Análisis de la utilización de antiulcerosos inhibidores de la bomba de protones en el área de atención primaria de la comarca Araba

OBJETIVO: Los antiulcerosos inhibidores de la bomba de protones (IBP) son uno de los grupos farmacologicos mas prescritos en atencion primaria. El objetivo del trabajo fue conocer la prescripcion de IBP en el Area de Atencion Primaria de la Comarca Araba de Osakidetza para sensibilizar a los medicos de familia sobre su correcta utilizacion, asi como fomentar la prescripcion de los IBP mas eficientes.METODOS: Estudio descriptivo de la prescripcion de IBP de 200 medicos de familia de la Comarca Araba de Osakidetza a partir de las recetas facturadas por las oficinas de farmacia durante los anos 2009-2014. Se analizo el importe del consumo y las Dosis por 1000 habitantes/dia (DHD) de IBP, asi como el consumo relativo de omeprazol respecto al resto de principios activos de este subgrupo terapeutico. El analisis estadistico se realizo mediante el programa IBM SPSS v23.RESULTADOS: La prescripcion de IBP se incremento un 23,75% (de 78,14 DHD en 2009 hasta 96,70 DHD en 2014), siendo su utilizacion muy superior a la de otros paises europeos. En el mismo periodo, el porcentaje de prescripcion relativa de omeprazol frente al resto de IBP disminuyo un 4,56% (el porcentaje de Dosis diaria definida (DDD) de omeprazol paso del 74,67% en 2009 al 70,11% en 2014). El gasto global de estos medicamentos disminuyo un 17,60%.CONCLUSIONES: Existe un incremento global en el numero de prescripciones de IBP, aunque ha disminuido el gasto por la reduccion de precios. Asimismo hay un descenso del consumo relativo de omeprazol, aunque no se han modificado las indicaciones aprobadas. La prescripcion de IBP debe realizarse con prudencia, ya que su elevado uso de forma injustificada en la prevencion de gastropatias aumenta el riesgo de prescripciones inadecuadas. El antiulceroso mas recomendado continua siendo el omeprAbstract OBJECTIVE: The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs. METHODS: Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23 statistic software. RESULTS: IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%. CONCLUSIONS: There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole

Análisis de la utilización de antiulcerosos inhibidores de la bomba de protones en el área de atención primaria de la comarca Araba

OBJETIVO: Los antiulcerosos inhibidores de la bomba de protones (IBP) son uno de los grupos farmacologicos mas prescritos en atencion primaria. El objetivo del trabajo fue conocer la prescripcion de IBP en el Area de Atencion Primaria de la Comarca Araba de Osakidetza para sensibilizar a los medicos de familia sobre su correcta utilizacion, asi como fomentar la prescripcion de los IBP mas eficientes.METODOS: Estudio descriptivo de la prescripcion de IBP de 200 medicos de familia de la Comarca Araba de Osakidetza a partir de las recetas facturadas por las oficinas de farmacia durante los anos 2009-2014. Se analizo el importe del consumo y las Dosis por 1000 habitantes/dia (DHD) de IBP, asi como el consumo relativo de omeprazol respecto al resto de principios activos de este subgrupo terapeutico. El analisis estadistico se realizo mediante el programa IBM SPSS v23.RESULTADOS: La prescripcion de IBP se incremento un 23,75% (de 78,14 DHD en 2009 hasta 96,70 DHD en 2014), siendo su utilizacion muy superior a la de otros paises europeos. En el mismo periodo, el porcentaje de prescripcion relativa de omeprazol frente al resto de IBP disminuyo un 4,56% (el porcentaje de Dosis diaria definida (DDD) de omeprazol paso del 74,67% en 2009 al 70,11% en 2014). El gasto global de estos medicamentos disminuyo un 17,60%.CONCLUSIONES: Existe un incremento global en el numero de prescripciones de IBP, aunque ha disminuido el gasto por la reduccion de precios. Asimismo hay un descenso del consumo relativo de omeprazol, aunque no se han modificado las indicaciones aprobadas. La prescripcion de IBP debe realizarse con prudencia, ya que su elevado uso de forma injustificada en la prevencion de gastropatias aumenta el riesgo de prescripciones inadecuadas. El antiulceroso mas recomendado continua siendo el omeprAbstract OBJECTIVE: The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs. METHODS: Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23 statistic software. RESULTS: IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%. CONCLUSIONS: There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole

Effect of resistance training and hypocaloric diets with different protein content on body composition and lipid profile in hypercholesterolemic obese women

Lifestyle changes such as following a hypocaloric diet and regular physical exercise are recognized as effective non-pharmacological interventions to reduce body fat mass and prevent cardiovascular disease risk factors. Purpose: To evaluate the interactions of a higher protein (HP) vs. a lower protein (LP) diet with or without a concomitant progressive resistance training program (RT) on body composition and lipoprotein profile in hypercholesterolemic obese women. Methods: Retrospective study derived from a 16-week randomized controlled-intervention clinical trial. Twentyfive sedentary, obese (BMI: 30-40 kg/m²) women, aged 40-60 with hypercholesterolemia were assigned to a 4-arm trial using a 2 x 2 factorial design (Diet x Exercise). Prescribed diets had the same calorie restriction (-500 kcal/day), and were categorized according to protein content as: lower protein ( 22% daily energy intake, HP). Exercise comparisons involved habitual activity (control) vs. a 16-week supervised whole-body resistance training program (RT), two sessions/wk. Results: A significant decrease in weight and waist circumference was observed in all groups. A significant decrease in LDL-C and Total-Cholesterol levels was observed only when a LP diet was combined with a RT program, the RT being the most determining factor. Interestingly, an interaction between diet and exercise was found concerning LDL-C values. Conclusion: In this study, resistance training plays a key role in improving LDL-C and Total-Cholesterol; however, a lower protein intake (< 22% of daily energy intake as proteins) was found to achieve a significantly greater reduction in LDL-C

Effects of heavy resistance training on maximal and explosive force production, endurance and serum hormones in adolescent handball players

Abstract To determine the eects of 6-weeks of heavyresistance training on physical ®tness and serum hormone status in adolescents (range 14±16 years old) 19 male handball players were divided into two dierent groups: a handball training group (NST, n = 10), and a handball and heavy-resistance strength training group (ST, n = 9). A third group of 4 handball goalkeepers of similar age served as a control group (C, n = 4). After the 6-week training period, the ST group showed an improvement in maximal dynamic strength of the leg extensors (12.2%; P &lt; 0.01) and the upper extremity muscles (23%; P &lt; 0.01), while no changes were observed in the NST and C groups. Similar dierences were observed in the maximal isometric unilateral leg extension forces. The height of the vertical jump increased in the NST group from 29.5 (SD 4) cm to 31.4 (SD 5) cm (P &lt; 0.05) while no changes were observed in the ST and C groups. A signi®cant increase was observed in the ST group in the velocity of the throwing test [from 71.7 (SD 7) km á h A1 to 74.0 (SD 7) km á h A1 ; P &lt; 0.001] during the 6-week period while no changes were observed in the NST and C groups. During a submaximal endurance test running at 11 km á h A1 , a signi®cant decrease in blood lactate concentration occurred in the NST group [from 3.3 (SD 0.9) mmol á l A1 to 2.4 (SD 0.8) mmol á l A1 ; P &lt; 0.01] during the experiment, while no change was observed in the ST or C groups. Finally, a signi®cant increase (P &lt; 0.01) was noted in the testosterone:cortisol ratio in the C group, while the increase in the NST group approached statistical signi®cance (P &lt; 0.08) and no changes in this ratio occurred in the ST group. The present ®ndings suggested that the addition of 6-weeks of heavy resistance training to the handball training resulted in gains in maximal strength and throwing velocity but it compromised gains in leg explosive force production and endurance running. The tendency for a compromised testosterone:cortisol ratio observed in the ST group could have been associated with a state of overreaching or overtraining

Energy metabolism during repeated sets of leg press exercise leading to failure or not

This investigation examined the influence of the number of repetitions per set on power output and muscle metabolism during leg press exercise. Six trained men (age 34±6 yr) randomly performed either 5 sets of 10 repetitions (10REP), or 10 sets of 5 repetitions (5REP) of bilateral leg press exercise, with the same initial load and rest intervals between sets. Muscle biopsies (vastus lateralis) were taken before the first set, and after the first and the final sets. Compared with 5REP, 10REP resulted in a markedly greater decrease (P<0.05) of the power output, muscle PCr and ATP content, and markedly higher (P<0.05) levels of muscle lactate and IMP. Significant correlations (P<0.01) were observed between changes in muscle PCr and muscle lactate (R2 = 0.46), between changes in muscle PCr and IMP (R2 = 0.44) as well as between changes in power output and changes in muscle ATP (R2 = 0.59) and lactate (R2 = 0.64) levels. Reducing the number of repetitions per set by 50% causes a lower disruption to the energy balance in the muscle. The correlations suggest that the changes in PCr and muscle lactate mainly occur simultaneously during exercise, whereas IMP only accumulates when PCr levels are low. The decrease in ATP stores may contribute to fatigue

Effects of strength training on submaximal and maximal endurance performance capacity in middle-aged and older men

ABSTRACT Effects of a 16-week progressive strength-training program on blood lactate accumulation (LA), maximal workload (W max ) attained during progressive cycling exercise, maximum half-squat (1RM HS ), muscle cross-sectional area of the quadriceps femoris muscle group (CSA QF ), and serum hormone concentrations were examined in 11 middle-aged (46 year old [M46]) and 11 older (64 year old [M64]) men. During the 16 weeks of training, significant increases were observed in 1RM HS in M46 and M64 (41-45%; p Ͻ 0.001). The muscle CSA QF increased (13-11%; p Ͼ 0.01) for both groups. The first 8 weeks of training led to significant increases in W max (6-11%; p Ͻ 0.001) and decreases in submaximal (LA) in both groups, but no further training-induced changes were observed during the subsequent 8 weeks of training. Statistically significant relationships were observed in M64 and in the combined group M46 ϩ M64 between the training-induced changes observed in W max and serum testosterone-cortisol and free-testosterone-cortisol ratios, whereas in M46 the respective correlations values did not reach statistically significant levels. These data indicate that strength training results in a significant improvement in maximal and submaximal endurance during the first 8 weeks of strength training in both age groups, related in part to the intensity and the volume of resistance training used and to the training status of the subjects. The relationships found in this study between various indices of cycling testing and serum hormone concentrations after strength training suggest that maximal incremental cycling might be used as an additional test to detect anabolic-catabolic responses to prolonged strength training in middle-aged and older men. Key Words: lactate, maximal workload, testosterone, strength, cortisol, aging Reference Data: Izquierdo, M., K. Häkkinen, J. Ibañ ez, A. Antón, M. Garrués, M. Ruesta, and E.M. Gorostiaga. Effects of strength training on submaximal and maximal endurance performance capacity in middleaged and older men

Lymph Node Tumor Burden Correlates With Tumor Budding and Poorly Differentiated Clusters: A New Prognostic Factor in Colorectal Carcinoma?

Introduction: Molecular lymph node (LN) staging in early colorectal cancer (CRC) has demonstrated to be more precise than conventional histopathology pN staging. Tumor budding (TB) and poorly differentiated clusters (PDCs) are associated with LN metastases, recurrences, and lower survival in CRC. We evaluated the correlation between the total tumor load (TTL) in LNs from CRC surgical specimens with patient outcome, TB, and PDC. Methods: In this retrospective multicentre study, 5,931 LNs from 342 stage I-III CRC were analyzed by both hematoxylin and eosin and molecular detection of tumor cytokeratin 19 mRNA by one-step nucleic acid amplification. TB and PDC were evaluated by hematoxylin and eosin and cytokeratin 19 immunohistochemistry. Results: One-step nucleic acid was positive in 38.3% patients (n = 131). Tumor Budding was low in 45% cases, intermediate in 25%, and high in 30%. Poorly Differentiated Clusters were low-grade G1 in 53%, G2 in 32%, and G3 in 15%. TB and PDC correlated with TTL, high-grade, lymphovascular and perineural invasion, pT, pN and stage (P < 0.001). TB, PDC, and TTL ≥ 6,000 copies/µL were associated with worse overall survival (P = 0.002, P = 0.013, and P = 0.046) and disease-free survival (P < 0.001). Discussion: The implementation of more sensitive molecular methods to assess LN status is a promising alternative approach to pN staging, which could be integrated to other factors to help risk stratification and management of patients with early-stage CRC. This study demonstrates the correlation of the amount of LN tumor burden with TB and PDCs. TTL is related to the outcome and could be used as a new prognostic factor in CRC (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A512).This work was supported by the Instituto de Salud Carlos III (grants PI17/01304 to J.C and M.C; grant PI16/00766 to F.B., and a Miguel Servet grant to J.C, cofunded by the European Regional Development Fund (ERDF) (CPII18/00026), through the Plan Estatal de Investigacion Científica y Tecnica y de Innovación, and Agencia de Gestiò d’Ajuts Universitaris i de Recerca (2017SGR653 and 2017SGR1035). CIBERehd is funded by the Instituto de Salud Carlos III. We also acknowledge the support of the CERCA Programme/Generalitat de Catalunya, and the Xarxa de Bancs de Tumors de Catalunya (XBTC)

Azken hiru hamarkadetan Euskal Herriko kostaldean klima-aldaketak komunitate bentonikoetan (flora eta fauna) izan duen eragina

Errezela eratzen duten makroalgek, oro har, beherakada bortitza izan dute, eta horrek ekosistemako prozesuetan izango dituen eraginak ez dira oraindik ondo ezagutzen. Ikerketa honek Bizkaiko Golkoko hegoaldean 20 urte inguruko aldian substratu gogorreko ekosistema bentonikoak aztertu ditu, non Gelidium corneum makrofitoak beherakada nabarmena izan duen. Errezelak atzera egitearen edo aldaketaren tasa ikertu da, bai eta errezel-menpeko diren organismoen (algak eta ornogabeak) egitura taxonomiko eta funtzionalean ondorioak ere. Gure emaitzek erakutsi dute 2008an aldaketa garrantzitsuak zakarki gertatu zirela eta ondoren ez dela berreskuratze-seinalerik izan. Galera esanguratsuenak makroalga konplexu eta iraunkorrak diren formetan gertatu dira eta, aldiz, epifitoak diren eta ez diren suspentsiboroetan ere, alga sinple soropilduak ugaritu dira. Aldi berean, espezieen aberastasunak, algen dentsitateak eta flora eta faunaren ekitatibitateak gora egin dute. Ikerketaren 1. aldian (1998-2007), alga eta fauna espezie elkartuen talde koherenteak batera aldatzen dutela ikusten da. Hala ere, 2008tik aurrerantz finkatutako komunitate berrian algen eta ornogabeen arteko elkarte espezifikoak falta dira. Gure emaitzek flora eta fauna espezieen arteko ereduak daudela adierazten dute. Patroi hauek ekosistema bentonikoaren funtsezko espezie eta ezaugarri funtzionalen galeren ondorioak hobeto ulertzen lagunduko dute.; Canopy-forming macroalgae are globally facing drastic declines and the consequences for ecosystem processes remain still little known. The present investigation analyses in a 20 years period the retreat of shallow subtidal rocky benthos communities in the southern Bay of Biscay, where the macrophyte Gelidium corneum has suffered a notable decrease. The rate of change of canopy retreat was investigated as well as the effects of the decline on the taxonomic and functional structure of canopy-dependent organisms (algae and invertebrates). Our results show that major changes occurred abruptly in 2008, and no signs of recovery have been recorded afterwards. Major losses arose in complex perennial macroalgal forms together with epiphytic and no epiphytic suspensivores while simple turf-forming algae proliferated. At the same time, species richness, algal density and both flora and fauna evenness increased. There exist groups of coherent species of flora and fauna that covary during the first part of the studied period. However, from 2008 onwards the new established community lacked algal-invertebrate specific associations. Our results highlight patterns between flora and fauna species help to better understand the consequences of the loss of key species and functional traits for the benthic ecosystem