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The Global Burden of Disease (GBD) study measures the health of populations worldwide and by country on an annual basis and aims at helping guide public policy on health issues. The GBD estimates for Spain in 2016 and recent trends in mortality and morbidity from 2006 to 2016 were recently published. According to these estimates, chronic kidney disease was the 8th cause of death in Spain in 2016. Among the top ten causes of death, chronic kidney disease was the fastest growing from 2006 to 2016, after Alzheimer disease. At the current pace of growth, chronic kidney disease is set to become the second cause of death in Spain, after Alzheimer disease, by 2100. Additionally, among major causes of death, chronic kidney disease also ranked second only to Alzheimer as the fastest growing cause of Years Lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs). Public resources devoted to prevention, care and research on kidney disease should be in line with both its current and future burden, El estudio Global Burden of Disease (GBD) mide la salud de las poblaciones en todo el mundo y en cada país de forma annual, y tiene como objetivo ayudar a orientar las políticas públicas sobre cuestiones de salud. Recientemente se publicaron las estimaciones GBD 2016 para España y las tendencias recientes en mortalidad y morbilidad de 2006 a 2016. Según estas estimaciones, la enfermedad renal crónica fue la octava causa de muerte en España en 2016. Entre las 10 principales causas de muerte, la enfermedad renal crónica fue la que más creció entre 2006 y 2016, después de la enfermedad de Alzheimer. Al ritmo actual de crecimiento, la enfermedad renal crónica se convertirá en la segunda causa de muerte en España, después del Alzheimer, hacia el 2100. Además, entre las principales causas de muerte, la enfermedad renal crónica también ocupa el segundo lugar después del Alzheimer como la que más creció en años vividos con discapacidad (AVD) y en años de vida ajustados por discapacidad (AVAD). Los recursos públicos dedicados a la prevención, atención e investigación de la enfermedad renal deberían estar en línea con su carga actual y futura, Research by the authors has been supported by FIS PI16/02057, PI18/01366, ISCIII-RETIC REDinREN RD016/0009 FEDER funds, Sociedad Española de Nefrología, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), ISCIII Miguel Servet (MDSN), Comunidad de Madrid Biomedicina B2017/BMD-3686 CIFRA2-CM

PURPOSE: The Hortega Study is a prospective study, which investigates novel determinants of selected chronic conditions with an emphasis on cardiovascular health in a representative sample of a general population from Spain. PARTICIPANTS: In 1997, a mailed survey was sent to a random selection of public health system beneficiaries assigned to the University Hospital Rio Hortega's catchment area in Valladolid (Spain) (n=11 423, phase I), followed by a pilot examination in 1999-2000 of 495 phase I participants (phase II). In 2001-2003, the examination of 1502 individuals constituted the Hortega Study baseline examination visit (phase III, mean age 48.7 years, 49% men, 17% with obesity, 27% current smokers). Follow-up of phase III participants (also termed Hortega Follow-up Study) was obtained as of 30 November 2015 through review of health records (9.5% of participants without follow-up information). FINDINGS TO DATE: The Hortega Study integrates baseline information of traditional and non-traditional factors (metabolomic including lipidomic and oxidative stress metabolites, genetic variants and environmental factors, such as metals), with 14 years of follow-up for the assessment of mortality and incidence of chronic diseases. Preliminary analysis of time to event data shows that well-known cardiovascular risk factors are associated with cardiovascular incidence rates, which add robustness to our cohort. FUTURE PLANS: In 2020, we will review updated health and mortality records of this ongoing cohort for a 5-year follow-up extension. We will also re-examine elder survivors to evaluate specific aspects of ageing and conduct geolocation to study additional environmental exposures. Stored biological specimens are available for analysis of new biomarkers. The Hortega Study will, thus, enable the identification of novel factors based on time to event data, potentially contributing to the prevention and control of chronic diseases in ageing populations. Public funding agencies (Funds from the Carlos III National Health Institutes from Spain, including National Networks for Research such as CIBEROBN and CIBERDEM, and Regional Funds for Research from the Castilla y Leon county and European Networks such as Ingenious Hypercare) have supported the collection of biological samples and data from study participants (Phases I–III). In Phase IV, the core funding was provided by the FP7 EU project MASCARA, the Carlos III National Health Institutes and INCLIVA Research Institute. In particular, this work was supported by the Strategic Action for Research in Health sciences [CP12/03080, PI15/00071, PI10/0082, PI13/01848, PI14/00874, PI16/01402 and PI11/00726], GRUPOS 03/101; PROMETEO/2009/029 and ACOMP/2013/039 from the Valencia Government, GRS/279/A/08 from Castilla-Leon Government and European Network of Excellence Ingenious Hypercare (EPSS- 037093) from the European Commission; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN) [CIBER-02-08-2009, CB06/03 and CB12/03/30016] and CIBER de Diabetes y Enfermedades Metabólicas Relacionadas (CIBERDEM). The Strategic Action for Research in Health sciences, CIBEROBN and CIBERDEM are initiatives from Carlos III Health Institute Madrid and the Spanish Ministry of Economy and Competitiveness and co-funded with European Funds for Regional Development (FEDER). The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript Sí

The objective of this article is to evaluate different T-score cut-off points in the calcaneus in order to establish the prevalence of osteoporosis in the general population and to evaluate the clinical value of bone mineral density at the calcaneus as a tool to identify patients with spine or hip osteoporosis. A total of 1455 people (727 women and 728 men) from the Hortega cohort were studied. The densitometric studies were carried out in the calcaneal region using a Peripheral Instantaneous X-ray Imaging (PIXI) Lunar bone densitometer. We established three cut-off points (−1.6, −2.0, −2.5). One-hundred twenty-five patients (67 men with a mean age of 47 ±13 yr and 58 women with a mean age of 66 ±8 yr) from internal medicine outpatient clinics who were undergoing densitometry of the calcaneus, spine, and hip were subsequently studied. The prevalence of osteoporosis in women with a calcaneus T-score −1.6 was 12.4%, which is comparable to the 12.7% obtained with an axial densitometer in a Spanish population. The prevalence in men was 7.8%, with a calcaneus T-score of −1.0 enables the diagnosis of the disease to be excluded, whereas a calcaneus T-score of

Analyze the impact of known and unknown hypertension on health-related quality of life (HRQOL).A descriptive cross-sectional study in the health coverage area of the Rio Hortega University Hospital, in north-western Spain, on a simple random sample of 33022 individuals.Following a multiphase sampling, a final sample of 466 people, representative of the general population, was analyzed. The blood pressure of patients with known hypertension and those with a blood pressure ofor= 140/90 mmHg was subjected to ambulatory monitoring in order to evaluate the degree of blood pressure control and to detect those patients with white-coat hypertension, respectively.After adjustment for sociodemographic variables, associated cardiovascular risk factors, hypertension complications and comorbidity, the patients with known hypertension presented lower scores on four SF-36 scales: physical function, general health, vitality and mental health. The group of subjects with hypertension, whether diagnosed or not, displayed a poorer HRQOL with respect to the non-hypertensive patients, solely in physical functioning and general health. Those patients with known hypertension reported more bodily pain than those subjects with unknown hypertension, while there were no differences between patients with unknown hypertension and the non-hypertensive ones.Patients with known hypertension presented a poorer HRQOL. This deterioration of the subjective state of health was not observed in patients who had not yet been diagnosed, which suggests it is due, above all, to the labeling effect and/or to the treatment more than to the hypertension per se.

Fundamento y objetivo: Chlamydophila pneumoniae es un germen patogeno intracelular implicado en la patogenia inflamatoria de algunas enfermedades cronicas con alta prevalencia. Su capacidad de difusion es elevada porque los patrones serologicos de infeccion descritos para la poblacion general estan ampliamente distribuidos en todo el mundo; sin embargo, se desconoce la seroprevalencia en la poblacion adulta de Espana. Nuestro objetivo fue determinar la seroprevalencia de inmunoglobulinas (IgG) e IgA especificas frente a C. pneumoniae en la poblacion general adulta mediante su determinacion por inmunofluorescencia indirecta. Material y metodo: Se analizo 462 muestras de suero procedentes de individuos mayores de 15 anos de la poblacion general de Valladolid. Resultados: La seroprevalencia de IgG 1:16 fue del 74,1% (intervalo de confianza [IC] del 95%, 69,7-78,6) y para una IgG 1:64 del 32,2% (IC del 95%, 27,6-36,8), mientras que para la IgA fue del 21,5% (IC del 95%, 17,7-25,4) a una dilucion 1:16 y del 5,2% (IC del 95%, 3,3-7,2) a un titulo 1:32. Encontramos titulos mas altos en los varones y a medida que aumentaba la edad, especialmente para la IgA (p < 0,05). Solo el 3,6% (IC del 95%, 1,9-5,3) y el 0,7% (IC del 95%, 0,03-1,4) de los sujetos presentaron titulos de IgG 1:256 o 1:512, respectivamente. Conclusiones: C. pneumoniae mantiene una alta seroprevalencia de infeccion en la poblacion adulta espanola.

