Ataxia por déficit de vitamina E en una familia con posible afectación cardíaca / Vitamin E deficiency ataxia in a family with possible cardiac involvement

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BDNF levels and nigrostriatal degeneration in "drug naïve" Parkinson's disease patients. An "in vivo" study using I-123-FP-CIT SPECT.

INTRODUCTION: Parkinson's Disease (PD) is a common neurodegenerative disorder, characterized by a progressive loss of dopaminergic neurons and whose cause remains unclear. Brain-Derived Neurotrophic factor (BDNF) is a protein involved in dopaminergic cells survival. Previous studies have shown decreased serum BDNF levels in PD patients. AIM AND OBJECTIVES: The aim of the study was to evaluate serum BDNF levels in a group of recently diagnosed non-medicated PD patients and its relationship with the nigrostriatal system degeneration using I-123-FP-CIT. METHODS: 30 recently diagnosed, unmedicated PD patients were included in this study. Serum BDNF levels were measured twice using a sandwich enzyme linked immunoabsorbent assay and compared with levels of 27 unrelated Caucasian healthy adults. A I-123-FP-CIT SPECT was performed in all PD Patients in order to assess the association between serum BDNF levels and I-123-FP CIT uptake in several brain areas using a volumetric semi-automatic method. RESULTS: PD patients showed lower serum BDNF levels (Median = 49.61, IQ range: 43.55 to 61.82) than the controls (Median = 68.82, IQ range: 51.87 to 88.14) (U = 211.00, z = -3.10, p = 0.002). BDNF levels in PD patients correlated with both caudate (Spearman r = 0.58, p = 0.001 for ispilateral and r 0.55, p = 0.002 for contralateral) and putamen (Spearman r = 0.68, p < 0.001 for ipsilateral and r = 0.80, p < 0.001 for contralateral) I-123-FP-CIT uptake ratios. CONCLUSIONS: Serum BDNF levels were lower in recently diagnosed, untreated PD patients compared to controls. These lower levels were significantly correlated with the I-123-FP-CIT uptake ratios.

Compromiso por la calidad de las sociedades científicas en España / Commitment to quality of the Spanish scientific societies

En este artículo se resumen los objetivos, la metodología y las primeras conclusiones del proyecto «Compromiso por la calidad de las sociedades científicas en España», coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad, la Sociedad Española de Medicina Interna y el Instituto Aragonés de Ciencias de la Salud, en el que participan 48 sociedades científicas. Los objetivos de este proyecto son: disminuir la utilización de intervenciones médicas innecesarias, que son las que no han demostrado eficacia, tienen escasa o dudosa efectividad, o no son coste-efectivas; disminuir la variabilidad en la práctica clínica; difundir entre médicos y pacientes el compromiso con el uso adecuado de recursos sanitarios y, por último, promover la seguridad clínica. En el documento se incluyen 135 recomendaciones finales de «no hacer» elaboradas por 30 sociedades científicas españolas (AU)

This article summarises the objectives, methodology and initial conclusions of the project «Commitment to Quality of the Spanish Scientific Societies», coordinated by the Ministry of Health, Social Services and Equality, the Spanish Society of Internal Medicine and the Aragon Institute of Health Sciences, in which 48 scientific societies participate. This project's objectives are to decrease the use of unnecessary medical interventions, which are those that have shown no efficacy, have little or questionable effectiveness or are not cost-effective; decrease variability in clinical practice; promote the commitment among physicians and patients to properly use healthcare resources; and to promote clinical safety. The document includes 135 final recommendations for what not to do, prepared by 30 Spanish scientific societies (AU)

Commitment to quality of the Spanish scientific societies. / Compromiso por la calidad de las sociedades científicas en España.

This article summarises the objectives, methodology and initial conclusions of the project "Commitment to Quality of the Spanish Scientific Societies", coordinated by the Ministry of Health, Social Services and Equality, the Spanish Society of Internal Medicine and the Aragon Institute of Health Sciences, in which 48 scientific societies participate. This project's objectives are to decrease the use of unnecessary medical interventions, which are those that have shown no efficacy, have little or questionable effectiveness or are not cost-effective; decrease variability in clinical practice; promote the commitment among physicians and patients to properly use healthcare resources; and to promote clinical safety. The document includes 135 final recommendations for what not to do, prepared by 30 Spanish scientific societies.

Water consumption related to different diets in Mediterranean cities.

