Contaminante químico presente en alimentos grasos aumenta el riesgo de cáncer en varones

19 03 2015

Un estudio internacional, en el que participa la Universidad de Granada, demuestra que la exposición a un contaminante químico denominado PCB-153 se asocia positivamente con el riesgo de padecer cáncer.

Este compuesto, prohibido en España desde los años 80, está presente aún en muchos alimentos ricos en grasas, como el atún o el pez espada, debido a su elevada resistencia a la degradación, sin que exista aún un plan de eliminación efectivo.

Parte del grupo de investigación de la UGR que ha participado en este trabajo. De izquierda a derecha: Juan Pedro Arrebola, Marieta Fernández, Francisco Artacho, Inmaculada Jiménez y Rocío Pérez Lobato.

Un estudio internacional, en el que participa la Universidad de Granada, ha demostrado que la exposición a un contaminante químico denominado PCB-153 se asocia positivamente con el riesgo de padecer cáncer de los varones. Este compuesto, prohibido en España desde los años 80, está presente aún en muchos alimentos ricos en grasas, como los pescados grasos de gran tamaño (atún, salmón y pez espada, entre otros), debido a su elevada resistencia a la degradación.

En este trabajo, publicado en la revista Science of the Total Environment, participan diversas instituciones todas ellas incluidas en el Instituto de Investigación Biosanitaria (IBS) de Granada: la Universidad de Granada, el Complejo Hospitalario Universitario de Granada, la Escuela Andaluza de Salud Pública, CIBER en Epidemiología y Salud Pública (CIBERESP), y el Registro de Cáncer de Granada. Además, en este trabajo ha participado un investigador perteneciente al Bispebjerg University Hospital (Dinamarca).

Como explica el autor principal de esta investigación, Juan Pedro Arrebola, del Instituto de Investigación Biosanitaria (IBS), “en la actualidad existe una tendencia creciente en la incidencia de diversos tipos de cáncer, en parte atribuida a la influencia de diversos factores medioambientales, como la exposición a ciertos contaminantes químicos”.

 

Una muestra de 368 hombres y mujeres

El objetivo de este estudio fue analizar si la exposición a ciertos contaminantes químicos, acumulada a lo largo del tiempo, podría estar relacionada con el riesgo de padecer cáncer. Para ello, los científicos analizaron los niveles acumulados de un grupo de contaminantes en la grasa de 368 hombres y mujeres adultos, residentes en la provincia de Granada, y recogieron la incidencia de cáncer a lo largo de los nueve años posteriores al reclutamiento.

“Al cabo de este tiempo, encontramos que, entre los hombres, la exposición acumulada a un contaminante llamado PCB-153 se asoció positivamente con el riesgo de padecer cáncer. El PCB-153 pertenece a un grupo de compuestos químicos llamados Bifenilos Policlorados (PCBs), que fueron ampliamente utilizados en diversas aplicaciones industriales, incluyendo en transformadores eléctricos, condensadores industriales, sistemas hidráulicos, selladores de construcciones, plaguicidas, e incluso como componentes de material plástico”, señala Arrebola.

 

PCBs en el medio ambiente y en las personas

A pesar de que el uso de los PCBs fue prohibido en España durante los años 80, estos compuestos siguen presentes tanto en el medioambiente como en la mayoría de las personas, gracias a su elevada resistencia a la degradación, así como en equipos obsoletos.

“Se estima que los alimentos grasos son la principal vía de exposición a PCBs en la población general, por lo que niveles elevados de PCBs podrían ser, en parte, indicadores de una alimentación rica en grasas”, destaca el investigador. Por otro lado, se sospecha que los PCBs podrían provocar cáncer a través de diversos mecanismos, que incluyen su interacción con receptores hormonales de estrógenos y andrógenos, la producción de radicales libres, o con el ADN.

“Como el cáncer tiene un largo periodo de latencia, nuestro grupo de investigación continúa siguiendo a este grupo de personas para comprobar si estos resultados preliminares se mantienen tras un tiempo de seguimiento mayor”, concluye el investigador de la UGR.

 

Referencia bibliográfica:

Adipose tissue concentrations of persistent organic pollutants and total cancer risk in an adult cohort from Southern Spain: preliminary data from year 9 of the follow-up Arrebola JP, Fernández MF, Martín-Olmedo P, Molina-Molina JM, Sánchez-Pérez MJ, Sánchez-Cantalejo E, Molina-Portillo E, Expósito J, Bonde JP, Olea N. Sci Total Environ. 2014 Dec 1;500-501:243-9. doi: 10.1016/j.scitotenv.2014.08.043. Epub 2014 Sep 15. PubMed PMID: 25217999

 

Canalugr.es [en línea] Granada (ESP): canalugr.es, 19 de marzo de 2015 [ref. 27 de enero de 2015] Disponible en Internet: http://canalugr.es/index.php/ciencia-y-tecnologia-de-la-salud/item/75426-confirman-que-un-contaminante-presente-en-muchos-alimentos-grasos-aumenta-el-riesgo-de-padecer-cáncer-de-los-varones



Individual’s unique microbial ‘fingerprint’ drastically affects home environment

6 10 2014

A person’s home is their castle, and they populate it with their own subjects: millions and millions of bacteria.

 

A recent study investigated the complex interplay between the teeming communities of microbes that are unique to each person and the bacteria found in their homes. Courtesy of Argonne National Laboratory

A study published last week in Science provides a detailed analysis of the microbes that live in houses and apartments. The study was conducted by researchers from the U.S. Department of Energy’s Argonne National Laboratory and the University of Chicago.

 

The results shed light on the complicated interaction between humans and the microbes that live on and around us. Mounting evidence suggests that these microscopic, teeming communities play a role in human health and disease treatment and transmission.

 

“We know that certain bacteria can make it easier for mice to put on weight, for example, and that others influence brain development in young mice,” said Argonne microbiologist Jack Gilbert, who led the study. “We want to know where these bacteria come from, and as people spend more and more time indoors, we wanted to map out the microbes that live in our homes and the likelihood that they will settle on us.

 

“They are essential for us to understand our health in the 21st century,” he said.

