Estudis de cohorts per validar un model de categorització del risc de fractura per fragilitat en població femenina espanyola en base a l'algoritme FRAX ® de la OMS. Les cohorts FRIDEX i FROCAT /

Premi Extraordinari de Doctorat concedit pels programes de doctorat de la UAB per curs acadèmic 2016-2017Estudis internacionals han demostrat la utilitat de l'eina FRAX de l'Organització Mundial de la Salut (OMS) per a l'estimació del risc absolut de fractura osteoporòtica a 10 anys. S'ha evidenciat que a població femenina espanyola l'eina té una bona capacitat de discriminació per detectar dones que patiran una fractura per fragilitat de les que no, i que millora el model tradicional basat en la densitometria òssia (T-score ≤ -2.5 desviacions estandars (DE)). No obstant això, l'algoritme mostra una manca de concordança global entre la probabilitat estimada de fractura i la incidència de fractura observada individual a 10 anys, amb una tendència a infraestimar el risc. Per millorar la capacitat predictiva de fractura osteoporòtica principal s'ha desenvolupat el model FRIDEX, amb 3 categories de risc FRAX (calculat sense T-score de coll femoral) per població femenina espanyola ( 5%; ≥5 a 7,5%; ≥7,5%) que iclouen la incidència de fractures observades en la cohort, les quals estaven, al seu torn, respectivament dins els nivells tradicionalment considerats com de risc baix ( 20%) en altres estudis epidemiològics. L'objectiu d'aquesta tesi doctoral va ser validar aquest model FRIDEX de calibració del risc de fractura per fragilitat en població femenina espanyola en base a l'algoritme FRAX en la cohort ampliada FRIDEX i en la població general (cohort FROCAT). En primer lloc els resultats del treball validen les interpretacions de la capacitat discriminativa i predictiva de l'eina FRAX obtingudes en les primeres anàlisi de la cohort FRIDEX i, és important perquè d'aquests casos es va desenvolupar la proposta per categoritzar el risc de fractura en dones espanyoles. En segon lloc, validen externament el model FRIDEX de discriminació del risc de fractura principal a 10 anys en una cohort de dones de base poblacional i diferent de la cohort que ha servit per establir-lo

Two more ways of spelling Gini Coefficient with Applications

In this paper, we draw attention to a promising yet slightly underestimated measure of variability - the Gini coefficient. We describe two new ways of defining and interpreting this parameter. Using our new representations, we compute the Gini index for a few probability distributions and describe it in more detail for the negative binomial distribution. We also suggest the latter as a tool to measure overdispersion in epidemiology

Dynamic random intersection graph: Dynamic local convergence and giant structure.

Random intersection graphs containing an underlying community structure are a popular choice for modelling real-world networks. Given the group memberships, the classical random intersection graph is obtained by connecting individuals when they share at least one group. We extend this approach and make the communities dynamic by letting them alternate between an active and inactive phase. We analyse the new model, delivering results on degree distribution, local convergence, giant component, and maximum group size, paying particular attention to the dynamic description of these properties. We also describe the connection between our model and the bipartite configuration model, which is of independent interest

Structural insights into human Kif7, a kinesin involved in Hedgehog signalling

The human Kif7 motor domain structure provides insights into a kinesin of medical significance

M67-1194, an unusually Sun-like solar twin in M67

The rich open cluster M67 is known to have a chemical composition close to solar, and an age around 4Gyr. It thus offers the opportunity to check our understanding of the physics and the evolution of solar-type stars in a cluster environment. We present the first spectroscopic study at high resolution, R~50,000, of the potentially best solar twin, M67-1194, identified among solar-like stars in M67. Based on a pre-selection of solar-twin candidates performed at medium resolution by Pasquini et al. (2008), we explore the chemical-abundance similarities and differences between M67-1194 and the Sun, using VLT/FLAMES-UVES. Working with a solar twin in the framework of a differential analysis, we minimize systematic model errors in the abundance analysis compared to previous studies which utilized more evolved stars to determine the metallicity of M67. We find M67-1194 to have stellar parameters indistinguishable from the solar values, with the exception of the overall metallicity which is slightly super-solar ([Fe/H]=0.023 +/- 0.015). An age determination based on evolutionary tracks yields 4.2 +/- 1.6Gyr. Most surprisingly, we find the chemical abundance pattern to closely resemble the solar one, in contrast to most known solar twins in the solar neighbourhood. We confirm the solar-twin nature of M67-1194, the first solar twin known to belong to a stellar association. This fact allows us to put some constraints on the physical reasons for the seemingly systematic departure of M67-1194 and the Sun from most known solar twins regarding chemical composition. We find that radiative dust cleansing by nearby luminous stars may be the explanation for the peculiar composition of both the Sun and M67-1194, but alternative explanations are also possible. The chemical similarity between the Sun and M67-1194 also suggests that the Sun once formed in a cluster like M67

Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain

Background: Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age. Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years. Methods/Design: To assess the predictive power of the WHO FRAX (TM) tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. Study population: Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA) measurement and one extensive questionnaire related to fracture risk factors. Measurements: At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX (TM) tool from the official web site. Discussion: Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to low BMD. The extension of a method for calculating the risk (probability) of fractures using the FRAX (TM) tool is foreseeable in Spain and this would justify a study such as this to allow the necessary adjustments in calibration of the parameters included in the logarithmic formula constituted by FRAX (TM

Formation of Supermassive Black Holes

Evidence shows that massive black holes reside in most local galaxies. Studies have also established a number of relations between the MBH mass and properties of the host galaxy such as bulge mass and velocity dispersion. These results suggest that central MBHs, while much less massive than the host (~ 0.1%), are linked to the evolution of galactic structure. In hierarchical cosmologies, a single big galaxy today can be traced back to the stage when it was split up in hundreds of smaller components. Did MBH seeds form with the same efficiency in small proto-galaxies, or did their formation had to await the buildup of substantial galaxies with deeper potential wells? I briefly review here some of the physical processes that are conducive to the evolution of the massive black hole population. I will discuss black hole formation processes for `seed' black holes that are likely to place at early cosmic epochs, and possible observational tests of these scenarios.Comment: To appear in The Astronomy and Astrophysics Review. The final publication is available at http://www.springerlink.co

Measuring health-related quality of life in men with osteoporosis or osteoporotic fracture

<p>Abstract</p> <p>Background</p> <p>Osteoporosis is a serious health problem that worsens the quality of life and the survival rate of individuals with this disease on account the osteoporotic fractures. Studies have long focused on women, and its presence in men has been underestimated. While many studies conducted in different countries mainly assess health-related quality of life and identify fracture risks factors in women, few data are available on a Spanish male population.</p> <p>Methods/Design</p> <p>Observational study.</p> <p>Study population</p> <p>Men ≥ 40 years of age with/without diagnosed osteoporosis and with/without osteoporotic fracture included by their family doctor.</p> <p>Measurements</p> <p>The relationship between customary clinical risk factors for osteoporotic fracture and health-related quality of life in a Spanish male population. A telephone questionnaire on health-related quality of life is made.</p> <p>Statistical analysis</p> <p>The association between qualitative variables will be assessed by the Chi-square test. The distribution of quantitative variables by Student's t-test. If the conditions for using this test are not met, the non-parametric Mann-Whitney's U test will be used.</p> <p>The validation of the results obtained by the FRAX™ tool will be performed by way of the Hosmer-Lemeshow test and by calculating the area under the Receiver Operating Characteristic (ROC) curve (AUC). All tests will be performed with a confidence intervals set at 95%.</p> <p>Discussion</p> <p>The applicability and usefulness of Health-related quality of life (HRQOL) studies are well documented in many countries. These studies allow implementing cost-effective measures in cases of a given disease and reducing the costly consequences derived therefrom. This study attempts to provide objective data on how quality of life is affected by the clinical aspects involved in osteoporosis in a Spanish male population and can be useful as well in cost utility analyses conducted by health authorities.</p> <p>The sample selected is not based on a high fracture risk group. Rather, it is composed of men in the general population, and accordingly comparisons should not lead to erroneous interpretations.</p> <p>A possible bias correction will be ensured by checking reported fractures against healthcare reports and X-rays, or by consulting health care centers as applicable.</p

Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain

<p>Abstract</p> <p>Background</p> <p>Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age.</p> <p>Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years.</p> <p>Methods/Design</p> <p>To assess the predictive power of the WHO FRAX™ tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. Study population: Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA) measurement and one extensive questionnaire related to fracture risk factors. Measurements: At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX™ tool from the official web site.</p> <p>Discussion</p> <p>Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to low BMD. The extension of a method for calculating the risk (probability) of fractures using the FRAX™ tool is foreseeable in Spain and this would justify a study such as this to allow the necessary adjustments in calibration of the parameters included in the logarithmic formula constituted by FRAX™.</p