Practical guidelines for the early diagnosis of Sjogren's syndrome in primary healthcare

Primary care physicians can play a crucial role by recognising Sjogren's syndrome (SS) in the early stages identifying those patients with the greatest probability of being diagnosed with SS. SS has a very specific epidemiological profile at presentation (female aged 3050 years), which may aid an early diagnosis. Although the disease may be expressed in many guises, there are three predominant clinical presentations that should be considered as key clues to increased clinical suspicion (multiple symptoms of dryness, asthenia-polyalgia syndrome and systemic organ-specific manifestations). The physical examination may provide important clues to systemic involvement (parotid gland enlargement, skin lesions suggestive of purpura or annular erythema, respiratory crackles, arthritis, neurological sensory or motor deficits). Simple laboratory studies may be very useful in reinforcing the clinical suspicion of SS, and the triad of cytopenia, raised erythrocyte sedimentation rate and high serum gamma globulin levels is a very specific "biological" pattern suggesting SS. A solid clinical suspicion of SS requires both the patient reporting sicca symptoms and objective evidence that these symptoms are associated with dysfunction of the lachrymal and salivary glands. Ultrasonography of the parotid glands, a non-invasive method, may be a major advance in the diagnostic approach to SS in primary care. Primary care physicians must be considered essential members of the multidisciplinary team in charge of the follow-up of SS patients, due to their key role in the continuum of patient care and their cross-sectional knowledge of common diseases that frequently coexist in patients with SS.</p

Estimation of the advection effects induced by surface heterogeneities in the surface energy budget

Peer ReviewedPostprint (published version

Catàleg d'actuacions no farmacològiques en salut mental a l'atenció primària

Actuacions no farmacològiques; Salut mental; Atenció primàriaNon-pharmacological actions; Mental health; Primary careActuaciones no farmacológicas; Salud mental; Atención primariaAquest catàleg ha estat concebut amb la voluntat de presentar diferents actuacions no farmacològiques que han resultat efectives en algunes situacions per millorar la salut mental i que poden ser accessibles a professionals d’atenció primària. També vol servir de punt de partida per explorar/incorporar actuacions no farmacològiques en la pràctica assistencial de l’atenció primària per ajudar les persones a tenir més autonomia

Single-column Model Intercomparison for a Stably Stratified Atmospheric Boundary Layer

The parameterization of the stably stratified atmospheric boundary layer is a difficult issue, which has a large impact on the medium-range weather forecasts and on climate integrations. A non-strongly stratified arctic case is simulated by nineteen single-column turbulence schemes. The statistics from the Large-eddy simulation (LES) intercomparison made for the same case by eight different models are used as a guiding reference. The single-column parameterizations include research schemes and operational schemes from major forecast and climate research centres. First order schemes, a large number of turbulence kinetic energy closures, and other proposals have submitted results. There is a large spread in the results; in general, the operational schemes mix more efficiently than the research ones, and the TKE and other higher order closures give results closer to the LES statistics. The sensitivities of the schemes to the parameters of their turbulence closures are partially explored

Single-Column Model Intercomparison for a Stably Stratified Atmospheric Boundary Layer

The parameterization of the stably stratified atmospheric boundary layer is a difficult issue, having a significant impact on medium-range weather forecasts and climate integrations. To pursue this further, a moderately stratified Arctic case is simulated by nineteen single-column turbulence schemes. Statistics from a large-eddy simulation intercomparison made for the same case by eleven different models are used as a guiding reference. The single-column parameterizations include research and operational schemes from major forecast and climate research centres. Results from first-order schemes, a large number of turbulence kinetic energy closures, and other models were used. There is a large spread in the results; in general, the operational schemes mix over a deeper layer than the research schemes, and the turbulence kinetic energy and other higher-order closures give results closer to the statistics obtained from the large-eddy simulations. The sensitivities of the schemes to the parameters of their turbulence closures are partially explore