Estudio de la influencia de la nutrición y genética maternas sobre la programación del desarrollo del tejido adiposo fetal (Estudio PREOBE).

BACKGROUND. Maternal genetics and feeding before and during pregnancy, different maternal metabolic pathologies, as well as nutrient intakes of newborns in their first months of life may be involved in the obesity aetiology and its long-term consequences. The possible role of these and others factors, the mechanisms and the effects on the metabolism, and the development of this disease need further research. OBJECTIVE. To acquire more knowledge about foetal adipose tissue development and the influence of genetic, dietetic and environmental factors on the risk to suffer from obesity. METHODOLOGY. Four study groups have been established with 30 pregnant women in each one: 1) control group; 2) mothers with glucose intolerance/gestational diabetes; 3) women with low weight gain during pregnancy, and 4) women with overweight/obesity at the beginning of the pregnancy. The magnitudes to be studied are: 1) dietary intake; 2) life-style habits; 3) physical activity; 4) anthropometry and body composition; 5) haematological study; 6) biochemical study (lipid and metabolic biomarkers); 7) immune function profile related to nutritional status; 8) psychological profile; 9) genetic biomarkers, and 10) microbiological markers; all of them in relation to the development of the foetal adipose tissue in the first stages of life and the risk of suffering from obesity in the future. CONCLUSION. This project, coordinated by the Department of Paediatrics of the School of Medicine in the University of Granada, and with the collaboration of well-known and expert research groups, tries to contribute to the knowledge about the obesity aetiology in infancy and its subsequent development in later periods of life.

Human Exposure to Endocrine-Disrupting Chemicals and Prenatal Risk Factors for Cryptorchidism and Hypospadias: A Nested Case-Control Study

BACKGROUND. Exposure to xenoestrogens during pregnancy may disturb the development and function of male sexual organs. OBJECTIVE. In this study we aimed to determine whether the combined effect of environmental estrogens measured as total effective xenoestrogen burden (TEXB) is a risk factor for male urogenital malformations. METHODS. In a case-control study, nested in a mother-child cohort (n = 702) established at Granada University Hospital, we compared 50 newborns with diagnosis of cryptorchidism and/or hypospadias with 114 boys without malformations matched by gestational age, date of birth, and parity. Controls did not differ from the total cohort in confounding variables. TEXB and levels of 16 organochlorine pesticides were measured in placenta tissues. Characteristics of parents, pregnancy, and birth were gathered by questionnaire. We used conditional and unconditional regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS. TEXB from organohalogenated compounds was detectable in 72% and 54% of case and control placentas, respectively. Compared with controls, cases had an OR for detectable versus non-detectable TEXB of 2.82 (95% CI, 1.10-7.24). More pesticides were detected in cases than in controls (9.34 +/- 3.19 vs. 6.97 +/- 3.93). ORs for cases with detectable levels of pesticides, after adjusting for potential confounders in the conditional regression analysis, were o,p'-DDT (OR = 2.25; 95% CI, 1.03-4.89), p,p'-DDT (OR = 2.63; 95% CI, 1.21-5.72), lindane (OR = 3.38; 95% CI, 1.36-8.38), mirex (OR = 2.85; 95% CI, 1.22-6.66), and endosulfan alpha (OR = 2.19; 95% CI, 0.99-4.82). Engagement of mothers in agriculture (OR = 3.47; 95% CI, 1.33-9.03), fathers' occupational exposure to xenoestrogens (OR = 2.98; 95% CI, 1.11-8.01), and history of previous stillbirths (OR = 4.20; 95% CI, 1.11-16.66) were also associated with risk of malformations. CONCLUSIONS We found an increased risk for male urogenital malformations related to the combined effect of environmental estrogens in placenta.

