Elisa Puigdomenech-puig - Academia.edu (original) (raw)
Papers by Elisa Puigdomenech-puig
International Journal of Technology Assessment in Health Care
INTRODUCTION:The use of health apps is rapidly increasing. They intend to promote health or to tr... more INTRODUCTION:The use of health apps is rapidly increasing. They intend to promote health or to treat diseases; in some cases, substituting medical duties. No specific frameworks to assess mHealth solutions in a broad scope and in a comprehensive way have been identified. We aim to propose a framework for mHealth assessment.METHODS:The framework development was based on: •Literature review to identify existing assessment models including the evaluation of health effects•Exploratory analysis with experts and user group discussions•Definition of the assessment model, following the domains of health technology assessment.RESULTS:Existing frameworks are mainly focused on certification criteria. Professionals and users agreed on the need to undertake mHealth assessments as to better inform user decisions. Assessments should be sensible to continuous changes of these technologies and be undertaken by independent organizations.The proposed framework offers a step-by-step process by which an...
International Journal of Technology Assessment in Health Care
IntroductionDue to the specific characteristics and challenges of mobile health (mHealth) technol... more IntroductionDue to the specific characteristics and challenges of mobile health (mHealth) technologies there is a need to have assessment tools based on their particularities to be used by health technology assessment (HTA) agencies and evaluation experts. In the development of a comprehensive and practical evaluation tool for the evaluation of mHealth solutions we aimed to include the views and opinions of key stakeholders: health professionals, developers, hospital managers, HTA agencies, patients and general public.MethodsFocus groups and an online modification of the Delphi technique are being used to discuss and agree on domains and criteria to be included in the mHealth assessment tool. Domains and criteria used for health apps evaluation were drawn from a literature review on the topic. The initial list includes 95 criteria grouped into the following domains: purpose of the app, privacy and security, clinical effectiveness, content of the intervention, user experience and usa...
International Journal of Technology Assessment in Health Care
IntroductionThere are more than 320,000 accessible health apps, with the most downloaded of those... more IntroductionThere are more than 320,000 accessible health apps, with the most downloaded of those related to physical exercise and weight control. However the initiatives for their validation address only partial aspects of the evaluation. The EVALAPPS project aims to develop an assessment tool for overweight and obesity management apps, based on the evaluation of efficacy, effectiveness and safety. In the present phase of the project, the team is co-creating the assessment tool considering both the evidence and the expertise of professionals (co-creation process).MethodsProposed co-creation methodology includes: 1) a modified Delphi process for selecting the assessment criteria. Criteria were identified through a) an exhaustive review of the criteria used by several mHealth assessment tools and b) a systematic review of efficacy, safety and effectiveness criteria used in mHealth interventions that assess overweight and obesity management. 2) a co-creation session using “Design Thin...
BACKGROUND The use of Mobile Applications (apps) for managing overweightness/obesity has increase... more BACKGROUND The use of Mobile Applications (apps) for managing overweightness/obesity has increased over recent years. However, there is a lack of evidence on the efficacy, effectiveness and safety of these apps. The EVALAPPS project will develop and validate an assessment tool for specifically assessing these dimensions in overweightness/obesity management apps. OBJECTIVE To reach a consensus among stakeholders on a comprehensive set of criteria to guide development of the EVALAPPS assessment tool. A modified Delphi process was used in order to: 1) verify the robustness of the criteria identified through a literature review; 2) prioritize a set of the identified criteria. METHODS 31 stakeholders were invited to participate in a 2 round Delphi process with an initial number of 114 criteria identified in the literature. In Round 1 participants rated criteria according to relevance (0 = “I suggest to exclude this criteria”, 5 = “This criterion is extremely relevant”). A criterion was a...
International Journal of Technology Assessment in Health Care
Introduction:We aimed to pilot the evaluation of the PEGASO system, a smartphone-based interventi... more Introduction:We aimed to pilot the evaluation of the PEGASO system, a smartphone-based intervention (apps/wearables/game) to improve lifestyles and increase awareness.Methods:We conducted a before-after quasi-experimental pilot controlled study. Teenagers aged 13–16 in a 2:1 (intervention: comparative group [IG:CG]) basis from Spain, Italy and the United Kingdom were recruited. The IG had access to the apps and game for six months, and to smart sensors for the last two months. Schools were recruited by convenience sampling. Participants in both groups undertook (i) anthropometric measurements, (ii) diet (KIDMED), physical activity (PAQ-A) and sleep (HELENA study) validated questionnaires, and (iii) ad-hoc lifestyles knowledge questionnaire. PEGASO, if used, continuously recorded diet and physical activity. User experience was assessed through focus groups.Results:Five hundred and fifty-eight participants were included (IG:365 / CG:193). The mean (standard deviation; SD) age was 14.8...