Providing the sustainable development goals (SDGs) water, food and energy security to cities relies strongly on resource use outside city borders. Many modern cities have recently invested in a sustainable urban water system, and score high in international city rankings regarding water management and direct urban water use. However, these rankings generally neglect external resource use for cities. Here we quantify the water resources related to food consumption in thirteen cities located in Mediterranean countries, by means of the water footprint (WF) concept. These WFs amount from 3277l per capita per day (l/cap/d) to 5789l/cap/d. These amounts are about thirty times higher than their direct urban water use. We additionally analyse the WF of three diet scenarios, based upon a Mediterranean dietary pattern. Many authors identify the Mediterranean diet as cultural heritage, being beneficial for human health and a model for a sustainable food system. The first diet scenario, a healthy Mediterranean diet including meat, leads to WF reductions of -19% to -43%. The second diet scenario (pesco-vegetarian), leads to WF reductions of -28% to -52%. The third diet scenario (vegetarian), leads to WF reductions of -30% to -53%. In other words, if urban citizens want to save water, they need to look at their diets.

Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE / Costs resulting from premature mortality due to cardiovascular causes: a 20-year follow-up of the DRECE study

Objetivos. Las enfermedades cardiovasculares permanecen todavía como la principal causa de muerte en España. El estudio Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) se basa en una cohorte representativa de la población general española en la que se analizan los hábitos nutricionales y de vida estudiando su asociación con los patrones de morbimortalidad. Hemos estimado el impacto, en términos de pérdida de productividad, de la mortalidad prematura atribuida a las enfermedades cardiovasculares. Métodos. La pérdida de productividad atribuida a mortalidad prematura se calculó desde 1991, basándose en los años de vida y de vida laboral potencialmente perdidos. Resultados. Durante el seguimiento de 20años de una cohorte de 4.779 sujetos se produjeron 225 fallecimientos (hombres, 152). El 16% de las defunciones se atribuyó a enfermedades cardiovasculares. Los costes por pérdidas de productividad por mortalidad prematura superaron los 29 millones de euros. De ellos, 4 millones de euros (14% del coste total) se debieron a causas cardiovasculares. Conclusiones. La mortalidad prematura cardiovascular en la cohorte DRECE ha supuesto un importante coste social por pérdidas de productividad laboral (AU)

Objectives. Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. Methods. The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. Results. During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. Conclusions. Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity (AU)

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

Serum biochemical markers in drowning: diagnostic efficacy of Strontium and other trace elements.

The aim of our study was to analyse several serum biochemical markers in order to evaluate the discriminant capacity of trace elements individually and jointly in drowning (seawater drowning and freshwater drowning) and their correlation with age, sex, postmortem interval, time in water and concentrations of the trace elements in the drowning medium. Sixty-seven cases of drowning (53 seawater drownings (SWD); 14 freshwater drownings (FWD) and 73 control cases (other asphyxias, n=44, and other causes of death, n=29) were selected according to the scene, cause and circumstances of death, together with autopsy findings. Serum strontium (Sr), magnesium (Mg), sodium (Na), chloride (Cl), calcium (Ca), iron (Fe), urea, creatinine (Cr) and cardiac Troponine T (cTn-T) were measured in the left ventricle (Lv), right ventricle (Rv) and peripheral blood. Lv-Rv differences for each marker and Sr, Mg, Na, Cl, Ca and Fe concentrations in the drowning medium were determinated. Mean concentrations of Sr, Cl and Mg in both ventricles and peripheral serum and Lv-Rv differences and Ca Lv and Na Rv were significantly higher in cases of drowning than for other causes of death. In SWD, Sr, Mg, Ca, Na and Cl were significantly higher in Lv than in Rv as a result of aspirating water. In contrast, haemodilution is evident from the significantly higher levels of Fe and urea in Rv than in Lv in cases of SWD, and from the higher Mg and Cr levels in Rv in FWD. In the case of SWD, serum levels of Sr are confirmed as the best parameter for diagnosis, although other trace elements may also be useful, such as the serum concentrations of Mg and Cl. In the case of FWD, the joint determination of Sr and other biochemical markers, especially Fe, may increase correct diagnosis.

Evaluation of food consumption and dietary patterns in Spain by the Food Consumption Survey: updated information.

BACKGROUND/OBJECTIVES: The Food Consumption Survey (FCS), conducted for over 20 years by the Spanish Ministry of Agriculture, Fisheries and Food (MARM), is the most reliable source of data to evaluate the food consumption and dietary patterns of Spain. The aim of this study was to assess population food availability per capita per day, which allows the calculation of energy and nutrient intake and comparison with the Recommended Nutrient Intakes for the Spanish population. In addition, different markers of the quality of the diet have been evaluated. SUBJECTS/METHODS: The sample consisted of consumption and distribution data, obtained from the nationwide representative FCS for the period 2000-2006. A two-stage sampling method was applied, where in the first stage the units to be sampled were towns or local entities, and in the second stage households that were going to be part of the final sample from those entities were selected. Units consisted of towns or local entities in the national territory. The sample size was 619 selected entities. Units in the second stage were households from the selected towns (8200 homes). The data allowed the calculation of energy and nutrient intakes, using food composition tables. The quality of the diet was also evaluated: the adequacy of the diet in meeting the recommended intakes for energy and nutrients; energy profile; dietary fat quality; dietary protein quality; nutrient density; and Mediterranean diet adequacy indices. The present data were compared with previous data obtained by our research group in 1964, 1981 and 1991. RESULTS: Using the most recent data, average intake comprised milk and derivatives (379 g/person/day), fruit (310 g/person/day), vegetables and greens (302 g/person/day), cereals and derivatives (214 g/person/day), meat and meat products (179 g/day), fish (100 g/person/day), oil and fat (48 g/person/day), precooked food (34 g/person/day), eggs (32 g/person/day), and legumes and pulses (11.9 g/person/day). There was also a high consumption of non-alcoholic beverages (433 g/person/day) and alcoholic beverages (247 g/person/day). In consequence, meat and meat product consumption was higher than the recommendations, whereas for cereals and their derivatives, vegetables and greens, fruit, and legumes and pulses, consumption was below recommendations for the Spanish population. Some staple and traditional Mediterranean foods (bread, potatoes and olive oil) showed a dramatic decline when compared with data from Household Budget Surveys in 1964 data. Energy intake declined by about 300 kcal/person/day, when compared with the 1964 mean consumption. Insufficient nutrient intakes were found in the young adult population for zinc and folic acid in both sexes, and for iron in women, when compared with dietary reference values. CONCLUSIONS: Food consumption patterns in Spain and energy and nutrient intakes have changed markedly in the last 40 years, differing at present from the traditional and healthy Mediterranean diet.

Coberturas y factores asociados a la vacunación antigripal entre los niños españoles que padecen asma / Coverage and factors associated with anti-influenza vaccination among spanish children suffering asthma

Objetivos: Determinar la cobertura vacunal y los factores asociados con la vacunación antigripal en los niños españoles que padecen asma. Métodos: Se han analizado los registros individuos menores de 18 años incluidos en la Encuesta Nacional de Salud (ENS) de España del año 2003. Se han seleccionado para este trabajo los sujetos que declaran padecer asma. Como variable dependiente se ha utilizado la respuesta (“si”o “no”) a la pregunta, “Querríamos saber si su hijo se ha vacunadode la gripe en la última campaña”. Se analiza la influenza de variables sociodemográficas, estilos de vida, comorbilidad, percepción de la salud y uso de servicios sanitarios sobre la vacunación antigripal y se describe quién le indicó la vacunación al niño. Resultados: Se han analizado los registros de 6.869 individuos de ellos 313 (4,6%) declaraban padecer asma y el 19,9% señalaban haberse vacunado frente a la gripe en la ultima campaña. Entre los niños no asmáticos la cobertura era del 4,6%.(p<0,05)El único factor asociado significativamente con la vacunación antigripal en los niños asma fue el nivel de ingresos en el hogar, demostrándose que los que viven en hogares con mayor nivel de ingresos tenían mayor probabilidad de estar vacunados. La recomendación por parte el medico es el motivo señalado mayoritariamente para haber sido vacunado de la gripe. Conclusiones: Concluimos que las coberturas vacunales antigripales entre los niños asmáticos españoles son injustificablemente bajas y se hace imprescindible que se tomen medidas urgentes para mejorarlas

Objectives: To ascertain anti-influenza vaccination coverage and factors associated with anti-influenza vaccination among Spanish children suffering asthma. Methods: We analyzed data of subjects age under 18 years included in the Spanish National Health Survey (ENS) for 2003. We selected those children whose parents declared to be asthmatic. As a dependent variable, we used the reply (“yes” or “no”) to the question: Was your child vaccinated against influenza during the last campaign?”. We analyzed the influence variables regarding sociodemographic characteristics, life styles, comorbility, self rated health and use of health services on vaccination. The reason for vaccination is described. Results: Finally 6.869 children were analyzed, 313 (4.6%) were classified as asthmatics and the vaccination coverage for the last campaign was 19.9%. Among those without asthma coverage reached only 4.6% (p<0.05). The only factor significantly associated with anti-influenza vaccination in children with asthma was household income: those from homes with a higher level of income were more likely to be vaccinated. The main reason for vaccination in the infant population was “Recommendationby the physician”. Conclusions: Anti-influenza vaccination coverage in the Spanish asthmatic infant population is unjustifiably low. Strategies must be implemented urgently to improve such low coverages

Influenza vaccination coverage and related factors among Spanish children.

OBJECTIVES: To ascertain anti-influenza vaccination coverage and factors associated with anti-influenza vaccination among Spanish children. METHODS: We analyzed 6464 children (age under 16 years) included in the Spanish National Health Survey (ENS) for 2003. As a dependent variable, we used the reply ("yes" or "no") to the question: Was your child vaccinated against influenza during the last campaign? We calculated anti-influenza vaccine coverage for the whole population and depending on whether or not the vaccine is recommended due to the fact that the children present an associated chronic condition. We analyzed the influence of sociodemographic variables on vaccination. RESULTS: Vaccination coverage in the Spanish infant population was 5.1%, in children with associated conditions it was 17.5%, and 4.4% in healthy children. The only factor significantly associated with anti-influenza vaccination in children with associated conditions was household income: those from homes with a higher level of income were more likely to be vaccinated (OR=4.26). In children for whom vaccination is not recommended, the probability of being vaccinated against influenza is greater in those whose parents had a lower educational level (OR=2.22). CONCLUSIONS: Anti-influenza vaccination coverage in the Spanish infant population is very low. There seem to be socio-economic inequalities for receiving this vaccine in Spanish children.

[Nutritional planning of menus of public schools of the community of Madrid]. / Planificación nutricional de los menús escolares para los centros públicos de la Comunidad de Madrid.

Some nutritional unbalances have been observed in menus served at dining rooms of schools from the Community of Madrid (CM): small portions, inter-day variations up to 50% of energy intake, unbalances in caloric and lipidic profiles, little variety, lack of parental information, etc. The Education Council of the CM considered necessary to plan and regulate the basic conditions that menus of these dinning rooms should meet. The Spanish Nutrition Foundation (FEN) and the Nutrition Department of the Complutense University of Madrid (UCM) were put in charge of elaborating the bases to develop the Regulation (BOCM 24-05-01, 10-09-02). Collective catering companies were called for a tender to provide menus adapted to such Regulation. This work describes the adaptation of programmed dietary schemes of officially approved companies and mainly the impact on energy and nutritional content of menus and their adaptation to the recommended caloric and lipidic profiles. So far, a random sample of 171 schools with dining rooms (more than 37,000 schoolboys) has been visited by nutritionists, with no previous announcement, to control served menus. For this, at each centre a duplicate of the portion served that day was gathered. The energy and nutrient content was determined and the fatty acid composition was analysed. The adaptation to the Regulation by catering companies has substantially improved the menus as compared to previous times: more presence of vegetables, better quality of fat and less amount of fat and proteins at the expense of carbohydrates.

[Age-related changes in the dietary intake of elderly individuals. The Euronut-SENECA study]. / Cambios con la edad en la ingesta dietética de personas de edad avanzada. Estudio Euronut-SENECA.

There are few longitudinal studies linking eating habits, diets, nutritional content and their repercussions on health. For this reason, the European Union's Concerted Action on Nutrition and Health, Euronut, organized an international, multi-centric longitudinal cohort study in 1988 in an attempt to analyze these factors in various food cultures of Europe. This study was given the name SENECA (Survey in Europe on Nutrition and the Elderly: a Concerted Action). To this end, several types of tests were performed: a general questionnaire (collecting information on: personal details, social and demographic status, socio-economic situation, lifestyle and physical activity and dietary or other living habits), a dietary study, anthropometric and biochemical parameters. The present paper has attempted to assess the differences due to gender and age (in the same subjects), for which purpose data has been collated from a group of individuals between 71 and 80 years of age on the quantitative and qualitative food consumption, energy and nutrient intake and their contribution to the recommended daily intake. The four groups of foods most consumed in both parts of the study were: fruit, milk and its derivatives, vegetables, and cereals and their derivatives, during the four years that have elapsed, a significant reduction was seen in the consumption of certain foods, both in the total of the sample and for the distribution by gender. As a result, with a four-year increase in age, i.e. in the second part of the study, a reduction in energy intake was observed to have a considerable impact on the intake of most micronutrients. The percentile distribution shows that there are individuals who consume very small amounts (or nothing at all) of certain foods. High percentages of individuals were seen not to cover the recommended intake.

[Pheochromocytoma with ectopic secretion of ACTH]. / Feocromocitoma con secreción ectópica de ACTH.

Pheochromocytoma is a tumor displaying a considerable degree of clinical polymorphism both with respect to its location and the secretion of different types of catecholamines and its capacity to synthesize several ectopic hormones. The present work reports on a case of pheochromocytoma with secretion of ACTH that exhibited several clinical and biological peculiarities. Firstly, the clinical picture of the patient was characterized by a predominance of manifestations of adrenal hyperfunction as compared with those of the original tumor. Secondly a striking finding was an important degree of neutrophilia without band forms and a marked hypokalemia produced by the joint secretion of catecholamines and steroid hormones, as demonstrated later. Finally, the images obtained with computerized tomography were very characteristic, such that together with the above data it was possible to establish a preoperative diagnosis.