Estudio ansiedad-depresión del Donante Trasplante Renal vivio asociado con compartir o no la habitación con el receptor

En las últimas décadas, el Trasplante Renal demuestra ser el mejor tratamiento sustitutivo de la Insuficiencia Renal Crónica, siendo el Trasplante Renal de donante vivo la mejor elección en cuanto calidad de vida, supervivencia del injerto, menores complicaciones y menor coste-beneficio para el trasplantado. En la Fundación Puigvert de Barcelona, la pareja, donante-receptor, de trasplante renal de donación de vivo permanecen juntos durante el procedimiento, mientras que en otros Centros Hospitalarios Nacionales la estancia es separada durante todo el procedimiento o en el post-operatorio. El presente trabajo es un ensayo clínico cuyo objetivo es comprobar si la pareja donante receptor de trasplante renal vivo que comparte estancia hospitalaria en el proceso de la donación modifica su estado afectivo, el físico y la estancia hospitalaria frente aquellos que no la comparten. La población diana son parejas de donante-receptor de nuestro Centro dónde se lleva a cabo el proceso del trasplante renal. La estimación de la muestra necesaria es de 18 parejas en cada grupo, se fija un nivel de significación del 5% y el nivel de pérdidas. El Análisis estadístico se realizará mediante el test 2 de Pearson para las variables independientes cualitativas y el test t-student o Test Shapiro-Wilk. Procedimiento: Grupo A, pareja que ingresa en la misma habitación y Grupo B, pareja que ingresa en habitaciones diferentes. En primer lugar, mediante un estudio exploratorio se conoce la sintomatología de ansiedad-depresión que presenta la pareja donante-receptor previo al ingreso hospitalario y en la segunda parte, se establece un grupo control (estancia junta del donante y receptor) y un grupo experimental (estancia separada del donante y receptor). Se analizan tres momentos diferentes: el antes del ingreso hospitalario, el previo a la intervención quirúrgica y el día del alta hospitalaria.

Estudio comparado sobre la regulación de la objeción de conciencia de los agentes de salud o sanitarios ante la práctica del aborto en los sistemas jurídicos mexicano y español

Anàlisi comparatiu de la regulació jurídica de l'objecció de consciència dels agents de salut o sanitaris davant l'avortament a Mèxic i Espanya, que considerant l'experiència espanyola, proposa modificacions normatives a la legislació mexicana per tal de donar major claredat i certesa en la regulació d'aquest dret en aquells casos en què la norma positiva obligui els agents de salut o sanitaris a intervenir en la pràctica d'un avortament si això contravé la seva posició i convicció personals al respecte, sigui quina sigui la raó o fonament d'aquestes.

Incidència de l'aplicació d'un programa de control de la conducta violenta en joves infractors

En aquest estudi es pretén avaluar l'impacte de la intervenció de tres programes aplicats en centres educatius tancats de la Direcció General de Justícia juvenil per ajudar al jove al control de la seva conducta violenta. Aquest mateix programa s'ha aplicat a joves en medi obert que complien mesures imposades pel jutge de llibertat vigilada. La recerca intenta avaluar els resultats de l'aplicació i la seva perdurabilitat en el temps, un cop han passat uns anys des que van ser aplicats en els joves. El programa es plantejava el control de la conducta violenta dels joves a partir d'un plantejament cognitivo-conductual on les activitats proposades i desenvolupades amb els joves anaven encaminades al canvi i modificació d'aquests comportament. Per avaluar l'efectivitat d'aquests programes la recerca segueix a 31 joves que van fer el programa entre el 2002 i el 2004 i analitza el seu grau de satisfacció respecte la situació actual així com la taxa actual de reincidència. L'estudi aprofita per donar dades respecte el perfil socio-familiar, personal i criminològic dels joves que participen en les diferents aplicacions dels programes.

Vertebral fractures in patients with inflammatory bowel disease compared with a healthy population: a prospective case-control study.

