Cost-effectiveness of omalizumab for the treatment of severe pediatric allergic asthma-Results of a real-life study in Spain.

BACKGROUND: Severe pediatric allergic asthma (SPAA) induces a huge economic burden in terms of direct, indirect, and intangible costs. The use of omalizumab for the treatment of these patients has produced a significant improvement in several clinical outcomes, but at the same time, the cost for the management of the disease has also increased. The aim of this report was to evaluate whether the use of omalizumab is cost-effective. METHODS: A sample of 426 children with SPAA from the ANCHORS (Asthma iN CHildren: Omalizumab in Real-life in Spain) study was used to calculate the incremental cost-effectiveness ratio (ICER) for the avoidance of moderate-to-severe exacerbations (MSE) and also for the improvement in childhood Asthma Control Test (c-ACT) or the Asthma Control Questionnaire (ACQ5). We retrospectively collected data on health encounters and drug consumption before and up to 6 years after the beginning of the treatment with omalizumab. RESULTS: The ICER per avoided MSE was €2107 after 1 year, and it consistently decreased to €656 in those followed up to 6 years. Similarly, the ICER for the minimally important difference in control tests showed a decrease from €2059 to €380 per each 0.5 points of improvement in ACQ5 and from €3141 to €2322 per each 3 points improvement in c-ACT, at years 1 and 6, respectively. CONCLUSION: The use of OMZ is a cost-effective option for most children with uncontrolled SPAA, especially those who have frequent exacerbations; the costs are progressively reduced in successive years of treatment.

Development and Validation of a Questionnaire to Assess Adherence to the Healthy Food Pyramid in Spanish Adults.

We aimed to design and validate a new questionnaire of adherence to healthy food pyramid (HFP) (AP-Q), to improve previous instruments. The questionnaire was self-administered and included 28 questions from 10 categories (physical activity, health habits, hydration, grains, fruits, vegetables, oil type, dairy products, animal proteins, and snacks). A population of 130 Spanish adults answered it, obtaining scores from each category and a global score of HFP adherence (AP-Q score). Validation was performed through principal components analysis (PCA) and internal consistency by Cronbach's alpha. AP-Q was also externally validated with Kidmed-test, answered by 45 individuals from the cohort. The global AP-Q score was 5.1 ± 1.3, with an internal consistency of 64%. The PCA analysis extracted seven principal components, which explained 68.5% of the variance. The global AP-Q score was positively associated with Kidmed-test score. Our data suggest that AP-Q is a complete and robust questionnaire to assess HFP adherence, with several advantages: easy to complete, cost-effective, timesaving and has the competency to assess, besides diet, several features affecting health status, lacking in other instruments. We suggest that AP-Q could be useful in epidemiological research, although it requires additional calibration to analyze its reproducibility and validation in other populations.

Plasma Oxidative Status in Preterm Infants Receiving LCPUFA Supplementation: A Pilot Study.

