28 research outputs found
Efectividad de las actividades preventivas a los 8 años de su introducción en una consulta de medicina general de un centro de salud
ObjetivoPrincipal: valorar la modificación del riesgo coronario (RC) en pacientes adultos tras 8 años de su incorporación al Programa Actividades Preventivas y Promoción Salud (PAPPS). Secundario: determinar nivel de vacunación antitetánica alcanzado y cumplimiento de actividades.DiseñoEstudio de intervención sin asignación aleatoria «antes-después».EmplazamientoUna consulta de medicina general de un centro de salud.PacientesUn total de 429 pacientes (204 varones, 225 mujeres) de 30-65 años seguidos durante 8 años, captados por búsqueda activa de casos en la consulta diaria.IntervencionesDeterminación de tensión arterial, colesterol, peso, tabaquismo, ingesta etílica, estado vacunal antitetánico, cálculo del RC a los 10 años según Framinghan y grado de cumplimiento de actividades. Estas variables se determinaron al inicio, a los 4 y a los 8 años. Datos obtenidos de la historia clínica.ResultadosPoblación total: a los 8 años descenso del RC, 0,8 (IC diferencia, 0,4-1,2), equivalente al 8,5% del inicial. Incremento obtenido de la vacunación antitetánica correcta del 64,4% (IC diferencia, 59,9-69%). Cumplimiento actividades al inicio y al octavo año: tensión, 100%, 71%; consumo tabaco, 99,5%, 71%; determinación colesterol, 89%, 64%. Subgrupo RC inicial alto: a los 8 años descenso del RC, 6,7 (IC diferencia, 4,9-8,5), equivalente al 24,8% del inicial.ConclusionesEn la población total el descenso del RC obtenido no es clínicamente significativo, mientras que en el subgrupo con RC inicial alto el descenso sí lo ha sido. Probablemente debería hacerse búsqueda activa de los pacientes con RC alto y actuar sobre ellos.ObjectivesMain: to assess the change in coronary risk (CR) in adults after 8 years of their involvement in the Programme of Preventive Activities and Health Promotion (PAPPS). Secondary: to determine the level of anti-tetanus vaccination reached and patients' compliance with activities.Design«Before and after» intervention study without random allocation.SettingA general medical clinic at a health centre.Patients429 patients (204 men, 225 women) between 30 and 65 monitored for 8 years, recruited by active search for cases at daily consultations.InterventionsBlood pressure, cholesterol, weight, tobacco habit, alcohol intake, anti-tetanus vaccination state, CR calculation at 10 years on the Framingham scale, and degree of compliance with activities were all determined at the start, at 4 years and at 8 years. Data was obtained from the clinical notes.ResultsTotal population: a 0.8 drop in CR (CI difference: 0.4-1.2), equivalent to 8.5% of the initial figure. 64.4% increase in correct anti-tetanus vaccination (CI difference: 59.9-69). Compliance with activities at the start and after eight years: pressure 100%, 71%; tobacco consumption 99.5%, 71%; cholesterol determination 89%, 64%. Initially high CR sub-group: 6.7 drop of CR at 8 years (CI difference: 4.9-8.5), equivalent to 24.8% of the initial figure.ConclusionsIn the total population, the CR drop found was not clinically significant, whereas in the initially high CR sub-group the drop was. There should probably be an active search made for patients with high CR and action taken on them
Continuous intestinal infusion of levodopa-carbidopa in patients with advanced Parkinson's disease in Spain: Subanalysis by autonomous community
Objetivos: Comparar las características de los pacientes con enfermedad de Parkinson avan-
zada en tratamiento con infusión intestinal continua de levodopa-carbidopa (IICLC) y los datos
de efectividad y seguridad de IICLC entre diferentes comunidades autónomas (CC. AA.).
Métodos: Estudio longitudinal observacional y retrospectivo. Se incluyeron 177 pacientes de
11 CC. AA. que iniciaron tratamiento con IICLC entre enero de 2006 y diciembre de 2011. Se
compararon las características clínicas y demográficas, las variables de efectividad (cambios en
el tiempo OFF, ON con y sin discinesias discapacitantes, cambios en la escala de Hoehn y Yahr
y puntuación de la Unified Parkinson’s Disease Rating Scale, síntomas no motores e Impresión
Clínica Global) y seguridad (acontecimientos adversos), y la tasa de suspensión de IICLC.
Resultados: Se hallaron diferencias significativas entre las CC. AA. en diversas variables basa-
les: duración de la enfermedad hasta el inicio de IICLC, tiempo OFF (34,9-59,7%) y ON (con o
sin discinesias; 2,6-48,0%), Hoehn y Yahr en ON, Unified Parkinson’s Disease Rating Scale-III en
ON y OFF, presencia de ≥ 4 síntomas motores y dosis de IICLC. En el seguimiento (> 24 meses en
9 de 11 CC. AA.) hubo diferencias significativas en el porcentaje de tiempo OFF, tiempo ON sin
discinesias discapacitantes, frecuencia de acontecimientos adversos e Impresión Clínica Global.
