Talasoterapia y enfermedad neurológica

Introducción. La medicina termal (balneoterapia, talasoterapia, hidroterapia) en los últimos años ha experimentado un cambio conceptual (multidisciplinar) y ha iniciado con paso firme el camino a la evidencia científica en todas las fases del proceso terapéutico: prevención-mejoría sintomática-rehabilitación. El desarrollo químico farmacéutico y el incremento de la esperanza de vida mundial han modificado las indicaciones tradicionales de la talasoterapia (y balneoterapia) por otras. Existe un amplio sector de enfermedades en las cuales está justificado otro tipo de intervenciones con un mecanismo de acción diferente y que tenga en cuenta la potencialidad reactiva del sujeto: prevención, tratamiento de cuadros de evolución crónica sobre todo en aquellos con intolerancias medicamentosas y en aquellas secuelas sintomáticas de traumatismos, eventos vasculares o intervenciones quirúrgicas (rehabilitación). El ictus es la enfermedad vascular cerebral que aún hoy es la primera causa de muerte en mujeres (la segunda en hombres) y la principal causa de discapacidad adquirida en el adulto. En los últimos años se ha conseguido un descenso gradual de la mortalidad gracias al desarrollo de nuevas estrategias terapéuticas y preventivas; en cambio, se está observando un leve ascenso en la incidencia explicado principalmente por el envejecimiento de la población, lo cual implica aumentos en la supervivencia con secuelas y prevalencia global (estimadas).La planificación y gestión de los recursos económicos (sanitarios y sociales) de cada país con estos datos epidemiológicos es variable a tenor, todavía, de estudios poco concluyentes. Aunque la prevención primaria es crucial, y seguirá siendo la piedra angular de los esfuerzos para reducir la discapacidad global por ictus, existe demostración acumulada de que la mejora sistemática del manejo del ictus, incluida la rehabilitación puede también reducir la mortalidad y la discapacidad por esta causa. La rehabilitación es un proceso complejo. A pesar de Declaraciones de Consenso y Guías de práctica Clínica, existen diferencias respecto a los servicios de rehabilitación al que tienen acceso los pacientes tras un ictus.. La evidencia refleja beneficios significativos asociados a la rehabilitación intensiva con tiempos más cortos desde el ictus; pero, ni un solo método de medicina física es más (o menos) eficaz en la promoción de la recuperación funcional y movilidad tras el ictus. Las investigaciones clínicas en hidrología médica (a excepción de la hidroterapia) en enfermedades neurológicas son prácticamente inexistentes, pero en algunas enfermedades reumáticas son bastantes contundentes; las ciencias básicas existentes son estimulantes, pero no son lo suficientemente fuertes como para sacar conclusiones firmes respecto a los mecanismos de acción de la medicina termal. Aun así, la talasoterapia (y terapia acuática) en el tratamiento del ictus (con un enfoque holístico) actuaría en diferentes dominios de la ICF, tanto del individuo como ambientales. La posología y los efectos adversos/contraindicaciones no han sido convenientemente estudiados..

Evaluation of the Feasibility of a Two-Week Course of Aquatic Therapy and Thalassotherapy in a Mild Post-Stroke Population

Strokes are a leading cause of disability in developed countries. Patients with disabilities need rehabilitation to improve their physical functioning, mental status, and quality of life. Currently, no high-quality evidence can be found attesting the benefits of any of the interventions that are nowadays used. Water-based exercise may improve the physical conditions and quality of life of people in the post-stroke phase. The objective of this study is to test whether aquatic therapy in an enriched environment at the seaside (a thalassotherapy center) could play a role in this condition. A quasi-experimental prospective study consisting of a specific program assessed 62 patients with a mild-moderate disability pre- and post-2 weeks of intensive treatment. They followed a thalassotherapy regimen including aquatic therapy in a sea water pool at 32-34 degrees C for 45 min daily five times a week. The outcomes measured were the Berg Balance scale, the Timed Up and Go test, the 10-meter walking test, the 6-min walking test, the Pain Visual Analogue Scale, the WHO Well-being index, EuroQoL VAS and EuroQoL 5D. We observed a significant improvement in all outcomes measured (p < 0.001, except mobility EuroQoL p < 0.05), except in the other four dimensions of the EuroQoL 5D and 10-metre walking test (NS). Conclusion: A two-week intensive course of aquatic therapy and thalassotherapy may be beneficial in the short term by reducing pain and improving the functional status and overall well-being of post-stroke patients

Efficacy of Insulin Titration Driven by SMS in Improving Glycemic Control in People with Type 2 Diabetes

Insulin treatment; Text messaging; Type 2 diabetesTractament amb insulina; Missatge de text; Diabetis tipus 2Tratamiento con insulina; Mensaje de texto; Diabetes tipo 2Aim: To evaluate the efficacy of the self-management of insulin titration based on information received by the Short Message Service (SMS). Methods: A case-control study including 59 subjects in each arm with 16 weeks of follow-up was performed. The inclusion criteria were: (1) Subjects with type 2 diabetes (T2D) under basal insulin treatment; (2) Suboptimal glycemic control: HbA1c ≥ 7.5% and fasting capillary blood glucose (FCBG) > 140 mg/dL (>3 times per week). Subjects were invited to use an insulin titration service based on SMS feedback aimed at optimizing glycemic control depending on fasting blood glucose levels. Psychological aspects were evaluated in the interventional group by means of validated questionnaires (DDS, HADS and SF-12). Results: The intervention group achieved a lower mean FCBG (126 mg/dL ± 34 vs. 149 mg/dL ± 46, p = 0.001) and lower HbA1c (7.5% ± 1.3 vs. 7.9% ± 0.9, p = 0.021) than the control group. In addition, the intervention group showed a significant improvement in psychological aspects related to Emotional Burden (p = 0.031), Regimen Distress (p < 0.001), Depression (p = 0.049) and Mental Health (p < 0.01). Conclusions: The SMS-guided titration was effective in terms of improving glucometric parameters in comparison with the standard of care and improved significant psychological aspects—mainly, the stress associated with insulin treatmentThis research was funded by a Roche Diabetes Care unrestricted grant

