Search

Randomized controlled trials (RCTs) are the gold standard design to establish the efficacy of new drugs and to support regulatory decision making. However, a marked increase in the submission of single-arm trials (SATs) has been observed in recent years, especially in the field of oncology due to the trend towards precision medicine contributing to the rise of new therapeutic interventions for rare diseases. SATs lack results for control patients, and information from external sources can be compiled to provide context for better interpretability of study results. External comparator arm (ECA) studies are defined as a clinical trial (most commonly a SAT) and an ECA of a comparable cohort of patients-commonly derived from real-world settings including registries, natural history studies, or medical records of routine care. This publication aims to provide a methodological overview, to sketch emergent best practice recommendations and to identify future methodological research topics. Specifically, existing scientific and regulatory guidance for ECA studies is reviewed and appropriate causal inference methods are discussed. Further topics include sample size considerations, use of estimands, handling of different data sources regarding differential baseline covariate definitions, differential endpoint measurements and timings. In addition, unique features of ECA studies are highlighted, specifically the opportunity to address bias caused by unmeasured ECA covariates, which are available in the SAT.

Emerging evidence points to coordinated action of chemical and mechanical cues during brain development. At early stages of neocortical development, angiogenic factors and chemokines such as CXCL12, ephrins, and semaphorins assume crucial roles in orchestrating neuronal migration and axon elongation of postmitotic neurons. Here we explore the intrinsic mechanical properties of the developing marginal zone of the pallium in the migratory pathways and brain distribution of the pioneer Cajal-Retzius cells. These pioneer neurons are generated in several proliferative regions in the developing brain (e.g., the cortical hem and the pallial subpallial boundary) and migrate tangentially in the preplate/marginal zone covering the upper portion of the neocortex. These cells play crucial roles in correct neocortical layer formation by secreting several molecules such as Reelin. Our results indicate that the motogenic properties of Cajal-Retzius cells and their perinatal distribution in the marginal zone are also modulated by both chemical and mechanical factors, by the specific mechanical properties of Cajal-Retzius cells, and by the differential stiffness of the migratory routes. Indeed, cells originating in the cortical hem display higher migratory capacities than those generated in the pallial subpallial boundary which may be involved in the differential distribution of these cells in the dorsal-lateral axis in the developing marginal zone.

Vervet monkeys (Chlorocebus pygerythrus), considered a species of "least concern" by the International Union for Conservation of Nature (IUCN), are widely maintained at primate sanctuaries in South Africa. Permanent surgical contraception is a necessary method for the management of this species in captivity. In this study, a new vasectomy technique was evaluated and involves a prescrotal approach with only one surgical incision, aiming to excise a piece of vas deferens, leaving open the testicular side, and creating a loop on the prostatic side to avoid future recanalization. The birth rate was studied to assess the success of the technique. This technique significantly reduced breeding in the study population from 33 births in the first year to four births during the last year of the study. These results show that this type of vasectomy is a fast, simple, and safe technique for controlling monkey populations in sanctuaries.

Spirurids, specifically the Rictularia, Chitwoodspirura, Streptopharagus, and Protospirura genera, have been reported to parasitize all nonhuman primate taxa. Spirurid pathogenesis in nonhuman primates has not been reported frequently; however, Protospirura muricola has been associated with serious gastric pathologies, including gastric perforation. This study was a retrospective study of 38 vervet monkey (Chlorocebus pygerythrus) necropsies performed in a primate sanctuary that houses captive orphaned or injured wild-born vervet monkeys. Individuals were categorized according to their age, sex, and body condition score to investigate the relationships between these factors and parasite presence. This study identified P. muricola in 47.37% of the necropsied carcasses. Regarding individual factors associated with P. muricola infection, no significant differences between males and females were observed; however, relationships between parasite presence and poor body condition and advanced host age were observed. Furthermore, one monkey death was potentially directly related to spirurid pathogenic action, because the individual showed gastric perforation.

Three-dimensional printing is revolutionizing the development of scaffolds due to their rapid-prototyping characteristics. One of the most used techniques is fused filament fabrication (FFF), which is fast and compatible with a wide range of polymers, such as PolyLactic Acid (PLA). Mechanical properties of the 3D printed polymeric scaffolds are often weak for certain applications. A potential solution is the development of composite materials. In the present work, metal-PLA composites have been tested as a material for 3D printing scaffolds. Three different materials were tested: copper-filled PLA, bronze-filled PLA, and steel-filled PLA. Disk-shaped samples were printed with linear infill patterns and line spacing of 0.6, 0.7, and 0.8 mm, respectively. The porosity of the samples was measured from cross-sectional images. Biocompatibility was assessed by culturing Human Bone Marrow-Derived Mesenchymal Stromal on the surface of the printed scaffolds. The results showed that, for identical line spacing value, the highest porosity corresponded to bronze-filled material and the lowest one to steel-filled material. Steel-filled PLA polymers showed good cytocompatibility without the need to coat the material with biomolecules. Moreover, human bone marrow-derived mesenchymal stromal cells differentiated towards osteoblasts when cultured on top of the developed scaffolds. Therefore, it can be concluded that steel-filled PLA bioprinted parts are valid scaffolds for bone tissue engineering.

Spirurids, specifically the

Background Internal temperature data are essential for clinical evaluation in veterinary medicine. During the last decade, new thermometry devices have been developed. Identification microchips with a temperature sensor offer double utility to clinicians by satisfying animal identification regulations and providing a non-invasive method for temperature measurement. Methods During this study, 26 healthy vervet monkeys (Chlorocebus pygerythrus) were implanted with a subcutaneous temperature transponding microchip. For each monkey, internal temperature measurements from the microchip and from an anaesthetic monitor (rectal sensor) were recorded every 5 minutes during an anaesthetic procedure. Results In this study, there were 83 paired samples obtained under normothermic conditions and another 72 paired samples obtained under hypothermic conditions, with interclass correlation coefficients of 0.79 and 0.69, respectively, between the two temperature measurement approaches. Conclusion Measurements obtained using the examined microchip thermal sensor exhibited good and excellent correlation with rectal temperature measurements under hypothermic and normothermic conditions, respectively.

BackgroundMechanical stretch of cancer cells can alter their invasiveness. During mechanical ventilation, lungs may be exposed to an increased amount of stretch, but the consequences on lung tumours have not been explored.MethodsTo characterise the influence of mechanical ventilation on the behaviour of lung tumours, invasiveness assays and transcriptomic analyses were performed in cancer cell lines cultured in static conditions or under cyclic stretch. Mice harbouring lung melanoma implants were submitted to mechanical ventilation and metastatic spread was assessed. Additional in vivo experiments were performed to determine the mechanodependent specificity of the response. Incidence of metastases was studied in a cohort of lung cancer patients that received mechanical ventilation compared with a matched group of nonventilated patients.ResultsStretch increases invasiveness in melanoma B16F10luc2 and lung adenocarcinoma A549 cells. We identified a mechanosensitive upregulation of pathways involved in cholesterol processing in vitro, leading to an increase in pro-protein convertase subtilisin/kexin type 9 (PCSK9) and LDLR expression, a decrease in intracellular cholesterol and preservation of cell stiffness. A course of mechanical ventilation in mice harbouring melanoma implants increased brain and kidney metastases 2 weeks later. Blockade of PCSK9 using a monoclonal antibody increased cell cholesterol and stiffness and decreased cell invasiveness in vitro and metastasis in vivo. In patients, mechanical ventilation increased PCSK9 abundance in lung tumours and the incidence of metastasis, thus decreasing survival.ConclusionsOur results suggest that mechanical stretch promote invasiveness of cancer cells, which may have clinically relevant consequences. Pharmacological manipulation of cholesterol endocytosis could be a novel therapeutic target in this setting.

Resumen Antecedentes y objetivos La fibrilacion auricular es la arritmia cronica mas comun. El proposito de este estudio fue determinar la prevalencia de la fibrilacion auricular y su relacion con los factores de riesgo cardiovascular en Espana. Metodologia Estudio transversal a partir de un analisis agrupado de 17.291 individuos aleatorizados reclutados en 6 estudios poblacionales. Resultados La prevalencia de fibrilacion auricular fue de 1,5%. (intervalo de confianza 95%: 1,3-1,7%). Los hombres tuvieron mayor prevalencia que las mujeres (1,9 vs. 1,1%, respectivamente). La prevalencia de fibrilacion auricular se incremento progresivamente con la edad: 0,05% en los menores de 45 anos, 0,5% entre los 45-59 anos, 2,3% entre los 60-74 anos, y 6,3% en los mayores de 75 anos. El porcentaje de individuos que recibia tratamiento anticoagulante fue de 74,3%. Los factores de riesgo asociados significativamente con la arritmia fueron: edad mayor de 60 anos (odds ratio [OR]: 7,6; IC 95%: 5,1-11,2), sexo masculino (OR : 1,8; IC 95%: 1,4-2,4), hipertension arterial (OR : 1,6; IC 95%: 1,2-2,1), obesidad (OR : 1,5; IC 95%: 1,2-2,1), y antecedentes de enfermedad coronaria (OR : 1,9; IC 95%: 1,3-3,0). Conclusion La fibrilacion auricular es una enfermedad frecuente en los individuos de mayor edad mientras que su prevalencia es baja en individuos menores de 60 anos. La mayoria de los individuos con fibrilacion auricular estaban bajo tratamiento anticoagulante. Los factores de riesgo para padecer esta arritmia fueron la edad, el sexo masculino, la hipertension, la obesidad y los antecedentes de enfermedad coronaria.

Background and objectives Atrial fibrillation (AF) is the most common type of arrhythmia. The purpose of this study was to determine the prevalence of atrial fibrillation and its relationship with cardiovascular risk factors in Spain. Methodology Cross-sectional study based on a grouped analysis of 17,291 randomized individuals recruited in 6 population studies. Results The prevalence of atrial fibrillation was 1.5% (95% CI: 1.3–1.7%). Men had a greater prevalence of the disease than women (1.9 vs. 1.1%, respectively). The prevalence of atrial fibrillation progressively increased with age: 0.05% for patients younger than 45 years, 0.5% for those between 45 and 59 years of age, 2.3% for those between 60 and 74 years of age and 6.3% for those older than 75 years. The percentage of individuals who underwent anticoagulant treatment was 74.3%. The risk factors significantly associated with arrhythmia were ages older than 60 years (odds ratio [OR]: 7.6; 95% CI: 5.1–11.2), the male sex (OR: 1.8; 95% CI: 1.4–2.4), arterial hypertension (OR: 1.6; 95% CI: 1.2–2.1), obesity (OR: 1.5; 95% CI: 1.2–2.1) and a history of coronary artery disease (OR: 1.9; 95% CI: 1.3–3.0). Conclusion Atrial fibrillation is a common disease in elderly individuals, while its prevalence is low in individuals younger than 60 years. Most individuals with atrial fibrillation were on anticoagulant treatment. The risk factors for this type of arrhythmia are age, the male sex, hypertension, obesity and a history of coronary artery disease.

Objectives: The purpose of this study was to assess the value of estimated glomerular filtration rate (eGFR) calculated by different formulas for predicting the risk of death in heart failure (HF) ...

Resumen Introduccion y objetivos Actualizar la prevalencia del sindrome metabolico en Espana y su riesgo coronario asociado, empleando la definicion armonizada y la nueva propuesta de la Organizacion Mundial de la Salud (sindrome metabolico premorbido), que excluye diabetes mellitus y enfermedad cardiovascular. Metodos Analisis agrupado con datos individuales de 11 estudios, incluyendo a 24.670 individuos de 10 comunidades autonomas con edad 35-74 anos. El riesgo coronario se estimo con la funcion REGICOR. Resultados La prevalencia de sindrome metabolico fue del 31% (mujeres, 29%; intervalo de confianza del 95%, 25-33%; varones, 32%; intervalo de confianza del 95%, 29-35%). Entre los varones con sindrome metabolico, fueron mas frecuentes la elevacion de glucemia (p = 0,019) y trigliceridos (p Conclusiones La prevalencia de sindrome metabolico es del 31%; el sindrome metabolico premorbido la rebaja al 24% y delimita la poblacion para prevencion primaria. El incremento de riesgo coronario es proporcionalmente mayor en las mujeres, tanto en sindrome metabolico como en sindrome metabolico premorbido.

To update the prevalence of metabolic syndrome and associated coronary risk in Spain, using the harmonized definition and the new World Health Organization proposal (metabolic premorbid syndrome), which excludes diabetes mellitus and cardiovascular disease.Individual data pooled analysis study of 24,670 individuals from 10 autonomous communities aged 35 to 74 years. Coronary risk was estimated using the REGICOR function.Prevalence of metabolic syndrome was 31% (women 29% [95% confidence interval, 25%-33%], men 32% [95% confidence interval, 29%-35%]). High blood glucose (P=.019) and triglycerides (P.001) were more frequent in men with metabolic syndrome, but abdominal obesity (P.001) and low high-density lipoprotein cholesterol (P=.001) predominated in women. Individuals with metabolic syndrome showed moderate coronary risk (8% men, 5% women), although values were higher (P.001) than in the population without the syndrome (4% men, 2% women). Women and men with metabolic syndrome had 2.5 and 2 times higher levels of coronary risk, respectively (P.001). Prevalence of metabolic premorbid syndrome was 24% and the increase in coronary risk was also proportionately larger in women than in men (2 vs 1.5, respectively; P.001).Prevalence of metabolic syndrome is 31%; metabolic premorbid syndrome lowers this prevalence to 24% and delimits the population for primary prevention. The increase in coronary risk is proportionally larger in women, in both metabolic syndrome and metabolic premorbid syndrome.

Aims To address the incremental usefulness of biomarkers from different disease pathways for predicting risk of death in heart failure (HF). Methods and results We used data from consecutive patients treated at a structured multidisciplinary HF unit to investigate whether a combination of biomarkers reflecting ventricular fibrosis, remodelling, and stretch [ST2 and N-terminal pro brain natriuretic peptide (NTproBNP)] improved the risk stratification of a HF patient beyond an assessment based on established mortality risk factors (age, sex, ischaemic aetiology, left ventricular ejection fraction, New York Heart Association functional class, diabetes, glomerular filtration rate, sodium, haemoglobin, and beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatments). ST2 was measured with a novel high-sensitivity immunoassay. During a median follow-up time of 33.4 months, 244 of the 891 participants in the study (mean age 70.2 years at baseline) died. In the multivariable Cox proportional hazards model, both ST2 and NTproBNP significantly predicted the risk of death. The individual inclusion of ST2 and NTproBNP in the model with established mortality risk factors significantly improved the C statistic for predicting death [0.79 (0.76–0.81); P < 0.001]. The net improvement in reclassification after the separate addition of ST2 to the model with established risk factors and NTproBNP was estimated at 9.90% [95% confidence interval (CI) 4.34–15.46; P < 0.001] and the integrated discrimination improvement at 1.54 (95% CI 0.29–2.78); P = 0.015). Conclusions Our data suggest that in a real-life cohort of HF patients, the addition of ST2 and NTproBNP substantially improves the risk stratification for death beyond that of a model that is based only on established mortality risk factors.

Resumen Introduccion y objetivos Determinar el cambio en la mortalidad a corto y medio plazo por infarto agudo de miocardio en Espana y los factores terapeuticos relacionados. Metodos Se identifico y se siguio durante 6 meses a 9.949 pacientes con infarto agudo de miocardio con elevacion del ST ingresados en la unidad coronaria en los registros PRIAMHO I, II y MASCARA realizados en 1995, 2000 y 2005. Resultados En el periodo 1995-2005 aumento (p Conclusiones La mortalidad precoz y a los 6 meses del infarto con elevacion del ST disminuyo en 1995-2005. Los factores terapeuticos relacionados son: incremento de la reperfusion y mayor utilizacion de antitromboticos, bloqueadores beta, inhibidores del sistema renina-angiotensina e hipolipemiantes.

Resumen Introduccion y objetivos Tratar y controlar los factores de riesgo cardiovascular es una estrategia fundamental de prevencion primaria. El objetivo es analizar la proporcion de poblacion de prevencion primaria de 35-74 anos tratada y controlada, segun niveles de riesgo coronario. Metodos Analisis agrupado con datos individualizados de 11 estudios poblacionales de la primera decada del siglo xxi . Se utilizaron cuestionarios estandarizados y medidas de presion arterial, glucohemoglobina y perfil lipidico. Se considero buen control con presion arterial Resultados Se incluyo a 27.903 participantes (el 54% mujeres). Recibian tratamiento farmacologico el 68 y el 73% de los varones y las mujeres con antecedentes de hipertension, respectivamente (p Conclusiones La proporcion de personas con buen control es del 65% en el mejor de los casos. Los criterios de control de la hipercolesterolemia de las Sociedades Europeas apenas se alcanzan. El tratamiento hipolipemiante no se prioriza en personas de riesgo coronario alto.

ResumenObjetivoEstimar la prevalencia, detección, tratamiento y grado de control de los factores de riesgo cardiovascular en Extremadura.DiseñoEstudio observacional descriptivo transversal.EmplazamientoEstudio poblacional del área de salud Don Benito-Villanueva de la Serena (Badajoz).ParticipantesMuestra aleatoria de la población entre 25 y 79 años residentes en dicha área.MétodosSe encuestó sobre antecedentes de factores de riesgo y su tratamiento, se midió la presión arterial y se extrajo muestra sanguínea a todos los participantes. Se calculó las prevalencias de cada variable estandarizándose por edad y género, para la población extremeña.ResultadosDe los 3.521 elegibles participaron 2.833 (80,5%), edad media 51,2 años, género masculino 46,5%. Prevalencia ajustada en hombres de tabaquismo activo 40,5% (37,8-43,2), HTA 39,5% (37,3-41,7), hipercolesterolemia 37,9% (35,4-40,4), obesidad 36,5% (33,9-39,1), diabetes 13,7% (12,1-15,4). Prevalencia ajustada en mujeres de hipercolesterolemia 35,0% (32,9-37,2), HTA 33,0% (31,3-34,7), obesidad 30,7% (28,6-32,8), tabaquismo activo 26,6% (24,5-28,7), diabetes 12,0% (10,5-13,5). El grado de conocimiento global de la situación de riesgo fue superior al 70% para cada factor y el grado de control entre los tratados con fármacos del 51,0, 62,3 y 74,7% para HTA, diabetes e hipercolesterolemia respectivamente.ConclusionesLa población extremeña está muy expuesta a los factores de riesgo principales, sobre todo en hombres. Tabaquismo, obesidad y diabetes destacan, dentro del contexto nacional, como los de mayor prevalencia en esta comunidad.AbstractObjectiveTo estimate the prevalence, detection, treatment and degree of control of cardiovascular risk factors in Extremadura.DesignCross-sectional study.SettingPopulation study in Don Benito-Villanueva de la Serena health area (Badajoz).ParticipantsA random sample of the people between 25 and 79 years, who lived in this area, was selected.MethodsHistory of cardiovascular risk factors and its treatment were obtained by questionnaire. Blood pressure and blood sample were obtained for all participants. We calculated the prevalence of each variable standardized for age and gender for the population of Extremadura.ResultsOf the 3521 eligible, 2833 (80.5%) participants were included, mean age 51.2 years, male 46.5%. Adjusted prevalence of current smoking in men: 40.5% (37.8-43.2), hypertension 39.5% (37.3-41.7), hypercholesterolemia, 37.9% (35.4-40.4), obesity 36.5% (33.9-39.1), diabetes 13.7% (12.1-15.4). Adjusted prevalence of hypercholesterolemia in women: 35,0% (32.9-37.2), hypertension 33,0% (31.3-34.7), obesity 30.7% (28.6-32.8), current smoking 26,6% (24.5-28.7), diabetes 12,0% (10.5-13.5). The detection level of each factor was above 70%, and the degree of control among those treated of 51, 62.3 and 74.7% for hypertension, diabetes and hypercholesterolemia, respectively.ConclusionsExtremadura's population is highly exposed to major cardiovascular risk factors, especially men. Smoking, obesity and diabetes stand in the national context as the most prevalent in our community.

Resumen Introduccion y objetivos Analizar la prevalencia de factores de riesgo cardiovascular en personas de 35-74 anos en 10 comunidades autonomas espanolas y determinar el grado de variabilidad geografica en la distribucion de los factores de riesgo cardiovascular. Metodos Analisis agrupado con datos individuales de 11 estudios desarrollados en la primera decada del siglo xxi con un promedio de tasa de participacion del 73%. Se midio el perfil lipidico (con validacion cruzada de laboratorios), glucemia, presion arterial, perimetro de la cintura, peso y talla y se administraron cuestionarios estandarizados. Se estimo la prevalencia estandarizada a la poblacion europea de tabaquismo, diabetes, hipertension arterial, dislipemia y obesidad. Ademas, se estimo el coeficiente de variacion entre estudios componentes en la prevalencia de cada factor de riesgo. Resultados Se incluyo a 28.887 participantes. Los factores de riesgo cardiovascular mas prevalentes fueron: hipertension arterial (el 47% en varones y el 39% en mujeres), dislipemia con colesterol total ≥ 250 mg/dl (el 43 y el 40%), obesidad (el 29% en ambos sexos), tabaquismo (el 33 y el 21%) y diabetes mellitus (el 16 y el 11%). El colesterol total ≥ 190 y ≥ 250 mg/dl presento el coeficiente de variacion minimo y maximo, respectivamente (el 7-24% en varones y el 7-26% en mujeres). La concordancia media en las determinaciones lipidicas entre laboratorios fue excelente. Conclusiones La prevalencia de hipertension arterial, dislipemia, obesidad, tabaquismo y diabetes mellitus, es elevada, con variabilidad relativamente baja en la poblacion de 35 a 74 anos entre comunidades autonomas. Canarias, Extremadura y Andalucia presentan mayor numero de factores de riesgo cardiovascular significativamente mas prevalentes que el promedio de los 11 estudios componentes.

