Paloma Ortega’s research while affiliated with Complutense University of Madrid and other places

Purpose: Despite the notable increase on the prescription of antidepressants and anxiolytics during pregnancy, recommendation on maintaining the treatment during prenatal period is still controversial. We aimed to separately assess the role of effects of the antidepressants and anxiolytic and the underlying illness, controlled by potential confounding associated with miscarriage onset. Methods: We used data from a validated pregnant cohort aged 15-49 years from 2002-2016 using BIFAP database. All confirmed miscarriages were used to perform a nested control analysis using conditional logistic regression. Women were classified according to use of each drug of interest into four mutually exclusive groups: non-users, users only during pre-pregnancy, continuers, and initiators during first trimester. Adjusted odds ratios (aORs) for major confounders during pregnancy such as number of visits to Primary Care Practitioners (PCP) visits, obesity, smoking, HTA, diabetes with 95% confidence intervals (CIs) were calculated. Results: Compared with non-users, antidepressants continuers had the highest increased risk of miscarriage aOR (95%) of 1.29 (1.13-1.46), being continuers of paroxetine and fluoxetine the antidepressants with the strongest association. Likewise, continuers of anxiolytics and initiators showed an increased risk of 1.19 (1.04-1.37) and 1.30 (1.13-1.50). When separating the effect between the condition itself or the treatment, women exposed during first trimester, regardless treatment duration and/or the underlying illness, had the highest risk 1.27 (1.08-1.51) for antidepressants and 1.25 (1.13-1.39) for anxiolytics CONCLUSIONS: Our analysis showed an association between prenatal exposure to antidepressants and anxiolytics and miscarriage onset after controlling by potential confounding adjusting for confounders and the underlying illness. This association was not supported for hypnotic medications. Further studies are warranted to evaluate the risk of miscarriage among subpopulation of pregnant women requiring these medications. This article is protected by copyright. All rights reserved.

(1) Background: There is a major gap of knowledge towards the natural history of miscarriages in electronic medical records. We aimed to calculate the frequency of miscarriages using data from BIFAP database. (2) Methods: We identified all pregnancy losses and carried out a multistep validation exercise. Potential cases with positive predictive values (PPV) of miscarriage confirmation <85% or those confirming other pregnancy loss were excluded. Kaplan–Meier figures and incidence rates (IRs) of miscarriage with 95% confidence intervals (CIs) expressed by 1000 person-weeks were calculated. Stratifying analysis by age, specific high-risk groups, and drug exposure within the pre-pregnancy period were performed restricted to women with recording last menstrual period (LMP). (3) Results: Women with confirmed miscarriage (N = 18,070), tended to be older, with higher frequency of comorbidities and drug utilization. Restricting to women with LPM recorded, IR of miscarriage was 10.89 (CI 95% 10.68–11.10) per 1000 women-weeks, with a median follow-up of 10 weeks (IQR: 8–12). The IR according to age was: 2.71 (CI 95% 2.59–2.84) in those aged <30 years compared to 9.11 (CI 95% 8.55–9.70) in women aged ≥40 years. Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) CI 95%: 3.34 (3.08–3.62)), use of antihypertensives (1.49 (1.21–1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07–1.29)) showed to be positive predictors associated with increased risk of miscarriages. (4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization.

Introducción: Las personas mayores recurren con más frecuencia a los servicios sanitarios. El elevado consumo de medicamentos dificulta el cumplimiento terapéutico en este colectivo asociándose a un mayor riesgo de reacciones adversas. El objetivo de este proyecto es evaluar el conocimiento y manejo de los medicamentos en un grupo de personas que acuden a los centros de mayores. Material y métodos: Este estudio se enmarca en un proyecto de Aprendizaje y Servicio (ApS) entre la Universidad Complutense de Madrid (UCM) y el Ayuntamiento de Coslada. Los estudiantes diseñaron y elaboraron una encuesta de 32 ítems y entrevistaron a las personas mayores voluntarias (N=366) durante el periodo de Nov-Dic (2019). Tras la recogida de la información, se llevó a cabo un análisis descriptivo estratificado por sexo. Resultados: La edad media de los encuestados fue de 70,7 años, siendo mayoritariamente mujeres (70,2%). Más de dos tercios, percibe su calidad de vida entre muy buena y buena, siendo esta percepción ligeramente superior en mujeres. Los encuestados toman una media de 3,4 medicamentos y un 10% afirmo olvidar alguna toma. Pese a que la mayoría una independencia y autonomía a la hora de consumir la medicación, un 38% recurre a un método recordatorio. Conclusión: El colectivo de personas mayores de Coslada destaca por su alta calidad de vida percibida y conocimiento del manejo terapéutico. El ApS es una oportunidad única de extrapolación directa de conocimientos de Salud Pública a una realidad y necesidad social

Background: To evaluate relationship between socio-economic environment and overweight in Madrid and Barcelona, adjusting for possible confounding factors. Methods: We obtained three indicators which reflected socio-economic context, namely, unemployment rate, percentage of population with tertiary education, and percentage with a second home. The design is a cross sectional study. The association with overweight was estimated using odds ratios by multilevel logistic regression. The statistical analysis, data synthesis, or model creation was performed from the 2017. In all, 707 children from 21 districts of Madrid and 474 children from 10 districts of Barcelona were analysed. Results: In Madrid, standardised ORs for personal and family characteristics were 1.17, 1.53 and 1.57 by reference to unemployment rate and percentages of population with a university education and second home. After adjustment, only the OR obtained with unemployment rate decreased, specifically by 58%. In Barcelona, the following ORs were obtained: 1.80 with unemployment rate; 1.80 with population having a university education; and 1.86 with population having a second home. After being standardised, these ORs decreased by 14% in the case of unemployment rate, 10% in the case of population with a university education, and 9% in the case of population with a second home. Conclusions: Overweight displayed a risk gradient in Madrid and Barcelona alike. This risk of overweight is not accounted for by physical inactivity and could, in part, be due to the availability of sports facilities.

Objective: To compare mortality from the leading causes of death in farmers and in all other workers. Methods: Mortality by cause of death was calculated from a longitudinal study in which 9.5 million men were followed up for 10 years. We estimated the contribution of the causes of death to the difference in all-cause mortality. Results: Most of the excess in all-cause mortality in farmers was due to cardiovascular diseases, digestive diseases and external causes, which contributed 22.3%, 17.2% and 53.3% to the difference in all-cause mortality, respectively. Traffic accidents and suicide were the main contributors to the excess mortality from external causes. Conclusions: Farmers are a vulnerable group in terms of health, thus there is a need to identify the factors that influence excess mortality from cardiovascular diseases, digestive diseases, traffic accidents and suicide.

Background To evaluate trends in diabetes-related health behaviours and mortality from diabetes and other chronic diseases in the Spanish population before, during and after the 2008 economic crisis. Methods Annual population measurements were obtained from national surveys and administrative registries for 2004–2016. Using segmented regression analysis, we calculated the annual percentage change (APC) in 2004–2007, 2008–2010, 2011–2013 and 2014–2016 in risk behaviours (smoking, alcohol consumption, obesity and meals away from home), in healthy behaviours (fruit and vegetable intake and physical activity) and in mortality rates from diabetes, cardiovascular disease and cancer. Results In general, during the economic crisis (2008–2013), the Spanish population reduced risk behaviours and improved healthy behaviours as compared with the trend observed before and afterwards. Diabetes mortality decreased more during the crisis than before or afterwards. The APC in each time interval was −3.3, –3.7, −4.4 and −2.6 in all-age mortality and −2.9, –5.2, −6.7 and −1.3 in premature mortality (less than 75 years). Only in older people (≥75 years) diabetes mortality showed similar decline before and during the crisis. Mortality from cardiovascular disease also declined more during the crisis, except for all-age mortality and older people in the second part of the crisis, whereas the downward trend in cancer mortality was smaller during the crisis years. Conclusions During the 6 years of the economic crisis in Spain, the favourable changes in health behaviours were accompanied by an important reduction in diabetes mortality in the population.

Background: To evaluate whether the relationship between socio-economic environment and obesity and physical inactivity in children can be explained by household socio-economic position and area facilities. Methods: Two indicators of the socio-economic context of neighbourhood of residence based on wealth and deprivation were estimated in a sample of 727 children and adolescents residents in Madrid (Spain). Multilevel logit models were used to calculate the relationship between each indicator and obesity and physical inactivity. Results: After adjusting for household socio-economic position, obesity prevalence was 3.79 times higher among subjects living in deprived areas than among those living in non-deprived areas (CI: 1.95-7.34), and 2.38 higher among subjects living in less wealthy areas than in those living in wealthier areas (CI: 0.85-6.65). Adjustment for the availability of retail shops in subjects' neighbourhood of residence failed to change the magnitude of the association. Neither neighbourhood socio-economic context nor availability of sports facilities was related to physical inactivity. Conclusion: In the city of Madrid, socio-economic context of neighbourhood of residence shows an inverse relationship with obesity but not with physical inactivity among children. The relationship observed with obesity is not explained by the availability of area facilities.

The objective of this study is to ascertain whether income inequality and per capita income of area of residence show a relationship with mortality in Spain. Data are from a nation-wide prospective study with a 7-year mortality follow-up covering all persons living in Spain's 50 provinces in 2001. In total 28,944,854 subjects aged 25 years or over at baseline were studied. Rate ratio for total mortality and cause-specific mortality, according to provincial income inequality and per capita income in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). Provincial income inequality was not related to total mortality or cause-specific mortality. Total mortality rate ratios among residents of the poorest versus the richest provinces were 0.89 (95 % CI 0.95-0.93) in men and 0.91 (0.87-0.96) in women, among the adult population; and 1.02 (0.97-1.08) in men and 1.08 (1.02-1.16) in women, among the elderly population. With the exception of cardiovascular-disease mortality for which no association with per capita income was observed, adult residents of the poorest provinces registered the lowest mortality rate ratio for other causes of death. Elderly residents of the poorest provinces registered the highest mortality rate ratio for cardiovascular disease and the lowest mortality rate ratio for cancer and external causes. Aside from cardiovascular-disease mortality, the lowest mortality for most causes of death was registered by residents of the poorest provinces. Nevertheless, these findings need to be confirmed by similar studies using smaller areas as the unit of analysis.

To assess whether the relationship between neighborhood socioeconomic context of residence and childhood obesity is explained by family socioeconomic position, risk behaviors and availability of sports facilities. Based on the income and educational level of residents in the neighborhoods of the city of Madrid, two indicators of socioeconomic context were calculated using the information about income and education and grouped into quartiles. In a sample of 727 children aged 6-15 years, the relationship of these indicators with overweight and obesity was studied using multilevel logit models. With respect to children and adolescents living in neighborhoods having higher per capita incomes or higher population percentages with university education those living in neighborhoods having lower per capita incomes or lower population percentages with university education had age- and sex-adjusted odds ratios (ORs) of overweight that were 1.84 (95% CI, 1.03-3.29) and 1.68 (0.95-2.94) times higher, respectively. After adjustment for family socioeconomic position, unhealthy diet and physical inactivity, these ORs fell to 1.80 (0.99-3.29) and 1.56 (0.87-2.79), respectively. In the case of obesity, the age- and sex-adjusted ORs in these quartiles of both indicators of socioeconomic context were 3.35 (1.06-10.60) and 3.29 (1.03-10.52), respectively, rising to 3.77 (1.12-12.70) and 3.42 (1.00-11.68) after adjustment for the remaining variables. The highest OR was observed in the third quartile, except in the case of the relationship between per capita income and obesity. No relationship between the number of sport facilities per 1,000 population and physical inactivity was observed. The socioeconomic context is associated with obesity but not with overweight children in Madrid. The relationship is not explained by family socioeconomic position, risk behaviors and availability of sports facilities.