Trend di ospedalizzazione nell’asma dell’adulto: effetto di età e genere

Background: Hospital admissions due to asthma are a reliable source of information on the morbidity of the disease which, after the increase observed in the last quarter of the last century, shows a declining trend in the last few years. The aim of this study was to look at hospital admission trends due to asthma in our community and analyze some of its associated factors. Methods: Retrospective analysis of all hospital admissions involving adults aged 15 years and older with asthma as the primary or secondary diagnosis (if the first diagnosis was respiratory failure or respiratory infection) in Public Health Service hospitals in the Galician region of Spain between the years 1995-2009 (total 24,766 admissions). Results: The majority of patients admitted were female (71%), over 60 years of age (64%), and admission occurred predominantly in the winter months. The hospitalization rate due to asthma tripled over the period studied, this being mainly accounted for by women aged over 60 years. Mean hospital stay was 9.2 days, longer in older patients or those admitted over the weekend. Conclusions: A significant increase in hospital admissions due to asthma over the last few years has been observed in our community, mainly involving older women. The mean stay seems long, increasing with patients' age and admission over the weekend.Razionale: I ricoveri ospedalieri dovuti ad asma sono una fonte d’informazione attendibile sulla morbilità della patologia che, dopo un incremento osservato nell’ultimo quarto del secolo scorso, è in fase di declino negli ultimi anni. Scopo di questo studio era descrivere i trend di ospedalizzazione per asma nella nostra comunità ed analizzare alcuni dei fattori associati. Metodi: Analisi retrospettiva di tutte le ospedalizzazioni di adulti dai 15 anni in su per asma come diagnosi primaria, o come diagnosi secondaria in caso la prima diagnosi fosse insufficienza respiratoria o un’infezione respiratoria, in ospedali pubblici della regione Galizia della Spagna tra gli anni 1995 e 2009 (totale dei ricoveri: 24.766). Risultati: La maggioranza dei pazienti ricoverati erano femmine (71%), di età superiore a 60 anni (64%) e la maggior parte degli accessi avveniva nella stagione invernale. Il tasso di ospedalizzazione per asma è triplicato nel periodo studiato, soprattutto per le donne di età superiore a 60 anni. La durata media del ricovero era di 9,2 giorni, più prolungata nei pazienti più anziani ed in coloro che erano ricoverati nel fine settimana. Conclusioni: Un significativo incremento delle ospedalizzazioni per asma negli ultimi anni è stato osservato nella nostra comunità, soprattutto a carico delle donne più anziane. La durata media del ricovero appare lunga ed aumenta con l’età del paziente e nei ricoveri del fine settimana.S

Endoscopic biliary drainage in unresectable biliary obstruction: the role of endoscopic ultrasound-guidance in a cohort study

Background and study aims: the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) has increased in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) and there are some concerns. The main aim of the study was to determine the role of EUS-BD in a palliative case cohort. The secondary aim was to compare the efficacy, safety and survival of EUS-BD and ERCP procedures. Patients and methods: this was an observational study at a single tertiary institution, with a consecutive inclusion from January 2015 to December 2016. The inclusion criteria were unresectable tumors of the biliopancreatic region with an indication of BD. Statistical comparison analysis was performed between the ERCP and EUS-BD groups. The incidence between groups was compared using the Chi-square and Fisher exact tests. The log rank test was used to compare the risk of death. Results: fifty-two cases with an indication of palliative BD were included in the study. Transpapillary drainage via ERCP was possible in 44 procedures and EUS-BD was required in eight cases; 15.4% of the cohort and seven using lumen apposing metal stent (LAMS). The technical and clinical success of global endoscopic BD was 100% and 88.5% (ERCP: 84.6% and 78.9%; EUS-BD: 100% and 62.5%, respectively). Pancreatitis was the most frequent adverse event (AE) in the ERCP group (9.62%) and bleeding in the EUS-BD (25%). There were fatal AEs in ERCP (1.9%) and EUS-BD (25%) cases. Patient survival was higher with ERCP transpapillary stents compared to EUS-guided stents, which was statistically significant (p = 0.007). Conclusions: the requirement of EUS-BD in palliative biliopancreatic pathology is not marginal. EUS-BD is associated with a lower survival rate and a higher rate of fatal AE, which argues against its use as a first choice procedure

Quality of life in elderly men after a radical prostatectomy. A qualitative study

Prostate cancer is the second most frequent cancer in Spain. One of its main treatments is radical prostatectomy. This intervention generates a series of physical and psychological consequences in the patient that result in reducing their quality of life. The objective of this study was therefore to explore the experiences and perceptions of older adults about their quality of life after a radical prostatectomy. A descriptive qualitative study was conducted with 18 patients who had undergone a radical prostatectomy, with a mean age of 70.6 years. A focus group of 8 people was formed, and 10 individual interviews were carried out and transcribed in ATLAS.ti for later analysis. The quality of the criteria for qualitative research was guaranteed, and the pertinent ethical aspects were respected. Participants demonstrated worse urinary (incontinence) and sexual (erectile dysfunction) function after radical prostatectomy. Due to these consequences, they manifested shame, despair and relationship problems (lack of communication, absence of sexual life, etc.), thus causing a clear decrease in their quality of life. The participants also stated that they did not feel well-protected by the health care received. The physical sequelae on urinary and erectile function of prostatectomized patients decrease the patient’s quality of life. These limitations in their sexual life cause them additional psychological consequences that also contribute to a deterioration in the perceived quality of life. In a social environment, patients can find understanding and freedom to share feelings, which contributes to improving their quality of life. However, pressure and lack of communication can appear in the couple, which is perceived as a source of deterioration in quality of life. The care conditions in the health system are not appropriate to address the quality of life of this type of patient in a comprehensive manner

Fever of unkown origin in children. An approach to diagnosis and intervention in primary health care

Este trabajo obtuvo el Primer “Premio Colegio Oficial de Médicos” de Granada en la convocatoria 15 de Diciembre de 2009.Introducción. La fiebre es un motivo de consulta frecuente. Debido a que gran parte de lo publicado se refiere a atención Hospitalaria, nuestro objetivo es evaluar su diagnóstico, manejo e intervención en Pediatría de Atención Primaria. Material y métodos. Estudio transversal descriptivo, sobre población menor de 14 años con diagnóstico Fiebre 780.6 del CIE 9 (FSF), en dos consultas de pediatria. Se utiliza como comparativo el Proceso Fiebre en el Niño. Los datos se procesan con SPSS 15 y software de soporte para datos tabulados Epidat 3.1, se utiliza en su análisis la frecuencia 2 relativa y el test de la ÷ , como diferencia significativa p < 0,05. Resultados. Porcentaje medio de FSF 0,55 %, predominio de niños sobre niñas (p<0,05), del grupo de 3-36 meses de edad 59, 2%. Derivados a hospital 3,9 %. Bajo registro del grado de temperatura 26,2 %. Consulta en menos de 24 h del inicio febril 72,3 %. Solicitud exámenes complementarios 27,2 %, tira de orina en < 1 año 48,9 % y en fiebre de más de 48 h 19 %. Ausencia de registro antitérmico prescrito 34 %, vacunados contra neumococo 64,5 %. Revisión tras consulta inicial 34,5 % de ellos que se llego a un diagnóstico 88,7 %. Conclusiones. Bajo registro de FSF en AP. Rápida consulta por parte de los padres tras comienzo de fiebre. Más casos en el grupo de 3-36 meses. Bajo registro de temperatura y antitérmico recomendado. Escasa derivación al hospital, mayor en menor edad. Probable auto resolución de muchos casos. Poca variabilidad entre profesionales.Introduction. Fever is a common complaint leading patients to seek medical attention. Since majority of published papers deals with hospital attention, our aim is to evaluate its diagnosis, management and intervention in Paediatric consultations in Primary Health Care (PHC). Materials and methods. Transverse descriptive study, performed on <14-year-old population diagnosed with Fever 780.6 of the CIE 9 (FUO), in two paediatric surgeries. Procedure Fever in Child is used as comparative. The data is 2 processed with SPSS 15 and tabulated data support software Epidat 3.1. Relative frequency and the ÷ test was used in the analysis, with the p <0,05 significant difference. Results. Average percentage of FUO 0,55 %, predominant in boys (p < 0,001) and in 3-36 month-old age group 59, 2 %. Percentage sent to hospital 3,9 %. Actual temperature level recorded in few cases 26,2 %. Medical assistance sought in less than 24 h from the onset of fever. Complementary tests requested in 27,2 %, urine strips in <1 year olds 48,9 % and in fever lasting longer than 48 h 19 %. Register of antithermics prescribed absent in 34 %, vaccinated against pneumococcus 64,5 %. Follow-up appointment after the first consultation 34,5 % with diagnosis in 88,7 %. Conclusions. Low recordings of FUO in PHC. Fever checked briefly by parents on its onset. More cases found in the 3-36 months-old age group. Low percentage of temperatures documented and antipyretics prescribed. Few cases hospitalised, higher in younger age groups. In many cases fever resolved itself. Minor differences between professionals

Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design

Introduction: We present the protocol of a large population-based case-control study of 5 common tumors in Spain (MCC-Spain) that evaluates environmental exposures and genetic factors. Methods: Between 2008-2013, 10,183 persons aged 20-85 years were enrolled in 23 hospitals and primary care centres in 12 Spanish provinces including 1,115 cases of a new diagnosis of prostate cancer, 1,750 of breast cancer, 2,171 of colorectal cancer, 492 of gastro-oesophageal cancer, 554 cases of chronic lymphocytic leukaemia (CLL) and 4,101 population-based controls matched by frequency to cases by age, sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) and from 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociodemographic factors, environmental exposures, occupation, medication, lifestyle, and personal and family medical history. In addition, participants completed a self-administered food-frequency questionnaire and telephone interviews. Blood samples were collected from 76% of participants while saliva samples were collected in CLL cases and participants refusing blood extractions. Clinical information was recorded for cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals. Genotyping was done through an exome array enriched with genetic markers in specific pathways. Multiple analyses are planned to assess the association of environmental, personal and genetic risk factors for each tumor and to identify pleiotropic effects. Discussion: This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancers and will promote cancer research and prevention in Spain.The study was partially funded by the “Accion Transversal del Cancer”, approved on the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/0533, PI08/1359, PS09/00773, PS09/01286, PS09/01903, PS09/02078, PS09/01662, PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00488, PI12/00265, PI12/01270, PI12/00715, PI12/00150), by the Fundación Marqués de Valdecilla (API 10/09), by the ICGC International Cancer Genome Consortium CLL, by the Junta de Castilla y León (LE22A10-2), by the Consejería de Salud of the Junta de Andalucía (PI-0571), by the Conselleria de Sanitat of the Generalitat Valenciana (AP 061/10), by the Recercaixa (2010ACUP 00310), by the Regional Government of the Basque Country by European Commission grants FOOD-CT- 2006-036224-HIWATE, by the Spanish Association Against Cancer (AECC) Scientific Foundation, by the The Catalan Government DURSI grant 2009SGR1489

An International Study on Psychological Coping During COVID-19: Towards a Meaning-Centered Coping Style

Background/Objective This study examined the role of different psychological coping mechanisms in mental and physical health during the initial phases of the COVID-19 crisis with an emphasis on meaning-centered coping. Method A total of 11,227 people from 30 countries across all continents participated in the study and completed measures of psychological distress (depression, stress, and anxiety), loneliness, well-being, and physical health, together with measures of problem-focused and emotion-focused coping, and a measure called the Meaning-centered Coping Scale (MCCS) that was developed in the present study. Validation analyses of the MCCS were performed in all countries, and data were assessed by multilevel modeling (MLM). Results The MCCS showed a robust one-factor structure in 30 countries with good test-retest, concurrent and divergent validity results. MLM analyses showed mixed results regarding emotion and problem-focused coping strategies. However, the MCCS was the strongest positive predictor of physical and mental health among all coping strategies, independently of demographic characteristics and country-level variables. Conclusions The findings suggest that the MCCS is a valid measure to assess meaning-centered coping. The results also call for policies promoting effective coping to mitigate collective suffering during the pandemic

Proceso fiebre en la infancia : guía de información para pacientes

En la cub.: Respuestas sencillas a las preguntas más frecuentesPublicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Ciudadanía / Nuestro Compromiso por la Calidad / Guías de información para pacientes / Guías de información para pacientesYesEsta guía informativa está dirigida a personas que vayan a cuidar a una niña o a un niño con fiebre. Este documento ofrece información sobre la fiebre y su tratamiento

Microscopio virtual para las prácticas de sedimentología de carbonatos

Proyecto coordinado por José M. Martín, diseño gráfico Rafael Ruiz Ruiz.Esta guía virtual consta de dos partes. La primera corresponde a un archivo fotográfico que muestra los diferentes tipos de granos, texturas, cementos y modificaciones post-deposicionales (diagenéticas) más comunes. Con él, y con la ayuda de las tablas antes mencionadas, el alumno va a aprender a determinar el ambiente de formación y a descubrir las posibilidades de las diferentes muestras de rocas calizas de almacenar agua, petróleo o gas natural, en función de sus características. Esta primera fase constituye un apoyo importante a las explicaciones que imparte el profesor en clae y a las que se trata de complementar. Queda sin embargo, al igual que ocurre en clase, un aspecto final por cubrir, que es el del trabajo personal de propio alumno. Una vez se le proporcionan a este las herramientas adecuadas debe ser capaz, por sí sólo, de practicar y efectuar sus propias determinaciones y, una vez realizadas, comprobar si estas son o no correctas. Esta segunda parte la cubre la colección auto-práctica. Aquí, el ordenador selecciona al azar la lámina a estudiar. Una vez el alumno ha efectuado sus determinaciones aparecen desplegadas y marcadas sobre la propia lámina los componentes, la textura, los tipos de cementos y las modificaciones diagenéticas, al tiempo que se señala cuál es su ambiente de depósito.Proyecto de innovación docente nº11-197 financiado por la Universidad de Granada

Cambio climático en México y distribución potencial del grupo racial de maíz cónico

The aim of this study was to evaluate the effect of climate change for the period 2041-2060 on potential niche distribution of Mexican conical maize races. To do so, information from 9 823 georeferenced entries, corresponding to 12 races of this racial group was used. An information system with 20 climatic and topographic variables was generated for Mexico, based on climatologies from 1961-1990 and 2041-2060, for which were used images from the portal Earth System Grid (ESG) WorldClim imported into the Idrisi Selva system as images in raster format with a resolution of 2.5 arcmin. For the period 2041-2060 the general circulation model HadGEM2-AO and MIROC5 under two concentration pathways of greenhouse gases (GHG) (rcp4.5 and rcp6.0) were considered. Based on this information system the potential niche distribution of conical maize racial group was modeled by Maxent model. The results showed that climate change for the period 2041-2060 will increase the surface with high environmental suitability for distribution of conical maize racial group. In this regard, is more favorable the outcome that would occur under the path rcp4.5 than under the path rcp6.0 of GHG emissions and concentration. However, a differential effect of climate change on the races that make up the Conical group was identified, concluding that races that mostly benefit from climate change 2041-2060 will be, Mushito from Michoacan, Negrito and Conical, while the most adversely affected in their distribution potential will be Chalqueño, Conical Northern and Mushito.El objetivo del presente estudio fue evaluar el efecto del cambio climático del período 2041-2060 sobre los nichos potenciales de distribución de las razas mexicanas de maíz del grupo cónico. Para ello se utilizó información de datos pasaporte de 9 823 accesiones georreferenciadas, correspondientes a 12 razas de este grupo racial. Se generó un sistema de información con 20 variables climáticas y topográficas para la República Mexicana con base en las climatologías 1961-1990 y 2041-2060, para lo cual se utilizaron imágenes del portal Earth System Grid (ESG) de WorldClim importadas en el sistema Idrisi Selva como imágenes en formato raster con una resolución de 2.5 minutos de arco. Para el período 2041-2060 se consideraron los modelos de circulación general HadGEM2-AO y MIROC5, bajo dos vías de concentración de gases efecto invernadero (GEI) (rcp4.5 y rcp6.0). Con base en este sistema de información se modelaron los nichos potenciales de distribución del grupo racial cónico de maíz mediante el modelo Maxent. Los resultados mostraron que el cambio climático del período 2041-2060, incrementará la superficie con aptitud ambiental alta para la distribución del grupo racial cónico de maíz. A este respecto es más favorable el panorama que se presentaría bajo la ruta rcp4.5 que bajo la ruta rcp6.0 de emisiones y concentración de GEI. Sin embargo, se identificó un efecto diferenciado del cambio climático sobre las razas que integran el grupo Cónico, concluyéndose que las razas que mayormente se beneficiarán del cambio climático 2041-2060 serán, Mushito de Michoacán, Negrito y Cónico, mientras que las que resultarán más afectadas negativamente en su potencial de distribución serán Chalqueño, Cónico Norteño y Mushit