Opportunities for the improvement of the methadone service in primary health care, from the professionals’ point of view

Objetivo: Identificar y priorizar las oportunidades de mejora, según el modelo European Foundation for Quality Management (EFQM), del servicio de dispensación de metadona en los Centros de Atención Primaria (CAP) en Andalucía desde la perspectiva de los/as profesionales. Metodología: Método de consenso Delphi, a través de tres rondas de entrevistas con cuestionario administrado por correo electrónico a 39 profesionales durante septiembre de 2007 a marzo de 2008. Se configuró un panel de expertos/as formado por: Dispensadores/as y Prescriptores/ as de metadona así como Coordinadores/as de dispositivos asistenciales del Programa de Tratamiento con Metadona (PTM). Criterios de selección: Estar activo laboralmente y tener una experiencia de al menos 3 años. Variables de diversificación muestral en la composición del panel: Rol profesional, ámbito geográfico y tipo de hábitat. Captación: A través de profesionales claves de distintas instituciones. Resultados: En total se identificaron 48 oportunidades de mejoras. Trece oportunidades obtuvieron un nivel de acuerdo alto en la última ronda. Los criterios, según el modelo EFQM, que obtuvieron un mayor consenso para mejorar la atención fueron: Liderazgo, Alianzas y Recursos. Y la dimensión que obtuvo un mayor desacuerdo fue Procesos. Conclusiones: A pesar de su implementación desde 1997 en los CAP en Andalucía, el servicio de dispensación de metadona se encuentra en una fase de despliegue más que de perfeccionamiento.Objective: To identify and prioritize improvement opportunities, according to the European Foundation for Quality Management model (EFQM) model, of the methadone dispensing service in Andalusian Primary Health Care, from the point of view of professionals. Method: Delphi consensus method, implemented from September 2007 to March 2008 by means of three rounds of interviews with questionnaires administered by electronic mail to 39 professionals. The Panel of experts was made up of Dispensers and Prescribers of methadone as well as Coordinators of welfare services from the Methadone Treatment Program (MTP). Selection criteria were: Being in active employment with a minimum of 3 years experience. Sample diversification variables: Professional role, geographical environment and type of habitat. Recruitment: By means of key professional bodies from different institutions. Results: 48 improvement opportunities were identified. Thirteen of these obtained a high level of agreement in the final round. According to the EFQM model, the dimensions that obtained the most consensus in relation to improving the care service were: Leadership, Alliances and Resources. The dimension that caused the greatest disagreement was Processes. Conclusions: In spite of its having been implemented since 1997 in Andalusian Primary Health Care, the methadone dispensing service is at an implementation phase, rather than what could be classed as a fully deployed stage

Chronic hypoxia aggravates Alzheimer’s disease pathology by causing microglial dysfunction

Trabajo presentado en el XXXVII Congreso de la Sociedad Española de Bioquímica y Biología Molecular (SEBBM), celbrado en Granada del 9 al 12 de septiembre de 2014.Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder and the most common form of dementia. In many cases AD patients present concomitant vascular pathology. Low oxygen levels are also frequently found in the brain of AD patients. The most accepted hypothesis to explain the correlation between hypoxia and AD is the deposition of amyloid ß (Aß) occurring in the microvasculature (amyloid angiopathy) and the affectation by the disease of the locus coeruleus, a brain region involved in the control of brain blood flow. However, few data has been collected to understand the relation between hypoxia and AD progression. We show here the accumulation of the hypoxic marker HIF1 α (Hypoxia-inducible-factor 1α), the major transcription factor for the adaptation to hypoxic conditions, in the brain of AD patients by western blot. We have also characterized the consequences of chronic exposition to hypoxia in the progression of the disease using a widely accepted AD mice model. AD mice were exposed to physiologic hypoxia (8.5% oxygen, 21 days) at initial and advances stages of the pathology. Brains from hypoxic animals showed no differences in the Aß content and number of plaques, but they showed a clear reduction in the total number of microglial cells that was even more evident around the Aß plaques. In vitro analyses suggest that hypoxia slows down proliferation and chemotaxis towards polymeric Aß in both cell line and primary microglial cultures. Interestingly, the brain cortex from the hypoxic animals showed a high increase in the number of dystrophic neurites surrounding the microglia- free Aß plaques. We observed also a decrease in the mRNA levels of two markers of interneurons, Somatostatin and Neuropeptide-Y, in the hippocampus of hypoxic mice. These data suggest that hypoxia accelerates the progression of AD pathology. The pathway underlying microglial affectation by hypoxia has an enormous potential in neurodegenerative disorders where microglia function is correlated with the progression of the disease.N

Hypoxia compromises the mitochondrial metabolism of Alzheimer’s disease microglia via HIF1

Genetic Alzheimer’s disease (AD) risk factors associate with reduced defensive amyloid β plaque-associated microglia (AβAM), but the contribution of modifiable AD risk factors to microglial dysfunction is unknown. In AD mouse models, we observe concomitant activation of the hypoxia-inducible factor 1 (HIF1) pathway and transcription of mitochondrial-related genes in AβAM, and elongation of mitochondria, a cellular response to maintain aerobic respiration under low nutrient and oxygen conditions. Overactivation of HIF1 induces microglial quiescence in cellulo, with lower mitochondrial respiration and proliferation. In vivo, overstabilization of HIF1, either genetically or by exposure to systemic hypoxia, reduces AβAM clustering and proliferation and increases Aβ neuropathology. In the human AD hippocampus, upregulation of HIF1α and HIF1 target genes correlates with reduced Aβ plaque microglial coverage and an increase of Aβ plaque-associated neuropathology. Thus, hypoxia (a modifiable AD risk factor) hijacks microglial mitochondrial metabolism and converges with genetic susceptibility to cause AD microglial dysfunction.R.M.-D. was the recipient of a Sara Borrell fellowship from Instituto de Salud Carlos III (ISCIII) (CD09/0007). N.L.-U., C.O.-d.S.L., C.R.-M. and M.I.A.-V. were the recipients of FPU fellowships from Spanish Ministry of Education, Culture and Sport (FPU14/02115, AP2010‐1598, FPU16/02050 and FPU15/02898, respectively). A.H.-G. was the recipient of an FPI fellowship from the Spanish Ministry of Education, Culture and Sport (BES-2010-033886). This work was supported by grants from the Spanish MINEICO, ISCIII and FEDER (European Union) (SAF2012‐33816, SAF2015‐64111‐R, SAF2017-90794-REDT and PIE13/0004 to A.P.); by the Regional Government of Andalusia co-funded by CEC and FEDER funds (European Union) (‘Proyectos de Excelencia’; P12‐CTS‐2138 and P12‐CTS‐2232 to A.P.); by the ‘Ayuda de Biomedicina 2018’, Fundación Domingo Martínez (to A.P.) ; by the ISCIII of Spain, co-financed by FEDER funds (European Union) through grants PI18/01556 (to J.V.) and PI18/01557 (to A. Gutierrez); by Junta de Andalucía, co-financed by FEDER funds (grants UMA18-FEDERJA-211 (to A. Gutierrez) and US‐1262734 (to J.V.)); and by Spanish MINEICO (BFU2016-76872-R and BES-2011-047721 to E.B.).Peer reviewe

Opportunities for the improvement of the methadone service in primary health care, from the professionals’ point of view

Objective: To identify and prioritize improvement opportunities, according to the European Foundation for Quality Management model (EFQM) model, of the methadone dispensing service in Andalusian Primary Health Care, from the point of view of professionals. Method: Delphi consensus method, implemented from September 2007 to March 2008 by means of three rounds of interviews with questionnaires administered by electronic mail to 39 professionals. The Panel of experts was made up of Dispensers and Prescribers of methadone as well as Coordinators of welfare services from the Methadone Treatment Program (MTP). Selection criteria were: Being in active employment with a minimum of 3 years experience. Sample diversification variables: Professional role, geographical environment and type of habitat. Recruitment: By means of key professional bodies from different institutions. Results: 48 improvement opportunities were identified. Thirteen of these obtained a high level of agreement in the final round. According to the EFQM model, the dimensions that obtained the most consensus in relation to improving the care service were: Leadership, Alliances and Resources. The dimension that caused the greatest disagreement was Processes. Conclusions: In spite of its having been implemented since 1997 in Andalusian Primary Health Care, the methadone dispensing service is at an implementation phase, rather than what could be classed as a fully deployed stageA los/as profesionales que participaron en el estudio por sus aportaciones y a la Consejería de Salud de la Junta de Andalucía por la financiación (Expte.05/135) concedida para llevar a cabo el estudio.YesObjetivo: Identificar y priorizar las oportunidades de mejora, según el modelo European Foundation for Quality Management (EFQM), del servicio de dispensación de metadona en los Centros de Atención Primaria (CAP) en Andalucía desde la perspectiva de los/as profesionales. Metodología: Método de consenso Delphi, a través de tres rondas de entrevistas con cuestionario administrado por correo electrónico a 39 profesionales durante septiembre de 2007 a marzo de 2008. Se configuró un panel de expertos/as formado por: Dispensadores/as y Prescriptores/ as de metadona así como Coordinadores/as de dispositivos asistenciales del Programa de Tratamiento con Metadona (PTM). Criterios de selección: Estar activo laboralmente y tener una experiencia de al menos 3 años. Variables de diversificación muestral en la composición del panel: Rol profesional, ámbito geográfico y tipo de hábitat. Captación: A través de profesionales claves de distintas instituciones. Resultados: En total se identificaron 48 oportunidades de mejoras. Trece oportunidades obtuvieron un nivel de acuerdo alto en la última ronda. Los criterios, según el modelo EFQM, que obtuvieron un mayor consenso para mejorar la atención fueron: Liderazgo, Alianzas y Recursos. Y la dimensión que obtuvo un mayor desacuerdo fue Procesos. Conclusiones: A pesar de su implementación desde 1997 en los CAP en Andalucía, el servicio de dispensación de metadona se encuentra en una fase de despliegue más que de perfeccionamiento

Recomendaciones desde el modelo de la EFQM para la mejora del servicio de dispensación de metadona en atención primaria

Comunicación oral. Versión editor

Comparative analysis of endurance, strength and body composition indicators in professional, under-23 and junior cyclists

Purpose: To compare endurance, strength and body composition indicators between cyclists of three different competition age categories. Methods: Fifty-one male road cyclists classified as either junior (n = 13, age 16.4 ± 0.5 years), under-23 [(U23), n = 24, 19.2 ± 1.3 years] or professional (n = 14, 26.1 ± 4.8 years) were studied. Endurance (assessed through a maximal incremental test and an 8-minute time-trial), strength/power (assessed through incremental loading tests for the squat, lunge and hip thrust exercises) and body composition (assessed through dual energy X-ray absorptiometry) were determined on three different testing sessions. Results: U23 and, particularly professional, cyclists attained significantly (p < 0.05) higher values than juniors for most of the analyzed endurance indicators [time-trial performance, maximum oxygen uptake (VO2max), peak power output (PPO), respiratory compensation point (RCP), and ventilatory threshold (VT)]. Significant differences (p < 0.05) between U23 and professionals were also found for time-trial performance, PPO and VT, but not for other markers such as VO2max or RCP. Professional cyclists also showed significantly (p < 0.05) lower relative fat mass and higher muscle mass levels than U23 and, particularly, juniors. No consistent differences between age categories were found for muscle strength/power indicators. Conclusion: Endurance (particularly time-trial performance, PPO and VT) and body composition (fat and muscle mass) appear as factors that best differentiate between cyclists of different age categories, whereas no consistent differences are found for muscle strength/power. These findings might help in performance prediction and/or talent identification and may aid in guiding coaches in the design of training programs focused on improving those variables that appear more determinant.Instituto de Salud Carlos III (CD21/00138)Spanish Ministry of Economy and Competitiveness and Fondos FEDER (PI18/00139)4.755 JCR (2021) Q1, 20/81 Physiology1.126 SJR (2021) Q1, 42/189 PhysiologyNo data IDR 2021UE

Development of an international standard set of clinical and patient-reported outcomes for children and adults with congenital heart disease: A report from the International Consortium for Health Outcomes Measurement Congenital Heart Disease Working Group

Aims: Congenital heart disease (CHD) is the most common congenital malformation. Despite the worldwide burden to patient wellbeing and health system resource utilization, tracking of long-term outcomes is lacking, limiting the delivery and measurement of high-value care. To begin transitioning to value-based healthcare in CHD, the International Consortium for Health Outcomes Measurement aligned an international collaborative of CHD experts, patient representatives, and other stakeholders to construct a standard set of outcomes and risk-adjustment variables that are meaningful to patients. Methods and results: The primary aim was to identify a minimum standard set of outcomes to be used by health systems worldwide. The methodological process included four key steps: (i) develop a working group representative of all CHD stakeholders; (ii) conduct extensive literature reviews to identify scope, outcomes of interest, tools used to measure outcomes, and case-mix adjustment variables; (iii) create the outcome set using a series of multi-round Delphi processes; and (iv) disseminate set worldwide. The Working Group established a 15-item outcome set, incorporating physical, mental, social, and overall health outcomes accompanied by tools for measurement and case-mix adjustment variables. Patients with any CHD diagnoses of all ages are included. Following an open review process, over 80% of patients and providers surveyed agreed with the set in its final form. Conclusion: This is the first international development of a stakeholder-informed standard set of outcomes for CHD. It can serve as a first step for a lifespan outcomes measurement approach to guide benchmarking and improvement among health systems