BACKGROUND A prospective study was performed to compare the prevalence of morphometric vertebral fractures (MVF) between patients with inflammatory bowel disease (IBD) and healthy subjects and to identify predictive factors of fracture. METHODS A total of 107 patients with IBD (53 with Crohn's disease and 54 with ulcerative colitis) and 51 healthy subjects participated in the study. Information about anthropometric parameters, toxins, previous fractures, and parameters related to this disease were evaluated. The index of vertebral deformity, bone mass density (BMD), and biochemical parameters were calculated. RESULTS A total of 72 fractures were detected in 38.32% of patients with IBD, and 10 fractures were detected in 13.73% of healthy subjects; the risk of fracture in patients with IBD was higher than that in control subjects (OR, 4.03; 95% CI, 1.652-9.847; p < 0.002). We found no correlation between fracture and BMD in patients with IBD (lumbar spine, r = -0.103, p = 0.17 and femoral neck, r = -0.138, p = 0.07). Corticosteroid treatment was not associated with prevalent vertebral fractures nor with taking corticosteroids (r = 0.135, p = 0.14) or the duration for which they were taken (r = 0.08, p = 0.38), whereas this relationship was present in the controls (r = -0.365, p = 0.01). In the multivariate analysis, none of the measured parameters were significantly predictive of fracture, only to manifested IBD. Hypovitaminosis D was observed in 55.14% of patients with IBD. CONCLUSIONS The prevalence of morphometric vertebral fractures is higher in patients with IBD than in the healthy population, without association with BMD or corticoid treatment. Simply having IBD was proven to be a predictive factor of fracture. We observed a high incidence of hypovitaminosis D in patients with IBD.

Estudio comparativo del estatus clínico-nutricional en mujeres obesas posmenopáusicas incluídas en un programa de pérdida de peso basado en platos preparados.

INTRODUCTION Few studies have evaluated the efficacy and reliability of weight loss-focussed prepared food dishes in obese post-menopausal women. OBJECTIVE To compare the efficacy of a weight loss programme based on a balanced hypocaloric diet using prepared dishes* with that of a similar programme based on standard commercially available foods and with a non-intervened control group. A further aim was to evaluate the subjectivity of participants in the preparation of the diet-adjusted dishes based on usually consumed products. SUBJECTS Obese post-menopausal women aged between 55 and 65 years. DESIGN Controlled longitudinal interventional study. METHOD The sample of 75 female volunteers were divided into three groups of 25 women: a control group, who continued to consume their usual non-dietary adjusted meals (CG), an intervened group, treated with a diet adjusted to their individual requirements and based on standard commercially available food (SG), and another intervened group, treated with a similarly adjusted diet but based on prepared dishes (PG). Data were gathered on anthropometric variables, consumption habits and physical activity levels, and clinical-nutritional controls were conducted at the start and every two weeks to the end of the 8-week study in order to evaluate biochemical changes. RESULTS The weight loss was slightly higher in the prepared-dishes group (PG) than in the standard food diet group (SG), but the difference was not statistically significant, whereas it was considerably higher in both groups than in the non-dietary adjusted control group (CG) and this difference was highly significant (losses of 7.60 kg in PG and 7.01 kg in SG versus 2.10 kg in CG (p < 0.01). However, the PG showed a significantly higher (p < 0.01) loss of fatty mass and abdominal circumference versus the SG women. CONCLUSION More weight was lost by the two groups treated with a diet based on prepared dishes or usual food items in comparison to untreated controls, but the diet based on prepared dishes obtained more reliable and higher quality outcomes, achieving a positive change at fatty compartment level and in the abdominal circumference.

El proyecto EMECAS: protocolo del estudio multicéntrico en España de los efectos a corto plazo de la contaminación atmosférica sobre la salud.

The EMECAM Project demonstrated the short-term effect of air pollution on the death rate in 14 cities in Spain throughout the 1990-1995 period. The Spanish Multicentre Study on Health Effects of Air Pollution (EMECAS) is broadening these objectives by incorporating more recent data, information on hospital disease admissions and totaling 16 Spanish cities. This is an ecological time series study in which the response variables are the daily deaths and the emergency hospitalizations due to circulatory system diseases and respiratory diseases among the residents in each city. Pollutants analyses: suspended particles, SO2, NO2, CO and O3. Control variables: meteorological, calendar, seasonality and influenza trend and incidence. Statistical analysis: estimate of the association in each city by means of the construction of generalized additive Poisson regression models and metanalysis for obtaining combined estimators. The EMECAS Project began with the creation of three working groups (Exposure, Epidemiology and Analysis Methodology) which defined the protocol. The average levels of pollutants were below those established under the current regulations for sulfur dioxide, carbon monoxide and ozone. The NO2 and PM10 values were around those established under the regulations (40 mg/m3). This is the first study of the relationship between air pollution and disease rate among one group of Spanish cities. The pollution levels studied are moderate for some pollutants, although for others, especially NO2 and particles, these levels could entail a problem with regard to complying with the regulations in force.

