Ensayos clínicos que comparan dos fármacos antihipertensivos

Los estudios revisados incluyen los ensayos clínicos que comparan dos fármacos antihipertensivos y con fecha de publicación entre el año 1985 y el 2004. Se han clasificado en función de los fármacos utilizados como primera línea de tratamiento. Existen comparaciones entre los principales grupos de fármacos antihipertensivos: diuréticos frente a betabloqueantes, antagonistas del calcio, IECAS (inhibidores del enzima de conversión de la angiotensina) frente a diuréticos o betabloqueantes, alfabloqueantes frente a diuréticos, IECA frente antagonistas del calcio y antagonistas de los receptores de la angiotensina II (ARA II). El tratamiento ya sea con antagonistas del calcio, alfabloqueantes, IECAS, ARAII, Betabloqueantes o diuréticos muestra globalmente una eficacia similar, aunque se pueden señalar algunas consideraciones. Respecto a la prevención de infarto de miocardio se observa que los IECA son mejores que los diuréticos, que los diuréticos son mejores que los betabloqueantes y que los IECA son mejores que los antagonistas del calcio, y que el amlodipino es mejor que el valsartan. Respecto a la prevención de ictus los fármacos más favorables son el losartan y la benzofluazida. Ninguno de los estudios que comparan dos fármacos antihipertensivos han demostrado una reducción significativa de la mortalidad total. La elección de un fármacos antihipertensivo para iniciar el tratamiento de la hipertensión arterial depende más de consideraciones derivadas de un efecto protector sobre algún órgano de determinado, como por ejemplo, los IECA o ARA II en diabéticos con microalbuminuría o nefropatía, o los ARAII en pacientes con hipertrofia ventricular izquierda. Recientemente dos metaanálisis con fármacos antihipertensivos intentan responder a la pregunta de qué fármaco es el más adecuado para iniciar el tratamiento de la hipertensión arterial. El primero de ellos concluye que el tratamiento con cualquier fármaco antihipertensivo reduce el riesgo de enfermedad cardiovascular-con diferencias según el tipo de enfermedad-, y en general, mayores reducciones en la presión arterial producen mayores reducciones en el riesgo. El segundo metaanálisis concluye que los diuréticos tiazídicos a bajas dosis son el tratamiento más efectivo de primera línea de la hipertensión para prevenir eventos cardiovasculares, aun incluyendo estudios recientes como donde los IECA tenían ligeramente mejores resultados que los diuréticos en pacientes de edad avanzada. Los autores recomiendan que las guías de práctica clínica reflejen esta evidencia, y de hecho, en el mismo número donde aparece esta publicación, aparece el informe del Joint Nacional Committee 7, donde se recomienda explícitamente los diuréticos a dosis bajas (12.5-25 mg) como tratamiento inicial de la hipertensión, ya sea sólo o en combinación con otros fármacos. Esta es una opinión que sigue siendo discutible, y otros organismos recomiendan como primera línea cualquiera de los cinco grupos terapéuticos que han demostrado un beneficio en términos de morbimortalidad

Emotional Eating and Perfectionism as Predictors of Symptoms of Binge Eating Disorder: The Role of Perfectionism as a Mediator between Emotional Eating and Body Mass Index.

(1) Background: Perfectionism has been linked to eating disorders and might be a risk factor for the appearance of eating pathologies. The aims of this study are (a) to verify the relationship between perfectionism, emotional eating (EE), binge eating (BE), and body mass index (BMI); (b) to identify the variables that predict BE symptoms and BMI; (c) to study the role of perfectionism as a mediator between EE and BMI. (2) Methods: 312 adult participants answered a cross-sectional survey that included the Multidimensional Perfectionism Scale, the Emotional Eater Questionnaire (EEQ), the Binge Eating Scale (BES), and a sociodemographic questionnaire including BMI. (3) Results: The results suggest a direct correlation between EE, BE, and BMI, showing that EE is a powerful predictor of BE symptoms and BMI. Furthermore, two dimensions of perfectionism have a mediator role between EE and BMI, specifically doubts and actions and concern over mistakes: the presence of these two components of perfectionism reverses the relationship between EE and BMI. (4) Conclusions: These results have significant implications for the understanding of the two different (pathological) eating patterns: intake restriction and overeating and should be considered in intervention programs.post-print1043 K

Are Adherence to the Mediterranean Diet, Emotional Eating, Alcohol Intake, and Anxiety Related in University Students in Spain?.