Background: The relation between the sympathetic nervous system and bone metabolism has been known for some time, although diverse experimental studies do not show uniformity in their evaluation of the different data. The aim of this paper is to determine the relation between urinary catecholamines, as an expression of sympathetic activity, and bone mass among the general population. Methods: A study was made of 274 individuals (124 males and 150 females), who formed part of the Hortega cohort. All underwent measurement of fractionated catecholamines in urine (dopamine, noradrenaline and adrenaline) and calcaneal density, using a Pixi-Lunar (Lunar Corp., Madison, Wisc., USA). Results: The linear correlation study revealed a statistically significant association of dopamine with bone mass (r = 0. 229, p = 0.0001), which was not observed with the other catecholamines. The effect was shown in men (r = 0.184, p = 0.04) and women (r = 0.251, p = 0.002). When a multiple correlation analysis was performed, the effect of the dopamine (p = 0.038) persisted. Conclusions: Our study shows that dopamine is an independent, positive variable for bone mass in men and women in the general population, and for the latter, it is independent of their hormonal state.

To analyze the influence of sympathetic activity on blood pressure (BP) and its effects on urinary albumin excretion (UAE), the authors carried out a cross-sectional study in their local health coverage area. The following variables were monitored in a representative sample of the general population made up of 495 individuals: anthropometric parameters; blood glucose, creatinine, and lipid levels; 24-hour urinary albumin, norepinephrine, and epinephrine excretion; and BP of patients with known hypertension and newly discovered BPor =140/90 mm Hg, evaluated by ambulatory monitoring. In the multivariate analysis, only gender, systolic BP, and UAE were associated with norepinephrine levels; only gender, systolic BP, and body mass index were associated with epinephrine. After excluding those patients with chronic kidney disease, the multivariate analysis showed a strong association between UAEor =30 mg/d and elevated norepinephrine and epinephrine levels. The authors concluded that in the subject population there is an association between elevated adrenergic activity and higher UAE, independent of factors such as age and BP.

Chlamydophila pneumoniae is an intracelular pathogen involved in the inflammatory pathogenesis of some chronic diseases with high prevalence. Infectivity is supposed to be high because the serologic patterns published are widely spread out all over the world. However, the prevalence in the Spanish adult population is unknown. Our goal was to assess the seroprevalence of specific IgG and IgA against C. pneumoniae in the general adult population performing an indirect immunofluorescence assay.462 serum samples were analysed from subjects over 15 years of age in the general population in Valladolid.IgG 1:16 seroprevalence was 74.1% (95% confidence interval [CI], 69.7-78.6) and IgG 1:64 was 32.2% (95% CI, 27.6-36.8), whereas IgA 1:16 was 21.5% (95% CI, 17.7-25.4) and IgA 1:32 was 5.2% (95% CI, 3.3-7.2). Higher titles were found in men and with increasing age, specially for IgA (p0.05). Only 3.6% (95% CI, 1.9-5.3) and 0.7% (95% CI, 0.03-1.4) of subjects showed titles IgG 1:256 or 1:512, respectively. Almost one fourth showed a title 1:16 for both immunoglobulins.Chlamydophila pneumoniae maintains a high seroprevalence of infection in the Spanish adult population.

The objective of this article is to evaluate different T-score cut-off points in the calcaneus in order to establish the prevalence of osteoporosis in the general population and to evaluate the clinical value of bone mineral density at the calcaneus as a tool to identify patients with spine or hip osteoporosis. A total of 1455 people (727 women and 728 men) from the Hortega cohort were studied. The densitometric studies were carried out in the calcaneal region using a Peripheral Instantaneous X-ray Imaging (PIXI) Lunar bone densitometer. We established three cut-off points (-1.6, -2.0, -2.5). One-hundred twenty-five patients (67 men with a mean age of 47 +/- 13 yr and 58 women with a mean age of 66 +/- 8 yr) from internal medicine outpatient clinics who were undergoing densitometry of the calcaneus, spine, and hip were subsequently studied. The prevalence of osteoporosis in women with a calcaneus T-score -1.6 was 12.4%, which is comparable to the 12.7% obtained with an axial densitometer in a Spanish population. The prevalence in men was 7.8%, with a calcaneus T-score of-2.0. In women, the highest sensitivity (85%) was obtained with a calcaneus T-score of-1.0 and the highest specificity with a calcaneus T-score of-2.5. In men, the best sensitivity (61%) was obtained with a calcaneus T-score of-1.0 and the best specificity (98%) with a calcaneus T-score of-2.5. A calcaneus T-score-1.6 is an adequate cut-off to establish the prevalence of osteoporosis in population studies. In women, a calcaneus T-score of-1.0 enables the diagnosis of the disease to be excluded, whereas a calcaneus T-score of-2.5 enables the diagnosis to be confirmed and treatment to be initiated in both men and women.