 

The Home Microbiome Project followed seven families, which included eighteen people, three dogs and one cat, over the course of six weeks. The participants in the study swabbed their hands, feet and noses daily to collect a sample of the microbial populations living in and on them. They also sampled surfaces in the house, including doorknobs, light switches, floors and countertops.

 

Then the samples came to Argonne, where researchers performed DNA analyses to characterize the different species of microbes in each sample.

 

“We wanted to know how much people affected the microbial community on a house’s surfaces and on each other,” Gilbert said.

 

They found that people substantially affected the microbial communities in a house—when three of the families moved, it took less than a day for the new house to look just like the old one, microbially speaking.

 

Regular physical contact between individuals also mattered—in one home where two of the three occupants were in a relationship with one another, the couple shared many more microbes. Married couples and their young children also shared most of their microbial community.

 

Within a household, hands were the most likely to have similar microbes, while noses showed more individual variation.

 

Adding pets changed the makeup as well, Gilbert said—they found more plant and soil bacteria in houses with indoor-outdoor dogs or cats.

 

In at least one case, the researchers tracked a potentially pathogenic strain of bacteria called Enterobacter, which first appeared on one person’s hands, then the kitchen counter and then another person’s hands.

 

“This doesn’t mean that the countertop was definitely the mode of transmission between the two humans, but it’s certainly a smoking gun,” Gilbert said.

 

“It’s also quite possible that we are routinely exposed to harmful bacteria—living on us and in our environment—but it only causes disease when our immune systems are otherwise disrupted.”

 

Home microbiome studies also could potentially serve as a forensic tool, Gilbert said. Given an unidentified sample from a floor in this study, he said, “we could easily predict which family it came from.”

 

The research also suggests that when a person (and their microbes) leaves a house, the microbial community shifts noticeably in a matter of days.

“You could theoretically predict whether a person has lived in this location, and how recently, with very good accuracy,” he said.

 

Researchers used Argonne’s Magellan cloud computing system to analyze the data; additional support came from the University of Chicago Research Computing Center.

 

The study was funded by the Alfred P. Sloan Foundation. Additional funding also came from the National Institutes of Health, the Environmental Protection Agency and the National Science Foundation.

 

Other Argonne researchers on the study included Argonne computational biologist Peter Larsen, postdoctoral researchers Daniel Smith, Kim Handley and Nicole Scott, and contractors Sarah Owens and Jarrad Hampton-Marcell. UChicago graduate students Sean Gibbons and Simon Lax contributed to the paper, as well as collaborators from Washington University in St. Louis and the University of Colorado at Boulder.

 

 

 

News.uchicago.edu [en línea] Chicago, IL (USA): news.uchicago.edu, 06 de octubre de 2014 [ref. 02 de septiembre de 2014] Disponible en Internet: http://news.uchicago.edu/article/2014/09/02/individuals-microbial-fingerprint-affects-home-environment-study-finds



Nueva Escala que predice el riesgo de complicaciones respiratorias posoperatorias

1 09 2014

Este tipo de complicaciones son las más frecuentes y la principal causa de muerte después de una intervención quirúrgica

La escala consta de 7 ítems sencillos de calcular que permiten clasificar al paciente según 3 grupos de riesgo

Afinar más en el riesgo significa mejorar las medidas adoptadas antes, durante y después de la operación

El estudio se publica este mes de agosto en la edición en papel de la prestigiosa revista científica Anesthesiology, que le dedica la editorial

 

foto: Hospital Germans Trias i Pujol (Can Ruti)

foto: Hospital Germans Trias i Pujol (Can Ruti)

Profesionales del Servicio de Anestesiología y Reanimación del Hospital Universitari Germans Trias i Pujol han validado, en un estudio con 63 centros de 21 países europeos, una escala que predice el riesgo de que los pacientes intervenidos quirúrgicamente padezcan complicaciones respiratorias. Casi un 8% de las personas operadas en Europa sufren este tipo de complicaciones, que sobretodo se concretan en insuficiencia respiratoria o infección pulmonar, y que son la principal causa de muerte posoperatoria. Conocer su riesgo es necesario para actuar con antelación y reducir su incidencia.

Germans Trias creó y valido la escala en Catalunya (bajo el nombre de proyecto ARISCAT) en 2010, y este año ha ratificado su validez a nivel europeo (proyecto PERISCOPE). Así lo publicará la revista Anesthesiology de agosto, que hoy ya se puede consultar en línea y que además le dedica la editorial, ya que el estudio es el primero que valida internacionalmente una escala de estas características.

La escala, que los anestesiólogos pueden aplicar de forma sencilla en la consulta preanestésica con los pacientes, consiste en medir 7 ítems: la edad, la presencia de anemia en los análisis recientes, el tipo de intervención, su duración, la urgencia del procedimiento, las infecciones respiratorias previas y la saturación arterial de oxígeno. Este último es el único ítem que requiere una pequeña prueba en la misma consulta, colocando un aparato en el dedo. Más de 5.000 pacientes europeos aceptaron ser incluidos en el estudio, que ha confirmado que la escala funciona, una vez registrado si sufrieron o no complicaciones respiratorias posoperatorias y cómo evolucionaron.

 

50% depende de la intervención, 50% del estado del paciente

El proyecto PERISCOPE, que clasifica a los pacientes en 3 grupos en función del riesgo de complicaciones, ha ratificado que este riesgo depende en un 50% del estado de salud del paciente antes de la operación. El otro 50% hace referencia a las características de la intervención quirúrgica. También, ha detectado diferencias entre el riesgo de complicaciones respiratorias posoperatorias en función del área de Europa a la que se pertenezca, pero hace falta estudiar más esta cuestión para determinar sus causas.

El siguiente paso es concretar, en base a la experiencia, cuáles son las medidas más adecuadas a adoptar antes, durante y después de la intervención quirúrgica para minimizar el riesgo que PERISCOPE ayuda a afinar. El estudio ha sido financiado gracias a la Sociedad Europea de Anestesiología, mientras que el trabajo que lo precede, ARISCAT, se pudo llevar a cabo gracias a la Marató de TV3.

Gencat.cat [en línea] Badalona (ESP): gencat.cat, 01 de septiembre de 2014 [ref. 31 de julio de 2014] Disponible en Internet: http://www.gencat.cat/ics/germanstrias/arxius_imatges/2014/notesdepremsa/2014_07_31estudianesthesiologycas.pdf

 



Germs, Microbes Compete With Athletes in Sochi Olympics

17 02 2014

By Judy Stone

The Olympics are not just a chance for countries to bring home the gold. They also provide a perfect chance to spread infections all over the world. The Olympics are likely surpassed only by the annual Hajj Islamic pilgrimage to Mecca in the opportunity to rapidly disseminate infections. Let’s look at how.

 

 

Mass Gatherings

The Olympics pales in comparison to the largest gatherings, which are religious. The Hindu pilgrimage along the Ganges River, the Kumbh Mela, attracted 120 million in 2013; visitors may number 5 million on one day alone, but it lacks the global breadth of visitors. Kumbh Mela is thought to have contributed to the 1817-24 cholera pandemic, which spread from the Ganges to Kolkata and Mumbai, across India, and then was further disseminated by British soldiers and sailors to Europe and Asia.

The World Expo in Shanghai in 2010 attracted 73 million for a brief period. Other religious gatherings pale in comparison: Lourdes attracts 5 million/year, Manila’s Feast of the Black Nazarene 7-8 million in 2011. Other sports and political gatherings have generally been far less.

The annual Hajj pilgrimage has been a great place to study mass gatherings. The Hajj ritual attracts 2-3 million people from more than 183 countries to Saudi Arabia each year. Because the location of the gathering is always the same, it is an ideal place to study infectious disease mixing. The Islamic calendar is based on a lunar cycle, so the date and season of the Hajj shift every year, presenting additional challenges, like heat-related illnesses, some years. For example, in August, 1985, more than 18,000 needed treatment for heat exhaustion, there were 2000 cases of heat stroke and more than 1000 deaths at Hajj.
Previous infectious outbreaks at Hajj have included meningococcal infections, TB, pertussis, and influenza. Hajj has provided the opportunity to develop systems for real-time detection of diseases at mass gathering, as well as refinement of “global health diplomacy.”

Non-communicable diseases have had a larger impact than infectious diseases on deaths at mass gatherings. In particular, human stampedes and crush injuries have resulted in more than 7000 deaths and 14000 injured people over the past 27 years.

 

Infectious diseases at religious and sport events

While not likely quite as good as massive religious gatherings at disseminating infection, sports venues like the Olympics contribute their share to public health problems. For example, there have been these outbreaks of infections at mass gatherings:

2000-2001 – meningococcal outbreak at Hajj, led to global spread.

2002 – influenza in Salt Lake Winter Olympics

2006 – norovirus outbreak during the Football World Cup in Germany

2006 – chicken pox outbreak among members of the Maldives volleyball squad during the Asian Games in Doha, Qatar

2006 – leptospirosis in Germany among triathlon athletes

2008 – influenza World Youth Day, Sydney

2009 – Hajj, which took place during the influenza A H1N1 epidemic

2010 – measles at the Winter Olympics in Vancouver, Canada. The outbreak spread to remote areas of British Columbia, causing significant morbidity, especially among indigenous people.

 

What are the likely infections at mass gatherings?

Some of the likely infectious candidates are predictable, like norovirus, the highly contagious vomiting-and-diarrhea causing virus, which is notorious for outbreaks on cruise ships. Cholera has been a big problem in India, as noted above. Food and water-borne outbreaks can spread efficiently. For example, more than 50% of the ~12,700 attendees at the Rainbow Family meeting in North Carolina in 1987 became ill with an unusual strain of Shigella sonnei, due to contaminated drinking water and poor sanitation.

Outbreaks of meningococcal infections, which cause meningitis outbreaks, are less common at Hajj now, because of a mandatory vaccination requirement since 2002. Other respiratory transmitted pathogens include Legionella, tuberculosis, pertussis (whooping cough) and influenza. Flu is worrisome because of the potential for different strains to combine, as mentioned in my recent overview of flu, H1N-what?

Measles has the potential to be a huge problem, because it is highly communicable. Many countries in Europe, including Russia, have active, ongoing measles outbreaks.

Some less common bugs have surfaced, as well. For example, there was an outbreak of African tick-bite fever, caused by Rickettsia africae, among a group of participants in the “Raid Gauloises” in Lesotho and Natal, South Africa. This competition included multiple sports—rafting, horseback riding, trekking, and mountain biking. The attack rate ranged from 3.9-7.6% of participants, with those affected becoming ill with symptoms like headache, lymphadenopathy (swollen glands), fever, myalgias (muscle aches) and a typical rash called “tache noir.” There is a risk of acquiring the parasitic infection schistosomiasis from contact with contaminated water during swimming or water sports in South Africa.

Skin infections like MRSA (methicillin resistant Staph aureus) are frequently transmitted in gyms and locker rooms, or during close contact sports. Other odd outbreaks occur among wrestlers. There have been occasional outbreaks of molluscum, Herpes simplex (Herpes gladiotorum) and Hepatitis B among them. Unexpectedly, 1500 cases of Hepatitis B also occurred among those orienteering in Sweden.
Interestingly, intense exercise may increase an athlete’s susceptibility to infection, especially respiratory tract infections. Close quarters further facilitates spread of droplet and airborne infections.

Some infections likely are acquired not just directly at such sports venues, but through tourism around the event. Zoonotic illnesses from rabies, leptospirosis and tularemia are higher in Sochi than the average rate in Russia and, were it not for the Olympics being held in winter there, would pose an increased risk from people being active outdoors and being exposed to animals.

In 2016, the Olympics will be held in Rio de Janeiro—the first time South America has hosted the event. Dengue cases are common there. While malaria is not transmitted in Rio, ecotourism outside the city might expose visitors to that and to Leishmaniasis, a nasty parasitic infection transmitted by sandflies, as well as to Hepatitis A.

Exotic travel locales tend to lead to “loosening of sexual inhibitions.” Sexually transmitted diseases, including HIV are noted as a possibly high-risk public health problem associated with the Olympics. Presumably, excessive alcohol and drug use associated with sports events also increases this risk.

