[Influence of Clinical Practice Guidelines on the Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis. Data from the Registry of the Spanish Society of Pulmonology and Thoracic Surgery]. / Influencia de las guías de práctica clínica en el diagnóstico y tratamiento de la fibrosis pulmonar idiopática. Datos del Registro de la Sociedad Española de Neumología y Cirugía Torácica.

Objective: The objective of the study was to analyze the diagnostic process and the time until the start of treatment of patients with idiopathic pulmonary fibrosis in relation to the publication of successive clinical practice guide. Material and methods: Multicenter, observational, ambispective study, in which patients includes in the idiopathic pulmonary fibrosis registry of the Spanish Society of Pulmonologist and Thoracic Surgery were analyzed. An electronic data collection notebook was enabled on the society's website. Sociodemographic and clinical variables were collected at diagnosis and follow-up of the patients. Results: From January 2012 to december 2019, 1064 patients were included in the registry, with 929 finally analyzed. The diagnosis process varied depending on the year in which it was performed, and the radiological pattern observed in the high-resolution computed tomography. Up to 26.3% of the cases (244) were diagnosed with chest high-resolution computed tomography and clinical evaluation. Surgical biopsy was used up to 50.2% of cases diagnosed before 2011, while it has been used in 14.2% since 2018. The median time from the onset of symptoms to diagnosis was 360 days (IQR 120-720), taking more than 2 years in the 21.0% of patients. A percentage of 79.4 of patients received antifibrotic treatment. The average time from diagnosis to the antifibrotic treatment has been 309 ± 596.5 days, with a median of 49 (IQR 0-307). Conclusions: The diagnostic process, including the time until diagnosis and the type of test used, has changed from 2011 to 2019, probably due to advances in clinical research and the publication of diagnostic-therapeutic consensus guidelines.

The influence of childhood obesity on spatio-temporal gait parameters.

The musculoskeletal and neurosensorial development of children can be affected by excess body weight. Studies have examined how childhood obesity affects gait, but much about the influence of this factor remains to be determined. The aim of our study is to analyse, in a large sample of children, the influence of obesity on the spatiotemporal parameters of the gait cycle, in the most natural way possible, with the subjects walking overground at a self-selected speed. METHOD: For this study, the sample was composed of 238 healthy school children, composed of 114 (47.9%) girls and 124 (52.1%) boys, aged 7-11 years. For each one, the body mass index was calculated, according to which the subjects were classified by percentiles as low weight, normal weight, overweight or obese. Anthropometric variables were measured and the spatiotemporal parameters of gait were assessed by the OptoGait® portable photocell system. RESULTS: The spatial variables did not reveal significant differences between the children with normal weight and those with obesity. However, the differences for stance phase, load response and pre-swing phase (p = 0.0001, p = 0.016 and p = 0.0001, respectively) were clearly significant. CONCLUSIONS: Childhood obesity exerts a significant influence on gait by increasing the duration of load response and that of the pre-swing towards the oscillation phase and therefore the total duration of the support phase. This outcome requires greater energy expenditure to stabilise the gait of children with obesity, and could have biomechanical repercussions.

Ictus y discapacidad: estudio longitudinal en pacientes con discapacidad moderada-grave tras un ictus incluidos en un programa de rehabilitación multidisciplinar / Disability after stroke: a longitudinal study in moderate and severe stroke patients included in a multidisciplinary rehabilitation program

Introducción. Los ictus son causa frecuente de discapacidad en el adulto; sin embargo, la repercusión que los déficits que acontecen tras un ictus moderado-grave tiene sobre el grado de discapacidad final, así como la respuesta de éstos a programas de rehabilitación, no se ha estudiado por completo. Pacientes y métodos. Se incluyeron 396 pacientes con Rankin modificado >= 3 después de un ictus isquémico (n = 221) o hemorrágico (n = 175). En todos los pacientes se evaluó su situación cognitiva, conductual, emocional, motora y funcional. Todos los pacientes fueron incluidos en un programa de rehabilitación multidisciplinar y reevaluados tras seis meses de tratamiento. Resultados. El riesgo de caída (escala de equilibrio de Berg < 45 en el 83,1% de la muestra) y los déficits funcionales (índice de Barthel < 75 en el 82,8% de la muestra) fueron los problemas más prevalentes en el momento del ingreso, mientras que los conductuales lo fueron en el del alta (55,1% de la muestra). Los problemas emocionales fueron los que más mejoraron, mientras que los conductuales fueron los que menos lo hicieron. El nivel de discapacidad global mejoró tras el tratamiento, aunque sólo un 11% de los pacientes, especialmente los que tenían buena situación cognitiva en el ingreso, lograron alcanzar una discapacidad leve. Conclusiones. Las consecuencias del ictus son multidimensionales. La afectación de las distintas esferas y el patrón de recuperación son diferenciales, con predominio a largo plazo de los problemas conductuales (AU)

Introduction. Stroke is a recognized cause of disability among adults. However the impact that the deficits that occur after a moderate/severe stroke have on long-term disability, as well as the response of the resultant deficits to rehabilitation, are not completely understood. Patients and Methods: A total of 396 patients with a modified Rankin score >= 3 after an ischemic (n = 221) or hemorrhagic (n = 175) stroke were included in this study. All patients were assessed with cognitive, behavior, emotional, motor and functional domains. All patients were assessed at baseline and six months after inclusion in a multidisciplinary rehabilitation program. Results: Risk of falling (Berg Balance Scale < 45 in 83.1% of the sample at baseline and 49.5% at follow-up) and functional problems (82.8% with a Barthel Index < 75 at baseline and 53% at follow-up) were the most prevalent deficits. Emotional disturbances were those that most improved while behavioral problems were those that did less. Although global disability improved during treatment among most patients, only 11% of our patients, especially those with preserved cognitive function at baseline, could be classified as patients with mild disability at follow-up. Conclusions: Stroke consequences are multidimensional. The symptoms that the stroke can cause in multiple domains, as well as the pattern of recovery are widely diverse, with prevalence of behavioral long-term disturbances (AU)

Del estado vegetativo al estado de vigilia sin respuesta: una revisión histórica / From the vegetative state to unresponsive wakefulness: a historical review

Introducción. A lo largo de estas últimas décadas, la terminología, las técnicas diagnósticas y el tratamiento de los pacientescon niveles alterados de la conciencia han variado de forma considerable. A su vez, el porcentaje de pacientes en estasituación clínica se ha incrementado notablemente. Objetivo. Se presenta una revisión histórica de los diferentes términos que la literatura médica ha utilizado para la descripción de los pacientes con estados alterados de conciencia. El artículo incluye además los diferentes criterios diagnósticosempleados por los grupos de estudio que han centrado su interés en esta población. Desarrollo. Semiológicamente, el concepto de ‘estado vegetativo’ acuñado en los años setenta se ha transformado y se ha sustituido por términos con una connotación menos negativa, como el de ‘síndrome de vigilia sin respuesta’. Paralelamente, han surgido nuevas categorías clínicas (estado de mínima conciencia o de mínima conciencia plus) al reconocerse la existencia de pacientes con bajo nivel de conciencia pero con signos congruentes de interacción con el entorno a través de conductas inequívocamente voluntarias ante órdenes o gestos. Conclusión. El espectro semiológico de los pacientes con niveles alterados de conciencia refleja la heterogeneidad clínica y neuropatológica de estos estados. La tendencia actual es la de hacer una descripción clínica del estado, añadiendo la etiología y la fecha del evento que causó el cuadro clínico. Este artículo se centra en el contexto de un esfuerzo de la comunidad científica por hacer presente las necesidades de esta creciente población (AU)

Introduction. Over the last few decades, the terminology, diagnostic techniques and treatment of patients with alteredlevels of consciousness have varied considerably. At the same time, the percentage of patients in this clinical situation has undergone a marked increase. Aims. The purpose of this study is to present a historical review of the different terms that have been used in the medical literature to describe patients with altered states of consciousness. The article also includes the different diagnostic criteria utilised by research groups that have focused their attention on this population. Development. The concept of ‘vegetative state’, a term coined back in the sixties, has since been transformed and replaced by other terms with a less negative connotation, such as ‘unresponsive wakefulness syndrome’. In parallel, new clinical categories (minimally conscious state or minimally conscious plus) have appeared since it has been acknowledgedthat there are patients with a low level of consciousness but who nevertheless show signs that are consistent with interaction with the environment by means of unmistakeably voluntary behaviours in response to orders or gestures. Conclusions. The wide spectrum of signs and symptoms shown by patients with altered levels of consciousness reflects theclinical and neuropathological heterogeneity of these states. The current tendency is to describe the state clinically, adding the aetiology and the date of the event that caused the clinical picture. This article focuses on the context of an effort made by the scientific community to highlight the needs of this growing population (AU)

[From the vegetative state to unresponsive wakefulness: a historical review]. / Del estado vegetativo al estado de vigilia sin respuesta: una revisión histórica.

INTRODUCTION: Over the last few decades, the terminology, diagnostic techniques and treatment of patients with altered levels of consciousness have varied considerably. At the same time, the percentage of patients in this clinical situation has undergone a marked increase. AIMS: The purpose of this study is to present a historical review of the different terms that have been used in the medical literature to describe patients with altered states of consciousness. The article also includes the different diagnostic criteria utilised by research groups that have focused their attention on this population. DEVELOPMENT: The concept of 'vegetative state', a term coined back in the sixties, has since been transformed and replaced by other terms with a less negative connotation, such as 'unresponsive wakefulness syndrome'. In parallel, new clinical categories (minimally conscious state or minimally conscious plus) have appeared since it has been acknowledged that there are patients with a low level of consciousness but who nevertheless show signs that are consistent with interaction with the environment by means of unmistakeably voluntary behaviours in response to orders or gestures. CONCLUSIONS: The wide spectrum of signs and symptoms shown by patients with altered levels of consciousness reflects the clinical and neuropathological heterogeneity of these states. The current tendency is to describe the state clinically, adding the aetiology and the date of the event that caused the clinical picture. This article focuses on the context of an effort made by the scientific community to highlight the needs of this growing population.

Situación somatofisiológica y nutricional de los jóvenes inmigrantes en España. Variación según género y procedencia

Los 13 y 14 años del ciclo vital humano son muy sensibles al entorno, por lo que los procesos migratorios y los cambios de condiciones de vida asociados pueden incidir en mayor medida. El objetivo del estudio es caracterizar la situación somática y nutricional de la población adolescente inmigrante de Madrid con la objetividad de la valoración bioantropométrica. Se han evaluado 519 adolescentes escolarizados no nacidos en España. Los muestreos se efectuaron en los centros escolares públicos de la Comunidad de Madrid y se realizaron los siguientes grupos: Muestra control española (38,9%), América Latina (50,9%), Norte de África (4,5%), Asia (3,8%) y Europa del Este (1,9%). La situación ponderal es de Normopeso para el total de la muestra, salvo en los varones de Europa del Este (Sobrepeso). El patrón alimentario reflejó una frecuencia diaria de ingestas de 3,73±0,91, siendo la comida más representada la cena. La calidad de la dieta medida por KidMed mostró que el 10,2% seguía una dieta de baja calidad, el 58,6% presenta una dieta mejorable y el 31,2% óptima. Las mayores puntuaciones se encontraron en el colectivo Magrebí y las más bajas en el Asiático. En todos los grupos se encontró una tendencia al aumento de la ingesta de fruta y verdura en España.

The 13 and 14 years of human life cycle are very sensitive to environment, so that migration and changes in living conditions related may influence further. The aim of this study is to characterize the nutritional and somatic status of the immigrant adolescent population of Madrid with the objectivity of bioanthropometric assessment. 519 adolescent students not born in Spain were evaluated. The sample was taken in the public schools of the Community of Madrid and conducted the following groups: Spanish control sample (38.9%), Latin America (50.9%), Magreb (4.5%), Asia (3.8%) and Eastern Europe (1.9%). The situation is Normal weight for the total sample, except in boys of Eastern Europe (Overweight). The pattern reflected a daily dietary intake of 3.73 ± 0.91, being the dinner the most represented food. The diet quality as measured by KidMed showed that 10.2% followed a low quality diet, 58.6% have a better diet and 31.2% optimal. Higher scores were found in the Magreb group and lowest in Asia. In all groups showed a trend towards increased consumption of fruit and vegetables in Spain.

[Somatophysiologycal and nutritional characterization of teen immigrants in Spain. Variation by gender and origin]. / Situación somatofisiológica y nutricional de los jóvenes inmigrantes en España. Variación según género y procedencia.

The 13 and 14 years of human life cycle are very sensitive to environment, so that migration and changes in living conditions related may influence further. The aim of this study is to characterize the nutritional and somatic status of the immigrant adolescent population of Madrid with the objectivity of bioanthropometric assessment. 519 adolescent students not born in Spain were evaluated. The sample was taken in the public schools of the Community of Madrid and conducted the following groups: Spanish control sample (38.9%), Latin America (50.9%), Magreb (4.5%), Asia (3.8%) and Eastern Europe (1.9%). The situation is Normal weight for the total sample, except in boys of Eastern Europe (Overweight). The pattern reflected a daily dietary intake of 3.73 +/- 0.91, being the dinner the most represented food. The diet quality as measured by KidMed showed that 10.2% followed a low quality diet, 58.6% have a better diet and 31.2% optimal. Higher scores were found in the Magreb group and lowest in Asia. In all groups showed a trend towards increased consumption of fruit and vegetables in Spain.