¿Cómo abordar la dimensión colectiva de la salud de las personas? Informe SESPAS 2012

ResumenLa salud de los colectivos depende en gran parte de factores del entorno. Cabe plantearse cuál ha de ser el papel de los profesionales sanitarios, en especial de la salud pública y la atención primaria, en la formulación de objetivos y en el desarrollo de acciones para la mejora de la salud de la población. Se plantea un recorrido desde el conocimiento de las potencialidades y las necesidades de salud hasta las actividades que suponen una verdadera y positiva transformación, es decir, desde la información hasta la acción. Este recorrido transcurre a modo de conversacciones que sobre la salud cabe llevar a cabo. Se analiza la situación actual, sus debilidades y fortalezas, y se elaboran propuestas para todo el proceso: información, encuentro y acción. La información exige trascender los datos que las diferentes fuentes proporcionan, generando conocimiento a quienes pertenecen a la comunidad o están muy cerca de ella. Esta mirada debe contemplar, además de los déficits, los activos en salud, conocimiento útil para todos los que pueden influir en los determinantes de la salud, incluidos los sanitarios. Finalmente, al considerar las acciones para mejorar la salud, se insiste en los beneficios de la promoción de la salud en el sentido más genuino del término, mediante una reflexión en términos de efectividad y de eficiencia. El fracaso de una intervención que no consigue mejorar la salud, ¿se debe a su inutilidad o a que se desarrolla de manera inadecuada?AbstractThe health of the population largely depends on environmental factors, raising the issue of what the role of health professionals, particularly those in public health and primary care, should be in the planning of objectives and actions for improvement. The present article proposes a trajectory, starting with knowledge of the community's strong points in health and its needs, and ending with taking action. This trajectory requires discussion on how information can be transformed into action. We analyze the current situation and its strengths and weaknesses, and make proposals for the entire process: from information to action. Information is more than just the available data gathered from different sources; it is also knowledge of those who belong to the community or are very close to it. This perspective should include both health deficits and health assets. This information should be used not only by health professionals, but by all those in a position to influence the determinants of health. Finally, when considering the actions required to improve the health of a community, we emphasize the benefits of health promotion, in the genuine sense of the term, by reflecting on effectiveness and efficiency. The question of whether the failure of an intervention to improve health is due to the futility of the action, or to be action being undertaken in an inefficient way, is discussed

Museum visitors’ heterogeneity and experience processing

This research examines the relationships between affective and cognitive antecedents and consequences of satisfaction under a market heterogeneity approach. It includes co-creation of preparatory activities. The sample consisted of 276 museum visitors in London. Two analysis have been conducted: structural equation model and latent class path analysis. The paper contributes to the development of a theoretical framework for further understanding of service experience in which co-creation plays an important role. Two segments were identified: 1) emotional (with lower degree of co-creation, equally distributed by age and nationality); 2) rational (higher degree of co-creation, younger and domestic visitors). Our research shows significant differences between the two segments regarding variables such as satisfaction, loyalty, service experience, emotion, positive disconfirmation and willingness to pay more

El consumo de probiótico Lactobacillus plantarum CECT 7315/7316 mejora el estado de salud general en personas de edad avanzada

Fundamentos: Con la edad avanzada se producen cambios en la microflora intestinal que pueden afectar al estado de salud general. En este trabajo analizamos el efecto de Lactobacillus plantarum CECT 7315/7316 sobre la regulación del tránsito intestinal y el estado nutricional. Métodos: Hemos realizado un estudio clínico dobleciego, controlado por placebo y aleatorizado. Hemos evaluado la evolución de la frecuencia de defecación semanal y los niveles en sangre de proteínas totales, albúmina,colesterol y proteína C-reactiva. Resultados: Lactobacillus plantarum CECT 7315/7316 ayuda a regular el tránsito intestinal y mejora el estado nutricional en personas mayores. Conclusiones: El consumo de productos funcionales que contengan L. plantarum CECT 7315/7316 mejora la calidad de vida de personas de la tercera edad