JMIR mHealth and uHealth, Apr 27, 2018
Information and communication technologies are currently among the supporting elements that may c... more Information and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles. The aim of this study was to evaluate the long-term effectiveness of adding an app to standardized counseling in order to increase physical activity (PA) and adherence to the Mediterranean diet and to analyze the effects of app adherence in lifestyle changes. A randomized, multicenter clinical trial with a 12 month-follow up was conducted, involving 833 participants recruited by random sampling in 6 primary Spanish care centers (415 vs 418). Counseling on PA and the Mediterranean diet was given to both groups by a research nurse; however, the counseling + app group (intervention group) received additional training in the use of an app that was designed to promote the Mediterranean diet and PA over a 3-month period. Main outcomes and measures included PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and a...
PloS one, 2017
The aim of this systematic review and meta-analysis is to synthesize the available evidence in sc... more The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations. Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment. A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significa...
Nutrition Journal, 2015
Background and aims: Among fruits, kiwi is one of the richest in vitamins and polyphenols and has... more Background and aims: Among fruits, kiwi is one of the richest in vitamins and polyphenols and has strong anti-oxidant effects. We aimed to analyze the relationship between the consumption of kiwi and plasma lipid values, fibrinogen, and insulin resistance in adults within the context of a normal diet and physical-activity. Methods: Cross-sectional study. Participants (N = 1469), who were free of cardiovascular diseases, completed a visit, which included the collection of information concerning the participant's usual diet and kiwi consumption using a previously validated, semi-quantitative, 137-item food-frequency-questionnaire. Fasting laboratory determinations included plasma lipids, fibrinogen and insulin resistance. Regular physical-activity was determined using accelerometry. Results: Consumers of at least 1 kiwi/week presented higher plasma values of HDL-cholesterol (mean difference 4.50 [95 % CI: 2.63 to 6.36]) and lower triglyceride values (mean difference −20.03 [95 % CI: −6.77 to −33.29]), fibrinogen values (mean difference −13.22 [95 % CI: −2.18 to −24.26]) and HOMAir values (mean difference −0.30 [95 % CI: −0.09 to −0.50]) (p < 0.05, for all comparisons) than those who consumed less than 1 kiwi per week. In an adjusted logistic regression analysis, this group had a lower odds-ratio for presenting plasmatic fibrinogen concentrations above 400 mg/dL (OR = 0.68, 95 % CI 0.49 to 0.95), HDL-Cholesterol plasma values below 45 mg/dL (OR = 0.57, 95 % CI 0.36 to 0.91) and a HOMAir above 3 (OR = 0.61, 95 % CI 0.37 to 1.00). Conclusions: Consumption of at least one kiwi/week is associated with lower plasma concentrations of fibrinogen and improved plasma lipid profile in the context of a normal diet and regular exercise.
Primary Care at a Glance - Hot Topics and New Insights, 2012
Gaceta Sanitaria, 2008
No systematic review is available on studies conducted in Spain on human concentrations of persis... more No systematic review is available on studies conducted in Spain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrations of DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individuals may be over 200-fold higher than those of others. The actual magnitude of human contamination by PTS and their trends across Spain -as well as the geographic and social heterogeneity- remain largely unknown.
Diabetes Research and Clinical Practice, 2015
To assess the effectiveness of an intensive smoking cessation intervention based on the transtheo... more To assess the effectiveness of an intensive smoking cessation intervention based on the transtheoretical model of change (TTM) in diabetic smokers attending primary care. A cluster randomized controlled clinical trial was designed in which the unit of randomization (intervention vs. usual care) was the primary care team. An intensive, individualized intervention using motivational interview and therapies and medications adapted to the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s stage of change was delivered. The duration of the study was 1 year. A total of 722 people with diabetes who were smokers (345 in the intervention group and 377 in the control group) completed the study. After 1 year, continued abstinence was recorded in 90 (26.1%) patients in the intervention group and in 67 (17.8%) controls (p=0.007). In patients with smoking abstinence, there was a higher percentage in the precontemplation and contemplation stages at baseline in the intervention group than in controls (21.2% vs. 13.7%, p=0.024). When the precontemplation stage was taken as reference (OR=1.0), preparation/action stage at baseline showed a protective effect, decreasing 3.41 times odds of continuing smoking (OR=0.293 95% CI 0.179-0.479, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Contemplation stage at baseline also showed a protective effect, decreasing the odds of continuing smoking (OR=0.518, 95% CI 0.318-0.845, p=0.008). An intensive intervention adapted to the individual stage of change delivered in primary care was feasible and effective, with a smoking cessation rate of 26.1% after 1 year.
Gaceta sanitaria / S.E.S.P.A.S
The contamination by persistent toxic compounds (PTCs) of the general population is a fact of rel... more The contamination by persistent toxic compounds (PTCs) of the general population is a fact of relevance from a public health perspective. It is also relevant to health care professionals, as well as for environmental, food, industrial and economic policies. Though in Spain information on food contamination by PTCs shows large time and geographic gaps, the scarcity of data is even more severe on the concentrations that PTCs have in people: a representative study of a general healthy population living in a wide geographic area has never been conducted in the country. However, the available studies indicate that around 80-100% of the population has detectable concentrations of DDE, PCBs, hexachlorbenzene or lindane. Studies on the effects that PTCs have upon humans are extremely infrequent in Spain. Yet, the international literature suggests that some PTCs may induce significant biological and clinical effects at doses below those traditionally deemed "safe". The mechanism of...
Revista de Saúde Pública, 2006
Whilst their 'death' has often been certified, books remain highly important to most prof... more Whilst their 'death' has often been certified, books remain highly important to most professions and academic disciplines. Analyses of citations received by epidemiologic texts may complement other views on epidemiology. The objective was to assess the number of citations received by some books of epidemiology and public health, as a first step towards studying the influence of epidemiological thought and thinking in academia. For this purpose, Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledgedatabase was consulted, in May 2006. The book by Rothman & Greenland appeared to have received the highest number of citations overall (over 8,000) and per year. The books by Kleinbaum et al, and by Breslow & Day received around 5,000 citations. In terms of citations per year the book by Sackett et al ranks 3rd, and the one by Rose, 4th of those included in this preliminary study. Other books which were influential in the classrooms collected co...
Occupational and Environmental Medicine, 2011
Previous studies investigating associations between occupational history and risk of exocrine pan... more Previous studies investigating associations between occupational history and risk of exocrine pancreatic cancer (EPC) did not use biomarkers of exposure. The only two studies that measured internal concentrations of organochlorine compounds (OCs) in EPC did not analyse their relationship with occupation. To analyse the relationship between occupational history and blood concentrations of seven OCs in patients with EPC. Incident cases of EPC were prospectively identified, and during hospital admission were interviewed face-to-face on occupational history and life-style factors (n = 135). Occupations were coded according to the International Standard of Occupations 1988. Some occupational exposures were also assessed with the Finnish job-exposure matrix (Finjem). Serum concentrations of OCs were analysed by high-resolution gas chromatography with electron-capture detection. Craftsmen and related trades workers had significantly higher concentrations of polychlorinated biphenyl (PCB) congeners 138, 153 and 180. Years worked in agriculture did not influence concentrations of p,p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-DDT, p,p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-DDE, hexachlorobenzene or β-hexachlorocyclohexane. Subjects who ever worked in agriculture had lower concentrations of PCBs (all p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Occupational exposure to lead, nickel and low frequency magnetic fields was significantly associated with higher concentrations of PCBs. Certain occupations were associated with higher concentrations of PCBs, suggesting that these compounds may account for some increased risks found in previous studies. The lack of association between work in agriculture and concentrations of OC pesticides is consistent with occupation playing a lesser role than diet in influencing OC concentrations. Occupational studies on the relationships among exposure to industrial agents and EPC risk may need to consider adjusting for exposure to PCBs.
