Evaluación web de la comunicación institucional. Los ayuntamientos de la provincia de Cáceres

El estudio se enmarca en el proyecto nacional de investigación “Comunicación pública, transparencia, rendición de cuentas y participación en los gobiernos locales”, en el que participan universidades de casi toda España. En una primera fase realizó la evaluación de los 5 municipios de la provincia de Cáceres más poblados (de más de 10.000 habitantes), en el período comprendido entre enero y abril de 2015 (antes de las elecciones municipales). En una segunda fase desarrollada entre enero y abril de 2016, se han analizado los municipios de la provincia de Cáceres de más de 7000 habitantes. El objetivo final es el fomento de las buenas prácticas en materia de comunicación e información en las corporaciones municipales, así como la mejora entre los representantes políticos, los técnicos municipales y los periodistas y, por último, facilitar la participación ciudadana en el control de la gestión de los gobiernos

Abordaje integrativo del insomnio en atención primaria: medidas no farmacológicas y fitoterapia frente al tratamiento convencional

ResumenIntroducciónEl insomnio es un trastorno del sueño que imposibilita iniciarlo o mantenerlo. En algún momento de la vida, hasta un 50% de adultos lo padecen ante situaciones estresantes.ObjetivoEvaluar el impacto de medidas higiénicas del sueño, técnicas de relajación y fitoterapia para abordar el insomnio, comparado con medidas habituales (tratamiento farmacológico).MetodologíaEstudio experimental, retrospectivo, sin asignación aleatorizada. Revisión de pacientes diagnosticados de insomnio (2008-2010).Los pacientes de grupo intervención (GI) recibieron abordaje integrativo (medidas higiénicas, técnicas de relajación y fitoterapia), y los del grupo control (GC), tratamiento convencional.Se compararon resultados de uso de recursos (media mensual de visitas pre y posdiagnóstico), tipo de tratamiento farmacológico prescrito y dosis total.Evaluación de la calidad del sueño a los 18-24meses (test de Epworth).ResultadosSe incluyeron 48 pacientes en GI y 47 en GC (70% mujeres, media de edad 46años (DE: 14,3).La media mensual de visitas prediagnóstico fue 0,54(DE: 0,42) en GI y 0,53 (DE: 0,53) en GC (p=0,88). La media posterior fue 0,36 (DE: 0,24) y 0,65(DE: 0,46), respectivamente (p<0,0001), observándose reducción estadísticamente significativa en GI.Recibieron alguna benzodiacepina el 52,5% de los pacientes GI y el 93,6% de los del GC (p<0,0001). En GC se prescribió más alprazolam y lorazepam, con dosis acumuladas superiores.En la evaluación posterior no presentaban insomnio el 17% de los pacientes del GI y el 5% del GC. Presentaban insomnio severo el 13% de los pacientes del GC y ninguno del GI (p<0,0001).ConclusionesEl abordaje integrativo del insomnio puede ser resolutivo, disminuyendo las visitas y los efectos secundarios y la dependencia a benzodiacepinas.AbstractIntroductionInsomnia is a sleep disorder in which there is an inability to fall asleep or to stay asleep. At some point in life, 50% of adults suffer from it, usually in stress situations.AimTo evaluate the impact of sleep hygiene measures, relaxations techniques, and herbal medicine to deal with insomnia, compared with standard measures (drug treatment).MethodologyAn experimental, retrospective, non-randomized study was conducted by means of a review of patients diagnosed with insomnia (2008-2010).Patients in the intervention group (IG) received an integrative approach (hygiene measures, relaxation techniques, and herbal medicine) and a control group (CG) with conventional treatment.A comparison was made of the resources used in the two groups (average monthly visits pre- and post-diagnosis), type of prescribed drug therapy and total dose.Sleep quality was evaluated at 18-24months (Epworth test).ResultsA total of 48 patients were included in the IG and 47 in the CG (70% women, mean age 46years (SD: 14.3).Average monthly visit pre-diagnosis was 0.54 (SD: 0.42) in the IG and 0.53 (SD: 0.53) in the CG (P=.88). Post-diagnosis it was 0.36 (SD: 0.24) and 0.65 (SD: 0.46), respectively (P<.0001), with a statistically significant reduction being observed in the IG.More than half (52.5%) of the IG patients and 93.6% in the CG had received a benzodiazepine (P<.0001). Alprazolam and lorazepam were the most prescribed in the CG and with higher cumulative dose.In the subsequent evaluation, 17% of patients in the IG and 5% in CG did not have insomnia. Severe insomnia was present in 13% of patients in the IG and none in CG (P<.0001).ConclusionsThe integrative approach to insomnia may be worthwhile as it reduces resource use and side effects, as well as dependence to benzodiazepines

Massless Metric Preheating

Can super-Hubble metric perturbations be amplified exponentially during preheating ? Yes. An analytical existence proof is provided by exploiting the conformal properties of massless inflationary models. The traditional conserved quantity \zeta is non-conserved in many regions of parameter space. We include backreaction through the homogeneous parts of the inflaton and preheating fields and discuss the role of initial conditions on the post-preheating power-spectrum. Maximum field variances are strongly underestimated if metric perturbations are ignored. We illustrate this in the case of strong self-interaction of the decay products. Without metric perturbations, preheating in this case is very inefficient. However, metric perturbations increase the maximum field variances and give alternative channels for the resonance to proceed. This implies that metric perturbations can have a large impact on calculations of relic abundances of particles produced during preheating.Comment: 8 pages, 4 colour figures. Version to appear in Phys. Rev. D. Contains substantial new analysis of the ranges of parameter space for which large changes to the inflation-produced power spectrum are expecte

Chronic Exposure to Arsenic and Markers of Cardiometabolic Risk: A Cross-Sectional Study in Chihuahua, Mexico

BackgroundExposure to arsenic (As) concentrations in drinking water > 150 μg/L has been associated with risk of diabetes and cardiovascular disease, but little is known about the effects of lower exposures.ObjectiveThis study aimed to examine whether moderate As exposure, or indicators of individual As metabolism at these levels of exposure, are associated with cardiometabolic risk.MethodsWe analyzed cross-sectional associations between arsenic exposure and multiple markers of cardiometabolic risk using drinking-water As measurements and urinary As species data obtained from 1,160 adults in Chihuahua, Mexico, who were recruited in 2008–2013. Fasting blood glucose and lipid levels, the results of an oral glucose tolerance test, and blood pressure were used to characterize cardiometabolic risk. Multivariable logistic, multinomial, and linear regression were used to assess associations between cardiometabolic outcomes and water As or the sum of inorganic and methylated As species in urine.ResultsAfter multivariable adjustment, concentrations in the second quartile of water As (25.5 to < 47.9 μg/L) and concentrations of total speciated urinary As (< 55.8 μg/L) below the median were significantly associated with elevated triglycerides, high total cholesterol, and diabetes. However, moderate water and urinary As levels were also positively associated with HDL cholesterol. Associations between arsenic exposure and both dysglycemia and triglyceridemia were higher among individuals with higher proportions of dimethylarsenic in urine.ConclusionsModerate exposure to As may increase cardiometabolic risk, particularly in individuals with high proportions of urinary dimethylarsenic. In this cohort, As exposure was associated with several markers of increased cardiometabolic risk (diabetes, triglyceridemia, and cholesterolemia), but exposure was also associated with higher rather than lower HDL cholesterol.CitationMendez MA, González-Horta C, Sánchez-Ramírez B, Ballinas-Casarrubias L, Hernández Cerón R, Viniegra Morales D, Baeza Terrazas FA, Ishida MC, Gutiérrez-Torres DS, Saunders RJ, Drobná Z, Fry RC, Buse JB, Loomis D, García-Vargas GG, Del Razo LM, Stýblo M. 2016. Chronic exposure to arsenic and markers of cardiometabolic risk: a cross-sectional study in Chihuahua, Mexico. Environ Health Perspect 124:104–111; http://dx.doi.org/10.1289/ehp.140874

Association Between Variants in Arsenic (+3 Oxidation State) Methyltranserase ( AS3MT ) and Urinary Metabolites of Inorganic Arsenic: Role of Exposure Level

Variants in AS3MT, the gene encoding arsenic (+3 oxidation state) methyltranserase, have been shown to influence patterns of inorganic arsenic (iAs) metabolism. Several studies have suggested that capacity to metabolize iAs may vary depending on levels of iAs exposure. However, it is not known whether the influence of variants in AS3MT on iAs metabolism also vary by level of exposure. We investigated, in a population of Mexican adults exposed to drinking water As, whether associations between 7 candidate variants in AS3MT and urinary iAs metabolites were consistent with prior studies, and whether these associations varied depending on the level of exposure. Overall, associations between urinary iAs metabolites and AS3MT variants were consistent with the literature. Referent genotypes, defined as the genotype previously associated with a higher percentage of urinary dimethylated As (DMAs%), were associated with significant increases in the DMAs% and ratio of DMAs to monomethylated As (MAs), and significant reductions in MAs% and iAs%. For 3 variants, associations between genotypes and iAs metabolism were significantly stronger among subjects exposed to water As >50 versus ≤50 ppb (water As X genotype interaction P < .05). In contrast, for 1 variant (rs17881215), associations were significantly stronger at exposures ≤50 ppb. Results suggest that iAs exposure may influence the extent to which several AS3MT variants affect iAs metabolism. The variants most strongly associated with iAs metabolism—and perhaps with susceptibility to iAs-associated disease—may vary in settings with exposure level