Enric Duran Tauleria - Academia.edu (original) (raw)
Papers by Enric Duran Tauleria
European Child & Adolescent Psychiatry, Jul 1, 2004
Thorax, 1999
Background-There has been controversy over the relation between poverty and asthma in the communi... more Background-There has been controversy over the relation between poverty and asthma in the community. The aim of this analysis was to disentangle geographical and socioeconomic variation in asthma symptoms. Methods-The analysis is based on parental reports of symptoms from data collected in 1990 and 1991. Children aged 5-11 years from three populations (English representative sample, Scottish representative sample, and an English inner city sample) were included. Of 17 677 eligible children, between 14 490 (82.0%) and 15 562 (88.0%) children were available for analysis according to symptom group. Results-Wheezy symptoms were less prevalent in the Scottish sample than in the English samples and asthma attacks were most prevalent in the English representative sample. Asthma attacks were less prevalent in inner city areas than in the English representative sample (OR 0.79, 95% CI 0.66 to 0.95), but persistent wheeze and other respiratory symptoms were more prevalent (OR 1.95, 95% CI 1.65 to 2.32 and OR 1.67, 95% CI 1.52 to 1.84, respectively). The prevalence of persistent wheeze was higher in children whose father's social class was low and in those living in areas with a high Townsend score (an index of poverty) than in other children (p<0.001). Of the 14 areas with the highest Townsend score, 13 had an OR above 1 and six had an OR significantly higher than the reference area. Conclusions-Persistent wheeze is more prevalent in poor areas than in less deprived areas. This may indicate that poverty is associated with severe asthma or that a high percentage of persistent asthma symptoms in inner city areas are unrecognised and untreated.
Allergy, 2004
The prevalence of respiratory and skin symptoms associated with atopy has increased considerably ... more The prevalence of respiratory and skin symptoms associated with atopy has increased considerably over the last 20-30 years, particularly in Western industrialized countries (1-5). This is a cause for concern because of its impact on personal quality of life and the increasing costs to society (6-8). The present knowledge of risk factors for many of these symptoms indicates that opportunities for primary prevention are very limited. In contrast, secondary prevention is necessary and possible but its effectiveness may depend on the capacity to identify correctly atopic patients in primary care.
Investigative Ophthalmology & Visual Science, 2011
Revista de neurologia, Jan 15, 2005
Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neurop... more Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neuropsychiatric disorders beginning in childhood that present a high degree of familial aggregation. ASD is characterised by social interaction and communication disorders, whereas patients with ADHD display persistent inattention and/or hyperactive-impulsive behaviour. With the exception of a few cases of autism in which cytogenetic anomalies or mutations have been reported in specific genes, the aetiology of these diseases remains unknown. This is a group of multifactorial diseases with several genes having a lesser effect and there is also an environmental component. Genetic linkage studies have pointed to about 20 chromosomal regions that could well contain genes that grant susceptibility to autism, to ADHD or to both disorders. The challenge to researchers lies in the clinical characterisation, recruitment of patients with ASD and ADHD, gene dosage quantification studies, comparative gen...
Journal of Epidemiology & Community Health, 1995
Study objective-To examine the associations of social and biological factors with measures of obe... more Study objective-To examine the associations of social and biological factors with measures of obesity in children. Design-The study had a cross sectional design. Setting-The analyses were based on data from two national study of health and growth cross sectional surveys. The "representative sample" comprised 1990 data from 22 English areas and 1990-91 data from 14 Scottish areas; the "inner city sample" comprised 1991 data from 20 English areas. Participants-The subjects were primary school children aged mainly 5-11 years living in England and Scotland. The "representative" sample included 10628 children-6463 living in England and 4165 living in Scotland. The "inner city" sample included 7049 children-2183 white, 1124 Afro-Caribbean, 2696 Indian subcontinent, and 1046 from other groups. Due to missing values on continuous variables, 8374 children were included in the analyses. Measurements and main results-The relation between social environment and childhood overweight was studied using several indicators of obesity. Triceps, subscapular, the sum of triceps and subscapular skinfolds, and weight for height were used as dependent variables. The analyses were carried out in two stages. Firstly, multiple linear regression analyses were used to assess the factors associated with dependent variables treated as continuous. Secondly, multiple linear logistic regression analyses were used to examine the association between independent factors and overweight and fatness defined as binary variables. Birth weight, mother's body mass index (BMI), and father's BMI were consistently associated (p<0-001) in
European Respiratory Journal, 2005
The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s... more The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n5423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.