Occupational and Environmental Medicine, 2009
1. Professor Miquel Porta, Clinical and Molecular Epidemiology of Cancer Unit, Institut Municipal... more 1. Professor Miquel Porta, Clinical and Molecular Epidemiology of Cancer Unit, Institut Municipal d'Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; mporta {at} imim. es
International Journal of Technology Assessment in Health Care
INTRODUCTION:The use of health apps is rapidly increasing. They intend to promote health or to tr... more INTRODUCTION:The use of health apps is rapidly increasing. They intend to promote health or to treat diseases; in some cases, substituting medical duties. No specific frameworks to assess mHealth solutions in a broad scope and in a comprehensive way have been identified. We aim to propose a framework for mHealth assessment.METHODS:The framework development was based on: •Literature review to identify existing assessment models including the evaluation of health effects•Exploratory analysis with experts and user group discussions•Definition of the assessment model, following the domains of health technology assessment.RESULTS:Existing frameworks are mainly focused on certification criteria. Professionals and users agreed on the need to undertake mHealth assessments as to better inform user decisions. Assessments should be sensible to continuous changes of these technologies and be undertaken by independent organizations.The proposed framework offers a step-by-step process by which an...
International Journal of Technology Assessment in Health Care
IntroductionDue to the specific characteristics and challenges of mobile health (mHealth) technol... more IntroductionDue to the specific characteristics and challenges of mobile health (mHealth) technologies there is a need to have assessment tools based on their particularities to be used by health technology assessment (HTA) agencies and evaluation experts. In the development of a comprehensive and practical evaluation tool for the evaluation of mHealth solutions we aimed to include the views and opinions of key stakeholders: health professionals, developers, hospital managers, HTA agencies, patients and general public.MethodsFocus groups and an online modification of the Delphi technique are being used to discuss and agree on domains and criteria to be included in the mHealth assessment tool. Domains and criteria used for health apps evaluation were drawn from a literature review on the topic. The initial list includes 95 criteria grouped into the following domains: purpose of the app, privacy and security, clinical effectiveness, content of the intervention, user experience and usa...
International Journal of Technology Assessment in Health Care
IntroductionThere are more than 320,000 accessible health apps, with the most downloaded of those... more IntroductionThere are more than 320,000 accessible health apps, with the most downloaded of those related to physical exercise and weight control. However the initiatives for their validation address only partial aspects of the evaluation. The EVALAPPS project aims to develop an assessment tool for overweight and obesity management apps, based on the evaluation of efficacy, effectiveness and safety. In the present phase of the project, the team is co-creating the assessment tool considering both the evidence and the expertise of professionals (co-creation process).MethodsProposed co-creation methodology includes: 1) a modified Delphi process for selecting the assessment criteria. Criteria were identified through a) an exhaustive review of the criteria used by several mHealth assessment tools and b) a systematic review of efficacy, safety and effectiveness criteria used in mHealth interventions that assess overweight and obesity management. 2) a co-creation session using “Design Thin...
BACKGROUND The use of Mobile Applications (apps) for managing overweightness/obesity has increase... more BACKGROUND The use of Mobile Applications (apps) for managing overweightness/obesity has increased over recent years. However, there is a lack of evidence on the efficacy, effectiveness and safety of these apps. The EVALAPPS project will develop and validate an assessment tool for specifically assessing these dimensions in overweightness/obesity management apps. OBJECTIVE To reach a consensus among stakeholders on a comprehensive set of criteria to guide development of the EVALAPPS assessment tool. A modified Delphi process was used in order to: 1) verify the robustness of the criteria identified through a literature review; 2) prioritize a set of the identified criteria. METHODS 31 stakeholders were invited to participate in a 2 round Delphi process with an initial number of 114 criteria identified in the literature. In Round 1 participants rated criteria according to relevance (0 = “I suggest to exclude this criteria”, 5 = “This criterion is extremely relevant”). A criterion was a...
International Journal of Technology Assessment in Health Care
Introduction:We aimed to pilot the evaluation of the PEGASO system, a smartphone-based interventi... more Introduction:We aimed to pilot the evaluation of the PEGASO system, a smartphone-based intervention (apps/wearables/game) to improve lifestyles and increase awareness.Methods:We conducted a before-after quasi-experimental pilot controlled study. Teenagers aged 13–16 in a 2:1 (intervention: comparative group [IG:CG]) basis from Spain, Italy and the United Kingdom were recruited. The IG had access to the apps and game for six months, and to smart sensors for the last two months. Schools were recruited by convenience sampling. Participants in both groups undertook (i) anthropometric measurements, (ii) diet (KIDMED), physical activity (PAQ-A) and sleep (HELENA study) validated questionnaires, and (iii) ad-hoc lifestyles knowledge questionnaire. PEGASO, if used, continuously recorded diet and physical activity. User experience was assessed through focus groups.Results:Five hundred and fifty-eight participants were included (IG:365 / CG:193). The mean (standard deviation; SD) age was 14.8...
JMIR mHealth and uHealth, Apr 27, 2018
Information and communication technologies are currently among the supporting elements that may c... more Information and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles. The aim of this study was to evaluate the long-term effectiveness of adding an app to standardized counseling in order to increase physical activity (PA) and adherence to the Mediterranean diet and to analyze the effects of app adherence in lifestyle changes. A randomized, multicenter clinical trial with a 12 month-follow up was conducted, involving 833 participants recruited by random sampling in 6 primary Spanish care centers (415 vs 418). Counseling on PA and the Mediterranean diet was given to both groups by a research nurse; however, the counseling + app group (intervention group) received additional training in the use of an app that was designed to promote the Mediterranean diet and PA over a 3-month period. Main outcomes and measures included PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and a...
PloS one, 2017
The aim of this systematic review and meta-analysis is to synthesize the available evidence in sc... more The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations. Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment. A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significa...
Nutrition Journal, 2015
Background and aims: Among fruits, kiwi is one of the richest in vitamins and polyphenols and has... more Background and aims: Among fruits, kiwi is one of the richest in vitamins and polyphenols and has strong anti-oxidant effects. We aimed to analyze the relationship between the consumption of kiwi and plasma lipid values, fibrinogen, and insulin resistance in adults within the context of a normal diet and physical-activity. Methods: Cross-sectional study. Participants (N = 1469), who were free of cardiovascular diseases, completed a visit, which included the collection of information concerning the participant's usual diet and kiwi consumption using a previously validated, semi-quantitative, 137-item food-frequency-questionnaire. Fasting laboratory determinations included plasma lipids, fibrinogen and insulin resistance. Regular physical-activity was determined using accelerometry. Results: Consumers of at least 1 kiwi/week presented higher plasma values of HDL-cholesterol (mean difference 4.50 [95 % CI: 2.63 to 6.36]) and lower triglyceride values (mean difference −20.03 [95 % CI: −6.77 to −33.29]), fibrinogen values (mean difference −13.22 [95 % CI: −2.18 to −24.26]) and HOMAir values (mean difference −0.30 [95 % CI: −0.09 to −0.50]) (p < 0.05, for all comparisons) than those who consumed less than 1 kiwi per week. In an adjusted logistic regression analysis, this group had a lower odds-ratio for presenting plasmatic fibrinogen concentrations above 400 mg/dL (OR = 0.68, 95 % CI 0.49 to 0.95), HDL-Cholesterol plasma values below 45 mg/dL (OR = 0.57, 95 % CI 0.36 to 0.91) and a HOMAir above 3 (OR = 0.61, 95 % CI 0.37 to 1.00). Conclusions: Consumption of at least one kiwi/week is associated with lower plasma concentrations of fibrinogen and improved plasma lipid profile in the context of a normal diet and regular exercise.
Primary Care at a Glance - Hot Topics and New Insights, 2012
Gaceta Sanitaria, 2008
No systematic review is available on studies conducted in Spain on human concentrations of persis... more No systematic review is available on studies conducted in Spain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrations of DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individuals may be over 200-fold higher than those of others. The actual magnitude of human contamination by PTS and their trends across Spain -as well as the geographic and social heterogeneity- remain largely unknown.
Diabetes Research and Clinical Practice, 2015
To assess the effectiveness of an intensive smoking cessation intervention based on the transtheo... more To assess the effectiveness of an intensive smoking cessation intervention based on the transtheoretical model of change (TTM) in diabetic smokers attending primary care. A cluster randomized controlled clinical trial was designed in which the unit of randomization (intervention vs. usual care) was the primary care team. An intensive, individualized intervention using motivational interview and therapies and medications adapted to the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s stage of change was delivered. The duration of the study was 1 year. A total of 722 people with diabetes who were smokers (345 in the intervention group and 377 in the control group) completed the study. After 1 year, continued abstinence was recorded in 90 (26.1%) patients in the intervention group and in 67 (17.8%) controls (p=0.007). In patients with smoking abstinence, there was a higher percentage in the precontemplation and contemplation stages at baseline in the intervention group than in controls (21.2% vs. 13.7%, p=0.024). When the precontemplation stage was taken as reference (OR=1.0), preparation/action stage at baseline showed a protective effect, decreasing 3.41 times odds of continuing smoking (OR=0.293 95% CI 0.179-0.479, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Contemplation stage at baseline also showed a protective effect, decreasing the odds of continuing smoking (OR=0.518, 95% CI 0.318-0.845, p=0.008). An intensive intervention adapted to the individual stage of change delivered in primary care was feasible and effective, with a smoking cessation rate of 26.1% after 1 year.
