Efecto del estrés laboral sobre el sueño: Relación con variables sociodemográficas / Effect of work stress on sleep: Relationship with sociodemographic variables

El propósito de este estudio fue conocer el efecto de la tensión laboral en el bienestar del sueño y su relación con algunas características sociodemográficas como el género, el cargo laboral y la edad. La muestra del estudio fue de 119 participantes de diversas organizaciones en las zonas central y metropolitana de Puerto Rico (64% hombres, 36 % mujeres). La edad promedio de los participantes fue de 37 años y, de ellos, el 64% ostentaba un grado universitario. Se utilizaron dos instrumentos: uno como Indicador del Bienestar del Sueño y otro como Indicador de Demandas-Control-Apoyo. Se establecieron cuatro hipótesis de investigación y se confirmaron las cuatro, encontrando que el bienestar del sueño se afecta por la tensión laboral. Asimismo se corroboró la presencia de diferencias derivadas del género y el cargo laboral. También se encontró que la edad tiene una relación baja con el sueño. Se recomienda hacer más investigación sobre el tema

The purpose of this study was to know the effect of work stress on sleep well-being and its relationship with some sociodemographic characteristics such as gender, job position and age. The sample of the study was 119 participants from different organizations in the central and metropolitan areas of Puerto Rico (64% men, 36% women). The average age of the participants was 37 years and, of them, 64% held a university degree. Two instruments were used: one as a Sleep Wellbeing Indicator and the other as Demand Indicator-Control-Support. Four research hypotheses were established and the four were confirmed, finding that sleep wellbeing is affected by work stress. Likewise, the presence of differences derived from gender and job position was corroborated. It was also found that age has a low relation to sleep. It is recommended to do more research on the subject

Gender-specific desensitization of group I metabotropic glutamate receptors after maternal l-glutamate intake during lactation.

In the present work we have studied the effect of maternal intake of l-Glutamate (l-Glu) (1 g/L) during lactation on group I mGluR transduction pathway in brain plasma membrane from 15 days-old neonates. Results obtained have shown that maternal l-glutamate intake did not significantly affect neither weights of pups nor negative geotaxis reflex, an index of neurobehavioral development, but increased l-Glu plasma level in both male and female neonates. In male neonates, maternal l-Glu intake evoked a loss of mGluR1 whereas no variation on mGluR5 was observed as revealed by Western-blotting assay. The loss of mGlu1R was accompanied by a decrease on l-Glu-stimulated phospholipase C activity suggesting, therefore, a loss of group I mGluR functionality. Concerning female neonates, no variations were detected neither mGluR1 nor mGluR5 and group I mGluR functionality was also preserved.

ACTIVATE: the effect of aclidinium/formoterol on hyperinflation, exercise capacity, and physical activity in patients with COPD.

The Phase IV, 8-week, randomized, double-blind, placebo-controlled ACTIVATE study (NCT02424344) evaluated the effect of aclidinium/formoterol (AB/FF) 400/12 µg twice daily on lung hyperinflation, exercise capacity, and physical activity in patients with moderate-to-severe COPD. Patients received AB/FF (n=134) or placebo (n=133) (1:1) via the Genuair™/Pressair® dry powder inhaler for 8 weeks. From Weeks 5 to 8, all patients participated in behavioral intervention (BI; daily messages providing step goals). The primary end point was trough functional residual capacity (FRC) at Week 4. Exercise endurance time and physical activity were assessed at Week 4 (pharmacotherapy only) and at Week 8 (8 weeks of pharmacotherapy plus 4 weeks of BI). Other end points included post-dose FRC, residual volume, and inspiratory capacity (IC) at rest and during exercise. After 4 weeks, trough FRC improved with AB/FF versus placebo but did not reach significance (125 mL; P=0.0690). However, post-dose FRC, residual volume, and IC at rest improved significantly with AB/FF at Week 4 versus placebo (all P<0.0001). AB/FF significantly improved exercise endurance time and IC at isotime versus placebo at Week 4 (P<0.01 and P<0.0001, respectively) and Week 8 (P<0.05 and P<0.0001, respectively). AB/FF achieved higher step counts (P<0.01) with fewer inactive patients (P<0.0001) at Week 4 versus placebo. Following BI, AB/FF maintained improvements in physical activity at Week 8 and nonsignificant improvements were observed with placebo. AB/FF 400/12 µg demonstrated improvements in lung hyperinflation, exercise capacity, and physical activity versus placebo that were maintained following the addition of BI. A 4-week period of BI might be too short to augment the improvements of physical activity observed with AB/FF.

Chronic oral administration of MPEP, an antagonist of mGlu5 receptor, during gestation and lactation alters mGlu5 and A2A receptors in maternal and neonatal brain.

Antidepressant and anxiolytic drugs are widely consumed even by pregnant and lactating women. The metabotropic glutamate receptor 5 (mGlu5) antagonist 2-methyl-6-(phenylethynyl)-pyridine (MPEP) exerts antidepressant- and anxiolytic-like actions. Given that treatment for anxiety and depression use to be prolonged in time, it is conceivable a possible modulation of metabotropic glutamate receptors (mGlu receptors) after prolonged MPEP exposure, which could also modify adenosine A2A receptors (A2AR) since functional cross-talk between them has been reported. Here we report that MPEP crosses placental barrier and reaches neonatal brain through maternal milk using LC-MS/MS methods. Therefore, we analyzed mGlu receptors, mainly mGlu5, and A2AR in both maternal and fetal brain after chronic maternal consumption of MPEP during gestation and/or lactation using radioligand binding, Western-blotting, real-time PCR and phospholipase C (PLC) activity assays. In maternal brain, chronic MPEP consumption caused a significant loss of mGlu, including mGlu5, and A2AR receptors level in plasma membrane. PLC activity assays showed that mGlu5 signaling pathway was desensitized. No variations on mRNA level coding A2AR, A1R and mGlu5 were found after MPEP treatments. In female neonatal brain, maternal consumption of MPEP caused a significant increase in mGlu, including mGlu5, and A2AR receptors level. Neither mGlu receptors nor A2AR were modified in male neonatal brain after maternal MPEP intake. Finally, neither molecular nor behavioral changes (anxiety- and depression-like behavior) were observed in 3-month-old female offspring. In summary, mGlu5 and A2AR are altered in both maternal and female neonatal brain after chronic maternal consumption of MPEP during gestation and/or lactation.

Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases.

BACKGROUND: Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). METHODS: This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyzed: age, gender, body mass index (BMI), thrombosis risk factors, surgical technique, thromboembolic prophylaxis, primary surgery outcomes, clinical features, treatment, thrombophilia testing results, and follow-up findings, including imaging and endoscopic findings. RESULTS: A total of 1236 patients underwent LSG, and 5 (0.4 %) developed PMVT. The mean age was 34.4 years, and 3 patients were women. The mean BMI was 38.5 kg/m2. Two patients had received hormonal contraceptive treatment. Four patients had a history of smoking. All of the patients received anticoagulant treatment, and none required surgery. The mean hospitalization duration was 7.6 days. Two patients showed complete recanalization. One patient showed portal cavernomatosis on delayed images. Two patients had a positive thrombophilia test. No portal hypertension endoscopic findings were observed. CONCLUSIONS: PMVT is a rare complication, for which smoking was identified as a predominant risk factor. Early diagnosis and prompt anticoagulant therapy could lead to a dramatic decrease in the incidence of intestinal infarction, mortality, and extrahepatic portal hypertension in the near future. However, careful follow-up is necessary to evaluate the impact of PMVT on long-term patient outcomes.

Tormenta tiroidea: una urgencia endocrinológica / Thyroid storm: an endocrinological urgency

Thyroid storm is a rare and potentially fatal disease characterized by severe clinical manifestations of thyrotoxicosis. The most common cause of hyperthyroidism is Graves's disease (GD) and infections are the most important precipitating factor. A woman of 33 years with history of hyperthyroidism, hypertension and morbid obesity. She was treated with propylthiouracil for one year, and then suspended controls and treatment 2 years ago. Consult for 2 weeks characterized by dyspnea, cough and expectoration, plus an episode of generalized tonic-clonic seizure. In postictal state, persists with dyspnea and chest pain, which is brought to the emergency room. It is hypotensive, with fever and tachycardia, SatO2 60% on room air. It is intubated and connected to invasive mechanical ventilation. It evolves with monomorphic ventricular tachycardia, requiring cardioversion twice, recovering sinus rhythm. Imaging studies reported bilateral lung disease. CT scan brain and lumbar punture are normal. As is treated as septic shock lung focus. Among its tests: TSH 0.01 mIU/L, T4 T 23.9 ug/dL, T4L 4.77 ng/dL, T3 5.38 ng/ml, with Wartofsky Score: 90. It is managed as TS, treatment is initiated with methimazole, Propranolol, Hydrocortisone. Thyroid ultrasound shows: Goiter with cold nodules. In addition has positive TRAb. She recovers both of system cardiovascular and their respiratory infection. The patient is prepared with amiodarone and lugol for total thyroidectomy. Concordant biopsy with GD.

