The Game and Creative Cognition. A Proposal of Intervention / El juego y la cognición creativa: una propuesta de intervención

This paper is aimed at investigating the effects of the intervention through coupled variant games on the creative skills of a group of children. Coupled variant games refers to a group of games ed that meet the characteristic of being preferred by a group of children and, in addition, they were amended by the coupling of a variant designed for the purpose of promoting creative abilities. We worked with a group of children between the ages of 8 and 10 who were divided into two groups: experimental group and control group. Initially both groups participated in a pretest of creativity; then an intervention with coupled variant games was held for eight weeks with the experimental group. At the end of the process, both groups were evaluated with the same measures of creativity. The results that children who participated in the intervention increased their performance in tasks that the use of creative skills

El presente estudio tiene como propósito investigar los efectos de la intervención mediante juegos con variante acoplada en las habilidades creativas de un grupo de niños. Los juegos con variante acoplada se refieren a un grupo de juegos que se caracterizan por ser preferidos por los niños y que además han sido modificados para que desde sus demandas cognitivas promuevan las habilidades creativas. Se trabajó con un grupo de niños con edades entre 8 y 10 años, quienes fueron divididos en dos grupos: uno experimental y otro de control. Inicialmente, ambos grupos participaron en un pretest de creatividad para establecer una línea de base; posteriormente, se realizó una intervención con juegos con variante acoplada durante ocho semanas con el grupo experimental. Al finalizar el proceso, ambos grupos fueron evaluados con las mismas medidas de creatividad. Los resultados de esta investigación muestran que los niños que participaron del proceso de intervención con juegos con variante acoplada incrementaron significativamente su desempeño en tareas que requieren el uso de habilidades creativas

Metformina en el tratamiento de la diabetes tipo 2 con sobrepeso u obesidad / Metformin in the treatment of type-2 diabetes in over-weigthed or obese patients

Fundamento y objetivos: La Diabetes es la enfermedad crónica cuya prevalencia ha sufrido un mayor incremento en los últimos años. La obesidad es el factor de riesgo más importante para presentar esta enfermedad y la metformina se considera una terapia de primera línea en diabéticos obesos. El objetivo de este estudio es conocer la utilización de metformina y evaluar el grado de control de los factores de riesgo cardiovascular (FRC) asociados, en los pacientes con DM tipo 2 en situación de sobrepeso u obesidad. Pacientes y método: Estudio descriptivo trasversal sobre una muestra aleatoria de 308 pacientes en las consultas de atención primaria. Se clasificaron los sujetos según el tratamiento antidiabético recibido en cuatro grupos (dieta, insulina, metformina y otros antidiabéticos orales). Se evaluaron el grado de control de los FRC modificables, la existencia de complicaciones y el control metabólico de la población estudiada. Resultados: La edad media fue de 69,6 años, el 54% eran mujeres. El 36,6% de los pacientes seguían tratamiento con metformina y el 40,5% con sulfonilureas. La afectación macrovascular fue del 19,4%. El FRC más frecuente resultó la hipertensión arterial en el 76%. Los objetivos de control menos alcanzados fueron el cLDL < 100 mg/dl y TAS < 130 mmHg. Los diabéticos tratados sólo con dieta tuvieron mejores controles de glucemia basal y HbA1c% que los tratados con metformina (p < 0,001) e insulina (p < 0,001). El grupo tratado con metformina presentó valores de triglicéridos (TG) significativamente más elevados que el grupo de dieta (p = 0,009) e insulina (p = 0,041). Conclusiones: A pesar de que el tratamiento indicado es la metformina, ésta se utiliza en una proporción similar a las sulfonilureas en DM tipo 2 con sobrepeso u obesidad. Existe un pobre control de la mayoría de los FRC de la población diabética estudiada

Fundament and objectives: Diabetes is the disease that has suffered a greater increase in his incidence in the last years. Obesity is the most important risk factor to develop this disease and metformin is considered as a first line drug in overweighted diabetic patients. The aim of this study is to evaluate the use of metformin and the degree of control of the associated cardiovascular risk factors (CVRF) in patients suffering of type 2 diabetes and overweight or obesity. Patients and methods: This is a transversal descriptive study over a random chosen group of 308 patients followed at primary care level. They were classified in four different groups depending on the treatment used to control them (diet, insulin, metformin and other oral antidiabetic drugs). They were evaluated upon the degree of control of the modifiable CVRF, the presence of complications and the metabolic control. Results: The average age was 69,6 years, 54% of the patients female. 36,6% followed treatment with metformin and 40,5% with sulfonylureas. The macrovascular percentage of affection was 19,4%. The most frequent CVRF was arterial hypertension (76%). The goal levels of control that were less in range were the levels of cLDL < 100mg/dl and systolic blood pressure < 130 mmHg. Diabetic patients only treated with diet had a better control of fasten glycemia and HbA1c% than those ones treated with metformin (p < 0.001). The group treated with metformin showed levels of triglycerides (TG) significantly higher than those of the diet controlled group (p = 0.009) and insulin group (p < 0.001). Conclusions: Metformin and sulfonylureas are used in a similar proportion in type 2 diabetics with overweight or obesity. There is a poor control of the majority of the CVRF in the diabetic population studied

[Metformin in the treatment of type 2 diabetes in overweighted or obese patients]. / Metformina en el tratamiento de la diabetes tipo 2 con sobrepeso u obesidad.

