Coverage and development of specialist palliative care services across the World Health Organization European region (2005-2012): results from a European association for palliative care task force survey of 53 countries

Background: The evolution of the provision of palliative care specialised services is important for planning and evaluation. Aim: To examine the development between 2005 and 2012 of three specialised palliative care services across the World Health Organization European Region – home care teams, hospital support teams and inpatient palliative care services. Design and setting: Data were extracted and analysed from two editions of the European Association for Palliative Care Atlas of Palliative Care in Europe. Significant development of each type of services was demonstrated by adjusted residual analysis, ratio of services per population and 2012 coverage (relationship between provision of available services and demand services estimated to meet the palliative care needs of a population). For the measurement of palliative care coverage, we used European Association for Palliative Care White Paper recommendations: one home care team per 100,000 inhabitants, one hospital support team per 200,000 inhabitants and one inpatient palliative care service per 200,000 inhabitants. To estimate evolution at the supranational level, mean comparison between years and European sub-regions is presented. Results: Of 53 countries, 46 (87%) provided data. Europe has developed significant home care team, inpatient palliative care service and hospital support team in 2005–2012. The improvement was statistically significant for Western European countries, but not for Central and Eastern countries. Significant development in at least a type of services was in 21 of 46 (46%) countries. The estimations of 2012 coverage for inpatient palliative care service, home care team and hospital support team are 62%, 52% and 31% for Western European and 20%, 14% and 3% for Central and Eastern, respectively. Conclusion: Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient to meet the palliative care needs of the population

Cálculo de los tiempos de circularvección en una población con patología vestibular. Influencia del estímulo visual

[corrected] To describe the results obtained for circularvection times (tCV) in a study of the phenomenon of visual-vestibular interaction for a population with vestibular pathology and to analyze differences in its calculation among patients reporting a worsening of their symptoms with visual stimuli. MATERIAL AND METHODS: A detailed case history was taken for all patients, followed by a sensory organization test using computerized dynamic posturography and the calculation of their tCV. RESULTS: The mean tCV results were: tCV2= 6.32+/-3.17 s; tCV3=6.57+/-3.68 s; tCVr=6.27+/-6.02 s. Significant differences were obtained in tCV2 (P=.046) and tCVr (P=.023). CONCLUSIONS: tCV is a diagnostic test using simple tools that can help differentiate patients in whom the visual stimulus is influenced

Schizophrenia and hospital admissions for cardiovascular events in a large population: the APNA study

(1) Background: patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: the APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031–1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267–3.933). (4) Conclusions: patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.Menarini supported this study with an unconditional sponsored research grant. DM2-12-2017

Methodological and ethical quality checklist assessment in issues of Annals of Family Medicine Clinical Trials (2010-2013)

Abstract Introduction: At present, the quality of the publication of Control Trials (CTs) in medical journals improved due to the inclusion of the CONSORT (CONsolidated Standards of Reporting Trials) standards and the Declaration of Helsinki. The aim is to analyse methodological and ethical quality of published CTs in Annals of Family Medicine journal. Material and methods: We use a 133-item checklist divided into 11 sections based on CONSORT and the Declaration of Helsinki. The Confidence Interval of 95% (95% CI) of Clopper-Pearson for κ average is calculated. Results: We found 35 CTs in a literature review (2010-2013) on March 25, 2014 according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis). CT was mentioned in all heading/subheadings; CT controlled parallels in 80%; cluster type 45.7%. The most observed method was masked, active-controlled, decentralized randomization. The most frequently found category was an open CT assessing a medical intervention, with a positive significant result surveyed. The most common Informed Consent (IC) was in writing, not clearly voluntary, without prior knowledge and doubtful. It was not withdrawn in 45.7% of cases. A grant/scholarship was found to be the most frequent incentive for researchers. In 28 CTs there was no conflict of interest. The κ average was 0.93 (95% CI, 0.90-0.96). Conclusions: CT published “standard” characteristic are indicated. Following the CONSORT standards publication, it has increased the overall quality of the CTs published. But there are some areas for improvement in the methodological and ethical quality of the CTs published from 2010 to 2013 in Annals of Family Medicine

Alimentación materna y desarrollo de alergias en menores de 6 y 7 años

Objetivo: Determinar la prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la nutrición materna Materiales y métodos: Estudio transversal descriptivo de prevalencia de alergias en niños y niñas de 6 y 7 años y su relación con la alimentación de la madre se recolecto la información a través del cuestionario del International Study of Asthma and Allergies in Childhood el cual es empleado para describir el comportamiento epidemiológico de las enfermedades como asma, rinitis y eccema en niños y jóvenes, este fue resuelto por los padres de los menores previa firma y entrega del consentimiento informado, el cuestionario arrojo una confiabilidad del 0,78 en el alfa de cronbach, a las categorías de interés de este estudio se les hizo análisis de proporción, el contraste de hipótesis se realizó mediante diferencia de proporciones con intervalo de confianza en un nivel del 95%, y cálculo de error aceptado Resultados: Teniendo en cuenta los resultados sobre el consumo de alimentos de la madre en etapa de gestación y la presencia de síntomas de alergia en los menores se concluye que: Valor-P= 0,0  Valor-Zα/2= -34,6241   No se acepta  la H0 para un α/2= 0,025, se encontró en el estudio que aunque las madres refirieron haber consumido mayormente alimentos saludables, sus hijos presentaron síntomas de enfermedades alérgicas, asociados a asma, rinitis y eccema Conclusiones: No existe un consenso sobre si la dieta materna influye positivamente en la disminución de alergias en los neonatos, se sugiere continuar con las recomendaciones de los expertos en lo referente a una nutrición balanceada que culmine en un óptimo estado de salud de la gestante y el fet

Production of vegetables and artichokes is associated with lower cardiovascular mortality: An ecological study

Mortality due to cardiovascular disease (CVD), including cerebrovascular disease (CED) and ischaemic heart disease (IHD), was considerably different in eight municipalities of the province of Castellón, Community of Valencia (Spain) during the period of 1991–2011. In addition, these villages showed differences in agricultural practices and production. Since high vegetable consumption has been linked to decreased all-cause, CVD, and CED mortalities, we hypothesized that the diversity in vegetable and artichoke production, used as proxies for their consumption, could be associated with the diversity of mortality rates. In order to test our hypothesis, we estimated the smoothed standardized mortality ratios (SMRs) of CVD, CED, and IHD mortalities and a directed, age-adjusted mortality rate (AMR). We used a multilevel linear regression analysis to account for the ecological nature of our study. After adjustment, the CVD and CED SMRs were inversely associated with vegetable and artichoke production, with a reduction in SMRs for CVD: −0.19 (95% Confidence Interval [CI] −0.31 to −0.07) and −0.42 (95% CI −0.70 to −0.15) per hectare/103 inhabitants, respectively. The SMRs for CED also decreased: −0.68 (95% CI −1.61 to −0.19) and −1.47 (95% CI −2.57 to −0.36) per hectare/103 inhabitants, respectively. The SMRs for IHD were not associated with vegetal and artichoke production. When the directed AMR was used, CED mortality was consistent with the previous results, whereas the CVD mortality association was lost. Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities

Lifestyle factors modify obesity risk linked to PPARG2 and FTO variants in an elderly population: a cross-sectional analysis in the SUN Project.

Genetic factors may interact with lifestyle factors to modify obesity risk. FTO and PPARG2 are relevant obesogenes. Our aim was to explore the effect of Pro12Ala (rs1801282) of PPARG2 and rs9939609 of FTO on obesity risk and to examine their interaction with lifestyle factors in an elderly population. Subjects (n = 978; aged 69 ± 6) were recruited from the SUN (Seguimiento Universidad de Navarra) Project. DNA was obtained from saliva, and lifestyle and dietary data were collected by validated self-reported questionnaires. Genotyping was assessed by RT-PCR plus allele discrimination. Subjects carrying the Ala allele of PPARG2 gene had a significantly increased obesity risk compared to non-carrier (Pro12Pro) subjects (OR, 1.66; 95 % CI, 1.01-2.74; p = 0.045). Greater obesity risk was also found in inactive or high carbohydrate intake subjects with the Ala12 allele of PPARG2 gene. Interestingly, subjects carrying the Ala allele of the PPARG2 gene and with a high CHO (>246 g/day) intake had an increased obesity risk compared to Pro12Pro subjects (OR, 2.67; 95 % CI, 1.3-5.46; p = 0.007; p for [CHO × PPARG2] interaction = 0.046). Moreover, in subjects with a high CHO intake, the co-presence of the Ala allele of PPARG2 gene and one minor A allele (rs9939609) of FTO gene did increase obesity risk (OR, 3.26; 95 % CI, 1.19-8.89; p = 0.021) when compared to non-carrier (Pro12Pro/TT) subjects. In conclusion, it appears that lifestyle factors may act as effect modifiers for obesity risk linked to Ala12 allele of the PPARG2 gene and the minor A allele of FTO gene in an elderly population

Public health stakeholders' perceived status of health communication activities for the prevention and control of communicable diseases across the EU and EEA/EFTA countries

Executive summary: Health communication activities to inform and influence individual and community decisions are increasingly being used to support the prevention and control of communicable diseases. Research shows that properly designed media campaigns can have a significant positive impact on health-related attitudes, beliefs, and behaviour. However, the extent and nature of the use of health communication activities for the prevention and control of communicable diseases across Europe is currently unknown. To address this knowledge gap, the European Centre for Disease Prevention and Control (ECDC) commissioned a Research Consortium of universities to map current use and application of health communication activities, and to identify perceived needs for efficacious use of health communication, in particular in relation to the prevention and control of communicable diseases across the European Union (EU) and European Economic Area (EEA)/European Free Trade Association (EFTA) countries. The purpose of this report is to present the findings from the mapping exercise and needs assessment gathered across the 30 EU and EEA/EFTA countries. The information is derived from data collection via telephone interviews and an e-survey, as well as an expert consultation. Questions sought to identify and map the following: what is currently being done in health communication; how are activities used; who is involved; which specific disease groups are being addressed; what are the key target audiences and the channels used to reach them; what education and training programmes for health communication are available; and how health communication activities are being evaluated. Furthermore, the data collection also identified priority areas to improve health communication in the EU and the perceived needs of public health bodies in order to be able to practice health communication effectively. The report presents the methodology used for the data collection followed by the aggregated information gathered. The discussion considers some of the main results and observations from the data collected and assesses their relevance and implication in relation to published literature, best practice and areas for improvement. The report's annexes include specific health communication plans and policies identified by study participants, as well as examples of health communication initiatives for the prevention and control of communicable diseases. Specific health communication education and training courses identified by participants are also included, as well as identified stakeholder organisations in the area of health communication and communicable diseases

Evaluating the Efficacy of ChatGPT in Navigating the Spanish Medical Residency Entrance Examination (MIR): Promising Horizons for AI in Clinical Medicine.

UNLABELLED: The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model\u27s overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. MATERIAL AND METHODS: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4\u27s new image analysis capability. RESULTS: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p \u3c 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as error requiring intervention to sustain life and error resulting in death , had a 0% rate. CONCLUSIONS: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model\u27s high success rate is commendable, understanding the error severity is critical, especially when considering AI\u27s potential role in real-world medical practice and its implications for patient safety

Validación del Cuestionario de Orientación a la Vida (OLQ-13) de Antonovsky en una muestra de estudiantes universitarios en Navarra

Fundamento. El sentido de coherencia interna (SOC), concepto central del modelo salutogénico descrito por Aaron Antonovsky, se ha empleado como predictor de medidas de salud percibida y objetiva, se relaciona fuerte y positivamente con comportamientos saludables, y se desarrolla principalmente en la juventud y en la época de estudiante. Los universitarios son un grupo de jóvenes diana para aplicar medidas promotoras de salud en función de su nivel SOC, siendo necesario comprobar la calidad de la medición de la escala. El objetivo es validar y estudiar las propiedades psicométricas de la escala SOC en los estudiantes de la Universidad de Navarra, y conocer su evolución temporal. Sujetos y método. Se analizaron los estudiantes de nuevo acceso de la Universidad de Navarra. Estudio de cohortes con seguimiento a los tres años. Los instrumentos utilizados fueron el cuestionario de orientación a la vida (OLQ-13), la Escala del Estrés Percibido (EEP) y el Índice de malestar. Se estudiaron la calidad de los datos y viabilidad, asunciones escalares, estabilidad temporal, fiabilidad, validez de criterio concomitante y clínica, y estructura factorial y análisis confirmatorio de los datos obtenidos. Se utilizaron los paquetes estadísticos SPSS v. 19 y Amos v.7. Resultados. La muestra ha sido de 508 estudiantes, 33,5% varones y el 65,9% mujeres. Fiabilidad alta (Alfa de Cronbach de 0,814). Adecuada validez convergente con la EEP. Inadecuada validez clínica. Análisis de componentes principales con tres factores que explican el 50,73% de la varianza. Conclusiones. Instrumento válido que permite proponerlo como herramienta para aplicar medidas promotoras de salud en jóvenes.Background. The sense of coherence (SOC), the central concept of the salutogenesis model described by Aaron Antonovsky, has been employed as a predictor of measures of perceived and objective health. It is strongly and positively related to healthy behaviour and is mainly developed while young and studying. University students are a target youth group for applying measures promoting health according to their SOC level; it is therefore necessary to check the quality of the scale’s measurement. The goal is to validate and study the psychometric properties of the SOC scale in students at the University of Navarre and determine their temporal evolution. Methods. Newly enrolled students at the University of Navarre were analysed. Cohort study with a 3 year follow-up. The instruments used were the Orientation to Life Questionnaire (OLQ-13), Perceived Stress Scale (PSS) and the Discomfort Index. The following were studied: the quality and viability of the data, scale assumptions, temporal stability, reliability, concurrent and clinical validity, as well as factorial structure and confirmatory analysis of the data obtained. SPSS v. 19 and Amos v.7 statistical software were used. Results. The study sample consisted of 508 students, 33.5% male and 65.9% female. High reliability (Cronbach Alpha 0.814). Adequate validity converging with the PSS. Inadequate clinical validity. Analysis of main components with three factors that explain 50.73% of the variation. Conclusions. A valid instrument that makes it possible to propose it as a tool for applying measures promoting health in young people