Enfermedad cardiovascular previa y posterior a la infección por COVID-19. Supervivencia a un año / Cardiovascular disease before and after COVID-19 infection: One-year survival

Objetivos Analizar el riesgo de COVID-19 con relación a la morbilidad previa, así como el riesgo de nuevos eventos cardiovasculares (ECV) en pacientes COVID-19 y la supervivencia a un año. Metodología Estudio casos-control y estudio de cohortes prospectivo. Se incluyeron 275 pacientes aleatorizados >18 años diagnosticados de COVID-19 y se aparearon con 825 COVID-19 negativos por edad y sexo (proporción 1:3). Las variables principales fueron diagnóstico de COVID-19 y eventos post-COVID-19. Se estudiaron variables sociodemográficas, comorbilidad y ECV previo. Se realizaron sendos modelos predictivos de factores asociados al desarrollo de COVID-19 y de ECV post-COVID-19, así como un análisis de supervivencia a un año. Resultados Los varones con ECV previo duplican el riesgo de padecer COVID-19 (odds ratio [OR] 2,11; intervalo de confianza [IC] 95% 1,32–3,36). En las mujeres el riesgo aumenta con la edad (OR 1,01; IC 95% 1,00–1,02), la diabetes mellitus (DM) (OR 1,90; IC 95% 1,14–3,17) y el deterioro cognitivo (OR 4,88; IC 95% 2,50–9,53). La inmunosupresión actúa como factor protector en ambos sexos. La edad (OR 1,02; IC 95% 1,00–1,04), hipertensión arterial (HTA) (OR 2,21; IC 95% 1,17–4,17), la infección COVID-19 (OR 4,81; IC 95% 2,89–7,98) y el ECV previo (OR 4,46; IC 95% 2,56–7,75) predicen el desarrollo de un nuevo ECV post-COVID-19. Los pacientes COVID-19 positivos tienen menor supervivencia (mediana de siete vs. 184 días). Conclusiones El ECV previo en varones y la DM junto al deterioro cognitivo en mujeres aumentan el riesgo de presentar COVID-19. La edad, HTA, ECV previo y la infección COVID-19 predicen la aparición de un ECV (AU)

Aim To analyze the risk of COVID-19 in relation to previous morbidity; to analyze the risk of new cardiovascular events (CVE) in COVID-19 patients and one-year survival. Methodology Case–control study and prospective cohort study. Two hundred and seventy-five randomized patients >18 years old with COVID-19 were included and matched with 825 without COVID-19 by age and sex (ratio 1:3). The main variables were diagnosis of COVID-19 and post-COVID-19 events. Sociodemographic variables, comorbidity, and previous CVD were studied. Two predictive models of factors associated with the development of COVID-19 and post-COVID-19 CVE were performed, as well as a one-year survival analysis. Results Men with a previous CVE double the risk of suffering from COVID-19 (OR 2.11; 95% CI: 1.32–3.36). In women, the risk increases with age (OR 1.01; 95% CI: 1.00–1.02), diabetes (DM) (OR 1.90; 95% CI: 1.14–3.17) and cognitive impairment (OR 4.88; 95% CI: 2.50–9.53). Immunosuppression acts as a protective factor in both sexes. Age (OR 1.02; 95% CI: 1.00–1.04), arterial hypertension (OR 2.21; 95% CI: 1.17–4.17), COVID-19 infection (OR 4.81; 95% CI: 2.89–7.98) and previous CVE (OR 4.46; 95% CI: 2.56–7.75) predict the development of a new post-COVID-19 CVE. Positive COVID-19 has lower survival (median 7 days vs. 184 days). Conclusions Previous CVE in men and DM along with cognitive impairment in women increase the risk of presenting COVID-19. Age, arterial hypertension, previous CVE, and COVID-19 infection predict the appearance of new CVE (AU)

[Cardiovascular disease before and after COVID-19 infection: One-year survival]. / Enfermedad cardiovascular previa y posterior a la infección por COVID-19. Supervivencia a un año.

