Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study.

BACKGROUND Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors - healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. RESULTS After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. CONCLUSIONS Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.

A Typology of agents and subjects of regional cooperation: the experience of the Mediterranean Arch

El document és el resultat d'una investigació més àmplia sobre la construcció de l'Arc Mediterrani. El seu objectiu és posar en relleu el notable grau de desenvolupament de la cooperació regional en la matèria, a través d'una anàlisi detallada de les diferents figures institucionalitzades de cooperació territorial existents (o haver existit) a la zona. L'anàlisi s'ha dut a terme des d'un punt de vista temàtic, basat en els objectius prioritaris d'aquestes institucions. En concret, les xifres estudiades es limiten a les institucions formals o les associacions de col · laboració de caràcter específic, com ara euroregions o les agrupacions europees d'interès econòmic, entès com les figures de major institucionalització dels espais transnacionals a nivell europeu. En canvi, hem deixat de banda altres figures, com Interreg (finançat pel FEDER), ja que no són entitats correctament. Encara que de vegades els acords de cooperació establerts per als projectes d'Interreg han donat lloc a algunes de les entitats estudiades aquí.

The Öresund region: A dynamic region in Europe due to inter-regional collaboration?

El cluster Medicon Valley es troba a la regió d'Oresund binacional que s'estén per Dinamarca i Suècia, inclosa la Universitat de Lund, ciutat i tercera ciutat més gran de Suècia, Malmö (veure figura 1). El 2000, aquestes dues parts nacionals estaven connectades físicament per l'establiment dels 18 quilòmetres de longitud, enllaç fix del Øresund (ponts i túnels).

El proyecto de Tratado Constitucional: la participación regional en el control de subsidiariedad

La subsidiarietat és el principi filosòfic que es nodreix de diferents fonts teòriques. Una de les definicions més comunes és la que sosté que la presa de decisions s'ha de fer el més a prop possible dels ciutadans de manera que els nivells superiors de govern s'ocupin només del que els nivells inferiors no estiguin en condicions de dur a terme eficaçment per si sols. Partint d'aquesta premissa, aquest treball es divideix en tres apartats. El primer repassa l'evolució del principi de subsidiarietat a la UE des del Tractat de Maastricht. El segon analitza el debat que va tenir lloc a la Convenció Europea voltant d'aquest principi i la proposta final recollida en el projecte de Tractat Constitucional. El tercer i últim estudia les implicacions institucionals que podrien derivar d'aquesta per les regions amb competències legislatives i, en particular, per les Comunitats Autònomes

Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study.

BACKGROUND Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. METHODS The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. RESULTS The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. CONCLUSIONS Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

Regional-scale debris-flow risk assessment for an alpine valley

In this paper, we perform a societal and economic risk assessment for debris flows at the regional scale, for lower Valtellina, Northern Italy. We apply a simple empirical debris-flow model, FLOW-R, which couples a probabilistic flow routing algorithm with an energy line approach, providing the relative probability of transit, and the maximum kinetic energy, for each cell. By assessing a vulnerability to people and to other exposed elements (buildings, public facilities, crops, woods, communication lines), and their economic value, we calculated the expected annual losses both in terms of lives (societal risk) and goods (direct economic risk). For societal risk assessment, we distinguish for the day and night scenarios. The distribution of people at different moments of the day was considered, accounting for the occupational and recreational activities, to provide a more realistic assessment of risk. Market studies were performed in order to assess a realistic economic value to goods, structures, and lifelines. As terrain unit, a 20 m x 20 m cell was used, in accordance with data availability and the spatial resolution requested for a risk assessment at this scale. Societal risk the whole area amounts to 1.98 and 4.22 deaths/year for the day and the night scenarios, respectively, with a maximum of 0.013 deaths/year/cell. Economic risk for goods amounts to 1,760,291 ?/year, with a maximum of 13,814 ?/year/cell.

Indicadores de desempeño educativo regional: metodología y resultados para los cursos 2005-06 a 2008-09

En este trabajo se construyen algunos indicadores de desempeño para los sistemas educativos no universitarios de las regiones españolas durante los cursos 2005-06 a 2008-09 a partir de información suministrada por diversas publicaciones del Ministerio de Educación. Estos indicadores permiten ofrecer respuestas a la pregunta de qué comunidades autónomas obtienen los mejores resultados educativos de acuerdo con una serie de criterios de desempeño definidos con claridad que recogen tanto aspectos de proceso (acceso a, éxito en y duración de los distintos ciclos educativos) como de resultados medidos en términos de la adquisición de conocimientos. Con el fin de poder hacer comparaciones válidas entre sistemas educativos que se enfrentan a circunstancias muy diversas, hemos construido también indicadores de valor añadido depurando los índices brutos de desempeño de los efectos de dos variables externas que tienen un fuerte impacto sobre los mismos: la disponibilidad de recursos económicos y el nivel educativo de las familias, aproximado por el número medio de años de escolarización de la población adulta.

¿Qué reformas necesita el sistema de financiación regional?

This paper argues that the current Spanish system of regional financing does not adequately respect the principles of equality, autonomy, responsibility and transparency that should guide its design. It also advances a series of recommendations for the reform of the system that can be classified into two broad headings: guaranteeing the effective application of the constitucional principle of equality and reinforcing the fiscal responsibility and the accountability of regional governments.

