http://www.recercat.cat:80/handle/2072/48777 Sat, 18 May 2013 08:01:19 GMT 2013-05-18T08:01:19Z http://www.recercat.cat:80/bitstream/id/34131/ http://www.recercat.cat:80/handle/2072/48777 http://www.recercat.cat:80/handle/2072/211298 Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial Fernández Serrano, Silvia; Dorca i Sargatal, Jordi; Garcia Vidal, Carolina; Fernández Sabé, Núria; Carratalà, Jordi; Fernández-Agüera, Ana; Corominas Sánchez, Mercè; Padrones, Susana; Gudiol i Munté, Francesc; Manresa Presas, Federico Introduction The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) requiring hospital admission remains unclear. This study aimed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP. Methods This was a prospective, double-blind and randomized study. All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone (MPDN) administered randomly and blindly as an initial bolus, followed by a tapering regimen, or placebo. Results Of the 56 patients included in the study, 28 (50%) were treated with concomitant corticosteroids. Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever, as well as greater radiological improvement at seven days. The time to resolution of morbidity was also significantly shorter in this group. Six patients met the criteria for mechanical ventilation (MV): five in the placebo group (22.7%) and one in the MPDN group (4.3%). The duration of MV was 13 days (interquartile range 7 to 26 days) for the placebo group and three days for the only case in the MPDN group. The differences did not reach statistical significance. Interleukin (IL)-6 and C-reactive protein (CRP) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN. No differences in mortality were found among groups. Conclusions MPDN treatment, in combination with antibiotics, improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission. http://www.recercat.cat:80/handle/2072/211298 http://www.recercat.cat:80/handle/2072/211154 Genetic and genomic analysis modeling of germline c-MYC overexpression and cancer susceptibility Solé, Xavier; Hernández, Pilar; López de Heredia, Miguel; Armengol, Lluís; Rodríguez Santiago, Benjamín; Gómez, Laia; Maxwell, Christopher A.; Aguiló Lúcia, Fernando; Condom, E.; Abril, Jesús; Pérez Jurado, Luis; Estivill, Xavier, 1955-; Nunes Martínez, Virginia; Capellà, Gabriel; Gruber, Stephen B.; Moreno Aguado, Víctor; Pujana, Miguel Angel Background: Germline genetic variation is associated with the differential expression of many human genes. The phenotypic effects of this type of variation may be important when considering susceptibility to common genetic diseases. Three regions at 8q24 have recently been identified to independently confer risk of prostate cancer. Variation at 8q24 has also recently been associated with risk of breast and colorectal cancer. However, none of the risk variants map at or relatively close to known genes, with c-MYC mapping a few hundred kilobases distally. Results: This study identifies cis-regulators of germline c-MYC expression in immortalized lymphocytes of HapMap individuals. Quantitative analysis of c-MYC expression in normal prostate tissues suggests an association between overexpression and variants in Region 1 of prostate cancer risk. Somatic c-MYC overexpression correlates with prostate cancer progression and more aggressive tumor forms, which was also a pathological variable associated with Region 1. Expression profiling analysis and modeling of transcriptional regulatory networks predicts a functional association between MYC and the prostate tumor suppressor KLF6. Analysis of MYC/Myc-driven cell transformation and tumorigenesis substantiates a model in which MYC overexpression promotes transformation by down-regulating KLF6. In this model, a feedback loop through E-cadherin down-regulation causes further transactivation of c-MYC. Conclusion: This study proposes that variation at putative 8q24 cis-regulator(s) of transcription can significantly alter germline c-MYC expression levels and, thus, contribute to prostate cancer susceptibility by down-regulating the prostate tumor suppressor KLF6 gene. http://www.recercat.cat:80/handle/2072/211154 http://www.recercat.cat:80/handle/2072/209845 Immunomodulatory effect of mesenchymal stem cells on B cells Franquesa, M.; Hoogduijn, M.J.; Bestard, O.; Grinyo Boira, Josep M. The research on T cell immunosuppression therapies has attracted most of the attention in clinical transplantation. However, B cells and humoral immune responses are increasingly acknowledged as crucial mediators of chronic allograft rejection. Indeed, humoral immune responses can lead to renal allograft rejection even in patients whose cell-mediated immune responses are well controlled. On the other hand, newly studied B cell subsets with regulatory effects have been linked to tolerance achievement in transplantation. Better understanding of the regulatory and effector B cell responses may therefore lead to new therapeutic approaches. Mesenchymal stem cells (MSC) are arising as a potent therapeutic tool in transplantation due to their regenerative and immunomodulatory properties.The research on MSCs has mainly focused on their effects onT cells and although data regarding the modulatory effects of MSCs on alloantigen-specific humoral response in humans is scarce, it has been demonstrated that MSCs significantly affect B cell functioning. In the present review we will analyze and discuss the results in this field. http://www.recercat.cat:80/handle/2072/209845 http://www.recercat.cat:80/handle/2072/205207 Quality study of a lung cancer committee: study of agreement between preoperative and pathological staging Macià Vidueira, Iván; Moya Amorós, Juan; Escobar Campuzano, Ignacio; Ramos Izquierdo, Ricard; Masuet Aumatell, Cristina; Gamez, Cristina; Llatjos, Roger; Martinez-Ballarin, Ignacio Objective: Accurate preoperative staging is essential to provide the best treatment for lung cancer. The objective of the present study was to determine agreement between preoperative and surgical pathological staging and to analyse the impact of any disparity on treatment. Methods: This is a descriptive study of a series of 176 lung cancer cases treated by surgery between 2005 and 2007. Preoperative staging was based on clinical information and computed tomography (CT), positron emission tomography (PET), PET-CT, bronchoscopy and mediastinoscopy. In all cases, surgical pathological staging was based on the analysis of surgical samples and the findings during surgery. Both preoperative and pathological stage determination were based on the TNM (tumour, node, metastasis) classification established in 1997. Concordance was measured by calculating agreement rates and the kappa value. Results: Preoperative and surgical pathological staging agreed in 102 cases, an agreement rate of 58% and kappa value of 0.54 (95% confidence interval (CI) 0.44 0.63). The highest kappa value (0.68, 95% CI 0.53 0.82) was obtained in stage IA patients. Patients who underwent PET or PET-CT had a better kappa index (0.56, 95% CI 0.45 0.67, vs 0.39, 95% CI 0.21 0.56). Surgical pathological staging validated surgery in 145 cases (82%), while 21 (12%) were revised to stage IIIA N2 and 10 (6%) to non-surgical stages. Conclusions: Global agreement between preoperative and surgical pathological staging was moderate. The best agreement was found in stages IV and IA. http://www.recercat.cat:80/handle/2072/205207 http://www.recercat.cat:80/handle/2072/204941 Aspectes mèdics i quirúrgics de l'avortament Lailla Vicens, José Ma. (José María), 1948- Mèdicament l"avortament és la finalització de la gestació abans de la setmana 22 complerta. Els avortaments poden ser precoços o de primer trimestre o bé tardans o de segon trimestre. Les causes de l"avortament es classifiquen en maternes o ovulars i/o fetals. També hi ha la possibilitat de practicar una Interrupció Legal de l"Embaràs (ILE), que en la llei espanyola inclou tres supòsits. Els procediments medicoquirúrgics que s"utilitzaran per a la interrupció de l"embaràs depenen del període de gestació en el qual es troba la dona. http://www.recercat.cat:80/handle/2072/204941 http://www.recercat.cat:80/handle/2072/203417 Treatment of cancer with oral drugs: a position statement by the Spanish Society of Medical Oncology Colomer Bosch, Ramón; Alba, Emilio; González-Martin, Antonio; Paz-Ares, Luis; Martín, Miguel; Llombart Bosch, Antonio; Rodríguez Lescure, Álvaro; Salvador Bofill, Javier; Albanell, Joan; Isla, Dolores; Lomas, María; Rodríguez, César A.; Trigo, José Manuel; Germà Lluch, José Ramón; Bellmunt Molins, Joaquim, 1959-; Tabernero, Josep; Rosell Costa, Rafael; Aranda, Enrique; Cubedo, Ricardo; Baselga Torres, Josep, 1959-; Spanish Society of Medical Oncology Cancer treatment involves the participation of multiple medical specialties and, as our knowledge of the disease increases, this fact becomes even more apparent. The degree of multidisciplinarity is determined by several factors, which include the severity and type of disease, the increasing diversity in the available pharmacological and non-pharmacological therapies, and the range of specialists involved in cancer therapy, such as medical oncologists, radiotherapists, gynecologists, gastroenterologists, urologists, surgeons, and pneumologists, among others. Across Europe, the situation of cancer care can be variable due to the diversity of health systems, differences in drug reimbursement, and the degree of establishment of Medical Oncology as a medical specialty in the European Union states. http://www.recercat.cat:80/handle/2072/203417 http://www.recercat.cat:80/handle/2072/203416 A prospective cohort study of healthcare visits and rehospitalizations after hospital discharge in community-acquired pneumonia Adamuz, Jordi; Viasus, Diego; Campreciós Rodríguez, Paula; Cañavate Jurado, Olga; Jiménez Martínez, Emilio; Isla Pera, Ma. Pilar (María Pilar); García Vidal, Carol; Carratalà, Jordi Background and objective: We aimed to identify the frequency of, reasons for and risk factors associated with additional healthcare visits and rehospitalizations (healthcare interactions) by patients with community-acquired pneumonia (CAP) within 30 days of hospital discharge. Methods: Observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital (2007-2009). Additional healthcare interactions were defined as the visits to a primary care centre or emergency department and hospital readmissions within 30 days of discharge. Results: Of the 934 hospitalized patients with CAP, 282 (34.1%) had additional healthcare interactions within 30 days of hospital discharge: 149 (52.8%) needed an additional visit to their primary care centre and 177 (62.8%) attended the emergency department. Seventy-two (25.5%) patients were readmitted to hospital. The main reasons for additional healthcare interactions were worsening of signs or symptoms of CAP and new or worsening comorbid conditions independent of pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to primary care centre or emergency department was alcohol abuse (odds ratio [OR] = 1.65; 95% confidence interval [CI]: 1.03-2.64). Prior hospitalization (≤ 90 days) (OR = 2.47; 95% CI: 1.11-5.52) and comorbidities (OR = 3.99; 95% CI: 1.12-14.23) were independently associated with rehospitalization. Conclusions: Additional healthcare visits and rehospitalizations within 30 days of hospital discharge are common in patients with CAP. This is mainly due to a worsening of signs or symptoms of CAP and/or comorbid conditions. These findings may have implications for discharge planning and follow-up of patients with CAP. http://www.recercat.cat:80/handle/2072/203416 http://www.recercat.cat:80/handle/2072/202768 Clinical pharmacokinetics of mycophenolic acid and its metabolites in solid organ transplant recipient Colom Codina, Helena; Lloberas Blanch, Núria; Caldés, Ana; Andreu, Franc; Torras Ambròs, Joan; Oppenheimer Salinas, Federico; Sanchez-Plumed, Jaime; Gentil, Miguel A.; Kuypers, Dirk R.; Brunet i Serra, Mercè; Ekberg, Henrik; Grinyo Boira, Josep M. Mycophenolate mofetil (MMF), an ester prodrug of the immunosuppressant mycophenolic acid (MPA), is widely used for maintenance immunosuppressive therapy and prevention of renal allograft rejection in renal transplant recipients.MPA inhibits inosine monophosphate dehydrogenase (IMPDH), an enzyme involved in the “de novo” synthesis of purine nucleotides, thus suppressing both T-cell and B-cell proliferation. MPA shows a complex pharmacokinetics with considerable interand intra- patient by between- and within patient variabilities associated to MPA exposure. Several factors may contribute to it. The pharmacokinetic modeling according to the population pharmacokinetic approach with the non-linear mixed effects models has shown to be a powerful tool to describe the relationships between MMF doses and the MPA exposures and also to identify potential predictive patients’ demographic and clinical characteristics for dose tailoring during the post-transplant immunosuppresive treatment.; Podeu consultar el llibre complet a: http://hdl.handle.net/2445/32393 http://www.recercat.cat:80/handle/2072/202768 http://www.recercat.cat:80/handle/2072/200804 Standardizing admission and discharge processes to improve patient flow: A cross sectional study Ortiga, Berta; Salazar, Albert; Jovell, Albert; Escarrabill, Joan; Marca, Guillem; Corbella, Xavier Background: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. Methods: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00¿am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann¿Whitney test for non-normal continuous variables. Results:The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p&0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p&0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p&0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00¿am was 5 patients in 2007 and 3 patients in 2009 (p&0.01). Conclusions: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput. http://www.recercat.cat:80/handle/2072/200804 http://www.recercat.cat:80/handle/2072/198301 Salivary cotinine concentrations in daily smokers in Barcelona, Spain: a cross-sectional study Fu Balboa, Marcela; Fernández Muñoz, Esteve; Martínez Sánchez, José M.; Pascual, José A.; Schiaffino, Anna; Agudo, Antoni; Ariza, Carles; Borràs Andrés, Josep Maria; Samet, Jonathan M. Background: Characterizing and comparing the determinant of cotinine concentrations in different populations should facilitate a better understanding of smoking patterns and addiction. This study describes and characterizes determinants of salivary cotinine concentration in a sample of Spanish adult daily smoker men and women. Methods: A cross-sectional study was carried out between March 2004 and December 2005 in a representative sample of 1245 people from the general population of Barcelona, Spain. A standard questionnaire was used to gather information on active tobacco smoking and passive exposure, and a saliva specimen was obtained to determine salivary cotinine concentration. Two hundred and eleven adult smokers (&16 years old) with complete data were included in the analysis. Determinants of cotinine concentrations were assessed using linear regression models. Results: Salivary cotinine concentration was associated with the reported number of cigarettes smoked in the previous 24 hours (R2 = 0.339; p & 0.05). The inclusion of a quadratic component for number of cigarettes smoked in the regression analyses resulted in an improvement of the fit (R2 = 0.386; p & 0.05). Cotinine concentration differed significantly by sex, with men having higher levels. Conclusion: This study shows that salivary cotinine concentration is significantly associated with the number of cigarettes smoked and sex, but not with other smoking-related variables. http://www.recercat.cat:80/handle/2072/198301 http://www.recercat.cat:80/handle/2072/196885 La salud bucodental de los españoles mayores de 64 años. Impacto en el estado de salud individual Subirà Pifarré, Carles; Ramon Torrell, Josep M. (Josep Mari Introducción: los cambios epidemiológicos sufridos en los países occidentales en el siglo XX han propiciado un aumento del número absoluto y de la proporción de ancianos en todos ellos. Pacientes y Método: se realizó un estudio descriptivo transversal de prevalencia de enfermedades bucodentales en una población de 3.460 individuos en 7 Comunidades Autónomas españolas, tanto institucionalizados (10%) como no institucionalizados (90%). Resultados: la edad media de los encuestados fue de 73,6±7 años. Un 31,4% de los individuos del estudio eran desdentados totales. Los individuos dentados presentaban un promedio de 14,8±8 dientes. El CAOD de los individuos de la muestra fue de 20,8±10, siendo de 23,7±9,8 en los institucionalizados. La última visita al dentista había sido de media 4 años y medio antes, pero los institucionalizados hacía 7 años. Discusión: es totalmente inaceptable que la prevención y el tratamiento las enfermedades bucodentales. especialmente entre las personas de edad más avanzada, se sigan considerando como un aspecto totalmente optativo para el mantenimiento de la salud del individuo. Estudios epidemiológicos. bacteriológicos e Inmunológicos demuestran que la enfermedad periodontal o la caries pueden ser las causantes de un importante aumento de la morbi-mortalidad especialmente entre las personas de más edad. http://www.recercat.cat:80/handle/2072/196885 http://www.recercat.cat:80/handle/2072/183738 Tratamiento farmacológico del juego patológico Turón Gil, Vicente José; Crespo, J. M. (José Manuel) El tratamiento farmacológico del juego patológico conlleva una serie de dificultades que se pueden relacionar con la ausencia de un sustrato neurobiológico universalmente aceptado, altas tasas de abandonos y no cumplimentación del tratamiento, y ausencia de ensayos controlados que comparen diferentes modalidades de tratamiento en la misma población. El abordaje farmacológico del juego patológico se puede reaiizar desde diferentes perspectivas: desde un punto de vista etiopatonénico, desde el tiatumiento de-las patologías asociadas al juego patológico e incluso tratatando esta conducta como un síntoma de otra patología, como la mania. En las siguientes páginas 10s autores intentan revisar 10s diferentes fármacos propuestos en varios estudios. Los autores no recomiendan un tratamiento especifico para el juego patológico ya que existen diferentes posibilidades según las características del paciente. http://www.recercat.cat:80/handle/2072/183738 http://www.recercat.cat:80/handle/2072/183737 La relación angustia depresión desde una perspectiva clínica Vallejo Ruiloba, Julio Se analizan, desde el punto de vista clinico, las relaciones existentes entre angustia y depresión, según la hipótesis unitaria (ambos estados serían variantes dentro de un mismo núcleo afectivo) o binaria (ambas entidades son totalmente independientes). Se expone, por último, una interpretación personal de este problema. http://www.recercat.cat:80/handle/2072/183737 http://www.recercat.cat:80/handle/2072/183736 Problemas de la investigación psicofarmacológica clínica Vallejo Ruiloba, Julio Tras una breve referencia histórica a los comienzos de la psicofarmacologia moderna, se abordan 10s problemas mas importantes que ésta tiene planteados, tales como la dificultad de conseguir muestras homogéneas de catlfermos, problema derivado en parte de la imposibilidad de establecer diagnosticos exactos que estén sustentados no solo por el criterio clinico, sino en lrases objetivas y objetivables. Se analizan los criterios diagnósticos disponililes: clinico, escalas de evaluación y bases somáticas con especial referencia; i estas ultimas. Finalmente, se considera el problema de la evaluación y control de los efectos psicofarmacológicos, aspecto, por otro lado, estrechamente ligado al anterior. http://www.recercat.cat:80/handle/2072/183736 http://www.recercat.cat:80/handle/2072/181407 Widening social inequalities in smoking cessation in Spain, 1987-1997 Fernández Muñoz, Esteve; Schiaffino, Anna; García, M.; Borràs Andrés, Josep Maria http://www.recercat.cat:80/handle/2072/181407 http://www.recercat.cat:80/handle/2072/181406 Loss of bone mineral density in premenopausal women with systemic lupus erythematosus Formiga Pérez, Francesc; Moga Sempere, Isabel; Nolla Solé, Joan Miquel; Pac Ferraz, Visitación; Mitjavila Villeró, Francesca; Roig Escofet, D. (Daniel) http://www.recercat.cat:80/handle/2072/181406 http://www.recercat.cat:80/handle/2072/180187 Isolated HLA-B27 cross reactive group (CREG) associated Achilles tendinitis. Nolla Solé, Joan Miquel; Juanola Roura, X.; Valverde García, José; Roig Escofet, D. (Daniel) http://www.recercat.cat:80/handle/2072/180187 http://www.recercat.cat:80/handle/2072/180189 Rheumatoid factor in patients with systemic lupus erythematosus. Moreno Pinillos, Rosa; Nolla Solé, Joan Miquel; Juanola, Xavier; Pac Ferraz, Visitación; Vidaller Palacín, Antonio; Moga Sempere, Isabel http://www.recercat.cat:80/handle/2072/180189 http://www.recercat.cat:80/handle/2072/180188 Munchausen's syndrome simulating reflex sympathetic dystrophy Rodríguez Moreno, Jesús; Ruiz Martin, José Miguel; Mateo Soria, Lourdes; Rozadilla Sacanell, Antoni; Roig Escofet, D. (Daniel) A 15 year old girl who had pain, oedema of her left hand, and fever of four months' duration is described. Marked demineralisation of her hand was shown by radiography, and increased articular uptake by technetium-99m bone scan. All these changes were indistinguishable from reflex sympathetic dystrophy. After two admissions to hospital and multiple explorations we discovered that she had induced her symptoms herself and a diagnosis of Munchausen's syndrome was made. As far as we know this presentation has not been previously reported and might help to explain the physiopathology of some signs of reflex sympathetic dystrophy. http://www.recercat.cat:80/handle/2072/180188 http://www.recercat.cat:80/handle/2072/180184 Infectious arthritis in patients with rheumatoid arthritis Mateo Soria, Lourdes; Nolla Solé, Joan Miquel; Rozadilla Sacanell, Antoni; Valverde García, José; Roig Escofet, D. (Daniel) Eleven cases of infectious arthritis occurring in patients with rheumatoid arthritis are reported. Staphylococcus aureus was the causative organism in eight patients. Streptococcus anginosus and Streptococcus agalactiae in one patient each, and Mycobacterium tuberculosis in two patients. The mean duration of symptoms before diagnosis was 16 days in patients with pyogenic arthritis. The diagnosis of joint infection caused by Mycobacterium tuberculosis was especially delayed (57 days). Four patients died; they were found to have a longer time to diagnosis and two of them had multiple joint infection. Although Staphylococcus aureus is the microorganism most often affecting patients with rheumatoid arthritis, infection caused by Mycobacterium tuberculosis must also be considered in such patients. http://www.recercat.cat:80/handle/2072/180184 http://www.recercat.cat:80/handle/2072/180183 The time of blood sampling for osteocalcin determinations. Nolla Solé, Joan Miquel; Rozadilla Sacanell, Antoni http://www.recercat.cat:80/handle/2072/180183 http://www.recercat.cat:80/handle/2072/180186 Septic arthritis complicating hip osteoarthritis. Nolla Solé, Joan Miquel; Mateo Soria, Lourdes; Rozadilla Sacanell, Antoni; Blanco, J. del http://www.recercat.cat:80/handle/2072/180186 http://www.recercat.cat:80/handle/2072/180185 Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures. Nolla Solé, Joan Miquel; Gómez Vaquero, Carmen; Fiter, Jordi; Roig Vilaseca, Daniel; Mateo Soria, Lourdes; Rozadilla Sacanell, Antoni; Romera i Baurés, Montserrat; Valverde García, José; Roig Escofet, D. (Daniel) Objective: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. Results: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm2 and the T score was ¿2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm2 and the T score was ¿2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60¿70, and 60% in patients over 70. Conclusion: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD. http://www.recercat.cat:80/handle/2072/180185 http://www.recercat.cat:80/handle/2072/180179 Low birthweight, preterm, and small for gestational age babies in Scotland, 1981-1984. Sanjosé Llongueras, Silvia de; Roman, Eve The aim was to examine the effect of maternal age, gravidity, marital status, previous perinatal deaths, and parental social class on babies born low birthweight, preterm, and small for gestational age. DESIGN--The study used data on discharge summaries from all maternity hospitals in Scotland. SETTING--The study was based on all singleton deliveries in Scotland. PARTICIPANTS--The analysis involved information on 259,462 singleton babies born during the four years 1981-84 in Scotland. MEASUREMENTS AND MAIN RESULTS--Previous perinatal death was found to be the strongest predictor for both preterm and low birthweight. Single mothers were at particularly high risk of having a small for gestational age baby and those who were previously married of having a preterm baby. Women aged less than 20 years old, those over 34 years old, nulligravidae, and those of parity 3 or more were also at increased risk of adverse pregnancy outcome. Mothers and fathers in manual social classes and those who could not be assigned a social class on the basis of their occupation were at increased risk for all three adverse outcomes studied. The babies of parents who were in manual occupations were twice as likely as those of parents in non-manual occupations to be small for gestational age and almost twice as likely to be low birthweight. CONCLUSIONS--Mother's social class is a risk factor for adverse pregnancy outcome independent of maternal age, parity, and adverse reproductive history, and also independent of father's social class. Information on both parents' occupations should be collected in maternity discharge systems. http://www.recercat.cat:80/handle/2072/180179 http://www.recercat.cat:80/handle/2072/180180 Cervical cancer: incidence and survival in migrants within Spain Borràs Andrés, Josep Maria; Sánchez, Victoria; Moreno Aguado, Víctor; Izquierdo Font, Àngel Xavier; Viladiu i Quemada, Pau This study examined the incidence of cervical cancer and survival rates according to migrant experience of women from different regions of Spain to Girona, Catalonia (Spain). DESIGN--Using data from the population based cancer registry of Girona for the period 1980-89, crude and age adjusted incidence rates were calculated for local-born and first generation migrants from other Spanish regions. The age standardised rate ratio (SRR) was calculated and Cox's regression model was used to adjust survival according to migrant status for age and stage at diagnosis. MAIN RESULTS--The incidence of cervical cancer was significantly higher in first generation Spanish migrants compared with locally born women (SRR: 2.02; 95% CI 1.40:2.92). The stage at diagnosis was more advanced among migrants. Survival probability was significantly associated with stage at diagnosis, but age and region of birth were not. CONCLUSIONS--Migrants from the southern Spanish regions show a twofold excess in the incidence of cervical cancer compared with the Girona-born female population. Cases of cervical cancer in migrants are diagnosed at a more advanced stage and as a consequence have a poorer prognosis. http://www.recercat.cat:80/handle/2072/180180 http://www.recercat.cat:80/handle/2072/180181 Changes in leisure time and occupational physical activity over 8 years: The Cornellà health Interview Survey Follow-Up Study Cornelio, C. I.; García, M.; Schiaffino, Anna; Borràs Andrés, Josep Maria; Nieto, F. Javier; Fernández Muñoz, Esteve Aim: To describe changes in leisure time and occupational physical activity status in an urban Mediterranean population-based cohort, and to evaluate sociodemographic, health-related and lifestyle correlates of such changes. Methods: Data for this study come from the Cornellè Health Interview Survey Follow-Up Study, a prospective cohort study of a representative sample (n¿=¿2500) of the population. Participants in the analysis reported here include 1246 subjects (567 men and 679 women) who had complete data on physical activity at the 1994 baseline survey and at the 2002 follow-up. We fitted Breslow-Cox regression models to assess the association between correlates of interest and changes in physical activity. Results: Regarding leisure time physical activity, 61.6% of cohort members with ¿sedentary¿ habits in 1994 changed their status to ¿light/moderate¿ physical activity in 2002, and 70% who had ¿light/moderate¿ habits in 1994 did not change their activity level. Regarding occupational physical activity, 74.4% of cohort members who were ¿active¿ did not change their level of activity, and 64.3% of participants with ¿sedentary¿ habits in 1994 changed to ¿active¿ occupational physical activity. No clear correlates of change in physical activity were identified in multivariate analyses. Conclusion: While changes in physical activity are evident in this population-based cohort, no clear determinants of such changes were recognised. Further longitudinal studies including other potential individual and contextual determinants are needed to better understand determinants of changes in physical activity at the population level. http://www.recercat.cat:80/handle/2072/180181 http://www.recercat.cat:80/handle/2072/180182 Self perceived health and smoking in adolescents. Rius Gibert, Cristina; Fernández Muñoz, Esteve; Schiaffino, Anna; Borràs Andrés, Josep Maria; Rodríguez Artalejo, Fernando http://www.recercat.cat:80/handle/2072/180182 http://www.recercat.cat:80/handle/2072/180178 Role of technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis: a comparative study Nolla Solé, Joan Miquel; Mateo Soria, Lourdes; Rozadilla Sacanell, Antoni; Mora Salvador, Jaume; Valverde García, José; Roig Escofet, D. (Daniel) A comparative study of the parts played by technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis is presented. Nineteen patients were included in the study. All patients (11 men aged 19-70 years and eight women aged 18-72 years) had a history of back pain varying in duration from one to 15 weeks. A 99mTc diphosphonate bone scan was positive in 17 patients. The two patients with negative results had less than two weeks of back pain. The 67Ga citrate bone scan showed uptake in all patients. http://www.recercat.cat:80/handle/2072/180178 http://www.recercat.cat:80/handle/2072/180177 Sex differences in hospital readmission among colorectal cancer patients. González Ruiz, Juan Ramón; Fernández Muñoz, Esteve; Moreno Aguado, Víctor; Ribes Puig, Josepa; Peris, Mercè; Navarro, Matilde; Cambray, M.; Borràs Andrés, Josep Maria Background: While several studies have analysed sex and socioeconomic differences in cancer incidence and mortality, sex differences in oncological health care have been seldom considered. Objective: To investigate sex based inequalities in hospital readmission among patients diagnosed with colorectal cancer. Design: Prospective cohort study. Setting: Hospital Universitary in L¿Hospitalet (Barcelona, Spain). Participants: Four hundred and three patients diagnosed with colorectal between January 1996 and December 1998 were actively followed up until 2002. Main outcome measurements and methods: Hospital readmission times related to colorectal cancer after surgical procedure. Cox proportional model with random effect (frailty) was used to estimate hazard rate ratios and 95% confidence intervals of readmission time for covariates analysed. Results: Crude hazard rate ratio of hospital readmission in men was 1.61 (95% CI 1.21 to 2.15). When other significant determinants of readmission were controlled for (including Dukes¿s stage, mortality, and Charlson¿s index) a significant risk of readmission was still present for men (hazard rate ratio: 1.52, 95% CI 1.17 to 1.96). Conclusions: In the case of colorectal cancer, women are less likely than men to be readmitted to the hospital, even after controlling for tumour characteristics, mortality, and comorbidity. New studies should investigate the role of other non-clinical variable such as differences in help seeking behaviours or structural or personal sex bias in the attention given to patients. http://www.recercat.cat:80/handle/2072/180177 http://www.recercat.cat:80/handle/2072/180175 Microalbuminuria is associated with limited joint mobility in type I diabetes mellitus. Montanya Mias, Eduard; Rozadilla Sacanell, Antoni; Nolla Solé, Joan Miquel; Gómez, N.; Roig Escofet, D. (Daniel); Soler Ramon, Joan http://www.recercat.cat:80/handle/2072/180175