AIM: To analyze the risk of COVID-19 in relation to previous morbidity; to analyze the risk of new cardiovascular events (CVE) in COVID-19 patients and one-year survival. METHODOLOGY: Case-control study and prospective cohort study. Two hundred and seventy-five randomized patients >18 years old with COVID-19 were included and matched with 825 without COVID-19 by age and sex (ratio 1:3). The main variables were diagnosis of COVID-19 and post-COVID-19 events. Sociodemographic variables, comorbidity, and previous CVD were studied. Two predictive models of factors associated with the development of COVID-19 and post-COVID-19 CVE were performed, as well as a one-year survival analysis. RESULTS: Men with a previous CVE double the risk of suffering from COVID-19 (OR 2.11; 95% CI: 1.32-3.36). In women, the risk increases with age (OR 1.01; 95% CI: 1.00-1.02), diabetes (DM) (OR 1.90; 95% CI: 1.14-3.17) and cognitive impairment (OR 4.88; 95% CI: 2.50-9.53). Immunosuppression acts as a protective factor in both sexes. Age (OR 1.02; 95% CI: 1.00-1.04), arterial hypertension (OR 2.21; 95% CI: 1.17-4.17), COVID-19 infection (OR 4.81; 95% CI: 2.89-7.98) and previous CVE (OR 4.46; 95% CI: 2.56-7.75) predict the development of a new post-COVID-19 CVE. Positive COVID-19 has lower survival (median 7 days vs. 184 days). CONCLUSIONS: Previous CVE in men and DM along with cognitive impairment in women increase the risk of presenting COVID-19. Age, arterial hypertension, previous CVE, and COVID-19 infection predict the appearance of new CVE.

Injury epidemiology in competing and non-competing spanish crossfit® practitioners / Epidemiología lesional en practicantes de crossfit® competidores y no competidores españoles

La falta de estudios sobre lesiones en Crossfit® en España, motiva la realización de este estudio epidemiológico descriptivo, observacional y retrospectivo, analizando la incidencia y las características de las lesiones sufridas por practicantes de Crossfit® competidores y no competidores. Se registraron las lesiones sufridas por 434 deportistas entre el 1 de enero y el 31 de diciembre de 2019. Se registraron datos sobre el número de lesiones, lesiones más frecuentes, distribución, tipo, ubicación, el momento en que ocurrieron y la causa de las lesiones que afectan el sistema musculoesquelético. La tasa de lesiones en esta población fue de 3,48 lesiones por 1000 horas de exposición al riesgo. El hombro y la zona lumbar fueron las zonas anatómicas más frecuentemente lesionadas, siendo el musculo y el tendón el tejido de asiento más habitual de las lesiones. El Powerlifting fue la actividad más lesiva. (AU)

The lack of studies on Crossfit® injuries in Spain, motivates the realization of this descriptive, observational and retrospective epidemiological study, analyzing the incidence and characteristics of injuries suffered by Crossfit® competitors and non-competitors.The injuries suffered by 434 athletes between from January 1st to December 31st 2019 were recorded. We collected data on the number of injuries, the most frequent injuries, their distribution, type, location, the moment at which these occurred and the cause of the injuries affecting the musculoeskeletal system. We found that the injury rate in this population was 3,48 injuries per 1000 hours of risk. The shoulder and lumbar area were the most frequently injured anatomical areas, with muscle and tendon being the most common seat tissue of injuries. Powerlifting was the most damaging activity. (AU)

Development of a calculator to establish indications to refer patients with lumbar degenerative disease for spinal surgery consultation. / Desarrollo de una calculadora para establecer indicación de derivación a consulta de cirugía del raquis en patología degenerativa lumbar.