 

Besides these direct person-to-person forms of transmission, vector-borne diseases can potentially cause big problems. We’ve just seen that with the recent emergence of a viral infection, Chikungunya, in the Carribbean, where it has just become established for the first time. Previously, this virus was limited to Asia and Africa, then spread to Italy in 2007, before arriving in St. Maarten’s. Just in the past month, there has been an explosion in cases, now spreading throughout the Carribbean. This virus, like dengue, is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Asian tiger mosquitoes  (A. albopictus) were introduced to the Americas in the mid-1980s, probably in old scrap tires with pools of standing water. Initial spread then followed the interstate highway routes. These specific mosquitoes can transmit these tropical diseases, allowing them to become established now in the western hemisphere. No doubt Chikungunya will soon follow dengue and move to the Florida coast and Tex-Mex border as well.  All it takes is an infected traveler to be bitten by a mosquito, who then transmits it to another person. Or it could set up housekeeping in New York City, by the combination of travelers and global warming allowing the mosquito to propagate. Some worry that Yellow Fever could similarly become reestablished in the USA in this way, just as dengue did in the 1980s.

 

Planning considerations

At the Olympics, as for Hajj, planning for infectious disease has to take a number of factors into consideration. These include what diseases might be endemic in the region of the gathering, and what diseases might be circulating seasonally, like the current influenza. A particular problem is that air travel enables dissemination of an infection like the flu or measles, both of which are highly transmissible, before the incubation period is complete. Seasonal flu will not be readily detected by surveillance systems, unless a new strain emerges. Such surveillance systems, like GeoSentinel, are more likely to pick up a spike or cluster of unusual infections. For example, in 2000, 304 athletes from 26 countries participated in an endurance race in Borneo, Malaysia. After they returned home, a London GeoSentinal clinic identified a patient with suspected leptospirosis, an infection associated with exposure to water which has been contaminated by rodent waste during sports (think kayaking, swimming, for example). Within hours, other suspected cases were identified in Canada and the US. An alert enabled others who were exposed to receive prompt antibiotic treatment.
Projects like HealthMap and ProMed are invaluable resources, gathering data from search engine queries and case reports, serving as an early warning system. Besides, they are just fun sites to browse, as there is often something weird and new being reported.

The scope of the logistical planning involved is also intriguing. Modeling helps in evaluating different scenarios and predicting problem spots. But think of the magnitude of concerns—from transportation and moving people without provoking riots, stampedes, and crushing deaths, to housing. Think of providing food and water for 3 million in 1 week at Hajj. How do you handle sanitation and waste disposal? It seems miraculous that there are not more infectious outbreaks linked to mass gatherings. Add to this the number of countries sending visitors, the various languages, and the need for cooperation between so many countries, and the success becomes even more impressive. Imagine if such cooperation occurred in other situations.

From the infectious disease perspective, surveillance is essential, as are strict regulations to try and prevent the spread of communicable disease. Mass gatherings are not the place to try raw goat milk for all, or undercooked meat. Sanitation needs to be efficient. And it is imperative to insist on vaccinations, as Saudi Arabia did for reducing meningococcal infections during Hajj.

 

What to watch for in Sochi

So the big things to watch for, bug wise, are influenza and measles rapidly spreading. Colds, strep throat, and similar common infections are readily spread in close quarters and by athletes pushing themselves to compete, even when ill. Twenty years ago, there was a memorable outbreak of diptheria in Russia; fortunately, that has been well-controlled.

Drug-resistant tuberculosis (MDR-TB) is rising in Eastern Europe. The Russian Federation ranks third globally in total cases of multi drug-resistant TB (MDR-TB), beaten only by China and India. A scary recent genetic study of 1000 TB isolates from Russia found not only widespread drug resistance, but mutations that enabled the TB to spread more readily.

If the flu strains commingle, we could see new pandemic strains emerge, with athletes bringing home far more than the gold.

 

What can we do to reduce risk of infections?

Several diseases are highly contagious before a person develops symptoms, including influenza, measles, and chickenpox. This obviously makes them of great concern wherever large numbers of people gather. Just as Saudi Arabia now requires meningococcal vaccine to attend Hajj, thought should be given to requiring some vaccinations to attend sports and other mass gatherings—particularly measles and influenza.
To protect yourself—at home and abroad—be sure to have your vaccinations:
Hepatitis A & B
measles-mumps-rubella (MMR) vaccine,
diphtheria-tetanus-pertussis vaccine,
varicella (chickenpox) vaccine,
polio vaccine, and your yearly flu shot.

Without those precautions, Olympic visitors and participants in other mass gatherings may get far more than than they bargained for when they purchased their tickets. Additionally, I always get a baseline TB test before I leave and after I return from higher-risk travel overseas.
I also keep my Kwikpoint translator card handy (most recently, it was handy on an international flight where attendants couldn’t communicate with a passenger seated near me). I love those cards.

So enjoy your travels. I’m going to sit back and watch for any new diseases that might emerge, and marvel at how epidemiologists do their sleuthing. Disease detection is a great spectator sport!

 

 

 

About the Author: Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website.

 

Credits:

Measles and tuberculosis maps, courtesy WHO

 

Blogs.scientificamerican.com [en línea] Cumberland, MD (USA): blogs.scientificamerican.com, 17 de febrero de 2014 [ref. 05 de febrero de 2014] Disponible en Internet: http://blogs.scientificamerican.com/molecules-to-medicine/2014/02/05/germs-microbes-compete-with-athletes-in-sochi-olympics/



Trastorno por atracón: una enfermedad muy prevalente pero no tratada

13 02 2014

La Organización Mundial de la Salud acaba de publicar los resultados de un estudio realizado sobre el trastorno por atracón, un trastorno de alta prevalencia pero que pasa ampliamente desapercibido y que no está tratado a pesar de que conlleva alteraciones comparables a las de la bulimia nerviosa. El estudio se ha realizado a partir de estudios epidemiológicos realizados en 12 países de todo el mundo, con un total de 22.635 adultos encuestados y muestra que el trastorno por atracón es aproximadamente dos veces más común que la bulimia entre los países estudiados (EE.UU., Brasil, Colombia, México, Bélgica, Italia, Países Bajos, Irlanda del Norte, Portugal, Rumania, España y Nueva Zelanda ). El estudio en España ha sido liderado por Jordi Alonso, director del Programa de Epidemiología y Salud Pública del IMIM (Instituto Hospital del Mar de Investigaciones Médicas).

