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Background: In the development of breast cancer (BC), estrogen exposure and the increase in breast density (BD) are two determinant factors for BC risk., Objective: To identify the relationship between the XbaI and PvuII polymorphisms in the estrogen receptor (ER-alpha) with BD., Material and Methods: Cross-sectional study which included 225 women, aged 40-65 years, without evident cancer data, who underwent routine mammography for early BC diagnosis in a radiology department. Two groups were formed: women with increased and with normal BD. Participants were genotyped for the XbaI and PvuII polymorphisms., Results: 19.1% had normal weight, 37.7% overweight, and 43.2% were obese women. In relation to high-risk patterns, 105 women had increased BD and 120 had normal BD (53.3%). The frequency of women with increased BD was also lower in postmenopausal women. Regarding the type of BD, there was no statistically significant difference between frequencies of PvuII and XbaI genotypes. Logistic regression showed that only age and body mass index (BMI) were associated with BD., Conclusion: PvuII and XbaI ER-alpha genotypes were similar among women with dense and non-dense breasts; differently, other factors were associated with BD (age, BMI and menopausal status). Therefore, emphasis should be placed on clinical practice in the relationship between BMI and BD., (Copyright: © 2020 Revista Medica del Instituto Mexicano del Seguro Social.)

The quality and availability of water are affected by numerous variables, through which the evaluation of water uses from different perspectives, and policy proposals to save water have now become essential. This paper aims to study water use and the water footprint from a river basin perspective, taking into account regions, sectors, and municipalities, while considering the physical frontier along with the administrative sectors. To this end, we have constructed a multi-regional input-output table for the Ebro river basin, disaggregating the primary sector into 18 different crops and 6 livestock groups. We pay special attention to crop production because it is the most water-consuming industry. The construction of the multi-regional input-output model represents an important contribution to the literature, in itself, since, to the best of our knowledge, it is the first to be built for this large basin. We extend this multi-regional input-output model to assess the water footprint by sectors and regions within the basin. We use these data to propose two scenarios: reallocating final demand to reduce the blue water footprint (scenario 1), and increasing value added (scenario 2). These scenarios outline the opportunity costs of saving water in socioeconomic terms in the basin. In another application, we downscale the multi-regional input-output model results at the municipal level and depict them using a geographical information system, identifying the hotspots and the areas that would pay for the socioeconomic opportunity costs of saving water. Our results suggest that saving 1 hm 3 of blue water could cost around €41,500 of value added if we consider the entire basin. However, this water re-allocation implies losses and gains at the municipal level: some municipalities would reduce value added by more than €30,000, while others would gain more than €85,000 of value added. These tools and results can be useful for policy makers when considering re-allocating water. The contribution and the novelty of this paper is the construction of the multiregional input-output model for the Ebro river basin, and its link with geographical systems analysis at the municipal level., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Computable General Equilibrium models are widely used in the literature to analyse the global effects of certain events with economic repercussions. The intensity of these events is usually justified, although somewhat vaguely. Based on the implementation of new technologies to certain production processes, we analyse the economic impacts of a replacement in the energy supply, from classical to renewable sources. In particular, this work focuses on the pig sector, due to its relatively high off-grid energy use, taking Aragon (Northern Spain) as a case study because of the significance of the sector in this region. A partial equilibrium approach to evaluate this replacement is first addressed. This partial analysis provides the intensity level of the impact of the change. On the basis of these data, the impact of the energy replacement is simulated using a Computable General Equilibrium model developed for the regional economy of Aragon. Findings show a slight increase in (pig) production and exports, and suggest the convenience of combining partial equilibrium analysis, which involves a mix of engineering and economic issues, to estimate the endogenous increase in efficiency, with general equilibrium models., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Cervical cancer is the leading cause of cancer deaths in Honduras. With the availability of a vaccine to prevent human papillomavirus (HPV), the causative agent for cervical cancer, the Honduran Secretary of Health undertook a cost-effectiveness analysis of introducing the HPV vaccine to support their national decision-making process., Methods: A national multidisciplinary team conducted this analysis with the CERVIVAC model, developed by the London School of Hygiene and Tropical Medicine in collaboration with the Pan American Health Organization's ProVac Initiative. The cumulative costs and health benefits of introducing the HPV vaccine were assessed over the lifetime of one single cohort of 11-year-old girls. We assumed a three-dose series with 95% vaccination coverage of the cohort using a mixture of school-based and facility-based delivery. To estimate national cervical cancer cases and deaths, we used United Nations demographic projections and GLOBOCAN estimates based on registry data from El Salvador, Guatemala, and Nicaragua. Based on estimates from the World Health Organization (WHO) and the Division of Intensified Cooperation with Countries (ICO), we assumed that 70% of cervical cancer would be due to vaccine types HPV16 and HPV18. We used a vaccine dose price of US$ 13.45 and evidence from the scientific literature to estimate vaccine effectiveness. National information was used to estimate health service utilization and costs of cervical cancer treatment. All costs and health benefits were discounted at 3%., Results: Upon fully vaccinating 86,906 11-year old girls, 2250 (undiscounted) cervical cancer cases and 1336 (undiscounted) deaths would be prevented over the lifetime of the cohort. After discounting future health benefits at 3% per year, the equivalent cases and deaths prevented were 421 and 170. HPV vaccination is estimated to cost around US$ 5 million per vaccinated cohort, but this would be offset by around US$ 1 million in avoided costs borne by the government to treat cervical cancer. Furthermore, 4349 discounted disability adjusted life years (DALYs) could be avoided at a cost of US$ 926 per DALY avoided, making HPV vaccination in Honduras a highly cost-effective intervention., Discussion: The net cost of HPV vaccination per DALY avoided is less than the WHO threshold for cost-effectiveness. However, at a cost of around US$ 5 million per vaccinated cohort, an important element to consider in this discussion is the budgetary implications that the introduction of the HPV vaccine would cause for the country., Conclusions: When comparing the costs and benefits of HPV vaccine introduction in Honduras, it is clear that this intervention would be highly cost-effective and that the intervention would greatly reduce cervical cancer disease. For these reasons, it is in the country's best interest to explore financing opportunities that could support the vaccine's introduction., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The primary purpose of this paper is to examine youth addiction and other justifications for adolescent smoking, and how they affect the level of consumption., Methods: Data from the Spanish 'State Survey on Drug Use among High School Students' aged between 14 and 18 years old were used in this paper. To account for the nature of the cigarette consumption data, several count data models were estimated in order to select the one that best fits adolescent smoking consumption., Results: Most adolescent smokers smoke because it relaxes them, and about a quarter of them recognize that they are addicted. Moreover, the latter group smoke 44% more cigarettes than the rest (IRR = 1.444), revealing the strong addictive nature of tobacco, even at early ages. Moreover, parents' smoking increases the probability of smoking and has an impact on the level of consumption., Conclusions: The implications of these findings offer insight for parents, researchers, educators, and cessation interventionists, as awareness of self-reported and other predictors held by smoking youth creates a vantage point to facilitate changes in smoking behavior.

We construct a multiregional input-output model for Spain, in order to evaluate the pressures on the water resources, virtual water flows, and water footprints of the regions, and the water impact of trade relationships within Spain and abroad. The study is framed with those interregional input-output models constructed to study water flows and impacts of regions in China, Australia, Mexico, or the UK. To build our database, we reconcile regional IO tables, national and regional accountancy of Spain, trade and water data. Results show an important imbalance between origin of water resources and final destination, with significant water pressures in the South, Mediterranean, and some central regions. The most populated and dynamic regions of Madrid and Barcelona are important drivers of water consumption in Spain. Main virtual water exporters are the South and Central agrarian regions: Andalusia, Castile-La Mancha, Castile-Leon, Aragon, and Extremadura, while the main virtual water importers are the industrialized regions of Madrid, Basque country, and the Mediterranean coast. The paper shows the different location of direct and indirect consumers of water in Spain and how the economic trade and consumption pattern of certain areas has significant impacts on the availability of water resources in other different and often drier regions.

Seeking to advance our knowledge of water flows and footprints and the factors underlying them, we apply, on the basis of an extended 2004 Social Accounting Matrix for Spain, an open Leontief model in which households and foreign trade are the exogenous accounts. The model shows the water embodied in products bought by consumers (which we identify with the Water Footprint) and in trade (identified with virtual water trade). Activities with relevant water inflows and outflows such as the agrarian sector, textiles, and the agri-food industry are examined in detail using breakdowns of the relevant accounts. The data reflect only physical consumption, differentiating between green and blue water. The results reveal that Spain is a net importer of water. Flows are then related to key trading partners to show the large quantities involved. The focus on embodied (or virtual) water by activity is helpful to distinguish indirect from direct consumption as embodied water can be more than 300 times direct consumption in some food industry activities. Finally, a sensitivity analysis applied to changes in diets shows the possibility of reducing water uses by modifying households' behavior to encourage healthier eating.

Background and Aims: The etiology of preeclampsia (PE) is unknown and the only treatment is removal of the fetus and placenta. The critical changes of this state include the increase of vascular resistance and hypoperfusion in the uteroplacental microcirculation that predispose to hypoxia and ischemia and, therefore, increased oxidative stress through 8-isoprostane, which is characterized by damage to the placenta and endothelium. We undertook this study to compare oxidative stress in pregnant women with PE., Methods: A case-control, cross-sectional and comparative study was undertaken. Pregnant women between 28 and 38 weeks of gestation with and without PE were recruited. Venous blood samples were taken for determination of 8-isoprostane. Obstetrical variables were measured and 8-isoprostane by radioimmunoassay. SPSS v.11 for Windows was used for descriptive statistics. Mean ± standard deviation, correlation and χ(2) were used for comparison between groups., Results: We studied 45 patients: 20 with PE (44.6%) and 25 without PE (55.4%). The average for 8-isoprostane in preeclamptic patients was 699.2 ± 38.6 pg/dl and without PE was 113.9 ± 52.4 pg/dL (p <0.01), gestational age 32.1 ± 2.6 and 35.1 ± 1.8 weeks, birth weight 1880 ± 238 g and 2787 ± 312 g, respectively. Apgar at birth was similar in both groups., Conclusions: We found statistical differences in the 8-isoprostane levels in both groups. There was no correlation in perinatal results in both groups according to 8-isoprostane levels. These results could be the basis for the use of antioxidants in the management of PE to counteract tissue damage., (Copyright © 2011 IMSS. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Childhood obesity is an important risk factor for the development of insulin resistance (IR) and its co-morbidities. However, visceral adipose tissue (VAT) rather than obesity appears to have a determining role in the development of IR. Adiponectin is considered a key molecule for protection against metabolic abnormalities related to IR. Several studies have documented that lower adiponectin concentrations are related to VAT, but the results are still controversial. We undertook this study to assess the association between VAT and adiponectin concentrations with respect to body mass index (BMI) and pubertal stage in children and adolescents., Methods: Eighty five subjects were studied (46 prepubertal and 39 pubertal) and classified according to BMI into obese and normal weight groups. All participants were given a clinical examination. Glucose, insulin, lipid profile and adiponectin were measured. VAT was estimated using helical computed tomography., Results: In the prepubertal group, obese children had lower adiponectin concentrations than nonobese subjects (p <0.001) but not in pubertal group (p = 0.67). When the total population was subclassified according to VAT, those with higher VAT had greater systolic and diastolic blood pressure, triglycerides, post-load glucose, insulin and HOMA-IR (p <0.001) compared to those with less VAT. HDL-C and adiponectin values trends to diminish as VAT increased (p = 0.005 and p = 0.015, respectively)., Conclusions: Adiponectin concentrations are inversely associated with VAT in children. The higher amount of VAT is related to metabolic abnormalities including lower values of adiponectin, which could confer a greater risk of developing type 2 diabetes mellitus and cardiovascular disease., (Copyright © 2011 IMSS. Published by Elsevier Inc. All rights reserved.)

Oxidative stress (OxS) and inflammation are physiopathological mechanisms related to diabetes and aging. We evaluated the additive effect of diabetes and aging on OxS and inflammation in a cross-sectional comparative study of 228 subjects: (1) 56 healthy adults (mean age, 47 ± 7 years); (2) 60 diabetic adults (mean age, 52 ± 6 years); (3) 40 healthy elderly adults (mean age, 67 ± 7 years); and (4) 72 diabetic elderly adults (mean age, 68 ± 7 years). We measured levels of glycosylated hemoglobin (HbA1c), plasma lipid peroxides, superoxide dismutase, glutathione peroxidase, total antioxidants, and tumor necrosis factor-alpha (TNF-α). The results indicate that diabetes is a risk factor for subjects with high serum levels of TNF-α (odds ratio [OR] = 12.1; 95% confidence interval [95% CI], 5.0-28; p < 0.001); this correlation becomes stronger when it is also associated with aging (OR = 14; 95% CI, 3.7-53.7; p < 0.05). Likewise, we observed that diabetes is an independent risk factor for OxS (OR = 2.1; 95% CI, 1.2-3.8; p < 0.05), and a stronger factor in older patients (OR = 3.1; 95% CI, 1.3-7.5; p < 0.05). Our findings suggest that aging, in concert with diabetes, exerts an additive effect on OxS and inflammation.

Aim: The DD genotype of angiotensin-converting enzyme (ACE) has been suggested as a major contributor of diabetic nephropathy in several populations. The purpose of the present study was to determine whether micro/macroalbuminuria is associated with ACE insertion/deletion (I/D) polymorphism in Mexican Mestizos with type 2 diabetes mellitus., Methods: A total of 435 patients with type 2 diabetes mellitus, of whom 233 had albuminuria, were characterized for the ACE I/D polymorphism by the polymerase chain reaction method., Results: Clinical and biochemical characteristics and frequencies according to DD, ID and II genotypes in patients with and without albuminuria showed no significant differences. However, only females with micro/macroalbuminuria showed higher frequency of a DD genotype than those without albuminuria (27.9%, 21.2% and 10.5%, respectively; P

Context: Studies have demonstrated that high serum leptin levels are associated with aging. However, we do not know whether hyperleptinemia is a relevant risk factor for high blood pressure (HBP) in the elderly., Objective: To determine the relationship between hyperleptinemia and HBP in the elderly., Design: A comparative cross-sectional study was carried out in a convenience sample of 70 healthy elderly persons comprising 46 women (mean age, 67 +/- 5.8 years) and 24 men (mean age, 73 +/- 7.5 years), and a group of 91 elderly persons with HBP, comprising 62 women (mean age, 67 +/- 8.2 years) and 29 men (mean age, 70 +/- 0.3 years). We measured serum leptin levels through the radioimmunoassay method., Results: The elderly subjects with HBP had significantly higher leptin levels than the healthy elderly subjects (P = .02). Furthermore, in female elderly subjects we observed a statistically significant correlation between systolic blood pressure and leptin (r = 0.37, P = .003), as well as systolic blood pressure and age (r = 0.29, P = .02), but not with diastolic blood pressure. In male elderly subjects, there was no correlation between leptin and systolic blood pressure or leptin and diastolic blood pressure. However, hyperleptinemia as risk factor for HBP was nearly 5 times higher in men than in women (men, odds ratio = 18.0, 95% confidence interval 3.2-100.9, P < .001 vs women, odds ratio = 3.33, 95% confidence interval 1.4-7.4, P = .003)., Conclusions: Our data suggest that hyperleptinemia was a significant risk factor for HBP elderly individuals, mainly in men.

Objective: To evaluate the influence of overweight, waist circumference, age, gender, and insulin resistance as risk factors for hyperleptinemia., Research Methods and Procedures: A cross-sectional study was carried out in a population of 197 subjects: 59 men (21 aged < 60 years and 38 aged > or =60 years) and 138 women (37 aged < 60 years and 101 aged > or =60 years). The groups were stratified by overweight and normal weight. After a 12-hour fasting period, we measured serum leptin and insulin levels with radioimmunoassay methods. We also measured serum glucose and lipid profile. The data were analyzed by means of comparative tests. A variance-stabilizing transformation (natural logarithmic) was used to meet multiple linear regression, analysis of covariance, and logistic regression models., Results: The leptin serum levels were higher and statistically significant in young and older women than they were in men. We observed an interaction between gender and body mass index to explain the difference in leptin levels (p < 0.0001). Our study demonstrated an inverse relationship between leptin with age and high-density lipoprotein cholesterol. In logistic regression analysis, the overweight x gender interaction and waist circumference have a statistically significant influence as independent variables on hyperleptinemia (overweight x gender odds ratio = 6.81; 95% confidence interval, 1.10 to 46.86; p < 0.05 and waist circumference odds ratio = 4.34; 95% confidence interval, 1.47 to 12.83; p = 0.001)., Discussion: Women who were overweight or had a higher waist circumference (women > or = 88 cm and men > or = 102 cm) have a significantly higher risk of having hyperleptinemia. The increase in age as an isolated variable is not a risk factor for hyperleptinemia.