Manuela García de la Hera

Esophageal cancer risk by type of alcohol drinking and smoking: a case-control study in Spain

BackgroundThe effect of tobacco smoking and alcohol drinking on esophageal cancer (EC) has never been explored in Spain where black tobacco and wine consumptions are quite prevalent. We estimated the independent effect of different alcoholic beverages and type of tobacco smoking on the risk of EC and its main histological cell type (squamous cell carcinoma) in a hospital-based case-control study in a Mediterranean area of Spain.MethodsWe only included incident cases with histologically confirmed EC (n = 202). Controls were frequency-matched to cases by age, sex and province (n = 455). Information on risk factors was elicited by trained interviewers using structured questionnaires. Multiple logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals (CI).ResultsAlcohol drinking and tobacco smoking were strong and independent risk factors for esophageal cancer. Alcohol was a potent risk factor with a clear dose-response relationship, particularly for esophageal squamous-cell cancer. Compared to never-drinkers, the risk for heaviest drinkers (≥ 75 g/day of pure ethanol) was 7.65 (95%CI, 3.16–18.49); and compared with never-smokers, the risk for heaviest smokers (≥ 30 cigarettes/day) was 5.07 (95%CI, 2.06–12.47). A low consumption of only wine and/or beer (1–24 g/d) did not increase the risk whereas a strong positive trend was observed for all types of alcoholic beverages that included any combination of hard liquors with beer and/or wine (p-trend<0.00001). A significant increase in EC risk was only observed for black-tobacco smoking (2.5-fold increase), not for blond tobacco. The effects for alcohol drinking were much stronger when the analysis was limited to the esophageal squamous cell carcinoma (n = 160), whereas a lack of effect for adenocarcinoma was evidenced. Smoking cessation showed a beneficial effect within ten years whereas drinking cessation did not.ConclusionOur study shows that the risk of EC, and particularly the squamous cell type, is strongly associated with alcohol drinking. The consumption of any combination of hard liquors seems to be harmful whereas a low consumption of only wine may not. This may relates to the presence of certain antioxidant compounds found in wine but practically lacking in liquors. Tobacco smoking is also a clear risk factor, black more than blond.

Vegetable but not fruit intake during pregnancy is associated with newborn anthropometric measures.

We examined the relationship between consumption of fruit and vegetables during pregnancy and anthropometric measures at birth in a general population mother-infant cohort in Valencia, Spain. A total of 787 infants born between May 2004 and February 2006 were included. Fruit and vegetable consumption during pregnancy was assessed by a FFQ administered using an in-person interview. We used multiple linear regression to assess associations between fruit and vegetable intake (in quintiles) and birth weight and length adjusted for sex and gestational age, and logistic regression to assess being small for gestational age (SGA) in weight and SGA in length, defined as adjusted birth weight or length below the 10th percentile. A linear relationship was found between vegetable consumption and having a SGA (weight) and SGA (length) baby. Women in the lowest quintile of vegetable intake during the first trimester had a higher odds of having a SGA (weight) baby than women in the highest quintile [odds ratio (OR), 3.7; 95% CI: 1.5-8.9; P-trend < 0.001] and had a higher odds of having an SGA (length) baby in the third trimester (OR, 5.5; 95% CI: 1.7-17.7; P-trend = 0.04) in multivariate analysis. We found a nonmonotonic relationship between adjusted birth weight and length and vegetable consumption during the first trimester; newborns in the 2 lowest quintiles of intake had a significantly lower weight and length than those in the 4th quintile. There was no association between fruit consumption and birth outcomes. Our findings indicate that vegetable consumption throughout pregnancy may have a beneficial effect on fetal growth.

Impact of hepatitis C infection on long-term mortality of injecting drug users from 1990 to 2002: differences before and after HAART.

Objective:To assess the impact of HIV and hepatitis C virus (HCV) infection on long-term mortality in injecting drug users (IDU). Design:Community-based prospective cohort study. Methods:Mortality data from follow-up in clinical sites and the Mortality Registry by December 2002 were collected for 3247 IDU who attended three centres for voluntary counselling and testing for HIV/AIDS, HCV and hepatitis B virus (HBV) in 1990–1996. Mortality rates by Poisson regression were adjusting for age, sex, duration of drug use, education, HBV and calendar period (1990–1997 and 1998–2002). Results:Overall, 11.2% were HIV/HCV negative, 43.7% positive only for HCV and 45.1% positive for both. During 26 772 person-years of follow-up, 585 deaths were detected (2.19/100 person-years). Before 1997, HIV/HCV-positive subjects had a five-fold increase in risk of death [relative risk (RR), 5.4; 95% confidence interval (CI), 2.5–11.4] compared with those negative for both; after 1997, a three-fold increase was observed (RR, 2.7; 95% CI, 1.7–4.2). Being HCV positive/HIV negative was not associated with an increase in the risk of death either before (RR, 1.3; 95% CI, 0.6–2.9) or after (RR, 1.2; 95% CI, 0.8–1.9) 1997 compared with HCV/HIV negative. While increases in mortality were seen in those HCV/HIV negative (RR, 1.6; 95% CI, 0.7–3.7) and those only positive for HCV (RR, 1.5; 95% CI, 1.0–2.1), a 20% reduction among coinfected IDUs was observed after 1997 (interaction P = 0.033). Conclusions:HCV/HIV coinfection has had a large impact on mortality in IDU. After 1997, mortality increased in HIV negative/HCV positive subjects and decreased in HIV positive/HCV positive.

Gender differences in progression to AIDS and death from HIV seroconversion in a cohort of injecting dug users from 1986 to 2001

Background: Although the consensus is that gender does not influence HIV progression, its relevance may depend on the setting. Aim: To study gender differences in HIV progression to AIDS and death from 1986 to 2001 in a cohort of injecting drug user (IDU) seroconverters in Spain. Methods: Risk of AIDS and death in persons infected for the same length of time were compared through Kaplan-Meier, allowing for late entry, and Cox regression adjusting for gender, age, and calendar period (before 1992, 1992–1995, 1996–1998, 1999–2001) fitted as time dependent covariates. Results: Of 929 IDU, 24.7% were women. Median seroconversion year was 1993.3 for men and women. 44% of women and 34% of men received antiretroviral therapy. Risk of AIDS was lower in women in univariate (hazard ratio (HR) 0.72; 95%CI:0.51 to 1.01) and multivariate analyses (HR 0.73 95%CI:0.52 to 1.03). A 46% reduction in risk of AIDS for period 1999–2001 compared with 1992–1995 was seen in both men and women (HR: 0.56 (95%CI:0.36 to 0.87). As for mortality, women’s risk of death was lower univariately (HR 0.67 95%CI:0.45 to 0.99) although compared with 1992–95, men experienced a 34% reduction in mortality during 1999–2001 (HR 0.66 95%CI:0.40 to 1.01), which was not statistically significant in women. Conclusions: HIV progression was lower in female IDU before and after 1997 and their uptake of antiretroviral therapy was higher than male IDU. The inability to detect a reduction in mortality for women during 1999–2001 is probably attributable to lack of power. Differences in severity of addiction, drug using patterns, and competing causes of death may explain these findings.

Folic Acid Supplements During Pregnancy and Child Psychomotor Development After the First Year of Life

IMPORTANCE Folate intake during pregnancy has been associated with improved neuropsychological development in children, although the effects of high dosages of folic acid (FA) supplements are unclear. OBJECTIVE To examine the association between the use of high dosages of FA supplements during pregnancy and child neuropsychological development after the first year of life. DESIGN, SETTING, AND PATIENTS The multicenter prospective mother-child cohort Infancia y Medio Ambiente (INMA) Project recruited pregnant women from 4 areas of Spain (Asturias, Sabadell, Gipuzkoa, and Valencia) between November 2003 and January 2008. Pregnant women completed an interviewer-administered questionnaire on the usual dietary folate intake and FA supplements at 10 to 13 weeks and 28 to 32 weeks of gestation. The main analyses were based on a sample of 2213 children with complete information on neuropsychological development and FA supplement intake during pregnancy. Multiple linear and logistic regression analyses were used to explore the effects of FA supplements on child neuropsychological development. MAIN OUTCOMES AND MEASURES Neuropsychological development was assessed using the Bayley Scales of Infant Development. We calculated mental scale and psychomotor scale scores. One SD below the mean established a delay in neurodevelopment (score <85). RESULTS A high proportion of women (57.3%) did not reach the recommended dosages of FA supplements (400 μg/d), but 25.2% women took more than 1000 μg/d of FA supplements (3.5% consuming >5000 μg/d). In multivariate analysis, we observed that children whose mothers used FA supplement dosages higher than 5000 μg/d during pregnancy had a statistically significantly lower mean psychomotor scale score (difference, -4.35 points; 95% CI, -8.34 to -0.36) than children whose mothers used a recommended dosage of FA supplements (400-1000 μg/d). An increased risk of delayed psychomotor development (psychomotor scale score <85) was also evident among children whose mothers took FA supplement dosages higher than 5000 μg/d, although the association was not statistically significant (odds ratio = 1.59; 95% CI, 0.82-3.08). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first time a detrimental effect of high dosages of FA supplements during pregnancy on psychomotor development after the first year of life has been shown. Further research from longitudinal studies is warranted to confirm these results.