Introduccion y objetivos. La posicion socioeconomica se relaciona con la mortalidad cardiovascular. El objetivo de este estudio fue analizar la relacion entre la posicion socioeconomica y sus diferentes indicadores y el riesgo de infarto agudo de miocardio (IAM), y determinar si esta era independiente de los factores de riesgo cardiovascular (FRCV). Metodos. Estudio caso-control apareado por edad, sexo y ano de reclutamiento. Los casos se obtuvieron de un registro hospitalario y los controles, de estudios transversales de base poblacional. La posicion socioeconomica se determino por el nivel de estudios y la clase social basada en ocupacion. Se recogio informacion autodeclarada sobre los FRCV. Resultados. Se incluyo a 1.369 casos y controles. Hubo interaccion entre nivel de estudios y clase social: en los trabajadores no manuales el nivel de estudios se asocio de forma lineal, inversa e independiente de los FRCV con el riesgo de IAM (estudios secundarios, odds ratio [OR] = 1,63; intervalo de confianza [IC] del 95%, 1,16-2,3; estudios primarios, OR = 3,88; IC del 95%, 2,79-5,39) respecto a universitarios; en los trabajadores manuales no se observo una asociacion entre nivel de estudios y riesgo de IAM. Los trabajadores manuales presentaban un exceso de riesgo de IAM respecto a los no manuales universitarios, este exceso de riesgo era independiente de los FRCV en el grupo con estudios primarios (OR = 2,09; IC del 95%, 1,59-2,75). Conclusiones. Hay relacion entre la posicion socioeconomica y el riesgo de IAM. El grupo de la poblacion con nivel de estudios primarios presenta mayor riesgo de IAM que es independiente de los FRCV y de la clase social basada en la ocupacion

To compare the prevalence and classification of chronic kidney disease (CKD) in accordance with the estimated glomerular filtration rate (eGFR) by MDRD-4 IDMS and CKD-EPI in individuals ≥ 60 years of age in primary care.Cross-sectional descriptive observational study. Subjects ≥ 60 years treated at 40 primary care centres with serum creatinine determination conducted between 1 January and 31 December 2010 at a single centralised laboratory.renal transplantation, home care.socio-demographic, anthropometric, risk factors and cardiovascular disease as recorded in electronic medical records and serum creatinine concentration by a standardised compensated kinetic Jaffe method with IDMS and eGFR by MDRD-4 IDMS and CKD-EPI. Agreement was analysed using the kappa coefficient and the Bland-Altman graphical method.97,554 individuals (57.3% women, mean age 70.0 [Q1: 65.0, Q3: 77.0]). Median eGFR with MDRD 78.7 [66.7, 91.0] ml/min/1.73m² (77.9 for women, 79.7 for men, P.001) and 81.8 [68.5, 90.5] ml/min/1.73 m² (P=.311) with CKD-EPI, eFG(MDRD) prevalence60 15.0% (16.5% women, 13.1% men and 6.5% in ≤ 70 years, 24%70 years) with CKD-EPI 14.2% (15.0% female, 13.0% male, 4.7% in ≤ 70 years, 24.1% in70 years) . There was an overall agreement of 85.6% (kappa coefficient = 0.75) in women70 years of 86.6% (kappa = 0.77), of 83.2% (kappa = 0.69) in men70 years, of 82.7% (kappa = 0.68) in women ≤ 70 years and 90% (kappa = 0.81) in men ≤ 70 years.CKD-EPI decreased the prevalence of CKD especially in women ≤ 70 years; the prevalence increased in men70 years. One in eight individuals with stage 3a was reclassified to no disease; reclassified individuals had lower comorbidity.

ObjectiveThe aim of the present study was to assess the concurrent and construct validity of two diet-quality indices, a modified Mediterranean diet score (mMDS) and a Mediterranean-like diet score (MLDS) additionally incorporating unhealthy food choices, as determined by an FFQ.DesignA validation study assessing FFQ intake estimates compared with ten or more unannounced 24 h recalls. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Bland–Altman plots and the limits of agreement method were used to assess the between-method agreement of scores. Construct validity was shown using associations between nutrient intakes derived from multiple 24 h recalls and the mMDS and MLDS derived from the FFQ.SettingGerona, Spain.SubjectsA total of 107 consecutively selected participants from a population-based cross-sectional survey.ResultsPearson's correlations for the energy-adjusted mMDS and MLDS compared with multiple recalls were 0·48 and 0·62, respectively. The average FFQ energy-adjusted mMDS and MLDS were 102 % and 98 % of the recall-based mMDS and MLDS estimates, respectively. The FFQ under- and overestimated dietary recall estimates of the energy-adjusted MLDS by 28 % and 25 %, respectively, with slightly wider boundaries for the mMDS (31 % and 34 %). The ICC, which assesses absolute agreement, was similar to Pearson's correlations (mMDS = 0·48 and MLDS = 0·61). The mean differences between methods were similar across the range of average ratings for both scores, indicating the absence of bias. The FFQ-derived mMDS and MLDS correlated in the anticipated directions with intakes of eleven (73·3 %) and thirteen of fifteen nutrients (86·7 %), respectively.ConclusionsThe FFQ provides valid estimates of diet quality as assessed by the mMDS and MLDS.

A B S T R A C T Introduction and objectives: The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. Methods: Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure

The unification of criteria for the diagnosis of metabolic syndrome, together with the subsequent World Health Organization (WHO) proposal to eliminate diabetes and cardiovascular diseases from the diagnostic criteria, will change estimates of the known prevalence of this syndrome. The aim of this study was to determine the prevalence of metabolic syndrome in a health area of Badajoz (Spain) using the latest consensus criteria and eliminating diabetes and cardiovascular disease.We performed a cross-sectional population-wide study of randomly selected individuals aged between 25 and 79 years old in a health area of Badajoz. In all patients, data on their history of cardiovascular risk factors were gathered, waist circumference and blood pressure were measured and a fasting blood sample was collected. The prevalence of metabolic syndrome, following recent criteria, was compared by age and gender.We recruited 2,833 individuals (46.5% men). The mean age was 51.2 years The prevalence of metabolic syndrome was 33.6% and was significantly higher in men (36.7% vs 30.9%; p0.001). The prevalence of metabolic syndrome fell significantly after exclusion of patients with diabetes or cardiovascular disease (20.8%; p0.001). The difference in prevalence between the distinct criteria was significant for the whole population and by sex (p0.000). A significant difference in prevalence between genders was observed from the age of 45-54 years in men and 55-64 years in womenThe prevalence of metabolic syndrome in a health area of Badajoz is among the highest reported in population-based studies in Spain. Although estimates of the prevalence are decreased by the new international recommendations, a considerable proportion of the young population requires preventive measures.

ResumenObjetivosLa unificación de criterios para el diagnóstico del síndrome metabólico, junto con la propuesta de la Organización Mundial de la Salud de eliminar de ellos a los pacientes con diabetes o con enfermedades cardiovasculares, cambiará la estimación de su prevalencia. Nuestro objetivo fue determinar la prevalencia del síndrome metabólico en un área de salud extremeña siguiendo ambas recomendaciones.MétodosEstudio transversal, poblacional, con selección aleatoria de individuos entre 25 y 79 años de edad, en un Área de Salud de Badajoz. Se recogieron los antecedentes de factores de riesgo cardiovascular, la presión arterial y el perímetro abdominal, y una muestra de sangre en ayunas. Se comparó la prevalencia del síndrome metabólico siguiendo los recientes criterios, por sexo y edad.ResultadosSe reclutaron 2.833 personas, el 46,5% eran hombres, y la edad media 51,2 años. La prevalencia del síndrome metabólico fue del 33,6%, significativamente mayor en los hombres (36,7% frente a 30,9%; p

To determine whether mortality from acute myocardial infarction has reduced in Spain and the possibly related therapeutic factors.Nine thousand, nine hundred and forty-nine patients with ST-segment elevation myocardial infarction admitted to the Coronary Care Unit were identified from PRIAMHO I, II and MASCARA registries performed in 1995, 2000 and 2005, with a 6 month follow-up.From 1995 to 2005 patients were increasingly more likely to have hypertension, hyperlipidemia and anterior infarction, but age of onset and the proportion of females did not increase. Twenty-eight-day mortality rates were 12.6%, 12.3% and 6% in 1995, 2000 and 2005 respectively, and 15.3%, 14.6% and 9.4% at 6 months (both P-trend.001). Multivariate analysis was performed and the adjusted odds ratio for 28-day mortality for an infarction occuring in 2005 (compared with 1995) was 0.62 (95% confidence interval: 0.44-0.88) whereas the adjusted hazard ratio for mortality at 6 months was 0.40 (95% confidence interval: 0.24-0.67). Other variables independently associated with lower mortality at 28 days were: reperfusion therapy, and the use of anti-thrombotic treatment, beta-blockers and angiotensin-converting enzyme inhibitors. The 28-day-6-month period had an independent protective effect on the following therapies: coronary reperfusion, and prescription of antiplatelet agents, beta-blockers and lipid lowering drugs upon discharge.Twenty-eight-day and six-month mortality rates fell among patients with ST-elevation myocardial infarction in Spain from 1995 to 2005. The possibly related therapeutic factors were the following: more frequent reperfusion therapy and increased use of anti-thrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors and lipid lowering drugs.

OBJECTIVE: To estimate the prevalence, detection, treatment and degree of control of cardiovascular risk factors in Extremadura. DESIGN: Cross-sectional study. SETTING: Population study in Don Benito-Villanueva de la Serena health area (Badajoz). PARTICIPANTS: A random sample of the people between 25 and 79 years, who lived in this area, was selected. METHODS: History of cardiovascular risk factors and its treatment were obtained by questionnaire. Blood pressure and blood sample were obtained for all participants. We calculated the prevalence of each variable standardized for age and gender for the population of Extremadura. RESULTS: Of the 3521 eligible, 2833 (80.5%) participants were included, mean age 51.2 years, male 46.5%. Adjusted prevalence of current smoking in men: 40.5% (37.8-43.2), hypertension 39.5% (37.3-41.7), hypercholesterolemia, 37.9% (35.4-40.4), obesity 36.5% (33.9-39.1), diabetes 13.7% (12.1-15.4). Adjusted prevalence of hypercholesterolemia in women: 35,0% (32.9-37.2), hypertension 33,0% (31.3-34.7), obesity 30.7% (28.6-32.8), current smoking 26,6% (24.5-28.7), diabetes 12,0% (10.5-13.5). The detection level of each factor was above 70%, and the degree of control among those treated of 51, 62.3 and 74.7% for hypertension, diabetes and hypercholesterolemia, respectively. CONCLUSIONS: Extremadura's population is highly exposed to major cardiovascular risk factors, especially men. Smoking, obesity and diabetes stand in the national context as the most prevalent in our community.

Introduction and objectives: To estimate the prevalence of cardiovascular risk factors in individuals aged 35-74 years in 10 of Spain’s autonomous communities and determine the geographic variation of cardiovascular risk factors distribution. Methods: Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. The average response rate was 73%. Lipid profile (with laboratory crossvalidation), glucose level, blood pressure, waist circumference, height, and weight were measured and standard questionnaires administered. Age-standardized prevalence of smoking, diabetes, hypertension, dyslipidemia, and obesity in the European population were calculated. Furthermore, the coefficient of variation between component studies was determined for the prevalence of each risk factor. Results: In total, 28,887 participants were included. The most prevalent cardiovascular risk factors were high blood pressure (47% in men, 39% in women), total cholesterol � 250 mg/dL (43% and 40%, respectively), obesity (29% and 29%, respectively), tobacco use (33% and 21%, respectively), and diabetes (16% and 11%, respectively). Total cholesterol � 190 and � 250 mg/dL were the respective minimum and maximum coefficients of variation (7%-24% in men, 7%-26% in women). Average concordance in lipid measurements between laboratories was excellent. Conclusions: Prevalence of high blood pressure, dyslipidemia, obesity, tobacco use and diabetes is high. Little variation was observed between autonomous communities in the population aged 35-74 years. However, presence of the most prevalent cardiovascular risk factors in the Canary Islands, Extremadura and Andalusia was greater than the mean of the 11 studies.