Influencia de la dispersión y el envejecimiento de la población sobre la realización de algunos procedimientos comunes en personas de edad avanzada / Influence of dispersion and aging on the frequency of some common interventions in the elderly

Fundamento y objetivo. Las administraciones han de procurar asistencia equitativa que compense los factores de resistencia, tales como las dificultades de comunicación y las derivadas del envejecimiento. Nuestro objetivo fue analizar la influencia de la dispersión y del envejecimiento de la población, sobre la tasa de realización de algunos procedimientos quirúrgicos comunes en pacientes ancianos. Población y métodos. Se utilizó la base de datos de la actividad quirúrgica del único hospital público de una provincia española para identificar las intervenciones de cataratas, cadera e implantes de marcapasos efectuadas durante el año 2010. Se calculó la tasa de realización de cada procedimiento, y la proporción de mayores de 65 años en cada municipio en función del censo del Instituto Nacional de Estadística. Como medida de dispersión se analizó el tiempo de acceso al hospital. Resultados. La población se distribuía en 339 núcleos de población, el 90% menores de 1.000 habitantes. Las poblaciones peor comunicadas eran menores (r=-0,194; p<0,0001)y tenían una proporción mayor de ancianos (r=0,406; p<0,0001). No se identificó relación entre la frecuentación de las intervenciones y el número de habitantes o el tiempo de desplazamiento. Cuando se analizó la población agrupada en isocronas de 30min tampoco se encontraron diferencias. El porcentaje de mayores de 65 años se asoció de forma independiente a la frecuentación de la catarata (beta=0,211; p<0,001), y mostró tendencia a una mayor frecuentación para intervenciones de marcapasos y cadera. Conclusiones. Con la actual organización de la asistencia, ni la dispersión ni el envejecimiento parecen reducir la frecuentación de intervenciones típicas de población anciana en el territorio analizado(AU)

Background and objective. Public administrations have to procure equitable care that compensates resistance factors such as communication problems and those arising from aging. Our objective was to analyze the influence of population dispersion and aging on the frequency rate of some common surgical procedures in elderly patients. Patients and methods. We used the database of surgical activity of the only hospital in a Spanish province to identify cataract surgeries, hip replacements and pacemaker implants performed during 2010. Using the National Statistics Institute Census, we calculated the rate for each procedure and the proportion of inhabitants over 65 in each municipality. Time needed to access the hospital by road from each municipality was used as a measure of dispersion. Results. The population was distributed into 339 population centers, 90% of which had less than 1,000 inhabitants. The worst communicated populations were smaller (r=−0.194; P<.0001) and had a higher proportion of elderly (r=0.406; P<.0001). No relationship was found between the frequentation of the selected interventions and the number of inhabitants or travel time. Similarly, no differences were found when the analysis was done by pooling the population for 30 minutes isochrones. The percentage of those over 65 years was independently associated to the frequency rate of cataract surgery (beta=0.211; P<.001) and showed a trend to increased frequency for the implantation of pacemakers and hip replacements. Conclusions. Our study shows that, with the current organization of care and in the territory analyzed, neither population dispersion nor aging seems to reduce frequentation of several interventions typical of the elderly population(AU)

Influence of dispersion and aging on the frequency of some common interventions in the elderly.

BACKGROUND AND OBJECTIVE: Public administrations have to procure equitable care that compensates resistance factors such as communication problems and those arising from aging. Our objective was to analyze the influence of population dispersion and aging on the frequency rate of some common surgical procedures in elderly patients. PATIENTS AND METHODS: We used the database of surgical activity of the only hospital in a Spanish province to identify cataract surgeries, hip replacements and pacemaker implants performed during 2010. Using the National Statistics Institute Census, we calculated the rate for each procedure and the proportion of inhabitants over 65 in each municipality. Time needed to access the hospital by road from each municipality was used as a measure of dispersion. RESULTS: The population was distributed into 339 population centers, 90% of which had less than 1,000 inhabitants. The worst communicated populations were smaller (r=-0.194; P<.0001) and had a higher proportion of elderly (r=0.406; P<.0001). No relationship was found between the frequentation of the selected interventions and the number of inhabitants or travel time. Similarly, no differences were found when the analysis was done by pooling the population for 30 minutes isochrones. The percentage of those over 65 years was independently associated to the frequency rate of cataract surgery (beta=0.211; P<.001) and showed a trend to increased frequency for the implantation of pacemakers and hip replacements. CONCLUSIONS: Our study shows that, with the current organization of care and in the territory analyzed, neither population dispersion nor aging seems to reduce frequentation of several interventions typical of the elderly population.