 El trastorno por atracón (adaptación del término inglés Binge Eating Disorder) es un trastorno de la conducta alimentaria que supone en la mayoría de los casos un aumento de peso y, incluso, obesidad, pero también otras importantes implicaciones físicas y psicológicas. El caso típico es el de una persona que siente deseos diarios de ingerir alimentos de forma descontrolada (en ocasiones, sobrepasando la ingesta de 6000 calorías diarias), pero, a diferencia de la bulimia, no busca contrarrestar el empacho provocándose el vómito.

El Trastorno por atracón ha sido ampliamente ignorado por los proveedores de atención de la salud, pero tiene un enorme coste para la salud física y el bienestar psicológico de las personas con la enfermedad“, explica Ronald Kessler, profesor de Políticas de Salud en la Escuela de Medicina de Harvard y autor principal del artículo. “Cuando todos los casos de la enfermedad se toman en conjunto, los niveles elevados de depresión, el suicidio y los días perdidos en el trabajo representan costes importantes para la sociedad.”

Este es un trastorno recientemente reconocido como trastorno independiente de la conducta alimentaria por la Asociación Psiquiátrica Americana y se cree que pueden existir factores genéticos que predispongan a su desarrollo que, además, tiene asociada una alta incidencia de comorbilidad psiquiátrica. El estudio confirma que tanto el trastorno por atracón como la bulimia nerviosa surgen durante la adolescencia y van asociados con una serie de trastornos mentales de inicio tardío (incluyendo trastornos de depresión y ansiedad) y de trastornos físicos (por ejemplo, los trastornos musculoesqueléticos y la diabetes).

“Este estudio ha permitido conocer por primera vez la prevalencia del trastorno por atracón a nivel internacional y comprender mejor la magnitud del problema. Además, los resultados evidencian que hay que conocer y detectar mejor los trastornos de la alimentación durante los años escolares, ya que esto será de gran ayuda para prevenir la aparición de trastornos mentales y físicos posteriores y las deficiencias asociadas a estos trastornos” explica Jordi Alonso, director del Programa de Epidemiología y Salud Pública del IMIM.

El análisis de este trabajo se llevó a cabo conjuntamente con la Encuesta Mundial de la Salud de la Organización Mundial de la Salud Mental (WMH), y estuvo apoyada por el Instituto Nacional de Estados Unidos para la Salud Mental, el Estudio de la carga de la Salud Mental y por una serie de organismos gubernamentales en los demás países participantes, así como por fundaciones y patrocinadores de la industria.

 

Artículo de referencia

A comparative analysis of role attainment and impairment in binge – eating disorder and bulimia nervosa : results from the WHO World Mental Health Surveys” RC Kessler , V. Shahly , J.I. Hudson, D. Supina , P.A. Berglund , W.T. Chiu , M. Gruber , S. Aguilar- Gaxiola , J. Alonso, L.H. Andrade, C. Benjet , R. Bruffaerts , G. de Girolamo , R. de Graaf , S.E. Florescu , J.M. Haro, S.D. Murphy, J. Posada-Villa, K. Scott and M. Xavier. Epidemiology and Psychiatric Sciences doi : 10.1017/S2045796013000516

 

 

 

Imim.es [en línea] Barcelona (ESP): imim.es, 13 de febrero de 2014 [ref. 17 de octubre de 2013] Disponible en Internet: http://www.imim.es/noticias/360/trastorno-por-atracon-una-enfermedad-muy-prevalente-pero-no-tratada



BENEFICIOS DE LA INNOVACIÓN TECNOLÓGICA EN LA SALUD

30 12 2013

Un estudio realizado alrededor de ocho países descubrió que el 70 % de los encuestados se sentirían cómodos utilizando sensores de tocador, sensores en botellas de medicina o monitores de salud tragados para recolectar información personal de salud.

 

La encuesta, llevada a cabo por la agencia de estudios de mercado Penn Schoen Berland y patrocinada por Intel, también demostró que la mayor parte de la gente cree que la innovación tecnológica representa la solución más viable para curar enfermedades fatales, aun más que incrementar el número de doctores o aumentar el presupuesto de investigación.

Asimismo, los encuestados dijeron sentirse cómodos con la idea de formar parte de revisiones remotas a través de teleconferencias. De hecho, el 72 % dijo apoyar la idea de conectarse remotamente con su médico a través de tecnologías de comunicación y la mayoría se sentiría cómoda utilizando tecnología desde casa en su propio organismo en lugar de asistir al médico.

Más de la mitad de los encuestados (57 %) cree que, eventualmente, los hospitales se volverán obsoletos y más del 80 % dijo que compartirían información anónimamente para reducir costos de salud y mejorar servicios y tratamientos.

Intel dice que el estudio revela que la mayor parte de la gente quiere servicios de salud personalizados, basados en sus propia conducta y biología, lo cual brinda la posibilidad de obtener cuidados de la salud en cualquier lugar y momento.

 

 

Cioal.com [en línea] Doral, FL (USA): cioal.com, 30 de diciembre de 2013 [ref. 11 de diciembre de 2013] Disponible en Internet: http://www.cioal.com/2013/12/11/beneficios-de-la-innovacion-tecnologica-en-la-salud/



Descubren las causas de la fibrosis pulmonar idiopática

31 10 2013

Investigadores del Hospital Universitario Vall d’Hebron y del grupo de neumología del Vall d’Hebron Institut de Recerca (VHIR) han demostrado que se pueden determinar las causas de la fibrosis pulmonar idiopática en la mitad de los casos tras la realización de un estudio clínico en profundidad, que incluye un interrogatorio exhaustivo y sistematizado, determinación de anticuerpos frente a las substancias causales, pruebas de inhalación, cultivos y mediciones ambientales en los lugares que frecuenta el paciente (casa y trabajo) para detectar los antígenos que puedan causar esta grave enfermedad.

