Benefit of health education by a training nurse in patients with axial and/or peripheral psoriatic arthritis: A systematic literature review.

The aim of this study was to systematically review the literature available about the benefit of health education by a training nurse in patients with axial and/or peripheral psoriatic arthritis in the framework of the drawing up of the axial spondyloarthritis and psoriatic arthritis guidelines of the "Spanish Society of Rheumatology". Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, Medline/PubMed, CINAHL) were systematically searched from inception to 2014 using medical subject headings and keywords. Only articles in English, Spanish and French were included. The patients studied had to be diagnosed of psoriatic arthritis (all ages, both sexes) with axial involvement and/or peripheral arthritis who had received health education by a specialized nurse. We included in the search randomized clinical trials, cohort observational studies, descriptive studies and case series and qualitative research studies. Measured outcomes were those related to the education provided in a nursing consultation such as increased adherence to biological therapy, conducting exercises, smoking cessation and patient satisfaction. Eight studies were included, five randomized clinical trials with moderate level of quality and three intervention studies with no control group with low level of quality. Meta-analyses were not undertaken due to clinical heterogeneity. According to our results, it can be concluded that although there is little evidence on the role of a trained nurse in patients with psoriatic arthritis, this role can be beneficial to the patients because it can increase the rate of adherence to treatment prescribed by a rheumatologist, promotes patient self-management of their disease and increases patient satisfaction.

Calibrated prevalence of infertility in 30- to 49-year-old women according to different approaches: a cross-sectional population-based study.

STUDY QUESTION: How does the estimated prevalence of infertility among 30- to 49-year-old women vary when using different approaches to its measurement? SUMMARY ANSWER: The prevalence of women with difficulties in conceiving differed widely according to the measurement approach adopted. WHAT IS KNOWN ALREADY: Establishing the true magnitude of infertility as a public health problem is challenging, given that it is not categorized as a disability or chronic condition and may be largely unreported. The time required to conceive is an increasingly frequent concern among couples of reproductive age. Population-based studies do not consider multiple approaches to infertility measurement in the same sample. STUDY DESIGN, SIZE, DURATION: A face-to-face cross-sectional population-based survey of 443 women aged between 30 and 49 years residing in Huelva, southern Spain, was carried out. The sample size estimation was based on an assumed prevalence of infertility of 19%, a sampling error of ±4.84 percentage points, a design effect of 1.8 and a 95% confidence level. The information was collected in 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS: Self-reported information was gathered on socio-demographic data, pregnancy history, time required to become pregnant and perception of difficulties in becoming pregnant. Eight approaches to the estimation of infertility prevalence were considered: diagnosed infertility, subjective infertility, 1-year infertility, primary infertility, secondary infertility and subfertility based on the time taken to conceive (6, 12 or 24 months). Calibration estimators (indirect estimation techniques) were used to extrapolate the infertility prevalences to the whole of Spain. MAIN RESULTS AND THE ROLE OF CHANCE: The response rate was 61.05%. Among 30- to 49-year-old Spanish women, 1.26% had a clinical diagnosis of infertility, 17.58% did not achieve pregnancy in 1 year (1-year infertility), 8.22% perceived difficulties in procreation (subjective infertility), 6.12% had not succeeded in having biological children (primary infertility) and 11.33% had not been able to have another biological child (secondary infertility). Finally, pregnancy was not achieved within 6, 12 and 24 months of starting to attempt conception in 19.98, 11.21 and 4.36% of women, respectively. These approaches to estimate the prevalence of infertility show similar socio-demographic patterns except for educational level. Calibration adjustments allowed extrapolation of these prevalences to Spain and a reduction of from 3.7 to 90.4% in their variances. LIMITATIONS, REASONS FOR CAUTION: The response rate was moderate but acceptable in comparison to similar studies. We only asked whether the women had practiced intercourse without contraceptive methods for >1 year. Hence, we could only calculate the time for which a couple were trying to become pregnant when the woman became pregnant, and we do not know whether it was longer than 1 year for the women failing to conceive. Future research should avoid this study weakness by gathering quantitative data on the months during which vaginal sexual intercourse was practiced, with no time limit. The only prevalence with a high coefficient of variation was that for diagnosed infertility, and our estimation for this prevalence should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS: Despite major differences according to the approach adopted, the prevalences of infertility estimated in our study are comparable with those obtained in other similar studies. A set of categories to measure infertility including subjective infertility, 1-year infertility and subfertility have been proposed here, which may be useful for cross-disciplinary comparisons of infertility in clinical and population-based studies. These measures may also assist health managers to tailor fertility resources and services to the real needs of the population and provide a more rapid and effective response to couples. Finally, the calibration adjustments (indirect estimation techniques) applied to the infertility prevalences help to maximize their generalization and improve accuracy. This technique may be considered as a model for application in other epidemiological studies.

Atributos psicométricos de la versión española de la escala de cribado A-TAC para trastornos del espectro autista / Psychometric attributes of the spanish version of A-TAC screening scale for autism spectrum disorders

Introducción: Actualmente debido a la ausencia de marcadores biológicos, el cribado de trastornos del espectro autista (TEA) se centra fundamentalmente en la presencia de alteraciones conductuales caracterizadas por alteraciones en la interacción social y comunicación verbal y no verbal. Objetivo: Evaluar los atributos psicométricos de la versión española de la escala de autismo Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC), como medida de cribado de TEA. Material y métodos: Se incluyó en el estudio a 140 escolares (43% niños, 57% niñas), de edades comprendidas entre los 6 y los 16 años, con TEA (n = 15), discapacidad intelectual (n = 40), enfermedades psiquiátricas (n = 22), tics (n = 12) y participantes controles (n = 51). Se analizaron los principales atributos psicométricos como la fiabilidad, asunción escalar, la consistencia interna, la precisión y la validez predictiva. Resultados: La consistencia interna de la A-TAC fue alta (α = 0,93) y el error estándar de medida fue adecuado (1,13 [intervalo de confianza del 95%, —1,08 a 3,34]). Las puntuaciones medias de la escala A-TAC fueron más altas en participantes diagnosticados con TEA y discapacidad intelectual comparadas con el resto de participantes (p < 0,001), siendo el área bajo la curva de 0,96 para el grupo de TEA. Conclusión: La subescala de autismo de la escala A-TAC es un instrumento fiable, válido y preciso para el cribado de TEA en la población escolar española (AU)

Background: As there are no biological markers for Autism Spectrum Disorders (ASD), screening must focus on behaviour and the presence of a markedly abnormal development or a deficiency in verbal and non-verbal social interaction and communication. Objective: To evaluate the psychometric attributes of a Spanish version of the autism domain of the Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC) scale for ASD screening. Material and methods: A total of 140 subjects (43% male, 57% female) aged 6-16, with ASD (n = 15), Mental Retardation (n = 40), Psychiatric Illness (n = 22), Tics (n = 12) and controls (n = 51), were included for ASD screening. The predictive validity, acceptability, scale assumptions, Internal consistency, and precision were analysed. Results: The internal consistency was high (α = 0.93), and the standard error was adequate (1.13 [95% CI, -1.08 a 3.34]). The mean scores of the Autism module were higher in patients diagnosed with ASD and mental disability compared to the rest of the patients (P < 0.001). The area under the curve was 0.96 for the ASD group. Conclusion: The autism domain of the A-TAC scale seems to be a reliable, valid and precise tool for ASD screening in the Spanish school population (AU)

[Psychometric attributes of the Spanish version of A-TAC screening scale for autism spectrum disorders]. / Atributos psicométricos de la versión española de la escala de cribado A-TAC para trastornos del espectro autista.

BACKGROUND: As there are no biological markers for Autism Spectrum Disorders (ASD), screening must focus on behaviour and the presence of a markedly abnormal development or a deficiency in verbal and non-verbal social interaction and communication. OBJECTIVE: To evaluate the psychometric attributes of a Spanish version of the autism domain of the Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC) scale for ASD screening. MATERIAL AND METHODS: A total of 140 subjects (43% male, 57% female) aged 6-16, with ASD (n=15), Mental Retardation (n=40), Psychiatric Illness (n=22), Tics (n=12) and controls (n=51), were included for ASD screening. The predictive validity, acceptability, scale assumptions, internal consistency, and precision were analysed. RESULTS: The internal consistency was high (α=0.93), and the standard error was adequate (1.13 [95% CI, -1.08 a 3.34]). The mean scores of the Autism module were higher in patients diagnosed with ASD and mental disability compared to the rest of the patients (P<.001). The area under the curve was 0.96 for the ASD group. CONCLUSION: The autism domain of the A-TAC scale seems to be a reliable, valid and precise tool for ASD screening in the Spanish school population.

New Neandertal remains from Cova Negra (Valencia, Spain).

New Neandertal fossils from the Mousterian site of Cova Negra in the Valencia region of Spain are described, and a comprehensive study of the entire human fossil sample is provided. The new specimens significantly augment the sample of human remains from this site and make Cova Negra one of the richest human paleontological sites on the Iberian Peninsula. The new specimens include cranial and postcranial elements from immature individuals and provide an opportunity to study the ontogenetic appearance of adult Neandertal characteristics in this Pleistocene population. Children younger than 10 years of age constitute four of the seven minimum number of individuals in the sample, and this relative abundance of children at Cova Negra is similar that in to other Neandertal sites in Europe and southwest Asia. The recognition of diagnostic Neandertal features in several of the specimens, as well as their western European context and late Pleistocene age, suggests that all the human remains from Cova Negra represent Neandertals. The archaeological evidence from Cova Negra indicates sporadic, short-term occupations of the site, suggesting a high degree of mobility among Neandertals.

Evaluación clínica de los pacientes con artritis reumatoide en España / Clinical evaluation of patients with rheumatoid arthritis in Spain

Fundamento: En los últimos años se han desarrollado instrumentos que permiten evaluar la eficacia clínica de las intervenciones en pacientes con artritis reumatoide (AR). Sin embargo, no hay datos sobre su utilización en la evaluación rutinaria de los pacientes con AR en nuestro país. Objetivo: Analizar los instrumentos utilizados en la evaluación clínica de pacientes con AR en España. Material y métodos: Revisión de 1.379 historias clínicas (HC), seleccionadas aleatoriamente, de pacientes con AR atendidos en 48 servicios de atención especializada de 16 comunidades autónomas. Se realizó una estimación semicuantitativa del número de visitas en dos años en las que se habían utilizado diferentes instrumentos de seguimiento clínico. Resultados: La rigidez matutina y la valoración subjetiva del médico en una escala adjetiva fueron los instrumentos más utilizados (habitualmente o siempre en más del 70% de las HC). El 49,5% de los pacientes tenía al menos un recuento formal de articulaciones dolorosas y tumefactas; el recuento articular más utilizado fue el índice completo del American College of Rheumatology (ACR). La utilización de escalas analógicas visuales (EAV) fue muy infrecuente. Ninguno de los instrumentos de valoración del estado funcional y del estado general de salud fue utilizado habitualmente en la práctica clínica diaria. Conclusiones: El uso de instrumentos cuantitativos en la valoración clínica y el seguimiento de los pacientes con AR en nuestro país es muy escaso, prevaleciendo los instrumentos de seguimiento tradicionales

Background: Several instruments to evaluate the efficacy of clinical interventions in patients with rheumatoid arthritis (RA) have been developed in the last few years. However, there are no data on the utilization of these instruments in the routine evaluation of patients with RA in Spain. Objective: To analyze the instruments used in the clinical evaluation of patients with RA in Spain. Material and methods: The medical records of 1,379 patients diagnosed with RA randomly selected and treated in 48 specialized care units in 16 Autonomous Communities were reviewed. The number of consultations in which several clinical follow-up instruments were employed in a 2-year period was estimated semiquantitatively. Results: The most frequently used instruments (usually or always in > 70% of medical records) were morning stiffness and the physician's overall assessment of disease activity using adjective scales. A total of 49.5% of the patients had at least one formal count of tender and swollen joints and the ACR index was the most commonly used. Visual analogue scales (VAS) were used very infrequently. None of the instruments to evaluate functional ability or overall health status were routinely used in daily practice. Conclusions: The use of quantitative instruments in the clinical evaluation and follow-up of patients with RA is low and traditional instruments of follow-up prevail

Epidemiología actual y futura de la infertilidad / No disponible

No disponible

Variabilidad en el manejo de la osteoporosis en pacientes con artritis reumatoide en España / Variability in the management of osteoporosis in patients with rheumatoid arthritis in Spain

Objetivo: Estudiar en España la variabilidad regional en el diagnóstico y tratamiento de la osteoporosis en los pacientes con artritis reumatoide (AR).Pacientes y métodos: El estudio emAR se realizó mediante la revisión de las historias clínicas de 1.379 sujetos seleccionados de forma aleatoria en 48 servicios clínicos de 15 comunidades autónomas españolas. Entre otros, se recogieron datos relacionados con el diagnóstico de osteoporosis, la prescripción de fármacos para el tratamiento o prevención de esta enfermedad, así como la presencia de tratamiento glucocorticoideo. Resultados: Se habían realizado estudios densitométricos en el 10,8 por ciento de los pacientes. En 549 pacientes (39,8 por ciento) se había prescrito algún tipo de tratamiento para la osteoporosis, con una gran variabilidad que osciló del 8,3 al 66,6 por ciento según la comunidad autónoma. El fármaco empleado con más frecuencia fue el calcio con o sin vitamina D (de 8,3 a 58,3 por ciento), seguido de bifosfonatos (de 0 a 23,1 por ciento) y calcitonina (de 0 a 16,7 por ciento). Todos los fármacos mostraron una marcada variabilidad regional en su uso, incluso en las poblaciones con mayor riesgo de osteoporosis: sexo femenino, tratamiento con glucocorticoides y edad superior a 65 años. Conclusión: Existe una escasa búsqueda activa del diagnóstico de osteoporosis en los pacientes con AR, y una baja prescripción de fármacos antirresortivos, incluso en aquellas subpoblaciones de mayor riesgo (AU)

Evaluación clínica de los pacientes con artritis reumatoide en España / Clinical evaluation of patients with rheumatoid arthritis in Spain

Fundamento: En los últimos años se han desarrollado instrumentos que permiten evaluar la eficacia clínica de las intervenciones en pacientes con artritis reumatoide (AR). Sin embargo, no hay datos sobre su utilización en la evaluación rutinaria de los pacientes con AR en nuestro país. Objetivo: Analizar los instrumentos utilizados en la evaluación clínica de pacientes con AR en España. Material y métodos: Revisión de 1.379 historias clínicas (HC), seleccionadas aleatoriamente, de pacientes con AR atendidos en 48 servicios de atención especializada de 16 comunidades autónomas. Se realizó una estimación semicuantitativa del número de visitas en dos años en las que se habían utilizado diferentes instrumentos de seguimiento clínico. Resultados: La rigidez matutina y la valoración subjetiva del médico en una escala adjetiva fueron los instrumentos más utilizados (habitualmente o siempre en más del 70% de las HC). El 49,5% de los pacientes tenía al menos un recuento formal de articulaciones dolorosas y tumefactas; el recuento articular más utilizado fue el índice completo del American College of Rheumatology (ACR). La utilización de escalas analógicas visuales (EAV) fue muy infrecuente. Ninguno de los instrumentos de valoración del estado funcional y del estado general de salud fue utilizado habitualmente en la práctica clínica diaria. Conclusiones: El uso de instrumentos cuantitativos en la valoración clínica y el seguimiento de los pacientes con AR en nuestro país es muy escaso, prevaleciendo los instrumentos de seguimiento tradicionales (AU)

Background: Several instruments to evaluate the efficacy of clinical interventions in patients with rheumatoid arthritis (RA) have been developed in the last few years. However, there are no data on the utilization of these instruments in the routine evaluation of patients with RA in Spain. Objective: To analyze the instruments used in the clinical evaluation of patients with RA in Spain. Material and methods: The medical records of 1,379 patients diagnosed with RA randomly selected and treated in 48 specialized care units in 16 Autonomous Communities were reviewed. The number of consultations in which several clinical follow-up instruments were employed in a 2-year period was estimated semiquantitatively. Results: The most frequently used instruments (usually or always in > 70% of medical records) were morning stiffness and the physician’s overall assessment of disease activity using adjective scales. A total of 49.5% of the patients had at least one formal count of tender and swollen joints and the ACR index was the most commonly used. Visual analogue scales (VAS) were used very infrequently. None of the instruments to evaluate functional ability or overall health status were routinely used in daily practice. Conclusions: The use of quantitative instruments in the clinical evaluation and follow-up of patients with RA is low and traditional instruments of follow-up prevail (AU)

Ventriculomegalia cerebral unilateral: diagnóstico ecográfico prenatal / Unilateral cerebral ventriculomegaly: prenatal ultrasonographic diagnosis

Presentamos un caso de ventricuIomegalia cerebral unilateral sin asociación a otras malformaciones por lo raro del caso y por el buen desarrollo neurológico posnatal existente (AU)

El estudio sobre el manejo de la artritis reumatoide en España (emAR) (II). Características de los pacientes / Study on the treatment of Rheumatoid Arthritis in Spain (emAR) (II). Patients' characteristics

Fundamento: El estudio sobre el manejo de la artritis reumatoide (AR) en España ha supuesto una oportunidad para conocer si las características de los pacientes difieren de una comunidad autónoma a otra dentro del ámbito español. Material y método: Revisión de 1.379 historias clínicas seleccionadas de forma aleatoria entre 9.299 individuos diagnosticados de AR y atendidos en 48 servicios de atención especializada de 16 comunidades autónomas. Se analizaron las características sociodemográficas, de la enfermedad y diferentes variables administrativas. Resultados: La mediana de edad fue de 63 años (53,1-71), el 73 por ciento eran mujeres y el tiempo de evolución 105 meses (57-172), sin diferencias entre comunidades autónomas. El 75 por ciento era factor reumatoide positivo y el 37,4 por ciento tenía alguna manifestación extraarticular. El 51 por ciento había tenido una AR activa a lo largo de 2 años de seguimiento, la mayoría se encontraba en una clase funcional II del ACR y el 25,9 por ciento necesitó de alguna cirugía. El estudio sobre el manejo de la artritis reumatoide en España (emAR) (II). Características de los pacientes articular a lo largo de su evolución. Existió una gran variabilidad en la expresión clínica de la enfermedad de una comunidad autónoma a otra. La mayoría de los pacientes fueron derivados por servicios de atención primaria. Los pacientes derivados desde servicios de urgencia tuvieron un acceso temprano a atención especializada. Conclusiones: Las características clínicas y demográficas de los pacientes con AR en España no difieren globalmente de los estudios ya publicados, pero existe una marcada variabilidad entre comunidades autónomas. (AU)

Factors related to radiological damage in 61 Spaniards with early rheumatoid arthritis.

OBJECTIVE: To determine whether the presence of radiographic erosions at disease onset in patients with early rheumatoid arthritis (RA) is associated with clinical, serological, or genetic factors of poor outcome and whether patients with erosions only in the feet have a different pattern of presentation. METHODS: Sixty one patients with early RA (<6 months of evolution) were studied. Clinical evaluation and serological, radiological, and genetic studies were performed at disease onset and after one year. RESULTS: Forty one (67%) patients showed erosions in their hands or in their feet, or in both. Subjects with erosive RA had a higher number of swollen joints (SJN; 9 (SD 6) v. 6 (3), p=0.008), and rheumatoid factor (RF) positivity was more common (80% v. 50%, p<0.02) than those without erosions. Seven (17%) of the 41 patients in the group with erosions had erosions only in their feet. This group had a longer duration of morning stiffness (120 (60) v. 72 (52) min, p<0.005), better patient's global assessment of general health (34 (22) v. 57 (25), p< 0.05), and lower erythrocyte sedimentation rate (32 (22) v. 60 (30) mm/1st h, p <0.05) than the rest of the subjects with erosions, and none of them was in remission after one year. Remission after one year was related to a lack of cortical damage at onset and RF negativity. CONCLUSIONS: Radiological damage at disease onset is associated with a worse clinical presentation and RF positivity, which are markers of poor outcome. There is a subgroup of patients, with erosions only in their feet, whose clinical presentation is less aggressive. To identify these cases of early erosive RA, radiographs of the feet should be obtained routinely.