[Emergent drugs (III): hallucinogenic plants and mushrooms]. / Drogas emergentes (III): plantas y hongos alucinógenos.

An increase in the consumption of vegetable substances with a hallucinogenic effect has been observed. Some of these substances are associated with ancestral religious ceremonies, while many of them are legal or are partially regulated. Salvia divinorum is a powerful kappa receptor agonist, with dissociative and hallucinogenic properties, which start quickly and have a short duration. Kratom (Mytragyna speciosa) has mitragynine as its principal alkaloid, with stimulating effects at low doses (coke-like effect), and sedative effects (opiate-like effect) at high doses. Several deaths from its consumption have been detected. The consumption of hallucinogenic mushrooms appears in cyclic form, although there has been increase in their online offer. They are consumed in search of their hallucinogenic effects, above all those belonging to the family of psilocybes, which contain tryptamines with a hallucinogenic effect similar to LSD. Peyote (Lophophora psilocybes), a cactus rich in mescaline (trimetoxifeniletilamina), produces hallucinations of the five senses, and forms part of the religious culture of the North American Indians. Daturas, which are ubiquitous, produce anticholinergic symptoms and effects on the central nervous system (delirium, hallucinations, etc.), due to their high atropine and scopolamine content. Other substances used for their hallucinogenic effects include the drink known as ayahuasca, and seeds for preparing infusions like Ololiuqui, Morning Glory (Ipomoea violacea), Hawaian Baby Woodrose (Argyreia nervosa), Syrian Rue (Peganum harmala) and Iboga Rootbark (Tabernanthe iboga).

Genetic testing in the European Union: does economic evaluation matter?

OBJECTIVE: We review the published economic evaluation studies applied to genetic technologies in the EU to know the main diseases addressed by these studies, the ways the studies were conducted and to assess the efficiency of these new technologies. The final aim of this review was to understand the possibilities of the economic evaluations performed up to date as a tool to contribute to decision making in this area. METHODS: We have reviewed a set of articles found in several databases until March 2010. Literature searches were made in the following databases: PubMed; Euronheed; Centre for Reviews and Dissemination of the University of York-Health Technology Assessment, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database; and Scopus. The algorithm was "(screening or diagnosis) and genetic and (cost or economic) and (country EU27)". We included studies if they met the following criteria: (1) a genetic technology was analysed; (2) human DNA must be tested for; (3) the analysis was a real economic evaluation or a cost study, and (4) the articles had to be related to any EU Member State. RESULTS: We initially found 3,559 papers on genetic testing but only 92 articles of economic analysis referred to a wide range of genetic diseases matched the inclusion criteria. The most studied diseases were as follows: cystic fibrosis (12), breast and ovarian cancer (8), hereditary hemochromatosis (6), Down's syndrome (7), colorectal cancer (5), familial hypercholesterolaemia (5), prostate cancer (4), and thrombophilia (4). Genetic tests were mostly used for screening purposes, and cost-effectiveness analysis is the most common type of economic study. The analysed gene technologies are deemed to be efficient for some specific population groups and screening algorithms according to the values of their cost-effectiveness ratios that were below the commonly accepted threshold of 30,000€. CONCLUSIONS: Economic evaluation of genetic technologies matters but the number of published studies is still rather low as to be widely used for most of the decisions in different jurisdictions across the EU. Further, the decision bodies across EU27 are fragmented and the responsibilities are located at different levels of the decision process for what it is difficult to find out whether a given decision on genetic tests was somehow supported by the economic evaluation results.

