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Gutierrez-Gonzalez, Enrique

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Enrique

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Gutierrez-Gonzalez

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ISCIII

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ISCIII::Escuela Nacional de Sanidad (ENS)

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Enfermedades Meningocócica en España. Análisis de la temporada 2015-2016
(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2017-10-08) Gutierrez-Gonzalez, Enrique; Martínez-Sánchez, Elena Vanesa; Amillategui Dos Santos, Rocío; Cano-Portero, Rosa
[ES] La enfermedad meningocócica es de declaración obligatoria en España. Los casos se notifican de manera individualizada con periodicidad semanal incluyendo información epidemiológica y microbiológica a través de la Red Nacional de Vigilancia Epidemiológica (RENAVE). La presentación de esta enfermedad en la población española ha sufrido cambios muy importantes. El uso de la vacuna frente al serogrupo C ha causado un gran descenso de la incidencia por este serogrupo. Además en la última década también han disminuido los casos por serogrupo B. En la temporada 2015-2016 se notificaron 314 casos, de los que se confirmaron 268 y la incidencia fue de 0,58 por 100.000 habitantes. Se presenta el análisis de los resultados generales de la vigilancia epidemiológica de la enfermedad meningocócica para la temporada 2015-2016 en España y su comparación con las previas. [EN] Meningococcal disease is notifiable in Spain. The cases are notified individually on a weekly basis, including epidemiological and microbiological information through the National Network of Epidemiological Surveillance (RENAVE). The incidence of this disease in the Spanish population has undergone very important changes. Vaccination against serogroup C has caused a large decrease in the incidence of this serogroup. In addition, in the last decade cases caused by serogroup B have also decreased. In the 2015-2016 season, 314 cases were notified, of which 268 were confirmed and the incidence was 0.58 per 100,000 inhabitants. We analyzed the results of the epidemiological surveillance of meningococcal disease for the 2015-2016 season in Spain and its comparison with the previous ones.
Intervención grupal de promoción de hábitos saludables en el ámbito laboral: Programa IPHASAL
(Instituto de Salud Carlos III (ISCIII). Escuela Nacional de Medicina del Trabajo (ENMT), 2021-03) García-Solano, Marta; Gutierrez-Gonzalez, Enrique; Santos-Sanz, Sara; Yusta-Boyo, Mª José; Villar-Villalba, Carmen; Dal Re-Saavedra, Mª Angeles
[ES] Introducción: Las enfermedades cardiovasculares constituyen un grave problema de salud pública. El ámbito la boral es óptimo para intervenir sobre los factores de riesgo cardiovascular. El objetivo es evaluar una intervención grupal de promoción de hábitos saludables (programa IPHASAL) mediante apoyo entre iguales en el ámbito laboral. Método: En el programa participaron 325 trabajadores de 13 empresas con factores de riesgo cardiovascular (hiper tensión, tabaquismo, exceso de peso, inactividad física). Antes y después del programa se midió peso y altura, ten sión arterial y se pasó un cuestionario sobre hábitos de salud. El programa consistía en asistir a talleres formativos y sesiones grupales en las que los participantes compartían experiencias, conocimientos y progresos sobre hábitos saludables. El resultado se midió con el Índice Fuster BEWAT (IFB), calculado con la puntuación de 5 variables: ten sión arterial, ejercicio, peso, alimentación y tabaco.Resultados: Los participantes sin criterios de exclusión en el proyecto fueron 273. El 79% asistió a 3 o más talleres y el 73,9% acudió a 3 o más sesiones. Todos los parámetros del IFB mejoraron significativamente tras el programa, siendo el mayor incremento en la actividad física y el menor en el tabaquismo. El IFB total aumentó un 17,4% (1,5 puntos), siendo superior el aumento en mujeres (19,6%) que en hombres (14,0%) y en el grupo más joven (21,6%). Conclusiones: La intervención grupal IPHASAL es aplicable al ámbito laboral y contribuye a mejorar el perfil de riesgo cardiovascular, ayudando a los trabajadores a potenciar el cambio hacia estilos de vida.[EN] Introduction: Cardiovascular disease is a major public health problem. The workplace is an optimal setting to intervene on cardiovascular risk factors. The aim is to evaluate a group intervention to promote healthy habits (IPHASAL program) through peer support in the workplace.Method: The program involved 325 workers in 13 companies with cardiovascular risk factors (hypertension, smoking, overweight, physical inactivity). Before and after the program, weight and height, blood pressure were measured and a questionnaire on health habits was administered. The program consisted of training workshops and group sessions in which participants shared experiences, knowledge and progress on healthy habits. The outcome was measured with the Fuster BEWAT Index (FBI), calculated with the score of 5 variables under study: blood pressure, exercise, weight, diet and smoking. Results: Participants without exclusion criteria in the project were 273. 79% attended 3 or more workshops and 73.9% attended 3 or more sessions. All FBI parameters improved significantly after the program, with the largest increase in physical activity and the smallest increase in smoking. Total FBI increased by 17.4% (1.5 points), with a higher increase in women (19.6%) than in men (14.0%) and in the youngest group (21.6%). Conclusions: The IPHASAL group program is applicable to the workplace and contributes to improving the cardiovascular risk profile, helping workers to promote change towards healthy lifestyles.
Exploring clinical, echocardiographic and molecular biomarkers to predict bronchopulmonary dysplasia
(Public Library of Science (PLOS), 2019) Alvarez-Fuente, Maria; Moreno, Laura; Lopez-Ortego, Paloma; Arruza, Luis; Avila-Alvarez, Alejandro; Muro, Marta; Gutierrez-Gonzalez, Enrique; Zozaya, Carlos; Sanchez-Helguera, Gema; Elorza, Dolores; Martinez-Ramas, Andrea; Villar, Gema; Labrandero, Carlos; Martinez, Lucia; Casado, Teresa; Cuadrado, Irene; Del Cerro, Maria Jesus; Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF); Instituto de Salud Carlos III
INTRODUCTION: Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in childhood, related to prematurity, and the most common cause of pulmonary hypertension (PH) secondary to pulmonary disease in children. Moderate and severe BPD have a worse outcome and relate more frequently with PH. The prediction of moderate or severe BPD development in extremely premature newborns is vital to implement preventive strategies. Starting with the hypothesis that molecular biomarkers were better than clinical and echocardiographic factors, this study aims to explore the ability of clinical, echocardiographic and analytical variables to predict moderate or severe BPD in a cohort of extremely preterm infants. PATIENTS AND METHODS: We designed a prospective longitudinal study, in which we followed a cohort of preterm newborns (gestational age <28 weeks and weight ≤ 1250 grams). In these newborns we recorded weekly clinical and echocardiographic variables as well as blood and tracheal aspirate samples, to analyze molecular biomarkers (IL-6, IL-1, IP10, uric acid, HGF, endothelin-1, VEGF, CCL5). Variables and samples were collected since birth up to week 36 (postmenstrual age), time-point at which the diagnosis of BPD is established. RESULTS: We included 50 patients with a median gestational age of 26 weeks (IQR 25-27) and weight of 871 g (SD 161,0) (range 590-1200g). Three patients were excluded due to an early death. Thirty-five patients (74.5%) developed BPD (mild n = 14, moderate n = 15, severe n = 6). We performed a logistic regression in order to identify risk factors for moderate or severe BPD. We compared two predictive models, one with two variables (mechanical ventilation and inter-ventricular septum flattening), and another-one with an additional molecular biomarker (ET-1). CONCLUSIONS: The combination of clinical and echocardiographic variables is a valuable tool for determining the risk of BPD. We find the two variable model (mechanical ventilation and echocardiographic signs of PH) more practical for clinical and research purposes. Future research on BPD prediction should be oriented to explore the potential role of ET-1.
Zinc en dieta y uñas y cáncer de próstata
(2023-02-01) Gutierrez-Gonzalez, Enrique
Presentación de la Tesis "Zinc en dieta y uñas y cáncer de próstata" dirigida por Beatríz Pérez Gómez. Sus objetivos eran: revisar la evidencia científica sobre el papel de las uñas de los pies como biomarcador de exposición a metales esenciales; investigar qué factores determinan las concentraciones de Zn en las uñas de los pies en hombres y mujeres de la población general en España e investigar la asociación entre la exposición a Zn y el riesgo de cáncer de próstata y explorar si varía según el grado o la extensión del tumor o el grado de susceptibilidad genética de los individuos al tumor.
Dietary Zinc and Risk of Prostate Cancer in Spain: MCC-Spain Study
(Multidisciplinary Digital Publishing Institute (MDPI), 2018-12-20) Gutierrez-Gonzalez, Enrique; Castelló Pastor, Adela; Fernandez-Navarro, Pablo L; Castaño-Vinyals, Gemma; Llorca, Javier; Salas, Dolores; Salcedo-Bellido, Inmaculada; Aragonés, Nuria; Fernández-Tardón, Guillermo; Alguacil, Juan; Gràcia-Lavedan, Esther; García-Esquinas, Esther; Gómez-Acebo, Inés; Amiano, Pilar; Romaguera, Dora; Kogevinas, Manolis; Pollan-Santamaria, Marina; Perez-Gomez, Beatriz; Instituto de Salud Carlos III; Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF); Fundación Marqués de Valdecilla; Regional Government of Andalusia (España); Generalitat Valenciana (España); Basque Government (España); Fundación Caja de Ahorros de Asturias; University of Oviedo (España); Ministerio de Economía y Competitividad (España)
Zinc is a key trace element in normal prostate cell metabolism, and is decreased in neoplastic cells. However, the association between dietary zinc and prostate cancer (PC) in epidemiologic studies is a conflicting one. Our aim was to explore this association in an MCC-Spain case-control study, considering tumor aggressiveness and extension, as well as genetic susceptibility to PC. 733 incident cases and 1228 population-based controls were included for this study. Dietary zinc was assessed using a food frequency questionnaire, and genetic susceptibility was assessed with a single nucleotide polymorphisms (SNP)-based polygenic risk score (PRS). The association between zinc intake and PC was evaluated with mixed logistic and multinomial regression models. They showed an increased risk of PC in those with higher intake of zinc (Odds Ratio (OR) tertile 3vs1: 1.39; 95% Confidence interval (CI):1.00⁻1.95). This association was mainly observed in low grade PC (Gleason = 6 RRR tertile 3vs1: 1.76; 95% CI:1.18⁻2.63) as well as in localized tumors (cT1-cT2a RRR tertile 3vs1: 1.40; 95% CI:1.00⁻1.95) and among those with higher PRS (OR tertile 3vs1: 1.50; 95% CI:0.89⁻2.53). In conclusion, a higher dietary zinc intake could increase the risk of low grade and localized tumors. Men with higher genetic susceptibility0020might also have a higher risk of PC associated with this nutrient intake.
Toenails as biomarker of exposure to essential trace metals: A review.
(Elsevier, 2019) Gutierrez-Gonzalez, Enrique; García-Esquinas, Esther; Fernandez de Larrea-Baz, Nerea; Salcedo-Bellido, Inmaculada; Navas-Acien, Ana; Lope Carvajal, Virginia; Gómez-Ariza, José Luis; Pastor-Barriuso, Roberto; Pollan-Santamaria, Marina; Perez-Gomez, Beatriz; Instituto de Salud Carlos III
Health problems associated with essential trace metals can result from both inadequate (i.e., low intake) and excessive exposures (i.e., from environmental and/or occupational source). Thus, measuring the exposure level is a real challenge for epidemiologists. Among non-invasive biomarkers that intend to measure long-term exposure to essential trace metals, the toenail is probably the biological matrix with the greatest potential. This systematic review collects the current evidence regarding the validity of toenail clippings as exposure biomarker for trace metals such as boron, cobalt, copper, iron, manganese, molybdenum, selenium, silicon, vanadium and zinc. Special attention was paid to the time-window of exposure reflected by the toenail, the intraindividual variability in exposure levels over time in this matrix, and the relationship of toenail with other biomarkers, personal characteristics and environmental sources. Our search identified 139 papers, with selenium and zinc being the most studied elements. The variability among studies suggests that toenail levels may reflect different degrees of exposure and probably correspond to exposures occurred 3-12 months before sampling (i.e., for manganese/selenium). Few studies assessed the reproducibility of results over time and, for samples obtained 1-6 years apart, the correlation coefficient were between 0.26 and 0.66. Trace metal levels in toenails did not correlate well with those in the blood and urine and showed low-moderate correlation with those in the hair and fingernails. Available data suggests that for some elements (Se, Mn, Zn) toenail concentrations reflect long-term external exposures in fairly reproducible levels, while for other metals, this association has not yet been assessed. Among dietary factors, only toenail selenium showed clear associations with the intake of supplements or specific foods. The toenail levels could also represent occupational exposure, for instance, Mn exposure in welders. The scarcity of information on other essential trace elements, together with the great heterogeneity among studies makes the validation of the usage of toenails as biomarkers of exposure to these elements difficult. Standardization of sample collection, quality control, analytical techniques and reporting procedures might facilitate further research focused on the clear understanding of the significance of essential levels in this promising matrix and would enhance its utility in epidemiological research.
Toxic metals in toenails as biomarkers of exposure: A review
(Elsevier, 2021) Salcedo-Bellido, Inmaculada; Gutierrez-Gonzalez, Enrique; García-Esquinas, Esther; Fernandez de Larrea-Baz, Nerea; Navas Acien, Ana; Tellez-Plaza, Maria; Pastor-Barriuso, Roberto; Lope Carvajal, Virginia; Gómez-Ariza, José Luis; García-Barrera, Tamara; Pollan-Santamaria, Marina; Jiménez Moleón, José Juan; Perez-Gomez, Beatriz; Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF); Instituto de Salud Carlos III; Plan Nacional de I+D+i (España); NIH - National Institute of Environmental Health Sciences (NIEHS) (Estados Unidos)
Toenails have been used as biomarkers of exposure to toxic metals, but their validity for this purpose is not yet clear and might differ depending on the specific agent. To evaluate this issue, we reviewed the literature on: a) the time-window of exposure reflected by toenails; b) the reproducibility of toenail toxic-metal levels in repeated measures over time; c) their relationship with other biomarkers of exposure, and; d) their association with potential determinants (i.e. sociodemographic, anthropometric, or lifestyle characteristics) or with sources of exposure like diet or environmental pollution. Thus, we performed a systematic review, searching for articles that provided original data for levels of any of the following toxic metals in toenails: aluminum, beryllium, cadmium, chromium, mercury, nickel, lead, thallium and uranium. We identified 88 articles, reporting data from 67 different research projects, which were quite heterogeneous with regard to population profile, sample size and analytical technique. The most commonly studied metal was mercury. Concerning the time-window of exposure explored by toenails, some reports indicate that toenail cadmium, nickel and lead may reflect exposures that occurred 7-12 months before sampling. For repeated samples obtained 1-6 years apart, the range of intraindividual correlation coefficients of aluminum, chromium and mercury was 0.33-0.56. The correlation of toxic metal concentrations between toenails and other matrices was higher for hair and fingernails than for urine or blood. Mercury levels were consistently associated with fish intake, while other toxic metals were occasionally associated with specific sources (e.g. drinking water, place of residence, environmental pollution, and occupation). The most frequently evaluated health endpoints were cardiovascular diseases, cancer, and central nervous system diseases. Available data suggest that toenail mercury levels reflected long-term exposures and showed positive associations with fish intake. The lack of standardization in sample collection, quality control, analytical techniques and procedures - along with the heterogeneity and conflicting results among studies - mean it is still difficult to conclude that toenails are a good biomarker of exposure to toxic metals. Further studies are needed to draw solid conclusions about the suitability of toenails as biomarkers of exposure to toxic metals.
Effect of vaccination, comorbidities and age on mortality and severe disease associated with influenza during the season 2016-2017 in a Spanish tertiary hospital.
(Elsevier, 2019) Gutierrez-Gonzalez, Enrique; Cantero-Escribano, José M; Redondo Bravo, Lidia; San Juan-Sanz, Isabel; Robustillo-Rodela, Ana; Cendejas-Bueno, Emilio; Influenza Working Group
Identifying risk factors for complications or death associated with influenza remains crucial to target preventive interventions. Scores like the Charlson comorbidity index (CCI) may be of help. The aims of this study were to assess the effect of vaccination and comorbidities on severe influenza disease and influenza-related death among hospitalized patients during the season 2016/17; and to evaluate the validity of the CCI to predict death among these patients. Data from adult patients (≥18 years old) with influenza infection admitted to La Paz University Hospital (LPUH) were recorded during the 2016/17 epidemic. The effect of influenza vaccine to prevent severe influenza or death was evaluated using multivariate logistic regression models. The area under the curve of the CCI and the age-adjusted CCI were compared to assess the predictive effect on mortality. A total of 342 adult patients with influenza infection were admitted, of which 83 developed severe influenza and 25 died during hospitalization. There were no differences between patients who survived and those who died concerning the CCI, but the age-adjusted CCI was higher in fatal cases (p-value=0.005). Influenza vaccine had no statistically significant effect on the risk of mortality (p-value=0.162) while age (OR: 1.12, p-value<0.001) and dementia (OR: 3.05, p-value=0.016) proved to be independent predictors for mortality. The seasonal vaccine was found to be protective for severe infection (OR: 0.54, p-value=0.019). The age-adjusted CCI was a better predictor of mortality than the crude CCI. Age and dementia are significant independent risk factors for mortality associated with influenza among hospitalized patients. The age-adjusted CCI seems to be a better predictor of mortality than the crude CCI. Influenza vaccine has shown to be effective in preventing severe influenza in the season 2016/17 among hospitalized patients and should be promoted in population at risk.