Efectividad de la terapia combinada a dosis fijas en una cohorte de hipertensos no controlados con monoterapia

ObjetivoEvaluar la efectividad de lisinoprilhidroclorotiazida a dosis fijas en el control de la presión arterial en hipertensos tratados con monoterapia y mal controlados.DiseñoEstudio observacional, prospectivo.EmplazamientoAtención primaria.ParticipantesCiento noventa y nueve médicos de atención primaria que incluyeron a 931 pacientes (56,7% mujeres), con edad media de 62,0 ± 10,3 años. Finalizaron el estudio 915 pacientes (98%) que se incluyeron en el análisis.Mediciones principalesSe siguieron las recomendaciones de la OMS/SIH en la medición de la presión arterial y el diagnóstico de mal control. Además, se evaluaron presión del pulso, índice de masa corporal y parámetros analíticos básicos. Se realizaron 4 visitas durante 6 meses de seguimiento.ResultadosLisinopril-hidroclorotiazida (20/12,5mg) disminuyó significativamente la PAS (24,6 ± 3,5mmHg) y la PAD (14,3 ± 0,7mmHg) (p < 0,001). El control de la presión arterial aumentó hasta el 52,8% (p < 0,001). La edad fue la única variable que influyó en el control de la presión arterial (OR, 0,81; IC del 95%, 0,71-0,92%; p = 0,001). La presión del pulso disminuyó 10,4 ± 4,3mmHg (p < 0,001). A las 24 semanas de tratamiento, se observó una mejoría en el perfil glucémico y lipídico, y de la HbA1c en los diabéticos.ConclusionesEn atención primaria, lisinopril-hidroclorotiazida (20/12,5mg), controló la presión arterial del 52,8% los de hipertensos mal controlados con monoterapia. Además, disminuyó la presión del pulso y mejoró el perfil lipídico y el glucémico.ObjectiveTo evaluate the effectiveness of the fixed dose of a lisinoprilhydrochlorothiazide combination treatment in the control of blood pressure, in poorly controlled high blood pressure people, treated with monotherapy.DesignProspective observational study.SettingPrimary care frame.Participants931 patients (56.7% women) with an average age of 62.0±10.3 years, were included by 199 primary care physicians. 915 patients (98%) ended the study and finally they were included for the statistical analysis.Main measurementsOMS/SIH recommendations on blood pressure measurement and diagnose of poor control were followed. Pulse pressure, body mass index and basic clinical analyses were assessed. Four continuation visits were made during six months.ResultsLisinopril–hidrochlorothiazide (20/12.5mg) reduced significantly SBP (24.6±3.5mm Hg) and DBP (14,3±0.7mm Hg) (P<.001). Blood pressure control was only influenced by age (OR, 0.81; 95% CI, 0.71-0.92; P=.001). Pulse pressure was reduced in 10.4±4.3mm Hg (P<.001). After 24 weeks of treatment, glycemic and lipidic profiles showed an improvement, as well as HbA1c in diabetic people.ConclusionsIn Primary care, a 52.8% of poorly controlled with monotherapy high blood pressure people were controlled by a combination of lisinoprilhydrochlorothiazide (20/12.5mg). In addition, pulse pressure was decreased and both lipid and glucose blood profiles improved

Sumando en salud en beneficio del paciente en el 1er congreso SEMERGEN-SEFAC

Asistimos en España a un progresivo envejecimiento demográfico, que en las próximas décadas se agravará de manera más palpable. Este irreversible cambio en la pirámide de población es ya una realidad de pronóstico inquietante: en el año 2060, las personas de más de 65 años representarán más de un tercio –concretamente, un 35,6%– del total de la población española. Organismos como el Observatorio Europeo de Sistemas de Políticas de salud alertan de que los agentes de salud aún no han encontrado fórmulas para adecuar los procesos de prevención y manejo de enfermedades a la nueva realidad sociosanitaria. Sobra voluntad, pero faltan mecanismos.Asistimos en España a un progresivo envejecimiento demográfico, que en las próximas décadas se agravará de manera más palpable. Este irreversible cambio en la pirámide de población es ya una realidad de pronóstico inquietante: en el año 2060, las personas de más de 65 años representarán más de un tercio –concretamente, un 35,6%– del total de la población española. Organismos como el Observatorio Europeo de Sistemas de Políticas de salud alertan de que los agentes de salud aún no han encontrado fórmulas para adecuar los procesos de prevención y manejo de enfermedades a la nueva realidad sociosanitaria. Sobra voluntad, pero faltan mecanismos

A corpus-based study of Spanish L2 mispronunciations by Japanese speakers

Abstract In a companion paper (Carranza et al.) submitted to this conference we discuss the importance of collecting specific L1-L2 speech corpora for the sake of developing effective Computer Assisted Pronunciation Training (CAPT) programs. In this paper we examine this point more deeply by reporting on a study that was aimed at compiling and analysing such a corpus to draw up an inventory of recurrent pronunciation errors to be addressed in a CAPT application that makes use of Automatic Speech Recognition (ASR). In particular we discuss some of the results obtained in the analyses of this corpus and some of the methodological issues we had to deal with. The corpus features 8.9 hours of spontaneous, semi-spontaneous and read speech recorded from 20 Japanese students of Spanish L2. The speech data was segmented and transcribed at the orthographic, canonical-phonemic and narrow-phonetic level using Praat software We report on the analyses of the combined annotations and draw up an inventory of errors that should be addressed in the training. We then consider how ASR can be employed to properly detect these errors. Furthermore, we suggest possible exercises that may be included in the training to improve the errors identified

Illusory vowels in Spanish-English sequential bilinguals: Evidence that accurate L2 perception is neither necessary nor sufficient for accurate L2 production

Spanish native speakers are known to pronounce onset /sC/ clusters in English with a prothetic vowel, as in esport for sport, due to their native language phonotactic constraints. We assessed whether accurate production of e.g. spi instead of espi was related to accurate perceptual discrimination of this contrast in second language (L2) speech of Spanish–English sequential bilinguals. A same–different discrimination task in stimulus pairs such as spi–espi assessed speech perception and a phonemic verbal fluency task elicited speech production. Logistic mixed model regressions revealed significant differences in accuracy between the bilinguals and the English monolinguals, although some bilinguals performed within the monolingual range. For the production task, but not for the perception task, bilinguals with more exposure to English and greater grammatical knowledge of English performed significantly more accurately than those with less exposure and lower grammatical knowledge. There was no significant correlation between production accuracy and perception accuracy. Through examining phonotactic constraints, these results expand a growing body of research into single sounds which suggests dissociations between L2 perception and production. In contrast to predictions made by L2 speech models, the findings indicate that accurate L2 perception is neither necessary nor sufficient for accurate L2 production, and instead are interpreted to indicate that the two capacities recruit different executive control mechanisms and are acquired – at least to a certain extent – independently in L2 acquisition.Peer Reviewe

Beneficial effects of word final stress in segmenting a new language: evidence from ERPs

Background: How do listeners manage to recognize words in an unfamiliar language? The physical continuity of the signal, in which real silent pauses between words are lacking, makes it a difficult task. However, there are multiple cues that can be exploited to localize word boundaries and to segment the acoustic signal. In the present study, word-stress was manipulated with statistical information and placed in different syllables within trisyllabic nonsense words to explore the result of the combination of the cues in an online word segmentation task. Results: The behavioral results showed that words were segmented better when stress was placed on the final syllables than when it was placed on the middle or first syllable. The electrophysiological results showed an increase in the amplitude of the P2 component, which seemed to be sensitive to word-stress and its location within words. Conclusion: The results demonstrated that listeners can integrate specific prosodic and distributional cues when segmenting speech. An ERP component related to word-stress cues was identified: stressed syllables elicited larger amplitudes in the P2 component than unstressed ones

EDUCORE project: a clinical trial, randomised by clusters, to assess the effect of a visual learning method on blood pressure control in the primary healthcare setting

<p>Abstract</p> <p>Background</p> <p>High blood pressure (HBP) is a major risk factor for cardiovascular disease (CVD). European hypertension and cardiology societies as well as expert committees on CVD prevention recommend stratifying cardiovascular risk using the SCORE method, the modification of lifestyles to prevent CVD, and achieving good control over risk factors. The EDUCORE (Education and Coronary Risk Evaluation) project aims to determine whether the use of a cardiovascular risk visual learning method - the EDUCORE method - is more effective than normal clinical practice in improving the control of blood pressure within one year in patients with poorly controlled hypertension but no background of CVD;</p> <p>Methods/Design</p> <p>This work describes a protocol for a clinical trial, randomised by clusters and involving 22 primary healthcare clinics, to test the effectiveness of the EDUCORE method. The number of patients required was 736, all between 40 and 65 years of age (n = 368 in the EDUCORE and control groups), all of whom had been diagnosed with HBP at least one year ago, and all of whom had poorly controlled hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg). All personnel taking part were explained the trial and trained in its methodology. The EDUCORE method contemplates the visualisation of low risk SCORE scores using images embodying different stages of a high risk action, plus the receipt of a pamphlet explaining how to better maintain cardiac health. The main outcome variable was the control of blood pressure; secondary outcome variables included the SCORE score, therapeutic compliance, quality of life, and total cholesterol level. All outcome variables were measured at the beginning of the experimental period and again at 6 and 12 months. Information on sex, age, educational level, physical activity, body mass index, consumption of medications, change of treatment and blood analysis results was also recorded;</p> <p>Discussion</p> <p>The EDUCORE method could provide a simple, inexpensive means of improving blood pressure control, and perhaps other health problems, in the primary healthcare setting;</p> <p>Trial registration</p> <p>The trial was registered with ClinicalTrials.gov, number NCT01155973 [<url>http://ClinicalTrials.gov</url>].</p

The same but different: Understanding entrepreneurial behaviour in disadvantaged communities

While entrepreneurship is widely viewed as being equally accessible in all contexts, it could be questioned if potential or nascent entrepreneurs from minority and disadvantaged communities experience entrepreneurship in a similar manner to the mainstream population. This chapter examines immigrant, people with disability, youth, gay and unemployed communities to explore how their entrepreneurial behaviour might differ from the practices of mainstream entrepreneurs. What emerges is that marginalised communities can frequently find it difficult to divorce business from social living. This can have both positive and negative connotations for an entrepreneur, plus they face additional and distinctive challenges that mainstream entrepreneurs do not experience. The chapter concludes by proposing a novel ‘funnel approach’ that policymakers might adopt when seeking to introduce initiatives targeted at these disadvantaged communities