After birth, preterm infants are deficient in arachidonic acid (ARA), docosahexaenoic acid (DHA), and antioxidants, increasing their risk of oxidative stress-related pathologies. The principal aim was to evaluate if supplementation with long-chain polyunsaturated fatty acids (LCPUFAs) improves antioxidant defenses. In total, 21 preterm infants were supplemented with ARA and DHA in a 2:1 ratio (ARA:DHA-S) or with medium-chain triglycerides (MCT-S). Plasma n-3 and n-6 LCPUFAs were measured at birth, postnatal day 28, and 36 weeks of postmenstrual age (36 WPA) by gas chromatography-mass spectroscopy. Plasma antioxidants (glutathione (GSH), catalase, and thiols) and oxidative damage biomarkers (malondialdehyde (MDA), carbonyls) were analyzed at the same time points by spectrophotometry, and scores of antioxidant status (Antiox-S) and oxidative damage (Proxy-S) were calculated. At 36 WPA, linoleic acid (LA) and dihomo--linolenic acid (DGLA) were decreased in ARA:DHA-S compared to the MCT-S group (LA: ARA:DHA-S = 18.54 1.68, MCT-S = 22.80 1.41; p = 0.018; DGLA: ARA:DHA-S = 1.68 0.38, MCT-S = 2.32 0.58; p = 0.018). Furthermore, α-linolenic acid (ALA) was increased in ARA:DHA-S (ARA:DHA-S = 0.52 0.33, MCT-S = 0.22 0.10; p = 0.018). Additionally, LA:DHA ratio was decreased in the ARA:DHA-S compared to control group (ARA:DHA-S = 6.26 2.35, MCT-S = 8.21 2.65; p = 0.045). By the end of supplementation (36 WPA), catalase, thiol groups, and Antiox-S were significantly higher in neonates receiving ARA:DHA-S compared to those receiving MCT-S, with no differences in oxidative stress biomarkers. In conclusion, ARA:DHA supplementation in preterm neonates resulted in an overall improvement in antioxidant to oxidant balance and a decrease in early fatty acid precursors of the n-6 relative to the n-3 pathway. These effects may reduce oxidative stress and inflammation.

Chronic lymphocytic leukemia with isochromosome 17q: An aggressive subgroup associated with TP53 mutations and complex karyotypes.

Although i(17q) [i(17q)] is frequently detected in hematological malignancies, few studies have assessed its clinical role in chronic lymphocytic leukemia (CLL). We recruited a cohort of 22 CLL patients with i(17q) and described their biological characteristics, mutational status of the genes TP53 and IGHV and genomic complexity. Furthermore, we analyzed the impact of the type of cytogenetic anomaly bearing the TP53 defect on the outcome of CLL patients and compared the progression-free survival (PFS) and overall survival (OS) of i(17q) cases with those of a group of 38 CLL patients harboring other 17p aberrations. We detected IGHV somatic hypermutation in all assessed patients, and TP53 mutations were observed in 71.4% of the cases. Patients with i(17q) were more commonly associated with complex karyotypes (CK) and tended to have a poorer OS than patients with other anomalies affecting 17p13 (median OS, 44 vs 120 months, P = 0.084). Regarding chromosomal alterations, significant differences in the median OS were found among groups (P = 0.044). In conclusion, our findings provide new insights regarding i(17q) in CLL and show a subgroup with adverse prognostic features.

Prevalence and determinants of the dual burden of malnutrition at the household level in Puna and Quebrada of Humahuaca, Jujuy, Argentina / Prevalencia y determinantes de la doble carga de malnutrición en hogares en La Puna y Quebrada de Humahuaca, Jujuy, Argentina

Objective: The objective of the present study was to identify households in which overweight and underweight coexisted (dual burden of malnutrition) and explore the factors that could be contributing to the dual burden of malnutrition at the household level in this population.Study design: Cross-sectional nutritional survey. Methods: After applying the exclusion criteria, 136households were included. Mothers were classified as normal weight or overweight/obese based on body mass index (BMI) cut-off points and children and adolescents were classified as stunted or not based on height-for-agez-score. Households with an obese mother and a stunted children or adolescent were categorized as dual burdenhouse holds. Results: The prevalence of dual burden household was12%. Compared with other households, dual burden households tended to have more people living in the house, and the educational level of the head of household was lower. Individuals living in dual burden households showed overall lower energy intakes and were more likely to have inadequate intakes of calcium and iron. Conclusions: The nutrition transition in this community might be one of the leading causes of the observed dual burden of malnutrition. The results presented here indicate the need to consider whether programs that focus on only one type of nutritional problem come might actually exacerbate the other (AU)

El objetivo del presente estudio fue identificar los hogares en los que coexisten el sobrepeso y bajo peso(doble carga de malnutrición) y explorar los factores que podrían contribuir a la doble carga de malnutrición en los hogares de esta población. Después de aplicar los criterios de exclusión, se incluyeron 136 hogares. Las madres fueron clasificadas como de peso normal o con sobrepeso/obesidad basado en puntos de corte del índice de masa corporal (IMC), los niños y adolescentes fueron clasificados según z-score de la talla para la edad, si tenían o no retraso en el crecimiento (Stunted). Los hogares con una madre obesa y niños o adolescentes con retraso en el crecimiento fueron clasificados como hogares de doble carga. La prevalencia de hogares con doble carga fue del12 %. En comparación con los otros hogares, en los hogares con doble carga de malnutrición habitan un mayor número de personas en la casa, y el nivel de educación del jefe de familia fue menor. Las personas que viven en hogares de doble carga mostraron ingestas de energía global más bajas y eran más propensos a tener una ingesta insuficiente de calcio y hierro. Una de las principales causas de la doble carga de malnutrición observada en esta comunidad podría ser la transición nutricional. Los resultados presentados aquí indican la necesidad de considerar a los programas que se centran en un solo tipo de problema nutricional y que en realidad podrían exacerbar el otro (AU)

Fideos libres de gluten elaborados con harinas no tradicionales: características nutricionales y sensoriales / Gluten-free noodles made with non-traditional flours: nutritional and sensory characteristics

Los productos farináceos sin gluten son formulados con harinas y/o almidones refinados y generalmente aportan bajas cantidades de proteínas, minerales y fibra. La complementación de esos productos podría incrementar la calidad nutricional de las dietas libres de gluten. Los cultivos andinos son adecuados para realizar la complementación. El haba (vicia faba) y la quínoa (Chenopodium quinoa) presentan proteínas que se complementan adecuadamente con las de cereales, alto contenido de algunas vitaminas, hierro, fibra dietaria y componentes funcionales. El objetivo del trabajo fue caracterizar nutricionalmente fideos de harinas mezclas maíz/haba y maíz/quínoa. Las mezclas utilizadas fueron harina maíz/quínoa (M/Q) 80:20 y maíz/haba (M/H) 70:30, para elaborar fideos tipo espaguetis por extrusión-cocción. Se determinó composición proximal,contenidos de minerales, fibra dietaria, ácidos grasos, Utilización Proteica Neta (UPN), Digestibilidad (D) y Valor Biológico (VB). Los fideos mejorados nutricionalmente mostraron un incremento significativo de macro y micronutrientes, como así también de UPN y VB y una ligera disminución en la D respecto a la harina de maíz pura utilizada como control. Una porción de estos fideos aporta 10-20% del valor diario recomendado de fibra dietaria. El agregado de harinas de habas y quínoa a sistemas farináceos sin gluten permite obtener fideos con características tecnológicas adecuadas y calidad nutricional mejorada.

Fideos libres de gluten elaborados con harinas no tradicionales: características nutricionales y sensoriales / Gluten-free noodles made with non-traditional flours: nutritional and sensory characteristics

Los productos farináceos sin gluten son formulados con harinas y/o almidones refinados y generalmente aportan bajas cantidades de proteínas, minerales y fibra. La complementación de esos productos podría incrementar la calidad nutricional de las dietas libres de gluten. Los cultivos andinos son adecuados para realizar la complementación. El haba (vicia faba) y la quínoa (Chenopodium quinoa) presentan proteínas que se complementan adecuadamente con las de cereales, alto contenido de algunas vitaminas, hierro, fibra dietaria y componentes funcionales. El objetivo del trabajo fue caracterizar nutricionalmente fideos de harinas mezclas maíz/haba y maíz/quínoa. Las mezclas utilizadas fueron harina maíz/quínoa (M/Q) 80:20 y maíz/haba (M/H) 70:30, para elaborar fideos tipo espaguetis por extrusión-cocción. Se determinó composición proximal,contenidos de minerales, fibra dietaria, ácidos grasos, Utilización Proteica Neta (UPN), Digestibilidad (D) y Valor Biológico (VB). Los fideos mejorados nutricionalmente mostraron un incremento significativo de macro y micronutrientes, como así también de UPN y VB y una ligera disminución en la D respecto a la harina de maíz pura utilizada como control. Una porción de estos fideos aporta 10-20% del valor diario recomendado de fibra dietaria. El agregado de harinas de habas y quínoa a sistemas farináceos sin gluten permite obtener fideos con características tecnológicas adecuadas y calidad nutricional mejorada.(AU)

Satisfaction with pregnancy and birth services: the quality of maternity care services as experienced by women.