Research has suggested that university students are at risk from certain unhealthy habits, such as poor diet or alcohol abuse. At the same time, anxiety levels appear to be higher among university students, which may lead to high levels of emotional eating. The aim of this study was to analyze the degree of adherence to the Mediterranean diet (AMD), emotional eating, alcohol intake, and anxiety among Spanish university students, and the interrelationship of these variables. A total of 252 university students filled out the Mediterranean Diet Quality Index (KIDMED) questionnaire for Mediterranean diet adherence, an Alcohol Use Disorders Identification Test, a State-Trait Anxiety Inventory and the Emotional Eater Questionnaire. We analyzed descriptive data, a t-test and analysis of variance (ANOVA) for differences, a Pearson correlation, and multiple regression tests. Results showed low levels of AMD among university students (15.5%) and considerable levels of emotional eating (29%) and anxiety (23.6%). However, levels of alcohol dependence were low (2.4%). State-anxiety was a predictor of the emotional eater score and its subscales, and sex also was predictive of subscale guilt and the total score. However, AMD was predicted only by trait-anxiety. These models accounted for between 1.9% and 19%. The results suggest the need for the implementation of educational programs to promote healthy habits among university students at risk.post-print555 K

Factor Structure and Psychometric Properties of Emotional Eater Questionnaire (EEQ) in Spanish Colleges.

Emotional eating (EE) patterns have been shown to play a relevant role in the development of overweight problems. However, there is a gap in research aimed at validating questionnaires to assess EE in specific populations. The aim of the study was to analyze factor structure and psychometric properties of Emotional Eater Questionnaire (EEQ) in Spanish universities. EEQ, state-anxiety subscale of STAI and a questionnaire about health habits were filled out by 295 students. Exploratory Factor Analysis (EFA) by using Unweight Least Squares (ULS) method was carried out. To determine factor numbers we used eigenvalues, parallel analysis, and goodness of fit statistics. Cronbach’s alpha and Spearman correlations were used to analyze reliability, convergent, and concurrent validity. The parallel analysis and goodness of fit statistics showed that unifactorial structure of seven items was the most appropriate what accounted for 57% of the variance. Internal consistency was good ( = 0.753), as well as convergent validity (r = 0.317; p < 0.001). Concurrent validity was significant for three of the five criteria (r = �����0.224; p < 0.001 and r = �����0.259; p < 0.001). The results suggest some di erences in the structure of the psychometric assessment of EE in sub-clinical population in comparison with previous studies carried on with an overweight population, what could be relevant to obesity prevention.post-print366 K

Internet addiction and executive functions in university students: a systematic review.

Internet addiction is a growing public health problem and university students have number of characteristics which make them a population at risk. Numerous studies suggest a relation between addiction and the impairment of executive functions. This bibliographical review aims to identify neuropsychological variables which indicate a risk of developing an addiction to different internet applications among university students. A systematic search was made of online databases (Medline, PsycInfo, PubMED, ScienceDirect, Scopus & Web of Science) for empirical studies published between 2000 and 2019 on the relation between internet addiction and executive functions in this population. After eliminating duplicates and applying eligibility criteria, a total of 30 studies were selected. The results of these studies suggest an alteration of executive functions due to addiction (inhibitory control, decision-making and verbal fluency), although the findings do not provide a clear internet addiction risk profile. More study is necessary into the nature of this relation, differentiating the different internet applications and controlling certain variables such as gender, the nature of the task and the type of stimuli, in order to design effective addiction prevention strategies.post-print454 K

Drug-induced hepatitis superimposed on the presence of anti-SLA antibody: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Effectiveness and Cost-Effectiveness of Case Management in Advanced Heart Failure Patients Attended in Primary Care : A Systematic Review and Meta-Analysis

Tots els drets reservats $a Aims: Nurse-led case management (CM) may improve quality of life (QoL) for advanced heart failure (HF) patients. No systematic review (SR), however, has summarized its effectiveness/cost-effectiveness. We aimed to evaluate the effect of such programs in primary care settings in advanced HF patients. We examined and summarized evidence on QoL, mortality, hospitalization, self-care, and cost-effectiveness. Methods and results: The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI −0.84 to 2.17; participants = 450; studies = 3; I = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY. Conclusions: Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries