Josep Maria Manresa

Prevalencia de diabetes mellitus en la provincia de Girona, España: el estudio REGICOR

El objetivo fue determinar la prevalencia de diabetes mellitus en la poblacion de 25 a 74 anos de la provincia de Girona. Se obtuvieron los antecedentes personales de diabetes mellitus conocida y la glucemia en ayunas en sangre venosa. Se aplicaron los criterios diagnosticos de la American Diabetes Association de 1997. La prevalencia cruda de antecedentes de diabetes mellitus fue del 10% y la estandarizada por edad del 7,7% (intervalo de confianza [IC] del 95%, 7,3-8,1). La prevalencia cruda de glucosa alterada en ayunas fue del 8,6% y la estandarizada por edad del 7,6% (IC del 95%, 7,2-8,1). La prevalencia cruda de antecedentes de diabetes mellitus conocida mas la definida por glucemia (prevalencia total de diabetes mellitus) fue del 13% y la estandarizada del 10% (IC del 95%, 9,6-10,5). Se observo una mayor prevalencia en varones y un aumento con la edad. Estas cifras difieren de las obtenidas en algunos estudios realizados en Espana.

Relationship of classical and non-classical risk factors with genetic variants relevant to coronary heart disease.

Background In addition to the well established cardiovascular risk factors, evidence suggests a possible role of genetic and non-classical risk factors in the development and progression of atherothrombosis. We aimed to determine the relationship of classical and non-classical cardiovascular risk factors with candidate gene polymorphisms potentially involved in cardiovascular risk in the general Mediterranean population. Design Cross-sectional study. Methods We have determined the prevalence of classical (lipid profile, blood pressure, glycaemia, diabetes, smoking, body mass index, menopause and family history of coronary heart disease) and non-classical cardiovascular risk factors (infectious processes, homocysteinaemia, oxidative status, C-reactive protein, lipoprotein (a) and fibrinogen) in a population-based study. We analysed the relationship of these risk factors with the following five gene polymorphisms potentially involved in cardiovascular risk: ATP-binding cassette transporter A1-R219K, Peroxisome proliferator-activated receptor (PPAR)-α-L162V, Lipoprotein lipase (LPL)–HindIII, Paraoxonase (PON)1-Q192R, and Tumour necrosis factor (TNF)-α- G-308A. Results We found PPAR-α-V and LPL-H+ alleles to be associated with decreased high-density lipoprotein-cholesterol (HDL-c) concentration and with increased total cholesterol: HDL-c and triglyceride: HDL-c ratios. Regarding the non-classical risk factors, C-reactive protein concentration was higher for the PPAR-α-V allele. A higher oxidative status was shown in homozygotes for LPL-H+ and TNF-α-G alleles, although the latter also had lower homocysteinaemia. Conclusions Three of the genetic variants analysed, PPAR-α-L162V, LPL-HindIII, and TNF-α-G-308A, were associated with non-classical risk factors, specifically lipid profile, inflammation, and oxidative status.

Prevalence of Diabetes Mellitus in the Province of Girona, Spain: the REGICOR Study

Our aim was to determine the prevalence of diabetes mellitus in the 25-to-74-year-old population in the province of Gerona, Spain. History of known diabetes mellitus was recorded, and fasting glycemia was measured in venous blood. The 1997 diagnostic criteria of the American Diabetes Association were used. Crude prevalence of known diabetes mellitus was 10.0%, and age-standardized prevalence was 7.7% (95% confidence interval [CI], 7.3%-8.1%). Crude prevalence of impaired fasting glucose was 8.6%, and age-standardized prevalence was 7.6% (95% CI, 7.25%-8.1%). Crude prevalence of known diabetes mellitus combined with diabetes mellitus according to glycemia value (total prevalence of diabetes mellitus) was 13.0%, and age-standardized prevalence was 10.0% (95% CI, 9.6%-10.5%). A higher prevalence in men and an increase in prevalence with age were observed. The figures are different from those of other studies in Spain.

Polimorfismo 192 del gen de la paraoxonasa 1, actividad física y lipoproteínas de alta densidad en la mujer

Fundamento y objetivo: La practica de ejercicio fisico regular se asocia a un aumento del colesterol ligado a las lipoproteinas de alta densidad (cHDL), cuyo efecto antioxidante y protector frente a la enfermedad coronaria es bien conocido. La paraoxonasa 1 (PON1) es una enzima relacionada con la actividad antioxidante de la HDL. Se han descrito varios polimorfismos en el gen PON1, uno de ellos situado en el locus 192 (PON1-192) y que comprende los alelos Q (baja actividad de PON1) y R (alta actividad de PON1). El objetivo de este estudio ha sido determinar si existe un efecto de la actividad fisica en el perfil lipidico distinto en funcion del genotipo PON1-192 en mujeres. Pacientes y metodo: Formaron parte de este estudio de cohorte retrospectiva 651 mujeres participantes en un estudio transversal de factores de riesgo. Se analizaron las caracteristicas antropometricas, lipidos y lipoproteinas sericos, presion arterial, genotipos del polimorfismo PON1-192, menopausia, y se utilizo el cuestionario de la actividad fisica en el tiempo libre de Minnesota para valorar la cantidad de ejercicio fisico realizado diariamente durante el ultimo ano. Resultados: Las participantes en el estudio se clasificaron en 3 categorias correspondientes a los terciles de la cantidad de ejercicio fisico realizado. Si bien no se hallaron diferencias de los parametros lipidicos en la muestra global del estudio, se observo una tendencia lineal creciente de los valores de cHDL y decreciente para el cociente log trigliceridos/cHDL al aumentar la actividad fisica en mujeres homocigotas RR. Un analisis posterior en subgrupos revelo que las asociaciones de un incremento del cHDL y de un decremento del cociente log trigliceridos/cHDL con una mayor practica de actividad fisica eran exclusivas de mujeres no menopausicas y homocigotas RR. Conclusiones: Este hallazgo indica que el polimorfismo 192 de la PON1 podria modular el efecto de la actividad fisica en la concentracion de cHDL y el catabolismo de las particulas ricas en trigliceridos en mujeres en edad fertil.

Analysis of three strategies to increase screening coverage for cervical cancer in the general population of women aged 60 to 70 years: the CRICERVA study

BackgroundCervical cancer is a frequently diagnosed cancer in women worldwide. Despite having easy preventive and therapeutic approaches, it is an important cause of mortality among women.MethodsThe CRICERVA study is a cluster clinical trial which assigned one of three interventions to the target population registered in Cerdanyola, Barcelona. Among the 5,707 resident women aged 60 to 70 years in the study area, women with no record of cervical cytology over the last three years were selected. The study included four arms: three interventions all including a pre-assigned date for screening visit and i) personalized invitation letter; ii) adding to i) an informative leaflet; and, iii) in addition to ii) a personalized appointment reminder phone call, and iv) no specific action taken (control group). Participants were offered a personal interview about social-demographic characteristics and about screening attitudes. Cervical cytology and HPV DNA test (HC2) were offered as screening tests. In the case of screening positive in any of these tests, the women were followed up until a full diagnosis could be obtained. The effect size of each study arm was estimated as the absolute gain in coverage between the original coverage and the final coverage.ResultsFrom the intervention groups (4,775 women), we identified 3,616 who were not appropriately screened, of which 2,560 women answered the trial call and 1,376 were amenable to screening. HPV was tested in 920 women and cervical cytology in all 1,376. Overall, there was an absolute gain in coverage of 28.8% in the intervention groups compared to 6% in the control group. Coverage increased from 51.2% to 76.0% in strategy i); from 47.4% to 79.0% in strategy ii) and from 44.5% to 74.6% in strategy iii). Lack of information about the relevance of screening was the most important factor for not attending the screening program.ConclusionsThe study confirms that actively contacting women and including a date for a screening visit, notably increased participation in the screening program. Efforts to improve health education in preventative activities are warranted.Trial registrationClinical Trials.gov Identifier NCT01373723. Registered 14 June 2011.

Acceso y uso de nuevas tecnologías entre los jóvenes de educación secundaria, implicaciones en salud. Estudio JOITIC

OBJECTIVE To determine ICT accessibility and use among the adolescents attending High School and to analyse related factors. DESIGN Cross-sectional multicentric study. SETTING High Schools participating in the Community Health «Salut i Escola» Programme. PARTICIPANTS 5,538 students from first to fourth degree at 28 centres in the area of Barcelona. MAIN MEASUREMENTS Self administered questionnaire including sociodemographic information, ICT use and accessibility. RESULTS Missing answers were below 1% in all items except in school performance (3,13%); 48,6% were female, mean age 14years (range 11-20); 15,5% foreigners; 23% reported low school performance; 75,2% took extracurricular activities; 88,9% refers a good relationship with their parents. ICT access is homogeneously massive: 98% had a computer at home, 44,8% used it for two or more hours daily. 98,6% could access Internet, 47,2% without parental control. 90% owned a mobile phone (83% in first grade, 95% in fourth); 45,6% owned one before 12years old. Girls use it for social relationships and boys for playing. 68,4% played videogames, 36,5% for three or more hours a week and 66,8% without parental control. Their use decreases with age. The ICT parental control is associated with better school performance. CONCLUSIONS Our high scholars gain access to the ICT at younger ages and they use them in almost every aspect of their lives. There have been detected some gender differences in their use, as well as in the age of the users and between the type of school.

The problematic use of Information and Communication Technologies (ICT) in adolescents by the cross sectional JOITIC study

BackgroundThe emerging field of Information and Communications Technology (ICT) has brought about new interaction styles. Its excessive use may lead to addictive behaviours.The objective is to determine the prevalence of the problematic use of ICT such as Internet, mobile phones and video games, among adolescents enrolled in mandatory Secondary Education (ESO in Spanish) and to examine associated factors.MethodsCross sectional, multi-centric descriptive study. Population: 5538 students enrolled in years one to four of ESO at 28 schools in the Vallès Occidental region (Barcelona, Spain). Data collection: self-administered socio-demographic and ICT access questionnaire, and validated questionnaires on experiences related to the use of the Internet, mobile phones and video games (CERI, CERM, CERV).ResultsQuestionnaires were collected from 5,538 adolescents between the ages of 12 and 20 (77.3 % of the total response), 48.6 % were females. Problematic use of the Internet was observed in 13.6 % of the surveyed individuals; problematic use of mobile phones in 2.4 % and problematic use in video games in 6.2 %.Problematic Internet use was associated with female students, tobacco consumption, a background of binge drinking, the use of cannabis or other drugs, poor academic performance, poor family relationships and an intensive use of the computer.Factors associated with the problematic use of mobile phones were the consumption of other drugs and an intensive use of these devices.Frequent problems with video game use have been associated with male students, the consumption of other drugs, poor academic performance, poor family relationships and an intensive use of these games.ConclusionsThis study offers information on the prevalence of addictive behaviours of the Internet, mobile phones and video game use.The problematic use of these ICT devices has been related to the consumption of drugs, poor academic performance and poor family relationships.This intensive use may constitute a risk marker for ICT addiction.

Continued smoking abstinence in diabetic patients in primary care: A cluster randomized controlled multicenter study

AIMS To assess the effectiveness of an intensive smoking cessation intervention based on the transtheoretical model of change (TTM) in diabetic smokers attending primary care. METHODS A cluster randomized controlled clinical trial was designed in which the unit of randomization (intervention vs. usual care) was the primary care team. An intensive, individualized intervention using motivational interview and therapies and medications adapted to the patients stage of change was delivered. The duration of the study was 1 year. RESULTS A total of 722 people with diabetes who were smokers (345 in the intervention group and 377 in the control group) completed the study. After 1 year, continued abstinence was recorded in 90 (26.1%) patients in the intervention group and in 67 (17.8%) controls (p=0.007). In patients with smoking abstinence, there was a higher percentage in the precontemplation and contemplation stages at baseline in the intervention group than in controls (21.2% vs. 13.7%, p=0.024). When the precontemplation stage was taken as reference (OR=1.0), preparation/action stage at baseline showed a protective effect, decreasing 3.41 times odds of continuing smoking (OR=0.293 95% CI 0.179-0.479, p<0.001). Contemplation stage at baseline also showed a protective effect, decreasing the odds of continuing smoking (OR=0.518, 95% CI 0.318-0.845, p=0.008). CONCLUSIONS An intensive intervention adapted to the individual stage of change delivered in primary care was feasible and effective, with a smoking cessation rate of 26.1% after 1 year.

Nutritional status of iodine in pregnant women in Catalonia (Spain): study on hygiene-dietetic habits and iodine in urine.

BackgroundIt is a priority to achieve an adequate nutritional status of iodine during pregnancy since iodine deficiency in this population may have repercussions on the mother during both gestation and post partum as well as on the foetus, the neonate and the child at different ages. According to the WHO, iodine deficiency is the most frequent cause of mental retardation and irrreversible cerebral lesions around the world. However, few studies have been published on the nutritional status of iodine in the pregnant population within the Primary Care setting, a health care level which plays an essential role in the education and control of pregnant women. Therefore, the aim of the present study is: 1.- To know the hygiene-dietetic habits related to the intake of foods rich in iodine and smoking during pregnancy. 2.- To determine the prevalence of iodine deficiency and the factors associated with its appearance during pregnancy.Methods/designWe will perform a cluster randomised, controlled, multicentre trial. Randomisation unit: Primary Care Team. Study population: 898 pregnant women over the age of 17 years attending consultation to a midwife during the first trimester of pregnancy in the participating primary care centres. Outcome measures: consumption of iodine-rich foods and iodine deficiency. Points of assessment: each trimester of the gestation. Intervention: group education during the first trimester of gestation on healthy hygiene-dietetic habits and the importance of an adequate iodine nutritional status. Statistical analysis: descriptive analysis of all variables will be performed as well as multilevel logistic regression. All analyses will be done carried out on an intention to treat basis and will be fitted for potential confounding factors and variables of clinical importance.DiscussionEvidence of generalised iodine deficiency during pregnancy could lead to the promotion of interventions of prevention such as how to improve and intensify health care educational programmes for pregnant women.Trial RegistrationClinicalTrials.gov: NCT01301768

Economic evaluation of three populational screening strategies for cervical cancer in the county of Valles Occidental: CRICERVA clinical trial

BackgroundA high percentage of cervical cancer cases have not undergone cytological tests within 10 years prior to diagnosis. Different population interventions could improve coverage in the public system, although costs will also increase. The aim of this study was to compare the effectiveness and the costs of three types of population interventions to increase the number of female participants in the screening programmes for cancer of the cervix carried out by Primary Care in four basic health care areas.Methods/DesignA cost-effectiveness analysis will be performed from the perspective of public health system including women from 30 to 70 years of age (n = 20,994) with incorrect screening criteria from four basic health care areas in the Valles Occidental, Barcelona, Spain. The patients will be randomly distributed into the control group and the three intervention groups (IG1: invitation letter to participate in the screening; IG2: invitation letter and informative leaflet; IG3: invitation letter, informative leaflet and a phone call reminder) and followed for three years. Clinical effectiveness will be measured by the number of HPV, epithelial lesions and cancer of cervix cases detected. The number of deaths avoided will be secondary measures of effectiveness. The temporal horizon of the analysis will be the life expectancy of the female population in the study. Costs and effectiveness will be discounted at 3%. In addition, univariate and multivariate sensitivity analysis will be carried out.DiscussionIG3 is expected to be more cost-effective intervention than IG1 and IG2, with greater detection of HPV infections, epithelial lesions and cancer than other strategies, albeit at a greater cost.Trial RegistrationClinical Trials.gov IdentifierNCT01373723