To validate the 'Test of Adherence to Inhalers' (TAI), a 12-item questionnaire designed to assess the adherence to inhalers in patients with COPD or asthma.
A total of 1009 patients with asthma or ...COPD participated in a cross-sectional multicenter study. Patients with electronic adherence ≥80% were defined as adherents. Construct validity, internal validity, and criterion validity were evaluated. Self-reported adherence was compared with the Morisky-Green questionnaire.
Factor analysis study demonstrated two factors, factor 1 was coincident with TAI patient domain (items 1 to 10) and factor 2 with TAI health-care professional domain (items 11 and 12). The Cronbach's alpha was 0.860 and the test-retest reliability 0.883. TAI scores correlated with electronic adherence (ρ=0.293, p=0.01). According to the best cut-off for 10 items (score 50, area under the ROC curve 0.7), 569 (62.5%) patients were classified as non-adherents. The non-adherence behavior pattern was: erratic 527 (57.9%), deliberate 375 (41.2%), and unwitting 242 (26.6%) patients. As compared to Morisky-Green test, TAI showed better psychometric properties.
The TAI is a reliable and homogeneous questionnaire to identify easily non-adherence and to classify from a clinical perspective the barriers related to the use of inhalers in asthma and COPD.
High levels of protein in fish feeds result in higher costs and nitrogen waste. Therefore, studies focused on protein substitution by alternative energy sources are necessary. Here we examine whether ...the protein:carbohydrate ratio in extruded diets affects protein-turnover parameters and the main tissue components in brown trout. Juvenile fish were adapted to two extruded diets: one higher in protein and lower in carbohydrate, C: 45/28 and the other higher in carbohydrate and lower in protein, HC: 37/40. Gross energy was 19 MJ kg-¹ DM in both diets. Protein and lipid digestibility were high and similar in both groups (almost equal to90%), whereas total and carbohydrate digestibility and digestible energy were lower in the HC-fed group than in the C-fed group. Consequently, when fish were adapted to the diets, plasma levels of glucose and insulin differed between diets. HC-group presented higher plasma glucose levels and lower plasma insulin levels than C-group. Protein synthesis rates in white muscle, liver and whole body did not differ significantly between diets. In contrast, protein accretion rate of white muscle and whole body were significantly lower in the HC group, indicating an increase of protein degradation in these tissues and a decrease of synthesis retention efficiency. In spite of the daily protein intake of HC group was lower than C-group, the anabolic stimulation efficiency was increased by 34% in HC group. Protein and lipid contents in white muscle and liver were stable throughout the experiment. No hepatomegalia or increased fat deposition was observed in fish fed HC. Differences in specific growth rates (C: 0.88%; HC: 0.77%) were associated more with the lower protein consumption rate and the lower level of digestible energy in fish fed HC than with the higher dietary carbohydrate content of the diet.
For developing efficient diets, two sets of experiments examined whether the use and allocation of dietary protein can be traced by labelling with stable isotopes (¹⁵N and ¹³C) in two culture fish ...(Oncorhynchus mykiss and Sparus aurata). In the first experiment, natural abundance and tissue distribution of these isotopes were determined, by measuring the δ¹³C and δ¹⁵N values by isotopic ratio mass spectrometry, in fingerlings (14-17 g) adapted to diets differing in the percentage of fish meal replacement by plant protein sources. For both species, δ¹⁵N and δ¹³C were greater in tissues with higher protein and lower lipid content. Delta ¹⁵N of diets and tissues decreased as replacement increased, suggesting δ¹⁵N can be used as a marker for dietary protein origin. The ¹⁵N fractionation (δ¹⁵N fish - δ¹⁵N diet) differed between groups, and could thus be used to indicate protein catabolism. In the second experiment, fish (75-90 g) of each species ingested a diet enriched with ¹⁵N-protein (10 g kg⁻¹ diet) and ¹³C-protein (30 g kg⁻¹ diet). These proportions were suitable for determining that the delta values of tissue components were high enough above natural levels to allow protein allocation to be traced at 11 and 24 h after feeding, and revealed clear metabolic differences between species.
We report the fate of glucose, both as a source of energy and as a temporary store, in the tissues of brown trout (Salmo trutta) in control, fasted and glucose-loaded fish. Tissue glucose utilization ...(^sup 3^H-2-deoxyglucose phosphorylation) and storage (conversion of ^sup 14^C-glucose into glycogen, protein, and lipid) were measured in immature brown trout, and the oxidation rate was calculated as glucose utilization minus storage and ^sup 14^C-ionic metabolites remaining in the tissue. The glucose utilization rate is tissue-specific, the highest values being found in spleen, kidney, hindgut, brain, and gill. All these tissues also showed a highly active glycolytic pathway. The lowest utilization indices were observed in white and red muscles, skin, stomach and caeca, which also presented the largest proportion of glucose converted into stores (mainly protein and glycogen). Fasting reduced the glucose disappearance rate by 24%, although there were no significant variations in glucose utilization indices or distribution profile. After a glucose load, plasma glucose and insulin levels rose and the rates of glucose utilization, storage, and oxidation also increased in all tissues (from 1.5- to 4-fold). The relative importance of each tissue in glucose disposal was similar to that in normoglycaemia. In liver, only glucose storage was measured reliably; the conversion of glucose to glycogen was higher than in other tissues, and rose markedly (35-fold) in glucose-loaded fish. In most tissues glucose flux into lipids, glycogen and protein increased. The distribution of glucose may not be a merely substrate-mediated process because fasting in glucose-loaded fish caused lower tissue glucose utilization, particularly in gut, red muscle and gills. Conversion of glucose to tissue stores was reduced, lipids being the most affected.PUBLICATION ABSTRACT
Abstract
Background
A significant percentage of patients with IBD do not respond to biological treatment. Tacrolimus (TAC) has shown utility in Crohn’s disease (CD) and severe ulcerative colitis (UC) ...refractory to anti-TNFα. There are no published data on combination of biological therapy and TAC in IBD. We therefore investigated the efficacy and safety of combination intensified biological treatment (IBT) and TAC in severe IBD refractory to IBT alone.
Methods
Observational, prospective study of patients with IBD in Hospital de Sagunto, Spain, from 2012 to the present. Inclusion criteria are adult patients with moderate-to-severe IBD without clinical response to IBT 12 weeks after initiation were included. We introduced TAC therapy (0.2 mg/kg/day) in these patients. Blood TAC levels were performed at week 2, 4, 8 and every two months thereafter. The response was measured according to the Harvey Index for CD and Mayo Index for UC. Biological response was considered as ≥50% decrease in CRP and fecal calprotectin and biological remission was considered as normalisation of these values.
Results
Fourteen patients (three women) were included. Six UC (two with UC left and four with pancolitis) and eight CD (three L2; five L3; four B1; three B2; four p). Average age was 42 years. Average of years of IBD evolution was 12.4. 42.8% of the patients were corticodependents and 21.4% were refractory patients. 78.6% of the patients were in cotreatment with immunosuppressant (thiopurine/methotrexate). Only six patients (all with infliximab) had received a single biological, eight received ≥2 biologicals. Of the 14 patients included, 6 received IFX, four Adalimumab, three Vedolizumab, and one ustekinumab. All patients were intensified according to usual clinical practice. In all patients, thiopurine or methotrexate was withdrawn prior to the introduction of TAC. In 100% of patients, the previous endoscopy showed moderate–severe activity. Average time of TAC treatment was 7.8 months (1–18). Nowadays, seven patients continued on combination therapy. Clinical response and remission during follow-up were achieved in 64% of UC patients and 43% of CD patients. In four of six corticoid-dependents patients, corticosteroids withdrawal was achieved. Almost half of the patients presented biological remission and 36% did not respond biologically. TAC blood levels out of range were presented in 8 patients. During combination therapy, these adverse effects were recorded: tremor (5), abdominal pain (2), hypertension (1), renal (1), insomnia (1). Three patients had to suspend due to bad tolerance of TAC therapy. Any serious adverse events were developed.
Conclusions
Almost half of patients with severe IBD and no response to intensified biological therapy achieve clinical remission with the combination of TAC, without any serious adverse events.
Childhood cancer mortality has sharply declined in most economically developed countries over the last years, whereas no substantial changes in the incidence have been observed. In Catalonia (Spain), ...childhood cancer mortality showed a considerable decline until 1992, but incidence trends have not been analysed in this population. To assess both recent incidence and mortality trends in this population, we analysed childhood (0-14 years) cancer data from the population-based Tarragona Cancer Registry and from the Mortality Registry of Catalonia (Spain) from 1980 to 1998. All cancer mortality decreased by -2.6% annually in boys (95% confidence interval, 95% CI -3.7, -1.6) and -3.7% in girls (95% CI -4.9, -2.5). Mortality due to leukaemia decreased annually -3.0% in boys (95% CI -4.7, -1.4) and -4.4% in girls (95% CI -6.3, -2.4). Mortality for brain tumours showed a reduction of -3.2% in boys (95% CI -5.5, -0.9) and of -4.4% in girls (95% CI -6.3 -2.4). No significant trend in incidence rates, either in boys or in girls, was observed (annual per cent of change for all cancers -0.5%, 95% CI -3.5, 2.7, in boys and 1.7%, 95% CI -1.9, 5.5, in girls). These results suggest an improvement in both childhood cancer diagnosis and treatment, which may explain current higher childhood cancer survival rates.
