pertension, serum cholesterol, and diabetes mellitus decreases the risk of Parkinson's disease (PD). We therefore examined the epidemiologic association of PD with hypertension, serum total cholesterol, and diabetes mellitus by conducting a detailed meta-analysis of all studies published regarding this subject. METHODS: A systematic comprehensive literature search was performed using PubMed, EMBASE, and CINAHL (until March 2012) for observational cohort and case-control studies using relevant keywords. Pooled relative risk (RR) was calculated using random effects model. Pre specified subgroup analysis was performed to assess the source of heterogeneity, according to study design, number of covariates adjusted and adjusted for BMI and cardiovascular diseases. Subgroup and sensitivity analysis were also done. Heterogeneity and publication bias were also assessed. RESULTS: 24 studies were included in the analysis. The pooled risk ratio of PD due to hypertension (nϭ8) was 0.78 (95% CI, 0.67-0.92, I2ϭ71.85%), due to high serum cholesterol (nϭ7) was 0.95 (95% CI, 0.77-1.17, I2ϭ 75.86%), and due to diabetes (nϭ14) was 0.94 (95% CI, 0.76-1.16, I2ϭ 89.62%). Subgroup analysis showed a significant difference in effect estimate pooled by cohort and case-control studies (Pin-teractionϽ0.001). Pooled analysis of cohort studies for diabetes showed a pooled risk ratio of 1.34 (95%CI, 1.12-1.60, I2ϭ76.77%). We found no significant difference in any subgroup analysis. CONCLUSIONS: We found evidence of significant inverse associations of hypertension, hypercholesterolemia, and diabetes mellitus with the risk of PD. Further well-designed investigations of the association of vascular risk factors with the risk of PD are needed, particularly large-scale prospective studies.
OBJECTIVES:We estimated the impact of influenza A(H1N1)2009 infection in terms of patient's health care services utilization, work absenteeism and costs, both during the pandemic (2009-10) and postpandemic-seasonal (2010-11) waves in Spain. METHODS: Longitudinal, multi-centre study of in-and outpatients with RT-PCR confirmed diagnosis of influenza at pandemic(PAND) and postpandemic-seasonal(POST) waves. Health care and social resources utilization were the main variables, together with clinical and sociodemographic characteristics. Evaluations were conducted at hospital-admission or ambulatory index-visit, and after recovery (medianϭ100 days). Unitary costs and Monte Carlo simulation were applied to A520