Anticoncepción poscoital. Características de la demanda

ObjetivoConocer el perfil de las mujeres que demandan anticoncepción poscoital (APC).DiseñoDescriptivo transversal. Emplazamiento. Centro de Orientación Familiar (COF), Área 4 del Instituto Madrileño de Salud. Madrid.ParticipantesTodas las mujeres que acudieron en el año 2000 para requerir APC (n = 404).MedicionesSe realizó una encuesta con variables sociodemográficas relacionadas con la APC y con la vida sexual.ResultadosLa edad media fue de 23,9 años (límites, 14–49); el 9,9% era menor de edad. La media de coitos al mes era de 6,7, el número de años de relaciones sexuales era de 4,9 y el primer coito se produjo, de media, a los 18 años. El 90,9% afirmaba tener pareja estable. Tenía estudios secundarios o universitarios un 75%. El 55,7% manifestaba no haber recibido información sobre anticonceptivos. El 19,5% utilizó APC en otra ocasión. El 6,5% había tenido alguna interrupción voluntaria de embarazo y de éstas, el 36% había utilizado APC anteriormente. Los motivos de consulta fueron: rotura de preservativo (69,3%), preservativo retenido (16,9%) y coito sin protección (12%). El 7% tuvo otros coitos de riesgo en el mismo ciclo. Un 33,2% las remitía su equipo de atención primaria, acudió por conocidos el 19% y desde servicios de urgencias el 16%. Conocía el COF un 26,1%. En el 12,2% no se prescribió APC por mínimo riesgo de embarazo. Realizaron la valoración una enfermera (52,6%), médicos residentes (34,4%) y una ginecóloga (13%).ConclusionesFalta información sobre métodos anticonceptivos. La mayoría de las pacientes son derivadas por otros servicios sanitarios.ObjectiveDefine the profile of the women that ask for emergency contraception (EC).DesignTransversal descriptive investigation.SettingFamiliar Planning Center of 4th Area of Instituto Madrileño de Salud. in Madrid. Participants. All the women that went in the year 2000 requiring EC (n=404).MeasurementsWas carried out a survey with sociodemographic variables, related with the EC and with the sexual life.ResultsThe average age was of 23.9 years (age range 14 to 49) were inquired, 9.9 were under 18. They had an average of 6.7 intercourses per month, the first intercourse when they were 18 years old on average, and 4.9 years of sexual relationships. 90.9% stated to have a couple. 75% were graduated from high school or university, and 55.7% said they had never received information about contraceptives. For 19.5% this was not the first time they asked for EC. 6.5% had interrupted on purpose pregnancy and 36% of them had used EC before. The reasons to demand EC were: condom break (69.3%), held condom (16.9%) and intercourse without any protection (12%). 7% acknowledged other risky intercourses during the same period. 33.2% had been sent by a General Practitioner, 26.1% knew the center, 19% were sent by acquaintances and 16% from Emergency Services. EC was not prescribed in 12.2% of the cases because of minimum risk to pregnancy. The evaluation was made by a nurse (52.6%), by a doctor (34.4%) and by a gynecologist (13%).ConclusionsThere is a lack of information about contraceptive methods. Most of the patients are sent from other sanitary services

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo‐oxygenase‐2 inhibitors, traditional non‐aspirin non‐steroidal anti‐inflammatory drugs, aspirin and combinations

BACKGROUND: The risks and benefits of coxibs, non‐steroidal anti‐inflammatory drugs (NSAIDs), and aspirin treatment are under intense debate. OBJECTIVE: To determine the risk of peptic ulcer upper gastrointestinal bleeding (UGIB) associated with the use of coxibs, traditional NSAIDs, aspirin or combinations of these drugs in clinical practice. METHODS: A hospital‐based, case–control study in the general community of patients from the National Health System in Spain. The study included 2777 consecutive patients with endoscopy‐proved major UGIB because of the peptic lesions and 5532 controls matched by age, hospital and month of admission. Adjusted relative risk (adj RR) of UGIB determined by conditional logistic regression analysis is provided. RESULTS: Use of non‐aspirin‐NSAIDs increased the risk of UGIB (adj RR 5.3; 95% confidence interval (CI) 4.5 to 6.2). Among non‐aspirin‐NSAIDs, aceclofenac (adj RR 3.1; 95% CI 2.3 to 4.2) had the lowest RR, whereas ketorolac (adj RR 14.4; 95% CI 5.2 to 39.9) had the highest. Rofecoxib treatment increased the risk of UGIB (adj RR 2.1; 95% CI 1.1 to 4.0), whereas celecoxib, paracetamol or concomitant use of a proton pump inhibitor with an NSAID presented no increased risk. Non‐aspirin antiplatelet treatment (clopidogrel/ticlopidine) had a similar risk of UGIB (adj RR 2.8; 95% CI 1.9 to 4.2) to cardioprotective aspirin at a dose of 100 mg/day (adj RR 2.7; 95% CI 2.0 to 3.6) or anticoagulants (adj RR 2.8; 95% CI 2.1 to 3.7). An apparent interaction was found between low‐dose aspirin and use of non‐aspirin‐NSAIDs, coxibs or thienopyridines, which increased further the risk of UGIB in a similar way. CONCLUSIONS: Coxib use presents a lower RR of UGIB than non‐selective NSAIDs. However, when combined with low‐dose aspirin, the differences between non‐selective NSAIDs and coxibs tend to disappear. Treatment with either non‐aspirin antiplatelet or cardioprotective aspirin has a similar risk of UGIB

Leukocytes from obese individuals exhibit an impaired SPM signature

Specialized proresolving mediators (SPMs) biosynthesized from docosahexaenoic acids (DHAs) including resolvins (Rvs), protectins, and maresins are potent endogenous autacoids that actively resolve inflammation, protect organs, and stimulate tissue regeneration. Our hypothesis was that failure of resolution programs may lead to unremitting inflammation in obesity, contributing to the development of metabolic comorbidities in this condition. Obese individuals with persistent low-grade systemic inflammation showed reduced leukocyte production of the DHA-derived monohydroxy fatty acid 17- hydroxy-DHA (HDHA) and unbalanced formation of SPMs (in particular D-series Rvs) accompanied by enhanced production of proinflammatory lipid mediators such as leukotriene B4. Mechanistic studies attributed this impairment to reduced 15-lipoxygenase (LOX) activity rather than altered DHA cellular uptake. Moreover, leukocytes from obese individuals exhibited decreased 5-LOX levels and reduced 5-LOX Ser271 phosphorylation and distinct intracellular 5-LOX redistribution. However, 15-LOX appears to be the most critical factor for the deficient production of SPMs by obese leukocytes because the formation of D-series Rvs was completely rescued by incubation with the intermediate precursor 17-HDHA. These data provide proof of concept that administration of intermediate precursors of SPM biosynthesis ( e.g., 17-HDHA) could be more efficient in overriding impaired formation of these proresolving lipid mediators in conditions characterized by dysfunctional LOX activity, such as obesity

Usefulness of FRAX tool for the management of osteoporosis in the Spanish female population

Background and objective: Osteoporotic fractures involve a significant consumption of health resources. Bone densitometry has been essential in the management of osteoporosis. However, for fracture absolute risk prediction, other important clinical risk factors are also important. WHO published a risk estimation tool (FRAX), and the National Osteoporosis Guideline Group (NOGG) reported thresholds for densitometry assessment based on cost-effectivity criteria. Our goal is to determine the diagnostic predictive validity of FRAX in our population, and to assess how its use (according to NOGG guidelines) would modify the current number of referrals to DXA scan in our health system. Subjects and methods: Diagnostic validation study in a consecutive sample of 1,650 women, 50 to 90 years old, under no treatment with anti-resortives, from the FRIDEX cohort. DXA and a questionnaire regarding risk factors were performed. ROC curve and area under the curve (AUC) were used to assess FRAX's diagnostic validity for femoral neck osteoporosis (FNOP). Risk of fracture was calculated using FRAX pre and postDXA, and women were classified according to their risk, following NOGG recommendations. Results: FRAX's ROC AUC for FNOP was 0.812 for major fracture and 0.832 for hip fracture. Using FRAX according to NOGG would result in performing only 25.2% of the current tests. If we added previous fracture antecedent to the algorithm, 49.4% of the tests performed would be advised. Conclusions: The use of NOGG thresholds applied to FRAX would reduce about 50% the current number of referrals to DXA scan in our population. FRAX has a good diagnostic validity for FNOP. © 2010 Elsevier España, S.L. All rights reserved