Elaboración de una fórmula farmacéutica a tráves de un diseño experimental de mezclas / A pharmaceutical formulation development using a experimental mixture design

El objetivo principal de este trabajo es aplicar el diseño experimental de mezclas a la formulación de una forma farmacéutica sólida (ibuprofeno) mediante el estudio de sus excipientes y la proporción de estos en la formulación, además de mostrar cómo el personal de investigación y desarrollo en las empresas farmacéuticas nacionales puede utilizar las herramientas estadísticas, como el diseño experimental de mezclas, para obtener un producto con las características requeridas, y posteriormente su optimización reduciendo no sólo los costos de investigación sino también los costos de producción. El diseño experimental de mezclas permite estudiar el comportamiento de la formulación de ibuprofeno desde el punto de vista farmacotécnico, a través del análisis del ángulo de reposo, la dureza del núcleo y la friabilidad, además del índice de Carr´s caracterizando una superficie de respuesta que permite un eficiente aprovechamiento de esta metodología para la resolución del problema de formulación. El ángulo de reposo muestra que se debe mejorar la fluidez de la formulación para garantizar un correcto llenado de las matrices en el proceso de tableteado a escala industrial, los parámetros de dureza y friabilidad muestran que las formulaciones cumplen y que se puede seguir con un proceso de optimización de la formulación.

Sexually mature male goldfish release large quantities of androstenedione into the water where it functions as a pheromone.

Previous studies have demonstrated that ovulatory female goldfish release a variety of sex steroids into the water where they function as a pheromonal blend dominated by C21 steroids that stimulates male hormone release, sperm production and behavior. This study investigated whether male goldfish might also release sex steroids with pheromonal activity. It found that spermiated male goldfish release substantial quantities of androstenedione (AD; about 50 ng/h) together with smaller (10-20 ng/h) quantities of several other related C19 steroids but only very small quantities (<5 ng/h) of C21 steroids. Further, when sexually aroused by females and/or their pheromones, males released even greater quantities of AD (up to 1 microg/h) while C21 steroid release rate changed little. This created a ratio of C19 to C21 steroids of about 50:1 that was dramatically different from that emitted by females (1:7). The male olfactory system was also found to be extremely sensitive to AD, detecting it to near picomolar concentrations. Together with previous studies that have shown water-borne AD to increase male aggressive behavior while suppressing responsiveness to female pheromones, this study establishes AD as a male pheromone in the goldfish. Because ovulating females also release AD but in the presence of C21 steroids, recognition of the male-derived steroid pheromone is presumably mixture dependent.

[The state of poisoning in Navarra]. / Situación de las intoxicaciones en Navarra.

We briefly comment on the state of clinical toxicology in Navarra and in the rest of Spain, with reference to the Toxicology Committee of Navarra and its aims. Epidemiological data from the Emergency Service of the Hospital of Navarra is presented, as well as where to find information on the subject; the epidemiological registration sheet designed by the SEMESTOX group is attached. A description is given of the characteristics of therapeutic drugs and drugs of abuse determination (type of sample, methodology and interpretation of results) carried out in the toxicological analytical unit of the Hospital of Navarra. Finally, reference is made to all of the antidotes available to the Pharmacy Service of the Hospital of Navarra, which is the reference center for the whole of the autonomous community of Navarra. A description is given for each medicine including its indications.

[Acute pharmacologic poisoning (I). Psychotropic and antiarrhythmic drugs]. / Intoxicaciones medicamentosas (I). Psicofármacos y antiarrítmicos.

In the evaluation of Acute Drug Poisoning (ADP) in patients seriously ill with a potentially non-toxic dose of the drug that is theoretically responsible, it is important to insist on anamnesis in the coingestion of other drugs or toxics. Initially attention is given to life support measures, oxygenation, protection of the airway and expanding the volemia. The ECG is a diagnostic tool of the first order in ADPs, above all for tricyclic antidepressants (TAD) and cardio-vascular drugs. In the majority of cases continuous monitoring is usually necessary during the first 12-24 hours. The benzodiazepines do not usually give rise to serious poisoning. The use of flumazenil will be reserved for cases of respiratory depression, deep coma or where the cause is undetermined. They can give rise to convulsions, above all in the case of mixed poisonings with anti-depressants and abstinence syndrome. The TADs have an enormous potential seriousness, as they can cause mortal arrhythmias. The therapeutic range of lithium is very narrow; it can produce signs of basically digestive and neurological toxicity. In the case of poisoning by digoxin, the use of anti-digital anti-bodies will be considered in cases of serious bradyarrhythmias, AV blocks or PCR. Glucagon is the antidote for serious poisoning by beta-blockers and for refractory hypotension in cases of calcioantagonists.

