Open Access
Influence of the Mediterranean diet during pregnancy in the development of wheezing and eczema in infants in Pamplona, Spain
(Codon Publications, 2017-06-17) Álvarez Zallo, Noelia; Aguinaga Ontoso, Inés; Álvarez Álvarez, Ismael; Marín Fernández, Blanca; Guillén Grima, Francisco; Azcona San Julián, María Cristina; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background: this study examined the relationship between different food groups and the adherence to a Mediterranean diet during pregnancy and the risk of wheezing and eczema in children aged 12-15 months. Methods: the study involves 1087 Spanish infants from the International Study of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). The study of the association of the different food consumption and Mediterranean diet with wheezing, recurrent wheezing and eczema was performed using different models of unconditional logistic regression to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals (95% CI). Results: no association was found between a good adherence to the Mediterranean diet during pregnancy and the development of wheezing (p=0.372), recurrent wheezing (p=0.118) and eczema (p=0.315). The consumption once or twice a week of white fish (OR: 1.95[1.01-3.75]), cooked potatoes (OR: 1.75[1.22-2.51]) and industrial pastry (OR: 1.59[1.13-2.24]), and the consumption more than three times a week of industrial pastry (OR: 1.47 [1.01-2.13]) during pregnancy increases the risk of "wheezing" at 12 months. Instead, high fruit consumption during the pregnancy has a protective effect against "wheezing" in 12-month-old infants (OR: 0.44 [0.20-0.99]). No statistically significant differences were observed between food intake during pregnancy and "recurrent wheezing". No statistically significant differences were observed between the consumption of any food during pregnancy and the presence of eczema at 12 months. Conclusions: the present study showed that the consumption of Mediterranean diet during pregnancy did not have a protective effect for wheezing, recurrent wheezing or eczema.
Open Access
Trends, projections, and regional disparities of maternal mortality in Africa (1990-2030): an ARIMA forecasting approach
(MDPI, 2023) Onambele, Luc; Guillén Aguinaga, Sara; Guillén Aguinaga, Laura; Ortega-Leon, Wilfrido; Montejo, Rocío; Alas Brun, Rosa María; Aguinaga Ontoso, Enrique; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.
Open Access
Influencia de las características urbanísticas ambientales en el nivel de actividad física de la población de 18 a 65 años del área metropolitana de Pamplona
(Ministerio de Sanidad, Consumo y Bienestar Social, 2016) Orzanco Garralda, María Rosario; Guillén Grima, Francisco; Sáinz Suberviola, María Lourdes; Redín Areta, María Dolores; Rosa Eduardo, Rosanna de la; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Fundamentos: Un entorno adecuado puede favorecer la práctica de la actividad física, siendo una opción fácil para la población. El objetivo fue determinar la influencia de la percepción de los factores urbanísticos ambientales en el nivel de actividad física de las personas adultas. Métodos: Estudio transversal basado en el International Physical Activity and the Environment Network. Las personas participantes fueron seleccionadas de forma aleatoria y estratificada de la población de las zonas básicas de salud del Área Metropolitana de Pamplona entre las que tenían edad de 18 a 65 años. Se utilizó un cuestionario autoadministrado que incluyó la versión completa de la escala Neighborhood Environment Walkability Scale para valorar la percepción de los factores urbanísticos ambientales y la versión larga del International Physical Activity Questionnaire para recoger datos de actividad física. Se calculó la chi2 y se realizó un análisis multivariable mediante regresión logística no condicional Resultados: Participaron 905 sujetos (54,70% mujeres). Tener sendas de paseo próximas al domicilio o lugar de trabajo se relacionó con practicar actividad física moderada OR: 3,86 (IC 95% 1,70-8,74)] y actividad física total (suma de actividad física vigorosa, moderada y caminar) OR: 2,61 (IC 95% 1,24-5,45)]. La presencia en el barrio de lugares a los que podían ir caminando se asoció con dedicar más tiempo a caminar [OR: 1,26 (IC 95% 1,01-1,58)] y disponer cerca del domicilio o lugar de trabajo de espacios deportivos se asoció conpracticar más actividad física vigorosa [OR: 1,46 (IC 95% 1,01 - 2,12). Conclusiones: Existe asociación directa entre las personas que se declaran más activas y los factores urbanísticos ambientales, como sendas de paseo o instalaciones deportivas.
Open Access
Trends in hospital morbidity from Alzheimer's disease in the European Union, 2000-2014
(SAGE, 2018) Niu, Hao; Álvarez Álvarez, Ismael; Aguinaga Ontoso, Inés; Guillén Grima, Francisco; Ciencias de la Salud; Osasun Zientziak
Background: Alzheimer’s disease (AD) has become a concerning public health issue. We aimed to analyse the trends of hospital morbidity from AD in the European Union (EU) in the period 2000-2014. Methods: Data from hospital discharges of men and women over 50 years old hospitalised from AD in the EU were extracted from Eurostat database. We tested for secular trends computing the annual percent change, and identifying significant changes in the linear slope of the trend. Results: Hospital morbidity from AD showed a 0.8% (95% confidence intervals -2.2, 0.6) slight declining trend in the EU. In men and women, we recorded a -0.5% and -1.0% decrease in hospital morbidity rates, respectively. Several countries showed changing trends during the study period. Conclusion: AD hospital morbidity has slightly declined in the entire EU in the past years. Eastern European countries showed steadily increasing trends, whereas in western and Mediterranean countries rates decreased or levelled off.
Open Access
Evaluating the efficacy of ChatGPT in navigating the spanish medical residency entrance examination (MIR): promising horizons for AI in clinical medicine
(MDPI, 2023) Guillén Grima, Francisco; Guillén Aguinaga, Sara; Guillén Aguinaga, Laura; Alas Brun, Rosa María; Onambele, Luc; Ortega-Leon, Wilfrido; Montejo, Rocío; Aguinaga Ontoso, Enrique; Barach, Paul; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model’s overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. Material and methods: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4’s new image analysis capability. Results: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as “error requiring intervention to sustain life” and “error resulting in death”, had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model’s high success rate is commendable, understanding the error severity is critical, especially when considering AI’s potential role in real-world medical practice and its implications for patient safety.
Open Access
Meta-analysis of prevalence of wheezing and recurrent wheezing in infants
(Elsevier, 2016) Álvarez Álvarez, Ismael; Niu, Hao; Guillén Grima, Francisco; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Background: Wheezing affects children’s quality of life, and is related with asthma in childhood. Although prevalence of wheezing has been previously studied in several countries, there are no reference of worldwide prevalence in infants. The aim of this meta-analysis is to estimate the prevalence of wheezing and recurrent wheezing in infants aged up to two years, and compare the prevalence across world regions. Methods: Literature search was conducted in MEDLINE and SCOPUS databases, looking for observational studies published up to June 2016, including as keywords “prevalence” or “epidemiology” combined with “wheeze”, “wheezing” or “asthma symptoms” and “infant” or “preschool”. Fast*Pro software and random effects Bayesian model were used. Heterogeneity was estimated using I2 statistic, and sensitivity analyses were performed. Results: We identified 109 studies after duplicates were removed. After exclusions, 14 studies were included in the meta-analysis. Prevalence of wheezing and recurrent wheezing were 36.06% (95% CI 35.17-36.96), and 17.41% (95% CI 16.74-18.09), respectively. In European countries, prevalence of wheezing was 30.68% (95% CI 28.97-32.45), and 12.35% (95% CI 11.27-13.47) for recurrent wheezing. Prevalence of wheezing and recurrent wheezing in Latin America were higher, 40.55% (95% CI 39.40-41.71), and 19.27% (95% CI 18.44-20.11), respectively. In Africa, prevalence of wheezing was 15.97% (95% CI 14.05-18.00). Low or no heterogeneity was found in all cases. Conclusions: More than one third of infants suffer from wheezing and almost one fifth from recurrent wheezing, being these illnesses especially prevalent in Latin American countries, pointing out an important public health problem.
