Contribution of CSF biomarkers to early-onset Alzheimer's disease and frontotemporal dementia neuroimaging signatures

Prior studies have described distinct patterns of brain gray matter and white matter alterations in Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD), as well as differences in their cerebrospinal fluid (CSF) biomarkers profiles. We aim to investigate the relationship between early‐onset AD (EOAD) and FTLD structural alterations and CSF biomarker levels. We included 138 subjects (64 EOAD, 26 FTLD, and 48 controls), all of them with a 3T MRI brain scan and CSF biomarkers available (the 42 amino acid‐long form of the amyloid‐beta protein [Aβ42], total‐tau protein [T‐tau], neurofilament light chain [NfL], neurogranin [Ng], and 14‐3‐3 levels). We used FreeSurfer and FSL to obtain cortical thickness (CTh) and fraction anisotropy (FA) maps. We studied group differences in CTh and FA and described the "AD signature" and "FTLD signature." We tested multiple regression models to find which CSF‐biomarkers better explained each disease neuroimaging signature. CTh and FA maps corresponding to the AD and FTLD signatures were in accordance with previous literature. Multiple regression analyses showed that the biomarkers that better explained CTh values within the AD signature were Aβ and 14‐3‐3; whereas NfL and 14‐3‐3 levels explained CTh values within the FTLD signature. Similarly, NfL levels explained FA values in the FTLD signature. Ng levels were not predictive in any of the models. Biochemical markers contribute differently to structural (CTh and FA) changes typical of AD and FTLD

Programa SALUD 5-10: Programa para el tratamiento del sobrepeso y la obesidad en niños de 5 a 10 años: Antecedentes, Diseño y Metodología

Obesity is a particularly expensive and costly in economic and social terms disease for both people who suffer as public health institutions. Therefore, in recent decades, various international and national organizations have shown great concern for its implications, going to be treated as a real social problem. According to the World Health Organization, Spain is one of the EU countries with the highest prevalence of overweight children as recorded by 33% in the population between 5 and 17 years, whereas in Europe one in four children has overweight or obese. Furthermore, Spain is one of the countries where this disease has grown (in the eighties the prevalence was 15%). Several systematic reviews assessing the effectiveness of intervention programs based on increasing physical activity and dietary control of overweight and / or obesity in children and adolescents highlight the need to design specific programs for schoolchildren, and to assess objectively the effectiveness of such long-term programs in children and adolescents are overweight or obese. The aim of this paper is to describe the design and methodology used in 5-10 Health Program, a program that has been designed with the objective of addressing overweight and obesity in schoolchildren in the age group between 5-10 years.La obesidad es una enfermedad especialmente cara y costosa en términos económicos y sociales tanto para las personas que la padecen como para las instituciones públicas sanitarias. Por ello, en las últimas décadas distintas organizaciones internacionales y nacionales han mostrado una enorme preocupación por sus implicaciones, pasando a ser tratado como un verdadero problema social. Según la Organización Mundial de la Salud, España es uno de los países de la Unión Europea con mayor prevalencia de sobrepeso infantil, ya que registra un 33% en la población entre 5 y 17 años, mientras que en Europa uno de cada cuatro niños tiene sobrepeso o es obeso. Además, España es uno de los países donde más ha crecido esta enfermedad (en la década de los ochenta la prevalencia era de un 15%). Diversas revisiones sistemáticas que evalúan la efectividad de los programas de intervención basados en el aumento de la actividad física y el control dietético sobre el sobrepeso y/u obesidad en población infantil y adolescente resaltan la necesidad de diseñar programas específicos para los escolares, así como valorar objetivamente la eficacia de dichos programas a largo plazo en niños y adolescentes con sobrepeso u obesidad. El objetivo del presente trabajo es describir el diseño y metodología utilizada en el Programa SALUD 5-10, un programa que ha sido diseñado con el objetivo de abordar el sobrepeso y la obesidad en escolares de una franja de edad entre 5 a 10 años

Esófago de barrett y progresión a adenocarcinoma: estudio estadístico de los factores pronósticos en la malignización. Distribución en grupos de riesgo