[Drug poisoning]. / Intoxicación por drogas.

A review is made of acute poisoning by opiates and its treatment in the emergency services, bearing in mind the progressive decline in the number of cases presented with the arrival of new forms of their administration, as well as the presence of new addictive drugs that have resulted in a shift in consumption habits. Reference is also made to the way in which the different types of existing substances originated, with the aim of achieving a better understanding of their use and in order to administer the most suitable treatment when poisoning occurs. Cocaine poisoning is discussed, with reference to its clinical picture, diagnosis and treatment. The consumption of illegal drugs in our country has undergone a notable change in recent years, with heroin being relegated and the incorporation of cocaine, amphetamine derivatives such as "ecstasy" (MDMA), "liquid ecstasy" (GHB) and, to a lesser extent, ketamine. A review is made of cannabis and its derivates, from the history of its consumption and the preparations employed to the effects produced in the different bodily systems. A brief explanation is also given of its metabolites and its principal mechanisms of action. Finally, we comment on the effects of LSD and hallucinogenic mushrooms.

[Animal sting and bites]. / Picaduras y mordeduras de animales.

Under the heading of this subject we deal with stings by arthropods, making reference to the differences that exist between the stings of wasps and bees, commenting on the composition of the poisons and the different local and general reactions that are caused by such stings. Also discussed are the stings/bites caused by scorpions, spiders, ticks, and marine animals, with the clinical picture they provoke and the treatment that must be administered. Finally, snakebites are considered, with reference to the most frequent types of ophidia to be found in Navarra, how to differentiate between the bites of snakes and vipers, the different clinical pictures they provoke and the treatment to be applied

[Poisoning by foodstuffs, plants and mushrooms]. / Intoxicación por alimentos, plantas y setas.

Food poisoning is defined as poisoning caused by any foodstuff or alimentary product that causes poisoning because it contains toxic substances, germs, metals, additives, hormones, etc. It forms an important part of Clinical Toxicology, although in the majority of statistics, alimentary toxic infections provoked by bacteria, protozoa and viruses are not classified as poisonings, since they are caused by germs, and are classified as infections. Reference is made within this subject to all types of pathologies due to food, with special emphasis given to botulism. The clinical picture of botulism is discussed in its different clinical forms, but above all in its adult form which is contracted through the consumption of undercooked or badly preserved foods; poisoning by fish and seafood. Also described are the toxicological pictures that can be caused by the consumption of plants containing toxic substances, framed by the different symptomologies they produce; finally, poisonings by mushrooms are set out according to the period of incubation and possible confusions.

[Primary care: decentralization and efficiency]. / La Atención Primaria de Salud: descentralización y eficiencia.

OBJECTIVE: The purpose of this study was to evaluate whether the productive behavior of health centers in autonomous communities with competence in health is more efficient than that among centers belonging to Spanish public health system (INSALUD). METHODS: The technical efficiency of 66 health centers in Alava, Navarre and La Rioja was analyzed. Centers in autonomous communities that in 1997 had been granted complete authority from the central government to manage their healthcare services were compared with centers whose administration, in the same year, was still in the hands of INSALUD. The method used to measure and quantify the efficiency of these centers was data envelopment analysis. RESULTS: Nonparametric contrast of the health centers' mean efficiency rates revealed no significant differences in the (in)efficiency of centers from La Rioja, Navarre and Alava. CONCLUSIONS: The results obtained from the model of efficiency measurement used did not indicate that decentralization improves the productive efficiency of primary care centers.

La Atención Primaria de Salud: descentralización y eficiencia / Primary care: decentralization and efficiency

Objetivo: El propósito de este artículo es comprobar si el comportamiento productivo de los centros de salud pertenecientes a comunidades autónomas con competencias en sanidad es más eficiente que el de los centros dependientes del INSALUD. Métodos: Se lleva a cabo un análisis comparado de la eficiencia técnica de 66 centros de salud de Álava, Navarra y La Rioja; centros pertenecientes a comunidades autónomas que, en el año objeto de estudio (1997), tenían totalmente transferidas las competencias sanitarias, y centros cuya gestión, en dicho año, estaba en manos del INSALUD. El método utilizado para medir y cuantificar la eficiencia de dichos centros es el análisis envolvente de datos (AED). Resultados: El contraste no paramétrico de las tasas de eficiencia media de los centros de salud riojanos, navarros y alaveses no evidencia diferencias significativas en el comportamiento (in)eficiente de dichos centros. Conclusiones: Los resultados obtenidos a partir del modelo de medición de la eficiencia considerado no detectan una mayor eficiencia en el comportamiento productivo de los centros de salud descentralizados. (AU)

A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons.

AIMS/HYPOTHESIS: Insulin resistance usually precedes the diagnosis of Type II (non-insulin-dependent) diabetes mellitus. However, in most patients, the clinical expression of the disease could be prevented by dietary and lifestyle changes. We investigated the effects of a diet enriched in monounsaturated fatty acids (Mediterranean diet) and a low fat, high-carbohydrate diet on in vivo and in vitro glucose metabolism in 59 young subjects (30 men and 29 women). METHODS: We carried out an intervention dietary study with a saturated fat phase and two randomized-crossover dietary periods: a high-carbohydrate diet and a Mediterranean diet for 28 days each. We analysed the plasma lipoproteins fractions, free fatty acids, insulin sensitivity and glucose uptake in isolated monocytes at the end of the three dietary periods. RESULTS: In comparison to the saturated fat diet, the CHO and Mediterranean diets induced a decrease of LDL-cholesterol (p < 0.001) and HDL-cholesterol (p < 0.001). Steady-state plasma glucose decreased (p = 0.023) and basal and insulin-stimulated 2-deoxiglucose uptake in peripheral monocytes increased in both diets (CHO and Mediterranean), (p = 0.007) indicating an improvement in insulin sensitivity. Fasting free fatty acids plasma values were correlated positively with steady state plasma glucose (r = 0.45; p < 0.0001). In addition, there was an inverse correlation between the mean glucose of the steady state plasma glucose period and logarithmic values of basal (r = -0.34; p = 0.003) and insulin stimulated glucose uptake in monocytes (r = -0.32; p = 0.006). CONCLUSION/INTERPRETATION: Isocaloric substitution of carbohydrates and monounsaturated fatty acids for saturated fatty acids improved insulin sensitivity in vivo and in vitro, with an increase in glucose disposal. Both diets are an adequate alternatives for improving glucose metabolism in healthy young men and women.

Food intake inhibition by melatonin in goldfish (Carassius auratus).

Feeding regulation by monoamines, neuropeptides and certain hormones has been studied in fish, but a possible role of melatonin is unknown. The purpose of the present study was to investigate the effects of melatonin on food intake in goldfish. Fishes were housed in 12L:12D and injected with different doses of either melatonin or 2-iodomelatonin. Two routes of administration, intracerebroventricular and intraperitoneal injections, and two times of the daily photocycle, midday and midnight, were tested. Food intake was measured at 2, 5 and 8 h postinjection. Melatonin and its analog, 2-iodomelatonin intracerebroventricularly injected had no effect on food intake at any time. However, intraperitoneal injections of both indoleamines significantly reduced food intake at different postinjection times. The inhibitory effect of melatonin was blocked by intraperitoneal administration of its antagonist, luzindole. These results demonstrate the in vivo efficiency of luzindole as melatonin antagonist, and thus provide a useful experimental tool to investigate melatonin functions. In conclusion, both melatonin and its agonist 2-iodomelatonin administered peripherally, inhibit food intake in goldfish, and this inhibitory effect appears to be mediated via luzindole-sensitive melatonin receptors. Our results strongly suggest that melatonin is involved in the peripheral satiety mechanisms in goldfish.

NPY receptors and opioidergic system are involved in NPY-induced feeding in goldfish.