Estudio epidemiológico de carcinoma escamoso de piel en el área de Barcelonés Nord.

El carcinoma escamós de pell representa una de les neoplàsies més freqüents de la raça blanca. En aquest treball es pretén estimar la seva incidència acumulada a l'àrea del Barcelonès Nord. Altres objectius són conèixer la distribució per edat i sexe d'aquesta neoplàsia i la freqüència d'afectació de diferents àrees corporals. Mitjançant una revisió retrospectiva del registre hospitalari d'anatomia patològica de l'Hospital Universitari Germans Trias i Pujol es van recollir tots els casos incidents de carcinoma escamós de pell diagnosticats en el Barcelonès Nord durant un període de 12 mesos. La taxa d'incidència estandarditzada per a la població mundial ha estat de 17,9 / 100.000 habitants-any. Així mateix, es va trobar una afectació major del sexe masculí i de les àrees corporals exposades als raigs ultraviolats.

Estudio de la presión intraabdominal en el paciente quemado (EPIAPQ): Resultados preliminares

Se realizó un estudio observacional prospectivo, durante 6 meses, para determinar la incidencia y prevalencia de HIA y de SCA en pacientes grandes quemados, incluyendo todos los pacientes mayores de edad con quemaduras &20% superficie corporal total (SCT). n=10 pacientes, 8 (80%) = HIA, 1 (10%) = SCA. Incidencia de HIA = 0,6 casos/paciente-día, SCA = 0,1 casos/paciente-día. Ninguno de los pacientes sin HIA desarrolló ninguna disfunción orgánica; el 7 (87,5%) de los pacientes con HIA presentaron al menos un fallo orgánico. Así pues, en pacientes gran quemados la HIA presenta una importante prevalencia y se asocia a fallos orgánicos.

Deficits in executive and memory processes in delusional disorder: a case-control study

OBJECTIVE Delusional disorder has been traditionally considered a psychotic syndrome that does not evolve to cognitive deterioration. However, to date, very little empirical research has been done to explore cognitive executive components and memory processes in Delusional Disorder patients. This study will investigate whether patients with delusional disorder are intact in both executive function components (such as flexibility, impulsivity and updating components) and memory processes (such as immediate, short term and long term recall, learning and recognition). METHODS A large sample of patients with delusional disorder (n = 86) and a group of healthy controls (n = 343) were compared with regard to their performance in a broad battery of neuropsychological tests including Trail Making Test, Wisconsin Card Sorting Test, Colour-Word Stroop Test, and Complutense Verbal Learning Test (TAVEC). RESULTS When compared to controls, cases of delusional disorder showed a significantly poorer performance in most cognitive tests. Thus, we demonstrate deficits in flexibility, impulsivity and updating components of executive functions as well as in memory processes. These findings held significant after taking into account sex, age, educational level and premorbid IQ. CONCLUSIONS Our results do not support the traditional notion of patients with delusional disorder being cognitively intact.

Sarcoidosis, a propósito de 68 casos

La sarcoidosis es una enfermedad sistémica, granulomatosa de etiología desconocida que afecta al adulto joven. Puede interesar a cualquier órgano aunque también existen formas asintomáticas. En este trabajo se describen las características clínicas, el tratamiento y la evolución de una serie de pacientes diagnosticados de sarcoidosis. Es un estudio retrospectivo en un hospital universitario con un área de referencia de 700.000 habitantes. La manifestación de inicio más frecuente fue el síndrome de Löfgren. La mayoría de los pacientes recibieron tratamiento con antiinflamatorios esteroideos y no esteroideos y presentaron una buena evolución, con resolución de la enfermedad.

Estudio y prevalencia de la diabetes mellitus postrasplante; análisis en un grupo de pacientes trasplantados renales.