BACKGROUND AND AIM: Low-back pain remains a common pathological entity in the Western population. We have found no data in the literature that assess whether, with correct physical examination and evaluation of simple x-rays of the spine, it is possible to diagnose patients who are highly likely to be candidates for lumbar spine surgery and thus reduce the care burden and resource consumption that this disorder entails. The aim of the study was to develop a user-friendly calculator that allows only patients who are strong candidates for surgical treatment to be referred for spinal surgery consultation. MATERIAL AND METHOD: An observational and retrospective study that included all adult patients from the healthcare area of Talavera de la Reina (Toledo, Spain) with a clinical and/or radiological diagnosis of degenerative lumbar spine disease referred by other specialists over one calendar year to the spinal surgery unit to assess whether surgery was indicated after unsuccessful conservative treatment. All the patients were assessed under the same protocol with a follow-up of 6years, at the end of which we performed a check of those who had undergone lumber spine surgery. RESULTS: A total of 201 patients were studied and at the end of the 6-year follow-up, a total of 77 patients had been operated. Concordance of 70% was found between the indication for surgical treatment and the treatment received at the end of the follow-up. Therefore a logistic regression was performed in an attempt to predict the patients that could be referred to the spinal surgery units and from that a calculator was generated, which included the plain x-ray variable as an essential item, and which showed as statistically significant (P<.05): age, Waddell's non-organic signs, Lasegue's sign and plain x-ray assessment. Once this tool had been obtained, the likelihood of undergoing surgery was calculated for all patients who were proposed surgical treatment, obtaining results above 62% as the cut-off point when using the calculator. CONCLUSIONS: The use of the calculator predicts the possibility of being a candidate for surgical treatment with 70% reliability. Therefore, patients with a result in the calculator of above 62% should be referred for spinal surgery consultation for assessment by a specialist.

Evaluation of the potential use of a meta-population for genomic selection in autochthonous beef cattle populations.

This study investigated the potential application of genomic selection under a multi-breed scheme in the Spanish autochthonous beef cattle populations using a simulation study that replicates the structure of linkage disequilibrium obtained from a sample of 25 triplets of sire/dam/offspring per population and using the BovineHD Beadchip. Purebred and combined reference sets were used for the genomic evaluation and several scenarios of different genetic architecture of the trait were investigated. The single-breed evaluations yielded the highest within-breed accuracies. Across breed accuracies were found low but positive on average confirming the genetic connectedness between the populations. If the same genotyping effort is split in several populations, the accuracies were lower when compared with single-breed evaluation, but showed a small advantage over small-sized purebred reference sets over the accuracies of subsequent generations. Besides, the genetic architecture of the trait did not show any relevant effect on the accuracy with the exception of rare variants, which yielded slightly lower results and higher loss of predictive ability over the generations.

[Value of molecular imaging to examine the brain]. / Aportacion de la imagen molecular en la exploracion del cerebro.

TITLE: Aportacion de la imagen molecular en la exploracion del cerebro.

Genomic differentiation between Asturiana de los Valles, Avileña-Negra Ibérica, Bruna dels Pirineus, Morucha, Pirenaica, Retinta and Rubia Gallega cattle breeds.

The Spanish local beef cattle breeds have most likely common origin followed by a process of differentiation. This particular historical evolution has most probably left detectable signatures in the genome. The objective of this study was to identify genomic regions associated with differentiation processes in seven Spanish autochthonous populations (Asturiana de los Valles (AV), Avileña-Negra Ibérica (ANI), Bruna dels Pirineus (BP), Morucha (Mo), Pirenaica (Pi), Retinta (Re) and Rubia Gallega (RG)). The BovineHD 777K BeadChip was used on 342 individuals (AV, n=50; ANI, n=48; BP, n=50; Mo, n=50; Pi, n=48; Re, n=48; RG, n=48) chosen to be as unrelated as possible. We calculated the fixation index (F ST ) and performed a Bayesian analysis named SelEstim. The output of both procedures was very similar, although the Bayesian analysis provided a richer inference and allowed us to calculate significance thresholds by generating a pseudo-observed data set from the estimated posterior distributions. We identified a very large number of genomic regions, but when a very restrictive significance threshold was applied these regions were reduced to only 10. Among them, four regions can be highlighted because they comprised a large number of single nucleotide polymorphisms and showed extremely high signals (Kullback-Leiber divergence (KLD)>6). They are located in BTA 2 (5 575 950 to 10 152 228 base pairs (bp)), BTA 5 (17 596 734 to 18 850 702 bp), BTA 6 (37 853 912 to 39 441 548 bp) and BTA 18 (13 345 515 to 15 243 838 bp) and harbor, among others, the MSTN (Myostatin), KIT-LG (KIT Ligand), LAP3 (leucine aminopeptidase 3), NAPCG (non-SMC condensing I complex, subunit G), LCORL (ligand dependent nuclear receptor corepressor-like) and MC1R (Melanocortin 1 receptor) genes. Knowledge on these genomic regions allows to identify potential targets of recent selection and helps to define potential candidate genes associated with traits of interest, such as coat color, muscle development, fertility, growth, carcass and immunological response.

Bayesian analysis of parent-specific transmission ratio distortion in seven Spanish beef cattle breeds.

Transmission ratio distortion (TRD) is the departure from the expected Mendelian ratio in offspring, a poorly investigated biological phenomenon in livestock species. Given the current availability of specific parametric methods for the analysis of segregation data, this study focused on the screening of TRD in 602 402 single nucleotide polymorphisms covering all autosomal chromosomes in seven Spanish beef cattle breeds. On average, 0.13% (n = 786) and 0.01% (n = 29) of genetic markers evidenced sire- or dam-specific TRD respectively. There were no single nucleotide polymorphisms accounting for both sire- and dam-specific TRD at the same time, and only one marker (rs43147474) accounted for (sire-specific) TRD in all seven breeds. It must be noted that rs43147474 is located in the fourth intronic region of the GTP-binding protein 10 gene, and this locus has been previously linked to the maintenance of mitochondria and nucleolar architectures. Alternatively, other candidate genes surround this hot-spot for sire-specific TRD in the cattle genome, and they are related to embryonic and postnatal lethality as well as prostate cancer, among others. This research characterized the distribution of TRD in the bovine genome, highlighting heterogeneous results when comparing across breeds.

Variability and trends in the consumption of drugs for treating attention-deficit/hyperactivity disorder in Castile-La Mancha, Spain (1992-2015). / Variabilidad y tendencias en el consumo de fármacos para los trastornos por déficit de atención e hiperactividad en Castilla-La Mancha, España (1992-2015).

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disorders of childhood; its prevalence in Spain is estimated at 5-9%. Available treatments for this condition include methylphenidate, atomoxetine, and lisdexamfetamine, whose consumption increases each year. MATERIAL AND METHODS: The prevalence of ADHD was estimated by calculating the defined daily dose per 1,000 population per day of each drug and the total doses (therapeutic group N06BA) between 1992 and 2015 in each of the provinces of Castile-La Mancha (Spain). Trends, joinpoints, and annual percentages of change were analysed using joinpoint regression models. RESULTS: The minimum prevalence of ADHD in the population of Castile-La Mancha aged 5 to 19 was estimated at 13.22 cases per 1,000 population per day; prevalence varied across provinces (p<.05). Overall consumption has increased from 1992 to 2015, with an annual percentages of change of 10.3% and several joinpoints (2000, 2009, and 2012). methylphenidate represents 89.6% of total drug consumption, followed by lisdexamfetamine at 8%. CONCLUSIONS: Analysing drug consumption enables us to estimate the distribution of ADHD patients in Castile-La Mancha. Our data show an increase in the consumption of these drugs as well as differences in drug consumption between provinces, which reflect differences in ADHD management in clinical practice.

Linkage disequilibrium, persistence of phase, and effective population size in Spanish local beef cattle breeds assessed through a high-density single nucleotide polymorphism chip.

Linkage disequilibrium (LD) and persistence of phase are fundamental approaches for exploring the genetic basis of economically important traits in cattle, including the identification of QTL for genomic selection and the estimation of effective population size () to determine the size of the training populations. In this study, we have used the Illumina BovineHD chip in 168 trios of 7 Spanish beef cattle breeds to obtain an overview of the magnitude of LD and the persistence of LD phase through the physical distance between markers. Also, we estimated the time of divergence based on the persistence of the LD phase and calculated past from LD estimates using different alternatives to define the recombination rate. Estimates of average (as a measure of LD) for adjacent markers were close to 0.52 in the 7 breeds and decreased with the distance between markers, although in long distances, some LD still remained (0.07 and 0.05 for markers 200 kb and 1 Mb apart, respectively). A panel with a lower boundary of 38,000 SNP would be necessary to launch a successful within-breed genomic selection program. Persistence of phase, measured as the pairwise correlations between estimates of in 2 breeds at short distances (10 kb), was in the 0.89 to 0.94 range and decreased from 0.33 to 0.52 to a range of 0.01 to 0.08 when marker distance increased from 200 kb to 1 Mb, respectively. The magnitude of the persistence of phase between the Spanish beef breeds was similar to those found in dairy breeds. For across-breed genomic selection, the size of the SNP panels must be in the range of 50,000 to 83,000 SNP. Estimates of past showed values ranging from 26 to 31 for 1 generation ago in all breeds. The divergence among breeds occurred between 129 and 207 generations ago. The results of this study are relevant for the future implementation of within- and across-breed genomic selection programs in the Spanish beef cattle populations. Our results suggest that a reduced subset of the SNP panel would be enough to achieve an adequate precision of the genomic predictions.

Correlation between physical examination and intraoperative findings in shoulder disease treated by arthroscopy. Statistical analysis of 150 patients. / Correlación entre la exploración física y los hallazgos intraoperatorios de patología de hombro tratada mediante artroscopia. Análisis estadístico de 150 pacientes.

INTRODUCTION: Only a few clinical exploratory manoeuvres are truly discriminatory and useful in shoulder disease. The aim of this study is to correlate the physical examination results of the shoulder with the true diagnosis found by arthroscopy. METHODS: A retrospective case series of 150 patients with the most common surgical conditions of the shoulder. Data were collected on the suspicion of each pathology, the physical examination of the patient, and the actual discovery of the disease during arthroscopic surgery. RESULTS: The Bankart examination manoeuvres of the lesion show the best results, with a 92.1% positive prediction value (PPV), a 99.1% negative predictive value (NPV), followed by the impingement syndrome, with a PPV of 94.4%, and total cuff rupture with a PPV of 92.3%.Exploration of the superior labrum anterior to posterior (SLAP) lesion had an NPV of 99.1%. CONCLUSION: Physical examination is sufficient to diagnose or rule out Bankart. A positive physical examination provides the complete rupture of the rotator cuff, and requires further studies. The patients suspected of subacromial syndrome only need an NMR if the physical tests are negative. The conclusions drawn from this work can have a significant impact on both cost savings (by reducing forward tests), and saving time in certain cases in which, after appropriate physical examination, surgery may be indicated without losing time in intermediate steps.

Genetic diversity and divergence among Spanish beef cattle breeds assessed by a bovine high-density SNP chip.

The availability of SNP chips for massive genotyping has proven to be useful to genetically characterize populations of domestic cattle and to assess their degree of divergence. In this study, the Illumina BovineHD BeadChip genotyping array was used to describe the genetic variability and divergence among 7 important autochthonous Spanish beef cattle breeds. The within-breed genetic diversity, measured as the marker expected heterozygosity, was around 0.30, similar to other European cattle breeds. The analysis of molecular variance revealed that 94.22% of the total variance was explained by differences within individuals whereas only 4.46% was the result of differences among populations. The degree of genetic differentiation was small to moderate as the pairwise fixation index of genetic differentiation among breeds (F) estimates ranged from 0.026 to 0.068 and the Nei's D genetic distances ranged from 0.009 to 0.016. A neighbor joining (N-J) phylogenetic tree showed 2 main groups of breeds: Pirenaica, Bruna dels Pirineus, and Rubia Gallega on the one hand and Avileña-Negra Ibérica, Morucha, and Retinta on the other. In turn, Asturiana de los Valles occupied an independent and intermediate position. A principal component analysis (PCA) applied to a distance matrix based on marker identity by state, in which the first 2 axes explained up to 17.3% of the variance, showed a grouping of animals that was similar to the one observed in the N-J tree. Finally, a cluster analysis for ancestries allowed assigning all the individuals to the breed they belong to, although it revealed some degree of admixture among breeds. Our results indicate large within-breed diversity and a low degree of divergence among the autochthonous Spanish beef cattle breeds studied. Both N-J and PCA groupings fit quite well to the ancestral trunks from which the Spanish beef cattle breeds were supposed to derive.

Monitoring changes in the demographic and genealogical structure of the main Spanish local beef breeds.

Demographic and pedigree analyses describe the structure and dynamics of livestock populations. We studied information recorded in the herdbooks of Asturiana de los Valles (AV; N = 458,806), Avileña-Negra Ibérica (ANI; N = 204,623), Bruna dels Pirineus (BP; N = 62,138), Morucha (Mo; N = 65,350), Pirenaica (Pi; N = 217,428), Retinta (Re; N = 135,300), and Rubia Gallega (RG; N = 235,511) beef breeds from their creation until 2009. All breeds have increased in the number of registered cows in recent years. In all breeds, herds do not behave as isolated entities and a high rate of exchange of breeding males between herds exists. A percentage of herds (12-52%) make some type of selection and sell bulls to other herds. There were large differences in average number of progeny per bull, ranging from 15.6 (AV) to 373.7 animals (RG, with a high incidence of AI). Generation interval estimates ranged from 4.7 (AV) to 7.6 (RG) yr in the sire pathway and from 5.95 (AV) to 7.8 (Mo) yr in the dam pathway. Density of pedigrees varied among breeds, with Pi, ANI, and Re having the more dense pedigrees, with average completeness indexes of more than 96% in the first generation and 80% when 6 generations were considered. A general increase in average inbreeding was observed in all breeds in the years analyzed. For animals born in 2009, average inbreeding coefficients ranged from 0.6 (BP) to 7.2% (Re) when all animals were considered and from 3.6 (Pi) to 17.6% (BP) when only inbred animals were considered. Due to the lack of completeness of pedigrees in most populations, inbreeding coefficients may be considered as a lower bound of the true parameters. The proportion of inbred animals tended to increase in the periods analyzed in all breeds. Differences between inbreeding and coancestry rates (except in RG) suggest the presence of population structure. Effective population size (Ne) based on the inbreeding rate estimated by regression ranged from 43 to 378 for Re and BP, whereas Ne estimates based on coancestry were greater, with a range of 100 for RG to 9,985 for BP. These facts suggest that an adequate mating policy can help to monitor inbreeding so as not to lose genetic variability. Effective number of ancestors in 2009 for 6 of the breeds ranged from 42 (RG) to 220 (AV), with BP having much a greater value, and was lower than was the effective number of founders in all breeds, suggesting the existence of bottlenecks.

Geometry effects on Rayleigh-Bénard convection in rotating annular layers.

Rayleigh-Bénard convection is investigated in rotating annular cavities at a moderate dimensionless rotation rate Ω=60. The onset of convection is in the form of azimuthal traveling waves that set in at the sidewalls and at values of the Rayleigh number significantly below the value of the onset of convection in an infinitely extended layer. The present study addresses the effects of curvature and confinement on the onset of sidewall convection by using three-dimensional spectral solutions of the Oberbeck-Boussinesq equations. Such solutions demonstrate that the curvature of the outer boundary promotes the onset of the wall mode, while the opposite curvature of the inner boundary tends to delay the onset of the wall mode. An inner sidewall with a radius as low as one tenth of its height is sufficient, however, to support the onset of a sidewall mode. When radial confinement is increased the two independent traveling waves interact and eventually merge to form a nearly steady pattern of convection.

Seasonal variation of pharmaceutically active compounds in surface (Tagus River) and tap water (Central Spain).

Numerous studies have shown the presence of pharmaceutically active compounds (PhACs) in different environmental compartments, for example, in surface water or wastewater ranging from nanograms per litre to micrograms per litre. Likewise, some recent studies have pointed to seasonal variability, thus indicating that PhAcs concentrations in the aquatic environment may depend on the time of year. This work intended to find out (1) whether Tagus fluvial and drinking water were polluted with different groups of PhACs and (2) if their concentrations differed between winter and summer seasons. From the 58 substances analysed, 41 were found belonging to the main therapeutic groups. Statistical differences were seen for antibacterials, antidepressants, anxiolytics, antiepileptics, and cardiovascular drugs, with higher concentrations being detected in winter than in summer. These results might indicate that the PhACs analysed in this study undergo lower environmental degradation in winter than in summer. In order to confirm these initial results, a continuous monitoring should be performed especially on those PhACs that either because of an elevated consumption or an intrinsic chemical persistence are poorly degraded during winter months due to low temperatures and solar irradiation. It is especially important to identify which of these specific PhACs are in order to recommend their substitution by equally effective and safe substances but also environmentally friendly.

Influence of local factors in the relationship between mortality and heat waves: Castile-La Mancha (1975-2003).

