The Role of Hip Joint Clearance Discrepancy as Other Clinical Predictor of Reinjury and Injury Severity in Hamstring Tears in Elite Athletes.

Hamstring tear injuries (HTI) are the most prevalent injuries in athletes, with high reinjury rates. To prevent reinjury and reduce the severity of injuries, it is essential to identify potential risk factors. Hip characteristics are fundamental to optimal hamstring function. We sought to investigate the role of hip joint clearance discrepancy (JCD) as a risk factor for HTI and a clinical predictor of risk of reinjury and injury severity. A cross-sectional, retrospective study was performed with elite athletes (n = 100) who did (n = 50) and did not (n = 50) have a history of injury. X-rays were taken to assess JCD. We reviewed muscular lesions historial, and health records for the previous 5 years. Significant differences were found in injury severity (p = 0.026; ŋ2p = 0.105) and a number of injuries (p = 0.003; ŋ2p = 0.172). The multivariate analysis data indicated that JCD was significantly associated with the number of injuries and their severity (p < 0.05). In the stepwise regression model, JCD variability explained 60.1% of the number of injuries (R2 0.601) and 10.5% of injury severity (R2 0.0105). These results suggest that JCD could play an important role as a risk factor for HTI and also as a clinical predictor of reinjury and injury severity.

Los ejercicios respiratorios postoperatorios reducen el riesgo de complicaciones pulmonares en pacientes sometidos a lobectomía / Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy

Objetivo: Evaluar los efectos de un programa intensivo de fisioterapia postoperatoria basado en ejercicios respiratorios dirigido a pacientes lobectomizados mediante toracotomía abierta. Diseño : Estudio cuasiexperimental. Emplazamiento: Hospital universitario terciario. Participantes: Doscientos ocho (208) pacientes lobectomizados mediante toracotomía abierta. Intervención: Los pacientes del grupo control (n=102) recibieron atención médica/de enfermería estándar y los pacientes del grupo experimental (n=106), además de la atención clínica estándar, se sometieron a un programa de fisioterapia diaria basada en ejercicios respiratorios hasta el momento del alta hospitalaria. Variables de resultado: Las variables de resultado estudiadas incluyeron la frecuencia de complicaciones pulmonares postoperatorias (CPP) más susceptibles de tratamiento fisioterapéutico (neumonía, atelectasias e insuficiencia respiratoria) y la duración de la estancia hospitalaria (DEH). Resultados: Las características preoperatorias y quirúrgicas de ambos grupos fueron comparables. La incidencia de CPP registrada fue de un 20,6% en el grupo control y un 6,6% en el grupo experimental (p = 0,003). La mediana y el RIC de la DEH fue de 14 y 7días, respectivamente (estimador M de Huber 14,21) en el grupo control y de 12 y 6días (estimador M de Huber 12,81) en el grupo experimental. El modelo de regresión logística creado identificó al programa de fisioterapia evaluado (p = 0,017; EXP (B) [IC 95% 0,081-0,780]) y al porcentaje del FEV1 (p = 0,042; EXP (B) [IC 95% 0,941-0,999]) como factores protectores frente al desarrollo de CPP en los pacientes intervenidos de lobectomía. Conclusiones: La implementación de un programa intensivo de fisioterapia postoperatoria basado en ejercicios respiratorios reduce el riesgo de desarrollar CPP y la DEH en pacientes lobectomizados

Objective: To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Design: Quasi-experimental study. Setting: Tertiary referral academic hospital. Participants: 208 patients undergoing lobectomy by open thoracotomy. Interventions: Control group patients (n = 102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Outcomes: Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Results: Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P = .003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P = .017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P = .042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Conclusions: Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy

Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy. / Los ejercicios respiratorios postoperatorios reducen el riesgo de complicaciones pulmonares en pacientes sometidos a lobectomía.

OBJECTIVE: To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. DESIGN: Quasi-experimental study. SETTING: Tertiary referral academic hospital. PARTICIPANTS: 208 patients undergoing lobectomy by open thoracotomy. INTERVENTIONS: Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. OUTCOMES: Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). RESULTS: Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. CONCLUSIONS: Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy.

Perioperative physiotherapy in patients undergoing lung cancer resection.

Physiotherapy is considered an important component of the perioperative period of lung resection surgery. A systematic review was conducted to assess evidence for the effectiveness of different physiotherapy interventions in patients undergoing lung cancer resection surgery. Online literature databases [Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, SCOPUS, PEDro and CINAHL] were searched up until June 2013. Studies were included if they were randomized controlled trials, compared 2 or more perioperative physiotherapy interventions or compared one intervention with no intervention, included only patients undergoing pulmonary resection for lung cancer and assessed at least 2 or more of the following variables: functional capacity parameters, postoperative pulmonary complications or length of hospital stay. Reviews and meta-analyses were excluded. Eight studies were selected for inclusion in this review. They included a total of 599 patients. Seven of the studies were identified as having a low risk of bias. Two studies assessed preoperative interventions, 4 postoperative interventions and the remaining 2 investigated the efficacy of interventions that were started preoperatively and then continued after surgery. The substantial heterogeneity in the interventions across the studies meant that it was not possible to conduct a meta-analysis. The most important finding of this systematic review is that presurgical interventions based on moderate-intense aerobic exercise in patients undergoing lung resection for lung cancer improve functional capacity and reduce postoperative morbidity, whereas interventions performed only during the postoperative period do not seem to reduce postoperative pulmonary complications or length of hospital stay. Nevertheless, no firm conclusions can be drawn because of the heterogeneity of the studies included. Further research into the efficacy and effectiveness of perioperative respiratory physiotherapy in this patient population is needed.

Evolución de la incidencia de migraña en Álava en el período 2004-2008 / Evolution of the incidence of migraine in Álava over the period 2004-2008

Introducción. Existen muy pocos estudios sobre la incidencia de migraña en España, y los que hay tienen alguna limitación, como carecer de base poblacional clara. Objetivo. Examinar la evolución de la incidencia de migraña a lo largo del período 2004-2008 en la provincia de Álava (País Vasco, España).Pacientes y métodos. Los datos corresponden a personas de 15 o más años de edad registrados como nuevos casos diagnosticados de migraña en la base de datos del Servicio Vasco de Salud/Osakidetza. La tendencia en la incidencia de migraña se valoró mediante regresión lineal. Resultados. La incidencia de migraña fue significativamente mayor en las mujeres que en los hombres, a cualquier edad. No se observaron cambios en la incidencia de migraña en el período 2004-2008 en el conjunto de la población de Álava (p = 0,189). Sin embargo, se ha producido un descenso en la incidencia de migraña en las mujeres mayores de 64 años (p = 0,014), y un aumento en las de 15-24 años (p = 0,052) y 35-44 años (p = 0,057). Los nuevos casos de migrañadiagnosticada tendieron a aparecer en edades más jóvenes a lo largo de este período. Conclusiones. Estos resultados indican una ausencia de cambios en la tendencia de la incidencia de migraña a lo largo del período 2004-2008, excepto un descenso en el caso de las mujeres mayores de 64 años y un aumento en las jóvenes. Esta evolución es similar a la de otras regiones europeas (AU)

Introduction. Few studies have been conducted on the incidence of migraine in Spain, and those that have been carried out have some shortcomings, such as the lack of a clear population base. Aims. To examine the evolution of the incidence of migraine over the period 2004-2008 in the province of Álava (Basque Country, Spain).Patients and methods. Data concerned persons aged 15 or over who were registered in the Basque Health Service/Osakidetza database as new cases diagnosed with migraine. The tendency of the incidence of migraine was evaluated by means oflinear regression. Results. The incidence of migraine was significantly higher in females than in males, at any age. No significant changes in the incidence of migraine were observed over the period 2004-2008 in the population of Ávala as a whole (p = 0.189). Nevertheless, there have been both a decrease in the incidence of migraine in females over the age of 64 (p = 0.014) and an increase in those aged 15-24 years (p = 0.052) and 35-44 years (p = 0.057). The new cases of migraine that arediagnosed tended to appear at younger ages over this period. Conclusions. These results suggest an absence of changes in the tendency in the incidence of migraine throughout the period 2004-2008, except for a decrease in the case of females over 64 years of age and an increase in young females.This evolution is similar to that of other regions in Europe (AU)

[Evolution of the incidence of migraine in Álava over the period 2004-2008]. / Evolución de la incidencia de migraña en Álava en el período 2004-2008.

INTRODUCTION: Few studies have been conducted on the incidence of migraine in Spain, and those that have been carried out have some shortcomings, such as the lack of a clear population base. AIMS: To examine the evolution of the incidence of migraine over the period 2004-2008 in the province of Álava (Basque Country, Spain). PATIENTS AND METHODS: Data concerned persons aged 15 or over who were registered in the Basque Health Service/Osakidetza database as new cases diagnosed with migraine. The tendency of the incidence of migraine was evaluated by means of linear regression. RESULTS: The incidence of migraine was significantly higher in females than in males, at any age. No significant changes in the incidence of migraine were observed over the period 2004-2008 in the population of Ávala as a whole (p = 0.189). Nevertheless, there have been both a decrease in the incidence of migraine in females over the age of 64 (p = 0.014) and an increase in those aged 15-24 years (p = 0.052) and 35-44 years (p = 0.057). The new cases of migraine that are diagnosed tended to appear at younger ages over this period. CONCLUSIONS: These results suggest an absence of changes in the tendency in the incidence of migraine throughout the period 2004-2008, except for a decrease in the case of females over 64 years of age and an increase in young females. This evolution is similar to that of other regions in Europe.

Testosterone and cortisol changes in professional basketball players through a season competition.

We analyze the outcome on testosterone (T) and cortisol (C) responses in 12 professional basketball players during a season of competition. Serum adrenocorticotropic hormone (ACTH), C, total testosterone (TT), and free testosterone (FT) levels were analyzed in October, December, March, and April. A day after the games, blood samples were taken. Serum ACTH levels were maintained at the initial levels during the season. However, basal C significantly changed during the season, with lower levels in December and in April. Basal serum TT levels increased during the season until a maximum in March. No differences were presented in the TT values in December, March, and April. Basal FT presented high levels in October and December, followed by a low level in March, remaining low in April. The T/C increased during the season, attaining a maximum level in December, followed by a significant decrease in March. Free T/C ratio decreased during the season (lower level in March). In conclusion, the players maintained a good anabolic-catabolic balance. In our opinion, to prevent the stress provoked during the season, and control the recovery periods, it is useful to monitor C, T, and the level of training.

Cambios en el patrón farmacológico de utilización de antihipertensivos en el País Vasco durante el período 1992-2004 / Changes in the Pharmacological Pattern of Antihypertensive Drug Use During the Period 1992-2004 in the autonomous community of the Basque, Spain

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Estudios de utilización de medicamentos (EUM). Aspectos conceptuales y metodológicos / No disponible

Se puede definir la farmacoepidemiología como un campo del conocimiento relacionado con el impacto de los fármacos en poblaciones humanas, utilizando para ello el método epidemiológico. El objetivo último de la farmacoepidemiología es describir, analizar, predecir y, por lo tanto, planificar los usos y efectos de los diferentes tratamientos farmacológicos referidos a las variables de persona, lugar y tiempo. Resulta esta actividad de la conjunción de la farmacología clínica y de la epidemiología. La primera estudia los efectos de los fármacos en la especie humana, mientras que la epidemiología presta el método que le es propio y permite, así, conocer lo que ocurre con los medicamentos cuando son utilizados por grandes poblaciones. Las contribuciones más características de la farmacoepidemiología se refieren fundamentalmente a la seguridad y al coste de los medicamentos. El conocimiento derivado de los estudios farmacoepidemiológicos influye en una correcta selección de los medicamentos, la cual debe hacerse bajo criterios de eficacia, seguridad, calidad y coste de los mismos para lograr el Uso Racional del Medicamento. El objetivo de este trabajo se centra en comentar y aportar diversas ideas referidas a algunos aspectos conceptuales y metodológicos relevantes en el campo de la Farmacoepidemiología (AU)

Pharmacoepidemiology can be defined as a knowledge camp related with the drugs impact in human populations using for that the epidemiologyc method. Pharmacoepidemiology`s main objective is to describe, to analyse, to predict, and, therefore, to plan the use and effects of the different pharmacologyc treatments to refer to the person, place and time variables. This activity is the result of the conjunction of clinical-pharmacology and epidemiology. The first one studies the drugs effect in human specie, while the epidemiology lends its own method and in this way allow to know what does happen with the drugs when they are used by large populations. The most characteristics contribution of pharmacoepidemiology refers fundamentally to the safety and to the medicaments cost. The knowledge derived from the pharmacoepidemiologyc studies influences in a correct medicines selection, which has to be done with criterion as well as effectiveness, safety, quality and cost of them, in order to reach the drug rational use. The objective of this work is centred in remark and contribute different ideas of some conceptual aspect and relevant methodologies in the camp of pharmacoepidemiology (AU)

Trends in antimicrobial utilization at a Spanish general hospital during a 5-year period.