El Sistema de financiación regional: la liquidación de 2010 y algunas reflexiones sobre la reciente reforma

El pasado mes de julio el Ministerio de Hacienda y Administraciones Públicas hizo pública la liquidación del sistema de financiación de las comunidades autónomas de régimen común correspondiente a 2010, que marca la madurez del nuevo modelo acordado en 2009. En el presente trabajo se describe la distribución de recursos que se fija en este documento, se analizan las fuentes próximas de los cambios observados en la financiación de las distintas comunidades autónomas entre 2009 y 2010 y se realiza una valoración de los efectos de la reciente reforma sobre la equidad del reparto territorial de los recursos del sistema.

Serum sCD163 levels are associated with type 2 diabetes mellitus and are influenced by coffee and wine consumption: results of the Di@bet.es study.

OBJECTIVE Serum levels of soluble TNF-like weak inducer of apoptosis (sTWEAK) and its scavenger receptor CD163 (sCD163) have been linked to insulin resistance. We analysed the usefulness of these cytokines as biomarkers of type 2 diabetes in a Spanish cohort, together with their relationship to food consumption in the setting of the Di@bet.es study. RESEARCH DESIGN AND METHODS This is a cross-sectional, matched case-control study of 514 type 2 diabetes subjects and 517 controls with a Normal Oral Glucose Tolerance Test (NOGTT), using data from the Di@bet.es study. Study variables included clinical and demographic structured survey, food frequency questionnaire and physical examination. Serum concentrations of sTWEAK and sCD163 were measured by ELISA. Linear regression analysis determined which variables were related to sTWEAK and sCD163 levels. Logistic regression analysis was used to estimate odd ratios of presenting type 2 diabetes. RESULTS sCD163 concentrations and sCD163/sTWEAK ratio were 11.0% and 15.0% higher, respectively, (P<0.001) in type 2 diabetes than in controls. Following adjustment for various confounders, the OR for presenting type 2 diabetes in subjects in the highest vs the lowest tertile of sCD163 was [(OR), 2,01 (95%CI, 1,46-2,97); P for trend <0.001]. Coffee and red wine consumption was negatively associated with serum levels of sCD163 (P = 0.0001 and; P = 0.002 for coffee and red wine intake, respectively). CONCLUSIONS High circulating levels of sCD163 are associated with type 2 diabetes in the Spanish population. The association between coffee and red wine intake and these biomarkers deserves further study to confirm its potential role in type 2 diabetes.

Prospective multicenter study of the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bloodstream infections.

The impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bacteremia in a prospective multicenter (10 teaching hospitals) observational study of patients with monomicrobial bacteremia followed up for 30 days after the onset of bacteremia. The adjusted influence of carbapenem resistance on mortality was studied by using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible P. aeruginosa (CSPA) isolates, and 145 (23%) were caused by carbapenem-resistant P. aeruginosa (CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95% confidence interval [CI], 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the fifth day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratio for a Charlson score of 0 at day 30, 9.9 [95% CI, 3.3 to 29.4]; adjusted hazard ratio for a Charlson score of 5 at day 30, 2.6 [95% CI, 0.8 to 8]). This study clarifies the relationship between carbapenem resistance and mortality in patients with P. aeruginosa bacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may not be as great during the first days of the bacteremia or in the presence of comorbidities.

Participación social en salud: conceptos de usuarios, líderes comunitarios, gestores y formuladores de políticas en Colombia. Una mirada cualitativa.

BACKGROUND Health sector reforms taking place in Colombia during the Nineties included policies to promote social participation in the health system, which is considered essential to its functioning. The aim of this article is to analyse the meaning and the significance of participation in health for the different social actors involved in implementing policies in Colombia. METHODS A qualitative, descriptive, exploratory study was carried out using focal groups (FG) and semi-structured individual interviews (I) of the different social actors: 210 users (FG), 40 community leaders (FG), 3 policy makers (E) and 36 healthcare professionals (E). A carried out analysis was content up of the contents. The study area corresponded to the municipalities of Tulua and Palmira in Colombia. RESULTS The concept of participation was interpreted differently depending on the actor studied: for users and leaders the concept referred to contributing ideas, presence in social spaces, solidarity and frequently, and use of the health services. Healthcare professionals considered the activities carried out by institutions together with the community as social participation, the use of services and affiliation to the health system. Policy markers considered participation to concern evaluation and control of the health services by the community, to improve its quality. CONCLUSIONS The different concepts of participation reveal dif ferences between the content of the policy and how it is understood and interpreted by the different social actors in their interaction with the health services. These different perspectives must be taken into account to develop a link between society and the health services.

Guía de ejercicios para pacientes con enfermedad cardiovascular

Disponible en Página Web Hospital Regional de Málaga > Atención Ciudadana > Información Sobre Programas de Salud

Colorectal Cancer Classification and Cell Heterogeneity: A Systems Oncology Approach.

Colorectal cancer is a heterogeneous disease that manifests through diverse clinical scenarios. During many years, our knowledge about the variability of colorectal tumors was limited to the histopathological analysis from which generic classifications associated with different clinical expectations are derived. However, currently we are beginning to understand that under the intense pathological and clinical variability of these tumors there underlies strong genetic and biological heterogeneity. Thus, with the increasing available information of inter-tumor and intra-tumor heterogeneity, the classical pathological approach is being displaced in favor of novel molecular classifications. In the present article, we summarize the most relevant proposals of molecular classifications obtained from the analysis of colorectal tumors using powerful high throughput techniques and devices. We also discuss the role that cancer systems biology may play in the integration and interpretation of the high amount of data generated and the challenges to be addressed in the future development of precision oncology. In addition, we review the current state of implementation of these novel tools in the pathological laboratory and in clinical practice.