Efectos de un programa de ejercicio físico supervisado sobre la estructura cardíaca durante la gestación. Ensayo clínico aleatorizado

Objetivo: Analizar la seguridad del ejercicio aeróbico para el sistema cardiovascular de las mujeres gestantes y valorar las posibles mejoras cardiovasculares producidas. Sujetos y métodos: Se diseñó un ensayo clínico aleatorizado, no apareado, no enmascarado. El registro de datos se realizó en las semanas 20 y 34 de gestación. En la semana 20, se estudió a 45 gestantes del grupo de ejercicio (GE), de las cuales completaron el estudio 35. Del grupo de control (GC), en la semana 20 participaron 14, y completaron el estudio 9. Resultados: En la semana 20 hubo mejoras en el índice de masa corporal (GE: 25,1 4,3/GC: 27,9 4,5) (p = 0,04) y en la presión arterial sistólica (GE: 104,7 10,9/GC: 112,5 11,3) (p = 0,02). En el GC hubo presencia de hipertrofia concéntrica (n = 2, 14,3%). En la semana 34, el GE presentó un mayor volumen sistólico (GE: 52,33 10,42/GC: 43,69 9,48) (p = 0,03). Conclusión: El ejercicio aeróbico durante el embarazo es seguro para el sistema cardiovascular, mejorando incluso algunos parámetros

Exercise reduces prenatal depression in overweight and obese pregnant women: a randomised controlled trial

Estudio sobre el efecto del ejercicio en la depresión prenatal en mujeres obesas

Fetal and maternal heart rate responses to exercise in pregnant women. A randomized Controlled Trial

Fetal and maternal heart rate responses to exercise in pregnant women. A randomized Controlled Tria

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

The German savings puzzle

Der Beitrag untersucht das Sparen in Deutschland. Deutschland hat eines der grosszuegigsten oeffentlichen Renten- und Krankenversicherungssysteme weltweit und bis ins Alter hinein wird privat viel gespart. Die Ersparnis bleibt auch fuer aeltere Menschen positiv, selbst fuer die meisten Haushalte mit niedrigem Einkommen. Es stellt sich nun die Frage, wie das zu erklaeren ist, was die Autoren das 'deutsche Sparpuzzle' nennen. Die Autoren liefern hierzu eine komplexe Antwort, die historische Fakten mit unvollkommenen Kapitalmaerkten, Wohnungswesen, Steuer- und Rentenpolitik kombiniert. Der erste Teil des Aufsatzes beschreibt, wie deutsche Haushalte sparen, und basiert auf einem synthetischen Panel von vier Querschnitten der Einkommens- und Verbrauchsstichproben, die zwischen 1978 und 1993 gesammelt wurden. Der zweite Teil verbindet Sparverhalten mit oeffentlicher Politik, vor allem mit der Steuer- und Rentenpolitik. (ICDUebers)'Germany has one of the most generous public pension and health insurance systems of the world, yet private savings are high until old age. Savings remain positive in old age, even for most low income households. How can we explain what we might want to term the 'German savings puzzle'? We provide a complicated answer that combines historical facts with capital market imperfections, housing, tax and pension policies. The first part of the paper describes how German households save, based on a synthetic panel of four cross sections of the German Income and Expenditure Survey ('Einkommens- und Verbrauchsstichproben') collected between 1978 and 1993. The second part links saving behaviour with public policy, notably tax and pension policy.' (author's abstract)German title: Das deutsche SparpuzzleAvailable from <a href=http://www.vwl.uni-mannheim.de/institut/papers/594.pdf target=NewWindow>http://www.vwl.uni-mannheim.de/institut/papers/594.pdf</a> / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman