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.

Desenvolupament d'una metodologia per a la millora de les recomanacions en la fertilització nitrogenada dels cereals d'hivern. (II) Cereals d'hivern a les comarques de Barcelona i Girona

Es van realitzar un seguit d’assaigs de fertilització nitrogenada a les comarques de Girona i Barcelona, generalment més humides que les àrees on es van realitzar els assaigs per Sió et al., en aquest mateix volum. Els mètodes assajats van ser els del nitrogen mineral al sòl i el del contingut de nitrats a la base de les tiges (CNSBT). Per al conjunt de sòls i situacions contenido de nitratos en la base de los assajades el mètode del nitrogen mineral s'ha mostrat com una eina molt adequada per planificar l’adobat de cobertora. El mètode del CNSBT també es revela com una eina útil, especialment per a les situacions en què el cultiu té suficient nitrogen disponible al sòl; en altres tot i la seva relació amb el N mínim hi ha casos en què dóna resultats contradictoris que requereixen més recerca .

Metcalfa pruinosa (Say) (Homoptera: Flatidae), ¿una plaga potencial de plantas ornamentales en espacios verdes urbanos de Cataluña?

Se ha determinado la presencia y abundancia de Metcalfa pruinosa (Say) en espacios verdes urbanos de Cataluña. M. pruinosa es una especie ampliamente establecida en Cataluña, especialmente en la zona costera. Se ha registrado el insecto sobre más de 100 plantas distintas. La abundancia del insecto ha sido grande en parques y jardines de localidades como Figueres, Girona, Barcelona, Vilanova i la Geltrú, Tarragona o Salou, ocasionando daños estéticos de consideración. Por tanto, M. pruinosa puede considerarse ya una plaga real de los espacios verdes urbanos de Cataluña, aunque su abundancia y capacidad de daño pueden aumentar en el futuro.

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.

Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study.

BACKGROUND AND PURPOSE: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-APECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). We assessed the diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT (CTP) in the BASICS registry population. METHODS: We applied pc-ASPECTS to CTA-SI and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) parameter maps of BASICS patients with CTA and CTP studies performed. Hypoattenuation on CTA-SI, relative reduction in CBV or CBF, or relative increase in MTT were rated as abnormal. RESULTS: CTA and CTP were available in 27/592 BASICS patients (4.6%). The proportion of patients with any perfusion abnormality was highest for MTT (93%; 95% confidence interval [CI], 76%-99%), compared with 78% (58%-91%) for CTA-SI and CBF, and 46% (27%-67%) for CBV (P < .001). All 3 patients with a CBV pc-ASPECTS < 8 compared to 6/23 patients with a CBV pc-ASPECTS ≥ 8 had died at 1 month (RR 3.8; 95% CI, 1.9-7.6). CONCLUSION: CTP was performed in a minority of the BASICS registry population. Perfusion disturbances in the posterior circulation were most pronounced on MTT parameter maps. CBV pc-ASPECTS < 8 may indicate patients with high case fatality.

Projecte d'instal•lació d'un sistema de calefacció amb biomassa per a nau d'engreix de pollastres a Verges

Implementació d’un nou sistema de calefacció per a una granja d’engreix de pollastres. Es planteja el canvi de l’actual sistema de generació i distribució de calor (amb pantalles de gas propà), el qual és antic i ineficient pels seus anys de funcionament, per un sistema innovador mitjançant uns termoconvectors amb bescanvi aigua-aire. A més, la font de generació de calor serà amb una caldera de biomassa, aprofitant un combustible local i renovable: estella forestal. El canvi i la proposta d’instal•lació tenen dues finalitats ben diferenciades: millora en el maneig, la producció i el benestar animal dins de la nau dels pollastres d’engreix i estalvi econòmic potencial, fixat sobre el 70%, per millorar la rendibilitat de l’explotació i, a més, fomentant el consum d’un combustible renovable i de la zona, neutre en emissions de CO2. L’explotació ramadera es troba a Verges (Baix Empordà). L’empresa basa la seva activitat en l’engreix de pollastres i la producció extensiva de cereals

Anàlisi de l'activitat enoturística dels cellers de la D.O. Empordà

Anàlisi sobre l’activitat enoturística dels cellers adscrits a la Denominació d’Origen Empordà. Es pretén saber quina és la realitat dels cellers de l’Empordà que pertanyen a aquesta denominació d’origen, en quant al seu nivell i model de desenvolupament en matèria turística

Cicloturismo : caso de estudio : perfil y motivación del cliente alemán en tours de ciclismo de carretera

El objetivo principal del proyecto es establecer los elementos motivadores que llevan a un ciclista de carretera amateur a elegir un destino. El objetivo secundario, subordinado al primero, es tratar de determinar si "Costa Brava-Pirineo de Girona" ejerce una cierta atracción sobre el público alemán

Nuevos datos sobre los yacimientos wurmienses del litoral catalán

We present a new bed of cold Malacological fauna of the Wrm in the Catalan littoral, one af its species is dated for the first time iii the hlediterranean (Sipho curtus). We point out the predorninance of Gasteropoda as regards Bivalves in comparison with the other cold beds known.