OBJECTIVES: To investigate the opinions of women regarding satisfaction with the quality of maternity care received, and to establish whether health-care technology increases satisfaction or interferes with the construction of personal satisfaction in the process of care. DESIGN AND SETTING: Information was gathered using focus groups. The area of study comprised the postnatal groups run as part of the Sexual and Reproductive Health Programme of the Catalan Health Authority, Spain. PARTICIPANTS: Five focus groups were held between May 2006 and July 2007. FINDINGS: Quality of care is a complex concept in which a number of independent core features can be identified. These core features were grouped into three basic categories: safety (the hospital and its technological facilities, and the technical expertise of health professionals), the relationship between the carers and the service user, and the structural aspects that determine the context in which health care is provided. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The mothers in this study were satisfied with health-care technology and viewed it as a source of security. Technology was indispensable to reduce the anxiety provoked by their perceived lack of confidence in their ability as mothers. During pregnancy and, especially, when giving birth, women believe that their feelings and values should be understood by professionals, from whom they seek empathy and personal commitment, not just information.

[Tinidazole: a classical anaerobical drug with multiple potential uses nowadays]. / Tinidazol: un anaerobicida clásico con múltiples usos potenciales en la actualidad.

Tinidazole is a 5-nitroimidazole active in vitro against a wide variety of anaerobic bacteria and protozoa. Tinidazole is an effective treatment against anaerobic microorganisms based on its pharmacokinetic characteristics (C(max) 51 microg/ml, t(1/2) 12.5 h) and its excellent in vitro activity. Its long half-life allows once a day regimens. Tinidazole is as effective as metronidazole in the treatment of infections caused by T. vaginalis, giardiasis and amebiasis and bacterial vaginosis, malaria, odontogenic infections, anaerobic bacterial infections (pelvic inflammatory disease, diabetic foot), surgical prophylaxis (abdominal and hysterectomy) and Helicobacter pylori eradication. Tinidazole was recently approved by the Food and Drug Administration (FDA) for the treatment of infections caused by Trichomonas vaginalis, Entamoeba histolytica and Giardia lamblia.

Tinidazol: un anaerobicida clásico con múltiples usos potenciales en la actualidad / Tinidazole: a classical anaerobical drug with multiple potential uses nowadays

El tinidazol es un 5-nitroimidazol activo in vitro frente a una amplia variedad de bacterias y protozoos anaerobios. Sus características farmacocinéticas (Cmáx 51 μg/ml, t1⁄2 12,5 h) y su actividad in vitro frente a microorganismos anaerobios hacen de tinidazol un tratamiento eficaz para muchas infecciones causadas por estos microorganismos en dosis única o una vez al día. El tinidazol es tan eficaz como metronidazol en infecciones por T. vaginalis, giardiasis y amebiasis intestinal o hepática, así como en vaginosis bacterianas, malaria, infecciones odontógenas e infecciones por bacterias anaerobias (enfermedad inflamatoria pélvica o pie diabético). Además se ha empleado en la profilaxis antibiótica de la cirugía abdominal y ginecológica y figura en todos los protocolos de erradicación de Helicobacter pylori. Tinidazol ha recibido recientemente la aprobación de la Food and Drug Administration (FDA) para el tratamiento de infecciones por Trichomonas vaginalis, Entamoeba histolytica y Giardia lamblia (AU)

Tinidazole is a 5-nitroimidazole active in vitro against a wide variety of anaerobic bacteria and protozoa. Tinidazole is an effective treatment against anaerobic microorganisms based on its pharmacokinetic characteristics (Cmáx 51 μg/ml, t1⁄2 12.5 h) and its excellent in vitro activity. Its long half-life allows once a day regimens. Tinidazole is as effective as metronidazole in the treatment of infections caused by T. vaginalis, giardiasis and amebiasis and bacterial vaginosis, malaria, odontogenic infections, anaerobic bacterial infections (pelvic inflammatory disease, diabetic foot), surgical prophylaxis (abdominal and hysterectomy) and Helicobacter pylori eradication. Tinidazole was recently approved by the Food and Drug Administration (FDA) for the treatment of infections caused by Trichomonas vaginalis, Entamoeba histolytica and Giardia lamblia (AU)

Distribución geográfica de los médicos en España y su evolución temporal durante el período 1998-2007 / Physicians’ geographical distribution in Spain and its evolution during the period 1998-2007

Fundamento: La distribución geográfica de los profesionales sanitarios condiciona la accesibilidad de la población a la asistencia sanitaria. El presente estudio pretende analizar la distribución provincial de los médicos en España, su evolución temporal y los factores relacionados con la misma. Métodos: Estudio observacional, transversal, ecológico, descriptivo y analítico, a partir de fuentes oficiales de datos (Instituto Nacional de Estadística y Ministerio de Sanidad y Consumo). Se obtuvieron, a nivel provincial, variables relativas a la distribución de médicos, condiciones socioeconómicas, estructura sanitaria y capacidad de formación de médicos. Se construyeron distintos estadísticos de variabilidad para la distribución de médicos, y se analizaron las correlaciones bivariadas y multivariadas entre la ratio provincial de médicos y el resto de variables. Resultados: La razón entre los valores extremos de la variable ratio provincial de médicos en 2007 es de 2,109 (2,158 en 1998), el coeficiente de variación de 0,19 (0,185 en 1998) y el índice de Gini de 0,103 (0,097 en 1998). La distribución de médicos y la formación especializada provincial están fuertemente relacionadas, tanto en el análisis bivariado (r=0,87), como en el multivariado, en el que las variables socioeconómicas y de estructura sanitaria y la formación especializada explican un 83,3% de la varianza en la ratio provincial de médicos. Conclusiones: La variabilidad en la distribución geográfica de médicos en España se ha mantenido prácticamente estable en la última década, siendo similar a la existente en los países de nuestro entorno. La capacidad formativa de cada provincia parece jugar un papel fundamental en la distribución geográfica de los médicos (AU)

Background: Population accessibility to health care depends on the geographical distribution of health care professionals. The aim of this study is to analyse the provincial distribution of Spanish physicians, its recent evolution and the factors related with it. Methods: Observational, cross-sectional, ecological, descriptive and analytical study on data from public oficial data sources (Statistics National Institute, Health and Consume Ministry). We obtained, on a provincial basis, variables related with physicians’ distribution, socioeconomic conditions, health care resources and medical training capacity. We built some variability indicators for physicians’ distribution, and we analysed the bivariated and multivariated correlations between provincial physicians’ rate and the other variables. Results: The ratio between the upper and lower values of the population based physicians’ provincial ratio is 2,109 (2,158 in 1998), the variation coefficient is 0,19 (0,185 in 1998), and the Gini index is 0,103 (0,097 in 1998). There is a strong correlation between physicians’ distribution and the specialist training capacity of each province in bivariated (r=0,87) and multivariated analysis (where socioeconomic and health care structure indicators and postgraduate training capacity explain 83,3% of physicians’ distribution variance). Conclusions: The variability of physicians’ distribution in Spain has been almost steady in the last decade, and its level is similar to that in other European countries. The provincial training capacity seems to play a fundamental role in physicians’ distribution (AU)