 

De izquierda a derecha: Dra. Maria Jesús Cruz, Dr. Ferran Morell y la neumóloga Ana Villar

De izquierda a derecha: Dra. Maria Jesús Cruz, Dr. Ferran Morell y la neumóloga Ana Villar

La importancia de este estudio clínico, realizado con pacientes de la consulta externa del servicio de Neumología del Hospital, es que demuestra que con una asistencia sistematizada y en profundidad y con las técnicas adecuadas, también se pueden lograr adelantos para nuestro sistema sanitario”, afirma el Dr. Ferran Morell, autor principal del estudio.

 

El estudio, publicado en The Lancet Respiratory Medicine, se realizó entre 2004 y 2011 en 60 pacientes con esta enfermad y va a abrir una nueva vía en el diagnóstico y tratamiento de esta patología, ya que la identificación de las causas permitirá prevenir esta patología y con ello se evitará que la enfermedad evolucione hacia fases avanzadas o graves.

 

Los investigadores han descubierto que una de las principales causas de la fibrosis pulmonar idiopática es la exposición a los edredones y almohadones de plumas, así como también a la exposición a aves y hongos en cantidades mínimas pero persistentes. En definitiva, se trata de la enfermedad llamada Neumonitis por Hipersensibilidad crónica, enfermedad en la que el Hospital Universitari Vall d’Hebron es referencia mundial.

Para poder diagnosticar a tiempo esta patología, el Dr. Ferran Morell asegura que “es imprescindible para el estudio diagnóstico de los pacientes el tener a punto las técnicas para la detección de anticuerpos frente a las substancias causales y las pruebas de inhalación (broncoprovocación), así como la realización de extractos solubles a partir de las substancias, etc.”.

 

La fibrosis pulmonar idiopática es una enfermedad reconocida desde 1940, en la que ambos pulmones progresivamente se fibrosan (cicatrizan); así, el pulmón pierde elasticidad lo que dificulta la inspiración, perdiendo el paciente paulatinamente capacidad respiratoria. Esta enfermedad afecta a unos 10.000 pacientes en España (2.000 en Cataluña) y tiene una incidencia de entre 10 y 20 casos nuevos por cada 100.000 habitantes y año.

 

 

 

 

Vhir.org [en línea] Barcelona (ESP): vhir.org, 31 de octubre de 2013 [ref. 18 de octubre de 2013] Disponible en Internet: http://www.vhir.org/salapremsa/mitjans/mitjans_detall.asp?any=2013&num=269&mv1=5&mv2=1&Idioma=es&titol=Investigadores+de+Vall+d’Hebro



Epidemic Proportions

3 10 2013

The fight against infectious diseases increasingly links discovery with care

 

A WAR WITH LITTLE PEACE: The incidence of extensively drug-resistant tuberculosis continues to grow in Russia. This young man is a patient in a tuberculosis ward in a psychiatric hospital in the North Caucasus region of that nation.

 

 When Mycobacterium tuberculosis invades a person’s body, it doesn’t just settle into the lungs and look for a spot from which to eke out a living. It hijacks that person’s macrophages—cells that attack invading bacteria—and uses the mechanisms of inflammation to manipulate the environment around it, remodeling its new home to suit its needs.

 

Salmaan Keshavjee knew about Mycobacterium’s penchant for makeovers, and thought that this knowledge might be useful in the fight against tuberculosis. So he was intrigued when he learned of an unusual approach that researchers at Sweden’s Karolinska Institutet were taking to control these bacteria-orchestrated renovations.

To understand this twist in the body’s normal path of self-defense, and to find ways to get the immune response back on track, the Sweden-based team, led by Markus Maeurer, a professor of clinical immunology at the institute, had cultured the mesenchymal stem cells from patients with extensively drug-resistant tuberculosis (XDR TB), then reinfused the patients with those cultured stem cells. Because mesenchymal stem cells help suppress inflammation, the researchers wanted to see if they could safely dampen and refocus the inflammatory response without  compromising immune function.

“Their preliminary data suggested that the stem cells didn’t suppress immunity in an adverse way, and surprisingly, the patients who received the transplanted cells did much better on their XDR TB treatment than typical patients in their condition,” says Keshavjee, an HMS associate professor in the Department of Global Health and Social Medicine and a physician in the Division of Global Health Equity at Brigham and Women’s Hospital. With the treatments now in use, fewer than a third of patients with XDR TB recover, but in this small initial study, all the participants appeared to recover.

Keshavjee is developing a partnership with the institute’s team, laying a foundation for more-extensive trials of the treatment in Russia and Peru. “Saving lives from a disease that’s killing people—that’s always good,” Keshavjee says. “But this work also opens the door to thinking about tuberculosis differently. If the mycobacterium is manipulating its environment by modulating T cells and other immune cells, we need to ask, ‘What if we unmodulate that environment?’ ”

“Inside our bodies, the bugs are living in an ecosystem,” he adds. “As humans, we also have our own ecology, which plays out in society. Recognizing the complex biosocial nature of infectious diseases moves you toward some crucial insights about how these diseases work and how to fight them.”

To fight infectious diseases worldwide, biomedical researchers and clinicians are joining efforts to apply laboratory-based discoveries to the challenge of saving the lives of people with tuberculosis, cholera, and other age-old ravages. These international collaborations are increasingly considering such diseases in context, as integrated parts of complex interconnected systems that involve humans.

 

“We now have genomic and proteomic platforms that are beginning to have immediate relevance to the challenges of diagnosing and treating infectious disease in poor communities,” says Paul Farmer ’90, the Kolokotrones University Professor at Harvard, head of the Department of Global Health and Social Medicine at HMS, and a cofounder of Partners In Health, an international nonprofit that brings health care to the poor. “Many of these new technologies are more portable, scalable, and affordable than ever before.”

 

In Black and White

Tuberculosis is a global public health issue that is unevenly distributed: the burden of the disease is highest in Asia and Africa, with India and China accounting for almost 40 percent of cases. Africa has 24 percent of the world’s cases and the highest rates of disease and death per capita. In the Russian Federation, XDR TB is a particular concern: it has rapidly spread through prison populations. In Peru, while the incidence of tuberculosis is decreasing, the incidence of multidrug-resistant tuberculosis is on the rise. Overall, according to a 2012 report from the World Health Organization, there were an estimated 8.7 million new cases of tuberculosis and 1.4 million deaths worldwide from the disease in 2011.