Revista de Neurología, 2005
LARGE-SCALE GENOTYPING IN RESEARCH INTO AUTISM SPECTRUM DISORDERS AND ATTENTION DEFICIT HYPERACTI... more LARGE-SCALE GENOTYPING IN RESEARCH INTO AUTISM SPECTRUM DISORDERS AND ATTENTION DEFICIT HYPERACTIVITY DISORDER Summary. Introduction and development. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder ( ...
Pharmaceutics
BACKGROUND: Autistic spectrum disorders (ASD) are severe neurodevelopmental alterations character... more BACKGROUND: Autistic spectrum disorders (ASD) are severe neurodevelopmental alterations characterised by deficits in social communication and repetitive and restricted behaviours. About a third of patients receive pharmacological treatment for comorbid symptoms. However, 30–50% do not respond adequately and/or present severe and long-lasting side effects. METHODS: Genetic variants in CYP1A2, CYP2C19, CYP2D6 and SLC6A4 were investigated in N = 42 ASD sufferers resistant to pharmacological treatment. Clinical recommendations based on their pharmacogenetic profiles were provided within 24–48 h of receiving a biological sample. RESULTS: A total of 39 participants (93%) improved after the pharmacogenetic intervention according to their CGI scores (difference in basal-final scores: 2.26, SD 1.55) and 37 participants (88%) according to their CGAS scores (average improvement of 20.29, SD 11.85). Twenty-three of them (55%) achieved symptom stability (CGI ≤ 3 and CGAS improvement ≥ 20 points)...
European Respiratory Journal, 2011
Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in... more Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in primary care is suboptimal. The aim of the present study was to assess a web-based application aiming at fostering high-quality spirometry in primary care. This was a randomised controlled trial with 12 intervention primary care units (PCi) and six control units (PCc) studied over 12 months. All 34 naïve nurses (PCi and PCc) received identical training. The PCi units had access to educational material and remote expert support. Quality of spirometry and usability of the web application were assessed. We included 4,581 patients (3,383 PCi and 1,198 PCc). At baseline, quality was similar (PCi 71% and PCc 67% high-quality tests). During the study, PCi showed higher percentage (71.5%) of highquality tests than PCc (59.5%) (p,0.0001). PCi had 73% more chance of high-quality performance than PCc. The web application was better for assessing quality of testing than the automatic feedback provided by the spirometer. Healthcare professionals' satisfaction and usability were high. The web-based remote support for primary care by specialists generated a sustained positive impact on quality of testing. The study expands the potential of primary care for diagnosis and management of patients with pulmonary diseases.
Respiratory Research, 2010
... pulmonary disease: a population-based study Francisco Garcia-Rio*1, Marc Miravitlles2, Joan B... more ... pulmonary disease: a population-based study Francisco Garcia-Rio*1, Marc Miravitlles2, Joan B Soriano3, Luis Muñoz4, Enric Duran-Tauleria5, Guadalupe Sánchez6, Víctor Sobradillo7, Julio Ancochea8 and EPI-SCAN Steering Committee ...
Allergy, 2007
Background: Few data are available on the asthma burden in the general population. We evaluated t... more Background: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. Methods: In 1999-2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socioeconomic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. Results: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4-15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1-16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18-4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52-5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63-4.61) and sixfold (RRR = 5.76; 95% CI: 3.25-10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16-3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9-27.1%). Conclusions: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females.
European Respiratory Journal, 2010
We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in... more We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n54,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n53,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p,0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.