Open Access
Prevalencia e incidencia de la enfermedad de Alzheimer en Europa: metaanálisis
(Elsevier España, 2017) Niu, Hao; Álvarez Álvarez, Ismael; Guillén Grima, Francisco; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Introducción: La enfermedad de Alzheimer es el principal tipo de demencia, y una enfermedad de etiología desconocida. Con el aumento de la población anciana mundial, el número de pacientes con enfermedad de Alzheimer muestra una tendencia de crecimiento rápido. El objetivo de este metaanálisis es evaluar la prevalencia e incidencia de la enfermedad de Alzheimer en Europa. Metodología: La búsqueda de artículos se realizó en las bases de datos Medline, Scopus y CINAHL Complete utilizando las palabras claves “Alzheimer”, “Alzheimer’s disease” y “AD”; combinadas con “prevalence”, “incidence” y “epidemiology”. Se utilizó el modelo Bayesiano de efectos aleatorios, mostrando intervalos de credibilidad al 95%. Para estimar la heterogeneidad se usó el estadístico I2. Resultados: La prevalencia de enfermedad de Alzheimer en Europa fue 5,05% (IC 95% 4,73-5,39). La prevalencia por sexo en los hombres y las mujeres fue 3,31% (IC 95% 2,85-3,80) y 7,13% (IC 95% 6,56-7,72), respectivamente, y se encontró una tendencia creciente por grupos de edad. La incidencia de enfermedad de Alzheimer en Europa fue 11,08 por 1000 personas-año (IC 95% 10,30-11,89), siendo en los hombres y las mujeres de 7,02 por 1000 personas-año (IC 95% 6,06-8,05) y 13,25 por 1000 personas-año (IC 95% 12,05-14,51), respectivamente, con igual tendencia creciente con el aumento de la edad. Conclusiones: Los resultados del metaanálisis permiten una mejor comprensión de la enfermedad y su impacto en Europa.
Open Access
Variability in the control of type 2 diabetes in primary care and its association with hospital admissions for vascular events. The APNA study
(MDPI, 2021) Guillén Aguinaga, Sara; Forga, Lluís; Brugos Larumbe, Antonio; Guillén Grima, Francisco; Guillén Aguinaga, Laura; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284).
Open Access
Schizophrenia and hospital admissions for cardiovascular events in a large population: the APNA study
(MDPI, 2022) Guillén Aguinaga, Sara; Brugos Larumbe, Antonio; Guillén Aguinaga, Laura; Ortuño, Felipe; Guillén Grima, Francisco; Forga, Lluís; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
(1) Background: patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: the APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031–1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267–3.933). (4) Conclusions: patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.
Open Access
Factores asociados al asma en los niños y adolescentes de la zona rural de Navarra (España)
(Elsevier, 2018) Elizalde Beiras, Itsaso; Guillén Grima, Francisco; Aguinaga Ontoso, Inés; Ciencias de la Salud; Osasun Zientziak
Objetivos: Conocer los factores asociados al asma y síntomas relacionados con asma en la población infantil y adolescente en la zona rural de Navarra (España) a través de la validación del cuestionario ISAAC. Participantes y métodos: Estudio transversal mediante la realización del cuestionario ISAAC y variables adicionales por 797 niños y adolescentes, a través del cual se obtuvieron datos de prevalencia sobre síntomas de asma y factores asociados sin realizar ninguna prueba diagnóstica adicional. Emplazamiento: Marco de atención primaria. A través de las zonas básicas de salud se hizo la selección de la muestra y en los centros educativos de dichas zonas se realizó el cuestionario. Mediciones y resultados: El análisis estadístico se hizo a través de regresión logística, chi cuadrado e intervalo de confianza al 95%. La prevalencia asma referida es del 11,7% en niños y del 13,4% en adolescentes. En cuanto a los factores relacionados, según los valores de OR destacan: OR = 9,5 entre sibilancias y asma, y OR = 3,5 entre rinitis recientes y asma. Respecto a las sibilancias recientes, hallamos un OR = 11,5 entre despertares y sibilancias recientes, y un OR = 3,4 entre rinitis recientes y sibilancias recientes. Conclusiones: El asma referida es una enfermedad prevalente ligeramente superior en la adolescencia y la población femenina de los escolares de la zona rural. Rinitis y otros síntomas de asma están relacionados con el asma y con las sibilancias, así como la utilización de los servicios de urgencias en el caso del asma y la bronquitis con las sibilancias.