Occupational exposures and risk of stomach cancer by histological type

Objective To explore the relationship between stomach cancer (SC), by histological type, and occupations and occupational exposures. Methods The authors conducted a hospital-based case–control study in south-east Spain. Subjects were 399 incident histological confirmed SC cases (241 intestinal and 109 diffuse adenocarcinomas) and 455 controls frequency matched by sex, age and province of residence. Occupation was coded according to the Spanish National Classification of Occupations 1994. Occupational exposures were assessed by the FINJEM Job Exposure Matrix. ORs were estimated by unconditional logistic regression adjusting for matching variables and education, smoking, alcohol and diet. Results In men, statistically significant increased risk of the diffuse subtype was found for ‘cooks’ (OR 8.02), ‘wood-processing-plant operators’ (OR 8.13) and ‘food and related products machine operators’ (OR 5.40); for the intestinal subtype, a borderline association was found for ‘miners and quarry workers’ (OR men 4.22, 95% CI 0.80 to 22.14). Significant increased risk was observed between the diffuse subtype of SC and the highest level of exposure to ‘pesticides’ (ORH both sexes 10.39, 95% CI 2.51 to 43.02, ptrend=0.02) and between the intestinal subtype and asbestos (ORH men 3.71, 95% CI 1.40 to 9.83, ptrend=0.07). Restricted analyses of exposures of 15 years and longer showed significant associations between the diffuse subtype and the exposure to ‘wood dust’ (OR men 3.05). Conclusions This study supports the relationship previously suggested between SC and occupational exposure to dusty and high temperature environments. Several occupations may also increase the risk of diffuse SC but not the intestinal subtype.

Validez del peso y talla auto-referido en población universitaria y factores asociados a las discrepancias entre valores declarados y medidos

INTRODUCTION Obesity is an important public health problem related to a higher risk of death from chronic degenerative diseases such as diabetes, cardiovascular diseases and several types of cancer. In epidemiological studies of big sample size, only self-reported weight and height can be collected for feasibility reasons and body mass index (BMI) estimates may be questioned. OBJECTIVES In this study we compare self-reported and measured weight, height and BMI in a mostly young population of university students, and explore factors associated with discrepancies between self-reported and measured data. METHODS In the period 2006-2012, 628 University students (476 women) from health sciences subject gave consent to participate in this study. Self-reported weight and height were collected by questionnaire and compared with weight and height measured afterward in health exams wearing light clothes and using standardized protocols. The validity of self-reported anthropometric estimates was explored by correlation coefficients and sensitivity, specificity, predictive values and kappa to detect measured overweight/obesity (BMI ≥ 25 kg/m²). Multiple linear regression was used to explore the factors related to the discrepancies between self-reported and measured data. RESULTS The mean of self-reported weight, height and BMI was 62.5 kg, 167.6 cm and 22.1 kg/m² and the mean of measured data was 62.6 kg, 167.4 cm y 22.2 kg/m² respectively. Correlations between self-reported and measured data were r = 0.97 for weight, 0.96 for height and 0.95 for BMI. The sensitivity to detect overweight (IMC ≥ 25 kg/m²) using self-reported data was 81.0%, the specificity was 98.5%, the predictive value was 90.6% and the kappa index was 0.75. The discrepancy between measured and self-reported weight, height and BMI was associated with a higher age, and a higher sleeping time was also associated to discrepancies in self-reported and measured height. CONCLUSIONS Despite the self-reported weight and BMI may underestimate the true weight and BMI, and self-reported height overestimate, the validity of self-reported anthropometric measures is adequate to use be used in epidemiological studies among young people with a high educational level.

The Opinions of Injecting Drug User (IDUs) HIV Patients and Health Professionals on Access to Antiretroviral Treatment and Health Services in Valencia, Spain

The benefits of HIV treatment (Highly Active Antiretroviral Therapy [HAART]) have been less apparent in injecting drug users (IDUs), most probably as a result of poor adherence to treatment. We explored factors related to HIV treatment adherence as reported by 23 IDU-HIV patients and nine health professionals from healthcare services in Alicante and Valencia, Spain. We carried out a qualitative study based on personal interviews. Health professionals reported the lack of coordination among hospital services and difficulties in accessibility to nonspecialized services for IDU-HIV patients as relevant factors for treatment adherence. Their perception of a patient’s likelihood of treatment adherence was also considered to influence the decision to prescribe HAART. A better treatment adherence was reported by those IDU-HIV patients with a good doctor–patient relationship and by women with family responsibilities. Patients considered the side effects of HIV treatment, the lack of social support, and the active use of recreational drugs as relevant factors to explain incompliance. Interventions and training of health providers should be aimed at the reduction of barriers in patient–provider communication and the overcoming of stereotypes, thus avoiding discriminatory attitudes in treatment in this vulnerable population.

Utilización de servicios sanitarios según el sexo en una cohorte de usuarios de drogas por vía parenteral infectados por el virus de la inmunodeficiencia humana

Fundamento y objetivo: Se han descrito diferencias por sexo tanto en el uso de los servicios como en el acceso a los tratamientos antirretroviral y profilactico en personas infectadas por el virus de la inmunodeficiencia humana (VIH). El objetivo de este estudio es determinar las caracteristicas del uso de los servicios de salud segun el sexo en usuarios de drogas por via parenteral (UDVP) con infeccion por el VIH. Pacientes y metodo: Cohorte prospectiva de UDVP que incluyo a 926 sujetos infectados por el VIH en su primera visita, entre enero de 1987 y diciembre de 1996. Generaron 3.429 visitas en distintos servicios sanitarios. Se ajustaron modelos de regresion logistica utilizando metodos robustos para estimar las odds ratio (OR). Resultados: De las 926 personas estudiadas, el 25,4% eran mujeres. Aunque no hubo diferencias relevantes por sexo en el uso de los distintos servicios sanitarios, desde la introduccion de los tratamientos antirretrovirales de gran actividad, los varones han tenido menos ingresos hospitalarios que las mujeres (OR = 0,50; intervalo de confianza [IC] del 95%, 0,25-0,99). Desde la introduccion de estos tratamientos se ha detectado una mayor prescripcion a los varones de tratamiento antirretroviral (OR = 1,30; IC del 95%, 0,97-1,24), profilaxis de tuberculosis (OR = 2,22; IC del 95%, 1,24-4,16) y de Pneumocystis carinii (OR = 1,50; IC del 95%, 1,17-1,91). Estas asociaciones se atenuaron al ajustar por variables sociodemograficas y de estado clinico, excepto para la profilaxis de P. carinii. Conclusion: No hay diferencias relevantes por sexo en el cuidado de la enfermedad por el VIH. Los beneficios de los antirretrovirales de gran actividad pueden tener un impacto menor a corto plazo en las mujeres, dependiendo de la prescripcion y de otras variables que deben confirmarse en estudios de seguimiento a mas largo plazo.

Effect of maternal high dosages of folic acid supplements on neurocognitive development in children at 4–5 y of age: the prospective birth cohort Infancia y Medio Ambiente (INMA) study

Background: The benefits of the use of folic acid supplements (FASs) during the periconception period to prevent neural tube defects and to ensure normal brain development in offspring are well known. There is concern, however, about the long-term effects of the maternal use of high dosages of FASs that exceed the Tolerable Upper Intake Level (UL) (≥1000 μg/d) on child neurocognitive outcomes.Objective: The objective of the study was to examine the association between the use of high dosages of FASs during pregnancy and child neuropsychological development at ages 4-5 y.Design: The multicenter prospective mother-child cohort study, the Infancia y Medio Ambiente (INMA) Project, was conducted in 4 regions of Spain: Asturias, Sabadell, Gipuzkoa, and Valencia. Pregnant women were recruited between 2003 and 2008. Data on 1682 mother-child pairs were included in the final analyses. The pregnant women completed an interviewer-administered questionnaire that was validated to estimate typical dietary folate intake and the use of FASs at 10-13 and 28-32 wk of gestation. Neuropsychological development scores at 4-5 y of age were estimated with the use of the McCarthy Scales of Childrens Abilities. Multiple linear regression and meta-analysis were used to obtain combined-effect estimates.Results: During the periconception period, one-third of the women (n = 502) took FAS dosages ≥1000 μg/d. The use of FAS dosages ≥1000 μg/d in this period was negatively associated with several neuropsychological outcomes scores in children: global verbal (β = -2.49; 95% CI: -4.71, -0.27), verbal memory (β = -3.59; 95% CI: -6.95, -0.23), cognitive function of posterior cortex (β = -2.31; 95% CI: -4.45, -0.18), and cognitive function of left posterior cortex (β = -3.26; 95% CI: -5.51, -1.01).Conclusions: The use of FAS dosages exceeding the UL (≥1000 μg/d) during the periconception period was associated with lower levels of cognitive development in children aged 4-5 y. The use of FAS dosages ≥1000 μg/d during pregnancy should be monitored and prevented as much as possible, unless medically prescribed.