La tasa de suspensión fue de entre 20-40% en todas las CC. AA., excepto en 2 (78 y 80%).
Conclusiones: Este estudio muestra una amplia variabilidad en la selección de los pacientes y
en la efectividad y seguridad de IICLC entre las diferentes CC. AA. Podrían influir las caracterís-
ticas basales de los pacientes, la disponibilidad de un equipo multidisciplinar y la experiencia
clínica.Objectives: To compare the characteristics of patients undergoing treatment with continuous
intestinal infusion of levodopa-carbidopa (CIILC) for advanced Parkinson’s disease and the data
on the effectiveness and safety of CIILC in the different autonomous communities (AC) of Spain.
Methods: A retrospective, longitudinal, observational study was carried out into 177 patients
from 11 CAs who underwent CIILC between January 2006 and December 2011. We analysed data
on patients’ clinical and demographic characteristics, variables related to effectiveness (chan-
ges in off time/on time with or without disabling dyskinesia; changes in Hoehn and Yahr scale
and Unified Parkinson’s Disease Rating Scale scores; non-motor symptoms; and Clinical Global
Impression scale scores) and safety (adverse events), and the rate of CIILC discontinuation.
Results: Significant differences were observed between CAs for several baseline variables:
duration of disease progression prior to CIILC onset, off time (34.9-59.7%) and on time (2.6-
48.0%; with or without disabling dyskinesia), Hoehn and Yahr score during on time, Unified
Parkinson’s Disease Rating Scale-III score during both on and off time, presence of ≥ 4 motor
symptoms, and CIILC dose. Significant differences were observed during follow-up (> 24 months
in 9 of the 11 CAs studied) for the percentage of off time and on time without disabling dys-
kinesia, adverse events frequency, and Clinical Global Impression scores. The rate of CIILC
discontinuation was between 20-40% in 9 CAs (78 and 80% in remaining 2 CAs).
Conclusions: This study reveals a marked variability between CAs in terms of patient selection
and CIILC safety and effectiveness. These results may have been influenced by patients’ baseline
characteristics, the availability of multidisciplinary teams, and clinical experience
Genetic relationships within and among Iberian fescues (Festuca L.) based on PCR-amplified markers
The genus Festuca comprises approximately 450 species and is widely distributed around the world. The Iberian Penninsula, with more than 100 taxa colonizing very diverse habitats, is one of its main centers of diversification. This study was conducted to assess molecular genetic variation and genetic relatedness among 91 populations of 31 taxa of Iberian fescues, based on several molecular markers (random amplified polymorphic DNA, amplified fragment length polymorphisms, and trnL sequences). The analyses showed the paraphyletic origin of the broad-leaved (subgenus Festuca, sections Scariosae and Subbulbosae, and subgenus Schedonorus) and the fine-leaved fescues (subgenus Festuca, sections Aulaxyper, Eskia, and Festuca). Schedonorus showed a weak relationship with Lolium rigidum and appeared to be the most recent of the broad-leaved clade. Section Eskia was the most ancient and Festuca the most recent of the fine-leaved clade. Festuca and Aulaxyper were the most related sections, in concordance with their taxonomic affinities. All taxa grouped into their sections, except F. ampla and F. capillifolia (section Festuca), which appeared to be more closely related to Aulaxyper and to a new independent section, respectively. Most populations clustered at the species level, but some subspecies and varieties mixed their populations. This study demonstrated the value in combining different molecular markers to uncover hidden genetic relationships between populations of Festuca
New trends on the numerical representability of semiordered structures
[EN] We introduce a survey, including the historical back-ground, on different techniques that have recently been issued in the search for a characterization of the representability of semiordered structures, in the sense of Scott and Suppes, by means of a real-valued function and a strictly
positive threshold of discrimination.This work has been supported by the research projects MTM2007-62499, ECO2008-01297, MTM2009-12872-C02-02 and MTM2010-17844 (Spain)Abrísqueta, F.; Campión, M.; Catalán, R.; De Miguel, J.; Estevan, A.; Induráin, E.; Zudaire, M.... (2012). New trends on the numerical representability of semiordered structures. Mathware & Soft Computing Magazine. 19(1):25-37. http://hdl.handle.net/10251/57632S253719
Non-motor symptom burden in patients with Parkinson's disease with impulse control disorders and compulsive behaviours : results from the COPPADIS cohort
The study was aimed at analysing the frequency of impulse control disorders (ICDs) and compulsive behaviours (CBs) in patients with Parkinson's disease (PD) and in control subjects (CS) as well as the relationship between ICDs/CBs and motor, nonmotor features and dopaminergic treatment in PD patients. Data came from COPPADIS-2015, an observational, descriptive, nationwide (Spain) study. We used the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) for ICD/CB screening. The association between demographic data and ICDs/CBs was analyzed in both groups. In PD, this relationship was evaluated using clinical features and treatment-related data. As result, 613 PD patients (mean age 62.47 ± 9.09 years, 59.87% men) and 179 CS (mean age 60.84 ± 8.33 years, 47.48% men) were included. ICDs and CBs were more frequent in PD (ICDs 12.7% vs. 1.6%, p < 0.001; CBs 7.18% vs. 1.67%, p = 0.01). PD patients had more frequent previous ICDs history, premorbid impulsive personality and antidepressant treatment (p < 0.05) compared with CS. In PD, patients with ICDs/CBs presented younger age at disease onset, more frequent history of previous ICDs and premorbid personality (p < 0.05), as well as higher comorbidity with nonmotor symptoms, including depression and poor quality of life. Treatment with dopamine agonists increased the risk of ICDs/CBs, being dose dependent (p < 0.05). As conclusions, ICDs and CBs were more frequent in patients with PD than in CS. More nonmotor symptoms were present in patients with PD who had ICDs/CBs compared with those without. Dopamine agonists have a prominent effect on ICDs/CBs, which could be influenced by dose
Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.
Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited
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
Utilización de los modelos multinivel en investigación sanitaria Use of multilevel models in health research
Objetivo: El propósito de este artículo es analizar el uso de la metodología multinivel en las ciencias de la salud. Diseño: Se llevó a cabo una búsqueda bibliográfica en Medline de los artículos publicados entre 1995 y 2001, utilizando 15 palabras de búsqueda, entre las que se encuentran «multilevel model», «multilevel analysis», «hierarchical linear model», «mixed model» y «random effects model», obteniéndose un total de 1.288 resúmenes de artículos. Se examinaron los 222 artículos teóricos y/o aplicaciones realmente relacionadas con métodos multinivel, para determinar el nivel de uso actual, el tipo de modelo, el número de niveles, las unidades de análisis y las variables de respuesta a través de las especialidades en salud. Resultados: El 66,7% de los artículos estudiados se encontraron con las palabras de búsqueda «multilevel analysis», «multilevel modelling» y «multilevel model». El 56% de los artículos son aplicaciones de multinivel en diferentes áreas de la salud; no obstante, merece destacar que un 10% de los trabajos tienen como objetivo exponer y difundir la metodología en un lenguaje comprensible para los no especialistas. Conclusiones: El uso de los modelos multinivel en salud ha aumentado con los años, aplicándose en diferentes áreas o especialidades de salud, pero aún no se los considera una técnica de uso habitual.Objective: The aim of this study was to analyze the use of multilevel methodology in health sciences. Design: A literature search was performed in Medline for articles published between 1995 and 2001. Fifteen search words were used, some of which were «multilevel model», «multilevel analysis», «hierarchical linear model», «mixed model», and «random effects model». A total of 1288 abstracts were retrieved. Two hundred twenty-two of the articles on theoretical and/or applied issues related to multilevel methods were examined to determine their current use, the type of model, the number of levels, the units of analysis and the outcome variables related to health sciences. Results: 66.7% of the articles studied was found with the keywords: «multilevel analysis», «multilevel modelling» and «multilevel model». Fifty-six percent of the articles were multilevel applications in different health sciences. However, in 10% of the articles, the main objective was to present and disseminate the methodology in a language comprehensible to non-specialists. Conclusions: The use of multilevel modelling in health has increased with time and is being applied in different health areas and specialties. However, it is still not considered a commonly used technique
Expression of the chloride channel CLC-K in human airway epithelial cells
Airway submucosal gland function is severely disrupted in cystic fibrosis (CF), as a result of genetic mutation
of the cystic fibrosis transmembrane conductance regulator (CFTR), an apical membrane Cl– channel. To identify other
Cl– channel types that could potentially substitute for lost CFTR function in these cells, we investigated the functional and
molecular expression of Cl– channels in Calu-3 cells, a human cell line model of the submucosal gland serous cell. Whole
cell patch clamp recording from these cells identified outwardly rectified, pH- and calcium-sensitive Cl– currents that resemble
those previously ascribed to ClC-K type chloride channels. Using reverse transcription – polymerase chain reaction,
we identified expression of mRNA for ClC-2, ClC-3, ClC-4, ClC-5, ClC-6, ClC-7, ClC-Ka, and ClC-Kb, as well as the
common ClC-K channel b subunit barttin. Western blotting confirmed that Calu-3 cells express both ClC-K and barttin
protein. Thus, Calu-3 cells express multiple members of the ClC family of Cl– channels that, if also expressed in native
submucosal gland serous cells within the CF lung, could perhaps act to partially substitute lost CFTR function. Furthermore,
this work represents the first evidence for functional ClC-K chloride channel expression within the lung