Prevalence of hyponatraemia in patients over the age of 65 who have an in-hospital fall

Background and aim: Hyponatraemia is the most common electrolyte disorder. Some studies have found that it increases morbidity and mortality. There are new lines of research that are investigating the link between hyponatraemia and patient falls. Aim: To determine if hyponatraemia is associated with falls in elderly hospitalised patients. Methods: Design observational, analytical, case-control study. Study population: Patients older than 65 years who had fallen during their hospitalisation at Gregorio Marañón Hospital (Madrid) were considered cases. Patients who did not fall were considered to be controls, paired according to the following variables: hospital ward, age, length of hospital stay, gender and Downton fall risk index. The sample size was 206 subjects. Data collection: Socio-demographic factors, variables included in the falls record sheet, Downton fall risk index and sodium levels were studied (hyponatraemia was considered Na+&lt; 135 mmol/l). Analysis: A descriptive analysis was performed to determine the sample homogeneity. The OR was calculated, and an analytical analysis using Chi-square test and a multivariate logistic regression analysis were also performed. Results: Of 103 cases recruited, 61 were men (50.4%) and 42 were women (49.4%). Hyponatraemia was detected in 29 cases with an association with falls of P: 0.002. The adjusted OR was 3.708 (1.6-8.3), 95% CI. Risk factors for falls were identified as hyponatraemia and limb sensory deficits. Conclusions: Given that hyponatraemia could be considered a risk factor for falls, the inclusion of the determination of sodium level would be important for fall prevention strategies in the elderly.Fundamento y objetivo: La hiponatremia es el trastorno electrolítico más frecuente. Algunos estudios afirman que aumenta la morbimortalidad. Existen nuevas líneas de investigación que buscan la relación entre hiponatremia y caídas. Objetivo: Determinar si la hiponatremia es un factor relacionado con las caídas en ancianos hospitalizados. Método: Disen˜ o observacional analítico de casos y controles. Población de estudio: Se consideraron casos los pacientes mayores de 65 an˜ os que experimentaron una caída durante su ingreso en unidades de hospitalización del Hospital General Universitario Gregorio Maran˜ ón de Madrid. Los controles fueron pacientes que no wxperimentaron caída, pareados según las variables: unidad, edad, periodo de ingreso, género y Downton. El taman˜ o fue de 206 sujetos. Recogida de datos: Se estudiaron factores sociodemográficos, las variables incluidas en la ficha de registro de caídas y escala de Downton, y el sodio sérico. Se consideró hiponatremia Na+ < 135 mmol/l. Análisis: Se realizó un análisis descriptivo para valorar la homogeneidad de la muestra, un análisis analítico utilizando el test chi cuadrado, calculando la OR y un análisis multivariante con regresión logística. Resultados: De 103 casos, 61 eran hombres (50,4%) y 42 mujeres (49,4%). En 29 se detectó hiponatremia; la relación con las caídas fue p: 0,002. La OR ajustada fue de 3,708 (1,6-8,3), IC 95%. Se identificaron como factores de riesgo para las caídas: hiponatremia y déficits sensoriales en extremidade

Seminario de Economía Mexicana

Serie de ponencias referentes al Seminario de Economía Mexicana. Memorias del Seminario de Economía Mexicana de 199

A crowdsourcing database for the copy-number variation of the Spanish population

Background: Despite being a very common type of genetic variation, the distribution of copy-number variations (CNVs) in the population is still poorly understood. The knowledge of the genetic variability, especially at the level of the local population, is a critical factor for distinguishing pathogenic from non-pathogenic variation in the discovery of new disease variants. Results: Here, we present the SPAnish Copy Number Alterations Collaborative Server (SPACNACS), which currently contains copy number variation profiles obtained from more than 400 genomes and exomes of unrelated Spanish individuals. By means of a collaborative crowdsourcing effort whole genome and whole exome sequencing data, produced by local genomic projects and for other purposes, is continuously collected. Once checked both, the Spanish ancestry and the lack of kinship with other individuals in the SPACNACS, the CNVs are inferred for these sequences and they are used to populate the database. A web interface allows querying the database with different filters that include ICD10 upper categories. This allows discarding samples from the disease under study and obtaining pseudo-control CNV profiles from the local population. We also show here additional studies on the local impact of CNVs in some phenotypes and on pharmacogenomic variants. SPACNACS can be accessed at: http://csvs.clinbioinfosspa.es/spacnacs/. Conclusion: SPACNACS facilitates disease gene discovery by providing detailed information of the local variability of the population and exemplifies how to reuse genomic data produced for other purposes to build a local reference database

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Materiales didácticos sobre el pueblo gitano para Educación Primaria

Ilustraciones de María del Mar Camacho MunielEl pueblo gitano forma parte de la diversidad española desde hace siglos contribuyendo a la configuración de su realidad sociocultural, y sin embargo, su historia, su cultura y su legado apenas han sido objeto de aprendizaje en las aulas. Se ofrece a la comunidad educativa unos recursos y materiales didácticos que faciliten la incorporación de contenidos de historia y cultura gitana en su labor docente. Consta de tres propuestas ilustradas, prácticas y versátiles de materiales didácticos que abordan de manera especializada contenidos gitanos encuadrándolas en tres asignaturas concretas de primaria: materiales didácticos sobre la Lengua Gitana en la asignatura de Lengua Castellana; materiales didácticos sobre la Historia del Pueblo Gitano en la asignatura de Ciencias Sociales; y una tercera propuesta que se ha denominado Diversidad Gitana que puede ser desarrollada en la asignatura de Valores Sociales y Cívicos. De esta manera se facilitan recursos para la incorporación de la historia y cultura gitanas en el Currículo Escolar, con la firme creencia de que la escuela ha de ser un escenario primordial para transmitir los valores de convivencia y respeto de una sociedad intercultural.ES

Maskana. Revista científica

La remoción de la hemoglobina (Hb) por adsorción de la proteína sobre nanopartículas (Nps) magnéticas de Fe3O4/TiO2 (núcleo/coraza) aplicando un campo magnético externo, fue investigada mediante espectroscopia ultravioleta en el rango del ultravioleta y visible (UV-VIS). Durante la etapa de contacto de las Nps con la Hb se varió la concentración de las Nps y la temperatura, complementariamente durante la etapa de remoción del complejo Fe3O4/TiO2-Hb se varió la intensidad del campo magnético externo. Con una concentración inicial de Nps de 8 mg ml-1, el valor de la absorbancia del sobrenadante disminuye en un 11% con respecto a la solución inicial de Hb (0,8 g l-1) y al aumentar en un 50% la concentración de Nps, el valor disminuye hasta un 17%. Al incrementar la temperatura de 25 a 35ºC disminuye la adsorción de la Hb pero no se observa indicios de desnaturalización de la misma. Durante la etapa de remoción del complejo Fe3O4/TiO2-Hb, al incrementar la fuerza magnética se logra una caída en la intensidad de la absorbancia, casi un 30%. Finalmente, se determinó la demanda bioquímica de oxígeno (DBO5) de la solución inicial de Hb y del sobrenandante, el valor para la solución inicial de Hb fue de 100 mg ml-1 y los resultados obtenidos para todas las soluciones tratadas fueron inferiores (62 mg ml-1) verificando el impacto que tuvo el uso de las Nps magnéticas de Fe3O4/TiO2 en la remoción de la Hb.The removal of Hemoglobin (Hb) by protein adsorption on magnetic nanoparticles (Nps) of Fe3O4/TiO2 (core/shell), applying an external magnetic field, was investigated using ultraviolet spectroscopy in the ultraviolet and visible range (UV-VIS). The Nps concentration and temperature was varied during the contact step between Nps and Hb. Complementary, the intensity of the external magnetic field was varied during the removal of the Fe3O4/TiO2-Hb complex. With an initial Nps concentration of 8 mg ml-1, the absorbance of the supernatant solution showed a decrease of 11% with respect to the initial Hb solution (0,8 g l-1), and a decrease of 17% when the Nps concentration was increased with 50%. A reduction of the absorbtion of Hb was observed by increasing the temperature from 25 to 35ºC, but no evidence of denaturalization was found. During the Fe3O4/TiO2-Hb complex removal step, the absorption intensity nearly decreased 30% by increasing the strength of the magnetic field. Finally, the biochemical oxygen demand (BOD5) of the initial Hb solution and supernatant was determinated. The value of the initial Hb solution was 100 mg ml-1 and the results for all treated solutions were lower (< 62 mg ml-1) reflecting the impact of magnetic Nps in the removal of Hb.CuencaVol. 5; no. 2 (diciembre 2014

Social Agency for 2030 in matters of violence against minors: contributions from the creation of Crime Observatory in the stage of Childhood and Adolescence

Este proyecto se propone en el marco de la elaboración de la Ley Orgánica de Protección Integral a la Infancia y la Adolescencia frente a la Violencia, para analizar el desafío que supone la violencia cero contra el menor, y asegurar a futuro los contenidos y fines propuestos por la ley.This project has proposed, within the framework as of the Integral Protection to the Childhood and Adolescence against Violence, to analyse the challenge that is violence zero against minor, and ensure the contents and purposes by the law.Depto. de Derecho Procesal y Derecho PenalFac. de DerechoFALSEsubmitte