The present study evaluated the effects of both intraperitoneal (i.p. ) and intracerebroventricular administration of selective Y(1) [(Leu(31), Pro(34))-NPY] and Y(2) [(Pro(13), Tyr(36))-NPY (13-36)] receptor agonists on food intake in satiated goldfish. Food intake (FI) was significantly increased by central administration of the Y(1) agonist (1 microg), but not by the Y(2) agonist, at 2 h postinjection. The feeding increase induced by (Leu(31), Pro(34))-NPY was in a similar magnitude to that obtained after ICV injection of the neuropeptide Y, and both feeding stimulations were reversed by the NPY (27-36), a general NPY antagonist. The i.p. administration of the agonists either did not significantly modify (Y(2) agonist) or decreased (Y(1) agonist) food intake in goldfish. These data indicate that it is the Y(1)-like (similar to Y(1) and/or Y(5)) receptor, and not Y(2), that is involved in the central modulation of the feeding behavior in goldfish. We also investigated the possible involvement of opioid peptides as mediators of the NPY stimulatory action on food intake in goldfish. The ICV administration of naloxone (10 microg), a general opioid antagonist, blocked the NPY-induced feeding in goldfish, suggesting that the opioidergic system is involved in feeding regulation by NPY.

Naltrindole administration during the preweanling period and manipulation affect adrenocortical reactivity in young rats.

The effect of a daily injection of the delta-selective opioid antagonist naltrindole (1 mg/kg), from birth to postnatal day 19, on basal and post-stress corticosterone levels in 25-day old rats of both sexes was investigated. The effects of manipulation were studied by including two control groups, one group received daily injections of saline and a second one was not manipulated. The stress protocol consisted of a 3 min swimming session in water at 20 degrees C. Corticosterone determinations were performed by radioimmunoassay. Control non-manipulated animals showed a significant increase in corticosterone levels in response to stress. Manipulation decreased basal hormone levels in females and prevented the stress-induced rise in corticosterone in males. Functional blockade of the delta-receptor during the preweanling period by the naltrindole treatment inhibited the corticosterone response to stress in females. The results indicate the existence of sex differences in the effects of manipulation on hypothalamus-pituitary-adrenal axis activity and the involvement of the delta-opioid receptor in the modulation of the adrenocortical response to stress during the postnatal period.

Alpha1-adrenergic and dopaminergic receptors are involved in the anoretic effect of corticotropin-releasing factor in goldfish.

This study investigates the noradrenergic and/or dopaminergic receptors subtypes involved in the anoretic action of CRF in goldfish. Agonists and antagonists of alpha1- and alpha2-adrenoceptors, and D1- and D2-dopaminergic receptors were intracerebroventricularly (i.c.v.) administered alone or in combination with CRF in the case of antagonists. Food intake and hypothalamic content of catecholamines and their metabolites were measured at 2 h postinjection. On one hand, alpha1-adrenergic receptor antagonist, but not alpha2, blocked the anoretic effect of CRF. Moreover, we found a blockade of CRF-induced anoretic action by pretreatment with specific D1- and D2-dopaminergic antagonists. On the other hand, the i.c.v. administration of CRF reduced hypothalamic norepinephrine (NE) and dopamine (DA) content, without modifications in their metabolism. Thus, our results suggest that the anoretic effect of CRF appears to be mediated by alpha1-adrenergic and dopaminergic receptors in fish. Second, the reduction in hypothalamic NE and DA synthesis could be due to a direct effect of CRF treatment and/or a secondary effect of food intake reduction.

Inhibitory effect of serotonin on feeding behavior in goldfish: involvement of CRF.

The possible action of 5-HT on feeding behavior in goldfish has been studied. Food intake was significantly reduced by intracerebroventricular (ICV) injection of serotonin (5-HT, 10 microg) at 2 h postinjection. After peripheral (intraperitoneal) administration of 5-HT (1 and 10 microg/g bw), no significant modifications in food intake were detected. Thus, it can be concluded that there is a central anoretic action of 5-HT in teleost fish. Taking in mind the inhibitory effect of corticotropin releasing factor (CRF) on feeding in teleosts and the interactions between 5-HT and CRF described in mammals, we investigated the possible involvement of CRF as mediator of the 5-HT anoretic action in goldfish. The ICV pretreatment with alpha-Helical CRF[9-41](20 microg) partially blocked the inhibitory effect of 5-HT on food consumption in goldfish. These results show that CRF mediates, at least in part, the 5-HT-induced feeding inhibition in goldfish. On the other hand, the alterations in hypothalamic indoleamines content evoked by ICV treatments would suggest that the activation of CRF neurons by 5-HT appears to inhibit hypothalamic serotoninergic transmission, supporting the intermediate role of this neuropeptide in the central anoretic effect of 5-HT in goldfish.