Similar sobering statistics can be found for cholera. Although up to 80 percent of cholera cases can be successfully treated with low-cost oral rehydration salts, the WHO estimates that annually more than 100,000 people succumb to the disease.The impact of cholera is most acute in regions with poor sanitation and unsafe supplies of drinking water, conditions that annually spawn three to five million cases worldwide. The entire country of Bangladesh is considered at high risk for this disease, the only country with this designation from the WHO.

 

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Like tuberculosis, cholera elicits a complex immune response. The infection takes place in the mucosal membrane of the small intestine, where billions of beneficial bacteria live. Our gut microbiota perform welcome chores such as fermenting carbohydrates to release their useful energy. Although our gut mucosa is always on the alert for foreign bacteria, killing every newcomer would be imprudent, as some may be useful in maintaining the health of their human host. Yet when a pathogen is identified, the mucosal cells mount a vigorous immune response.

 

Unfortunately, the basic mechanisms of that response are still poorly understood. This knowledge gap has hindered the development of effective, durable vaccines for diseases such as cholera. In fact, current vaccines offer only partial protection that lasts for just a few years.

To extend this protection, or perhaps even block the disease permanently, researchers, including John Mekalanos, the Adele H. Lehman Professor of Microbiology and Molecular Genetics and head of the Department of Microbiology and Immunobiology at HMS, are tweaking the genetic makeup of Vibrio cholerae. The trick has been determining how to eliminate the genes that turn off the disease without disturbing the ones that elicit an immune reaction. Mekalanos, along with Mike Levine at the University of Maryland, has pioneered the use of a live oral cholera vaccine. This vaccine uses a genetically altered version of the organism that is unable to cause disease.

In addition to learning which genes halt the cholera bacterium, it is necessary to understand which ones are activated during its transmission and infection. Stephen Calderwood ’75, the Morton N. Swartz, M.D. Academy Professor of Medicine (Microbiology and Immunobiology) at HMS and Massachusetts General Hospital, is looking at gene expression at different points in V. cholerae’s life cycle to determine which genes are expressed by the pathogen during infection, as well as which trigger immune responses in the human host.

For this research, Calderwood is collaborating with clinicians and researchers at the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh. Calderwood’s team has collected thousands of samples from patients who have been hospitalized with severe cholera.

 

The Sniff Test

The insights from such molecular biology studies can also lead to some surprising diagnostic tools for infectious disease. The tubercle bacterium, for example, can be insidious; it can lurk in the lungs of a mildly infected patient for years. Active infections of the bacterium, however, release a detectable signature of volatile organic compounds. This airborne fingerprint may be useful in diagnosing the disease, particularly in children; not only is it difficult for them to produce sufficient sputum for analysis, their sputum contains relatively few of the organisms.

“A baby’s exhalation could be captured,” says Ed Nardell, an HMS associate professor of medicine at Brigham and Women’s, “so she wouldn’t need to produce a sputum sample.”

 

Nardell is part of a team that’s investigating the effectiveness of a new gas chromatography technology that can detect the chemical signature of M. tuberculosis in a few puffs of human breath. In some parts of the world, giant Gambian rats, trained to sniff out the bacterium’s signature compounds, are already being used to detect M. tuberculosis in sputum samples. Unlike humans using microscopes, these trained rats accurately examine specimen after specimen without fatigue—and all for the fee of a sweet treat.

 

Phase Shifts

Another complicating factor in the fight against these diseases is that the causal agents change throughout their life cycles. The tubercle bacterium modifies its environment to suit its needs. By contrast, the cholera bacterium acclimates itself to the environment it inhabits. Many cholera microbes spend their lives in water, feeding on plankton to derive energy. During this aquatic phase, the adaptations that help them survive in water make them much less infectious in humans. Calderwood and his team, however, have discovered that the cholera microbes found in the fecal matter of infected humans—before the microbes adapt to the aquatic environment—are hyperinfectious for a brief period following their evacuation from the host.

Because this human ecology is important to the transmission of the disease, Calderwood’s collaborators in Bangladesh dispatch research teams to patients’ homes. To study disease transmission in a household, the team invites all family members, sick or well, to participate. While visiting, the team can survey a patient’s living conditions and, if needed, provide medical care to other family members.

 

“These diseases are perfect examples of how knowing the social context of an infection can be crucial,” says Mercedes Becerra, an HMS associate professor of global health and social medicine. “It’s not some vague notion of social context; it’s actually seeing the physical setting where people live and testing the strains that have infected different members of a family or community. The household is a really important unit for analysis and for medical interaction.”

Just as it is crucial to see how the bacteria operate—at the chemical and genetic levels—in human hosts, it is important to understand how the illness plays out in the context of specific human populations, according to Becerra.

 

Knit One, World View

These diseases also interact in another key ecosystem: the community of HMS researchers working on global health and infectious disease. Some may be community health workers with knowledge of the lives of their neighbors. Some are social scientists measuring the clinical effectiveness of different approaches to preventing and treating these diseases, or mapping the social, political, and historical aspects of health. Geneticists, immunologists, engineers, and architects—each play a role in teasing out the intricacies of these diseases and the pathogens that cause them.

“To beat these diseases, somebody has to understand the immune system and the bugs at different levels,” Becerra says, “while others have to work on understanding the impact on patients and families. That’s why it’s so important to work together from multiple angles, linking discovery with care delivery—and then turn around to look for new discoveries.”

Jake Miller is a science writer in the HMS Office of Communications and External Relations.

 

by Jake Miller

 

 

 

Hms.harvard.edu [en línea] Cambridge, MA (USA)

hms.harvard.edu, 03 de octubre de 2013 [ref. Summer 2013] Disponible en Internet: http://hms.harvard.edu/news/harvard-medicine/harvard-medicine/how-bugs-are-built/epidemic-proportions



Dr VALDERAS: Cuando lo que cuentan son los resultados en salud percibidos por los pacientes: ¿ensayo de una utopía?

1 04 2013

 

Jose M Valderas

Director del Grupo de Investigación en Servicios y Políticas de Salud en el Departamento de Atención Primaria de la Universidad de Oxford. 