PURPOSE: Antimicrobials are a major part of hospital pharmacy budgets and must be considered in resource planning and spending projections. This study describes the profile of antibiotic use at a medium-sized hospital (by examining the ICU separately) and analyses its evolution over the period 1996-2000. METHODS: Descriptive and retrospective study. Pharmacy records were reviewed to identify oral and parenteral antimicrobial agents administered to inpatients. Results were expressed in Daily Defined Doses (DDD) per 100 stays and day. RESULTS: During the 5-year study period 176.162 DDD/100 s-d of antibiotics were consumed in the ICU, whereas in the rest of the hospital usage was much lower (54.438 DDD/100 s-d). Aminoglycosides, cephalosporins, penicillins, glycopeptides and carbapenems were the most commonly used groups of antimicrobials in the ICU, and penicillins, cephalosporins, trimethoprim/sulfonamide combinations, aminoglycosides and quinolones in the rest of the hospital. CONCLUSIONS: ICUs have some special features which make them different to the other inpatient areas. Because of that fact we consider it important to study this specific patient-care area separately.

Prescripción de antimicrobianos en adultos en una zona rural / Antimicrobian prescription for adults in a rural area

La utilización de antimicrobianos es especialmente importante en la sociedad por la elevada incidencia de enfermedades infecciosas y porque su uso abusivo contribuye al desarrollo de resistencias. Objetivo: Estudiar la prescripción de antimicrobianos en la edad adulta en un núcleo rural. Método: Estudio retrospectivo. Se valoró el empleo de antimicrobianos durante un período de 18 meses mediante la revisión de las historias clínicas de los pacientes que conformaron la muestra a estudiar (n = 800). Resultados: Al 45,63 por ciento de la muestra le fue pautado algún antimicrobiano, existiendo diferencias estadísticamente significativas a favor de las mujeres. Los subgrupos más prescritos fueron las asociaciones de antibióticos, las penicilinas, los macrólidos, las cefalosporinas y las quinolonas, por este orden. Los principios activos más empleados fueron la asociación amoxicilina - ácido clavulánico, amoxicilina, claritromicina, cefuroxima axetilo y norfloxacino, respectivamente. A los hombres se les prescriben más macrólidos que a las mujeres y a éstas más quinolonas, particularmente norfloxacino. Se observa una significativa tendencia al aumento de la prescripción de este tipo de fármacos con la edad. Conclusiones: La elevada utilización de los agentes antimicrobianos obliga a promover un empleo más racional de los mismos, por ello consideramos importante la realización de este tipo de estudios con el fin de valorar su evolución (AU)

The high incidence of infectious diseases and the development of bacterial resistances, as a consequence of the abusive consumption of antibiotics, emphasize the importance of controlling the use of this type of drugs. Objective: To study the prescription of antibiotics among adult people in a rural area. Method: A retrospective study. The use of antimicrobial agents during [8 months was evaluated by reviewing the clinic histories of those patients previously selected for the study (n = 800). Main results: The 45,63% of the patients had at least one type of antimicrobial during the period of study. The prescription of this type of drugs was signficantly higher among women but for both sexes, it increases significantly with age. Associations of antibiotics, penicillins, macrolides, cephalosporins and quinolones were, in this order, the most utilized groups of antimicrobial drugs. Amoxycillin - clavulanic acid, amoxycillin, clarithromycin, cefuroxime and norfloxacin were, respectively, the most prescribed drugs. The prescription of macrolides is significantly higher among men whereas quinolones, and particularly norfloxacin, are more used by women. Conclusions: Antibiotics should be utilized in a rational way, however the current consumption existing in our society is excessive. We consider that this kind of studies should be promoted to control and to evaluate how the use of these drugs evolves with time (AU)