted in May 2004 in a representative sample of 106 men in Pweto aged between 15 and 65 years old, with a precision of 9.5%. Questionnaire items about current or previous ulceration and urethral discharge where self-reported and referred to the previous year as of the date of the survey. To study the associations, crude and adjusted odds ratios (OR) were calculated using multivariate logistic regression. RESULTS: The prevalence was 39.6% (95% confidence interval [CI], 30-49) for urethral discharge and 33% (95%CI, 24-42) for genital ulcer. Soldiers were identified as a risk group independently of age, the number of sexual partners during the previous year, and marital status. The multivariate analysis showed an adjusted OR of 3.25 (95%CI, 1.10-9.95) (p < 0.05) for the frequency of urethral discharge in soldiers compared with other professions. CONCLUSIONS: The high prevalence of sexually transmitted infections in Pweto and the associated factors identified prompted the initiation of a controlled condom donation program for soldiers. In conflict situations with a high prevalence of sexually transmitted infections and lack of health services, humanitarian aid organizations should implement prevention activities focused on risk groups

Maternal Dietary Patterns during Pregnancy and Their Association with Gestational Weight Gain and Nutrient Adequacy.

Several epidemiologic studies have shown an association between Gestational Weight Gain (GWG) and offspring complications. The GWG is directly linked to maternal dietary intake and women's nutritional status during pregnancy. The aim of this study was (1) to assess, in a sample of Spanish pregnant women, the association between maternal dietary patterns and GWG and (2) to assess maternal dietary patterns and nutrient adequate intake according to GWG. A retrospective study was conducted in a sample of 503 adult pregnant women in five hospitals in Eastern Andalusia (Spain). Data on demographic characteristics, anthropometric values, and dietary intake were collected from clinical records by trained midwives. Usual food intake was gathered through a validated Food Frequency Questionnaire (FFQ), and dietary patterns were obtained by principal component analysis. Nutrient adequacy was defined according to European dietary intake recommendations for pregnant women. Regression models adjusted by confounding factors were constructed to study the association between maternal dietary pattern and GWG, and maternal dietary patterns and nutritional adequacy. A negative association was found between GWG and the Mediterranean dietary pattern (crude β = -0.06, 95% CI: -0.11, -0.04). Independent of maternal dietary pattern, nutrient adequacy of dietary fiber, vitamin B9, D, E, and iodine was related to a Mediterranean dietary pattern (p < 0.05). A Mediterranean dietary pattern is related to lower GWG and better nutrient adequacy. The promotion of healthy dietary behavior consistent with the general advice promoted by the Mediterranean Diet (based on legumes, vegetables, nuts, olive oil, and whole cereals) will offer healthful, sustainable, and practical strategies to control GWG and ensure adequate nutrient intake during pregnancy

Lung, Breast and Colorectal Cancer Incidence by Socioeconomic Status in Spain: A Population-Based Multilevel Study

Socioeconomic inequalities in cancer incidence are not well documented in southern Europe. We aim to study the association between socioeconomic status (SES) and colorectal, lung, and breast cancer incidence in Spain. We conducted a multilevel study using data from Spanish populationbased cancer registries, including incident cases diagnosed for the period 2010–2013 in nine Spanish provinces. We used Poisson mixed-effects models, including the census tract as a random intercept, to derive cancer incidence rate ratios by SES, adjusted for age and calendar year. Male adults with the lowest SES, compared to those with the highest SES, showed weak evidence of being at increased risk of lung cancer (risk ratio (RR): 1.18, 95% CI: 0.94–1.46) but showed moderate evidence of being at reduced risk of colorectal cancer (RR: 0.84, 95% CI: 0.74–0.97). Female adults with the lowest SES, compared to those with the highest SES, showed strong evidence of lower breast cancer incidence with 24% decreased risk (RR: 0.76, 95% CI: 0.68–0.85). Among females, we did not find evidence of an association between SES and lung or colorectal cancer. The associations found between SES and cancer incidence in Spain are consistent with those obtained in other European countries.Spanish National Health Institute Carlos III Miguel Servet-I Investigator grant/award, grant number CP17/00206-EU-FEDERInstituto de Salud Carlos III (ISCIII): PI18/01593 and CP17/00206-EU/FEDERAsociación Española Contra el Cáncer (AECC): PROYE20023SÁNCCancer Epidemiological Surveillance Subprogram (VICA) from the CIBER Epidemiologia y Salud Pública (CIBERESP) from the Instituto de Salud Carlos IIILa Caixa Foundatio

Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study.

BACKGROUND: Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain. Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study the association of socioeconomic inequalities with overall mortality and survival among CRC patients in southern Spain. METHODS: We conducted a multilevel population-based cohort study, including CRC cases for the period 2011-2013. The study time-to-event outcome was death, and the primary exposure was CRC patients' socioeconomic status assessed by the Spanish deprivation index at the census tract level. We used a mixed-effects flexible hazard model, including census tract as a random intercept, to derive overall survival estimates by deprivation. RESULTS: Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died before the end of the follow-up. Mortality by deprivation showed the highest mortality rate for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0-110.2). After adjusting for sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1-2.3). CONCLUSIONS: We found a consistent association between deprivation and CRC excess mortality and survival. The reasons behind these inequalities need further investigation in order to improve equality cancer outcomes in all social groups

[Incidence and risk factors for acute gastroenteritis among pilgrims following the French way to Santiago de Compostela (Spain) in summer 2008].

OBJECTIVES: To determine the incidence of acute gastroenteritis in pilgrims on St. James' Way, as well as associated risk factors and microbiological characteristics. METHODS: Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression. RESULTS: In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/10³ pilgrims-day (95% CI: 18.9-2.4/10³. In the case-control study, the major risk factors were age <20 years (OR=4.72; 95% CI: 2.16-10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98-2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91-4.82). The most frequent etiologic agent was norovirus (56%). CONCLUSIONS: Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis

Mucosal Immune Defence Gene Polymorphisms as Relevant Players in the Pathogenesis of IgA Vasculitis?

ITGAM&ndash;ITGAX (rs11150612, rs11574637), VAV3 rs17019602, CARD9 rs4077515, DEFA (rs2738048, rs10086568), and HORMAD2 rs2412971 are mucosal immune defence polymorphisms, that have an impact on IgA production, described as risk loci for IgA nephropathy (IgAN). Since IgAN and Immunoglobulin-A vasculitis (IgAV) share molecular mechanisms, with the aberrant deposit of IgA1 being the main pathophysiologic feature of both entities, we assessed the potential influence of the seven abovementioned polymorphisms on IgAV pathogenesis. These seven variants were genotyped in 381 Caucasian IgAV patients and 997 matched healthy controls. No statistically significant differences were observed in the genotype and allele frequencies of these seven polymorphisms when the whole cohort of IgAV patients and those with nephritis were compared to controls. Similar genotype and allele frequencies of all polymorphisms were disclosed when IgAV patients were stratified according to the age at disease onset or the presence/absence of gastrointestinal or renal manifestations. Likewise, no ITGAM&ndash;ITGAX and DEFA haplotype differences were observed when the whole cohort of IgAV patients, along with those with nephritis and controls, as well as IgAV patients, stratified according to the abovementioned clinical characteristics, were compared. Our results suggest that mucosal immune defence polymorphisms do not represent novel genetic risk factors for IgAV pathogenesis

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat