Browsing by Keyword "Epidemiology"
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Publication A Novel Sampling Model to Study the Epidemiology of Canine Leishmaniasis in an Urban Environment.(Frontiers Media, 2021) Parker, Lucy A; Acosta, Lucrecia; Gutierrez, Mariana Noel; Cruz, Israel; Nieto Martinez, Francisco Javier; Deschutter, Enrique Jorge; Bornay-Llinares, Fernando Jorge; Unión Europea. Comisión Europea. 6 Programa Marco; Generalitat Valenciana (España)Background: Visceral leishmaniasis (VL) is one of the most important parasitic diseases in the world. The domestic dog is the main reservoir of zoonotic VL and a high prevalence of canine leishmaniasis (CanL) is associated with transmission of infection to humans. Here we describe the methodology used to obtain a rapid and representative sample of domestic dogs in the city of Posadas, Misiones, and compare the prevalence of Leishmania infection with a sample of shelter dogs. Methodology: We used the city land registry to make a random selection of homes and systematically recruited 349 domestic dogs from the selected properties. We also included all dogs from the main canine shelter within the city. Dogs were examined by two experienced veterinarians who recorded the presence of clinical signs common in CanL using a standardized protocol. We extracted a blood sample from each dog and performed four different serological tests to reveal the presence of anti-Leishmania antibodies. Results: After clinical examination, 145 domestic dogs (41.5%) and 63 (90%) shelter dogs had clinical signs compatible with CanL (p < 0.001). The seroprevalence among domestic dogs was 20.1% (95% CI 16.1-24.6) which was significantly lower than among the abandoned dogs (38.6%, 95% CI 27.7-50.6, p < 0.001). The spatial distribution of infected dogs was fairly homogenous throughout the city. Among domestic dogs, we observed a positive association between where the dog slept and presence of anti-Leishmania antibodies (p = 0.034). Of the seropositive domestic dogs 38 (54.4%) were asymptomatic. Conclusions: Our findings demonstrate how seroprevalence results can be highly influenced by sampling methodology. We demonstrate how the land registry can be used to estimate the prevalence of CanL in representative sample of domestic dogs in an urban setting, allowing decision makers to deepen their understanding the epidemiology of CanL in a timely and efficient manner for the development of plans to address both human and canine disease.Publication A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: mplications for effectively managing HIV prevention programmes and policy(BioMed Central (BMC), 2015-06-19) Fakoya, Ibidun; Alvarez-del Arco, Debora; Woode-Owusu, Melvina; Monge Corella, Susana; Rivero-Montesdeoca, Yaiza; Delpech, Valerie; Rice, Brian; Noori, Teymur; Pharris, Anastasia; Amato-Gauci, Andrew J; Amo, Julia del; Burns, Fiona M.; Unión Europea. European Centre for Disease Prevention and Control (ECDC)Background: Migrant populations from countries with generalised HIV epidemics make up a significant proportion of all HIV/AIDS cases in many European Union and European Economic Area (EU/EEA) countries, with heterosexual transmission the predominant mode of HIV acquisition. While most of these infections are diagnosed for the first time in Europe, acquisition is believed to have predominantly occurred in the home country. A proportion of HIV transmission is believed to be occurring post-migration, and many countries may underestimate the degree to which this is occurring. Our objectives were to review the literature estimating the proportion of migrants believed to have acquired their HIV post-migration and examine which EU member states are able to provide estimates of probable country of HIV acquisition through current surveillance systems. Methods: A systematic review was undertaken to gather evidence of sexual transmission of HIV within Europe among populations from countries with a generalised epidemic. In addition, national surveillance focal points from 30 EU/EEA Member States were asked to complete a questionnaire about surveillance methods and monitoring of the likely place of HIV acquisition among migrants. Results & discussion: Twenty-seven papers from seven countries were included in the review and 24 countries responded to the survey. Estimates of HIV acquisition post-migration ranged from as low as 2% among sub Saharan Africans in Switzerland, to 62% among black Caribbean men who have sex with men (MSM) in the UK. Surveillance methods for monitoring post-migration acquisition varied across the region; a range of methods are used to estimate country or region of HIV acquisition, including behavioural and clinical markers. There is little published evidence addressing this issue, although Member States highlight the importance of migrant populations in their epidemics. Conclusions: There is post-migration HIV acquisition among migrants in European countries but this is difficult to quantify accurately with current data. Migrant MSM appear at particular risk of HIV acquisition post-migration. Countries that identify migrants as an important part of their HIV epidemic should focus on using an objective method for assigning probable country of HIV acquisition. Robust methods to measure HIV incidence should be considered in order to inform national prevention programming and resource allocation.Publication Additive influence of genetic predisposition and conventional risk factors in the incidence of coronary heart disease: a population-based study in Greece(BMJ Publishing Group, 2014-02-05) Yiannakouris, Nikos; Katsoulis, Michail; Trichopoulou, Antonia; Ordovas, Jose M; Trichopoulos, Dimitrios; Hellenic Health Foundation; Stavros Niarchos Foundation; United States Department of AgricultureOBJECTIVES: An additive genetic risk score (GRS) for coronary heart disease (CHD) has previously been associated with incident CHD in the population-based Greek European Prospective Investigation into Cancer and nutrition (EPIC) cohort. In this study, we explore GRS-'environment' joint actions on CHD for several conventional cardiovascular risk factors (ConvRFs), including smoking, hypertension, type-2 diabetes mellitus (T2DM), body mass index (BMI), physical activity and adherence to the Mediterranean diet. DESIGN: A case-control study. SETTING: The general Greek population of the EPIC study. PARTICIPANTS AND OUTCOME MEASURES: 477 patients with medically confirmed incident CHD and 1271 controls participated in this study. We estimated the ORs for CHD by dividing participants at higher or lower GRS and, alternatively, at higher or lower ConvRF, and calculated the relative excess risk due to interaction (RERI) as a measure of deviation from additivity. RESULTS: The joint presence of higher GRS and higher risk ConvRF was in all instances associated with an increased risk of CHD, compared with the joint presence of lower GRS and lower risk ConvRF. The OR (95% CI) was 1.7 (1.2 to 2.4) for smoking, 2.7 (1.9 to 3.8) for hypertension, 4.1 (2.8 to 6.1) for T2DM, 1.9 (1.4 to 2.5) for lower physical activity, 2.0 (1.3 to 3.2) for high BMI and 1.5 (1.1 to 2.1) for poor adherence to the Mediterranean diet. In all instances, RERI values were fairly small and not statistically significant, suggesting that the GRS and the ConvRFs do not have effects beyond additivity. CONCLUSIONS: Genetic predisposition to CHD, operationalised through a multilocus GRS, and ConvRFs have essentially additive effects on CHD risk.Publication Aetiological and prognostic roles of frailty, multimorbidity and socioeconomic characteristics in the development of SARS-CoV-2 health outcomes: protocol for systematic reviews of population-based studies(BMJ Publishing Group, 2022-11-22) Makovski, Tatjana T; Ghattas, Jinane; Monnier Besnard, Stephanie; Ambrozova, Monika; Vasinova, Barbora; Feteira-Santos, Rodrigo; Bezzegh, Peter; Ponce Bollmann, Felipe; Cottam, James; Haneef, Romana; Devleesschauwer, Brecht; Speybroeck, Niko; Nogueira, Paulo; Forjaz, Maria João; Coste, Joel; Carcaillon-Bentata, Laure; Unión Europea. Comisión Europea. H2020Introduction: There is growing evidence that the impact of COVID-19 crisis may be stronger for individuals with multimorbidity, frailty and lower socioeconomic status. Existing reviews focus on few, mainly short-term effects of COVID-19 illness and patients with single chronic disease. Information is also largely missing for population representative samples.Applying population-based approach, the systematic reviews will have two objectives: (1) to evaluate the aetiological roles of frailty, multimorbidity and socioeconomic status on SARS-CoV-2 infection probability, hospitalisation, intensive care unit (ICU) admission, mechanical ventilation and COVID-19 related mortality among general population and (2) to investigate the prognostic roles of frailty, multimorbidity and socioeconomic characteristics on the risk of hospitalisation, ICU admission, mechanical ventilation, COVID-19 mortality, functioning, quality of life, disability, mental health and work absence. Methods and analysis: For this ongoing work, four databases were searched: PubMed, Embase, WHO COVID-19 Global literature on coronavirus disease and PsycINFO, for the period between January 2020 and April 7 2021. Peer-reviewed published literature in English and all types of population-based studies will be considered. Studies using standard tools to assess multimorbidity such as disease count, comorbidity indices or disease combinations will be retained, as well as studies with standard scales and scores for frailty or measurement of a socioeconomic gradient. Initial search included 10 139 articles, 411 for full-text reading. Results will be summarised by risk factor, objective and outcome. The feasibility of meta-analysis will be determined by the findings and will aim to better understand uncertainties of the results. Quality of studies will be assessed using standardised scales. Ethics and dissemination: The study will be based on published evidence, and it is exempt from the ethical approval. This work is part of the Population Health Information Research Infrastructure (PHIRI) project. Dissemination of the results will imply conference presentation, submission for scientific publication and PHIRI project report.Publication An Exome-Wide Sequencing Study of the GOLDN Cohort Reveals Novel Associations of Coding Variants and Fasting Plasma Lipids(Frontiers Media, 2019) Geng, Xin; Irvin, Marguerite R; Hidalgo, Bertha; Aslibekyan, Stella; Srinivasasainagendra, Vinodh; An, Ping; Frazier-Wood, Alexis C; Tiwari, Hemant K; Dave, Tushar; Ryan, Kathleen; Ordovas, Jose M; Straka, Robert J; Feitosa, Mary F; Hopkins, Paul N; Borecki, Ingrid; Province, Michael A; Mitchell, Braxton D; Arnett, Donna K; Zhi, Degui; National Institutes of Health (Estados Unidos); NIH - National Heart, Lung, and Blood Institute (NHLBI) (Estados Unidos); United States Department of Agriculture; United States Department of Agriculture. National Institute of Food and AgricultureBackground: Associations of both common and rare genetic variants with fasting blood lipids have been extensively studied. However, most of the rare coding variants associated with lipids are population-specific, and exploration of genetic data from diverse population samples may enhance the identification of novel associations with rare variants. Results: We searched for novel coding genetic variants associated with fasting lipid levels in 894 samples from the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) with exome-wide sequencing-based genotype data. In single variant tests, one variant (rs11171663 in ITGA7) was associated with fasting triglyceride levels (P = 7.66E-08), explaining approximately 3.2% of the total trait variance. In gene-based tests, we found statistically significant associations between ITGA7 (P = 1.77E-07) and SLCO2A1 (P = 7.18E-07) and triglycerides, as well as between POT1 (P = 3.00E-07) and low-density lipoprotein cholesterol. In another independent replication cohort consisting of 3,183 African American samples from Hypertension Genetic Epidemiology Network (HyperGEN) and the Genetic Epidemiology Network of Arteriopathy (GENOA), the top genes achieved P-values of 0.04 (ITGA7), 0.08 (SLCO2A1), and 0.02 (POT1). In GOLDN, gene transcript levels of ITGA7 and SLCO2A1 were associated with fasting triglycerides (P = 0.07 and P = 0.02), highlighting functional relevance of our findings. Conclusion: In this study, we present preliminary evidence of novel rare variant determinants of fasting lipids, and reveal potential underlying molecular mechanisms. Moreover, these results were replicated in an independent cohort. Our findings may inform novel biomarkers of disease risk and treatment targets.Publication Análisis de situación de la incapacidad. La epidemiología en la gestión de la incapacidad(Instituto de Salud Carlos III (ISCIII). Escuela Nacional de Medicina del Trabajo (ENMT), 2016) Quilez Félez, Mª Teresa[ES] El observatorio de las enfermedades profesionales nace como consecuencia de la implantación de un nuevo cuadro de enfermedades profesionales en el Sistema de la Seguridad Social, según Real Decreto 1299/2006 de 10 de noviembre. El sistema CEPROSS de Comunicación de Enfermedades Profesionales en la Seguridad Social) en el ámbito de la Seguridad Social pone a disposición de la Administración Laboral, la Inspección de Trabajo y Seguridad Social, y demás administraciones, instituciones, organizaciones y entidades datos que facilitan el cumplimiento de sus fines en materia de salud y seguridad en el trabajo y el análisis de resultados, que es lo que se refleja en esta ponencia. Conclusiones: Dentro de la Estrategia Española de Seguridad Social y Salud en el Trabajo se debe contemplar: — Mantener un sistema de información adecuado sobre los accidentes de trabajo y las enfermedades profesionales y sus consecuencias. — Que los profesionales médicos presten una atención especial a la correcta codificación de las enfermedades causadas por el trabajo y del diagnóstico, para posibilitar una base de datos consistente. — Fomentar el sistema de incentivos a las empresas que contribuyan eficazmente a la prevención de la siniestralidad laboral y por tanto a su disminución.— Trasladar medios económicos para el desarrollo de actuaciones en materia de prevención de los accidentes de trabajo y de las enfermedades profesionales, revisando la tarifa de cotización a la Seguridad Social por contingencias profesionales. [EN] Conclusions: Within the Spanish Strategy for Social Security and Health at Work should include: — Maintain an adequate system of information on accidents and occupational diseases and their Consequences. — Medical professionals pay special attention to the correct coding of diseases caused by work and diagnosis to enable a consistent database. — To promote the system of incentives to companies that effectively contribute to the prevention of occupational accidents and therefore its decline. — Move financial means for the development of actions on prevention of occupational accidents and occupational diseases, checking the rate of contribution to Social Security for professional contingenciesPublication Análisis Epidemiológico de las infecciones urinarias y la exposición a Fosfomicina durante el embarazo en madres de niños con y sin defectos congénitos: Distribución por años y por comunidades autónomas(Instituto de Salud Carlos III (ISCIII). Instituto de Investigación de Enfermedades Raras (IIER), 2011-12) García-Benítez, María Regla; Real, María Montserrat; Fernández, Paloma; Bermejo-Sanchez, Eva; Martínez-Frías, María LuisaThe objective of this study was to epidemiologically analyze urinary tract infections (UTI) suffered by pregnant women, and the prenatal exposure to Fosfomycin. To accomplish this objective, data from the Spanish Collaborative Study of Congenital Malformations (ECEMC) were analyzed for the period 1978-2009. A total of 40,060 newborn infants with congenital defects, and a similar number of healthy controls were registered. The proportions of mothers of cases and controls who suffered UTI during the first trimester were 2.69% and 2.56%, respectively. These figures go up to 9.94% and 8.86% when considering UTI at any time during pregnancy. The proportions of mothers who were treated with fosfomycin during the first trimester of pregnancy were 0.67% and 0.69%, respectively for cases and controls, and those figures go up to 2.69% y 2.54% when considering exposures at any time during pregnancy. Use of fosfomycin at any time during pregnancy has progressively increased with time. When studying the geographical distribution of the frequency some differences regarding UTI and use of fosfomycin were detected. The increase in use of fosfomycin has caused a decrease of the use of other antibiotics, and these trends are also observed in several autonomous regions in Spain. The use of fosfomycin during pregnancy seems to be safe, and suffering an UTI is quite common during pregnancy and somehow dangerous for the progress of gestation. It is important to underline that the percentage of mothers without treatment was between 20 and 35%. Therefore, it is advisable to treat UTI as soon as possible, in order to avoid complications both for the mother and fetus.Publication Applications of the European Parkinson's Disease Association sponsored Parkinson's Disease Composite Scale (PDCS)(Nature Publishing Group, 2019-11) Balestrino, Roberta; Hurtado-Gonzalez, Carlos Alberto; Stocchi, Fabrizio; Radicati, Fabiana Giada; Chaudhuri, K Ray; Rodriguez-Blazquez, Carmen; Martínez-Martín, Pablo; PDCS European Study Group; European Parkinson’s Disease AssociationThis study was addressed to determine the presence of Parkinson disease (PD) manifestations, their distribution according to motor subtypes, and the relationships with health-related quality of life (QoL) using the recently validated European Parkinson's Disease Association sponsored Parkinson's Disease Composite Scale (PDCS). Frequency of symptoms was determined by the scores of items (present if >0). Using ROC analysis and Youden method, MDS-UPDRS motor subtypes were projected on the PDCS to achieve a comparable classification based on the PDCS scores. The same method was used to estimate severity levels from other measures in the study. The association between the PDCS and QoL (PDQ-39) was analyzed by correlation and multiple linear regression. The sample consisted of 776 PD patients. We found that the frequency of PD manifestations with PDCS and MDS-UPDRS were overlapping, the average difference between scales being 5.5% only. Using the MDS-UPDRS subtyping, 215 patients (27.7%) were assigned as Tremor Dominant (TD), 60 (7.7%) Indeterminate, and 501 (64.6%) Postural Instability and Gait Difficulty (PIGD) in this cohort. With this classification as criterion, the analogous PDCS-based ratio provided these cut-off values: TD subtype, ≥1.06; Indeterminate, <1.06 but >0.65; and PIGD, <0.65. The agreement between the two scales on this classification was substantial (87.6%; kappa = 0.69). PDCS total score cut-offs for PD severity were: 23/24 for mild/moderate and 41/42 for moderate/severe. Moderate to high correlations (r = 0.35-0.80) between PDCS and PDQ-39 were obtained, and the four PDCS domains showed a significant independent influence on QoL. The conclusions are: (1) the PDCS assessed the frequency of PD symptoms analogous to the MDS-UPDRS; (2) motor subtypes and severity levels can be determined with the PDCS; (3) a significant association between PDCS and QoL scores exists.Publication Arsenic and chromium topsoil levels and cancer mortality in Spain(Springer, 2016-09) Nuñez, Olivier; Fernandez-Navarro, Pablo L; Martín-Méndez, Iván; Bel-Lan, Alejandro; Locutura, Juan F; Lopez-Abente, Gonzalo; Instituto de Salud Carlos IIISpatio-temporal cancer mortality studies in Spain have revealed patterns for some tumours which display a distribution that is similar across the sexes and persists over time. Such characteristics would be common to tumours that shared risk factors, including the chemical soil composition. The objective of the present study is to assess the association between levels of chromium and arsenic in soil and the cancer mortality. This is an ecological cancer mortality study at municipal level, covering 861,440 cancer deaths in 7917 Spanish mainland towns from 1999 to 2008. Chromium and arsenic topsoil levels (partial extraction) were determined by ICP-MS at 13,317 sampling points. To estimate the effect of these concentrations on mortality, we fitted Besag, York and Mollié models, which included, as explanatory variables, each town's chromium and arsenic soil levels, estimated by kriging. In addition, we also fitted geostatistical-spatial models including sample locations and town centroids (non-aligned data), using the integrated nested Laplace approximation (INLA) and stochastic partial differential equations (SPDE). All results were adjusted for socio-demographic variables and proximity to industrial emissions. The results showed a statistical association in men and women alike, between arsenic soil levels and mortality due to cancers of the stomach, pancreas, lung and brain and non-Hodgkin's lymphomas (NHL). Among men, an association was observed with cancers of the prostate, buccal cavity and pharynx, oesophagus, colorectal and kidney. Chromium topsoil levels were associated with mortality among women alone, in cancers of the upper gastrointestinal tract, breast and NHL. Our results suggest that chronic exposure arising from low levels of arsenic and chromium in topsoil could be a potential risk factor for developing cancer.Publication Association between Polyphenol Intake and Gastric Cancer Risk by Anatomic and Histologic Subtypes: MCC-Spain.(Multidisciplinary Digital Publishing Institute (MDPI), 2020-10-26) Rubín-García, María; Vitelli-Storelli, Facundo; Molina, Antonio José; Zamora-Ros, Raúl; Aragones, Nuria; Adarnaz, Eva; Castaño-Vinyals, Gemma; Obón-Santacana, Mireia; Gómez-Acebo, Inés; Molina-Barceló, Ana; Fernández-Tardón, Guillermo; Jimenez-Moleon, Jose J.; Alguacil, Juan; Chirlaque, María Dolores; Toledo, Estefanía; Perez-Gomez, Beatriz; Pollan-Santamaria, Marina; Kogevinas, Manolis; Martín, Vicente; Instituto de Salud Carlos III; Fundación Marqués de Valdecilla; Ministerio de Economía y Competitividad (España); Red Temática de Investigación Cooperativa en Cáncer (RTICC) (España); Junta de Castilla y León (España); Regional Government of Andalusia (España); Generalitat Valenciana (España); Fundación La Caixa; Basque Government (España); Gobierno de la Región de Murcia (España); Unión Europea. Comisión Europea; Asociación Española Contra el Cáncer; Government of Catalonia (España); Fundación Caja de Ahorros de Asturias; University of Oviedo (España); Ministerio de Educación (España); University of Leon (España); Ministerio de Ciencia e Innovación (España)Several anticancer properties have been largely attributed to phenolics in in vivo and in vitro studies, but epidemiologic evidence is still scarce. Furthermore, some classes have not been studied in relation to gastric cancer (GC). The aim of this study was to assess the relationship between the intake of phenolic acids, stilbenes, and other phenolics and the risk of developing GC and its anatomical and histological subtypes. We used data from a multi-case-control study (MCC-Spain) obtained from different regions of Spain. We included 2700 controls and 329 GC cases. Odds ratios (ORs) were calculated using mixed effects logistic regression considering quartiles of phenolic intake. Our results showed an inverse association between stilbene and lignan intake and GC risk (ORQ4 vs. Q1 = 0.47; 95% CI: 0.32-0.69 and ORQ4 vs. Q1 = 0.53; 95% CI: 0.36-0.77, respectively). We found no overall association between total phenolic acid and other polyphenol class intake and GC risk. However, hydroxybenzaldehydes (ORQ4 vs. Q1 = 0.41; 95% CI: 0.28-0.61), hydroxycoumarins (ORQ4 vs. Q1 = 0.49; 95% CI: 0.34-0.71), and tyrosols (ORQ4 vs. Q1 = 0.56; 95% CI: 0.39-0.80) were inversely associated with GC risk. No differences were found in the analysis by anatomical or histological subtypes. In conclusion, a diet high in stilbenes, lignans, hydroxybenzaldehydes, hydroxycoumarins, and tyrosols was associated with a lower GC risk. Further prospective studies are needed to confirm our results.Publication Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people(Cambridge University Press, 2017-04) Damian, Javier; Pastor-Barriuso, Roberto; Valderrama-Gama, Emiliana; Pedro-Cuesta, Jesus de; Instituto de Salud Carlos IIIBACKGROUND: Studies on depression and mortality in nursing homes have shown inconclusive findings, and none has studied the role of detection. We sought to measure the association of depression with long-term all-cause mortality in institutionalised older people and evaluate a potential modification in the association by its detection status. METHODS: We selected a stratified cluster sample of 591 residents aged 75 years or older (mean age 84.5 years) living in residential and nursing homes of Madrid, Spain, who were free of severe cognitive impairment at the 1998-1999 baseline interview. Mortality was ascertained until age 105 years or September 2013 (median/maximum follow-up 4.8/15.2 years) through linkage to the Spanish National Death Index. Detected depression was defined at baseline as a physician's diagnosis or antidepressant use, undetected depression as significant depressive symptoms (score of 4 or higher on the ten-item version of the Geriatric Depression Scale) without documented diagnosis or treatment, and no depression as the absence of diagnosis, treatment, and symptoms. Constant and age-dependent hazard ratios for mortality comparing detected and undetected depression with no depression were estimated using Cox models, and absolute years of life gained and lost using Weibull models. RESULTS: The baseline prevalences of detected and undetected depression were 25.9 and 18.8%, respectively. A total of 499 participants died during 3575 person-years of follow-up. In models adjusted for age, sex, type of facility, number of chronic conditions, and functional dependency, overall depression was not associated with long-term all-cause mortality (hazard ratio 0.87, 95% confidence interval (CI): 0.70-1.08). However, compared with no depression, detected depression showed lower mortality (hazard ratio 0.63, 95% CI: 0.46-0.86), while undetected depression registered higher, not statistically significant, mortality (hazard ratio 1.35, 95% CI: 0.98-1.86). The median life expectancy increased by 1.8 years (95% CI: -3.1 to 6.7 years) in residents with detected depression and decreased by 6.3 years (95% CI: 2.6-10.1 years) in those undetected. Results were more marked in women than men and they were robust to the exclusion of antidepressants from the definition of depression and also to the use of a stricter cut-off for the presence of depressive symptoms. CONCLUSIONS: The long-term mortality risk associated with depression in nursing homes depends on its detection status, with better prognosis in residents with detected depression and worse in those undetected. The absolute impact of undetected depressive symptoms in terms of life expectancy can be prominent.Publication Association of disability with mortality in the Spanish adult non-institutionalised population(BMJ Publishing Group, 2022) Damian, Javier; Padron-Monedero, Alicia; Almazan-Isla, Javier; Garcia Lopez, Fernando Jose; Pedro-Cuesta, Jesus de; Pastor-Barriuso, Roberto; Instituto de Salud Carlos IIIBackground: There are scant studies focused on measuring the association between disability and all-cause mortality based on large representative national samples of the community-dwelling adult population; moreover, the number of such studies which also include cause-specific mortality is yet lower. Methods: Longitudinal cohort study that used baseline data from 162 381 adults who participated in a countrywide disability survey (2008). A nationally representative sample was selected and interviewed in their homes. We present data on people ≥18 years. Disability was considered as any substantial limitation found on a list of 44 life activities that have lasted or are expected to last more than 1 year and originate from an impairment. Cause-specific mortality data were obtained from the Spanish Statistical Office. Subjects contributed follow-up time from baseline interview until death or the censoring date (31 December 2017). We computed standardised rate ratios (SRRs), with age, sex, living with a partner and education level distribution of the total group as standard population. Results: Adults with disability (11%) had an adjusted mortality rate more than twice as high as adults without disability (SRR 2.37, 95% CI 2.24 to 2.50). The increased mortality risk remained over the 10-year follow-up period. Mortality due to diseases of the nervous system (SRR 4.86, 95% CI 3.93 to 6.01), diseases of the musculoskeletal system (SRR 3.45, 95% CI 2.18 to 5.47), infectious diseases (SRR 3.38, 95% CI 2.27 to 5.01) and diabetes mellitus (SRR 3.56, 95% CI 2.71 to 4.68) was particularly high in those with disability. Conclusions: All-cause mortality rates are markedly higher among adults with disability. Preventive measures and health promotion initiatives are needed to reduce mortality risk in this population. Special attention should be paid to disabled people with certain specific diseases.Publication Atlas of Cancer Mortality in Portugal and Spain (2003–2012)(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2021-12) Fernandez-Navarro, Pablo L; Roquette, Rita; Nuñez, Olivier; de Sousa-Uva, Mafalda; García-Pérez, Javier; Lopez-Abente, Gonzalo; Nunes, Baltazar; Gonzalez-Sanchez, Mario; Dinis, José; Carmona-Alferez, Rocio; Rocha Rodrigues, Jéssica; Aragones, Nuria; Bento, María José; Castelló Pastor, Adela; Rego, Raúl; Lope Carvajal, Virginia; Henrique, Rui; Boldo, Elena; Pais, Ana; Fernandez de Larrea-Baz, Nerea; Bastos, Joana; Ramis, Rebeca; Carrito, Branca; Pastor-Barriuso, Roberto; Miranda, Ana; Perez-Gomez, Beatriz; Forjaz, Gonçalo; Matias Dias, Carlos; Pollan-Santamaria, Marina; Instituto de Salud Carlos III. Centro Nacional de Epidemiología; Instituto de Salud Carlos III. Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública); Instituto Nacional de Saúde Doutor Ricardo Jorge. Departamento de Epidemiologia. Unidade de Investigação Epidemiológica; Instituto de Salud Carlos IIIEl 'Atlas of Cancer Mortality in Portugal and Spain 2003–2012', muestra la distribución espacial de la mortalidad municipal por distintos tipos cáncer para el periodo 2003-2012. Ha sido desarrollado por la Unidad de Epidemiología del Cáncer y Ambiental del Centro Nacional de Epidemiología del ISCIII, que forma parte del CIBERESP, y por el Departamento de Epidemiología del Instituto Nacional De Saúde Doutor Ricardo Jorge de Portugal. El estudio de la distribución geográfica del riesgo de fallecer por cáncer es una de las herramientas que se usan en epidemiología para generar hipótesis sobre la posible implicación de factores ambientales en el origen de los tumores.Publication Barriers of mental health treatment utilization among first-year college students: First cross-national results from the WHO World Mental Health International College Student Initiative(Wiley, 2019-06) Ebert, David D; Mortier, Philippe; Kaehlke, Fanny; Bruffaerts, Ronny; Baumeister, Harald; Auerbach, Randy P; Alonso, Jordi; Vilagut, Gemma; Martinez, Kalina U; Lochner, Christine; Cuijpers, Pim; Kuechler, Ann-Marie; Green, Jennifer; Hasking, Penelope; Lapsley, Coral; Sampson, Nancy A; Kessler, Ronald C; WHO World Mental Health-International College Student Initiative collaborators; Roca, Miquel; Gili, MargalidaBackground: Although mental disorders and suicidal thoughts-behaviors (suicidal thoughts and behaviors) are common among university students, the majority of students with these problems remain untreated. It is unclear what the barriers are to these students seeking treatment. Aims: The aim of this study is to examine the barriers to future help-seeking and the associations of clinical characteristics with these barriers in a cross-national sample of first-year college students. Method As part of the World Mental Health International College Student (WMH-ICS) initiative, web-based self-report surveys were obtained from 13,984 first-year students in eight countries across the world. Clinical characteristics examined included screens for common mental disorders and reports about suicidal thoughts and behaviors. Multivariate regression models adjusted for socio-demographic, college-, and treatment-related variables were used to examine correlates of help-seeking intention and barriers to seeking treatment. Results: Only 24.6% of students reported that they would definitely seek treatment if they had a future emotional problem. The most commonly reported reasons not to seek treatment among students who failed to report that they would definitely seek help were the preference to handle the problem alone (56.4%) and wanting to talk with friends or relatives instead (48.0%). Preference to handle the problem alone and feeling too embarrassed were also associated with significantly reduced odds of having at least some intention to seek help among students who failed to report that they would definitely seek help. Having 12-month major depression, alcohol use disorder, and suicidal thoughts and behaviors were also associated with significantly reduced reported odds of the latter outcome. Conclusions: The majority of first-year college students in the WMH-ICS surveys report that they would be hesitant to seek help in case of future emotional problems. Attitudinal barriers and not structural barriers were found to be the most important reported reasons for this hesitation. Experimental research is needed to determine whether intention to seek help and, more importantly, actual help-seeking behavior could be increased with the extent to which intervention strategies need to be tailored to particular student characteristics. Given that the preference to handle problems alone and stigma and appear to be critical, there could be value in determining if internet-based psychological treatments, which can be accessed privately and are often build as self-help approaches, would be more acceptable than other types of treatments to student who report hesitation about seeking treatment.Publication Breast and prostate cancer: an analysis of common epidemiological features in mortality trends in Spain(BioMed Central (BMC), 2014-11-24) Lopez-Abente, Gonzalo; Mispireta, Sergio; Pollan-Santamaria, Marina; Instituto de Salud Carlos IIIBACKGROUND: Breast cancer in women and prostate cancer are the first and second leading tumour respectively in terms of incidence world-wide. Our objective is to ascertain the similarities and differences between mortality trends in breast cancer among women and prostate cancer in Spain using age-period-cohort models, and analyse the correlation between incidence of breast and prostate cancer at cancer registries locally and world-wide. METHODS: We analysed the independent effects of age, period of death and birth cohort on mortality rates for breast cancer in women and prostate cancer in Spain across the period 1952-2011. Segmented regression analyses were performed to detect and estimate changes in period and cohort curvatures. Correlation among age-adjusted incidence rates at 246 population cancer registries world-wide was analysed for the period 2003-2007. RESULTS: The mortality trend displayed common characteristics in terms of the annual number of deaths due to these tumours, their adjusted mortality rates and the change points detected in the cohort and period effects. The trend in incidence was very different to that in mortality, due to early detection and progressive improvement in survival. Correlation between the incidence rates of both tumours recorded by registries around the world proved to be a generalised phenomenon. CONCLUSIONS: This study shows that breast cancer mortality in women and prostate cancer mortality and their trends in Spain display visible similarities in terms of the number of deaths due to these tumours, their adjusted mortality rates and the changes experienced by mortality over time. The effects of advances in the diagnosis of both tumours correspond to a decline in mortality which becomes evident after a lag of approximately eight years. Correlation between breast and prostate cancer incidence rates is very high in Spain and at registries on all continents.Publication Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017(BMJ Publishing Group, 2020) Haagsma, Juanita A; James, Spencer L; Castle, Chris D; Dingels, Zachary V; Fox, Jack T; Hamilton, Erin B; Liu, Zichen; Lucchesi, Lydia R; Roberts, Nicholas L S; Sylte, Dillon O; Adebayo, Oladimeji M; Ahmadi, Alireza; Ahmed, Muktar Beshir; Aichour, Miloud Taki Eddine; Alahdab, Fares; Alghnam, Suliman A; Aljunid, Syed Mohamed; Al-Raddadi, Rajaa M; Alsharif, Ubai; Altirkawi, Khalid; Anjomshoa, Mina; Antonio, Carl Abelardo T; Appiah, Seth Christopher Yaw; Aremu, Olatunde; Arora, Amit; Asayesh, Hamid; Assadi, Reza; Awasthi, Ashish; Ayala Quintanilla, Beatriz Paulina; Balalla, Shivanthi; Banstola, Amrit; Barker-Collo, Suzanne Lyn; Bärnighausen, Till Winfried; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Behzadifar, Masoud; Behzadifar, Meysam; Benjet, Corina; Bennett, Derrick A; Bensenor, Isabela M; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A; Bijani, Ali; Borges, Guilherme; Borschmann, Rohan; Bose, Dipan; Boufous, Soufiane; Brazinova, Alexandra; Campuzano Rincon, Julio Cesar; Cárdenas, Rosario; Carrero, Juan J; Carvalho, Félix; Castañeda-Orjuela, Carlos A; Catala-Lopez, Ferran; Choi, Jee-Young J; Christopher, Devasahayam J; Crowe, Christopher Stephen; Dalal, Koustuv; Daryani, Ahmad; Davitoiu, Dragos Virgil; Degenhardt, Louisa; De Leo, Diego; De Neve, Jan-Walter; Deribe, Kebede; Dessie, Getenet Ayalew; deVeber, Gabrielle Aline; Dharmaratne, Samath Dhamminda; Doan, Linh Phuong; Dolan, Kate A; Driscoll, Tim Robert; Dubey, Manisha; El-Khatib, Ziad; Ellingsen, Christian Lycke; El Sayed Zaki, Maysaa; Endries, Aman Yesuf; Eskandarieh, Sharareh; Faro, Andre; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Franklin, Richard Charles; Fukumoto, Takeshi; Gezae, Kebede Embaye; Gill, Tiffany K; Goulart, Alessandra C; Grada, Ayman; Guo, Yuming; Gupta, Rahul; Haghparast Bidgoli, Hassan; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hamadeh, Randah R; Hamidi, Samer; Haro, Josep Maria; Hassankhani, Hadi; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hendrie, Delia; Henok, Andualem; Híjar, Martha; Hole, Michael K; Homaie Rad, Enayatollah; Hossain, Naznin; Hostiuc, Sorin; Hu, Guoqing; Igumbor, Ehimario U; Ilesanmi, Olayinka Stephen; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q; Jacobsen, Kathryn H; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jayatilleke, Achala Upendra; Jha, Ravi Prakash; Jonas, Jost B; Jorjoran Shushtari, Zahra; Jozwiak, Jacek Jerzy; Jürisson, Mikk; Kabir, Ali; Kalani, Rizwan; Kasaeian, Amir; Kelbore, Abraham Getachew; Kengne, Andre Pascal; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khan, Ejaz Ahmad; Khoja, Abdullah T; Kiadaliri, Aliasghar