Self perceived health and smoking in adolescents Rius, Cristina; Fernandez, Esteve; Schiaffino, Anna ...
Journal of epidemiology and community health,
08/2004, Volume:
58, Issue:
8
Journal Article
Peer reviewed
Open access
While long term health consequences of smoking as cancer, cardiovascular diseases, or pulmonary diseases have been largely analysed, short term health consequences of smoking have been poorly ...studied, as the case of teenage smokers who are short duration smokers. Some studies, mainly from the United States and northern European countries, have shown that more absence from school, poorer self perceived health, more frequent use of medication, and more frequent contact with health services are more prevalent among adolescent smokers.1,2 However, in southern European countries this relation has been rarely assessed. The aim of this study was to examine the association between daily smoking among adolescents and their self perceived health, different health problems, use of medication, and use of health services.
The time to first cigarette smoked after waking up appears to be a good predictor of plasma and urine cotinine levels; however, collection of blood and urine is difficult in population-based studies ...and may influence participation. We aimed to test whether time to first cigarette is associated with salivary cotinine.
We used data from a cross-sectional study on a representative sample of the general population of Barcelona, Spain. We gathered information on smoking by means of a questionnaire and collected saliva for cotinine analysis. Of 1,245 participants, 22.9% were daily smokers, and the final sample for analysis consisted of 210 daily smokers.
There were significant associations between salivary cotinine and time to first cigarette, between cigarette consumption and time to first cigarette, and between salivary cotinine and cigarette consumption. Salivary cotinine had decreased as time to first cigarette increased. After adjusting for cigarette consumption and sex, there were significant differences in mean salivary cotinine according to time to first cigarette (≤ 5 min: 219.2 ng/ml; 6-30 min: 175.8 ng/ml; 31-60 min: 168.5 ng/ml; >60 min: 137.2 ng/ml). All paired comparisons were significant (p < .001) except in the 6- to 30-min group versus the 31- to 60-min group (p = .701).
After adjustment for the number of cigarettes smoked in the last 24 hr, time to first cigarette is associated with salivary cotinine concentration.
Background. The role of gender and socioeconomic status in smoking has been characterized in the United States and Northern European countries. However, there is scarce information of the dynamic of ...the tobacco epidemic in Southern European countries. The aim of this study was to analyze smoking initiation and cessation according to level of education and gender in Catalonia, Spain.
Methods. Data from the Catalan Health Survey (1994), a cross-sectional study based in a representative sample of the noninstitutionalized population of Catalonia, was used. The relative risks and 95% confidence interval of smoking initiation were computed by means of Cox's regression. The odds ratios and 95% confidence intervals of quitting smoking were derived from logistic regression models. Direct responses from 4,370 men and 5,213 women ages 25 years or over were included for analysis.
Results. Ever smoking was inversely related to level of education in men. Males with the highest educational level tended to have a lower probability of being a smoker at a given age than those with less than primary school (relative risk = 0.6; 95% confidence interval: 0.5–0.7). This pattern appeared with small variation across age groups. In women, a reverse trend was present: the higher the level of education the higher the relative risk of starting smoking (relative risk = 4.6; 95% confidence interval: 3.1–6.7). Quitting smoking was more likely among men and women with higher education as compared to men and women with less than primary school (men: odds ratio = 1.5; 95% confidence interval 1.1–2.1; women: odds ratio = 4.6; 95% confidence interval: 2.1–10.4).
Conclusions. The differential effect of education according to gender may reflect different phases of the smoking epidemic. In Catalonia, the transition of smoking from upper and lower socioeconomic groups occurred recently among men, and women have currently begun to experience this transition.
To describe the factors associated with smoking reduction in a population-based cohort study in Cornella de Llobregat (Barcelona, Spain).
We used data from the Cornella Health Interview Survey ...Follow-up Study (
n = 2,500). We included for the analysis those subjects who declared to be daily smokers at baseline (1994) and continued smoking after eight years of follow-up (
n = 234). We considered as operational definition of reduction to reduce ≥10 cigarettes/day. We calculated the relative risk (RR) of smoking reduction vs. maintain or increase tobacco consumption and 95% confidence intervals (CI) by means of a Breslow–Cox regression model.
The average reduction on number of cigarettes among subjects who reduced their tobacco consumption was similar in men and women (13 cigarettes/day). The consumption intensity and self-perceived health are the characteristics associated with reduction: smoking reduction was associated with being a smoker >20 cigarettes/day (RR = 3.25; 95% CI: 1.69–6.25) and individuals who declared having a suboptimal health showed a 3-fold risk of reducing smoking (RR = 3.13; 95% CI: 1.52–6.43).
Heavy smokers and smokers with poor health are those smokers more likely to reduce their tobacco consumption. Specific actions targeting them could lead to increase reduction and even smoking cessation.
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