Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Polyphase karstification processes in Crema Marfil quarries (Pinoso, Alicante). Application to exploitation of dimension stones

Complex speleothem networks have been recognised in the quarries of the commercial marble Crema Marfil (Paleogene limestones, Monte Coto Pinoso, Alicante). The characterisation of these speleothems (mineralogy, petrography, stable isotopes) has enable us to discriminate different phases of speleothem formation in terms of paleotemperature or structural control. U/Th dates of some of these phases are 178,7± 15,6 Ka, 34,4+1,7 Ka y 33,7±3,4 Ka. A seismo-tectonic event has been recorded and dated (33-34Ka) by the study of speleothems. The recognition and characterisation of speleothem networks can be considered as a useful tool in the design of exploitation strategies of dimension stone

Chemistry of the waters in the Canelobre Cave (Alicante)

The Cave of Canalobre, located in the west middle of the Alicante province, is one of the most visited cave in Comunidad Valenciana. During the last years some drip water samples have been collected. The analytical results have allowed us the physico-chemical characterization of the waters. Use of principal components analysis (PCA) and a study of hydrodynamic equilibria have allowed us to stablish that the proper ties and composition of these waters depend on both dissolution proccess of the rock during the downward passage and climatic concentration in the soil of the components dissolved in the rainwate

Space-time variations of Ca-Mg-Sr on drip water of Canelobre Cave (Alicante): example of infiltration processes on semiarid karstic areas

From may/2006 to april/2007 a monthly sampling of the recharge conditions and main hydrogeochemical parameters was conducted at a network of dripping points within Canelobre cave (Alicante). Speleothems are fed by a combination of seepage and fracture water, indicating that the system consists of a matrix with a network of discontinuities (fractures or conduits) with different characteristics. Control of Mg/Ca and Sr/ Ca indexes has provided data to identify several water infiltration processes into the vadose zone under arid conditions: ranges of flow-through times to drips, prior calcite precipitation and dissolution of Mg and Sr. Both indexes depend on the discharge intensity, though their variability adjust to a spatial framework determined by cave geomorphology (grade of karst development, stratigraphic contacts and fractures

Role of soil pore structure in water infiltration and CO2 exchange between the atmosphere and underground air in the vadose zone: A combined laboratory and field approach

The soils above caves represent a membrane that regulates the connection between the underground environment and the outside atmosphere. In this study, soils from two different field sites (Cueva de Altamira and Cueva del Rull in Spain) are investigated. Field results are analysed and linked to laboratory tests. Several laboratory experiments are performed to quantify CO diffusion coefficients and water infiltration rates in these soils under different degrees of soil water saturation and compaction. Tests confirm that the grain size distribution, organic matter content, mineral composition and water content of soils affect gas transport through the soil pore network. Both field and lab results reveal that Altamira soil has a coarser texture and therefore has higher CO diffusion coefficients, infiltration rates and hydraulic conductivity values than Rull soil. Rull soil contains a higher proportion of fine particles and organic matter, which explains the lower fluid transport coefficients. When soils are near saturation, fluid transport does not depend on the physical properties of soil but depends on the soil water content. In this state, liquid transport regulates the available space within the soil pores, which leads to a reduction in the gaseous diffusion coefficient of the soil. After rainfall episodes, the connection between the exterior atmosphere and underground cavities is hindered due to a rise in the soil water content, which is responsible for the closure of the overlying membrane. This study demonstrates that soil-produced CO reaches the underground atmosphere through diffusion processes that are controlled by the intrinsic properties of soil (porosity, grain size distribution, texture, mineralogy and organic matter content) and soil water content.This research was funded by the Spanish Ministry of Economy and Competitiveness projects CGL2011-25162 and CGL2013-43324-R and its programme Torres Quevedo (PTQ 13-06296). A pre-doctoral research fellowship (BES-2012-053468) was awarded to C. Pla for the project CGL2011-25162. Funding was also provided by the People Programme (Marie Curie Actions Intra-European Fellowships, call 2013) of the European Union's Seventh Framework Programme (FP7/2007–2013) under the REA grant agreement n° 624204.Peer Reviewe