Estudio de la angina estable en España y su impacto en la calidad de vida del paciente. Registro AVANCE / Stable angina in Spain and its impact on quality of life. The AVANCE registry

Introducción y objetivos. La mortalidad por cardiopatía isquémica aguda se ha reducido, pero los pacientes crónicos persisten sintomáticos en una proporción importante. Se pretende conocer las características clínicas y la terapéutica del paciente con angina estable y el impacto de esta enfermedad en la calidad de vida. Métodos. Estudio observacional, multicéntrico y de corte transversal, sobre 2.039 pacientes con angina estable en control ambulatorio. Además de variables clínicas, el investigador recogió su valoración subjetiva sobre la gravedad de la angina y la limitación causada por ella. Los pacientes contestaron sobre percepción de gravedad y calidad de vida con cuestionarios específicos. Resultados. Se analizó a 2.024 pacientes. El 73% eran varones (media de edad, 68±10 años). El 50,3% estaba asintomático (menos de una crisis de angina por semana en las últimas 4 semanas), el 39,2% había tenido entre una y tres crisis por semana, y el 10,5% declaró más de tres crisis por semana. El 66% había sido revascularizado, y de ellos el 59% volvía a tener angina. Los pacientes puntuaron la gravedad de la enfermedad más que los médicos (4,5±2,5 frente a 4,3±2,3; p=0,002). Las percepciones del médico y del paciente sobre la repercusión de la angina tuvieron poca concordancia (índice kappa<0,3), pues los pacientes consideraron que su enfermedad era más grave, más invalidante y con mayor disminución de la calidad de vida. Conclusiones. Persiste una elevada proporción de pacientes sintomáticos y con reducción de la calidad de vida. La percepción del paciente sobre la enfermedad es peor que la del médico (AU)

Introduction and objectives. Mortality from acute coronary syndrome has fallen but a substantial number of chronic patients remain symptomatic. The present study was designed to determine the clinical characteristics and therapeutic treatment of patients with stable angina and its impact on their quality of life. Methods. A cross-sectional, multicenter, observational study of 2039 patients with stable angina attended in outpatient clinics was performed. Data were collected on clinical variables and on the subjective perception of the severity of angina and the resulting limitations. Patients completed questionnaires on their perception of severity and quality of life. Results. We analyzed data on 2024 patients; 73% were men (mean age 68 [10] years). Some 50.3% were asymptomatic (<1 angina attack per week in the previous 4 weeks), 39.2% reported 1-3 attacks per week and 10.5% reported >3 attacks per week; 66% had previously undergone revascularization, and 59% of these developed recurrent angina. Patients rated the severity of their condition higher than did their physicians (4.5 [2.5] vs 4.3 [2.3]; P=.002). Physicians’ and patients’ perceptions of the repercussions of angina showed little concordance (kappa<0.3). The patients believed their condition was much more severe, more debilitating, and had a greater negative impact on their quality of life. Conclusions. A high proportion of patients with stable angina remains symptomatic and their quality of life is impaired. Their perception of the condition is worse than that of their physicians (AU)

Stable angina in Spain and its impact on quality of life. The AVANCE registry.

INTRODUCTION AND OBJECTIVES: Mortality from acute coronary syndrome has fallen but a substantial number of chronic patients remain symptomatic. The present study was designed to determine the clinical characteristics and therapeutic treatment of patients with stable angina and its impact on their quality of life. METHODS: A cross-sectional, multicenter, observational study of 2039 patients with stable angina attended in outpatient clinics was performed. Data were collected on clinical variables and on the subjective perception of the severity of angina and the resulting limitations. Patients completed questionnaires on their perception of severity and quality of life. RESULTS: We analyzed data on 2024 patients; 73% were men (mean age 68[10] years). Some 50.3% were asymptomatic (<1 angina attack per week in the previous 4 weeks), 39.2% reported 1-3 attacks per week and 10.5% reported >3 attacks per week; 66% had previously undergone revascularization, and 59% of these developed recurrent angina. Patients rated the severity of their condition higher than did their physicians (4.5 [2.5] vs 4.3 [2.3]; P=.002). Physicians' and patients' perceptions of the repercussions of angina showed little concordance (kappa<0.3). The patients believed their condition was much more severe, more debilitating, and had a greater negative impact on their quality of life. CONCLUSIONS: A high proportion of patients with stable angina remains symptomatic and their quality of life is impaired. Their perception of the condition is worse than that of their physicians.

Diferencias en el pronóstico de la insuficiencia cardiaca con función sistólica conservada o deprimida en pacientes mayores de 70 años que toman bloqueadores beta / Differences in outcome of heart failure with preserved or depressed systolic function in patients older than 70 years who receive beta blockers

Introducción y objetivos. La mayoría de los trabajos han puesto de manifiesto que el pronóstico de la insuficiencia cardiaca con función sistólica conservada es tan malo como el de la insuficiencia cardiaca con función sistólica deprimida, aunque estos resultados pueden estar sesgados debido a que estos dos tipos de insuficiencia cardiaca tienen características distintas (edad, comorbilidades, tratamiento) que pueden influir en el pronóstico. Nuestro objetivo es evaluar si la morbimortalidad a corto plazo es distinta en estos dos subgrupos de insuficiencia cardiaca, con pacientes homogéneos en cuanto a edad, comorbilidad y tratamiento recibido. Métodos. Analizamos dos grupos de pacientes mayores de 70 años y que pudieran recibir bloqueadores beta, dados de alta consecutivamente tras un ingreso por insuficiencia cardiaca en 53 hospitales españoles (función sistólica deprimida, 245; función sistólica conservada, 374), y se comparó la morbimortalidad cardiovascular a los 3 meses del alta. Resultados. Las medias de edad fueron similares (77,5±4,8 frente a 78,2±5,5 años). La fracción de eyección ventricular izquierda fue de 56,2±8,1% frente a 33±6,9% (p<0,001). La incidencia del evento combinado (muerte, ingreso por insuficiencia cardiaca, síndrome coronario agudo o ictus) a los 3 meses del alta fue menor en los pacientes con insuficiencia cardiaca y función sistólica conservada (el 13,4 frente al 20,6%; p=0,026). Tener la función sistólica deprimida fue predictor independiente de mayor incidencia de eventos (odds ratio=1,732; p=0,048). Conclusiones. En pacientes de edad similar que reciben el mismo tratamiento, el pronóstico a corto plazo es mejor en los pacientes con insuficiencia cardiaca y función sistólica conservada que en aquellos con función sistólica deprimida (AU)

Introduction and objectives. Most studies have shown that prognosis of heart failure with preserved systolic function is as poor as that of heart failure with depressed systolic function, although these results may be biased by the fact that these types of heart failure have different characteristics (age, comorbidity, treatment), which can influence prognosis. Our aim was to determine whether short-term morbidity and mortality differed in these 2 subgroups of heart failure patients when they were comparable in terms of age, associated comorbidity, and therapy. Methods. We analyzed 2 groups of patients aged >70 years who were candidates to receive beta blockers (preserved systolic function, 245; depressed systolic function, 374), consecutively discharged from 53 participating Spanish hospitals with a diagnosis of heart failure, and compared cardiovascular morbidity and mortality 3 months after discharge. Results. Mean age was similar (77.5±4.8 vs 78.2±5.5 years). Left ventricular ejection fraction was 56.2%±8.1% vs 33%±6.9% (P<.001). The combined event rate (death, hospitalization for heart failure, acute coronary syndrome, or stroke) at 3 months after discharge was lower in patients with heart failure and preserved systolic function (13.4% vs 20.6%; P=.026). Depressed systolic function was an independent predictor of greater incidence of events (odds ratio=1.732; P=.048). Conclusions. In patients of similar age and receiving similar treatment, short-term prognosis is better in patients with heart failure and preserved systolic function than in those with depressed systolic function (AU)

Differences in outcome of heart failure with preserved or depressed systolic function in patients older than 70 years who receive beta blockers.

INTRODUCTION AND OBJECTIVES: Most studies have shown that prognosis of heart failure with preserved systolic function is as poor as that of heart failure with depressed systolic function, although these results may be biased by the fact that these types of heart failure have different characteristics (age, comorbidity, treatment), which can influence prognosis. Our aim was to determine whether short-term morbidity and mortality differed in these 2 subgroups of heart failure patients when they were comparable in terms of age, associated comorbidity, and therapy. METHODS: We analyzed 2 groups of patients aged >70 years who were candidates to receive beta blockers (preserved systolic function, 245; depressed systolic function, 374), consecutively discharged from 53 participating Spanish hospitals with a diagnosis of heart failure, and compared cardiovascular morbidity and mortality 3 months after discharge. RESULTS: Mean age was similar (77.5±4.8 vs 78.2±5.5 years). Left ventricular ejection fraction was 56.2%±8.1% vs 33%±6.9% (P<.001). The combined event rate (death, hospitalization for heart failure, acute coronary syndrome, or stroke) at 3 months after discharge was lower in patients with heart failure and preserved systolic function (13.4% vs 20.6%; P=.026). Depressed systolic function was an independent predictor of greater incidence of events (odds ratio=1.732; P=.048). CONCLUSIONS: In patients of similar age and receiving similar treatment, short-term prognosis is better in patients with heart failure and preserved systolic function than in those with depressed systolic function.

Niveles de malnutrición por exceso en la población atacameña de una región rural y una urbana en el norte de Chile / Malnutrition causeing overweigth and obesity in urban and rural populations of atacameños from northern Chile

