Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain)

Background: At present, it is complicated to use screening trials to determine the optimal age intervals and periodicities of breast cancer early detection. Mathematical models are an alternative that has been widely used. The aim of this study was to estimate the effect of different breast cancer early detection strategies in Catalonia (Spain), in terms of breast cancer mortality reduction (MR) and years of life gained (YLG), using the stochastic models developed by Lee and Zelen (LZ). Methods: We used the LZ model to estimate the cumulative probability of death for a cohort exposed to different screening strategies after T years of follow-up. We also obtained the cumulative probability of death for a cohort with no screening. These probabilities were used to estimate the possible breast cancer MR and YLG by age, period and cohort of birth. The inputs of the model were: incidence of, mortality from and survival after breast cancer, mortality from other causes, distribution of breast cancer stages at diagnosis and sensitivity of mammography. The outputs were relative breast cancer MR and YLG. Results: Relative breast cancer MR varied from 20% for biennial exams in the 50 to 69 age interval to 30% for annual exams in the 40 to 74 age interval. When strategies differ in periodicity but not in the age interval of exams, biennial screening achieved almost 80% of the annual screening MR. In contrast to MR, the effect on YLG of extending screening from 69 to 74 years of age was smaller than the effect of extending the screening from 50 to 45 or 40 years. Conclusion: In this study we have obtained a measure of the effect of breast cancer screening in terms of mortality and years of life gained. The Lee and Zelen mathematical models have been very useful for assessing the impact of different modalities of early detection on MR and YLG in Catalonia (Spain).

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

Background: Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods: In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results: Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ≥10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p < 0.001) Conclusion: Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions.

Cost-effectiveness of early detection of breast cancer in Catalonia (Spain)

Background: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.

Flow resistance equations for mountain rivers

Three models of flow resistance (a Keulegan-type logarithmic law and two models developed for large-scale roughness conditions: the full logarithmic law and a model based on an inflectional velocity profile) were calibrated, validated and compared using an extensive database (N = 1,533) from rivers and flumes, representative of a wide hydraulic and geomorphologic range in the field of gravel-bed and mountain channels. It is preferable to apply the model based on an inflectional velocity profile in the relative submergence (y/d90) interval between 0.5 and 15, while the full logarithmic law is preferable for values below 0.5. For high relative submergence, above 15, either the logarithmic law or the full logarithmic law can be applied. The models fitted to the coarser percentiles are preferable to those fitted to the median diameter, owing to the higher explanatory power achieved by setting a model, the smaller difference in the goodness-of-fit between the different models and the lower influence of the origin of the data (river or flume).

Contribution of early detection and adjuvant treatments to breast cancer mortality reduction in Catalonia, Spain

Background: Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings: A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975-2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30-69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance: Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods.

In search for better pharmacological prophylaxis for acute mountain sickness: looking in other directions.

Despite decades of research, the exact pathogenic mechanisms underlying acute mountain sickness (AMS) are still poorly understood. This fact frustrates the search for novel pharmacological prophylaxis for AMS. The prevailing view is that AMS results from an insufficient physiological response to hypoxia and that prophylaxis should aim at stimulating the response. Starting off from the opposite hypothesis that AMS may be caused by an initial excessive response to hypoxia, we suggest that directly or indirectly blunting-specific parts of the response might provide promising research alternatives. This reasoning is based on the observations that (i) humans, once acclimatized, can climb Mt Everest experiencing arterial partial oxygen pressures (PaO2 ) as low as 25 mmHg without AMS symptoms; (ii) paradoxically, AMS usually develops at much higher PaO2 levels; and (iii) several biomarkers, suggesting initial activation of specific pathways at such PaO2 , are correlated with AMS. Apart from looking for substances that stimulate certain hypoxia triggered effects, such as the ventilatory response to hypoxia, we suggest to also investigate pharmacological means aiming at blunting certain other specific hypoxia-activated pathways, or stimulating their agonists, in the quest for better pharmacological prophylaxis for AMS.

Centrality and investment strategies at the beginning of industrialisation in mid-nineteenth-century Catalonia

We apply social networks analysis to the study of an important database on investment and companies" share in the Catalonia (Spain) of the nineteenth century. In contrast with most of the existing related literature, usually addressing power relationships across administration boards, we focus on the structure of interactions among individual investors and firms. Centrality analysis uncovers interesting roles played by certain economic sectors (e.g. textile and financial). Furthermore, the diverse composition (in terms of economic activity) of communities in the network (subgroups more densely connected internally than with the rest of the network) reveals a high investment diversification, which nicely agrees with a known characteristic of traditional Catalan business strategies.

Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Estratigrafía y sedimentología del Paleógeno de la Sierra de Tramuntana (Mallorca)

El Palegeóno aflorante en la Sierra de Tramuntana muestra la existencia de dos unidades litoestratigráficas principales: la inferior (Fm. Calizas de Peguera) está constituida predominantemente por materiales carbonatados lacustres, con depósitos carbonosos en su base, un nivel intermedio de sedimentos detríticos fluviales y una intercalación marina a techo, mientras que la unidad superior (Fm. Detritica de Cala Blanca) registra la evolución lateral de un sistema detrítico fluvio-aluvial con paleocorrientes hacia el SE, progradante sobre una unidad basal de calcarenitas marinas.

Characteristics of 2D convective structures in Catalonia (NE Spain): an analysis using radar data and GIS

Flood simulation studies use spatial-temporal rainfall data input into distributed hydrological models. A correct description of rainfall in space and in time contributes to improvements on hydrological modelling and design. This work is focused on the analysis of 2-D convective structures (rain cells), whose contribution is especially significant in most flood events. The objective of this paper is to provide statistical descriptors and distribution functions for convective structure characteristics of precipitation systems producing floods in Catalonia (NE Spain). To achieve this purpose heavy rainfall events recorded between 1996 and 2000 have been analysed. By means of weather radar, and applying 2-D radar algorithms a distinction between convective and stratiform precipitation is made. These data are introduced and analyzed with a GIS. In a first step different groups of connected pixels with convective precipitation are identified. Only convective structures with an area greater than 32 km2 are selected. Then, geometric characteristics (area, perimeter, orientation and dimensions of the ellipse), and rainfall statistics (maximum, mean, minimum, range, standard deviation, and sum) of these structures are obtained and stored in a database. Finally, descriptive statistics for selected characteristics are calculated and statistical distributions are fitted to the observed frequency distributions. Statistical analyses reveal that the Generalized Pareto distribution for the area and the Generalized Extreme Value distribution for the perimeter, dimensions, orientation and mean areal precipitation are the statistical distributions that best fit the observed ones of these parameters. The statistical descriptors and the probability distribution functions obtained are of direct use as an input in spatial rainfall generators.

Aspectos bio y cronoestratigraficos del Mioceno de Bera (Tarragona )

Se estudian los Moluscos, Foraminíferos, Palinología, Nanoplancton calcáreo de unos nuevos niveles arcilloso-limosos descubiertos en la excavación de un pozo en las proximidades de la Ermita de Berà (Tarragona); la excelente conservación de los restos paleontológicos permite un estudio más exahustivo. En conjunto, la mayoría de las características indican que se trataría de una sedimentación en condiciones neríticas alrededor de los 30 metros de profundidad con ciertas influencias de carácter estuarino. La presencia de abundantes Orbulina, T. mayeri, junto con G. praemenardii y ausencia de G. fohsi peripheroronda (presente en otras secciones próximas) permite atribuir los niveles a la biozona de G. mayeri, de edad Serravalliense; los datos de Nanoplancton son acordes con dicha edad.

Magnetoestratigrafía de las sucesiones cenozoicas de la cuenca de As Pontes(La Coruña, Noroeste de España).

La cuenca terciaria de As Pontes (Noroeste de España), asociada a un corredor de fallas transcurrentes de dirección NW-SE, ha sido datada mediante magnetoestratigrafia, para lo cual se han estudiado un total de cuatro sucesiones magnetoestratigráficas. Las litologías estudiadas han sido sobre todo arcillas aluviales y palustres-lacustres, con un contenido variable de materia orgánica. En total se han desmagnetizado unos 900 especímenes, mediante desmagnetización térmica y por campos alternantes. Los minerales responsables de la magnetización en las rocas estudiadas son la magnetita y los sulfuros de hierro. A partir de los datos paleomagnéticos, se puede establecer que la sedimentación en la cuenca comenzó en el cron 10r (parte alta del Starnpiense) y se prolongó, como mínimo, hasta el subcron 6AAr.2n (Aquitaniense superior). Así, la duración de la sedimentación en la cuenca fue de unos 6,2 Ma, abarcando desde la última parte del Oligoceno temprano hasta el Mioceno temprano. La correlación magnetoestratigráfica de las diferentes sucesiones de la cuenca ha permitido establecer una correlación cronológica muy precisa a escala de cuenca, determinando la casi total isocronía de la mayor parte de los diferentes niveles de lignito y de las unidades litoestratigráficas de la cuenca. Por otro lado, las declinaciones medias muestran una rotación de 9'+4' para el relleno sedimentario de la cuenca de As Pontes, en sentido horario con respecto a la declinación del Oligoceno-Mioceno, coherente con el movimiento dextrógiro del corredor de fallas transcurrentes de dirección NW-SE. La datación del registro sedimentario de la cuenca de As Pontes permite establecer que los sistemas de fallas transcurrentes de orientación NW-SE del noroeste de la Península Ibérica fueron fuertemente activos desde la última parte del Oligoceno temprano hasta el Mioceno temprano. La finalización del movimiento principal de estos sistemas de fallas coincidió con el fin de actividad del margen entre la microplaca Ibérica y la placa Europea. Esto implicaría que el final de la actividad tectónica principal coincide en el ofshore y en el onshore del NW peninsular.

Plant diversity across five vegetation belts in the Pyrenees (Catalonia, Spain)

In this paper we analyze the size and habitat partitioning of the vascular floras of five areas of the NE Iberian Peninsula, representing five distinct vegetation belts and three floristic regions: Mediterranean (basal belt), medio-European (submontane and montane belts) and Boreo-Alpine (subalpine and alpine belts). Each area covered over 1000 ha, and was fairly uniform in terms of potential vegetation, bedrock and bioclimate. They excluded large villages and field areas, the landscape being mainly natural or moderately anthropized.

Mesozoic geology of Cape Shirreff, Livingston Island, South Shetland Islands, Antarctica.

Al Cap de Shirr e ff (Fig. 1) hi aflora una successió volcànica de com a mínim 450 m de potència, constituïda principalment per laves i, en menor proporció, bretxes vulcanoclàstiques (Fig. 2). Les laves són basalts olivínics subalcalins i andesites basàltiques, que generalment tenen un aspecte massiu. Tot i això, la successió volcànica localment forma una alternança decimètrica de nivells durs i tous, amb potències va r i a bles i presència local de discordances angulars i onlaps, que reflecteixen geometries deposicionals complexes. A la zona nord del Cap de Shirr e ff hi ha aflorament de bretxes vulcanoclàstiques d"aspecte massiu, que localment tenen intercalacions de laves...