Clinical and functional characteristics of patients two years after being affected by the soybean asthma epidemic in Barcelona

Background: Patients affected during the asthma outbreaks caused by soybean dust inhalation in Barcelona presented with sudden onset of severe asthma followed by the rapid relief of symptoms after treatment. Two years after the epidemics ended, a case-control study was conducted in which the clinical, functional, and immunological characteristics of these asthma patients (a randomised sample of asthmatic patients admitted as emergency cases on epidemic days, n = 213) were compared with those of a control group (a random sample of asthmatic patients admitted as emergency cases for attacks of asthma on non-epidemic days, n = 170). METHODS--The study included the administration of the ATS-DLD78 standardised respiratory questionnaire, the measurement of atopy, and performance of spirometric tests and a methacholine inhalation test. Results: Patients with epidemic asthma reported fewer symptoms of asthma, had attended emergency departments less frequently during the previous year for acute attacks of asthma, were taking fewer inhaled corticosteroids at the time of the study, and attended medical follow up less frequently than did the patients with non-epidemic asthma. However, the cases and controls showed no differences in ventilatory capacity or reactivity to the methacholine bronchoprovocation test. Conclusions: Two years after the end of the soybean epidemics, people affected by epidemic asthma had a favourable prognosis. This finding contrasts with a higher risk of life threatening asthma and death during the epidemics. This paradox could be the result of a complex interaction between host and conditions of exposure

Estructura del sistema frontal de cabalgamientos en el Pirineo Oriental: control estratigráfico en la geometría y secuencia de emplazamiento de los cabalgamientos

El manto del Cadí, la unidad estructural más extensa del Pirineo Oriental meridional, involucra cerca de 5 km de sucesión paleógena depositada en una cuenca de antepaís. Esta secuencia constituye un sistema petrolífero que ha sido explorado desde el año 1960 y suprayace discordantemente un basamento Paleozoico involucrado en el apilamiento antiforme que caracteriza el centro de la cordillera. En el antepaís, la sucesión paleógena presenta un espesor menor y está constituida por un conjunto de facies diferente, en general más somera. La interpretación de datos sísmicos reprocesados recientemente y su integración con datos de superficie y de sondeos son la base de un nuevo modelo estructural del área. La presencia de un espesor anómalo de una serie de rocas evaporíticas por debajo del sinclinal de Ripoll (2000m perforados en el sondeo El Serrat-1) ha sido interpretada como asociada a un cambio lateral de facies entre una formación turbidítica (Campdevànol) septentrional, la formación evaporítica de Beuda y una formación carbonática meridional (Perafita) y a su apilamiento en un dúplex

Impacto de la Cintura Hipertrigliceridémica en el Riesgo coronario

Introducción: La cintura hipertrigliceridémica (CHTG) es un indicador metabólico del riesgo coronario asociado a la obesidad visceral. Se determinó la relación entre esta variable y el riesgo coronario en la población en general.Métodos y Resultados: Se estudió un total de 545 pacientes, se determinó el riesgo coronario de forma cuantitativa: 11,50 para varones y 10,46 para mujeres; y en forma cualitativa (categorías de riesgo): 61% riesgo bajo, 10,24% moderado, 12,48% moderadamente elevado, 10,64% riesgo elevado y muy elevado 0,18%. Al comparar los pacientes con riesgo coronario no bajo y los demás pacientes, según la presencia de CHTG (3 definiciones) se obtuvo: según  el  National Cholesterol Education Program  una OR de 1.95 (IC 95%: 1.17-3.24), según la Federación internacional de Diabetes  una OR de 2,08 (IC 95%: 1.427-3.035) y según Gómez una OR de 2,01 (IC 95%: 1.361-2.976); todos con p<0,001. Cuando se aplicó la regresión logística a los componentes de CHTG por separado y el riesgo coronario se obtuvo para la cintura: 0.088 en hombres y - 0.035 en mujeres (p no significativa); para los triglicéridos: -0.074 para varones y  -0.016 para mujeres (p no significativa).  Además se encontró que por cada incremento de un centímetro en la cintura el riesgo se incrementa en 0,11 veces su valor previo.Conclusiones: La CHTG duplica la posibilidad de tener una categoría de riesgo alto en relación a los que no lo tienen, independientemente de su definición. La asociación de cintura y triglicéridos esta significativamente asociada a mayor riesgo coronario a diferencia de su predicción por separado.Sindrome X metabólico; Cintura hipertrigliceridémica; enfermedad coronaria

Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case

Background: Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain). Methods: Prospective cohort study over one year period, 2017-2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data. Results: HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified. Conclusions: We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care. Registration: ClinicalTrials.gov (26/04/2017; NCT03130283). Keywords: Chronic care, Health Delivery Assessment, Health Services Research, Hospital at Home, Implementation Science, Multiple Criteria Decision Analysis, Triple Ai

The Trouble with Ed Schools: A Book Review

American schools of education, whose two primary objectives are to prepare highly qualified teachers and to conduct valid and reliable education research, are often decried as “weak institutions” by many in academia and society in general. American schools of education are very often scorned by scholars and academia as intellectually inferior, referred to by teachers in the field as the “ivory tower” and considered to be out of touch and completely unrelated to what really transpires in schools, perceived by political leaders at all levels to be a primary contributing factor to the substandard state of contemporary public education. These are the observations and assertions of David Labaree, a professor in the school of education at Stanford University, who in The Trouble with Ed Schools employs critical sociological and historical analyses to analyze and examine the factors that have directly contributed to the lowly status of education schools in general, and the contemporary assumptions and perceptions that perpetuate this lowly status. If we as educators (and a society for that matter) are to achieve excellence in education we must be willing to engage in critical self reflection and analysis about the means by which we prepare teachers and engage in educational research and policy making. The Trouble with Ed Schools serves well as an impetus for such reflection and analysis