A; Kim, Young-Eun; Kim, Daniel; Kisa, Adnan; Koyanagi, Ai; Kuate Defo, Barthelemy; Kucuk Bicer, Burcu; Kumar, Manasi; Lalloo, Ratilal; Lam, Hilton; Lami, Faris Hasan; Lansingh, Van C; Leasher, Janet L; Li, Shanshan; Linn, Shai; Lunevicius, Raimundas; Machado, Flavia R; Magdy Abd El Razek, Hassan; Magdy Abd El Razek, Muhammed; Mahotra, Narayan Bahadur; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Malik, Manzoor Ahmad; Malta, Deborah Carvalho; Manda, Ana-Laura; Mansournia, Mohammad Ali; Massenburg, Benjamin Ballard; Maulik, Pallab K; Meheretu, Hailemariam Abiy Alemu; Mehndiratta, Man Mohan; Melese, Addisu; Mendoza, Walter; Mengesha, Melkamu Merid; Meretoja, Tuomo J; Meretoja, Atte; Mestrovic, Tomislav; Miazgowski, Tomasz; Miller, Ted R; Mini, G K; Mirrakhimov, Erkin M; Moazen, Babak; Mohammad Gholi Mezerji, Naser; Mohammadibakhsh, Roghayeh; Mohammed, Shafiu; Molokhia, Mariam; Monasta, Lorenzo; Mondello, Stefania; Montero-Zamora, Pablo A; Moodley, Yoshan; Moosazadeh, Mahmood; Moradi, Ghobad; Moradi-Lakeh, Maziar; Morawska, Lidia; Velásquez, Ilais Moreno; Morrison, Shane Douglas; Moschos, Marilita M; Mousavi, Seyyed Meysam; Murthy, Srinivas; Musa, Kamarul Imran; Naik, Gurudatta; Najafi, Farid; Nangia, Vinay; Nascimento, Bruno Ramos; Ndwandwe, Duduzile Edith; Negoi, Ionut; Nguyen, Trang Huyen; Nguyen, Son Hoang; Nguyen, Long Hoang; Nguyen, Huong Lan Thi; Ningrum, Dina Nur Anggraini; Nirayo, Yirga Legesse; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oh, In-Hwan; Oladimeji, Olanrewaju; Olagunju, Andrew T; Olagunju, Tinuke O; Olivares, Pedro R; Orpana, Heather M; Otstavnov, Stanislav S; P A, Mahesh; Pakhale, Smita; Park, Eun-Kee; Patton, George C; Pesudovs, Konrad; Phillips, Michael R; Polinder, Suzanne; Prakash, Swayam; Radfar, Amir; Rafay, Anwar; Rafiei, Alireza; Rahimi, Siavash; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rai, Rajesh Kumar; Ramezanzadeh, Kiana; Rawaf, Salman; Rawaf, David Laith; Renzaho, Andre M N; Resnikoff, Serge; Rezaeian, Shahab; Roever, Leonardo; Ronfani, Luca; Roshandel, Gholamreza; Sabde, Yogesh Damodar; Saddik, Basema; Salamati, Payman; Salimi, Yahya; Salz, Inbal; Samy, Abdallah M; Sanabria, Juan; Sanchez Riera, Lidia; Santric Milicevic, Milena M; Satpathy, Maheswar; Sawhney, Monika; Sawyer, Susan M; Saxena, Sonia; Saylan, Mete; Schneider, Ione J C; Schwebel, David C; Seedat, Soraya; Sepanlou, Sadaf G; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamsizadeh, Morteza; Sharif-Alhoseini, Mahdi; Sheikh, Aziz; Shen, Jiabin; Shigematsu, Mika; Shiri, Rahman; Shiue, Ivy; Silva, João Pedro; Singh, Jasvinder A; Sinha, Dhirendra Narain; Soares Filho, Adauto Martins; Soriano, Joan B; Soshnikov, Sergey; Soyiri, Ireneous N; Starodubov, Vladimir I; Stein, Dan J; Stokes, Mark A; Sufiyan, Mu'awiyyah Babale; Sunshine, Jacob E; Sykes, Bryan L; Tabarés-Seisdedos, Rafael; Tabb, Karen M; Tehrani-Banihashemi, Arash; Tessema, Gizachew Assefa; Thakur, Jarnail Singh; Tran, Khanh Bao; Tran, Bach Xuan; Tudor Car, Lorainne; Uthman, Olalekan A; Uzochukwu, Benjamin S Chudi; Valdez, Pascual R; Varavikova, Elena; Nogales Vasconcelos, Ana Maria; Venketasubramanian, Narayanaswamy; Violante, Francesco S; Vlassov, Vasily; Waheed, Yasir; Wang, Yuan-Pang; Wijeratne, Tissa; Winkler, Andrea Sylvia; Yadav, Priyanka; Yano, Yuichiro; Yenesew, Muluken Azage; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Younis, Mustafa Z; Yu, Chuanhua; Zafar, Shamsa; Zaidi, Zoubida; Zaman, Sojib Bin; Zamani, Mohammad; Zhao, Yong; Zodpey, Sanjay; Hay, Simon I; Lopez, Alan D; Mokdad, Ali H; Vos, Theo; Bill & Melinda Gates FoundationBackground: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.Publication C-reactive protein levels in patients at cardiovascular risk: EURIKA study(BioMed Central (BMC), 2014) Halcox, Julian P. J.; Roy, Carine; Tubach, Florence; Banegas, José Ramón; Dallongeville, Jean; De Backer, Guy; Guallar, Eliseo; Sazova, Oguen; Medina, Jesus; Perk, Joep; Steg, Philippe Gabriel; Rodríguez-Artalejo, Fernando; Borghi, Claudio; Oxford PharmaGenesisBackground: Elevated C-reactive protein (CRP) levels are associated with high cardiovascular risk, and might identify patients who could benefit from more carefully adapted risk factor management. We have assessed the prevalence of elevated CRP levels in patients with one or more traditional cardiovascular risk factors. Methods: Data were analysed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials. gov Identifier: NCT00882336), which included patients (aged = 50 years) from 12 European countries with at least one traditional cardiovascular risk factor but no history of cardiovascular disease. Analysis was also carried out on the subset of patients without diabetes mellitus who were not receiving statin therapy. Results: In the overall population, CRP levels were positively correlated with body mass index and glycated haemoglobin levels, and were negatively correlated with high- density lipoprotein cholesterol levels. CRP levels were also higher in women, those at higher traditionally estimated cardiovascular risk and those with greater numbers of metabolic syndrome markers. Among patients without diabetes mellitus who were not receiving statin therapy, approximately 30\% had CRP levels >= 3 mg/ L, and approximately 50\% had CRP levels = 2 mg/ L, including those at intermediate levels of traditionally estimated cardiovascular risk. Conclusions: CRP levels are elevated in a large proportion of patients with at least one cardiovascular risk factor, without diabetes mellitus who are not receiving statin therapy, suggesting a higher level of cardiovascular risk than predicted according to conventional risk estimation systems.Publication Campañas de vacunación contra las enfermedades víricas en España durante el siglo XX: una visión desde la prensa (1951-1986)(Consejo Superior de Investigaciones Científicas (CSIC), 2020) Noelia M. Martín Espinosa; María Victoria Caballero Martínez; Mariño-Gutierrez, Lourdes[ES]Desde finales del siglo XIX, fue posible luchar contra varias de las enfermedades víricas (rabia, viruela, gripe, polio, sarampión, rubéola y parotiditis), que, a lo largo del siglo XX, afectaron masivamente a la población adulta e infantil, a través de programas de vacunación que se establecieron una vez que estuvieron disponibles vacunas seguras para prevenirlas. España fue adoptando estas medidas preventivas progresivamente, especialmente a partir de su incorporación a la Organización Mundial de la Salud (OMS) en 1951. Cuando se promulgó la Ley General de Sanidad, en 1986, algunas de estas enfermedades habían podido controlarse y/o eliminarse mediante la vacunación sistemática. El tratamiento que ha realizado la prensa nacional de estos hechos ha sido escasamente estudiado. Este artículo tiene como objetivo analizar la repercusión en la prensa nacional de las campañas de vacunación contra estas enfermedades víricas hasta el año 1986 y comprobar si los medios de comunicación escritos reflejaron las medidas epidemiológicas globales adoptadas por la OMS para combatirlas. Junto a ello, estudiar su posible influencia, tanto en la puesta en marcha de políticas públicas de vacunación, como en el modo de transmitir dicha información a la población en los diferentes contextos sociopolíticos y científico-sanitarios cambiantes del periodo estudiado. [EN]Since the end of the 19th century, it has been possible to fight against several viral diseases (smallpox, rabies, influenza, polio, measles, rubella and mumps) that, during the 20th century, had a massive effect on the adult and child population through vaccination programmes established when safe vaccines were available to prevent such diseases. Spain progressively incorporated these preventive measures, especially after its incorporation into the World Health Organization (WHO) in 1951. By the time the General Health Law was enacted in 1986, it had been possible to control and/or eliminate some of these diseases through systematic vaccination.The treatment and monitoring that the Spanish national press has given to the implementation of the vaccination campaigns against these diseases has been little studied. Therefore, the objectives of this paper are to analyse the repercussions in the national press of the vac-cination campaigns against these viral diseases between 1951 and 1986 and to check whether the written media reflected the global epidemiological measures adopted by WHO to combat them. Besides, to study its possible influence both in the development of public policies of vaccination and in the way how this information was transmitted to the population during the different socio-political and scientific contexts in the studied period.Publication Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation(BioMed Central (BMC), 2015-01-17) Balcells, Eva; Gimeno-Santos, Elena; de Batlle, Jordi; Antonia Ramon, Maria; Rodriguez, Esther; Benet, Marta; Farrero, Eva; Ferrer, Antoni; Guerra, Stefano; Ferrer, Jaume; Sauleda, Jaume; Barbera, Joan A.; Agusti, Alvar; Rodriguez-Roisin, Robert; Gea, Joaquim; Anto, Josep M.; Garcia-Aymerich, Judith; PAC-COPD Study GrpBackground: Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD. Methods: The PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004-2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined undiagnosed COPD by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment. Results: Undiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%, p < 0.01), and fewer comorbidities (two or more, 40% vs. 56%, p < 0.01) when compared with patients with an established COPD diagnosis. Three months after hospital discharge, 16% of the undiagnosed COPD patients had stopped smoking (vs. 5%, p = 0.019). During follow-up, annual hospitalisation rates were lower in undiagnosed COPD patients (0.14 vs. 0.25, p < 0.01); however, this difference disappeared after adjustment for severity. Mortality was similar in both groups. Conclusions: Undiagnosed COPD patients have less severe disease and lower risk of re-hospitalisation when compared with hospitalised patients with known COPD.Publication Clinical and epidemiological features and prognosis of complicated pyelonephritis: a prospective observational single hospital-based study.(BioMed Central (BMC), 2014-12-10) Buonaiuto, Veronica A; Marquez, Ignacio; De Toro, Inmaculada; Joya, Carolina; Ruiz-Mesa, Juan D; Seara, Raimundo; Plata, Antonio; Sobrino, Beatriz; Palop, Begoña; Colmenero, Juan D; [Buonaiuto,VA; Marquez,I; Ruiz-Mesa,JD; Plata,A; Sobrino,B; Palop,B; Colmenero,JD] Infectious Diseases Department, Regional University Hospital, Málaga, Spain. [De Toro,I; Palop;B] Microbiology Unit, Regional University Hospital, Malaga, Spain. [Joya,C; Seara,R] Critical Care and Emergency Departments, Regional University Hospital, Malaga, Spain. [Buonaiuto,BA; Marquez,I; De Toro,I; Joya,C; Ruiz-Mesa,JD; Seara,R; Plata,A; Sobrino,B; Palop,B; Colmener,JD] IBIMA, Malaga University, Malaga, Spain.BACKGROUND: Complicated pyelonephritis (cPN), a common cause of hospital admission, is still a poorly-understood entity given the difficulty involved in its correct definition. The aim of this study was to analyze the main epidemiological, clinical, and microbiological characteristics of cPN and its prognosis in a large cohort of patients with cPN. METHODS: We conducted a prospective, observational study including 1325 consecutive patients older than 14 years diagnosed with cPN and admitted to a tertiary university hospital between 1997-2013. After analyzing the main demographic, clinical and microbiological data, covariates found to be associated with attributable mortality in univariate analysis were included in a multivariate logistic regression model. RESULTS: Of the 1325 patients, 689 (52%) were men and 636 (48%) women; median age 63 years, interquartile range [IQR] (46.5-73). Nine hundred and forty patients (70.9%) had functional or structural abnormalities in the urinary tract, 215 (16.2%) were immunocompromised, 152 (11.5%) had undergone a previous urinary tract instrumentation, and 196 (14.8%) had a long-term bladder catheter, nephrostomy tube or ureteral catheter. Urine culture was positive in 813 (67.7%) of the 1251 patients in whom it was done, and in the 1032 patients who had a blood culture, 366 (34%) had bacteraemia. Escherichia coli was the causative agent in 615 episodes (67%), Klebsiella spp in 73 (7.9%) and Proteus ssp in 61 (6.6%). Fourteen point one percent of GNB isolates were ESBL producers. In total, 343 patients (25.9%) developed severe sepsis and 165 (12.5%) septic shock. Crude mortality was 6.5% and attributable mortality was 4.1%. Multivariate analysis showed that an age >75 years (OR 2.77; 95% CI, 1.35-5.68), immunosuppression (OR 3.14; 95% CI, 1.47-6.70), and septic shock (OR 58.49; 95% CI, 26.6-128.5) were independently associated with attributable mortality. CONCLUSIONS: cPN generates a high morbidity and mortality and likely a great consumption of healthcare resources. This study highlights the factors directly associated with mortality, though further studies are needed in the near future aimed at identifying subgroups of low-risk patients susceptible to outpatient management.