Iminium Salts of ω-Dithiafulvenylpolyenals: An Easy Entry to the Corresponding Aldehydes and Doubly Proaromatic Nonlinear Optic-phores

A short, high-yielding route to ω-dithiafulvenylpolyenals (1) via the corresponding iminium salts (2) and starting from trimethyl-1,3-dithiolium tetrafluoroborate is reported. The Knoevenagel reactions of either 1 or 2 with isoxazolone-containing acceptors afford merocyanines 7 and 9, in a process that is often accompanied by a vinylene-shortening side reaction. Experimental and theoretical studies reveal that compounds 7 and 9, featuring two proaromatic end groups, are strongly polarized and show good second-order nonlinear optical responses

Methylthioadenosine (MTA) inhibits melanoma cell proliferation and in vivo tumor growth

BACKGROUND: Melanoma is the most deadly form of skin cancer without effective treatment. Methylthioadenosine (MTA) is a naturally occurring nucleoside with differential effects on normal and transformed cells. MTA has been widely demonstrated to promote anti-proliferative and pro-apoptotic responses in different cell types. In this study we have assessed the therapeutic potential of MTA in melanoma treatment. METHODS: To investigate the therapeutic potential of MTA we performed in vitro proliferation and viability assays using six different mouse and human melanoma cell lines wild type for RAS and BRAF or harboring different mutations in RAS pathway. We also have tested its therapeutic capabilities in vivo in a xenograft mouse melanoma model and using variety of molecular techniques and tissue culture we investigated its anti-proliferative and pro-apoptotic properties. RESULTS: In vitro experiments showed that MTA treatment inhibited melanoma cell proliferation and viability in a dose dependent manner, where BRAF mutant melanoma cell lines appear to be more sensitive. Importantly, MTA was effective inhibiting in vivo tumor growth. The molecular analysis of tumor samples and in vitro experiments indicated that MTA induces cytostatic rather than pro-apoptotic effects inhibiting the phosphorylation of Akt and S6 ribosomal protein and inducing the down-regulation of cyclin D1. CONCLUSIONS: MTA inhibits melanoma cell proliferation and in vivo tumor growth particularly in BRAF mutant melanoma cells. These data reveal a naturally occurring drug potentially useful for melanoma treatment

Low survival rate and muscle fiber-dependent aging effects in the McArdle disease mouse model

Altres ajuts: The present study was funded by grants received from the Fondo de Investigaciones Sanitarias (FIS, grant PI16/01492 and PI15/00558) and cofunded by 'Fondos FEDER'. Gisela Nogales-Gadea is supported by a Trampoline Grant #21108 from AMF Telethon.McArdle disease is an autosomal recessive disorder caused by the absence of the muscle glycogen phosphorylase, which leads to impairment of glycogen breakdown. The McArdle mouse, a model heavily affected by glycogen accumulation and exercise intolerance, was used to characterize disease progression at three different ages. The molecular and histopathological consequences of the disease were analyzed in five different hind-limb muscles (soleus, extensor digitorum longus, tibialis anterior, gastrocnemius and quadriceps) of young (8-week-old), adult (35-week-old) and old (70-week-old) mice. We found that McArdle mice have a high perinatal and post-weaning mortality. We also observed a progressive muscle degeneration, fibrosis and inflammation process that was not associated with an increase in muscle glycogen content during aging. Additionally, this progressive degeneration varied among muscle and fiber types. Finally, the lack of glycogen content increase was associated with the inactivation of glycogen synthase and not with compensatory expression of the Pygl and/or Pygb genes in mature muscle

Prevalencia de la obesidad en la población atendida en asistencia primaria de Girona, 1995–1999

