Perfil de los pacientes atendidos en los recursos ambulatorios por consumo de cannabis

El cannabis es la droga ilegal más consumida en todo el mundo, lo que constituye un importante problema de Salud Pública. Aunque el número de consumidores de cannabis en tratamiento se ha incrementado en los últimos años, continúa siendo bastante inferior al número de consumidores problemáticos. El objetivo de este trabajo es describir el perfil sociodemográfico y de consumo de los pacientes admitidos a tratamiento ambulatorio por dependencia de cannabis en Castilla y León y valorar las diferencias entre los años 2008 y 2015. Se han comparado los datos de los años 2008 y 2015 utilizando el indicador “Admisiones a tratamiento ambulatorio por consumo de sustancias psicoactivas” del Plan Nacional sobre Drogas. Las variables cuantitativas continuas se han comparado a través de la prueba T de Student y las categóricas mediante la comparación de proporciones con el test Chi-cuadrado de Pearson. El perfil del paciente ambulatorio en el año 2015 es el de un varón de 27,5 años, desempleado, con estudios primarios completados y que reside en casa, piso o apartamento. La edad de inicio de consumo se sitúa en 15,3 años y la del consumo problemático en los 18,2 años, mientras que el número medio de años de consumo hasta la demanda de tratamiento es de 12,3. La vía principal de consumo es fumada o inhalada y en un bajo porcentaje de casos se acompaña de consumo de alcohol o cocaína en el último mes. Estos pacientes acuden a tratamiento por iniciativa propia o son referidos desde los servicios legales policiales. Las características sociodemográficas y de consumo obtenidas son similares a los datos nacionales. El aumento de los casos de tratamiento por cannabis puede estar determinado por un mayor impacto del consumo sobre los individuos y por un mayor número de casos que están realizando cumplimientos alternativos de condenas o sanciones; sin embargo, la reducción en la demanda de tratamiento por iniciativa propia refleja la falta de conciencia de enfermedad en relación con el consumo de cannabisGrado en Medicin

Numerical simulation of the deadliest flood event of Portugal: Unravelling the causes of the disaster

The flood event of November 25 and 26, 1967 corresponds to the deadliest storm affecting Portugal in recent centuries being responsible for >500 fatalities. The main trigger was the heavy rain that fell in just a few hours, provoking a rapid increase in river flows, although other concurrent circumstances had to occur to reach the dramatic water levels estimated in some affected places. However, even today, several important uncertainties related to water levels achieved and timing of floods remain. Here we aim to clarify some of the pending issues by applying suitable high performance numerical tools to elucidate the main conditioning factors that played a key role in the intensification of this dramatic flood. In particular, the analysis has been focused on Quintas village, the location most affected, where >100 fatalities were recorded, close to 2/3 of its total population at the time. The main conclusion provided by the numerical simulations was that a plugging of water flow downstream of Quintas village, favoured by a poor terrain maintenance coupled with the bottleneck created by topographic features, caused the critical over-elevation of water levels. Simulations also corroborate the rapid increase in water levels in Quintas village, with an estimated rise of >2 m in just two hours, as well as the occurrence of the flood during the night, preventing many people to be aware of the extreme danger they were facing and safeguarding themselves.Universidade de Vigo/CISU

How to mitigate flood events similar to the 1979 catastrophic floods in the lower Tagus