INTRODUCTION: The onset of post-transplant diabetes mellitus (PTDM) among kidney recipients is associated with an increased risk of graft failure and high rates of morbidity and mortality. Minimize the risk of PTDM is a priority for improving long-term survival rates. Aims. This study aims to assess the prevalence of PTDM in a renal transplant patient population, to identify risk factors and assess the graft and patient survival. METHODS: The sample consisted of 112 renal transplant patients , 69 men and 43 women , renal transplant , who attended for five years post-transplant consultation. Were analyzed as potential risk factors for PTDM : age , sex, body mass index (BMI ) , obesity , VHC , hypertension, dyslipidemia , total cholesterol (TC) , serum triglyceride and immunosuppressive therapy ( cyclosporine , tacrolimus , mycophenolate mofetil and sirolimus ), also the prevalence of acute rejection episodes was evaluated. RESULTS: The prevalence of PTDM was 24.2 %, compared with 85 patients (75.8%) with standard glucose (PGN) . PTDM patients showed a higher BMI , a higher percentage of overweight , dyslipidemia , total cholesterol levels , triglycerides and performed a greater percentage of patients with PDMPT including Mycophenolate mofetil was administered. CONCLUSIONS: There is a high incidence of PTDM in kidney recipients , the importance of weight control and strict adherence to all identified risk factors , as well as in minimizing the doses of immunosuppressive therapies to prevent the onset of PTDM.

Circulating prolactin and in situ breast cancer risk in the European EPIC cohort: a case-control study.

INTRODUCTION The relationship between circulating prolactin and invasive breast cancer has been investigated previously, but the association between prolactin levels and in situ breast cancer risk has received less attention. METHODS We analysed the relationship between pre-diagnostic prolactin levels and the risk of in situ breast cancer overall, and by menopausal status and use of postmenopausal hormone therapy (HT) at blood donation. Conditional logistic regression was used to assess this association in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, including 307 in situ breast cancer cases and their matched control subjects. RESULTS We found a significant positive association between higher circulating prolactin levels and risk of in situ breast cancer among all women [pre-and postmenopausal combined, ORlog2 = 1.35 (95%CI 1.04-1.76), Ptrend = 0.03]. No statistically significant heterogeneity was found between prolactin levels and in situ cancer risk by menopausal status (Phet = 0.98) or baseline HT use (Phet = 0.20), although the observed association was more pronounced among postmenopausal women using HT compared to non-users (Ptrend = 0.06 vs Ptrend = 0.35). In subgroup analyses, the observed positive association was strongest in women diagnosed with in situ breast tumors <4 years compared to ≥4 years after blood donation (Ptrend = 0.01 vs Ptrend = 0.63; Phet = 0.04) and among nulliparous women compared to parous women (Ptrend = 0.03 vs Ptrend = 0.15; Phet = 0.07). CONCLUSIONS Our data extends prior research linking prolactin and invasive breast cancer to the outcome of in situ breast tumours and shows that higher circulating prolactin is associated with increased risk of in situ breast cancer.

Estudio longitudinal del síndrome metabólico tras el trasplante renal.

BACKGROUND: The occurence of the metabolic syndrome (MS) between the renal receptors is one of the major complications after transplantation and is associated with an increased risk of graft failure and high rates of obesity and diabetes new appearance. AIMS: This study aims to investigate the prevalence and risk factors associated with the development of the MS and to evaluate the association between the same with the allograft dysfunction. METHODS: The samples consisted of 138 renal transplant patients, 83 men and 55 women, kidney transplant, which was attended by over five years for the transplant consultation. Were analyzed as potential risk factors for MS: age, sex, body mass index (BMI), weight, hypertension, diabetes, LDL, HDL, triglycerides in serum and immunosuppressive therapy (cyclosporine, tacrolimus, mycophenolate mofetil), was also assessed the prevalence of acute rejection episodes and renal function. RESULTS: The prevalence of MS was 39.85 %. As statistically significant risk factors were obtained the BMI, overweight, HDL cholesterol levels, triglycerides and LDL as well as hypertension and diabetes. There were high rates of acute rejection and differences in story to the glomerular filtration rate. CONCLUSIONS: There is a high prevalence of the MS that severely compromised renal function and graft survival in renal transplant patients, it is very important the control and strict monitoring of all risk factors identified.