Irisin is a myokine that increases with leisure time physical activity (LTPA) and for which a cardiovascular protective role has been postulated. Our aim was to assess this role in the general ...population.
A cross-sectional analysis was performed in a large randomly selected population sample (n=2298 women and 1529 men). Apart from age and sex, we record anthropometrics (blood pressure, heart rate, obesity), lifestyle (LTPA, smoking, alcohol), and biochemical measurements (irisin, lipid profile, insulin resistance). Correlations and regression multivariate models were used to analyze the association of irisin levels with the studied factors.
The variables more strongly and directly associated with irisin, adjusting the studied factors separately in women and men, were HOMA-2 (p=0.043 and p=0.001, respectively) and LTPA (p<0.001 and p=0.001, respectively). Also heart rate inversely (p=0.005 and p=0.002, respectively) and DBP directly (p<0.005 and p=0.045, respectively) were associated to irisin in both sexes. The waist/height ratio (p<0.001) was inversely associated to irisin only in women, and the alcohol drinking was directly associated (p=0.029) only in men.
We provide new findings for irisin, such as its association with DBP and with heart rate; furthermore, in women irisin is associated to abdominal obesity, and in men is associated to the alcohol intake. We also corroborate the association of irisin with LTPA and insulin resistance. The associations detected point towards a protective role of irisin in the maintenance of cardiometabolic health.
To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008.
We examined mortality statistics in ...both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis.
During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain.
The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.
The demand for testing to detect celiac disease (CD) autoantibodies has increased, together with the cost per case diagnosed, resulting in the adoption of measures to restrict laboratory testing. We ...designed this study to determine whether opportunistic screening to detect CD-associated autoantibodies had advantages compared to efforts to restrict testing, and to identify the most cost-effective diagnostic strategy. We compared a group of 1678 patients in which autoantibody testing was restricted to cases in which the test referral was considered appropriate (G1) to a group of 2140 patients in which test referrals were not reviewed or restricted (G2). Two algorithms A (quantifying IgA and Tissue transglutaminase IgA TG-IgA in all patients), and B (quantifying only TG-IgA in all patients) were used in each group, and the cost-effectiveness of each strategy was calculated. TG-IgA autoantibodies were positive in 62 G1 patients and 69 G2 patients. Among those positive for tissue transglutaminase IgA and endomysial IgA autoantibodies, the proportion of patients with de novo autoantibodies was lower (p=0.028) in G1 (11/62) than in G2 (24/69). Algorithm B required fewer determinations than algorithm A in both G1 (2310 vs 3493; p<0.001) and G2 (2196 vs 4435; p<0.001). With algorithm B the proportion of patients in whom IgA was tested was lower (p<0.001) in G2 (29/2140) than in G1 (617/1678). The lowest cost per case diagnosed (4.63 euros/patient) was found with algorithm B in G2. We conclude that opportunistic screening has advantages compared to efforts in the laboratory to restrict CD diagnostic testing. The most cost-effective strategy was based on the use of an appropriate algorithm.
•In celiac disease screening in the laboratory, opportunistic detection has advantages over restricted testing.•Use of a suitable algorithm is more cost-effective than simply opting for the cheapest test kit.•A well-defined algorithm reaches the greatest efficiency when the strengths and limitations of every technique are known.•This algorithm can be optimized further by using a combination of techniques to reduce costs and response time.
Hereditary angioedema is a rare genetic condition caused by C1 esterase inhibitor deficiency, dysfunction, or kinin cascade dysregulation, leading to an increased bradykinin plasma concentration. ...Hereditary angioedema is a poorly recognized clinical entity and is very often misdiagnosed as a histaminergic angioedema. Despite its genetic nature, first-line genetic screening is not integrated in routine diagnosis. Consequently, a delay in the diagnosis, and inaccurate or incomplete diagnosis and treatment of hereditary angioedema are common.
In agreement with recent recommendations from the International Consensus on the Use of Genetics in the Management of Hereditary Angioedema, to facilitate the clinical diagnosis and adapt it to the paradigm of precision medicine and next-generation sequencing-based genetic tests, we aimed to develop a genetic annotation tool, termed Hereditary Angioedema Database Annotation (HADA).
HADA is built on top of a database of known variants affecting function, including precomputed pathogenic assessment of each variant and a ranked classification according to the current guidelines from the American College of Medical Genetics and Genomics.
HADA is provided as a freely accessible, user-friendly web-based interface with versatility for the entry of genetic information. The underlying database can also be incorporated into automated command-line stand-alone annotation tools.
HADA can achieve the rapid detection of variants affecting function for different hereditary angioedema types, and further integrates useful information to reduce the diagnosis odyssey and improve its delay.
Objectives. To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008.
Methods. We examined ...mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis.
Results. During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen’s d = −0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain.
Conclusions. The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.
Resumen Objetivo Obtener una escala de exposición al tabaco para abordar la deshabituación. Diseño Seguimiento de una cohorte. Validación de una escala. Emplazamiento Unidad de investigación de ...atención primaria. Tenerife. Participantes Seis mil setecientos veintinueve participantes de la cohorte «CDC de Canarias». Métodos Se construyó una escala bajo la hipótesis de que el tiempo de exposición al tabaco es el factor clave para expresar riego acumulado; su validez discriminante fue probada sobre casos prevalentes de infarto agudo de miocardio (IAM) (n = 171) y se obtuvo su mejor punto de corte para cribado preventivo. Se comprobó su validez predictiva con casos incidentes de IAM (n = 46), comparándose el poder predictivo con factores (hipertensión, diabetes, dislipemia) clásicos de riesgo de IAM, incluido el índice años a paquete diario (APD). Resultados La escala obtenida fue la suma del triple de años que se había fumado, más los expuestos al tabaco en casa y en el trabajo. La frecuencia de IAM aumentó con los valores de la escala, siendo el valor 20 años de exposición el mejor punto de corte para la actuación preventiva puesto que presentó adecuados valores predictivos para el IAM incidente. La escala superó a APD en la predicción del IAM y compitió con los marcadores y factores de riesgo conocidos. Conclusión La escala propuesta permite una medición válida de exposición al tabaco y proporciona un criterio útil y sencillo que puede ayudar a promover una disposición al cambio y realizar una prevención oportuna. Aún requiere probar su validez tomando como referente otros problemas asociados al tabaco.
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