[Abstract:] The floods that struck the lower Tagus valley in February 1979 correspond to the most intense floods in this river and affected the largest number of people in a river flow event in Portugal during the last 150 years. In fact, the vast area affected significantly impacted circa 10 000 people in the lower Tagus sector (and an additional 7000 in other regions of Portugal), including thousands of people evacuated or made homeless. In this context, the present study focuses on an in-depth analysis of this event from a hydrodynamic perspective by means of the Iber+ numerical model and on developing strategies to mitigate the flood episodes that occur in the lower section of the Tagus River using the exceptional floods of February 1979 as a benchmark. In this sense, dam operating strategies were developed and analyzed for the most important dam along the Tagus River basin in order to propose effective procedures to take advantage of these infrastructures to minimize the effect of floods. Overall, the numerical results indicate a good agreement with watermarks and some descriptions of the 1979 flood event, which demonstrates the model capability to evaluate floods in the area under study. Regarding flood mitigation, results obtained indicate that the frequency of floods can be reduced with the proposed strategies, which were focused on providing optimal dam operating rules to mitigate flooding in the lower Tagus valley. In addition, hydraulic simulations corroborated an important decrease in water depth and velocity for the most extreme flood events, and also a certain reduction in the flood extension was detected. This confirms the effectiveness of the proposed strategies to help in reducing the flood impact in the lower Tagus valley through the efficient functioning of dams.This research has been partially supported by Xunta de Galicia, Consellería de Cultura, Educación e Universidade, under project ED431C 2021/44 “Programa de Consolidación e Estructuración de Unidades de Investigación Competitivas”. This research has also been partially supported by the European Regional Development Fund under the Interreg POCTEP project RISC_PLUS (code: 0031_RISC_PLUS_6_E). This research has also been partially funded by the Portuguese Fundação para a Ciência e a Tecnologia (FCT) I.P./MCTES through national funds (PIDDAC) – UIDB/50019/2020 (https://doi.org/10.54499/UIDB/50019/2020), UIDP/50019/2020 (https://doi.org/10.54499/UIDP/50019/2020) and LA/P/0068/2020 (https://doi.org/10.54499/LA/P/0068/2020). Diego Fernández-Nóvoa was supported by Xunta de Galicia through a post-doctoral grant (ED481B-2021-108). Alexandre M. Ramos was supported by the Helmholtz “Changing Earth – Sustaining our Future” program. Cristina Catita was supported by EEA Financial Mechanism 2014–2021 and the Portuguese Environment Agency through Pre-defined Project 2 National Roadmap for Adaptation XXI (PDP-2). Orlando García-Feal was funded by the Spanish Ministerio de Universidades and European Union – NextGenerationEU – through a Margarita Salas post-doctoral grant. Ricardo M. Trigo was supported by the Portuguese Fundação para a Ciência e a Tecnologia (FCT) I.P./MCTES, through project AMOTHEC – DRI/India/0098/2020 (https://doi.org/10.54499/DRI/India/0098/2020).Xunta de Galicia; ED431C 2021/44Xunta de Galicia; ED481B-2021-108European Regional Development Fund (ERDF); 0031_RISC_PLUS_6_EPortugal. Fundação para a Ciência e a Tecnologia (FCT); UIDB/50019/2020Portugal. Fundação para a Ciência e a Tecnologia (FCT); UIDP/50019/2020Portugal. Fundação para a Ciência e a Tecnologia (FCT); LA/P/0068/2020Portugal. Fundação para a Ciência e a Tecnologia (FCT); DRI/India/0098/202

Wind speed description and power density in northern Spain

Wind resources are increasingly being investigated as a clean alternative for generating energy. This paper analyses the daily wind speed recorded at 46 automatic weather stations located in Navarre, northern Spain, in 2005e2015. Key points are the surface density of stations and the range of time that ensure a faithful depiction of wind speed together with surface calculations from image analysis and correlation with height. Different statistics were used. Median wind speed at 10 m was low, about 3.3 m s 1 and its interquartile range was narrow, about 2.3 m s 1. Nearly half the surface shows a median wind speed above 3.0 m s 1. The method of moments was employed to calculate the parameters of the Weibull distribution. Around half of the surface presented a shape parameter above 2.25 and the scale parameter was above 4 m s 1 for nearly 41% of the region. Although wind resources are not suitable for wind turbine applications in most of the region, since the wind speed is low in low-lying areas, about 12% of the region is suitable for stand-alone applications and, moreover, a substantial part of the region, around 23%, presents satisfactory wind resources for the installation of wind turbines.Ministry of Economy and Competitiveness and ERDF funds (project numbers CGL2009-11979 and CGL2014-53948-P

Guía gallega de manejo de la trombosis asociada a cáncer. II edición

Esta guía práctica y sencilla, guiará en el diagnóstico y tratamiento de los pacientes con trombosis y cáncer. Pretende reducir la variabilidad en el manejo en la Comunidad Autónoma de Galicia y reducir el impacto negativo que la trombosis presenta en los pacientes con cáncer.This practical and simple guide will guide in the diagnosis and treatment of patients with thrombosis and cancer. It aims to reduce variability in management in the Autonomous Community of Galicia and reduce the negative impact that thrombosis has on cancer patients.Esta guía práctica e sinxela, guiará no diagnóstico e tratamento dos pacientes con trombose e cancro. Pretende reducir a variabilidade no manexo na Comunidade Autónoma de Galicia, e reducir o impacto negativo que a trombose presenta nos pacientes con cancro.Con el Aval de la Sociedad Oncológica de Galicia (SOG) y la Sociedade Galega de Medicina Interna (SOGAMI). Publicado en Barcelona por Bubblegum Communication Services el 25 de ocutubre de 2019. ISBN: 978-84-09-1419-4LEO Pharm

Conserving Ecosystem Diversity in the Tropical Andes

Documenting temporal trends in the extent of ecosystems is essential to monitoring their status but combining this information with the degree of protection helps us assess the effectiveness of societal actions for conserving ecosystem diversity and related ecosystem services. We demonstrated indicators in the Tropical Andes using both potential (pre-industrial) and recent (~2010) distribution maps of terrestrial ecosystem types. We measured long-term ecosystem loss, representation of ecosystem types within the current protected areas, quantifying the additional representation offered by protecting Key Biodiversity Areas. Six (4.8%) ecosystem types (i.e., measured as 126 distinct vegetation macrogroups) have lost >50% in extent across four Andean countries since pre-industrial times. For ecosystem type representation within protected areas, regarding the pre-industrial extent of each type, a total of 32 types (25%) had higher representation (>30%) than the post-2020 Convention on Biological Diversity (CBD) draft target in existing protected areas. Just 5 of 95 types (5.2%) within the montane Tropical Andes hotspot are currently represented with >30% within the protected areas. Thirty-nine types (31%) within these countries could cross the 30% CBD 2030 target with the addition of Key Biodiversity Areas. This indicator is based on the Essential Biodiversity Variables (EBV) and responds directly to the needs expressed by the users of these countries

Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry

Objectives. This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE. Methods. RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity. Results. Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)]. Conclusion. Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Enfermedades crónicas

Adherencia al tratamiento farmacológico y relación con el control metabólico en pacientes con DM2Aluminio en pacientes con terapia de reemplazo renal crónico con hemodiálisis en Bogotá, ColombiaAmputación de extremidades inferiores: ¿están aumentando las tasas?Consumo de edulcorantes artificiales en jóvenes universitariosCómo crecen niños normales de 2 años que son sobrepeso a los 7 añosDiagnóstico con enfoque territorial de salud cardiovascular en la Región MetropolitanaEfecto a corto plazo de una intervención con ejercicio físico, en niños con sobrepesoEfectos de la cirugía bariátrica en pacientes con síndrome metabólico e IMC < 35 KG/M2Encuesta mundial de tabaquismo en estudiantes de profesiones de saludEnfermedades crónicas no transmisibles: Consecuencias sociales-sanitarias de comunidades rurales en ChileEpidemiología de las muertes hospitalarias por patologías relacionadas a muerte encefálica, Chile 2003-2007Estado nutricional y conductas alimentarias en adolescentes de 4º medio de la Región de CoquimboEstudio de calidad de vida en una muestra del plan piloto para hepatitis CEvaluación del proceso asistencial y de resultados de salud del GES de diabetes mellitus 2Factores de riesgo cardiovascular en población universitaria de la Facsal, universidad de TarapacáImplicancias psicosociales en la génesis, evolución y tratamiento de pacientes con hipertensión arterial esencialInfarto agudo al miocardio (IAM): Realidad en el Hospital de Puerto Natales, 2009-2010Introducción de nuevas TIC y mejoría de la asistencia a un programa de saludNiños obesos atendidos en el Cesfam de Puerto Natales y su entorno familiarPerfil de la mortalidad por cáncer de cuello uterino en Río de JaneiroPerfil del paciente primo-consultante del Programa de Salud Cardiovascular, Consultorio Cordillera Andina, Los AndesPrevalencia de automedicación en mujeres beneficiarias del Hospital Comunitario de Til-TiPrevalencia de caries en población preescolar y su relación con malnutrición por excesoPrevalencia de retinopatía diabética en comunas dependientes del Servicio de Salud Metropolitano Occidente (SSMOC)Problemas de adherencia farmacológica antihipertensiva en población mapuche: Un estudio cualitativoRol biológico de los antioxidantes innatos en pacientes portadores de VIH/SidaSobrepeso en empleados de un restaurante de una universidad pública del estado de São Paul

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years