UNLABELLED: FUNDAMENTALS AND OBJECTIVES: [corrected] Diabetes is the disease that has suffered a greater increase in his incidence in the last years. Obesity is the most important risk factor to develop this disease and metformin is considered as a first line drug in overweighted diabetic patients. The aim of this study is to evaluate the use of metformin and the degree of control of the associated cardiovascular risk factors (CVRF) in patients suffering of type 2 diabetes and overweight or obesity. PATIENTS AND METHODS: This is a transversal descriptive study over a random chosen group of 308 patients followed at primary care level. They were classified in four different groups depending on the treatment used to control them (diet, insulin, metformin and other oral antidiabetic drugs). They were evaluated upon the degree of control of the modifiable CVRF, the presence of complications and the metabolic control. RESULTS: The average age was 69.6 years, 54% of the patients female. 36.6% followed treatment with metformin and 40.5% with sulfonylureas. The macrovascular percentage of affection was 19.4%. The most frequent CVRF was arterial hypertension (76%). The goal levels of control that were less in range were the levels of cLDL < 100 mg/dl and systolic blood pressure < 130 mmHg. Diabetic patients only treated with diet had a better control of fasten glycemia and HbA1c% than those ones treated with metformin (p < 0.001). The group treated with metformin showed levels of triglycerides (TG) significantly higher than those of the diet controlled group (p = 0.009) and insulin group (p < 0.001). CONCLUSIONS: Metformin and sulfonylureas are used in a similar proportion in type 2 diabetics with overweight or obesity. There is a poor control of the majority of the CVRF in the diabetic population studied.

[Drug-to-drug interactions and pharmaceutical advice]. / Interacciones medicamento-medicamento y asesoramiento farmacéutico.

OBJECTIVE: To describe suspects of drug interactions in primary health care. DESIGN: Descriptive and transversal study during 1 month. SETTING: Urban health center, primary care, Madrid (Spain). PATIENTS AND OTHER PARTICIPANTS: Patients were treated simultaneously with more than 1 drug (145), 2 general practitioners (GP) and 1 pharmacist. INTERVENTIONS: GP registered in a sheet-form data from diagnostic and pharmacological treatments. The pharmacist checked the sheet-forms to detect drug interactions, and later assessed to the GP about it. The proposals were classified in 3 ways: no change in treatment; to modify or stop the current treatment, and to monitor plasmatic level or clinical parameters. MEASUREMENTS AND MAIN RESULTS: 333 drug interactions were detected in 145 patients. The 67.5% of interactions produced by 7 groups of drugs: theophylines, diuretics, antacids, benzodiacepines, betablockers, NSAID's and ACE's. GP accepted 74% of pharmacist's proposals (recommendations). CONCLUSIONS: Seven types of drugs were involved in the main interactions in primary care. The drug interactions increased as more drugs takes a patient in an accelerated trend. Older than 55 were the most affected. GP accepted 3/4 of the recommended pharmacist proposals.

[Something more about adverse reactions to medications]. / Algo más sobre reacciones adversas a medicamentos.

OBJECTIVE: To describe adverse drug effects (ADE) and their frequency in primary care patients. DESIGN: Descriptive and longitudinal study during 1 year (1990). SETTING: Urban Health Center. Primary Care. Madrid (Spain). PATIENTS AND OTHER PARTICIPANTS: 15,483 persons, nine general practitioner and one pharmacist. INTERVENTIONS: Doctors were invited to register any adverse drug effects they had notice in their patients. Doctors registered information and gave notice to the pharmacist about medicines, dosage and period of administration, clinical manifestations, and improving or not if drug was withdrawal. MEASUREMENTS AND MAIN RESULTS: 326 adverse drugs effects were notified, 30.9 ADE per thousand attended patients. 117 principles actives were involved, and 415 clinical manifestations were registered. The more affected patients were women (2/1). The age groups with higher ADE relative frequencies were children under one year and older people. CONCLUSIONS: The absolute frequency of medicines involved in ADE are different to relative frequencies when ADE per thousand prescription units are used. Some of the ADE notified were not referred before in the bibliography, so primary care is a good place to research on pharmacosurveillance.

[Computerized record system for the analysis of diagnosis of chronic diseases and their treatment in primary health care]. / Sistema informatizado de registro para el análisis de diagnósticos crónicos y sus tratamientos en atención primaria.

OBJECTIVE: To present the design and setting up of a computerised data base for primary care. DESIGN: A descriptive crossover study. The recording lasted a year. SETTING: Gómez Acebo Health Centre in Madrid. Primary Care. PATIENTS AND OTHER PARTICIPANTS: The whole of the health centre catchment population, comprising 14,407 people, as well as 20 doctors and nurses. INTERVENTIONS: The consultations of ten doctors and ten nurses at the health centre were computerised. The computer programme, language-designed for inter-related data bases, linked four data bases (users, chronic illnesses, medicines, and the diagnosis and treatment record-sheet). The population under study comprised 14,407 people over one year, 1993. MEASUREMENTS AND MAIN RESULTS: The users file held the data of 14,407 people. 7,867 of these contained 23,993 chronic diagnoses with 12,405 treatments. The commonest diagnosis groups were: cardiovascular, psychiatry, endocrinology and articulations. The therapeutic groups with most prescriptions were C (cardiovascular), A (digestive and metabolic), N (nervous system) and R (respiratory). Daily expenditure in medicines was 634,207 pesetas. CONCLUSIONS: The main contribution of this computerised data base is to be able to analyse the associations between pathologies and their associated treatments, along with the pharmacological cost per primary care transaction, interactions and adverse side-effects.