OBJETIVO: 1. Determinar, según el estudio estadístico, que factores y características de los pacientes con EB suponen un mayor riesgo de malignización. 2. Basándonos en estos factores, establecer grupos de riesgo de malignización, que nos permitan determinar la vigilancia y el tratamiento más eficaz. - Riesgo bajo - Riesgo intermedio - Riesgo alto METODOLOGÍA: A todos los pacientes se les realizó anualmente una entrevista clínica presencial y una endoscopia digestiva alta con toma múltiple de biopsias, o antes del año si reaparecieron los síntomas. En caso de existir displasia de bajo grado, la endoscopia y tomas de biopsias se repitieron a los 6 meses; hasta obtener dos endoscopias consecutivas con biopsias sin displasia, antes de pasar al protocolo anual. A los pacientes intervenidos quirúrgicamente se les realizó, al año de la cirugía y luego cada 5 años, una manometría y pHmetría esofágica. Solo a un subgrupo (n=30, 43 %) de pacientes con tratamiento médico, las pruebas funcionales esofágicas se repitieron sin interrumpir la medicación de IBPs, para estudiar la eficacia del tratamiento médico. El estudio del reflujo biliar con el Bilitec 2000, al ser una prueba más reciente, no se pudo realizar a todos los pacientes (n=72, 49 %). RESULTADOS: NO MALIGNIZADOS N=131 MALIGNIZADOS N=16 p UV p RL OR Longitud EB (cm) ≤ 4 (n=86) > 4 (n=61) 4,7 ± 2,8 7,19 ± 2,3 p < 0,095 p<0,003 1,252 (1,07-1,45) 81 (94,1%) 50 (82%) 5 (5,9%) 11 (18%) p < 0,003 11,918 (1,52-92,98) DBG No (n=129) Si (n=18) 120 (93%) 11 (61%) 9 (7%) 7 (39%) p < 0,0001 8,485 ki67 (n=83) ≤ 30% (n=70) > 30% (n=13) 65 (92,9%) 4 (30,8%) 5 (7,1%) 9 (69,2%) p < 0,0001 29,25 (6,6-129,54) p53 (n=81) ≤30% (n=69) >30% (n=12) 66 (95,7%) 1 (8,3%) 3 (4,3%) 11 (91,7%) p < 0,0001 242,00 (23,0-2541,22) Apoptosis (n=54) IA<1 (n=46) IA>1 (n=8) 34 (74%) 8 (100%) 12 (21%) 0 (0%) p < 0,009 10,00 NO MALIGNIZADOS N=131 MALIGNIZADOS N=16 p UNI p RL OR MOTILIDAD CE Hipomotilidad (n=62) Normal (n=62) 48 (77%) 60 (96,8%) 14 (22,6%) 2 (3,2%) p<0,001 8,7 (1,1-40,3) PRESIÓN MEDIA DEL EEI (mmHg) 8.7 ± 8.07 6.6 ± 3.19 p<0,330 Hipotensivo (n=91) Normal (n=35) 77 (84.6 %) 33 (94.3 %) 14 (15.4 %) 2 (5.7 %) p< 0,144 % TOTAL pH < 4.5 20,01 ± 14,1 31.7 ± 14,6 p<0,007 1,038(1,007-1,07) Reflujo ácido (> 24 %) Severo (n=49) Moderado (n=98) 39 (79.6%) 83 (93.7%) 10 (20,4%) 6 (6.1%) p<0,009 3,93(1,33-11,56) % BILITEC > 0.14 18,6 ± 19,9 30.9 ± 10,1 p<0,147 p<0.227 Reflujo biliar Severo (n=28) Moderado (n=34) 19 (67.9%) 33 (96.1%) 9 (3.1%) 1 (2.9%) p<0,002 15,63(1,8-135,08) CONCLUSIONES: 1.- El riesgo de malignización en los pacientes diagnosticados de esófago de Barrett es muy variable, dependiendo de diversas características de la enfermedad y del enfermo. 2.- La presencia de displasia de bajo grado en el epitelio metaplásico del esófago de Barrett y de una alta positividad inmunohistoquímica para los marcadores de proliferación p53 y ki67, supone un muy alto riesgo de malignización. 3.- Los pacientes diagnosticados de esófago de Barrett familiar tienen mayor riesgo de malignización que en los casos esporádicos, y además lo hacen más precozmente. 4.- Los hombres mayores de 65 años, segmentos metaplásicos mayores de 4 centímetros, pacientes con un elevado reflujo ácido y biliar patológico, hipomotilidad del cuerpo esofágico y fallo del tratamiento médico o quirúrgico; tienen un riesgo intermedio de malignización. 5.- En estos grupos, las opciones terapéuticas y seguimiento endoscópico debería ser diferente que en los pacientes con ausencia de esas características de la enfermedad, catalogados como riesgo bajo.OBJECTIVE: 1.According to statistical information, calculate which factors and features of EB patients have the highest malignance risk 2Based on these factors, establish malignance risk groups so that we may set both monitoring and the most effective treatment - Low risk - Medium risk - High risk METHODOLOGY: Annually both a face to face clinical interview was carried out with all the patients and also a high digestive endoscopy, extracting different biopsy samples. Even earlier if sinthoms flourished before the year. In low degree displasia cases, the endoscopy and de biopsies were repeated after six moths until two consecutive endocopies showed non displasia biopsy results; then these patients went back to the annual review. To those patients who went through surgery, it was carried out an esophageal manometry and a pH test. In order to study the effectiveness of the medical treatment, esophageal functional tests were repeated maintaining the IBPs medication (TREATMENT mejor pero por no repetir….) just to a subgroup (n=30, 43%). However, due to its recent introduction into the market, it was impossible to complete the study for the Bilitec 2000 and the biliary reflux to all the patients (n=72, 49%) Results NO MALIGNIZADOS N=131 MALIGNIZADOS N=16 p UV p RL OR Longitud EB (cm) ≤ 4 (n=86) > 4 (n=61) 4,7 ± 2,8 7,19 ± 2,3 p < 0,095 p<0,003 1,252 (1,07-1,45) 81 (94,1%) 50 (82%) 5 (5,9%) 11 (18%) p < 0,003 11,918 (1,52-92,98) DBG No (n=129) Si (n=18) 120 (93%) 11 (61%) 9 (7%) 7 (39%) p < 0,0001 8,485 ki67 (n=83) ≤ 30% (n=70) > 30% (n=13) 65 (92,9%) 4 (30,8%) 5 (7,1%) 9 (69,2%) p < 0,0001 29,25 (6,6-129,54) p53 (n=81) ≤30% (n=69) >30% (n=12) 66 (95,7%) 1 (8,3%) 3 (4,3%) 11 (91,7%) p < 0,0001 242,00 (23,0-2541,22) Apoptosis (n=54) IA<1 (n=46) IA>1 (n=8) 34 (74%) 8 (100%) 12 (21%) 0 (0%) p < 0,009 10,00 NO MALIGNIZADOS N=131 MALIGNIZADOS N=16 p UNI p RL OR MOTILIDAD CE Hipomotilidad (n=62) Normal (n=62) 48 (77%) 60 (96,8%) 14 (22,6%) 2 (3,2%) p<0,001 8,7 (1,1-40,3) PRESIÓN MEDIA DEL EEI (mmHg) 8.7 ± 8.07 6.6 ± 3.19 p<0,330 Hipotensivo (n=91) Normal (n=35) 77 (84.6 %) 33 (94.3 %) 14 (15.4 %) 2 (5.7 %) p< 0,144 % TOTAL pH < 4.5 20,01 ± 14,1 31.7 ± 14,6 p<0,007 1,038(1,007-1,07) Reflujo ácido (> 24 %) Severo (n=49) Moderado (n=98) 39 (79.6%) 83 (93.7%) 10 (20,4%) 6 (6.1%) p<0,009 3,93(1,33-11,56) % BILITEC > 0.14 18,6 ± 19,9 30.9 ± 10,1 p<0,147 p<0.227 Reflujo biliar Severo (n=28) Moderado (n=34) 19 (67.9%) 33 (96.1%) 9 (3.1%) 1 (2.9%) p<0,002 15,63(1,8-135,08) CONCLUSIONS: 1.- Malignance risk in Barrett’s esophagus patients is very irregular, it depends on different features of the illness itself, aswellas the patient. 2.- If low degree displasia in Barret’s esophagus metaplasic epitheliumis detected and also a high positive immunochemical result is obtained for p53 and ki67 spreading markers, a very high malignance should be considered. 3.- Not only inherited Barrett’s esophagus patients have a higher malignance risk that those isolated or random, but also earlier. 4Men above 65 years old, metaplasic segments over 4 centimetres, patients with pathological high acid and biliary reflux, esophagic body hipomotility and a non effective medical treatment or surgery; all of them have a médium malignance risk. 5.- In these groups, alternative treatments and endoscopy monitoring should be considered, different to the one carried out with those groups of patients classified as low risk, who do not show any symptoms of the disease

Gastroesophageal reflux in anesthetized dogs: a review

Gastroesophageal reflux can be a catastrophic illness in small animals during anesthesia since its complications can cause serious pathologies, such as esophagitis, esophageal stenosis and aspiration pneumonia. With an incidence from 12 to 78.5% in anesthetized dogs, gastroesophageal reflux is normally silent during anesthesia and will be notices only if regurgitation occurs and stomach acid is present in the nasal or oral cavities. In humans, gastroesophageal reflux disease (GERD) is a well-defined pathology where the lower esophageal sphincter has a sustained weakness. However, in dogs, gastroesophageal reflux disease as such is not well established, if at all; it has only been described as gastroesophagic reflux, occurring principally in anesthetized animals. There are several factors influencing the presentation of reflux in anesthetized dogs, which may be inherent to the patient (e.g. age, sex, breed, weight, or body condition), medications used prior to and during anesthesia, type of surgery or position of the animal during surgery. The objective of this review is to discuss a series of conditions that could predispose dogs to gastroesophageal reflux during anesthesia and to assist in the prevention and diagnosis of this condition

Gastroesophageal reflux in anesthetized dogs: a review

Gastroesophageal reflux can be a catastrophic illness in small animals during anesthesia since its complications can cause serious pathologies, such as esophagitis, esophageal stenosis and aspiration pneumonia. With an incidence from 12 to 78.5% in anesthetized dogs, gastroesophageal reflux is normally silent during anesthesia and will be notices only if regurgitation occurs and stomach acid is present in the nasal or oral cavities. In humans, gastroesophageal reflux disease (GERD) is a well-defined pathology where the lower esophageal sphincter has a sustained weakness. However, in dogs, gastroesophageal reflux disease as such is not well established, if at all; it has only been described as gastroesophagic reflux, occurring principally in anesthetized animals. There are several factors influencing the presentation of reflux in anesthetized dogs, which may be inherent to the patient (e.g. age, sex, breed, weight, or body condition), medications used prior to and during anesthesia, type of surgery or position of the animal during surgery. The objective of this review is to discuss a series of conditions that could predispose dogs to gastroesophageal reflux during anesthesia and to assist in the prevention and diagnosis of this condition.O refluxo gastroesofágico durante a anestesia pode ser uma entidade catastrófica na clínica de pequenas espécies, já que suas complicações resultam em entidades realmente graves, como esofagite, estenose esofágica e pneumonia por aspiração. O refluxo gastroesofágico em cães anestesiados é geralmente silencioso, com uma incidência de 12 até 78.5% e só é observada quando há regurgitação e o refluxo passa até a cavidade oral ou nasal. Nos humanos, a doença pelo refluxo gastroesofágico (ERGE) é uma patologia bem definida, onde o esfíncter esofágico inferior apresenta uma debilidade continua. Porém, esta doença em cães não está bem estabelecida, pelo qual só se descreve o refluxo gastroesofágico, que ocorre principalmente em animais anestesiados. Existem diversos fatores que influenciam na apresentação do refluxo em cães anestesiados. Estes podem ser inerentes ao paciente (por exemplo: idade, sexo, raça, peso ou condição corporal), a medicamentos utilizados previamente e durante a anestesia, ao tipo de cirurgia ou a posição do animal durante a cirurgia. O objetivo da revisão foi discutir uma guia das condições que predispõem à aparição de refluxo gastroesofágico durante a anestesia em cães com o fim de facilitar o diagnóstico e a prevenção dessa condição.El reflujo gastroesofágico durante la anestesia puede ser una entidad catastrófica en la clínica de pequeñas especies, ya que sus complicaciones derivan en entidades realmente graves como esofagitis, estenosis esofágica y neumonía por aspiración. Con una incidencia del 12 al 78.5% en perros anestesiados, el reflujo gastroesofágico durante la anestesia es generalmente silencioso y sólo se observa cuando existe regurgitación y el reflujo pasa a cavidad oral o nasal. En el humano, la enfermedad por reflujo gastroesofágico (ERGE) es una patología bien definida, donde el esfínter esofágico inferior presenta una debilidad sostenida. Sin embargo, en el perro esta enfermedad como tal no está bien establecida, si acaso se describe el reflujo gastroesofágico, que ocurre principalmente en animales anestesiados. Existen diversos factores que influyen en la presentación del reflujo en los perros anestesiados. Estos pueden ser inherentes al paciente (por ejemplo: edad, sexo, raza, peso o condición corporal), a medicamentos utilizados previamente y durante la anestesia, al tipo de cirugía o a la posición del animal durante la cirugía. El objetivo de esta revisión es discutir una guía de las condiciones que predisponen a la aparición de reflujo gastroesofágico durante la anestesia en perros con el fin de facilitar el diagnóstico y la prevención de esta condición

Prevalence of Mental Disorders in the South-East of Spain, One of the European Regions Most Affected by the Economic Crisis: The Cross-Sectional PEGASUS-Murcia Project

To describe the lifetime and 12-month prevalence, severity and age of onset distribution of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) disorders and to explore the association between socio-demographic variables and economic stressors with mental disorders during the economic crisis in the general population of Murcia (Spain).The PEGASUS-Murcia Project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia administered between June 2010 and May 2012. DSM-IV disorders were assessed by the Composite International Diagnostic Interview (CIDI 3.0). Main outcome measures were lifetime and 12-month prevalence of Anxiety, Mood, Impulse and Substance Disorders, Severity and Age of Onset. Sociodemographic variables and stressful economic life events during the preceding 12 months were entered as independent variables in a logistic regression analysis. A total of 2,621 participants (67.4% response rate) were interviewed, 54.5% female, mean age 48.6 years. Twelve-month prevalence (95%CI) of disorders: anxiety 9.7% (7.6-12.2), mood 6.6% (5.5-8.1), impulse 0.3% (0.1-1.2) and substance use 1.0% (0.4-2.4) disorders. Lifetime prevalence: anxiety 15.0% (12.3-18.1), mood 15.6% (13.5-18.1), impulse 2.4% (1.4-4.0) and substance use 8.3% (6.2-11.0) disorders. Severity among 12-month cases: serious 29.2% (20.8-39.4), moderate 35.6% (24.0-49.1) and mild severity 35.2% (29.5-41.5). Women were 3.7 and 2.5 times more likely than men to suffer 12-month anxiety and mood disorders, respectively. Substance use was more frequent among men. Younger age and lower income were associated with higher prevalence. Respondents exposed to multiple and recent economic stressors had the highest risk of anxiety disorders.Mental disorders in the adult population of Murcia during the economic crisis were more prevalent and serious than those in previous estimates for Spain. Prevalence was strongly associated with exposure to stressors related to the economic crisis

Validação de escala para mensurar a carga de trabalho das parteiras

Resumo Objetivo Validar a elaboração de uma escala para mensurar a carga de trabalho das parteiras com base na Classificação das Intervenções de Enfermagem (NIC) por meio da sua aplicação multicêntrica em diferentes unidades de parto. Métodos Estudo quantitativo, longitudinal, de caráter multicêntrico, realizado em três hospitais universitários gerais da rede pública de saúde. A amostra foi composta por cinquenta parteiras, que examinaram a validade de construto da escala elaborada, com um total de 370 partos. A coleta de dados iniciou-se por meio da escala elaborada ad hoc pela equipe de pesquisa, contabilizando o tempo e o número médio de intervenções NIC, realizadas a cada nascimento. Resultados As parteiras do estudo estão sujeitas a um aumento na sua carga de trabalho quanto ao número e ao tempo médio gasto na realização das NIC em cada parto atendido. Em sua jornada de trabalho (turno de 12 horas), elas destinam 960,61 minutos (16 horas no turno diurno) e 840,29 minutos (14 horas no turno noturno) para executar suas funções na assistência ao parto. Conclusões Os dados indicam a validade da escala elaborada ad hoc, pois esse instrumento reflete a real carga de trabalho vivenciada pelas parteiras do estudo

Percepción de la Utilidad del Expediente Clínico Electrónico en un Instituto Nacional de Salud

INTRODUCTION: The electronic clinical record is one of the most representative development examples of the biomedical informatics in Mexico. However the idea that prevails on the advantages it entails the implementation of this strategy in health facilities, after conducting a thorough review of the Ibero-American medical literature, not found evidence sufficient to recommend it as a good practice. MATERIAL AND METHODS: 890 electronic clinical record users were invited to participate in a public opinion survey Likert-type with a range of responses ranging from anything useful to very useful, they agreed to answer it 577 users among physicians, residents, nurses, administrative staff, social workers, therapists, psychologists and nutritionists/dietitians. The 23 version of the SPSS program was used for statistical analysis. RESULTS: Frequency, internal consistency (Cronbach´s alpha) and interobserver concordance (W Kendall) was calculated for each subset of users previous identification of reagents which shared the questionnaires of different disciplines and were subsequently grouped for each item, analyzing responses through non-parametric tests in order to find differences in the distribution of scores (Kruskal Wallis test), found that the questionnaires for physicians and nutrition staff had greater reliability for internal consistency (Cronbach = α. 943). Greater interobserver agreement took place between physicians (W Kendall =. 530). The questionnaire for nursing was the least consistent and concordant. CONCLUSION: Responses in general, provide evidence to recommend as good practice the use of the electronic clinical record during patients care since health professionals prefer this mode above the traditional clinical record; they believe that it contributes to improving the safety of patients to be more available information and approve its use is widespread in other national institutes of health.INTRODUCCIÓN: El Expediente Clínico Electrónico es uno de los ejemplos más representativos del desarrollo de la Informática Biomédica en México. No obstante la idea que prevalece sobre las ventajas que conlleva la implementación de esta estrategia en los establecimientos de salud, tras realizar una revisión exhaustiva de la literatura médica iberoamericana, no se encontró evidencia suficiente para recomendarla como punto de buena práctica. METODOLOGÍA: Se invitó a 890 usuarios del expediente clínico electrónico a participar en una encuesta de opinión tipo Likert con una gama de respuestas que va desde nada útil a muy útil, accedieron a responderla 577 usuarios entre los cuales se encontraban médicos adscritos y residentes, enfermeras, personal técnico administrativo, trabajadores sociales, terapeutas, psicólogos y nutriólogos/ dietistas. Para el análisis estadístico se utilizó la versión 23 del programa SPSS. RESULTADOS: La frecuencia, consistencia interna (alpha de Cronbach) y concordancia interobservador (W de Kendall) se calculó para cada subgrupo de usuarios previa identificación de los reactivos que compartían los cuestionarios de las diferentes disciplinas y posteriormente se agruparon para cada ítem, analizando las respuestas a través de pruebas no paramétricas con el fin de encontrar diferencias en la distribución de las puntuaciones (Prueba de Kruskal Wallis o de la mediana), se encontró que los cuestionarios para médicos adscritos y para el personal de nutrición tuvieron la mayor confiabilidad por consistencia interna (α de Cronbach= .943). La mayor concordancia interobservador sucedió entre los médicos adscritos (W de Kendall= .530). El cuestionario para enfermería fue el menos consistente y concordante. CONCLUSIÓN: Las respuestas en lo general, aportan evidencia para recomendar como punto de buena práctica el uso del expediente clínico electrónico durante el proceso de atención médica de los pacientes ya que los profesionales de la salud prefieren esta modalidad que el expediente clínico tradicional; consideran que contribuye a mejorar la seguridad de los pacientes al estar más disponible y consultable la información y aprueban que su uso se generalice en otros Institutos Nacionales de Salud