 

 

El Servicio Nacional de Salud británico (National Health Service (NHS)) está llevando a cabo una iniciativa única en el mundo en el ámbito de los resultados percibidos por los pacientes (patient reported outcomes) conocido como el Programa PROMS (por patient Reported Outcome Measures). Por vez primera, la retórica habitual sobre la importancia de estas medidas ha dado paso a un ambicioso proyecto cuya visión a largo plazo es que extender su uso a todos los ámbitos de la atención sanitaria en los que sea factible.

Desde 2009, se recogen mediciones de resultados percibidos para todos los pacientes y para cuatro procedimientos quirúrgicos electivos financiados por el NHS, tanto si se realizan en hospitales públicos como privados. Actualmente se está en fase de prueba piloto su extensión a procedimientos de revascularización coronaria, cáncer, enfermedades crónicas en Atención Primaria y demencia. El Reino Unido se coloca de esta forma una vez más como punta de lanza y auténtico laboratorio de ideas en investigación en servicios de salud, casi una década tras la implementación del sistema de incentivos de atención primaria conocido como Quality and Outcomes Framework.

 

Siguiendo la estela del anterior programa, una de las características clave de la iniciativa PROMS reside en que los objetivos se centran en el uso de la información para estimular la mejora de la calidad asistencial en su conjunto. Se basa por ello en información agregada (por profesional, centro y áreas sanitarias), pero aunque se están explorando aplicaciones de esa información como apoyo a ámbitos tan diversos como la evaluación de tecnologías sanitarias o la preparación de los contratos entre los grupos de Atención de Primaria y los proveedores de servicios sanitarios de segundo nivel, no existe por el momento ningún plan para avanzar en el uso clínico de la información. Y sin embargo es ésta una limitación que forzosamente se ha de ver superada por iniciativa de los proprio profesionales, para superar la brecha entre una evaluación por indicadores y una práctica clínica en los que esta información está ausente.

 

En estas cuestiones la implementación es absolutamente fundamental y en el plazo de escasos años podremos saber si se ha sabido extraer los máximos frutos a esta oportunidad y se prepara el terreno para su aplicación a otros ámbitos y países o si por el contrario se impone una vez más la dura realidad de la resistencia al cambio en la práctica clínica cimentada en la deficiente aplicación de las mejores ideas.

 

 

 

Para saber más:

 

http://www.ic.nhs.uk/proms

 

http://www.kingsfund.org.uk/publications/getting-most-out-proms

 



Chequeos de Salud: ¿reducen la morbimortalidad ligada a enfermedades?

31 12 2012

BMJ ha publicado una revisión sistemática y meta-análisis Cochrane sobre los chequeos (revisiones) generales en adultos sanos que pretenden reducir la morbilidad y la mortalidad ligada a enfermedades.

Los autores, del Centro Nórdico Cochrane de Copenhague, se plantearon como objetivo el cuantificar los beneficios y riesgos de estos chequeos, atendiendo especialmente a los resultados relevantes para los pacientes, la morbilidad y mortalidad, en vez de limitarse a los resultados en variables subrogadas como la colesterolemia o la tensión arterial.

Se revisaron 16 ensayos clínicos aleatorizados. Los resultados de la revisión: No se encontraron efectos beneficiosos de los chequeos de salud generales sobre morbilidad, hospitalización, incapacidad, preocupación, visitas médicas adicionales o absentismo laboral, pero no todos los estudios informaron sobre estos resultados. Un ensayo encontró que estos chequeos produjeron un aumento del 20% en el número total de nuevos diagnósticos por participante durante seis años, en comparación con el grupo control, así como un mayor número de personas que se autodefinen como afectados por enfermedades crónicas; un ensayo encontró una mayor prevalencia de hipertensión e hipercolesterolemia. Dos de cuatro estudios encontraron un mayor uso de antihipertensivos. Dos de cuatro ensayos encontraron pequeños efectos beneficiosos sobre la salud autopercibida que podría deberse a un sesgo.

Los autores concluyen que los chequeos generales de salud en adultos no redujeron la morbilidad o la mortalidad, ni general ni por causas cardiovasculares o cáncer, a pesar de que aumentó el número de nuevos diagnósticos. Con frecuencia, los importantes resultados perjudiciales para los pacientes que se someten a estos chequeos o no se estudian o no se informa de ellos en los resultados publicados.

Este tipo de chequeos generales pueden descubrir alteraciones como cifras de tensión arterial o de colesterol elevadas, que son factores de riesgo de padecer enfermedades, pero en sí mismas no producen síntomas y pasan desapercibidas por los afectados. De ahí se dedujo que los chequeos en salud periódicos, al desvelar factores de riesgo y diagnosticar precozmente enfermedades tratables, redundarían en una disminución de la morbilidad y la mortalidad. Los resultados de esta revisión, con un alto nivel de evidencia para la mortalidad global y por cáncer y con un nivel de evidencia moderado para la mortalidad por causas cardiovasculares, revelan que tales beneficios esperados no se producen en la realidad.

Lo que sí hay evidencia de que producen esos chequeos es iatrogenia. Personas que no padecen síntomas ni signos algunos, pasan tras los descubrimientos de estas revisiones a ser consideradas como enfermos, frecuentemente crónicos, con el impacto psicológico y en su calidad de vida que eso supone. Los tratamientos a los que se les somete tienen muchos, y algunos muy graves e incluso fatales, efectos adversos. Tanto los tratamientos como la cascada de nuevas pruebas diagnósticas y de control a las que se somete a estas personas suponen un gasto y un consumo de recursos muy importantes. Recursos cuyo consumo, a la luz de los resultados de esta revisión, no produce beneficios en salud sino problemas, y que podrían haber sido utilizados en otras actividades de beneficios bien conocidos.

Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General healthchecks in adults for reducing morbidity and mortality from disease: Cochranesystematic review and meta-analysis.

BMJ. 2012 Nov 20;345:e7191. doi: 10.1136/bmj.e7191.

Publicado por Jesús Palacio

Sano-y-salvo.blogspot.com.es [en línea]  (ESP): sano-y-salvo.blogspot.com.es, 19 de diciembre de 2012 [ref. 19 de diciembre de 2012] Disponible en Internet: http://sano-y-salvo.blogspot.com.es/2012/12/chequeos-generales-de-salud-en-adultos.html