ResumenObjetivosEstimar y comparar la prevalencia de la obesidad y el sobrepeso en la población de Girona, entre 1995 y 1999, estratificando geográficamente por sexo y edad.MétodosMedidas directas de talla y peso correspondientes a 24.554 usuarios mayores de 14 años (10.595 varones y 13.959 mujeres) atendidos en cuatro áreas básicas de salud (ABS): Girona 1, Girona 4, Salt y Camprodon, así como en un centro de atención primaria (CAP) de la provincia de Girona. Se calculó el índice de masa corporal (IMC) como el cociente entre el peso y la talla al cuadrado. La obesidad se define como los grados II y III del índice de Garrow (IMC ≥ 30 kg/m2) y el sobrepeso como el grado I (25 kg/m2 ≤ IMC < 30 kg/m2). Al no utilizarse una muestra aleatoria de sujetos, el cálculo de prevalencias y de sus errores estándar se corrigió mediante el uso de ponderaciones adecuadas. La comparación de las prevalencias entre dos ABS distintas para cada sexo se realizó utilizando un contraste paramétrico de diferencia de proporciones. La comparación entre las prevalencias de un determinado grado del índice de Garrow, controlando por sexo y edad, se llevó a cabo utilizando una regresión logística jerárquica.ResultadosLa prevalencia de la obesidad se estimó en 15,6% entre los varones de 20 a 74 años (desde el 14,0% en Girona 1 hasta el 22,4% en Camprodon) y en un 17,5% entre las mujeres (un 15,6% en Girona 1 y un 22,7% en Camprodon), un 16,7% de promedio ponderado. La prevalencia del sobrepeso se sitúa en el 44% en varones y en un 33% en mujeres, un 37,8% de promedio ponderado. Existe una gradación en las prevalencias de la obesidad, con diferencias estadísticamente significativas: Girona 1, Salt, Girona 4, Camprodon y Sils.ConclusionesLas estimaciones de la prevalencia de la obesidad y sobrepeso obtenidas en este trabajo no están tan alejadas como se creía de las estimadas en poblaciones de nuestro entorno. De hecho, podrían ser muy similares a las estimadas en la Unión Europea y, para algunos grupos de edad, incluso a las de Estados Unidos.AbstractObjectivesTo estimate the prevalence of obesity and overweight in the population of Girona (Spain) between 1995 and 1999 and to divide the prevalences in geographical areas according to age and sex.MethodsHeight and weight were directly measures in 24,554 health care consumers older than 14 years (10,595 men and 13,959 women) treated in four primary health care areas: Girona 1, Girona 4, Salt and Camprodon and in one primary health care center in the province of Girona. Body mas index (BMI) was calcuted by dividing weight in kilograms bye height in meters squared. Obesity was defined as grades II and III of Garrow's index (BMI ≥ 30 kg/m2) and overweight as degree I (25 kg/m2 ≥ BMI < 30 kg/m2). Because the sample was not randomized, the prevalences were adequately weighted. The comparison between prevalences in two different primary health care areas for each sex (in the same Garrow's index and age group) was carried out using a parametric test of differences in proportions (Student's t-test). A hierarchical logistic regression was used to compare prevalences in the same grade Garrow's index, controlling for age and sex.ResultsThe prevalence of obesity was estimated as 15.6% in men aged from 20-74 years (from 14.0% in Girona 1 to 22.4% in Camprodon) and 17.5% for women (15.6% in Girona 1, 22.7% in Camprodon). The weighted mean was 16.7%. The prevalence of overweight was 44% in men and 33% in women and the weighted mean was 37.8%. The prevalence of obesity was graduated with statistically significant differences between Girona 1, Salt, Girona 4, Camprodon and Sils.ConclusionsThe estimates of the prevalences of obesity and overweight obtained in this study were closer to those of other studies in similar populations than previously believed. Inde-ed, the prevalences may be similar to those of the European Union and, in some age groups, to those of the United States

Low aerobic capacity in McArdle disease : A role for mitochondrial network impairment?

McArdle disease is caused by myophosphorylase deficiency and results in complete inability for muscle glycogen breakdown. A hallmark of this condition is muscle oxidation impairment (e.g., low peak oxygen uptake (VO)), a phenomenon traditionally attributed to reduced glycolytic flux and Krebs cycle anaplerosis. Here we hypothesized an additional role for muscle mitochondrial network alterations associated with massive intracellular glycogen accumulation. We analyzed in depth mitochondrial characteristics-content, biogenesis, ultrastructure-and network integrity in skeletal-muscle from McArdle/control mice and two patients. We also determined VO in patients (both sexes, N = 145) and healthy controls (N = 133). Besides corroborating very poor VO values in patients and impairment in muscle glycolytic flux, we found that, in McArdle muscle: (a) damaged fibers are likely those with a higher mitochondrial and glycogen content, which show major disruption of the three main cytoskeleton components-actin microfilaments, microtubules and intermediate filaments-thereby contributing to mitochondrial network disruption in skeletal muscle fibers; (b) there was an altered subcellular localization of mitochondrial fission/fusion proteins and of the sarcoplasmic reticulum protein calsequestrin-with subsequent alteration in mitochondrial dynamics/function; impairment in mitochondrial content/biogenesis; and (c) several OXPHOS-related complex proteins/activities were also affected. In McArdle disease, severe muscle oxidative capacity impairment could also be explained by a disruption of the mitochondrial network, at least in those fibers with a higher capacity for glycogen accumulation. Our findings might pave the way for future research addressing the potential involvement of mitochondrial network alterations in the pathophysiology of other glycogenoses

The polygenic basis of relapse after a first episode of schizophrenia

Little is known about genetic predisposition to relapse. Previous studies have linked cognitive and psychopathological (mainly schizophrenia and bipolar disorder) polygenic risk scores (PRS) with clinical manifestations of the disease. This study aims to explore the potential role of PRS from major mental disorders and cognition on schizophrenia relapse. 114 patients recruited in the 2EPs Project were included (56 patients who had not experienced relapse after 3 years of enrollment and 58 patients who relapsed during the 3-year follow-up). PRS for schizophrenia (PRS-SZ), bipolar disorder (PRS-BD), education attainment (PRS-EA) and cognitive performance (PRS-CP) were used to assess the genetic risk of schizophrenia relapse.Patients with higher PRS-EA, showed both a lower risk (OR=0.29, 95% CI [0.11–0.73]) and a later onset of relapse (30.96± 1.74 vs. 23.12± 1.14 months, p=0.007. Our study provides evidence that the genetic burden of neurocognitive function is a potentially predictors of relapse that could be incorporated into future risk prediction models. Moreover, appropriate treatments for cognitive symptoms appear to be important for improving the long-term clinical outcome of relapse

GWAS for Systemic Sclerosis Identifies Multiple Risk Loci and Highlights Fibrotic and Vasculopathy Pathways

Systemic sclerosis (SSc) is an autoimmune disease that shows one of the highest mortality rates among rheumatic diseases. We perform a large genome-wide association study (GWAS), and meta-analysis with previous GWASs, in 26,679 individuals and identify 27 independent genome-wide associated signals, including 13 new risk loci. The novel associations nearly double the number of genome-wide hits reported for SSc thus far. We define 95% credible sets of less than 5 likely causal variants in 12 loci. Additionally, we identify specific SSc subtype-associated signals. Functional analysis of high-priority variants shows the potential function of SSc signals, with the identification of 43 robust target genes through HiChIP. Our results point towards molecular pathways potentially involved in vasculopathy and fibrosis, two main hallmarks in SSc, and highlight the spectrum of critical cell types for the disease. This work supports a better understanding of the genetic basis of SSc and provides directions for future functional experiments.Funding: This work was supported by Spanish Ministry of Economy and Competitiveness (grant ref. SAF2015-66761-P), Consejeria de Innovacion, Ciencia y Tecnologia, Junta de Andalucía (P12-BIO-1395), Ministerio de Educación, Cultura y Deporte through the program FPU, Juan de la Cierva fellowship (FJCI-2015-24028), Red de Investigación en Inflamación y Enfermadades Reumaticas (RIER) from Instituto de Salud Carlos III (RD16/0012/0013), and Scleroderma Research Foundation and NIH P50-HG007735 (to H.Y.C.). H.Y.C. is an Investigator of the Howard Hughes Medical Institute. PopGen 2.0 is supported by a grant from the German Ministry for Education and Research (01EY1103). M.D.M and S.A. are supported by grant DoD W81XWH-18-1-0423 and DoD W81XWH-16-1-0296, respectively