Integrative and Collaborative Approach in the Chronic Management of Obesity in Primary and Tertiary Care Setting: Vall Hebron-SAP Muntanya Healthcare Route

Integrative approach; Obesity; Primary careEnfoque integrador; Obesidad; Atención primariaEnfocament integrador; Obesitat; Atenció primàriaIntroduction: In the context of obesity pandemic, the health care providers involved in the primary care should have a significant role. Several guidelines for the management of obesity in primary care were proposed recently. In general lines, these guidelines include recommendation on the baseline assessment, therapy, and algorithm for referral to specialized obesity clinic and follow-up. Nevertheless, at present, there is no guideline or protocol that continuously and bidirectionally links the two settings: primary care and specialized obesity clinic. Methods: We present a model of continuous, bilateral, and integrative interaction between primary care units and reference tertiary care setting in the chronic management of obesity that is already implemented in a public health system. Results: The novelty of our algorithm is that incorporates the support and continuous communication with the specialized obesity clinic of the tertiary care setting from the beginning in the management of a patient with obesity, in a bidirectional manner. Conclusion: This kind of bidirectional and continuous collaboration will help engage health care providers in the management of obesity, optimize efforts, shorten the time until proper intervention, personalize the approach and, finally, save costs for the health system

Treball d'educació farmacèutica adreçat al pacient amb dolor crònic

Treballs d'Educació Farmacèutica als ciutadans. Unitat Docent d'Estades en Pràctiques Tutelades. Facultat de Farmàcia, Universitat de Barcelona. Curs: 2017-2018. Tutors: Montserrat Iracheta i Marian March Pujol.Pràcticament tothom sent dolor en algun moment de la seva vida; quan et fas un tall al dit, quan tens mal de cap... És la manera que té el nostre cos d’avisar que alguna cosa no va bé. Un cop el mal es cura, ja no es té més dolor. A diferència del dolor agut, entès com un signe d’alarma i reacció del cos davant d’una agressió, en el dolor crònic no sempre trobem una causa òbvia que l’expliqui en tota la seva magnitud. El dolor, en aquest cas, és un dels símptomes d’un terme més ampli que és el patiment, on aspectes psicològics i socials juguen un paper molt important. És un dolor que perdura setmanes, mesos o, fins i tot, anys

Gravimetric and magnetic fabric study of the Sintra Igneous complex: laccolith-plug emplacement in the Western Iberian passive margin

The geometry and emplacement of the ~ 96 km2, Late Cretaceous Sintra Igneous complex (SIC, ca. 80 Ma) into the West Iberian passive margin is presented, based on structural data, gravimetric modeling, and magnetic fabrics. A granite laccolith (~ 76 km2, < 1 km thick, according to gravimetric modeling) surrounds a suite of gabbro–diorite–syenite plugs (~ 20 km2, ~ 4 km deep) and is encircled by cone sheets and radial dykes. Anisotropy of Magnetic Susceptibility was interpreted from 54 sites showing fabrics of para- and ferro-magnetic origin. Most fabrics can be interpreted to have a magmatic origin, according to the scarcity of solid-state deformation in most part of the massif. Magnetic foliations are shallowly dipping in the granite laccolith and contain a sub-horizontal ENE–WSW lineation. The gabbro–syenite body displays concentric magnetic foliations having variable dips and steeply-plunging lineations. The SIC can be interpreted to be intruded along an NNW–SSE, 200 km-long fault, perpendicular to the magnetic lineation within the laccolith, and was preceded by the intrusion of basic sills and plugs. The SIC intruded the Mesozoic series of the Lusitanian Basin during the post-rift, passive margin stage, and its geometry was only slightly modified during the Paleogene inversion that resulted in thrusting of the northern border of the intrusion over the country rocks.Division of Marine Geology and Georesources, Instituto Português do Mar e da Atmosfera, PortugalUnidad de Zaragoza, Instituto Geológico y Minero de España, EspañaDepartamento de Geodinámica, Universidad del País Vasco, EspañaCentro de Investigação em Ciência e Engenharia Geológica, Universidade Nova de Lisboa, PortugalDepartamento de Geologia, Universidade de Lisboa, PortugalGeotransfer, Universidad de Zaragoza, EspañaDepartamento de Geociências, Universidade de Aveiro, Portuga

Integrative and collaborative approach in the chronic management of Obesity in Primary and Tertiary care setting: Vall Hebron-SAP Muntanya healthcare route

Introduction: In the context of obesity pandemic, the health care providers involved in the primary care should have a significant role. Several guidelines for the management of obesity in primary care were proposed recently. In general lines, these guidelines include recommendation on the baseline assessment, therapy and algorithm for referral to specialized obesity clinic and follow-up. Nevertheless, at present there is no guideline or protocol that continuously and bidirectionally links the two settings: primary care and specialized obesity clinic. Methods: We present a model of continuous, bilateral and integrative interaction between primary care units and reference tertiary care setting in the chronic management of obesity that is already implemented in a public health system. Results: The novelty of our algorithm is that incorporates the support and continuous communication with the specialized obesity clinic of the tertiary care setting from the beginning in the management of a patient with obesity, in a bidirectional manner. Conclusion: This kind of bidirectional and continuous collaboration will help engage health care providers in the management of obesity, optimize efforts, shorten the time until proper intervention, personalize the approach and, finally, save costs for the health system