Gaceta sanitaria / S.E.S.P.A.S
The contamination by persistent toxic compounds (PTCs) of the general population is a fact of rel... more The contamination by persistent toxic compounds (PTCs) of the general population is a fact of relevance from a public health perspective. It is also relevant to health care professionals, as well as for environmental, food, industrial and economic policies. Though in Spain information on food contamination by PTCs shows large time and geographic gaps, the scarcity of data is even more severe on the concentrations that PTCs have in people: a representative study of a general healthy population living in a wide geographic area has never been conducted in the country. However, the available studies indicate that around 80-100% of the population has detectable concentrations of DDE, PCBs, hexachlorbenzene or lindane. Studies on the effects that PTCs have upon humans are extremely infrequent in Spain. Yet, the international literature suggests that some PTCs may induce significant biological and clinical effects at doses below those traditionally deemed "safe". The mechanism of...
Revista de Saúde Pública, 2006
Whilst their 'death' has often been certified, books remain highly important to most prof... more Whilst their 'death' has often been certified, books remain highly important to most professions and academic disciplines. Analyses of citations received by epidemiologic texts may complement other views on epidemiology. The objective was to assess the number of citations received by some books of epidemiology and public health, as a first step towards studying the influence of epidemiological thought and thinking in academia. For this purpose, Institute for Scientific Information/ Thomson Scientific - Web of Science/ Web of Knowledgedatabase was consulted, in May 2006. The book by Rothman & Greenland appeared to have received the highest number of citations overall (over 8,000) and per year. The books by Kleinbaum et al, and by Breslow & Day received around 5,000 citations. In terms of citations per year the book by Sackett et al ranks 3rd, and the one by Rose, 4th of those included in this preliminary study. Other books which were influential in the classrooms collected co...
Occupational and Environmental Medicine, 2011
Previous studies investigating associations between occupational history and risk of exocrine pan... more Previous studies investigating associations between occupational history and risk of exocrine pancreatic cancer (EPC) did not use biomarkers of exposure. The only two studies that measured internal concentrations of organochlorine compounds (OCs) in EPC did not analyse their relationship with occupation. To analyse the relationship between occupational history and blood concentrations of seven OCs in patients with EPC. Incident cases of EPC were prospectively identified, and during hospital admission were interviewed face-to-face on occupational history and life-style factors (n = 135). Occupations were coded according to the International Standard of Occupations 1988. Some occupational exposures were also assessed with the Finnish job-exposure matrix (Finjem). Serum concentrations of OCs were analysed by high-resolution gas chromatography with electron-capture detection. Craftsmen and related trades workers had significantly higher concentrations of polychlorinated biphenyl (PCB) congeners 138, 153 and 180. Years worked in agriculture did not influence concentrations of p,p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-DDT, p,p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-DDE, hexachlorobenzene or β-hexachlorocyclohexane. Subjects who ever worked in agriculture had lower concentrations of PCBs (all p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Occupational exposure to lead, nickel and low frequency magnetic fields was significantly associated with higher concentrations of PCBs. Certain occupations were associated with higher concentrations of PCBs, suggesting that these compounds may account for some increased risks found in previous studies. The lack of association between work in agriculture and concentrations of OC pesticides is consistent with occupation playing a lesser role than diet in influencing OC concentrations. Occupational studies on the relationships among exposure to industrial agents and EPC risk may need to consider adjusting for exposure to PCBs.
Occupational and Environmental Medicine, 2009
1. Professor Miquel Porta, Clinical and Molecular Epidemiology of Cancer Unit, Institut Municipal... more 1. Professor Miquel Porta, Clinical and Molecular Epidemiology of Cancer Unit, Institut Municipal d'Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; mporta {at} imim. es