25 años de ciencia

Al celebrarse el vigésimo quinto aniversario de la Universidad MiguelHernández (UMH) de Elche, quiero reiterar la importancia que la investigacióntiene en nuestra universidad constituyendo uno de los elementos claves de surazón de ser lo que ha permitido impulsar una cultura científica y generar elconocimiento necesario para mejorar la calidad de vida de las personas. La universidad pública constituye en España el corazón de la ciencia pues desarrolla en torno al 70% de la investigación que se hace en nuestro país. En este contexto, quiero resaltar la importancia que tiene la inversión pública tanto para seguir ejerciendo la función de motor del conocimiento como para poder retener el talento de los investigadores que formamos en nuestra universidad pública

Bayesian Networks for the Diagnosis and Prognosis of Diseases: A Scoping Review

Bayesian networks (BNs) are probabilistic graphical models that leverage Bayes’ theorem to portray dependencies and cause-and-effect relationships between variables. These networks have gained prominence in the field of health sciences, particularly in diagnostic processes, by allowing the integration of medical knowledge into models and addressing uncertainty in a probabilistic manner. Objectives: This review aims to provide an exhaustive overview of the current state of Bayesian networks in disease diagnosis and prognosis. Additionally, it seeks to introduce readers to the fundamental methodology of BNs, emphasising their versatility and applicability across varied medical domains. Employing a meticulous search strategy with MeSH descriptors in diverse scientific databases, we identified 190 relevant references. These were subjected to a rigorous analysis, resulting in the retention of 60 papers for in-depth review. The robustness of our approach minimised the risk of selection bias. Results: The selected studies encompass a wide range of medical areas, providing insights into the statistical methodology, implementation feasibility, and predictive accuracy of BNs, as evidenced by an average area under the curve (AUC) exceeding 75%. The comprehensive analysis underscores the adaptability and efficacy of Bayesian networks in diverse clinical scenarios. The majority of the examined studies demonstrate the potential of BNs as reliable adjuncts to clinical decision-making. The findings of this review affirm the role of Bayesian networks as accessible and versatile artificial intelligence tools in healthcare. They offer a viable solution to address complex medical challenges, facilitating timely and informed decision-making under conditions of uncertainty. The extensive exploration of Bayesian networks presented in this review highlights their significance and growing impact in the realm of disease diagnosis and prognosis. It underscores the need for further research and development to optimise their capabilities and broaden their applicability in addressing diverse and intricate healthcare challenges

Informed consent in the health field: law 41/2002, of november 14 and law 10/2014, of december 29, on the health of the valencian community

La evolución de la relación médico-paciente dio lugar al reconocimiento del consentimiento informado. Este derecho, atribuido a todos los pacientes, implica que, para llevar a cabo cualquier intervención sanitaria es preciso contar con su autorización previa. De esta forma, los profesionales vienen obligados a prestar una adecuada información a los usuarios con la finalidad de que estos últimos puedan formar una decisión libre, voluntaria y consciente. En España, la regulación principal y básica de este derecho la encontramos en la Ley 41/2002, de 14 de noviembre, pero como quiera que el territorio está dividido en comunidades autónomas a las que se atribuye competencias, es preciso atender a las normativas sectoriales. En nuestro caso, cobra especial relevancia la Ley 10/2014, de 29 de diciembre, de Salud de la Comunitat ValencianaThe evolution of the doctor-patient relationship led to the recognition of informed consent. This right, attributed to all patients, implies that they must have their prior authorisation to carry out any health intervention. In this way, professionals must provide adequate information to users so that the latter can form a free, voluntary, and conscious decision. This right’s primary and essential regulation in Spain is found in Law 41/2002 of November 14. Still, since the territory is divided into autonomous communities to which competencies are attributed, it is necessary to attend to sectoral regulations. Law 10/2014, of December 29, on the Health of the Valencian Community, is especially relevant in our case

Clinical benefit of the FIFA 11 programme for the prevention of hamstring and lateral ankle ligament injuries among amateur soccer players

Objective To analyse the relationship between the implementation of ‘the 11’ protocol during the regular season in a men’s amateur soccer team and the rate of hamstring and lateral ankle ligament (LAL) injuries, and to estimate the clinical benefit of the programme according to the type of injury and the position field. Methods This cohort study was conducted in two different men’s amateur soccer teams. During two seasons, the exposed group (43 players) performed ‘the 11’ protocol twice a week, and the unexposed group (43 players) performed the regular training programme. All players trained three times per week for 1.5 hours per day. Data collection was performed for every 1000 hours of play. Results 18 hamstring injuries (injury rate (IR) of 2.26 injuries/1000 training+competition hours) and 15 LAL injuries (IR of 1.88 injuries/1000) were registered in the exposed group. In the unexposed group, there were 25 LAL injuries (IR of 3.14 injuries/1000) and 35 hamstring injuries (IR of 4.39 injuries/1000). The number needed to treat to prevent one new case was 3.9 in LAL injuries, 3.31 in biceps femoris injuries and 10.7 in recurrent hamstring injuries. Conclusions ‘The 11’ programme reduced the incidence of hamstring and LAL injuries in amateur players. According to the field position, the programme was effective for defenders and midfielders. In accordance with the type of injury, the exposed group had a lower risk of LAL, biceps femoris and hamstring injuries compared with those in the unexposed group

Initiation of ovarian stimulation independent of the menstrual cycle (random-start) in an oocyte donation programme a large, single-center experience

Research Question Do live birth rates differ between recipients matched with donors using conventional ovarian stimulation versus those using random-start protocols? Design Retrospective analysis of 891 ovarian stimulations in egg donors (January-December 2018) and clinical outcomes in matched recipients (n=935). Donors commenced ovarian stimulation on day 1/3 of the menstrual cycle (n=223) or in the mid/late-follicular (n=388) or luteal phase (n=280) under a conventional antagonist protocol. Live birth rate of matched recipients was the main outcome. Results Duration of stimulation and total gonadotropins dose were comparable between conventional versus random-start groups. The number of collected eggs were also similar: 17.6±8.8 vs 17.2±8.5, p=0.6, respectively. Sub-group analysis showed an increased stimulation length (10.2±1.8 vs 9.8±1.7 vs 10.4±1.7, p<0.001) and gonadotropin consumption (2041.5±645.3 vs 2003.2±647.3 vs 2158.2±685.7 IU, p=0.01) in the luteal phase group vs the mid/late follicular and conventional groups; respectively. In matched recipients receiving fresh oocytes and undergoing fresh embryo transfer, the biochemical pregnancy (63.8% and 63.3%; p=0.9), clinical pregnancy (54.6% and 56.1%; p=0.8) and live birth rates (47.7% and 46.6%; p=0.7) per embryo-transfer were similar between conventional versus random groups. Similar results were obtained in recipients receiving vitrified eggs. Euploidy rate was also comparable. Conclusions There were no notable variations in clinical outcomes using oocytes obtained from random-start protocols and those proceeding from conventional ovarian stimulation in oocyte donation treatments. However, luteal-phase stimulation seems to require longer stimulation and higher FSH consumption. Our results indicate that random-start stimulation strategy does not impair the potential of the oocyte yield or clinical outcomes in oocyte donation cycles

Effects of Watching Cartoons During an Echocardiography on Infants and Preschool Children. A Prospective Randomized Study

Echocardiography is currently the main diagnostic technique in pediatric cardiology, but sometimes it is difficult to use in very young children, as a complete and accurate study depends on the patient’s and family’s cooperation. Children’s behavior is one of the main problems for this procedure, and interventions like sedative medication have been used to facilitate its performance. The aim of this study was to analyze the effects of TV entertainment in infants and preschool children during echocardiography. We designed an experimental study in children with a heart murmur. An examination room was prepared with a TV on the ceiling, giving the children an unobstructed view during the echocardiography procedure. Fifty-eight patients were randomized into two groups: TV intervention vs. usual care (consisting of other distraction measures). The primary outcome was echocardiography time, but we also assessed blood pressure, quality of technique, child behavior, and parents’ stress level. The TV group showed a statistically significant reduction in duration of the echocardiography and systolic and diastolic blood pressure, as well as better quality of technique and child behavior. Consequently, we recommend the use of a TV as a simple and useful distraction method for improving echocardiography in young children

Tendencias de mortalidad prematura por cardiopatía isquémica en España durante el periodo 1998-2018

Introduction and objectives: Ischemic heart disease (IHD) is the leading cause of death and one of the leading causes of disability. The aim of this study was to analyze trends in premature mortality due to IHD in patients younger than 75 years in Spain from 1998 to 2018 by region. Methods: Observational study of temporal trends in premature mortality due to IHD in Spain by region and sex from 1998 to 2018. The study population included resident citizens aged between 0 and 74 years. The data sources were the continuous population register and the mortality registry of the National Institute of Statistics. We calculated age-adjusted mortality rates and their average annual percent change estimated by Poisson models. Results: During the study period, mortality rates due to IHD decreased, both in the country as a whole and by provinces (53% in men and 61% in women), with an average annual percent change of -3.92% and -5.07%, respectively. In the first year (1998), mortality was unequally distributed among provinces, with higher mortality in the south of Spain. Conclusions: Premature mortality due to IHD significantly decreased in Spain during the study period in both sexes to roughly half of initial cases. This decrease was statistically significant in almost all regions. Interprovincial differences in mortality and their variation also decreased in recent years.Introducción y objetivos: La cardiopatía isquémica (CI) es la primera causa de mortalidad y una de las principales causas de discapacidad. El objetivo de este estudio es analizar las tendencias de la mortalidad prematura de menores de 75 años por CI en España en el periodo 1998-2018, diferenciando por provincias. Me´todos: Estudio observacional de tendencias temporales de la mortalidad prematura por CI en Espan˜ a, provincial y por sexo en 1998-2018. La población abarca a los ciudadanos residentes con edades entre 0 y 74 años. Las fuentes de datos son el padrón continuo poblacional y el registro de defunciones del Instituto Nacional de Estadística. Se calcularon tasas de mortalidad ajustadas por edad y sus porcentajes de cambio medio anual estimados por modelos de Poisson. Resultados: Se observo´ en el periodo de estudio un descenso generalizado de las tasas de mortalidad por CI, tanto en España como por provincias, del 53% en varones y el 61% en mujeres, y con un porcentaje de cambio medio anual de –3,92 y –5,07 respectivamente. El primer año (1998) se observo´ una distribución de la mortalidad desigual entre provincias, mayor en el sur peninsular. Conclusiones: Se constato´ un importante descenso de la mortalidad prematura por CI en España durante el periodo de estudio y en ambos sexos, hasta la mitad de los casos iniciales. Este descenso fue estadísticamente significativo en prácticamente todas las provincias. Las diferencias interprovinciales de mortalidad y sus variaciones se están amortiguando en los años más recientes

Hyperuricemia as a prognostic factor after acute coronary syndrome

Background and aims: Many studies have reported the independent association between uric acid and cardiovascular disease, its role as a risk predictor for outcomes in people with acute coronary syndrome remains controversial. This study aims to assess the association between hyperuricemia and medium/ long-term clinical outcomes in people with acute coronary syndrome and determine whether adding hyperuricemia to the GRACE score improves its predictive capability. Methods: This cohort study included patients admitted for acute coronary syndrome between 2008 and 2013. Outcomes were cardiovascular and total mortality, and major cardiovascular events. We used a multivariate model to adjust for potential confounding covariates and presented event rates with Kaplan-Meier curves. After adding hyperuricemia to the GRACE score, we compared scores from the reclassification table and the net reclassification improvement. Results: 1119 participants were included and followed-up for a mean of 36 months. Multivariate models showed hyperuricemia was independently associated with higher cardiovascular mortality (HR:1.91; 95% CI:1.32e2.76; p < 0.01), higher all-cause mortality (HR:1.59; 95% CI:1.18e2.15; p < 0.01) and higher major cardiovascular event rates (HR:1.36; 95% CI:1.11e1.67; p < 0.01). The hyperuricemia addition to GRACE score led to reclassifying 26% of the participants, and net reclassification improvement was 34%. However, the area under the curve increase was 0.009 and not statistically significant (p > 0.05). Conclusions: Hyperuricemia is associated with higher medium/long-term mortality and major cardiovascular event rates in patients following acute coronary syndrome. The addition of hyperuricemia to the GRACE score seems to improve risk classification but the discrimination of the new predictive model did not change. Hyperuricemic patients had higher all-cause mortality in medium and high-risk score categories

OPENCRONIC Study. Knowledge and experiences of Spanish patients and carers about chronic disease

Background: Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods: Through a telephone or online survey of 24 questions, data was gathered on the characteristics of the respondents and their knowledge and experiences of chronic diseases. Results: Of the 2522 survey respondents, 325 had a chronic disease and were carers, 1088 had a chronic disease and were not carers, 140 did not have a chronic disease but were carers, and 969 did not have chronic disease and were not carers. The degree of knowledge on these diseases was good or very good for 69.4%, 56.0%, 62.2%, and 46.7%, respectively, for each group. All the groups agreed that chronic diseases mainly affect mood, quality of life and having to make sacrifices. Conclusions: Knowledge about chronic diseases is relatively good, although it can be improved among the Spanish population, especially among patients who report having a chronic disease and play the role of carers. However, it is important to continue maintaining the level of information and training concerning these diseases.Boehringer Ingelheim España, S.