Serrano, M. (Manuel)
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- Stakeholders in support systems for self-care for chronic illness: the gap between expectations and reality regarding their identity, roles and relationships(2017) Vassilev, I. (Ivo); Serrano, M. (Manuel); Christos, L. (Lionis); Wensing, M. (Michel); Foss, C. (Christina); Portillo, M.C. (María Carmen); Todorova, E. (Elka); Ruud-Knutsen, I. (Ingrid); Mujika, A. (Agurtzane); Rogers, A. (Anne); Roukova, P. (Poli); Pumar-Mendez, M.J. (María Jesús); Regaira, E. (Elena)Background and objective: The spread of self-care holds the promise of containing chronic illness burden. Falling within the framework of a FP7 collaborative research project, this paper reports the views of key informants from six countries regarding who the main stakeholders are at different levels in the support system for self-care for patients with chronic illness (SSSC) and how they accomplish their role and collaborate. Methods: 90 Interviews with purposefully selected key informants from Bulgaria, Greece, the Netherlands, Norway, Spain and United Kingdom were conducted. Interviews involved government and local authorities, politicians, academics, health professionals and private sector representatives. Interviewers followed an expert opinion-based guide. Analysis involved a cross-country examination with thematic analysis and framework method techniques. Results Key informants described the ideal SSSC as inclusive, interdependent and patient-centred. The following main stakeholders in SSSC were identified: patients, governments, health-care professionals, associations, private companies and the media. In the current SSSCs, collaboration among stakeholders within and across different levels was said to be lacking. Patients were seen as playing a passive subordinate role based on the following: their own attitudes; the paternalistic and medicalized attitudes of the health-care professionals; their misrepresentation by patient associations; and their exposure to the damaging influences of media and industries. Conclusions Making SSSC patient-centred constitutes the greatest challenge for European authorities. Strategies must be revised for promoting patient participation. They should undergo changes so as to promote industry and media social responsibility and patient association advocacy capacity.
- A brief assessment of eating habits and weight gain in a Mediterranean cohort(Cambridge University Press, 2010) Martinez-Gonzalez, M.A. (Miguel Ángel); Serrano, M. (Manuel); Zazpe, I. (Itziar); Bes-Rastrollo, M. (Maira); Ruiz-Canela, M. (Miguel); Sanchez-Villegas, A. (Almudena)Assessment of eating habits (EH) through closed questions could be an alternative tool to assess diet as a predictor of weight change in epidemiological studies. The aim was to assess the association between baseline EH and risk of weight gain or becoming overweight/obese in a Spanish dynamic prospective cohort (the SUN Project) of 10,509 participants. The baseline questionnaire included 10 short questions with two possible answers: Yes or No. We calculated a baseline EH score, categorized in quartiles, positively weighting answers on more fruit, vegetable, fish and fiber and less meat, sweets and pastries, fat, butter, fatty meats and added sugar to drinks. Reducing the consumption of meat or fat and removing fat from meat were significantly associated with lower weight gain. Partial correlation coefficient between EH score and weight change was -0.033 (p=0.001). We observed 1063 cases of incident overweight/obesity among 7217 participants without overweight/obesity at baseline. Trying to eat more fruit, fish, or fiber and less meat were inversely significantly associated with incident overweight/obesity. Those participants in the upper quartile of the score were at 38% (adjusted OR: 0.62; 95% CI: 0.48-0.81) lower risk of developing overweigh/obesity during follow-up compared to those in the lower quartile. However, the ROC curves for the model with and without the EH score were materially identical. Despite the apparent significant inverse association, this score had a low predictive value for future weight gain and for incident overweight/obesity in a Mediterranean population, although some EH were independently and positively associated with weight gain.
- Usefulness of plasma cardiotrophin-1 in assessment of left ventricular hypertrophy regression in hypertensive patients(Lippincott, Williams & Wilkins, 2005) Serrano, M. (Manuel); Lopez-Salazar, M.B. (María Begoña); Diez-Martinez, J. (Javier); Martin-Raymondi, D. (Diego); Lozano, E. (Elisa); Barba, J. (Joaquín); Gonzalez, A. (Arantxa); Varo-Cenarruzabeitia, M.N. (Miren Nerea)OBJECTIVE: We investigated whether regression of left ventricular hypertrophy (LVH) in response to antihypertensive treatment is associated with plasma cardiotrophin-1 (CT-1) in hypertensive patients. METHODS: The study was performed in 47 patients with mild to moderate essential hypertension, and LVH was assessed echocardiographically. The family doctor gave antihypertensive treatment and followed all patients. LVH regression was diagnosed if the baseline left ventricular mass index (LVMI) decreased to normal values after 1 year of treatment. Plasma CT-1 was determined by an enzyme-linked immunosorbent assay. RESULTS: The LVMI was normalized in 23 patients (49%) and persisted at an abnormally increased level in 24 patients (51%) after 1 year of treatment, whereas the reduction in clinic and home blood pressure was similar in the two groups: CT-1 decreased (-48%, P < 0.005) and increased (+35%, P < 0.05) in patients in whom LVH regressed and LVH persisted, respectively. Final values of CT-1 were inversely correlated (r = 0.534, P < 0.001) with the decrease in LVMI after treatment in all patients. A significant association (chi2 = 16.87, P < 0.001) was found between normalization of CT-1 and regression of LVH with treatment. A cut-off value of 41 fmol/ml for CT-1 provided a relative risk of 43.13 (95% confidence interval, 4.88-380.48) for detecting LVH regression. CONCLUSION: These results show an association between treatment-induced decrease of plasma CT-1 and LVH regression in essential hypertension. Although preliminary, these findings suggest that the determination of plasma CT-1 may be useful for the follow-up of hypertensive heart disease in routine clinical practice.
- Detección del DNA del virus de la hepatitis B en suero mediante amplificación génica en pacientes con hepatitis crónica B y en pacientes con hepatitis crónica C(Elsevier, 1992) Civeira, M.P. (María Pilar); Riezu-Boj, J.I. (José Ignacio); Serrano, M. (Manuel); Camps, J. (J.); Jauregui, J.I. (Javier Ignacio); Castilla, A. (Alberto); Prieto, J. (Jesús)
- Macronutrient intake and metabolic syndrome in subjects at high cardiovascular risk(Karger, 2010) Buil, P. (Pilar); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Serrano, M. (Manuel); Diez-Espino, J. (Javier); Bes-Rastrollo, M. (Maira); Cabello-Saavedra, E. (E.)The effect of macronutrient intake on the metabolic syndrome (MS) is still controversial. Our aim in this study was to assess the relationships between macronutrient intake and the risk of developing the MS in subjects at high cardiovascular risk. METHODS: In this cross-sectional study, 967 high-risk men and women (55-80 years) were assessed according to the MS criteria defined by the National Cholesterol Education Program Adult Treatment Panel III (ATP3) and those established by the International Diabetes Federation (IDF). A 137-item validated food frequency questionnaire was used. Odds ratios (OR) for macronutrient intake and MS were calculated and adjustments were made for potential confounders. RESULTS: When applying the ATP3 criteria, an inverse association was found for fiber and polyunsaturated fatty acid (PUFAs) intake, with ORs of 0.55 (95% CI: 0.35-0.86) and 0.60 (95% CI: 0.39-0.94), respectively, for the 5th versus the 1st quintile. Using the IDF criteria, an inverse association between fiber intake and the MS was obtained whereas a direct association was found between carbohydrate intake and the MS: OR = 1.71 (95% CI: 1.05-2.79) for the highest versus the lowest quintile. CONCLUSIONS: A diet rich in fiber and PUFAs is correlated with a reduced risk of MS in subjects at high cardiovascular risk.
- Types 1 and 2 plasminogen activator inhibitor and tumor necrosis factor alpha in patients with sepsis(Schattauer, 1990) Serrano, M. (Manuel); Paramo, J.A. (José Antonio); Rocha, E. (Eduardo); Perez, J.L. (J.L.)We have determined the plasma concentrations of types 1 and 2 of plasminogen activator inhibitor (PAI-1 and PAI-2), tumor necrosis factor (TNF-alpha) and endotoxin in 47 patients with bacterial infection (22 patients presented with positive blood cultures). Results were compared with those observed in 30 healthy subjects. There was a significant increase in PAI-1 and TNF-alpha in patients as compared to controls (p less than 0.0001), whereas no differences for PAI-2 were observed. PAI-1 and TNF-alpha were significantly higher in 18 patients with gram-negative bacteremia as compared to all other patients (p less than 0.0001). However, no correlation between the analyzed parameters and either endotoxin or clinical outcome was observed. We conclude that there is an increase of PAI-1 and TNF-alpha in patients with sepsis, which is not related to the endotoxin concentration. Our results suggest that PAI-1, but not PAI-2, is the main plasminogen activator inhibitor in human sepsis.
- Study of vascular risk in Navarre: objectives and design. Prevalence of metabolic syndrome and of vascular risk factors(Gobierno de Navarra. Departamento de Salud, 2007) Serrano, M. (Manuel); Grijalba, A.M. (A. M.); Los-Arcos, E. (E.); Gonzalez, P. (P.); Azmequeta, C. (C); Diez-Martinez, J. (Javier); Sobejano, I. (I.); Viñes, J.J. (José Javier); Barba, J. (Joaquín); Guembe, M.J. (María Jesús); Martinez-Vila, E. (Eduardo); Guerrero, D. (D.); Moreno, C. (Cristina)BACKGROUND: To determine in a representative sample of the population the prevalence of risk factors and metabolic syndrome; their association with sub-clinical atherosclerotic lesions and their impact on cardiocerebrovascular disease 10 years after. MATERIAL AND METHODS: (Phase 1) Cross sectional survey of a random sample stratified by age and sex of the population of Navarre aged between 35 and 84. Antecedents, risk factors, physical and analytical exploration. (Phase II) Ten year follow-up cohort study, in 500 exposed to MS and 500 not exposed persons, aged between 45 and 74 years; with an 82.25% power to detect a risk ratio of 2; with analytical and image markers of sub-clinical atherosclerosis. (Phase III) Follow up of vascular events at ten years. RESULTS: The subjects recruited were 6,553; excluded or not found 871; the final sample was 5,682 (2,644 men and 3,038 women); 4,168 (73,4%) took part in the study. The prevalence of MS was 22.1% (95%CI 20.5 - 23.7) for men and 17,2% (95%CI 15.8 - 18.5) for women. The main cardiovascular RF were high compared to other geographical areas except for HDL cholesterol. The rate was 8.5% (95%CI 7.4 - 9.6) for men and 1.7% (95%CI 1.3 - 2.2) CONCLUSIONS: There are important differences in risk between sex, being worst for men. The high figures for HDL cholesterol and the low prevalence of MS might mean a lower risk of vascular events in Navarra.
- Is plasma cardiotrophin-1 a marker of hypertensive heart disease?(Lippincott, Williams & Wilkins, 2005) Serrano, M. (Manuel); Beloqui, O. (Óscar); Borras-Cuesta, F. (Francisco); Lopez-Salazar, M.B. (María Begoña); Diez-Martinez, J. (Javier); Lozano, E. (Elisa); Fortuño, M.A. (María Antonia); Barba, J. (Joaquín); Gonzalez, A. (Arantxa); Díaz-Dorronsoro, I. (Inés); Sarobe, P. (Pablo); Tomas, L. (Lourdes); Varo-Cenarruzabeitia, M.N. (Miren Nerea); Lasarte, J.J. (Juan José)OBJECTIVE: This study was designed to investigate whether plasma concentration of cardiotrophin-1 (CT-1), a cytokine that induces cardiomyocyte hypertrophy and stimulates cardiac fibroblasts, is related to hypertensive heart disease, as defined by the presence of echocardiographically assessed left ventricular hypertrophy (LVH). METHODS: The study was performed in 31 normotensive subjects and 111 patients with never-treated essential hypertension (54 without LVH and 57 with LVH). Causes of LVH other than hypertension were excluded after a complete medical workup. A novel enzyme-linked immunosorbent assay was developed to measure plasma CT-1. RESULTS: Plasma CT-1 was increased (P < 0.001) in hypertensives compared with normotensives. The value of CT-1 was higher (P < 0.001) in hypertensives with LVH than in hypertensives without LVH. Some 31% of patients without LVH exhibited values of CT-1 above the upper normal limit in normotensives. A direct correlation was found between CT-1 and left ventricular mass index (r = 0.319, P < 0.001) in all subjects. Receiver operating characteristic curves showed that a cutoff of 39 fmol/ml for CT-1 provided 75% specificity and 70% sensitivity for predicting LVH with a relative risk of 6.21 (95% confidence interval, 2.95 to 13.09). CONCLUSIONS: These results show an association between LVH and the plasma concentration of CT-1 in essential hypertension. Although preliminary, these findings suggest that the determination of CT-1 may be an easy and reliable method for the initial screening and diagnosis of hypertensive heart disease.