Background There is insufficient evidence to provide recommendations for leisure-time physical activity among workers across various occupational physical activity levels.This study aimed to assess the association of ...Background There is insufficient evidence to provide recommendations for leisure-time physical activity among workers across various occupational physical activity levels.This study aimed to assess the association of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels.Methods This study utilized individual participant data from 21 cohort studies,comprising both published and unpublished data.Eligibility criteria included individual-level data on leisure-time and occupational physical activity(categorized as sedentary,low,moderate,and high)along with data on all-cause and/or cardiovascular mortality.A 2-stage individual participant data meta-analysis was conducted,with separate analysis of each study using Cox proportional hazards models(Stage 1).These results were combined using random-effects models(Stage 2).Results Higher leisure-time physical activity levels were associated with lower all-cause and cardiovascular mortality risk across most occupational physical activity levels,for both males and females.Among males with sedentary work,high compared to sedentary leisure-time physical activity was associated with lower all-cause(hazard ratios(HR)=0.77,95%confidence interval(95%CI):0.70-0.85)and cardiovascular mortality(HR=0.76,95%CI:0.66-0.87)risk.Among males with high levels of occupational physical activity,high compared to sedentary leisure-time physical activity was associated with lower all-cause(HR=0.84,95%CI:0.74-0.97)and cardiovascular mortality(HR=0.79,95%CI:0.60-1.04)risk,while HRs for low and moderate levels of leisure-time physical activity ranged between 0.87 and 0.97 and were not statistically significant.Among females,most effects were similar but more imprecise,especially in the higher occupational physical activity levels.Conclusion Higher levels of leisure-time physical activity were generally associated with lower mortality risks.However,results for workers with moderate and high occupational physical activity levels,especially women,were more imprecise.Our findings suggests that workers may benefit from engaging in high levels of leisure-time physical activity,irrespective of their level of occupational physical activity.展开更多
目的临床指南需要根据相关研究结果定期审查以确保其可靠性,但在更新临床指南的过程中仍然缺乏对于更新过程表述的优先报告条目。本文旨在介绍更新版指南报告清单(Checklist for the Reporting of Updated Guidelines,Check Up)及其制...目的临床指南需要根据相关研究结果定期审查以确保其可靠性,但在更新临床指南的过程中仍然缺乏对于更新过程表述的优先报告条目。本文旨在介绍更新版指南报告清单(Checklist for the Reporting of Updated Guidelines,Check Up)及其制定过程。方法基于临床指南更新的研究证据的概述,指南研究与评价工具(Appraisal of Guidelines for Research and EvaluationⅡ,AGREEⅡ)和报告清单专家组(33位)的建议开发了初始清单的各条目。然后,使用多个步骤对本清单进行了完善,包括评估10个现有的更新版临床指南,对关键信息提供者进行访谈[应答率为54.2%(13/24)],清单制定专家组内部进行的一个三轮的德尔菲(Delphi)共识调查,以及来自于临床指南方法学专家[应答率为90%(53/59)]和指南使用者[应答率为55.6%(10/18)]的外部评审意见。结果清单最终包括16个条目,主要涉及:(1)更新版指南的呈现;(2)编辑独立性;(3)更新过程采用的方法。结论更新版指南的报告清单作为一个工具可用于评估更新版指南报告的完整性,并为指南制定者提供撰写报告的要求。展开更多
Colorectal cancer(CRC)is a very heterogeneous disease that is caused by the interaction of genetic and environmental factors.CRC develops through a gradual accumulation of genetic and epigenetic changes,leading to the...Colorectal cancer(CRC)is a very heterogeneous disease that is caused by the interaction of genetic and environmental factors.CRC develops through a gradual accumulation of genetic and epigenetic changes,leading to the transformation of normal colonic mucosa into invasive cancer.CRC is one of the most prevalent and incident cancers worldwide,as well as one of the most deadly.Approximately 1235108 people are diagnosed annually with CRC,and 609051 die from CRC annually.The World Health Organization estimates an increase of77%in the number of newly diagnosed cases of CRCand an increase of 80%in deaths from CRC by 2030.The incidence of CRC can benefit from different strategies depending on its stage:health promotion through health education campaigns(when the disease is not yet present),the implementation of screening programs(for detection of the disease in its early stages),and the development of nearly personalized treatments according to both patient characteristics(age,sex)and the cancer itself(gene expression).Although there are different strategies for screening and although the number of such strategies is increasing due to the potential of emerging technologies in molecular marker application,not all strategies meet the criteria required for screening tests in population programs;the three most accepted tests are the fecal occult blood test(FOBT),colonoscopy and sigmoidoscopy.FOBT is the most used method for CRC screening worldwide and is also the primary choice in most population-based screening programs in Europe.Due to its non-invasive nature and low cost,it is one of the most accepted techniques by population.CRC is a very heterogeneous disease,and with a few exceptions(APC,p53,KRAS),most of the genes involved in CRC are observed in a small percentage of cases.The design of genetic and epigenetic marker panels that are able to provide maximum coverage in the diagnosis of colorectal neoplasia seems a reasonable strategy.In recent years,the use of DNA,RNA and protein markers in different biological samples has been explored as strategies for CRC diagnosis.Although there is not yet sufficient evidence to recommend the analysis of biomarkers such as DNA,RNA or proteins in the blood or stool,it is likely that given the quick progression of technology tools in molecular biology,increasingly sensitive and less expensive,these tools will gradually be employed in clinical practice and will likely be developed in mass.展开更多
AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with dono...AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.展开更多
Studying the causes of parasite geographic distribution is relevant to understand ecological and evolutionary processes that affect host populations as well as for species conservation. Temperature is one of the most ...Studying the causes of parasite geographic distribution is relevant to understand ecological and evolutionary processes that affect host populations as well as for species conservation. Temperature is one of the most important environmental variables affecting parasite distribution, as raising temperatures positively affect development, reproduction, and rate of transmission of both endo- and ectoparasites. In this context, it is generally accepted that, in mountains, parasite abundance decreases with elevation. However, empirical evidence on this topic is limited. In the present study, we analyzed the elevational variation of hemoparasites and ectoparasites of a lizard, Psammodromus algirus, along a 2,200-m elevational gradient in Sierra Nevada （SE Spain）. As pre- dicted, ectoparasite （mites, ticks, mosquitoes, and sandflies） abundance decreased with elevation. However, hemoparasite prevalence and intensity in the lizard augmented with altitude, showing a pattern contrary to their vectors （mites）. We suggest that tolerance to hemoparasites may increase with elevation as a consequence of lizards at high altitudes taking advantage of increased body condition and food availability, and reduced oxidative stress. Moreover, lizards could have been selected for higher resistance against hemoparasites at lowlands （where higher rates of replication are expected）, thus reducing hemoparasite prevalence and load. Our findings imply that, in a scen- ario of climate warming, populations of lizards at high elevation may face increased abundance of ectoparasites, accompanied with strong negative effects.展开更多
AIM:To establish a quantitative method to measure the amount of lipids.METHODS:The livers of 53 male Wistar rats(225 g) with different degrees of hepatic steatosis were studied.This model of hepatic steatosis was base...AIM:To establish a quantitative method to measure the amount of lipids.METHODS:The livers of 53 male Wistar rats(225 g) with different degrees of hepatic steatosis were studied.This model of hepatic steatosis was based on a high carbohydrate,fat-free modified diet.Biopsies were classified into four grades depending on fat accumulation,using the Kleiner and Brunt classification.Total fat was studied by the Soxtec method(SoxtecTM 2050 Auto Fat Extraction System),and agreement between both assays was assessed by calculating theκ coefficient.RESULTS:According to the histological classification,38% of rats presented grade 0,21% grade 1,22% grade 2 and 20% grade 3.The amount of fat per 100 g tissue was 2.60±0.64 g for grade 0,3.87±1.59 g for grade 1,5.82±1.37 g for grade 2 and 8.68± 2.30 g for grade 3.Statistically significant differences were found between the mean values for each of the histological grades(P<0.05).The correlation for the quantification of fat in the liver between both assays was moderate(κ=0.60).CONCLUSION:The biochemical quantification of fat in liver tissue by the Soxtec method was correlated with the histological classification,although the agreement between the two tests was only moderate.展开更多
Hepatitis C virus(HCV)infection represents a major public health issue.Hepatitis C can be cured bytherapy,but many infected individuals are unaware of their status.Effective HCV screening,fast diagnosis and characteri...Hepatitis C virus(HCV)infection represents a major public health issue.Hepatitis C can be cured bytherapy,but many infected individuals are unaware of their status.Effective HCV screening,fast diagnosis and characterization,and hepatic fibrosis staging are highly relevant for controlling transmission,treating infected patients and,consequently,avoiding end-stage liver disease.Exposure to HCV can be determined with high sensitivity and specificity with currently available third generation serology assays.Additionally,the use of point-of-care tests can increase HCV screening opportunities.However,active HCV infection must be confirmed by direct diagnosis methods.Additionally,HCV genotyping is required prior to starting any treatment.Increasingly,high-volume clinical laboratories use different types of automated platforms,which have simplified sample processing,reduced hands-on-time,minimized contamination risks and human error and ensured full traceability of results.Significant advances have also been made in the field of fibrosis stage assessment with the development of non-invasive methods,such as imaging techniques and serum-based tests.However,no single test is currently available that is able to completely replace liver biopsy.This review focuses on approved commercial tools used to diagnose HCV infection and the recommended hepatic fibrosis staging tests.展开更多
AIM:To study the prognosis(recurrence and mortality)of patients with ischemic colitis(IC).METHODS:This study was conducted in four Spanish hospitals,participants in the Ischemic Colitis in Spain study We analyzed pros...AIM:To study the prognosis(recurrence and mortality)of patients with ischemic colitis(IC).METHODS:This study was conducted in four Spanish hospitals,participants in the Ischemic Colitis in Spain study We analyzed prospectively 135 consecutive patients who met criteria for definitive or probable IC according to Brandt criteria,and follow up these patients during the next five years,retrospectively.Long-term results(recurrence and mortality)were evaluated retrospectively after a median interval of 62 mo(range54-75 mo).RESULTS:Estimated IC recurrence rates were 2.9%,5.1%,8.1%and 9.7%at years 1,2,3 and 5 years,respectively.Five-year survival was 69%(93 of 135)and 24%(10 of 42 patients)died for causes related to the IC.Among these 10 patients,8 died in their first episode at hospital(4 had gangrenous colitis and 4 fulminant colitis)and 2 due to recurrence.CONCLUSION:The five-year recurrence rate of IC was low.On the other hand,mortality during follow-up was high and was not associated with ischemic colitis.展开更多
