Influencia de la tectónica cuaternaria sobre la morfología del talud continental de la región de Adra (Mar de Alborán septentrional)

El análisis de un mosaico batimétrico y de perfiles sísmicos de alta resolución ha permitido definir la geomorfología tectónica del Margen de Adra, sector norte del Mar de Alborán. Se han identificado cuatro tipos morfológicos relacionados con estructuras tectónicas: (i) Crestas longitudinales (N50-70); (ii) Escarpes lineales (N30, N55, N130, N165, N-S); (iii) Depresiones tectónicas (N130, N165, N-S), y (iv) Líneas de cambio de la pendiente (N130). Este esquema morfoestructural se relaciona con un cabalgamiento ciego (NO-SE) en el sector NO, y en el oriental con la falla de desgarre siniestra de La Serrata (NE-SO). Entre estas dos estructuras se ha desarrollado un sistema de fallas de desgarre diestras (NO-SE) que incluye a la Falla de Adra, y un corredor NNE-SSO constituido por fallas secundarias NNO-SSE. Además se han observado fallas inversas menores N-S que pueden ser consecuencia de la interferencia de los principales sistemas de fallas de la región con el Banco de Chella.The analysis of multibeam bathymetric data and high resolution seismic profiles has allowed us to define the tectonic geomorphology of the Adra margin, northern Alboran Sea. Four geomorphic tectonic-related structures have been analyzed: (i) Longitudinal ridges (N50-70); (ii) Linear scarps (N30, N55, N130, N165, N-S); (iii) Tectonic depressions (N130, N165, N-S), and (iv) Lines of changes in the slope gradient (N130). In the northwestern sector morphostructure is related to a blind thrust (NE-SW), which folds Quaternary units, and in the eastern sector is linked to the NE-SW sinistral strike slip fault of La Serrata (NE-SW). Between these two structures, a NW-SE dextral strike-slip fault system, including the Adra Fault, and a NNE-SSW highly deformed corridor constituted by secondary NNW-SSE faults have been developed. Minor high angle N-S reverse faults can be related to secondary deformation features, due mainly to the interference of Chella Bank and the regional main fault systems.Postprin

Seafloor deformation related to Quaternary tectonics in the Majorca Channel, Balearic Promontory (Western Mediterranean)

El análisis morfotectónico del sector central del Promontorio Balear, entre las islas de Ibiza y Mallorca, mediante batimetría multihaz y perfiles sísmicos de muy alta resolución ha permitido diferenciar varios rasgos morfológicos relacionados con la tectónica a dos escalas. Los elementos de gran escala, de dirección NE-SO, son: i) el escarpe Émile Baudot; ii) el monte submarino Émile Baudot, y iii) la alineación de montes submarinos Ausiàs March y Ses Olives. Los elementos de pequeña escala son: i) dos elevaciones longitudinales (ENE-OSO); ii) escarpes rectilíneos (NO-SE a NE-SO); iii) depresiones tectónicas (NNE SSO a NE-SO); y iv) alineaciones rectilíneas de pockmarks (NO-SE a NNE-SSO). Los elementos de mayor tamaño responden a la configuración estructural neógeno-cuaternaria. El escarpe Émile Baudot limita el Promontorio Balear y la cuenca oceánica del Mediterráneo Occidental. La alineación de montes submarinos Ausiàs March y Ses Olives está generada por una fase extensional, y el monte submarino Émile Baudot forma parte de una alineación volcánica NO-SE asociada a la Zona de Fractura de Ibiza. Los elementos de pequeña escala están relacionados con estructuras tectónicas activas que deforman las unidades sedimentarias del Cuaternario y el fondo marino. Las elevaciones longitudinales están generadas por pliegues anticlinales, mientras que el resto de estructuras están asociadas a la actividad de fallas normales de buzamiento alto.A morphotectonic analysis has been carried out between the islands of Ibiza and Majorca in the central sector of the Balearic Promontory using multibeam bathymetry and very high-resolution seismic profiles. Several morphological features related to tectonics at two different scales have been differentiated. The large-scale features have a NE-SW direction, they are: i) the Émile Baudot Escarpment; ii) the Émile Baudot seamount, and iii) the Ausiàs March and Ses Olives seamounts alignment. The differentiated small-scale elements are i) two longitudinal elevations (ENE-WSW); ii) rectilinear scarps (NW-SE to NE-SW); iii) tectonic depressions limited by one or two scarps (NNE-SSW to NE-SW), and iv) rectilinear pockmarks alignments (NW-SE to NNE-SSW). The largest elements respond to the Neogene-Quaternary structural configuration. The Émile Baudot escarpment is the limit between the Balearic Promontory and the Western Mediterranean oceanic basin. The alignment of the Ausiàs March and Ses Olives seamounts respond to the last extensional phase, and the Émile Baudot seamount forms part of a NW-SE volcanic alignment that could be associated with the Ibiza Fracture Zone. The smaller elements are related to active tectonic structures that deform Quaternary sedimentary units and the seafloor. The longitudinal elevations correspond to anticlinal folds, while the rest of the structures are associated to the activity of near vertical normal faults.En prens

Professional interventions to implement guidelines to prevent hazardous alcohol consumption by patients in primary care settings (Protocol)

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Oral versus intramuscular administration of vitamin B12 for vitamin B12 deficiency in primary care : a pragmatic, randomised, non-inferiority clinical trial (OB12)

The trial was financed by Ministerio de Sanidad y Consumo Español through their call for independent clinical research, Orden Ministerial SAS/2377, 2010 (EC10-115, EC10-116, EC10-117, EC10-119, EC10-122); CAIBER—Spanish Clinical Research Network, Instituto de Salud Carlos III (ISCIII) (CAI08/010044); and Gerencia Asistencial de Atención Primaria de Madrid. This study is also supported by the Spanish Clinical Research Network (SCReN), funded by ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, project number PT13/0002/0007, within the National Research Program I+D+I 2013-2016 and co-funded with European Union ERDF funds (European Regional Development Fund). This project received a grant for the translation and publication of this article from the Foundation for Biomedical Research and Innovation in Primary Care (FIIBAP) Call 2017 for grants to promote research programs.Objectives To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. Design Pragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain). Participants 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm. Interventions The IM arm received 1 mg VB12 on alternate days in weeks 1–2, 1 mg/week in weeks 3–8 and 1 mg/month in weeks 9–52. The oral arm received 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. Main outcomes Serum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction. Results The follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were −0.7% (133 out of 135 vs 129 out of 130; 95% CI: −3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: −1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were −6.3% (103 out of 112 vs 115 out of 117; 95% CI: −11.9 to −0.1; p=0.025) and −6.8% (103 out of 140 vs 115 out of 143; 95% CI: −16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>−10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route. Conclusions Oral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low.Publisher PDFPeer reviewe

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

Evaluación del programa de residencia de medicina familiar y comunitaria de Madrid

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Psiquiatría. Fecha de lectura: 27 de Octubre de 199