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Biomedical subjects

Miguel Delgado-Rodríguez

Publications and source records attributed to Miguel Delgado-Rodríguez.

At least 19 recordsLinked to original sources
PubMed2006

Weekday but not weekend alcohol consumption before pregnancy influences alcohol cessation during pregnancy.

BACKGROUND: Cantabria has the highest prevalence of alcohol consumption among women in Spain. Patterns of alcohol consumption before pregnancy were assessed as a determinant of alcohol cessation in pregnant women in Cantabria. METHODS: Survey on a random sample of women delivering for the period 1998-2002 (n = 1510). Information was obtained from personal interview (data on alcohol consumption), clinical charts and prenatal care records. Relative risks (RR) and 95% confidence intervals (CI) were estimated. Multivariable analyses were carried out using logistic regression. RESULTS: Nearly half (49.5%) of the women drank regularly before pregnancy and 22.7% during pregnancy. Sociodemographic variables favouring alcohol cessation were: high education level and smoking cessation, whereas high social class, advanced maternal age and employment outside of home decreased the rate of alcohol cessation. Cessation decreased with the amount of alcohol consumed on weekdays (P < 0.001), but not with intake during weekends only. In women with alcohol use only during weekends, only the consumption of spirits increased the rate of alcohol cessation (adjusted RR = 1.40, 95% CI: 1.13-1.60). Pre-pregnancy binge drinking (> or =4 drinks on one occasion) decreased alcohol cessation in pregnancy (adjusted RR = 0.66, 95% CI: 0.40-0.97). CONCLUSIONS: Drinking patterns influenced the rate of alcohol cessation: the heavier the alcohol consumption on weekdays, the lower the rate of alcohol cessation.

Adult↗
PubMed2006

Indices of surgical site infection risk and prediction of other adverse outcomes during hospitalization.

OBJECTIVE: To assess which adverse postsurgical outcomes are best predicted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance system (NNIS) index. DESIGN: Prospective cohort study. SETTING: The service of general surgery at a tertiary care hospital. PATIENTS: A consecutive series of patients hospitalized for more than 1 day (n=2,989). RESULTS: The outcome best predicted by the SENIC and NNIS indices was assessed by estimating the area under the receiver operating characteristic (ROC) curve. The areas under the ROC curves for nosocomial infection and in-hospital death were higher for the NNIS index than they were for the SENIC index (P<.05). The NNIS index predicted in-hospital death better than it predicted surgical site infection (area under the ROC curve+/-SE, 0.836+/-0.022 vs 0.689+/-0.017; P=.001). CONCLUSIONS: The NNIS index is superior to the SENIC index for all adverse postsurgical outcomes. Its ability to predict in-hospital mortality is clearly better than its ability to predict surgical site infection.

Cohort Studies↗
PubMed2006

Expression of the antiapoptotic proteins clusterin and bcl-2 in laryngeal squamous cell carcinomas.

Bcl-2 and clusterin genes have been related to the inhibition of apoptosis, an event that plays a key role in malignant transformation and in invasive disease. In this work, we determine the significance of clusterin and bcl-2 expression in a large series of laryngeal carcinomas. We used immunohistochemical methods and in situ hybridization to examine the expression of these proteins. Nontumoral epithelial laryngeal tissues did not express clusterin and bcl-2 proteins. However, 9% (14 out of 154) and 25% of these tumors (39 of 154) had positive clusterin and bcl-2 staining, respectively. Clusterin expression was significantly related to the degree of local invasion and higher bcl-2 expression was found in these clusterin-positive tumors (p < 0.05). Bcl-2 expression was significantly correlated with supraglottic localization, nodal metastases, invasion in depth, and poorly differentiated tumors. However, by multivariate analysis, bcl-2 was shown to be an independent predictor of good prognosis in these tumors (OR = 0.12, 95% CI = 0.02-0.91). These findings indicate that clusterin and bcl-2 are upregulated in laryngeal carcinomas and their expression is related to the invasiveness of these tumors.

Apoptosis↗
PubMed2006

Relationship between bone quantitative ultrasound and fractures: a meta-analysis.

UNLABELLED: The relationship between bone QUS and fracture risk was estimated in a systematic review of data from 14 prospective studies of 47,300 individuals and 2350 incident fractures. In older women, low QUS values were associated with overall fracture risk, low-trauma fractures, and with hip, forearm, and humerus fractures separately. INTRODUCTION: Bone quantitative ultrasound (QUS) has emerged as a promising technique to evaluate bone status. The aim of this study was to determine the association between measurements of QUS with the risk of fracture. MATERIALS AND METHODS: A meta-analysis of prospective cohort studies published between 1985 and June 2005 with a baseline measurement of QUS and subsequent follow-up for fractures was carried out. Fourteen separate study populations, consisting of about 47,300 individuals (85.4% women), with about 124,000 person-years of observation and over 2350 fractures, including 653 hip, 529 forearm, and 386 humeral fractures, were analyzed. The main outcome measure was the estimated relative risk of fracture for a decrease in bone QUS parameters of 1 SD below sex- and age-adjusted mean in women. RESULTS: Eleven studies evaluated QUS at the heel, with patella and phalanx (two studies each) and distal radius (one study) being scarcely used. There was not significant heterogeneity among the studies included in the review. Relative risk estimates (95% CI) for overall fractures were 1.55 (1.35-1.78) for each SD decrease in broadband ultrasound attenuation (BUA), 1.63 (1.37-1.93) for speed of sound (SOS), and 1.74 (1.39-2.17) for QUS index/stiffness index (QUI/SI). Risk estimates were similar or slightly higher for hip fractures and low-energy trauma fractures. Humeral and forearm/wrist fractures were also related with lower QUS values. CONCLUSIONS: Measurements of bone QUS are significantly associated with nonspinal fracture risk in older women in a similar degree to DXA. QUS may be a valid alternative to evaluate fracture risk in situations where DXA is not accessible.

Age Factors↗
PubMed2005

Pattern of alcohol consumption during pregnancy and risk for low birth weight.

PURPOSE: The effects of moderate alcohol drinking on low birth weight are not clear, and conflicting results have been reported. We assessed the influence of different patterns of alcohol drinking during pregnancy on low birth weight. METHODS: A case-control study was carried out at the University of Cantabria Hospital, Spain, from 1998 to 2002. Cases (n = 552) were mothers delivering a single newborn weighing less than 2500 g. Controls (n = 1451) were selected from a random sample of all delivering women. Information was obtained from personal interview, clinical charts, and prenatal care records. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Adjustment for potential confounders was made by means of logistic regression. RESULTS: Alcohol consumption of less than 6 g/day decreased the risk for low birth weight (adjusted OR = 0.64; 95% CI, 0.46-0.88). A similar result was obtained for moderate drinkers (<12 g/day) on weekends only. The opposite relationship was observed between alcohol consumption on weekdays of 12 g/day or greater (adjusted OR = 2.67; 95% CI, 1.39-5.12), not observed in those drinking on weekends only. The interaction between alcohol consumption and tobacco smoking was analyzed. Weekday drinkers of 12 g/day or greater showed an increased risk in smokers. Alcohol consumption on weekends only in nonsmokers was inversely related. The influence of alcohol was greater for small-for-gestational-age (SGA) than non-SGA babies. CONCLUSIONS: Alcohol consumption of 12 g/day or greater increased the risk for low birth weight, whereas lower consumption during weekends showed the opposite effect (mainly in nonsmokers).

Adult↗
PubMed2005

Validation of self reported diagnosis of hypertension in a cohort of university graduates in Spain.