Introducción: El sobrepeso y la obesidad son cada vez más prevalentes y colaboran a mayor riesgo cardiovascular. No existen estudios sobre estas patologías en la población atacameña, (tercer grupo más numeroso entre las etnias originarias en Chile). Objetivo: Evaluar niveles de sobrepeso y obesidad de la población de etnia atacameña y comparar el estado nutricional de atacameños ubicados en una región Rural (Alto el Loa), y una urbana (Calama). Metodología: Se analizaron exámenes de medicina preventiva del adulto (EMPA) de postas rurales de Alto El Loa, y del Centro Comunitario de Salud Familiar (CECOF) de Calama en los años 2007 y 2008. Se seleccionaron pacientes con ambos apellidos de origen ataca-meño, quienes además tuvieran padres y abuelos (maternos y paternos) con apellidos del mismo origen. Se midió peso, talla, IMC, circunferencia de cintura (CC), presión arterial (PA), glicemia y colesterol plasmáticos. Resultados: 43 sujetos de Alto el Loa (AL) y 98 sujetos de Calama cumplieron criterios de selección. En el grupo Alto El Loa el peso fue normal en 30 por ciento de los sujetos, hubo sobrepeso en 46,5 por ciento y obesidad en 23,5 por ciento. Los valores correspondientes para el grupo de Calama fueron 25 por ciento, 42,7 por ciento y 32,3 por ciento, respectivamente (N.S.). Al comparar ambos grupos, solo hubo diferencias significativas en colesterol plasmático (163 mg/dl AL vs 188 mg/dl Calama) y CC en hombres (110cm AL vs 99,3cm Calama) y mujeres (113cm AL vs 90,6cm Calama). Conclusión: Ambos grupos de atacameños presentaron más de un 70 por ciento de malnutrición por exceso. Solo hubo diferencias entre ambos grupos en CC y colesterol total. Destaca la CC mayor en Alto El Loa (zona de menor mestizaje), que sugieren un genotipo atacameño con tendencia a mayores niveles de grasa abdominal.

Background: Overweight and obesity are cardiovascular risk factors becoming more prevalent in later years. There are no studies related to this problem in the atacameña population, which is the third largest group among original inhabitants in Chile. Aim: to evaluate prevalence of overweight and obesity in "atacameños" of northern Chile and to compare these findings in a rural (Alto el Loa) and an urban locations (Calama). Methods: The data obtained from preventive medical examinations performed in primary care centers of Alto el Loan and Calama during 2007 and 2008 were used for the analysis. The subjects included had both paternal and maternal grand parents with "atacameños" surnames. Weigth, height, body mass index, waist circumference, blood pressure, blood glucose level and serum cholesterol were determined. Results: 43 subjects from Alto el Loa and 98 subjects from Calama were included. Weight was normal in 30 percent of subjects from Alto el Loa; overweight was present in 46.5 percent and obesity in 23.5 percent. Corresponding values for subjects from Calama were 25 percent, 42.7 percent and 32.3 percent (NS). The only significantly different variables were serum cholesterol (163 mg/dl in Alto el Loa vs 188 mg/dl in Calama) and waist circumference: (110cm in Alto el Loa vs 99,3 cm in Calama for males, and 113cm in Alto el Loa vs 90.6cm in Calama for women). Conclusion: malnutrition leading to overweight and obesity affected 70 percent of "atacameños". Lower serum cholesterol levels and increased waist circumference suggest the presence of factors leading to accumulation of abdominal fat in the rural population.

¿Cómo se usan los bloqueadores beta en España? Análisis de las limitaciones para su uso en medicina interna y cardiología: estudio CARACTER-BETA / How Beta-Blockers Are Used in Spain? Analysis of Limitations in Their Use in Internal Medicine and Cardiology: CARACTER-BETA Study

Introducción y objetivos. El tratamiento con bloqueadores beta tiene una indicación de clase I y nivel de evidencia A en las guías de tratamiento de insuficiencia cardiaca, cardiopatía isquémica y fibrilación auricular. A pesar de ello, el uso de bloqueadores beta sigue siendo inferior a lo deseable. El objetivo principal del estudio es analizar el uso de los bloqueadores beta en España en pacientes con cardiopatía isquémica, insuficiencia cardiaca, fibrilación auricular. Métodos. Estudio epidemiológico observacional, transversal y multicéntrico, que incluye a 1.608 pacientes con cardiopatía isquémica, insuficiencia cardiaca y/o fibrilación auricular reclutados en 150 centros sanitarios por cardiólogos y médicos internistas. Resultados. El 78,6% de los pacientes fueron incluidos en cardiología, y el 21,4%, en medicina interna; se recogió al 25,8% en altas hospitalarias y al 74,2%, en consultas externas. El 67% eran varones. La media de edad era 68±12 años. El 73% tenía cardiopatía isquémica; el 42%, insuficiencia cardiaca, y el 36%, fibrilación auricular (variable multirrespuesta). El 82,8% de los tratados en cardiología recibió bloqueadores beta, frente al 71,6% de los tratados en medicina interna (p<0,0001). Por enfermedades, el 85,1% de los pacientes con cardiopatía isquémica, el 77% con insuficiencia cardiaca y el 72,4% con fibrilación auricular. Cardiología prescribió significativamente más bloqueadores beta que medicina interna en cardiopatía isquémica e insuficiencia cardiaca. El análisis multivariable mostró que los bloqueadores beta aumentan si se padece cardiopatía isquémica, se es tratado por un cardiólogo, se tiene dislipemia, accidente cerebrovascular y/o hipertrofia ventricular izquierda. Disminuyen los bloqueadores beta con la edad, el broncospasmo y el asma bronquial, la bradicardia, la enfermedad pulmonar obstructiva crónica y/o la claudicación intermitente. Conclusiones. Todavía existen márgenes de mejora en la prescripción de bloqueadores beta a pacientes con cardiopatía isquémica, insuficiencia cardiaca y/o fibrilación auricular en España (AU)

Introduction and objectives. Beta-blocker treatment has a class I indication, level of evidence A, in guidelines for the treatment of heart failure, ischemic heart disease, and atrial fibrillation. However, beta-blocker use continues to be less than optimal. In this study, beta-blocker use in Spain is analyzed in patients with heart failure, ischemic heart disease, and atrial fibrillation. Methods. Observational, epidemiologic, cross-sectional, multicenter study including 1608 patients with heart failure, ischemic heart disease, and/or atrial fibrillation, recruited in 150 healthcare centers by cardiologists and internal medicine specialists. Results. Cardiologists enrolled 78.6% patients and internal medicine specialists 21.4%; 25.8% were recruited at hospital discharge and 74.2% at outpatient centers. Men accounted for 77% of the sample, and age was 68 (12) years. Of the total, 73% had ischemic heart disease, 42% heart failure, and 36% atrial fibrillation (multiresponse variable). beta-blockers were given to 82.8% of those consulting in cardiology compared to 71.6% of those treated in internal medicine (P<.0001). By pathology, the prescription rate was 85.1% of patients with ischemic heart disease, 77.0% of those with heart failure, and 72.4% of those with atrial fibrillation. Cardiology prescribed significantly more beta-blockers for ischemic heart disease and heart failure than did internal medicine. Multivariate analysis showed that beta-blocker use increased when the patient had ischemic heart disease, was treated by a cardiologist, and had dyslipidemia, stroke, and/or left ventricular hypertrophy. Beta-blocker use decreased with age and with a history of bronchospasm, asthma, bradycardia, chronic obstructive pulmonary disease, and/or intermittent claudication. Conclusions. There is still room for improvement in beta-blocker prescription in Spain for patients with ischemic heart disease, heart failure, and/or atrial fibrillation (AU)

[How beta-blockers are used in Spain? Analysis of limitations in their use in internal medicine and cardiology: CARACTER-BETA study]. / ¿Cómo se usan los bloqueadores beta en España? Análisis de las limitaciones para su uso en medicina interna y cardiología: estudio CARACTER-BETA.

INTRODUCTION AND OBJECTIVES: Beta-blocker treatment has a class I indication, level of evidence A, in guidelines for the treatment of heart failure, ischemic heart disease, and atrial fibrillation. However, beta-blocker use continues to be less than optimal. In this study, beta blocker use in Spain is analyzed in patients with heart failure, ischemic heart disease, and atrial fibrillation. METHODS: Observational, epidemiologic, cross-sectional, multicenter study including 1608 patients with heart failure, ischemic heart disease, and/or atrial fibrillation, recruited in 150 healthcare centers by cardiologists and internal medicine specialists. RESULTS: Cardiologists enrolled 78.6% patients and internal medicine specialists 21.4%; 25.8% were recruited at hospital discharge and 74.2% at outpatient centers. Men accounted for 77% of the sample, and age was 68 (12) years. Of the total, 73% had ischemic heart disease, 42% heart failure, and 36% atrial fibrillation (multiresponse variable). Beta blockers were given to 82.8% of those consulting in cardiology compared to 71.6% of those treated in internal medicine (P<.0001). By pathology, the prescription rate was 85.1% of patients with ischemic heart disease, 77.0% of those with heart failure, and 72.4% of those with atrial fibrillation. Cardiology prescribed significantly more beta blockers for ischemic heart disease and heart failure than did internal medicine. Multivariate analysis showed that beta blocker use increased when the patient had ischemic heart disease, was treated by a cardiologist, and had dyslipidemia, stroke, and/or left ventricular hypertrophy. beta blocker use decreased with age and with a history of bronchospasm, asthma, bradycardia, chronic obstructive pulmonary disease, and/or intermittent claudication. CONCLUSIONS: There is still room for improvement in beta blocker prescription in Spain for patients with ischemic heart disease, heart failure, and/or atrial fibrillation.

Validation of the Spanish version of the Kansas city cardiomyopathy questionnaire.

INTRODUCTION AND OBJECTIVES: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is specifically designed to evaluate quality of life in patients with chronic heart failure (CHF). The purpose of this study was to assess the reliability, validity, and responsiveness to change of the Spanish version of the KCCQ. METHODS: The multicenter study involved 315 patients with CHF. Patients were evaluated at baseline and at weeks 24 and 26. The KCCQ, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Short Form-36 (SF-36) were administered. Reliability was assessed in stable patients (n=163) by examining test-retest and internal consistency measures between weeks 24 and 26. Validity was evaluated at baseline (n=315) by determining how KCCQ scores varied with New York Heart Association functional class and by comparing scores with those on similar domains of the MLHFQ and SF-36. Responsiveness to change was assessed in patients who experienced significant clinical improvement between baseline and week 24 (n=31) by determining the effect size. RESULTS: Reliability coefficients ranged between 0.70 and 0.96 for the different domains. Mean KCCQ scores varied significantly with New York Heart Association functional class (P<.001). Correlations with comparable domains on the other questionnaires were acceptable (e.g. for physical limitation, they were between 0.77 and 0.81). The changes observed at 24 weeks in the majority of KCCQ scores in the subsample that improved corresponded to a moderate effect size (i.e. 0.4-0.6). CONCLUSIONS: The Spanish version of the KCCQ has good metric properties (i.e. validity, reliability and responsiveness), which make it suitable for use in evaluating quality of life in Spanish CHF patients.

Validación de la versión española del Kansas City Cardiomyopathy Questionnaire / Validation of the spanish version of the Kansas City cardiomyopathy questionnaire

Introducción y objetivos. El Kansas City Cardiomyopathy Questionnaire (KCCQ) es un instrumento de calidad de vida específico para insuficiencia cardiaca crónica (ICC). El objetivo es evaluar la fiabilidad, la validez y la sensibilidad al cambio de la versión española del KCCQ. Métodos. Se realizó un estudio multicéntrico con 315 pacientes con ICC. Se realizó una evaluación basal y a las semanas 24 y 26. Se aplicaron el KCCQ, el Minnesota Living with Heart Failure Questionnaire (MLHFQ) y el Short Form 36 (SF-36). La fiabilidad se evaluó mediante test-retest y la consistencia interna en pacientes estables entre las semanas 24 y 26 (n=163). La validez se estudió basalmente (n=315) mediante gradiente de las puntuaciones según la New York Heart Association y las correlaciones, con las dimensiones del MLHFQ y SF-36. La evaluación de la sensibilidad al cambio se analizó en los pacientes (n=31) que habían mejorado significativamente entre la primera y la segunda evaluación mediante el coeficiente de tamaño del efecto. Resultados. Los coeficientes de fiabilidad oscilaron entre 0,7 y 0,96 según las dimensiones. Las medias de las puntuaciones mostraron diferencias significativas según la New York Heart Association (p<0,001). Las correlaciones entre las dimensiones de los diferentes cuestionarios fueron aceptables (por ejemplo, limitación física entre 0,77 y 0,81). El cambio a las 24 semanas en la submuestra de mejoría en la mayoría de las puntuaciones del KCCQ correspondió a tamaños del efecto moderados (0,4-0,6). Conclusiones. La versión española del KCCQ tiene unas adecuadas propiedades métricas (validez, fiabilidad y sensibilidad) como instrumento de valoración de calidad de vida en pacientes españoles con ICC (AU)

Introduction and objectives: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is specifically designed to evaluate quality of life in patients with chronic heart failure (CHF). The purpose of this study was to assess the reliability, validity, and responsiveness to change of the Spanish version of the KCCQ. Methods: The multicenter study involved 315 patients with CHF. Patients were evaluated at baseline and at weeks 24 and 26. The KCCQ, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Short Form-36 (SF-36) were administered. Reliability was assessed in stable patients (n = 163) by examining test–retest and internal consistency measures between weeks 24 and 26. Validity was evaluated at baseline (n = 315) by determining how KCCQ scores varied with NewYork Heart Association functional class and by comparing scores with those on similar domains of the MLHFQ and SF-36. Responsiveness to change was assessed in patients who experienced significant clinical improvement between baseline and week 24 (n = 31) by determining the effect size. Results: Reliability coefficients ranged between 0.70 and 0.96 for the different domains. Mean KCCQ scores varied significantly with New York Heart Association functional class (P < .001). Correlations with comparable domains on the other questionnaires were acceptable (e.g. for physical limitation, they were between 0.77 and 0.81). The changes observed at 24 weeks in the majority of KCCQ scores in the subsample that improved corresponded to a moderate effect size (i.e. 0.4–0.6). Conclusions: The Spanish version of the KCCQ has good metric properties (i.e. validity, reliability and responsiveness), which make it suitable for use in evaluating quality of life in Spanish CHF patients (AU)

Effect of a training program for primary care physicians on the optimization of beta-blocker treatment in elderly patients with heart failure.

INTRODUCTION AND OBJECTIVES: Underuse of betablockers may contribute to elevated mortality in chronic heart failure. The aim of this study was to determine whether a specific interventional training program for primary care physicians would help optimize the use of beta-blockers in elderly chronic heart failure patients. METHODS: This randomized comparative study included 627 patients aged 70 years or more who were discharged consecutively from 53 Spanish hospitals with a principal diagnosis of chronic heart failure. In total, 292 health-care centers in the catchment areas of these hospitals were randomly assigned to two groups: one group of 146 centers carried out an interventional training program on beta-blocker use for primary care physicians belonging to the centers assigned to training, and 146 centers served as a control group. The main outcome variable was the percentage of patients who were receiving a beta-blocker at the maximum or maximum tolerated dose 3 months after hospital discharge. RESULTS: The patients' mean age was 78+/-5 years and 42% were women. There was no difference between the groups in demographic characteristics, clinical care, or treatment at discharge. The percentage of patients who received beta-blockers at the maximum tolerated dose 3 months after discharge was greater in the training group (49% vs. 38%; P=.014). Being treated in the training group was an independent predictor of receiving a beta-blocker at the MTD (odds ratio=2.46; 95% confidence interval, 1.29-4.69; P< .001). CONCLUSIONS: Implementation of an interventional training program on beta-blocker treatment for primary care physicians improved the use of these medications in elderly chronic heart failure patients.

Efecto de un programa de formación en atención primaria sobre la optimización del tratamiento con bloqueadores beta en pacientes ancianos con insuficiencia cardiaca / Effect of a training program for primary care physicians on the optimization of beta-blocker treatment in elderly patients with heart failure

Introducción y objetivos. La infrautilización de bloqueadores beta puede influir en la elevada mortalidad de la insuficiencia cardiaca. El objetivo de nuestro estudio es evaluar si un programa específico de intervención sobre médicos de atención primaria permite optimizar el uso de bloqueadores beta en pacientes ancianos con insuficiencia cardiaca. Métodos. Se diseñó un estudio aleatorizado y comparativo en el que se incluyó a 627 pacientes de 70 o más años, dados de alta de forma consecutiva con el diagnóstico principal de insuficiencia cardiaca en 53 hospitales españoles. Se realizó una asignación aleatoria de los 292 centros de salud de las áreas de esos hospitales a dos grupos (formación, 146 centros, y control, 146 centros), para impartir un programa de intervención y formación sobre bloqueadores beta a los médicos pertenecientes a los centros del grupo formación. La variable principal fue el porcentaje de pacientes que recibían la dosis máxima o máxima tolerada de bloqueadores beta a los 3 meses del alta. Resultados. La edad de los pacientes era de 78 ± 5 años; el 42% eran mujeres. No hubo diferencias entre ambos grupos en sus características demográficas, clínicas o en el tratamiento al alta. El porcentaje de pacientes que recibían la dosis máxima tolerada de bloqueadores beta a los 3 meses del alta fue mayor en el grupo formación (el 49 frente al 38%; p = 0,014); pertenecer al grupo formación fue predictor independiente de recibir la dosis máxima tolerada de bloqueadores beta (odds ratio = 2,46; intervalo de confianza del 95%, 1,29-4,69; p < 0,001). Conclusiones. Un programa de formación sobre bloqueadores beta en atención primaria mejora su uso en pacientes ancianos con insuficiencia cardiaca (AU)

Introduction and objectives. Underuse of betablockers may contribute to elevated mortality in chronic heart failure. The aim of this study was to determine whether a specific interventional training program for primary care physicians would help optimize the use of beta-blockers in elderly chronic heart failure patients. Methods. This randomized comparative study included 627 patients aged 70 years or more who were discharged consecutively from 53 Spanish hospitals with a principal diagnosis of chronic heart failure. In total, 292 health-care centers in the catchment areas of these hospitals were randomly assigned to two groups: one group of 146 centers carried out an interventional training program on beta-blocker use for primary care physicians belonging to the centers assigned to training, and 146 centers served as a control group. The main outcome variable was the percentage of patients who were receiving a beta-blocker at the maximum or maximum tolerated dose 3 months after hospital discharge. Results. The patients’ mean age was 78±5 years and 42% were women. There was no difference between the groups in demographic characteristics, clinical care, or treatment at discharge. The percentage of patients who received beta-blockers at the maximum tolerated dose 3 months after discharge was greater in the training group (49% vs. 38%; P=.014). Being treated in the training group was an independent predictor of receiving a beta-blocker at the MTD (odds ratio=2.46; 95% confidence interval, 1.29-4.69; P < .001). Conclusions. Implementation of an interventional training program on beta-blocker treatment for primary care physicians improved the use of these medications in elderly chronic heart failure patients (AU)

[Cat-scratch disease. Review of eight adult patients hospitalized for fever or adenopathy]. / Enfermedad por arañazo de gato. Características clínicas y de laboratorio en pacientes adultos hospitalizados por fiebre o adenopatías.

BACKGROUND: Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever. AIM: To report the clinical and laboratory features of eight patients with cat-scratch disease. MATERIAL AND METHODS: Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence). RESULTS: Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials. CONCLUSIONS: Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.