INTRODUCTION: All the climate-change studies undertaken to date agree that one of the principal consequences of this phenomenon is the increase in heat waves, which, without exception, are linked to marked rises in mortality. The characteristics that modulate and determine the relationship between high temperatures and health must therefore be ascertained in the greatest possible detail, so that really effective prevention plans can be designed to address temperature extremes. METHODS: We examined the effect of heat waves on daily non-accidental-cause mortality across all age groups in the Castile-La Mancha region (Spain) from 1975 to 2003. Quantitative analyses were performed using autoregressive integrated moving average (ARIMA) models, with other covariates, such as pressure trends, relative humidity, and duration and chronological number of heat waves. RESULTS: Mortality increased significantly with respect to the mean, when temperatures exceeded the designated provincial thresholds in Castile-La Mancha. For each degree centigrade that temperatures exceeded these thresholds, the percentage increase in mortality amounted to increases of approximately 12% over the daily mean, albeit with clear provincial variations. The longest heat waves were associated with daily mortality, with those at the end of summer causing the lowest mortality. Meteorological situations most closely associated with increases in mortality were cyclonic conditions accompanied by low humidity. CONCLUSIONS: Spatio-temporal variability in the temperature-mortality relationship must be studied in order to enable really effective heat-wave prevention plans to be drawn up. The influence of variables, such as heat-wave duration or time of appearance, is important in the total increase in mortality during temperature extremes. Since parameters, such as humidity or pressure trends, can play very different roles in different geographical settings, they should be analysed separately from temperature.

¿Controlamos correctamente la diabetes desde atención primaria en Talavera de la Reina (Toledo)? / Do we control diabetes correctly from Primary Care in Talavera de la Reina (Toledo)?

Introducción. La diabetes mellitus es una enfermedad crónica con elevada morbilidad, con un elevado coste sanitario y social, cuyo correcto control es fundamental. La glucohemoglobina (HbA1c) se ha convertido en un elemento de controversia sobre su utilidad diagnóstica y de monitorización de la enfermedad. Material y métodos. Se han analizado todas las determinaciones de HbA1c de la población no pediátrica de la Gerencia de Atención Primaria de Talavera de la Reina (Toledo) entre los años 2006 a 2008. Todas las muestras han sido analizadas en el Servicio de Análisis Clínicos del Hospital Nuestra Señora del Prado de Talavera de la Reina de acuerdo a las normas internacionales. La concentración de HbA1c a partir de la que se ha considerado un buen o mal control de la DM es del 7%. Todos los resultados se han agregado por peticionario y por centro de salud. Resultados. Se han realizado 26.611 determinaciones, con un valor medio de la concentración de HbA1c 6,9%. No existen diferencias estadísticamente significativas entre centros de salud (p>0,05) ni entre profesionales (p>0,05). El 57,1% de la población del área está bien controlada, sin que existan diferencias estadísticamente significativas entre centros de salud (p>0,05). Conclusión. Nuestra población tiene un grado de control adecuado de su glucemia, de acuerdo a los valores de HbA1c, y no existen diferencias significativas entre centros de salud o entre los profesionales. La no existencia de diferencias estadísticas no significa que no se aprecie una variabilidad en el grado de control. Debemos seguir trabajando por reducir las diferencias encontradas, para que la población pueda acceder a los mismos niveles de salud (AU)

Introduction: Diabetes mellitus is a chronic disease with high morbidity, high health and social costs, and in which control is crucial. Glycosylated haemoglobin (HbA1c) has become a matter of controversy on its usefulness in diagnosing and monitoring the disease. Material and methods: We analysed all measures of HbA1c measurements in the population non-paediatric Primary Care population in Talavera de la Reina (Toledo, Spain) between the years 2006-2008. All samples were analysed in the Laboratory of the Hospital Nuestra Se˜nora del Prado, Talavera de la Reina in line with international standards. The concentration of HbA1c which has been considered to show good or poor control of DM is 7%. All results have been analysed by requester or by health centre. Results: A total of 26,611 determinations were made, with a mean HbA1c concentration of 6.9%. No statistically significant differences were found between health centres (p > .05) or between the professionals who requested the test (p > .05). The majority, 57.1% of the population of the area, was well controlled, with no statistically significant differences between health centres (p > .05). Conclusion: Our population has an adequate level of blood glucose control, according to the values of HbA1c values, with no significant differences between health centres or professionals. The absence of statistical differences does not necessarily mean that no variation was observed in the level of control. We must continue working to reduce the differences found, so that patients may have access to the same levels of health (AU)