European Respiratory Journal, 2011
Patients receiving LTOT are frequent users of healthcare services. Pilot studies have shown that ... more Patients receiving LTOT are frequent users of healthcare services. Pilot studies have shown that Integrated Care Services (IC) reduce hospitalizations in these patients and have also identified that deployment of ICS requires an operational definition of frailty that allows risk stratification of patients. Objective: To characterize the risk profile of LTOT patients in an urban area of 540.000 inh in order to allow the design of a one-year follow-up RCT to assess deployment of IC tailored by patient9s frailty. Methods: Observational study examining 751 patient9s records. We planned three home visits for health examination survey, assessment of determinants of frailty, measurement of arterial blood gases and perceived needs. Up to 423 (56%) patients with active LTOT were studied. Preliminary data from an unbiased sample of 282 patients are reported. Results: Eighty six patients (31%) had a P0 2 ≤ 55 mmHg and only 62 of them (22%) used LTOT ≥ 16 h/day. Most patients had never received...
Scientific Reports
Reduced lung function is associated with overall and cardiovascular mortality. Chronic low grade ... more Reduced lung function is associated with overall and cardiovascular mortality. Chronic low grade systemic inflammation is linked to impaired lung function and cardiovascular outcomes. We assessed the association of lung function with overall 8-year mortality in 867 individuals of the Activity and Function in the Elderly study using confounder-adjusted Cox proportional hazards models (including gait speed and daily walking time as measures of physical function) without and with adjustment for inflammatory and cardiac markers. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) but not FVC was related to mortality after adjustment for physical function and other confounders. Additional adjustment for inflammatory and cardiac markers did not change the hazard ratios (HR) markedly, e.g. for a FEV1/FVC below 0.7 from 1.55 [95% confidence-interval (CI) 1.14–2.11] to 1.49 (95% CI 1.09–2.03). These independent associations were also observed in the apparently lung healthy subpo...
Autism Research
This study aims to estimate the prevalence of autism spectrum disorders (ASD) in 2017 and the ASD... more This study aims to estimate the prevalence of autism spectrum disorders (ASD) in 2017 and the ASD diagnosis incidence between 2009 and 2017 in children living in Catalonia region in Spain, and their temporal and geographical variability. We used administrative data for all children aged 2-17 years who were insured in the public Catalan Health System between 2009 and 2017. We identified all ASD cases diagnosed between 2009 and 2017 (ICD-9 codes 299.0, 299.1, 299.8, and 299.9). We estimated the ASD prevalence in 2017 and the overall annual incidence between 2009 and 2017, then stratified by sex, age group, and healthcare area. We used Poisson regression models to assess temporal trends in the incidence and mixed-effects Poisson regression models to assess geographical variability. We observed an ASD prevalence of 1.23% (95% confidence interval [CI] 1.21-1.25) in 2017, with 1.95% (95% CI 1.92-1.99) for boys and 0.46% (95% CI 0.44-0.48) for girls, the highest prevalence being in 11-to 17-year-olds (1.80%, 95% CI 1.76-1.83). The ASD diagnosis incidence increased from 0.07% (95% CI 0.06-0.09) in 2009 to 0.23% (95% CI 0.21-0.24) in 2017, with a higher increase in girls, and in children aged 2-5 years at the time of diagnosis. We only observed geographical differences in prevalence in the 2017 data. We also detected a threefold increase in the diagnosis incidence overall, which was even more pronounced in girls and at early ages. In conclusion, the ASD prevalence observed in this study was 1.23% in 2017, with a sex ratio of 4.5 in favor of boys, which is consistent with previous studies.