BACKGROUND: The search for risk factors of hypertension requires the study of large populations. Sometimes, the only feasible way of studying these populations is to rely on self-reported data of the outcome. The objective of this study was to evaluate validity of self-reported diagnosis of hypertension in a cohort of university graduates in Spain. METHODS: The Seguimiento Universidad de Navarra (SUN) Study is a cohort of more than 15,000 university graduates in Spain. We selected a random sample of 79 cohort participants who reported a diagnosis of hypertension and 48 participants who did not report such diagnosis (76% participation proportion). Then, we compared information on the self-reported diagnosis of hypertension and hypertension status as assessed through two personal blood pressure measurements and an interview. Additionally, we compared self-reported and measured blood pressure levels with intraclass correlation coefficients and the survival-agreement plot. RESULTS: From those 79 reporting a diagnosis of hypertension, 65 (82.3%, 95% CI 72.8-92.8) were confirmed through conventional measurement of blood pressure and the interview. From those 48 that did not report a diagnosis of hypertension, 41 (85.4%, 95% CI 72.4-89.1) were confirmed as non hypertensives. Results were similar among men and women, but were worse for overweight and obese individuals, and for those with a family history of hypertension. The agreement between self-reported and measured blood pressure levels (as a continuous variable), as estimated by the intraclass correlation coefficient, was 0.35 for both systolic and diastolic blood pressure. CONCLUSION: Self-reported hypertension among highly educated participants in a cohort study is a relatively valid tool to assess the hypertensive status of participants. However, the investigators should be cautious when using self-reported blood pressure values.

Adult↗
PubMed2005

[Cardiovascular risk factors in Spanish population: metaanalysis of cross-sectional studies].

BACKGROUND AND OBJECTIVE: To review published studies on the prevalence of the main vascular risk factors -hypertension, hypercholesterolemia, diabetes mellitus, obesity and tobacco smoking- in Spain, and to combine their results in an estimate for the Spanish population. MATERIAL AND METHOD: After a bibliographic search, the studies fulfilling the following inclusion criteria were selected: cross-sectional design, sampling on Spanish population, results including prevalence data of at least one of the above mentioned risk factors, and objective [corrected] (not self-referred) determination of arterial blood pressure, total serum cholesterol, basal glucose, weight, size and body mass index. The combined prevalence was obtained by means of the random effects model, including weight for the proportion that the studied population supposes on the total Spanish population. RESULTS: Forty-eight studies were identified including a total of 130.945 subjects. According to these studies, the most frequent vascular risk factors were hypertension in the elderly (66.7%, CI 59-74%), overweight/obesity in adult women (48,3%, CI 41-55%) and smoking among men (41.1%, CI 38-44%). In the Spanish population as a whole, 23% showed total cholesterol levels above 250 mg/dl; 33% were smokers (41,1% in men and 24% in women); 34% suffered hypertension; 20% were obese (18% in men and 23% in women); and diabetes affected 8% women and 12% men. CONCLUSION: Cardiovascular risk in Spain is high. Monitoring the vascular risk factors at a population level is basic for preventive and health care measures.

Cardiovascular Diseases↗
PubMed2005

Survival analytical techniques were used to assess agreement of a quantitative variable.

BACKGROUND AND OBJECTIVE: Survival-agreement plots have been suggested as a new graphical approach to assess agreement in quantitative variables. We propose that survival analytical techniques can complement this method, providing a new analytical insight for agreement. METHODS: Two survival-agreement plots are used to detect the bias between to measurements of the same variable. The presence of bias is tested with log-rank test, and its magnitude with Cox regression. RESULTS: An example on C-reactive protein determinations shows how survival analytical methods would be interpreted in the context of assessing agreement. CONCLUSION: Log-rank test, Cox regression, or other analytical methods could be used to assess agreement in quantitative variables; correct interpretations require good clinical sense.

Bias↗
PubMed2005

Low-fat dairy consumption and reduced risk of hypertension: the Seguimiento Universidad de Navarra (SUN) cohort.

BACKGROUND: Some observational studies have shown a beneficial effect of dairy consumption on blood pressure, especially in overweight and relatively young (<40 y) persons. However, no results from prospective studies conducted in a free-living population exist that show this association in middle-aged adults. OBJECTIVE: The aim of the present study was to assess whether total, low-fat, and whole-fat dairy consumption was associated prospectively with the risk of hypertension. DESIGN: This was a prospective study conducted in 5880 university graduates in Spain, aged >20 y in 2000 (mean age: 37 y), free of hypertension and cardiovascular disease at baseline, and followed-up with mailed questionnaires for a median of 27 mo. Dairy consumption was assessed with a previously validated semiquantitative food-frequency questionnaire. RESULTS: One hundred eighty new cases of hypertension were identified. The hazard ratio of hypertension between extreme quintiles of low-fat dairy product consumption was 0.46 (95% CI: 0.26, 0.84; P for trend = 0.02) after adjustment for the main known risk factors for hypertension and several dietary factors. No significant association between whole-fat dairy products or total calcium intake and incident hypertension was seen. CONCLUSION: In this Mediterranean cohort, low-fat dairy consumption, but not whole-fat dairy consumption, was associated with a lower risk of incident hypertension.

Adult↗
PubMed2005

Quality of controlled clinical trials on glaucoma and intraocular high pressure.

AIM: To study the quality of controlled clinical trials on glaucoma. METHODS: Two hundred and twenty-six clinical trials published between 1980 and 1999 were selected from seven international ophthalmological journals. Their quality was assessed by four researchers with epidemiological skills using a structured questionnaire. RESULTS: Sample size was pre-estimated in 34 (15.0%) papers, which were of greater size (P = 0.05). Randomization was performed in 98.2% of the trials, although the procedure of randomization was scarcely reported. Masking was reported in 56.6% of the papers, and was more frequent in medical treatments (P < 0.001). The basal characteristics of the groups were compared in 139 papers (61.5%). Patient losses during the follow-up period were fully described in only 27 trials. Intention-to-treat analysis was used in 17 (7.7%) papers. Most trials reported P values, but a measure of effect (mean, proportion, or relative risk) appeared in only 16 trials (7.7%). Trials performed in the US more frequently compared baseline characteristics of the groups (P = 0.03), described the patient flow (P = 0.04), and used adequate statistical procedures (P = 0.03). Those trials that included a statistician or an epidemiologist among the authors were more commonly blinded (P = 0.06) and they always avoided the analyses of subgroups (P = 0.006). Several methodological issues have improved throughout the studied period. CONCLUSIONS: Several methodological characteristics should be improved when reporting a clinical trial on glaucoma. Using a checklist like that suggested by the CONSORT can help to achieve this.

Controlled Clinical Trials as Topic↗
PubMed2005

Nitrogen dioxide increases cardiorespiratory admissions in Torrelavega (Spain).

The objective of the study reported here was to analyze relationships between levels of air pollutants and emergency admissions for cardiorespiratory disease. Admission data from January 1, 1992, to December 31, 1995, were obtained from the Marques de Valdecilla University Hospital Admission Service; meteorological data (rainfall, temperatures wind speed, wind direction) were obtained from the National Meteorology Institute in Santander. Pollutant data on sulfur dioxide (SO2), hydrogen sulfide (H2S), total suspended particles (TSP), nitrogen oxide (NO), and nitrogen dioxide (NO2) were provided by the secretary of environment for the Cantabrian Regional Government. Rate ratios were estimated for each pollutant by Poisson regression; they were adjusted for meteorological variables. It was found that elevated NO2 increased by 20 percent the risk of having an admission for cardiorespiratory diseases; this effect was mainly due to respiratory diseases (rate ratio = 1.7, p < .001) and was negligible for cardiac diseases (rate ratio = 1.1, p = .28). In the one-pollutant model, elevated particulates and nitrogen monoxide were also related to admissions, but this effect disappeared when a five-pollutant model was used (p = .21 and p = 0.36, respectively. SO2 and SH2 did not show any relationship with admissions. Thus, nitrogen dioxide was the only pollutant the authors found to be related to emergency admissions for cardiorespiratory diseases. It is difficult to generalize from these results because of the small number of daily admissions and the variability in pollutant levels; therefore, more studies are necessary to improve knowledge about the relationship between air pollution and health in small towns.

Air Pollutants↗
PubMed2004

A new way to estimate the contribution of a risk factor in populations avoided nonadditivity.

OBJECTIVE: Attributable fraction in the exposed and (population) attributable fraction have been extensively used to determine the proportion of cases of a particular disease that can be attributable to any risk factor. Epidemiologists know that these measurements can add up to more than 100%; nevertheless, in a clinical context or in mass media, this characteristic is sometimes misinterpreted. This article provides a way to estimate the contribution of a risk factor in populations. STUDY DESIGN AND SETTING: McElduff et al. have suggested a method for estimating the contribution of a risk factor in a person with more than one risk factor. We extend their suggestion to populations where risk factors are mixed in different proportions. We illustrate the usage of this method by enlarging the example provided by them and compare it with the average attributable fraction suggested by Eide and Gefeller. RESULTS: Population attributable fraction can be modified to obtain additivity; therefore, the contribution of a risk factor in populations can be estimated, which would be of interest, for example, in clinical or in court settings. CONCLUSION: The suggested method and the average attributable fraction provide different results, and would be applicable under different assumptions.

Data Interpretation, Statistical↗
PubMed2004

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy.

BACKGROUND: For colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. METHODS: Primary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma > or =1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. RESULTS: Neoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. CONCLUSIONS: A strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.

Adenoma↗
PubMed2004

Breast-feeding and risk of hospitalization for all causes and fever of unknown origin.

BACKGROUND: Breast-feeding has shown to give a reduction in the risk of hospitalization due to respiratory tract infections and gastrointestinal conditions during the first two years of life. The association of breast-feeding with all admission causes and with fever of unknown origin (FUO) was analysed. METHODS: A case-reference study in Cantabria (northern Spain) was carried out. Cases (n=336) were hospitalized children aged less than 24 months at University of Cantabria Hospital; the reference was a 1:1 matched (by time from delivery to admission) sample of children from mothers delivering at the same hospital. Information on breast-feeding, socioeconomic variables and employment were obtained. Odds ratios (ORs), their 95% confidence intervals (CIs), and mean length of breast-feeding were estimated after adjusment for confounding variables. RESULTS: In the reference population, shorter duration of breast-feeding was associated with smoking, lower educational level, and less privileged social strata. The frequency of breast-feeding was higher in the reference than in the cases, 82.3% vs 75.6% (p=0.023). Significant negative trends were noted in univariate analyses between the length of breast-feeding and both all admission causes and FUO, although the statistical significance was lost after adjusting for confounding variables (educational level, social class, smoking, and use of incubator after delivery). The adjusted mean length of breast-feeding was shorter in hospitalized children < or = 6 months old for both all admission causes (40.6 +/- 5.4 vs 99.5 +/- 5.4, p < 0.001) and FUO (40.8 +/- 12.4 vs 91.7 +/- 12.4, p=0.006). CONCLUSION: Breast-feeding time is shorter in hospitalized children for both all admission causes and FUO.

Adult↗
PubMed2004

Bias.

The concept of bias is the lack of internal validity or incorrect assessment of the association between an exposure and an effect in the target population in which the statistic estimated has an expectation that does not equal the true value. Biases can be classified by the research stage in which they occur or by the direction of change in a estimate. The most important biases are those produced in the definition and selection of the study population, data collection, and the association between different determinants of an effect in the population. A definition of the most common biases occurring in these stages is given.

Bias↗
PubMed2003

Alcohol drinking as a predictor of intensive care and hospital mortality in general surgery: a prospective study.

AIMS: To analyse whether alcohol drinking increases admission to intensive care and in-hospital mortality in general surgery. DESIGN AND PARTICIPANTS: A prospective cohort study on a consecutive series of 1505 hospitalized patients in a Service of General Surgery of a tertiary hospital. MEASUREMENTS: Drinking pattern was defined by quantity, frequency and volume of drinking. Information on relevant confounders was obtained: smoking, body mass index, nutritional status (measured by serum albumin), cholesterol and its fractions, severity of the underlying disease and all therapeutic measures. Multivariate logistic regression was applied to assess the relationship between drinking and both admission to intensive care and in-hospital death. RESULTS: Twenty-nine (1.9%) patients died and 33 (2.1%) were admitted to the intensive care unit (ICU). Drinking was heavier in men, patients without antecedents of cancer, with lower preoperative risk assessment scores, number of co-morbidities and age and higher serum albumin levels. After adjusting for age, severity of underlying disease, smoking and serum albumin, male drinkers of 72+ g/day had an increased risk of being admitted to ICU, the effect being stronger for week-day drinking (odds ratio, OR = 8.48; 95% confidence interval, CI = 1.68-42.8). A significant association was also seen between week-day drinking (72+ g/day) and death in men (OR = 7.19, 95% CI = 1.43-36.1). Numbers for women were too small to evaluate. CONCLUSION: Heavy drinking increases admission to intensive care and in-hospital mortality in hospitalized male patients undergoing general surgery procedures.

Alcohol Drinking↗