Objective:To compare pre-and post-radical prostatectomy(RP)responses in the urinary incontinence domain of Expanded Prostate Cancer Index Composite-26(EPIC-26)in cohorts from the USA,Norway and Spain.Methods:A prospec...Objective:To compare pre-and post-radical prostatectomy(RP)responses in the urinary incontinence domain of Expanded Prostate Cancer Index Composite-26(EPIC-26)in cohorts from the USA,Norway and Spain.Methods:A prospective study of pre-and 1-year post-treatment responses in American(nZ537),Norwegian(nZ520)and Spanish(nZ111)patients,establishing the prevalence of urinary incontinence defined according to published dichotomization.Thereafter we focused on the response alternatives“occasional dribbling”,pad use and problem experience.A multivariate logistic regression analysis(significance level≤0.01)considered risk factors for“not retaining total control”.展开更多
To the Editor Cardiovascular disease （CVD） is the main cause of death in older adults. There is strong evidence that regular physical activity （PA） reduces the risk of CVD mortality in this population group. Howev...To the Editor Cardiovascular disease （CVD） is the main cause of death in older adults. There is strong evidence that regular physical activity （PA） reduces the risk of CVD mortality in this population group. However, these studies used baseline data and do not account for potential changes in PA.展开更多
Bottled water consumption is increasing worldwide, despite its huge economic and environmental cost. We aim to describe personal and tap water quality determinants of bottled water use in the city of Barcelona. This c...Bottled water consumption is increasing worldwide, despite its huge economic and environmental cost. We aim to describe personal and tap water quality determinants of bottled water use in the city of Barcelona. This cross-sectional study used data from the Health Survey of Barcelona in 2006（N = 5417 adults）. The use of bottled water to drink and to cook was evaluated in relation to age, gender, educational level, district and levels of trihalomethanes（THMs）, free chlorine, conductivity, chloride, sodium, p H, nitrate and aluminium in municipal tap water using Robust Poisson Regression. The prevalence of bottled water use to drink and cook was 53.9% and 6.7%, respectively. Chemical parameters in water had a large variability（interquartile range of THMs concentrations： 83.2–200.8 μg/L）and were correlated between them, except aluminium. Drinking bottled water increased with educational level, while cooking with bottled water was higher among men than among women and decreased with age. After adjusting by these personal determinants, a dose–response relationship was found between concentrations of all chemicals except aluminium in tap water and bottled water use. The highest association was found for THMs,with a Prevalence Ratio of 2.00（95%CI = 1.86, 2.15） for drinking bottled water and 2.80（95%CI = 1.72, 4.58） for cooking with bottled water, among those with 〉 150 μg/L vs. 〈 100 μg/L THMs in tap water. Conclusion： More than half of Barcelona residents regularly drank bottled water, and the main determinant was the chemical composition of tap water,particularly THM level.展开更多
To describe the smoking habits of the mothers participating in the INMA (INfancia y Medio Ambiente or Childhood and the Environment) cohort of Valencia and to determine which occupational factors are associated with s...To describe the smoking habits of the mothers participating in the INMA (INfancia y Medio Ambiente or Childhood and the Environment) cohort of Valencia and to determine which occupational factors are associated with smoking cessation during pregnancy. Cohort study comprising 855 pregnant women from Health Service Areas 6 and 7 was set up in the Autonomous Region of Valencia, Spain. Data on smoking and smoking cessation during pregnancy, and on sociodemographic and work related variables were collected through structured questionnaires at the first and third trimester of pregnancy. Multivariate logistic regression models were constructed to assess factors related to smoking at the beginning of the pregnancy and to continued smoking. 787 women followed in the project and completed all the data. Among them 40.9% smoked at the beginning of pregnancy and 56.2% continued until gestational week 32. Time and effort spent on housework was associated with smoking at the beginning of pregnancy while stress in the workplace related variables contributed to both the prevalence of smoking at the beginning of the pregnancy and the persistence in the habit throughout pregnancy. We found a high prevalence of smoking among the pregnant mothers. Both, conditions in the workplace, as well as the burden of housework were found to be risk factors for smoking and not quitting during pregnancy. These factors should be taken into account when developing health programs designed to encourage the incorporation of healthy habits into the lives of pregnant women.展开更多
BACKGROUND Faecal immunochemical test(FIT)has been recommended to assess symptomatic patients for colorectal cancer(CRC)detection.Nevertheless,some conditions could theoretically favour blood originating in proximal a...BACKGROUND Faecal immunochemical test(FIT)has been recommended to assess symptomatic patients for colorectal cancer(CRC)detection.Nevertheless,some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized.A positive FIT result could be related to other gastrointestinal cancers(GIC).AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients(threshold 10μg Hb/g faeces)without CRC.METHODS Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection.Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare,underwent a quantitative FIT before undergoing a complete colonoscopy.Patients without CRC were divided into two groups(positive and negative FIT)using the threshold of 10μg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research.We determined the cumulative risk of GIC,CRC and upper GIC.Hazard rate(HR)was calculated adjusted by age,sex and presence of significant colonic lesion.RESULTS We included 2709 patients without CRC and a complete baseline colonoscopy,730(26.9%)with FIT≥10μgr Hb/gr.During a mean time of 45.5±20.0 mo,a GIC was detected in 57(2.1%)patients:An upper GIC in 35(1.3%)and a CRC in 14(0.5%).Thirty-six patients(1.3%)died due to GIC:22(0.8%)due to an upper GIC and 9(0.3%)due to CRC.FIT-positive subjects showed a higher CRC risk(HR 3.8,95%CI:1.2-11.9)with no differences in GIC(HR 1.5,95%CI:0.8-2.7)or upper GIC risk(HR 1.0,95%CI:0.5-2.2).Patients with a positive FIT had only an increased risk of CRC-related death(HR 10.8,95%CI:2.1-57.1)and GIC-related death(HR 2.2,95%CI:1.1-4.3),with no differences in upper GIC-related death(HR 1.4,95%CI:0.6-3.3).An upper GIC was detected in 22(0.8%)patients during the first year.Two variables were independently associated:anaemia(OR 5.6,95%CI:2.2-13.9)and age≥70 years(OR 2.7,95%CI:1.1-7.0).CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC,regardless of the FIT result.Patients with a positive FIT have an increased risk of post-colonoscopy CRC.展开更多
Giardia is an enteric protozoan that infects a wide range of vertebrate hosts, being considered a major causative agent of gastrointestinal disease in humans in both developing and developed countries. Giardia infecti...Giardia is an enteric protozoan that infects a wide range of vertebrate hosts, being considered a major causative agent of gastrointestinal disease in humans in both developing and developed countries. Giardia infection has also a significant impact on livestock health, causing diarrhoea and resulting in significant economic lost. Transmission is either direct, through the faecal-oral route, or indirect, through ingestion of contaminated water or food. In this article, we review current knowledge about the epidemiology of giardiasis in different populations in Spain, including humans, livestock, companion animals, and wildlife. Environmental contamination of surface waters and raw foods by Giardia cysts is also addressed. Special relevance has been given to the data available on the molecular characterization of the Giardia isolates obtained from clinical and environmental samples, as determining thespecies/assemblages and subassemblages involved is essential for accurately identifying the parasite and assessing zoonotic transmission. The public health significance of these findings has also been thoroughly discussed.展开更多
AIM:To evaluate changes in colorectal cancer(CRC) survival over the last 20 years.METHODS:We compared two groups of consecutive CRC patients that were prospectively recruited:Group Ⅰincluded 1990 patients diagnosed b...AIM:To evaluate changes in colorectal cancer(CRC) survival over the last 20 years.METHODS:We compared two groups of consecutive CRC patients that were prospectively recruited:Group Ⅰincluded 1990 patients diagnosed between 1980 and 1994.GroupⅡincluded 871 patients diagnosed in 2001.RESULTS:The average follow up time was 21 mo(1-229)for GroupⅠand 50 mo(1-73.4)for GroupⅡ.Overall median survival was significantly longer in Group Ⅱthan in GroupⅠ(73 mo vs 25 mo,P<0.001)and the difference was significant for all tumor stages.Post surgical mortality was 8% for GroupⅠand 2% for Group Ⅱ(P<0.001).Only 17% of GroupⅠpatients received chemotherapy compared with 50% of GroupⅡpatients(P<0.001).CONCLUSION:Survival in colorectal cancer patients has doubled over the past 20 years.This increase seems to be partly due to the generalization in the administration of chemotherapy and to the decrease of post surgical mortality.展开更多
Background The positive influence of most types of exercise has been reported repeatedly,but what the most effective exercise approaches are for improving health-related quality of life(HRQoL)in people with cancer rem...Background The positive influence of most types of exercise has been reported repeatedly,but what the most effective exercise approaches are for improving health-related quality of life(HRQoL)in people with cancer remains unknown.The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment.Methods MEDLINE,SPORTDiscus,the Cochrane Library,Web of Science,and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer.Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires.We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains.Results In total,93 studies involving 7435 people with cancer were included.Network effect size estimates comparing exercise intervention vs.usual care were significant for combined exercise(0.35,95%confidence interval(95%CI):0.14–0.56)for HRQoL as measured by general questionnaires,and for combined(0.31,95%CI:0.13–0.48),mind–body exercise(0.54,95%CI:0.18–0.89),and walking(0.39,95%CI:0.04–0.74)for HRQoL as measured by cancer-specific questionnaires.Conclusion Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment.The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.展开更多
基金The Trùndelag Health Study (HUNT) is a collaboration between HUNT Research Centre (Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology), Trùndelag County Council, Central Norway Regional Health Authority, and the Norwegian Institute of Public HealthThe coordination of European Prospective Investigation into Cancer and Nutrition - Spain study (EPIC) is financially supported by the International Agency for Research on Cancer (IARC)+7 种基金by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC)supported by Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andaluc 1a, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain)funded by The Netherlands Organisation for Health Research and DevelopmentZon Mw (Grant No.: 531-00141-3)Funding for the SHIP study has been provided by the Federal Ministry for Education and Research (BMBFidentification codes 01 ZZ96030, 01 ZZ0103, and 01 ZZ0701)support from the Swedish Research Council (2018-02527 and 2019-00193)financed by the Helmholtz Zentrum München - German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria.
文摘Background There is insufficient evidence to provide recommendations for leisure-time physical activity among workers across various occupational physical activity levels.This study aimed to assess the association of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels.Methods This study utilized individual participant data from 21 cohort studies,comprising both published and unpublished data.Eligibility criteria included individual-level data on leisure-time and occupational physical activity(categorized as sedentary,low,moderate,and high)along with data on all-cause and/or cardiovascular mortality.A 2-stage individual participant data meta-analysis was conducted,with separate analysis of each study using Cox proportional hazards models(Stage 1).These results were combined using random-effects models(Stage 2).Results Higher leisure-time physical activity levels were associated with lower all-cause and cardiovascular mortality risk across most occupational physical activity levels,for both males and females.Among males with sedentary work,high compared to sedentary leisure-time physical activity was associated with lower all-cause(hazard ratios(HR)=0.77,95%confidence interval(95%CI):0.70-0.85)and cardiovascular mortality(HR=0.76,95%CI:0.66-0.87)risk.Among males with high levels of occupational physical activity,high compared to sedentary leisure-time physical activity was associated with lower all-cause(HR=0.84,95%CI:0.74-0.97)and cardiovascular mortality(HR=0.79,95%CI:0.60-1.04)risk,while HRs for low and moderate levels of leisure-time physical activity ranged between 0.87 and 0.97 and were not statistically significant.Among females,most effects were similar but more imprecise,especially in the higher occupational physical activity levels.Conclusion Higher levels of leisure-time physical activity were generally associated with lower mortality risks.However,results for workers with moderate and high occupational physical activity levels,especially women,were more imprecise.Our findings suggests that workers may benefit from engaging in high levels of leisure-time physical activity,irrespective of their level of occupational physical activity.
文摘目的临床指南需要根据相关研究结果定期审查以确保其可靠性,但在更新临床指南的过程中仍然缺乏对于更新过程表述的优先报告条目。本文旨在介绍更新版指南报告清单(Checklist for the Reporting of Updated Guidelines,Check Up)及其制定过程。方法基于临床指南更新的研究证据的概述,指南研究与评价工具(Appraisal of Guidelines for Research and EvaluationⅡ,AGREEⅡ)和报告清单专家组(33位)的建议开发了初始清单的各条目。然后,使用多个步骤对本清单进行了完善,包括评估10个现有的更新版临床指南,对关键信息提供者进行访谈[应答率为54.2%(13/24)],清单制定专家组内部进行的一个三轮的德尔菲(Delphi)共识调查,以及来自于临床指南方法学专家[应答率为90%(53/59)]和指南使用者[应答率为55.6%(10/18)]的外部评审意见。结果清单最终包括16个条目,主要涉及:(1)更新版指南的呈现;(2)编辑独立性;(3)更新过程采用的方法。结论更新版指南的报告清单作为一个工具可用于评估更新版指南报告的完整性,并为指南制定者提供撰写报告的要求。
基金Supported by Partially funded by the Carlos Ⅲ Health Institute No.PI11/01593
文摘Colorectal cancer(CRC)is a very heterogeneous disease that is caused by the interaction of genetic and environmental factors.CRC develops through a gradual accumulation of genetic and epigenetic changes,leading to the transformation of normal colonic mucosa into invasive cancer.CRC is one of the most prevalent and incident cancers worldwide,as well as one of the most deadly.Approximately 1235108 people are diagnosed annually with CRC,and 609051 die from CRC annually.The World Health Organization estimates an increase of77%in the number of newly diagnosed cases of CRCand an increase of 80%in deaths from CRC by 2030.The incidence of CRC can benefit from different strategies depending on its stage:health promotion through health education campaigns(when the disease is not yet present),the implementation of screening programs(for detection of the disease in its early stages),and the development of nearly personalized treatments according to both patient characteristics(age,sex)and the cancer itself(gene expression).Although there are different strategies for screening and although the number of such strategies is increasing due to the potential of emerging technologies in molecular marker application,not all strategies meet the criteria required for screening tests in population programs;the three most accepted tests are the fecal occult blood test(FOBT),colonoscopy and sigmoidoscopy.FOBT is the most used method for CRC screening worldwide and is also the primary choice in most population-based screening programs in Europe.Due to its non-invasive nature and low cost,it is one of the most accepted techniques by population.CRC is a very heterogeneous disease,and with a few exceptions(APC,p53,KRAS),most of the genes involved in CRC are observed in a small percentage of cases.The design of genetic and epigenetic marker panels that are able to provide maximum coverage in the diagnosis of colorectal neoplasia seems a reasonable strategy.In recent years,the use of DNA,RNA and protein markers in different biological samples has been explored as strategies for CRC diagnosis.Although there is not yet sufficient evidence to recommend the analysis of biomarkers such as DNA,RNA or proteins in the blood or stool,it is likely that given the quick progression of technology tools in molecular biology,increasingly sensitive and less expensive,these tools will gradually be employed in clinical practice and will likely be developed in mass.
文摘AIM To increase the number of available grafts.METHODS This is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation(LT) were performed with donors ≥ 70 years old(study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old(control group).RESULTS Graft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus(HCV)-positivity [hazard ratio(HR) = 2.35; 95% confidence interval(CI): 1.55-3.56; P = 0.00]; recipient age(HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease(D-MELD)(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase(HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium(HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD(donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients(77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00). CONCLUSION A DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.
文摘Studying the causes of parasite geographic distribution is relevant to understand ecological and evolutionary processes that affect host populations as well as for species conservation. Temperature is one of the most important environmental variables affecting parasite distribution, as raising temperatures positively affect development, reproduction, and rate of transmission of both endo- and ectoparasites. In this context, it is generally accepted that, in mountains, parasite abundance decreases with elevation. However, empirical evidence on this topic is limited. In the present study, we analyzed the elevational variation of hemoparasites and ectoparasites of a lizard, Psammodromus algirus, along a 2,200-m elevational gradient in Sierra Nevada （SE Spain）. As pre- dicted, ectoparasite （mites, ticks, mosquitoes, and sandflies） abundance decreased with elevation. However, hemoparasite prevalence and intensity in the lizard augmented with altitude, showing a pattern contrary to their vectors （mites）. We suggest that tolerance to hemoparasites may increase with elevation as a consequence of lizards at high altitudes taking advantage of increased body condition and food availability, and reduced oxidative stress. Moreover, lizards could have been selected for higher resistance against hemoparasites at lowlands （where higher rates of replication are expected）, thus reducing hemoparasite prevalence and load. Our findings imply that, in a scen- ario of climate warming, populations of lizards at high elevation may face increased abundance of ectoparasites, accompanied with strong negative effects.
基金Supported by CIBERehd and Donostia Hospital,CIBER is funded by the Instituto de Salud Carlos Ⅲ
文摘AIM:To establish a quantitative method to measure the amount of lipids.METHODS:The livers of 53 male Wistar rats(225 g) with different degrees of hepatic steatosis were studied.This model of hepatic steatosis was based on a high carbohydrate,fat-free modified diet.Biopsies were classified into four grades depending on fat accumulation,using the Kleiner and Brunt classification.Total fat was studied by the Soxtec method(SoxtecTM 2050 Auto Fat Extraction System),and agreement between both assays was assessed by calculating theκ coefficient.RESULTS:According to the histological classification,38% of rats presented grade 0,21% grade 1,22% grade 2 and 20% grade 3.The amount of fat per 100 g tissue was 2.60±0.64 g for grade 0,3.87±1.59 g for grade 1,5.82±1.37 g for grade 2 and 8.68± 2.30 g for grade 3.Statistically significant differences were found between the mean values for each of the histological grades(P<0.05).The correlation for the quantification of fat in the liver between both assays was moderate(κ=0.60).CONCLUSION:The biochemical quantification of fat in liver tissue by the Soxtec method was correlated with the histological classification,although the agreement between the two tests was only moderate.
基金Supported by A Miguel Servet contract No.MS09/00044 funded by FIS-ISCIII(Spanish Government)to MartróEgrant PI10/01734 within the"Plan Nacional de I+D+I"co-financed by"ISCIII-Subdirección General de Evaluación y el Fondo Eu-ropeo de Desarrollo Regional"(FEDER)to González V,Saludes V,MartróE
文摘Hepatitis C virus(HCV)infection represents a major public health issue.Hepatitis C can be cured bytherapy,but many infected individuals are unaware of their status.Effective HCV screening,fast diagnosis and characterization,and hepatic fibrosis staging are highly relevant for controlling transmission,treating infected patients and,consequently,avoiding end-stage liver disease.Exposure to HCV can be determined with high sensitivity and specificity with currently available third generation serology assays.Additionally,the use of point-of-care tests can increase HCV screening opportunities.However,active HCV infection must be confirmed by direct diagnosis methods.Additionally,HCV genotyping is required prior to starting any treatment.Increasingly,high-volume clinical laboratories use different types of automated platforms,which have simplified sample processing,reduced hands-on-time,minimized contamination risks and human error and ensured full traceability of results.Significant advances have also been made in the field of fibrosis stage assessment with the development of non-invasive methods,such as imaging techniques and serum-based tests.However,no single test is currently available that is able to completely replace liver biopsy.This review focuses on approved commercial tools used to diagnose HCV infection and the recommended hepatic fibrosis staging tests.
基金CIBERehd is funded by the Instituto de Salud Carlos Ⅲ
文摘AIM:To study the prognosis(recurrence and mortality)of patients with ischemic colitis(IC).METHODS:This study was conducted in four Spanish hospitals,participants in the Ischemic Colitis in Spain study We analyzed prospectively 135 consecutive patients who met criteria for definitive or probable IC according to Brandt criteria,and follow up these patients during the next five years,retrospectively.Long-term results(recurrence and mortality)were evaluated retrospectively after a median interval of 62 mo(range54-75 mo).RESULTS:Estimated IC recurrence rates were 2.9%,5.1%,8.1%and 9.7%at years 1,2,3 and 5 years,respectively.Five-year survival was 69%(93 of 135)and 24%(10 of 42 patients)died for causes related to the IC.Among these 10 patients,8 died in their first episode at hospital(4 had gangrenous colitis and 4 fulminant colitis)and 2 due to recurrence.CONCLUSION:The five-year recurrence rate of IC was low.On the other hand,mortality during follow-up was high and was not associated with ischemic colitis.
基金The study was funded by a grant from Health-RegionSouth. East, Norway (No. 8324).
文摘Objective:To compare pre-and post-radical prostatectomy(RP)responses in the urinary incontinence domain of Expanded Prostate Cancer Index Composite-26(EPIC-26)in cohorts from the USA,Norway and Spain.Methods:A prospective study of pre-and 1-year post-treatment responses in American(nZ537),Norwegian(nZ520)and Spanish(nZ111)patients,establishing the prevalence of urinary incontinence defined according to published dichotomization.Thereafter we focused on the response alternatives“occasional dribbling”,pad use and problem experience.A multivariate logistic regression analysis(significance level≤0.01)considered risk factors for“not retaining total control”.
文摘To the Editor Cardiovascular disease （CVD） is the main cause of death in older adults. There is strong evidence that regular physical activity （PA） reduces the risk of CVD mortality in this population group. However, these studies used baseline data and do not account for potential changes in PA.
文摘Bottled water consumption is increasing worldwide, despite its huge economic and environmental cost. We aim to describe personal and tap water quality determinants of bottled water use in the city of Barcelona. This cross-sectional study used data from the Health Survey of Barcelona in 2006（N = 5417 adults）. The use of bottled water to drink and to cook was evaluated in relation to age, gender, educational level, district and levels of trihalomethanes（THMs）, free chlorine, conductivity, chloride, sodium, p H, nitrate and aluminium in municipal tap water using Robust Poisson Regression. The prevalence of bottled water use to drink and cook was 53.9% and 6.7%, respectively. Chemical parameters in water had a large variability（interquartile range of THMs concentrations： 83.2–200.8 μg/L）and were correlated between them, except aluminium. Drinking bottled water increased with educational level, while cooking with bottled water was higher among men than among women and decreased with age. After adjusting by these personal determinants, a dose–response relationship was found between concentrations of all chemicals except aluminium in tap water and bottled water use. The highest association was found for THMs,with a Prevalence Ratio of 2.00（95%CI = 1.86, 2.15） for drinking bottled water and 2.80（95%CI = 1.72, 4.58） for cooking with bottled water, among those with 〉 150 μg/L vs. 〈 100 μg/L THMs in tap water. Conclusion： More than half of Barcelona residents regularly drank bottled water, and the main determinant was the chemical composition of tap water,particularly THM level.
文摘To describe the smoking habits of the mothers participating in the INMA (INfancia y Medio Ambiente or Childhood and the Environment) cohort of Valencia and to determine which occupational factors are associated with smoking cessation during pregnancy. Cohort study comprising 855 pregnant women from Health Service Areas 6 and 7 was set up in the Autonomous Region of Valencia, Spain. Data on smoking and smoking cessation during pregnancy, and on sociodemographic and work related variables were collected through structured questionnaires at the first and third trimester of pregnancy. Multivariate logistic regression models were constructed to assess factors related to smoking at the beginning of the pregnancy and to continued smoking. 787 women followed in the project and completed all the data. Among them 40.9% smoked at the beginning of pregnancy and 56.2% continued until gestational week 32. Time and effort spent on housework was associated with smoking at the beginning of pregnancy while stress in the workplace related variables contributed to both the prevalence of smoking at the beginning of the pregnancy and the persistence in the habit throughout pregnancy. We found a high prevalence of smoking among the pregnant mothers. Both, conditions in the workplace, as well as the burden of housework were found to be risk factors for smoking and not quitting during pregnancy. These factors should be taken into account when developing health programs designed to encourage the incorporation of healthy habits into the lives of pregnant women.
基金Supported by Instituto de Salud Carlos III through the project PI17/00837(Co-funded by European Regional Development Fund/European Social Fund"A way to make Europe"/"Investing in your future")
文摘BACKGROUND Faecal immunochemical test(FIT)has been recommended to assess symptomatic patients for colorectal cancer(CRC)detection.Nevertheless,some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized.A positive FIT result could be related to other gastrointestinal cancers(GIC).AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients(threshold 10μg Hb/g faeces)without CRC.METHODS Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection.Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare,underwent a quantitative FIT before undergoing a complete colonoscopy.Patients without CRC were divided into two groups(positive and negative FIT)using the threshold of 10μg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research.We determined the cumulative risk of GIC,CRC and upper GIC.Hazard rate(HR)was calculated adjusted by age,sex and presence of significant colonic lesion.RESULTS We included 2709 patients without CRC and a complete baseline colonoscopy,730(26.9%)with FIT≥10μgr Hb/gr.During a mean time of 45.5±20.0 mo,a GIC was detected in 57(2.1%)patients:An upper GIC in 35(1.3%)and a CRC in 14(0.5%).Thirty-six patients(1.3%)died due to GIC:22(0.8%)due to an upper GIC and 9(0.3%)due to CRC.FIT-positive subjects showed a higher CRC risk(HR 3.8,95%CI:1.2-11.9)with no differences in GIC(HR 1.5,95%CI:0.8-2.7)or upper GIC risk(HR 1.0,95%CI:0.5-2.2).Patients with a positive FIT had only an increased risk of CRC-related death(HR 10.8,95%CI:2.1-57.1)and GIC-related death(HR 2.2,95%CI:1.1-4.3),with no differences in upper GIC-related death(HR 1.4,95%CI:0.6-3.3).An upper GIC was detected in 22(0.8%)patients during the first year.Two variables were independently associated:anaemia(OR 5.6,95%CI:2.2-13.9)and age≥70 years(OR 2.7,95%CI:1.1-7.0).CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC,regardless of the FIT result.Patients with a positive FIT have an increased risk of post-colonoscopy CRC.
基金Supported by A grant from the Department of Health,Basque Government,Spain,Exp.No.2007111002
文摘Giardia is an enteric protozoan that infects a wide range of vertebrate hosts, being considered a major causative agent of gastrointestinal disease in humans in both developing and developed countries. Giardia infection has also a significant impact on livestock health, causing diarrhoea and resulting in significant economic lost. Transmission is either direct, through the faecal-oral route, or indirect, through ingestion of contaminated water or food. In this article, we review current knowledge about the epidemiology of giardiasis in different populations in Spain, including humans, livestock, companion animals, and wildlife. Environmental contamination of surface waters and raw foods by Giardia cysts is also addressed. Special relevance has been given to the data available on the molecular characterization of the Giardia isolates obtained from clinical and environmental samples, as determining thespecies/assemblages and subassemblages involved is essential for accurately identifying the parasite and assessing zoonotic transmission. The public health significance of these findings has also been thoroughly discussed.
文摘AIM:To evaluate changes in colorectal cancer(CRC) survival over the last 20 years.METHODS:We compared two groups of consecutive CRC patients that were prospectively recruited:Group Ⅰincluded 1990 patients diagnosed between 1980 and 1994.GroupⅡincluded 871 patients diagnosed in 2001.RESULTS:The average follow up time was 21 mo(1-229)for GroupⅠand 50 mo(1-73.4)for GroupⅡ.Overall median survival was significantly longer in Group Ⅱthan in GroupⅠ(73 mo vs 25 mo,P<0.001)and the difference was significant for all tumor stages.Post surgical mortality was 8% for GroupⅠand 2% for Group Ⅱ(P<0.001).Only 17% of GroupⅠpatients received chemotherapy compared with 50% of GroupⅡpatients(P<0.001).CONCLUSION:Survival in colorectal cancer patients has doubled over the past 20 years.This increase seems to be partly due to the generalization in the administration of chemotherapy and to the decrease of post surgical mortality.
基金supported by the European Regional Development Fund.Supported by Consejería de Educacion,Culturay Deportes-JCCMFondo Europeo de Desarrollo Regional funds (grant no.SBPLY/17/180501/000533)+1 种基金supported by a grant from the University of Castilla-La Mancha (2020-PREDUCLM-15596)supported by a grant from the Universidad de Castilla-La Mancha co-financed by the European Social Fund (2020-PREDUCLM-16746).
文摘Background The positive influence of most types of exercise has been reported repeatedly,but what the most effective exercise approaches are for improving health-related quality of life(HRQoL)in people with cancer remains unknown.The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment.Methods MEDLINE,SPORTDiscus,the Cochrane Library,Web of Science,and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer.Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires.We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains.Results In total,93 studies involving 7435 people with cancer were included.Network effect size estimates comparing exercise intervention vs.usual care were significant for combined exercise(0.35,95%confidence interval(95%CI):0.14–0.56)for HRQoL as measured by general questionnaires,and for combined(0.31,95%CI:0.13–0.48),mind–body exercise(0.54,95%CI:0.18–0.89),and walking(0.39,95%CI:0.04–0.74)for HRQoL as measured by cancer-specific questionnaires.Conclusion Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment.The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.