International Archives of Allergy and Immunology, 2015
phenotypes of allergic diseases and their interrelationships, to explore disease heterogeneity an... more phenotypes of allergic diseases and their interrelationships, to explore disease heterogeneity and to evaluate the measurements employed in disease diagnosis. Methods: We conducted a search of MEDLINE up to December 2012, to identify relevant original studies published in the English language that examine at least one objective of this systematic review in subjects aged 0-18 years. The screening of titles and abstracts and the extraction of data were conducted independently by two reviewers. Results: From a total of 13,767 citations, 197 studies met the criteria for inclusion, with 54% being cohort studies. Allergic diseases were studied as a single entity in 55% (109/197
Respiratory Medicine, 2013
Background: Patients with COPD may share some clinical characteristics with asthma sufferers. Thi... more Background: Patients with COPD may share some clinical characteristics with asthma sufferers. This phenotypic overlap between COPD and asthma is not yet well characterised. Method: We have analysed data from the EPI-SCAN study, an epidemiological, populationbased study in Spain that included 3885 (40 to 80-year-old) subjects in order to investigate the clinical and systemic inflammatory characteristics of COPD patients previously diagnosed with asthma. Generic and COPD-specific quality of life, as well as physical activity, were also assessed through standardised and validated questionnaires. Results: A total of 385 (10.1%) subjects were diagnosed with COPD, 67 (17.4%) being classified with the COPDeasthma overlap phenotype. Such patients were more likely to have dyspnea and wheezing (p < 0.001 in both comparisons) and more frequent exacerbations (p < 0.001).
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2013
Our aim was to describe the population-based distribution of several COPD multi-dimensional indic... more Our aim was to describe the population-based distribution of several COPD multi-dimensional indices and to evaluate their relationship with daily physical activity, co-morbidity, health status and systemic inflammatory biomarkers. From a population-based sample of 3,802 subjects aged 40-80 from the EPI-SCAN study, 382 subjects (10.2%) with a post-bronchodilator FEV1/FVC&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;0.7 were identified as COPD. Smoking habits, respiratory symptoms, quality of life, co-morbidities, lung function and inflammatory biomarkers were recorded. Health status and daily physical activity were assessed using the EQ-5D and LCADL questionnaires, respectively. The new GOLD grading and the BODE, ADO, DOSE, modified DOSE, e-BODE, BODEx, CPI, SAFE and HRS indices were determined. A notable dispersion in the total scores was observed, although 83-88% of the COPD patients were classified into the mildest level and 1-3% in the most severe. The SAFE index was the best independent determinant of daily physical activity; the SAFE and ADO indices were associated with presence of co-morbidity; and the SAFE and modified DOSE indices were independently related to health status. The systemic biomarkers showed a less consistent relation with several indices. In a population-based sample of COPD patients, the SAFE index reaches the highest relation with physical activity, co-morbidity and health status.
European Child & Adolescent Psychiatry, Jul 1, 2004
Thorax, 1999
Background-There has been controversy over the relation between poverty and asthma in the communi... more Background-There has been controversy over the relation between poverty and asthma in the community. The aim of this analysis was to disentangle geographical and socioeconomic variation in asthma symptoms. Methods-The analysis is based on parental reports of symptoms from data collected in 1990 and 1991. Children aged 5-11 years from three populations (English representative sample, Scottish representative sample, and an English inner city sample) were included. Of 17 677 eligible children, between 14 490 (82.0%) and 15 562 (88.0%) children were available for analysis according to symptom group. Results-Wheezy symptoms were less prevalent in the Scottish sample than in the English samples and asthma attacks were most prevalent in the English representative sample. Asthma attacks were less prevalent in inner city areas than in the English representative sample (OR 0.79, 95% CI 0.66 to 0.95), but persistent wheeze and other respiratory symptoms were more prevalent (OR 1.95, 95% CI 1.65 to 2.32 and OR 1.67, 95% CI 1.52 to 1.84, respectively). The prevalence of persistent wheeze was higher in children whose father's social class was low and in those living in areas with a high Townsend score (an index of poverty) than in other children (p<0.001). Of the 14 areas with the highest Townsend score, 13 had an OR above 1 and six had an OR significantly higher than the reference area. Conclusions-Persistent wheeze is more prevalent in poor areas than in less deprived areas. This may indicate that poverty is associated with severe asthma or that a high percentage of persistent asthma symptoms in inner city areas are unrecognised and untreated.
Allergy, 2004
The prevalence of respiratory and skin symptoms associated with atopy has increased considerably ... more The prevalence of respiratory and skin symptoms associated with atopy has increased considerably over the last 20-30 years, particularly in Western industrialized countries (1-5). This is a cause for concern because of its impact on personal quality of life and the increasing costs to society (6-8). The present knowledge of risk factors for many of these symptoms indicates that opportunities for primary prevention are very limited. In contrast, secondary prevention is necessary and possible but its effectiveness may depend on the capacity to identify correctly atopic patients in primary care.
