Manuel Fuentes

Is psycho-physical stress a risk factor for stroke? A case-control study

Background Chronic stress is associated with cardiovascular diseases, but the link with stroke has not been well established. Stress is influenced by life-style habits, personality type and anxiety levels. We sought to evaluate psycho-physical stress as a risk factor for stroke, while assessing gender influences. Methods Case-control study. Cases: patients (n=150) aged 18–65, admitted consecutively to our Stroke Unit with the diagnosis of incident stroke. Controls: (n=300) neighbours (paired with case ±5 years) recruited from the census registry. Study variables: socio-demographic characteristics, vascular risk factors, psychophysical scales of H&R (Holmes & Rahe questionnaire of life events), ERCTA (Recall Scale of Type A Behaviour), SF12 (QoL scale), GHQ28 (General Health Questionnaire). Statistical analyses included conditional multiple logistic regression models. Results Mean age was 53.8 years (SD: 9.3). Compared with controls, and following adjustment for confounding variables, significant associations between stroke and stress were: H&R values >150 OR=3.84 (95% CI 1.91 to 7.70, p<0.001); ERCTA (values >24) OR=2.23 (95% CI 1.19 to 4.18, p=0.012); mental SF12 (values >50) OR=0.73 (95% CI 0.39 to 1.37, p=0.330); psychological SF12 (values >50) OR=0.66 (95% CI 0.33 to 1.30, p=0.229), male gender OR=9.33 (95% CI 4.53 to 19.22, p<0.001), high consumption of energy-providing beverages OR=2.63 (95% CI 1.30 to 5.31, p=0.007), current smoker OR=2.08 (95% CI 1.01 to 4.27, p=0.046), ex-smoker OR=2.35 (95% CI 1.07 to 5.12, p=0.032), cardiac arrhythmia OR=3.18 (95% CI 1.19 to 8.51, p=0.022) and Epworth scale (≥9) OR=2.83 (95% CI 1.03 to 7.78, p=0.044). Conclusions Compared with healthy age-matched individuals, stressful habits and type A behaviour are associated with high risk of stroke. This association is not modified by gender.

Determining Electric Vehicle Charging Point Locations Considering Drivers’ Daily Activities

Abstract In this paper the daily temporal and spatial behavior of electric vehicles (EVs) is modelled using an activity-based (ActBM) micro-simulation model for Flanders region (Belgium). Assuming that all EVs are completely charged at the beginning of the day, this mobility model is used to determine the percentage of Flemish vehicles that cannot cover their programmed daily trips and need to be recharged during the day. Assuming a variable electricity price, an optimization algorithm determines when and where EVs can be recharged at minimum cost for their owners. This optimization takes into account the individual mobility constraint for each vehicle, as they can only be charged when the car is stopped and the owner is performing an activity. From this information, the aggregated electric demand for Flanders is obtained, identifying the most overloaded areas at the critical hours. Finally it is also analyzed what activities EV owners are underway during their recharging period. From this analysis, different actions for public charging point deployment in different areas and for different activities are proposed.

Blood lead and cadmium levels in a six hospital employee population. PESA study, 2009

INTRODUCTION Exposure to lead and cadmium is a public health problem due to the broad exposure to these toxic substances among the general population. The objective of this study is to determine blood lead and cadmium concentrations in a working population drawn from six university hospitals in Madrid, Getafe, Cartagena, Santiago de Compostela, Santander and Palma de Mallorca (Spain) and to identify associated factors. MATERIALS AND METHODS 951 individuals participated in the study and were administered the standardized PESA® questionnaire regarding exposure to lead and cadmium. The blood lead and cadmium concentrations were measured by electrothermal atomization atomic absorption spectrometry with Zeeman background correction in Perkin-Elmer spectrometers, guaranteeing the transferability of the results. RESULTS The median overall blood lead concentration was: 1.6 μg/dL (IQR: 0.9-2.7) and that of cadmium was: 0.21 μg/L (IQR: 0.10-0.50). There were significant differences in lead levels between men (2 μg/dL) and women (1.5 μg/dL), postmenopausal (2.6 μg/dL) and premenopausal women (1.1 μg/dL), and between participants who cooked in earthenware (2.1 μg/dL) and those who did not (1.5 μg/dL). The median of cadmium in women (0.24 μg/L) was higher than in men (0.11 μg/L) and was also higher in subjects who smoked (0.70 μg/L) than in non-smokers (0.13 μg/L). CONCLUSIONS A reduction in blood lead and cadmium levels was observed with respect to previous studies carried out in Spain. Nevertheless, the results suggest there are certain factors which increase risk such as age, gender, menopause, age of housing, cooking in lead-glazed earthenware and exposure to cigarette smoke.

Early predictors of gestational hypertension in a low-risk cohort. Results of a pilot study.

Objective: To determine if the clinical or biochemical markers used in pregnancy can be applied as early predictors of gestational hypertension. Design: Prospective cohort study. Population: 315 pregnant women referred from the Prenatal Diagnosis Unit between weeks 10–13 of pregnancy and followed up to the childbirth. Methods: Biomarkers were measured in serum specimens in the first and second trimester of pregnancy. Blood pressure (BP) was measured in the first, second and third trimester. Results: The cumulative incidence of gestational hypertension was 6.01%. In the first trimester gestational hypertension predictors were uric acid greater than 3.15 mg/dl (P = 0.01), BMI greater than 24 kg/m2 (P = 0.003) SBP at least 120 mmHg (P = 0.02) and DBP at least 71 mmHg (P = 0.007). After applied multivariate analysis just uric acid and SBP were statistically significant. Conclusion: In our cohort of healthy pregnant women uric acid above 3.15 mg/dl and SBP at least 120 mmHg are consistent predictors of gestational hypertension in the first trimester. The most important implication of our study is the possibility to identify in the first trimester women at risk to develop gestational hypertension using available markers.

A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study

Background Gestational diabetes mellitus (GDM) prevalence is increasing and becoming a major public health concern. Whether a Mediterranean diet can help prevent GDM in unselected pregnant women has yet to be studied. Methods We conducted a prospective, randomized controlled trial to evaluate the incidence of GDM with two different dietary models. All consecutive normoglycemic (<92 mg/dL) pregnant women at 8–12 gestational weeks (GW) were assigned to Intervention Group (IG, n = 500): MedDiet supplemented with extra virgin olive oil (EVOO) and pistachios; or Control Group (CG, n = 500): standard diet with limited fat intake. Primary outcome was to assess the effect of the intervention on GDM incidence at 24–28 GW. Gestational weight gain (GWG), pregnancy-induced hypertension, caesarean section (CS), preterm delivery, perineal trauma, small and large for gestational age (SGA and LGA) and admissions to neonatal intensive care unit were also assessed. Analysis was by intention-to-treat. Results A total of 874 women completed the study (440/434, CG/IG). According to nutritional questionnaires and biomarker analysis, women in the IG had a good adherence to the intervention. 177/874 women were diagnosed with GDM, 103/440 (23.4%) in CG and 74/434(17.1%) in IG, p = 0.012. The crude relative risk (RR) for GDM was 0.73 (95% CI: 0.56–0.95; p = 0.020) IG vs CG and persisted after adjusted multivariable analysis, 0.75(95% CI: 0.57–0.98; p = 0.039). IG had also significantly reduced rates of insulin-treated GDM, prematurity, GWG at 24–28 and 36–38 GW, emergency CS, perineal trauma, and SGA and LGA newborns (all p<0.05). Conclusions An early nutritional intervention with a supplemented MedDiet reduces the incidence of GDM and improves several maternal and neonatal outcomes.

Psychological Factors Affecting Response to Antidepressant Drugs in Fibromyalgia

BACKGROUND The use of antidepressant drugs in fibromyalgia is extensive despite small evidence of the real impact in the clinical practice setting. This study was aimed to evaluate the long-term efficiency of antidepressant treatment in fibromyalgia and the role of psychosocial factors in treatment response. METHODS A total of 102 consecutive patients with fibromyalgia from primary health care centers were studied with psychopathological and psychological assessment interviews and questionnaires. Sustained release venlafaxine was added to previous treatments in flexible doses from 150 to 300 mg daily for a 6-month period. Efficacy measures included the Clinical Global Impression (CGI) scale (patient and clinician versions) and the Fibromyalgia Impact Questionnaire (FIQ) score reduction. RESULTS At 6 months, 48% patients were considered responders to treatment (CGI change score 1 or 2) and 23.5% had a mild response. Of note, 57.8% had less fatigue and 31.4% had less pain. The proportion of responders was greater in the group with major depression (65%) than in those without depression (45%), but the difference did not reach statistical significance. However, the reduction of FIQ scores was significantly greater in depressed (21.1; IQR: 1.4-42.0) than in non-depressed patients (41.4; IQR: 23.6-52.6) (P<0.05). FIQ score reduction was significantly smaller in patients taking concomitant opiate treatment (P<0.01) and in patients seeking incapacitation (P<0.01). CONCLUSION Antidepressant treatment in fibromyalgia was effective in patients with and without major depression, but the functional response was greater in depressed patients. Treatment response to antidepressants might be significantly influenced by attitudinal and psychosocial factors of the disease.

Feasibility Study of a Building-Integrated PV Manager to Power a Last-Mile Electric Vehicle Sharing System

Transportation is one of the largest single sources of air pollution in urban areas. This paper analyzes a model of solar-powered vehicle sharing system using building-integrated photovoltaics (BIPV), resulting in a zero-emission and zero-energy mobility system for last-mile employee transportation. As a case study, an electric bicycle sharing system between a public transportation hub and a work center is modeled mathematically and optimized in order to minimize the number of pickup trips to satisfy the demand, while minimizing the total energy consumption of the system. The whole mobility system is fully powered with BIPV-generated energy. Results show a positive energy balance in e-bike batteries and pickup vehicle batteries in the worst day of the year regarding solar radiation. Even in this worst-case scenario, we achieve reuse rates of 3.8 people per bike, using actual data. The proposed system manages PV energy using only the batteries from the electric vehicles, without requiring supportive energy storage devices. Energy requirements and PV generation have been analyzed in detail to ensure the feasibility of this approach.

Capacidad de detección de patología psiquiátrica por el médico de familia

Resumen Objetivo Conocer la capacidad de detección de patología psiquiátrica por el médico de familia, comparando la presencia de patología psiquiátrica detectada mediante test validados y la referida por su médico de familia. Diseño Estudio transversal de doble fase. Emplazamiento Centros de Salud de un área urbana de Madrid. Participantes Pacientes entre 18 y 65 años que acuden a consulta por motivos no administrativos. Mediciones principales Para la detección de posible patología psiquiátrica, en la sala de espera se utilizaron instrumentos de cribado, el GHQ-28 (punto de corte 6 o superior) y el MULTICAGE CAD-4 (punto de corte 2 o superior). Como instrumento de identificación de «caso» en la segunda fase se utilizó la entrevista MINI en los pacientes con puntuación positiva en uno de los instrumentos de cribado y un 20% de los negativos. Por otro lado, cuando los pacientes entraban en la consulta entregaban a su médico una tarjeta con un número de identificación para que, de manera ciega, registrase: presencia de patología psiquiátrica actual según su criterio y existencia, o no, de tratamiento actual con psicofármacos. Resultados Participaron 628 sujetos. La prevalencia de patología psiquiátrica corregida por metodología de doble fase fue del 31,7% (IC 95%: 27,9-35,5). De 185 pacientes con patología psiquiátrica detectada, el 44,2% (IC 95%: 36,7-51,7) fueron identificados como pacientes con patología psiquiátrica por su médico de familia. Las patologías mejor identificadas fueron: hipomanía, trastorno distímico, episodio depresivo con síntomas melancólicos y trastorno por angustia. Conclusiones Un porcentaje importante de pacientes con patología psiquiátrica detectada con test validados no han sido identificados por su médico de familia.

Psychiatric morbidity and predisposing factors in a primary care population in Madrid

Objectives: The aim of this article is to estimate the prevalence of mental disorders in patients in primary care centers in an urban area of Madrid and to study possible associated risk factors. Methods: Cross-sectional month prevalence was evaluated in two phases in an urban area of Madrid. The sample for the first phase included 635 individuals (aged 18–65 years), and the second phase included 320 individuals. Socio-demographic variables (age, sex, educational level, living conditions and country of origin) and clinical variables (psychiatric diagnosis and level of psychosocial stress) were studied. The instruments used for screening were the General Health Questionnaire (GHQ)-28 item questionnaire and the MULTICAGE-CAD 4test. The Mini International Neuropsychiatric Interview (M.I.N.I.) was used in the second phase (in ‘possible cases’ and 20% of the ‘non-cases’). Prevalence was calculated using weighted logistic regression with the observed sampling fractions of the patients in study phase 2 as sample weights. Results and conclusions: The month prevalence of mental disorders was 31.3% (95% confidence interval (CI) = [27.6, 35.2]). Anxiety disorders were the most frequent diagnoses with a prevalence of 22.4% (95% CI = [17.8, 27.1]), followed by depressive disorders (16.6%; 95% CI = [12.9, 20.3]), substance abuse or dependence disorders (5.6%; 95% CI = [3.2, 6.9]) and posttraumatic stress disorder (PTSD; 4.4%; 95% CI = [2.0, 2.8]). Factors associated with mental disorders were the presence of stressful life events in the previous 12 months, Latin American region of origin, being woman aged 25 and 34 years and having a low education level.

Dietary Patterns and Weight Loss in New-onset Type 2 Diabetes Mellitus: A Sub-analysis of the St Carlos Study: A 3-year, Randomized, Clinic-based, Interventional Study

Objective: To assess lifestyle patterns associated with weight loss in newly-diagnosed type 2 diabetic patients (T2DM) in the St Carlos Study. Design: A 3-year, randomized, interventional study with three parallel groups. Setting: A single-center, outpatient clinic-based study. Participants: 195 newly-diagnosed T2DM were randomized to either the intervention group (self monitoring of blood glucose with-or-without an exercise program), or to the HbA1c control group. The same lifestyle-intervention protocol was applied in all patients.