Tres problemas y tres soluciones para la Universidad española del siglo XXI

La Universidad está en crisis, es una frase tópica. Si consideramos algunas acepciones del término, en un sentido médico, sería un: “Cambio brusco en el curso de una enfermedad, ya sea para mejorarse, ya para agravarse el paciente”. Otra acepción podría ser la de: “mutación importante en el desarrollo de otros procesos ya de orden físico, ya históricos o espirituales”. Con estas premisas podemos asegurar que la universidad es especialista en el padecimiento de estas crisis, su historia lo corrobora, así como también su capacidad de superarlas. Vivimos un tiempo en el que se hace necesario recuperar la capacidad de pensar, en este caso, repensar la universidad y hacer el diagnóstico de su situación y padecimientos. Por ello hace falta identificar de forma adecuada cuáles son los acontecimientos que concurren y rodean, en este momento, a la universidad. Hace falta identificar bien nuestro tiempo, saber más y mejor de la misión, visión y los valores que debe poner en juego la universidad del siglo XXI, de manera que, actuando de maneras distintas y diversas, mantenga el criterio de universitas, uno, unidad, “un todo”, a manera de un organismo que afronta la crisis, es decir “todo él”, enferma y “todo él” sana. De esa forma podrá recuperar su origen y sentido, pues somos una comunidad, asociación, con una meta común, implícita en la palabra universidad, afín a Universo y Universal. Se hace necesario recuperar, reconocer, actualizar, el sentido y valores de la universidad. Para conjugar estos verbos en el marco de la definición dada a las primeras universidades de la historia, allá en el medievo, asociaciones de maestros y alumnos, Universitas Magistrorum y Scholarium, con la perspectiva necesaria y el horizonte de este siglo. Mediante la identificación y acercamiento a tres problemas y tres posibles soluciones o alternativas, queremos reflexionar sobre la universidad de hoy que mira recelosa el tiempo que está por venir. El nuevo sentido de la universidad es un reto y una necesidad en este tiempo histórico, si queremos entrar, con prudencia, en la nueva sociedad del conocimiento.Palabras clave: universidad española, crisis, problemas, soluciones. Abstract: The current university is in crisis. From a medical perspective the term ‘crisis’ refers to: “a sudden change in the course of a disease, either to improve or to worsen the patient’s health”. Another meaning of the term is “a significant mutation in the development of any other physical, historical or spiritual process”. On this basis, we can then assure that the university specializes in the condition of these crises; its history confirms it, as well as its potential to overcome these crises. Now it is the moment to regain the ability to think, in this case, to rethink the university and to diagnose its position and conditions. Therefore, it is necessary to identify properly the events that are happening and that are surrounding the ’universitas’. Particularly in the current context, the university has to present itself again as a ‘universitas’, being one unified institution that as a body is facing the crisis. The body as a whole is ill and the body as a whole has to be cured. In this way, the university maybe can recuperate its origin and meaning, since all the members of the university form a community, an association, sharing one common objective, which is referred to in the terms university, universe and universal. It is necessary to recuperate, acknowledge and update the meaning and values of the university in order to conjugate these verbs, within the framework of the definition given to the first universities in history, dating back to the middle ages, i.e. associations of teachers and students, “Universitas Magistrorum et Scholarium”, of course placing this idea in a topical perspective. Through the identification of three problems and the suggestion of three possible solutions or alternatives, we want to meditate upon today’s university, the development of which during the years to come is regarded with suspicion. Giving a new interpretation to the term ‘university’ is a challenge and a necessity at this moment in history, in order to give it cautiously a place in the new knowledge society. Key Words: Spanish university, crises, problems, solutions.