Investigative Ophthalmology & Visual Science, 2011
Revista de neurologia, Jan 15, 2005
Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neurop... more Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neuropsychiatric disorders beginning in childhood that present a high degree of familial aggregation. ASD is characterised by social interaction and communication disorders, whereas patients with ADHD display persistent inattention and/or hyperactive-impulsive behaviour. With the exception of a few cases of autism in which cytogenetic anomalies or mutations have been reported in specific genes, the aetiology of these diseases remains unknown. This is a group of multifactorial diseases with several genes having a lesser effect and there is also an environmental component. Genetic linkage studies have pointed to about 20 chromosomal regions that could well contain genes that grant susceptibility to autism, to ADHD or to both disorders. The challenge to researchers lies in the clinical characterisation, recruitment of patients with ASD and ADHD, gene dosage quantification studies, comparative gen...
Journal of Epidemiology & Community Health, 1995
Study objective-To examine the associations of social and biological factors with measures of obe... more Study objective-To examine the associations of social and biological factors with measures of obesity in children. Design-The study had a cross sectional design. Setting-The analyses were based on data from two national study of health and growth cross sectional surveys. The "representative sample" comprised 1990 data from 22 English areas and 1990-91 data from 14 Scottish areas; the "inner city sample" comprised 1991 data from 20 English areas. Participants-The subjects were primary school children aged mainly 5-11 years living in England and Scotland. The "representative" sample included 10628 children-6463 living in England and 4165 living in Scotland. The "inner city" sample included 7049 children-2183 white, 1124 Afro-Caribbean, 2696 Indian subcontinent, and 1046 from other groups. Due to missing values on continuous variables, 8374 children were included in the analyses. Measurements and main results-The relation between social environment and childhood overweight was studied using several indicators of obesity. Triceps, subscapular, the sum of triceps and subscapular skinfolds, and weight for height were used as dependent variables. The analyses were carried out in two stages. Firstly, multiple linear regression analyses were used to assess the factors associated with dependent variables treated as continuous. Secondly, multiple linear logistic regression analyses were used to examine the association between independent factors and overweight and fatness defined as binary variables. Birth weight, mother's body mass index (BMI), and father's BMI were consistently associated (p<0-001) in
European Respiratory Journal, 2005
The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s... more The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n5423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.
Revista de Neurología, 2005
LARGE-SCALE GENOTYPING IN RESEARCH INTO AUTISM SPECTRUM DISORDERS AND ATTENTION DEFICIT HYPERACTI... more LARGE-SCALE GENOTYPING IN RESEARCH INTO AUTISM SPECTRUM DISORDERS AND ATTENTION DEFICIT HYPERACTIVITY DISORDER Summary. Introduction and development. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder ( ...
Pharmaceutics
BACKGROUND: Autistic spectrum disorders (ASD) are severe neurodevelopmental alterations character... more BACKGROUND: Autistic spectrum disorders (ASD) are severe neurodevelopmental alterations characterised by deficits in social communication and repetitive and restricted behaviours. About a third of patients receive pharmacological treatment for comorbid symptoms. However, 30–50% do not respond adequately and/or present severe and long-lasting side effects. METHODS: Genetic variants in CYP1A2, CYP2C19, CYP2D6 and SLC6A4 were investigated in N = 42 ASD sufferers resistant to pharmacological treatment. Clinical recommendations based on their pharmacogenetic profiles were provided within 24–48 h of receiving a biological sample. RESULTS: A total of 39 participants (93%) improved after the pharmacogenetic intervention according to their CGI scores (difference in basal-final scores: 2.26, SD 1.55) and 37 participants (88%) according to their CGAS scores (average improvement of 20.29, SD 11.85). Twenty-three of them (55%) achieved symptom stability (CGI ≤ 3 and CGAS improvement ≥ 20 points)...
European Respiratory Journal, 2011
Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in... more Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in primary care is suboptimal. The aim of the present study was to assess a web-based application aiming at fostering high-quality spirometry in primary care. This was a randomised controlled trial with 12 intervention primary care units (PCi) and six control units (PCc) studied over 12 months. All 34 naïve nurses (PCi and PCc) received identical training. The PCi units had access to educational material and remote expert support. Quality of spirometry and usability of the web application were assessed. We included 4,581 patients (3,383 PCi and 1,198 PCc). At baseline, quality was similar (PCi 71% and PCc 67% high-quality tests). During the study, PCi showed higher percentage (71.5%) of highquality tests than PCc (59.5%) (p,0.0001). PCi had 73% more chance of high-quality performance than PCc. The web application was better for assessing quality of testing than the automatic feedback provided by the spirometer. Healthcare professionals' satisfaction and usability were high. The web-based remote support for primary care by specialists generated a sustained positive impact on quality of testing. The study expands the potential of primary care for diagnosis and management of patients with pulmonary diseases.
Respiratory Research, 2010
... pulmonary disease: a population-based study Francisco Garcia-Rio*1, Marc Miravitlles2, Joan B... more ... pulmonary disease: a population-based study Francisco Garcia-Rio*1, Marc Miravitlles2, Joan B Soriano3, Luis Muñoz4, Enric Duran-Tauleria5, Guadalupe Sánchez6, Víctor Sobradillo7, Julio Ancochea8 and EPI-SCAN Steering Committee ...
Allergy, 2007
Background: Few data are available on the asthma burden in the general population. We evaluated t... more Background: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. Methods: In 1999-2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socioeconomic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. Results: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4-15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1-16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18-4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52-5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63-4.61) and sixfold (RRR = 5.76; 95% CI: 3.25-10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16-3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9-27.1%). Conclusions: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females.
European Respiratory Journal, 2010
We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in... more We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n54,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n53,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p,0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.
European Respiratory Journal, 2011
Patients receiving LTOT are frequent users of healthcare services. Pilot studies have shown that ... more Patients receiving LTOT are frequent users of healthcare services. Pilot studies have shown that Integrated Care Services (IC) reduce hospitalizations in these patients and have also identified that deployment of ICS requires an operational definition of frailty that allows risk stratification of patients. Objective: To characterize the risk profile of LTOT patients in an urban area of 540.000 inh in order to allow the design of a one-year follow-up RCT to assess deployment of IC tailored by patient9s frailty. Methods: Observational study examining 751 patient9s records. We planned three home visits for health examination survey, assessment of determinants of frailty, measurement of arterial blood gases and perceived needs. Up to 423 (56%) patients with active LTOT were studied. Preliminary data from an unbiased sample of 282 patients are reported. Results: Eighty six patients (31%) had a P0 2 ≤ 55 mmHg and only 62 of them (22%) used LTOT ≥ 16 h/day. Most patients had never received...
Scientific Reports
Reduced lung function is associated with overall and cardiovascular mortality. Chronic low grade ... more Reduced lung function is associated with overall and cardiovascular mortality. Chronic low grade systemic inflammation is linked to impaired lung function and cardiovascular outcomes. We assessed the association of lung function with overall 8-year mortality in 867 individuals of the Activity and Function in the Elderly study using confounder-adjusted Cox proportional hazards models (including gait speed and daily walking time as measures of physical function) without and with adjustment for inflammatory and cardiac markers. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) but not FVC was related to mortality after adjustment for physical function and other confounders. Additional adjustment for inflammatory and cardiac markers did not change the hazard ratios (HR) markedly, e.g. for a FEV1/FVC below 0.7 from 1.55 [95% confidence-interval (CI) 1.14–2.11] to 1.49 (95% CI 1.09–2.03). These independent associations were also observed in the apparently lung healthy subpo...
Autism Research
This study aims to estimate the prevalence of autism spectrum disorders (ASD) in 2017 and the ASD... more This study aims to estimate the prevalence of autism spectrum disorders (ASD) in 2017 and the ASD diagnosis incidence between 2009 and 2017 in children living in Catalonia region in Spain, and their temporal and geographical variability. We used administrative data for all children aged 2-17 years who were insured in the public Catalan Health System between 2009 and 2017. We identified all ASD cases diagnosed between 2009 and 2017 (ICD-9 codes 299.0, 299.1, 299.8, and 299.9). We estimated the ASD prevalence in 2017 and the overall annual incidence between 2009 and 2017, then stratified by sex, age group, and healthcare area. We used Poisson regression models to assess temporal trends in the incidence and mixed-effects Poisson regression models to assess geographical variability. We observed an ASD prevalence of 1.23% (95% confidence interval [CI] 1.21-1.25) in 2017, with 1.95% (95% CI 1.92-1.99) for boys and 0.46% (95% CI 0.44-0.48) for girls, the highest prevalence being in 11-to 17-year-olds (1.80%, 95% CI 1.76-1.83). The ASD diagnosis incidence increased from 0.07% (95% CI 0.06-0.09) in 2009 to 0.23% (95% CI 0.21-0.24) in 2017, with a higher increase in girls, and in children aged 2-5 years at the time of diagnosis. We only observed geographical differences in prevalence in the 2017 data. We also detected a threefold increase in the diagnosis incidence overall, which was even more pronounced in girls and at early ages. In conclusion, the ASD prevalence observed in this study was 1.23% in 2017, with a sex ratio of 4.5 in favor of boys, which is consistent with previous studies.
International Archives of Allergy and Immunology, 2015
phenotypes of allergic diseases and their interrelationships, to explore disease heterogeneity an... more phenotypes of allergic diseases and their interrelationships, to explore disease heterogeneity and to evaluate the measurements employed in disease diagnosis. Methods: We conducted a search of MEDLINE up to December 2012, to identify relevant original studies published in the English language that examine at least one objective of this systematic review in subjects aged 0-18 years. The screening of titles and abstracts and the extraction of data were conducted independently by two reviewers. Results: From a total of 13,767 citations, 197 studies met the criteria for inclusion, with 54% being cohort studies. Allergic diseases were studied as a single entity in 55% (109/197
Respiratory Medicine, 2013
Background: Patients with COPD may share some clinical characteristics with asthma sufferers. Thi... more Background: Patients with COPD may share some clinical characteristics with asthma sufferers. This phenotypic overlap between COPD and asthma is not yet well characterised. Method: We have analysed data from the EPI-SCAN study, an epidemiological, populationbased study in Spain that included 3885 (40 to 80-year-old) subjects in order to investigate the clinical and systemic inflammatory characteristics of COPD patients previously diagnosed with asthma. Generic and COPD-specific quality of life, as well as physical activity, were also assessed through standardised and validated questionnaires. Results: A total of 385 (10.1%) subjects were diagnosed with COPD, 67 (17.4%) being classified with the COPDeasthma overlap phenotype. Such patients were more likely to have dyspnea and wheezing (p < 0.001 in both comparisons) and more frequent exacerbations (p < 0.001).
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2013
Our aim was to describe the population-based distribution of several COPD multi-dimensional indic... more Our aim was to describe the population-based distribution of several COPD multi-dimensional indices and to evaluate their relationship with daily physical activity, co-morbidity, health status and systemic inflammatory biomarkers. From a population-based sample of 3,802 subjects aged 40-80 from the EPI-SCAN study, 382 subjects (10.2%) with a post-bronchodilator FEV1/FVC&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;0.7 were identified as COPD. Smoking habits, respiratory symptoms, quality of life, co-morbidities, lung function and inflammatory biomarkers were recorded. Health status and daily physical activity were assessed using the EQ-5D and LCADL questionnaires, respectively. The new GOLD grading and the BODE, ADO, DOSE, modified DOSE, e-BODE, BODEx, CPI, SAFE and HRS indices were determined. A notable dispersion in the total scores was observed, although 83-88% of the COPD patients were classified into the mildest level and 1-3% in the most severe. The SAFE index was the best independent determinant of daily physical activity; the SAFE and ADO indices were associated with presence of co-morbidity; and the SAFE and modified DOSE indices were independently related to health status. The systemic biomarkers showed a less consistent relation with several indices. In a population-based sample of COPD patients, the SAFE index reaches the highest relation with physical activity, co-morbidity and health status.