The prevalence of rheumatoid arthritis in the general population of Spain.

OBJECTIVE: To estimate the prevalence of rheumatoid arthritis (RA) in the adult Spanish population and to assess its distribution by basic sociodemographic characteristics. METHODS: Two thousand nine hundred and ninety-eight adults were selected randomly from the censuses of 20 municipalities. Trained rheumatologists administered a structured interview that included a screening questionnaire for RA. Subjects with a positive screening result were examined according to a standardized protocol. Cases were defined by the 1987 American College of Rheumatology (ACR) criteria adapted to epidemiological surveys. RESULTS: One hundred and eighty-six persons (8.5%) had a positive screening result for RA and 11 of these fulfilled the ACR criteria for RA. The estimated prevalence was 0.5% (95% confidence interval 0.25-0.85). The ratios of women to men and of urban to rural were both 4:1. Function and health perception of the cases were significantly impaired, even after controlling for age and sex. CONCLUSION: The prevalence of RA in Spain is comparable to that in other Mediterranean countries. RA may be less frequent in rural settings, a finding that merits further research. A significant proportion of RA cases in the community remain undiagnosed despite impaired functional status.

Activity indices in rheumatoid arthritis.

OBJECTIVE: To determine which activity indices better correlate with assessor's (AGA) and patient's (PGA) global assessment of disease activity and to compare the improvement with American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) criteria and their association with PGA and AGA of overall improvement. METHODS: Seventy-five patients with rheumatoid arthritis (RA) were studied. Swollen and tender joints, morning stiffness, grip strength, pain, AGA, PGA, Health Assessment Questionnaire (HAQ) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CPR), and hemoglobin were determined before and 6 months after treatment. Several activity indices were calculated: Disease Activity Score (DAS), DAS 3, DAS 28, DAS '28,' ACR > or = 20%, Mallya, Riel, IDA, and a modification of the Stoke index. RESULTS: All indices correlated with PGA and AGA before and after treatment (r > 0.38, p < 0.01), but better results were obtained with AGA than PGA. DAS, DAS 3, DAS 28, and modified Stoke had the best correlation with AGA (r > or = 0.77, p < 0.01). The indices that better detected the differences after treatment for AGA were DAS, DAS 3, DAS 28, and modified Stoke (r > or = -0.42, p < 0.01). The level of agreement between EULAR and ACR improvement classifications with both reduced and extensive joint counts was comparable and its association with PGA and AGA overall improvement was significant (p < 0.01). CONCLUSION: All activity indices correlated with PGA and AGA, although the best results were obtained with AGA. Although indices' correlations were similar, the DAS group and the modified Stoke seemed to be the most useful indices to measure disease activity in RA. The discriminating potential between ACR and EULAR improvement classification was comparable, as was the association with PGA and AGA overall improvement.

Difficulty walking. A presentation of idiopathic juvenile osteoporosis.

Idiopathic juvenile osteoporosis is a rare condition that may present as difficulty walking. Difficulty walking represents a challenging differential diagnosis in pediatrics. Diagnostic studies are usually oriented to rule out neuromuscular etiologies or, once organic causes have been reasonably discarded, conversion disorders. We describe 2 patients who presented with difficulty or inability to walk due to idiopathic juvenile osteoporosis, a rare disease unfamiliar to most physicians. However, early diagnosis in patients can avoid extensive testing and prolonged hospitalizations.