Improving cardiovascular health in Spanish seafarers

Background and aim: There is a high prevalence in the Spanish general population of some cardiovascular risk factors like overweight, obesity and hypercholesterolaemia. But there is lack of research on Spanish seafarers. On the other hand, there is strong evidence of the cardiovascular risk predictive value of some biomarkers. The purpose of this work was to study the convenience of the introduction of detailed diet questionnaires and the measurement of some biomarkers in the pre-embarkation medical examination. Materials and methods: Seafarers undergoing medical checkup during 2011 in Madrid, Spain (n = 334). Overweight and obese subjects received general advice on healthy diet and physical activity. Seventy-four of them were followed up in 2012 and 2013. Glycated haemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), thyrotropin (TSH) and microalbuminuria were measured in two selected groups of patients in 2011. Results: Overweight and obesity were present in 207 (62%) individuals of the studied population. Those followed up in 2012 and 2013 showed a reduction of body mass index, waist circumference and total cholesterol values. We observed risk value of HbA1c in 60 (35.5%) individuals with significant association to other cardiovascular risk factors. Microalbuminuria appeared in subjects with high blood pressure. High TSH and hs-CRP were not significantly present in our population. Conclusions: 1. Measurement of HbA1c during medical checkups improves early detection of cardiovascular risk in seafarers. 2. Individuals with overweight and obesity responded positively to medical advice and diminished their risk factors, thus it may be more effective to introduce detailed questionnaires on this issue

Follow-up in healthy schoolchildren and in adolescents with DOWN syndrome: psycho-environmental and genetic determinants of physical activity and its impact on fitness, cardiovascular diseases, inflammatory biomarkers and mental health; the UP&DOWN Study

[Background] An objective diagnosis of sedentary behaviour as well as of the physical activity and fitness levels in youth and to better understand how lifestyle is associated with cardiovascular disease risk factors and other phenotypes is of clinical and public health interest, and might be informative for developing intervention studies focused on the promotion of physical activity in these population. The aim of this methodological paper is to describe the design and assessment in the UP&DOWN study. [Methods/Design] The UP&DOWN study is a multi-center follow-up design where 2225 Spanish primary and secondary schoolchildren from Cadiz and Madrid, respectively, as well as 110 Spanish adolescents with Down syndrome from Madrid and Toledo were recruited to be assessed. Nine main measurement categories are assessed: i) socio-demographic and early determinants; ii) environmental determinants; iii) physical activity and sedentary behaviour; iv) health-related fitness; v) blood pressure and resting heart rate; vi) mental health; vii) dietary patterns; viii) blood samples; and ix) genetic analysis. During the 3-yr follow-up study, socio-demographic and early determinants, and genetic analysis are only assessed in the first year. Blood sampling is assessed in the first year and the third year (2nd follow-up), and all the other measurements are assessed every year. [Discussion] The findings of the UP&DOWN study may help the Health Information Systems and policy makers to identify the target population for primary prevention and health promotion policies, and to develop and test preventive strategies. Moreover, these data will allow following the trends at population level, as well as to modify/adapt/create new evidence-based physical activity guidelines at national level. The findings will also serve as a scientific platform for interventional studies.This study was supported by the DEP 2010-21662-C04-00 (DEP 2010-21662-C04-01, DEP 2010-21662-C04-02, DEP 2010-21662-C04-03, DEP 2010-21662-C04-04) RYC-2010-05957 grants from the National Plan for Research, Development and Innovation (R + D + i) MICINN

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Gregorio Marañon: médico, humanista y referente multidisciplinar

Acercarse a la vida y obra de D. Gregorio Marañón y Posadillo no solo permite considerar el valor de la biografía como recurso histórico, sino también, de manera muy especial, es una motivación para que las nuevas generaciones de profesionales de la medicina, las ciencias de la salud y de la vida, actualicen el legado y testimonio de este médico y humanista que nos precedió en la búsqueda de la verdad científica y el compromiso con la sociedad de su tiempo. Resulta pertinente y oportuno acercarse hoy a la vida y obra de D. Gregorio Marañón. Oportuno para identificar nuestro siglo y conjugar de manera renovada el verbo recordar, -cordis-, para visitar de nuevo el corazón, antigua sede del alma y la memoria, que facilita el encuentro con nosotros mismos. Sera el momento de reconocer, palíndromo que nos sitúa en el círculo virtuoso del tiempo, e identificar a un médico ejemplar, dedicado al servicio de los demás, en su tiempo histórico y biográfic

La bioética en España y Latinoamérica

El libro "La bioética en España y Latinoamérica. ¿Hay una bioética iberoamericana?" tiene como objetivo indagar en las posibles especialidades de lo que podría llamarse la bioética iberoamericana, si es que tal bioética existe; el texto versa concretamente sobre ética en biomedicina o ética clínica. Dentro del amplio terreno de juego que es la bioética, el libro se focaliza en su vertiente clínica. Asimismo, trata de resolver si existe una bioética iberoamericana, si tal bioética tiene características propias y, si fuera así, cuáles son. La última parte del texto se centra en James Drane, porque representa el puente entre España y América. Asimismo, entre las dos américas, como él mismo señala, porque James Drane es estadounidense. Desde su formación norteamericana ha sabido entender los problemas que hay en España y en Latinoamérica, y ha estado trabajando muchos años por la bioética en ambos lugares. Con respecto a los contenidos, a la pregunta sobre si hay una bioética en España y en Latinoamérica, la respuesta es afirmativa. A través de sus páginas se descubren las claves de esta bioética iberoamericana. Una disciplina que, por motivos prácticos, por los problemas que se plantean en la realidad clínica y en la investigación con seres humanos, tiene cada vez más importancia en Iberoamérica.Sin financiaciónNo data (2016)UE

Problemas éticos y jurídicos derivados de las investigaciones en el sujeto vivo. La Ley de Investigación Biomédica. Normas Comunitarias Biotecnología y desarrollo de la medicina. Situación actual y conflictos médico legales. Nuevos retos en biomedicina y Nanotecnología. Los biobancos. Bancos de Cordón

No data (2011)UE

Gregorio Marañón: cumbre y síntesis para el siglo XXI

Sin financiaciónNo data (2008)UE

Marcadores biológicos emergentes de riesgo cardiovascular en población laboral

Este estudio transversal y descriptivo se realizó sobre una población inicial de 200 trabajadores que, tras aplicar los criterios de exclusión, se redujo a 119 sujetos. Determinamos los factores de riesgo cardiovascular más prevalentes y relacionamos los marcadores emergentes (proteína C reactiva, lipoproteína (a) y homocisteina) con el valor de la clasificación de predicción de coronariopatía a los diez años de Framingham (FCRS). Finalmente valoramos la necesidad de introducirlos en el screening lipídico (prevención primaria). Concluímos que la hipercolesterolemia, el tabaquismo y el estrés son los factores de riesgo más frecuentemente observados y están fuertemente relacionados con los hábitos personales, siendo por tanto, modificables. La proteína C reactiva resultó ser el mejor marcador de riesgo de los tres marcadores (aunque no significativa estadísticamente), además de ser la más eficiente y no precisar especiales cuidados en la fase preanalítica.0.115 SJR (2006) Q3, 1183/1778 Medicine (miscellaneous

CYP2D6*4 allele and breast cancer risk: is there any association?

BACKGROUND: CYP2D6 is an important cytochrome P450 enzyme. These enzymes catalyse the oxidative biotransformation of about 25% of clinically important drugs as well as the metabolism of numerous environmental chemical carcinogens. The most frequent null allele of CYP2D6 in European populations, CYP2D6*4, has been studied here in order to elucidate whether a relationship exists between this allele and the risk of developing breast cancer in a Spanish population. MATERIALS AND METHODS: Ninety-six breast cancer Spanish patients and one hundred healthy female volunteers were genotyped for the CYP2D6*4 allele using AmpliChip CYP450 Test technology. RESULTS: Homozygous CYP2D6*4 frequency was significant lower in breast cancer patients than in the control group (OR=0.22, p=0.04). The heterozygous CYP2D6*4 group also displayed lower values in patients than in controls but the difference was not significant (OR=0.698, p=0.28). Therefore, the presence of the CYP2D6*4 allele seems to decrease susceptibility to breast carcinoma in the selected population. CONCLUSIONS: A possible decreased transformation of procarcinogens by CYP2D6*4 poor metabolisers could result in a protective effect against carcinogens.1.276 JCR (2012) Q4, 163/197 Oncolog