Actitud de los psiquiatras respecto al uso de olanzapina en la práctica clínica: una encuesta nacional / Attitude of psychiatrists on the use of olanzapine in clinical practice: a national survey

INTRODUCCIÓN: Actualmente disponemos de un amplio abanico de antipsicóticos para el tratamiento de las psicosis, pero a excepción de la clozapina en pacientes resistentes, las guías clínicas no aclaran qué antipsicótico ha de prescribirse en primer lugar. Teniendo en cuenta la eficacia contrastada de olanzapina y su perfil de efectos secundarios, existe un interés en investigar su patrón de prescripción en nuestro país y sus factores asociados. MATERIAL Y MÉTODOS: Se administró una encuesta autoaplicada de 62 ítems, de carácter anónimo y voluntario, a 118 psiquiatras del territorio nacional. RESULTADOS: El perfil más frecuente entre los participantes fue el de un psiquiatra de entre 30-50 años que trabajaba en un centro de salud mental (76%). Respecto a los patrones generales de prescripción, la eficacia fue lo más valorado a la hora de elegir un antipsicótico. El uso de una combinación de antipsicóticos fue reportado por el 95% de los encuestados y la formulación preferida fue la oral. Olanzapina fue seleccionada como el antipsicótico con mayor adherencia y eficacia. El motivo del uso más señalado fueron los primeros episodios psicóticos en un 32%, siendo la dosis más utilizada la de 10 mg/día. Se prefiere olanzapina especialmente en cuadros con elevada agitación y síntomas psicóticos acusados. El aumento de peso y el síndrome metabólico son los efectos adversos que más motivan al facultativo a descartar olanzapina como tratamiento. CONCLUSIONES: Este estudio constató la relevancia de la eficacia a la hora de elegir un tratamiento antipsicótico. La muestra encuestada percibe la olanzapina como un fármaco efectivo, de uso habitual y especialmente útil para determinados perfiles clínicos

INTRODUCTION: Although there is a wide range of antipsychotic drugs currently available for the treatment of psychiatric disorders, apart from clozapine in resistant patients, the clinical guidelines are not clear on which antipsychotic drug should be prescribed in the first place. Taking into account the known efficacy of olanzapine and its side-effects profile, it would be of interest to study its prescription pattern as well as its associated factors in this country. MATERIAL AND METHODS: A self-administered, 62-item questionnaire was anonymously and voluntarily completed by 118 psychiatrists from all over the country. RESULTS: The most common profile of the participants was a psychiatrist of 30-50 years that worked in a mental health centre (76%). As regards the general prescribing patterns, efficacy was the most valued when choosing an antipsychotic drug. The use of a combination of antipsychotic drugs was reported by 95% of those that completed the questionnaire, and the preferred administration route was oral. Olanzapine was chosen as the antipsychotic drug with greater adherence and efficacy. The most stated reason for use was for the first psychotic episodes in 32%, with 10 mg/day being the dose most used. Olanzapine was preferred particularly in clinical pictures with increased agitation and marked psychotic symptoms. An increase in weight and metabolic syndrome are the side-effects that most motivate the psychiatrist to rule out olanzapine as a treatment. CONCLUSIONS: This study shows the importance of efficacy when choosing antipsychotic treatment. The surveyed sample perceived olanzapine as an effective drug, in routine use, and especially useful for certain clinical profiles

Norovirus: ¿un huésped más en residencias de la tercera edad? / Norovirus: One more guest in residential homes for the elderly?

No disponible

Applying the Innov8 approach for reviewing national health programmes to leave no one behind: lessons learnt from Indonesia.

The World Health Organization's Innov8 Approach for Reviewing National Health Programmes to Leave No One Behind is an eight-step process that supports the operationalization of the Sustainable Development Goals' commitment to 'leave no one behind'. In 2014-2015, Innov8 was adapted and applied in Indonesia to review how the national neonatal and maternal health action plans could become more equity-oriented, rights-based and gender-responsive, and better address critical social determinants of health. The process was led by the Indonesian Ministry of Health, with the support of WHO. It involved a wide range of actors and aligned with/fed into the drafting of the maternal newborn health action plan and the implementation planning of the newborn action plan. Key activities included a sensitization meeting, diagnostic checklist, review workshop and in-country work by the review teams. This 'methods forum' article describes this adaptation and application process, the outcomes and lessons learnt. In conjunction with other sources, Innov8 findings and recommendations informed national and sub-national maternal and neonatal action plans and programming to strengthen a 'leave no one behind' approach. As follow-up during 2015-2017, components of the Innov8 methodology were integrated into district-level planning processes for maternal and newborn health, and Innov8 helped generate demand for health inequality monitoring and its use in planning. In Indonesia, Innov8 enhanced national capacity for equity-oriented, rights-based and gender-responsive approaches and addressing critical social determinants of health. Adaptation for the national planning context (e.g. decentralized structure) and linking with health inequality monitoring capacity building were important lessons learnt. The pilot of Innov8 in Indonesia suggests that this approach can help operationalize the SDGs' commitment to leave no one behind, in particular in relation to influencing programming and monitoring and evaluation.

Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica / Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice

Las VI Guías Europeas de Prevención Cardiovascular recomiendan combinar las estrategias poblacional y de alto riesgo, con los cambios de estilo de vida como piedra angular de la prevención, y proponen la función SCORE para cuantificar el riesgo cardiovascular. Esta guía hace más hincapié en las intervenciones específicas de las enfermedades y las condiciones propias de las mujeres, las personas jóvenes y las minorías étnicas. No se recomienda el cribado de aterosclerosis subclínica con técnicas de imagen no invasivas. La guía establece cuatro niveles de riesgo (muy alto, alto, moderado y bajo), con objetivos terapéuticos de control lipídico según el riesgo. La diabetes mellitus confiere un riesgo alto, excepto en sujetos con diabetes tipo 2 con menos de 10 años de evolución, sin otros factores de riesgo ni complicaciones, o con diabetes tipo 1 de corta evolución sin complicaciones. La decisión de iniciar el tratamiento farmacológico de la hipertensión arterial dependerá del nivel de presión arterial y del riesgo cardiovascular, teniendo en cuenta la lesión de órganos diana. Siguen sin recomendarse los fármacos antiplaquetarios en prevención primaria por el riesgo de sangrado. La baja adherencia al tratamiento exige simplificar el régimen terapéutico e identificar y combatir sus causas. La guía destaca que los profesionales de la salud pueden ejercer un papel importante en la promoción de intervenciones poblacionales y propone medidas eficaces, tanto a nivel individual como poblacional, para promover una dieta saludable, la práctica de actividad física, el abandono del tabaquismo y la protección contra el abuso de alcohol (AU)

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse (AU)

Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica / Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice

Las VI Guías Europeas de Prevención Cardiovascular recomiendan combinar las estrategias poblacional y de alto riesgo, con los cambios de estilo de vida como piedra angular de la prevención, y proponen la función SCORE para cuantificar el riesgo cardiovascular. Esta guía hace más hincapié en las intervenciones específicas de las enfermedades y las condiciones propias de las mujeres, las personas jóvenes y las minorías étnicas. No se recomienda el cribado de aterosclerosis subclínica con técnicas de imagen no invasivas. La guía establece cuatro niveles de riesgo (muy alto, alto, moderado y bajo), con objetivos terapéuticos de control lipídico según el riesgo. La diabetes mellitus confiere un riesgo alto, excepto en sujetos con diabetes tipo 2 con menos de 10 años de evolución, sin otros factores de riesgo ni complicaciones, o con diabetes tipo 1 de corta evolución sin complicaciones. La decisión de iniciar el tratamiento farmacológico de la hipertensión arterial dependerá del nivel de presión arterial y del riesgo cardiovascular, teniendo en cuenta la lesión de órganos diana. Siguen sin recomendarse los fármacos antiplaquetarios en prevención primaria por el riesgo de sangrado. La baja adherencia al tratamiento exige simplificar el régimen terapéutico e identificar y combatir sus causas. La guía destaca que los profesionales de la salud pueden ejercer un papel importante en la promoción de intervenciones poblacionales y propone medidas eficaces, tanto a nivel individual como poblacional, para promover una dieta saludable, la práctica de actividad física, el abandono del tabaquismo y la protección contra el abuso de alcohol (AU)

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse (AU)

[Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

[Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

[Spanish Adaptation of the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than 10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

A combination of hydroxypropyl cellulose and trehalose as supplementation for vitrification of human oocytes: a retrospective cohort study.

PURPOSE: This study aimed to determine whether the new formulation of vitrification solutions containing a combination of hydroxypropyl cellulose (HPC) and trehalose does not affect outcomes in comparison with using conventional solutions made of serum substitute supplement (SSS) and sucrose. METHODS: Ovum donation cycles were retrospectively compared regarding the solution used for vitrification and warming of human oocytes. The analysis included 218 cycles (N = 2532 oocytes) in the study group (HPC + trehalose) and 214 cycles (N = 2353 oocytes) in the control group (SSS + sucrose). RESULTS: No statistical differences were found in ovarian stimulation parameters and baseline characteristics of donors and recipients. The survival rate was 91.3% (95% confidence interval (CI) = 89.8-92.9) in the HPC + trehalose group vs. 92.1% (95% CI = 90.4-93.7) in the SSS + sucrose group (NS). The implantation rate (42.8%, 95% CI = 37.7-47.9 vs. 41.2%, 95% CI = 36.0-46.4), clinical pregnancy rate (CPR) per transfer (60.7%, 95% CI = 53.9-67.5 vs. 56.4%, 95% CI = 49.3-63.5), and ongoing pregnancy rate (OPR) per transfer (48.5%, 95% CI = 41.5-55.5 vs. 46.3%, 95% CI = 39.2-53.4) were similar for patients who received either HPC + trehalose-vitrified oocytes or SSS + sucrose-vitrified oocytes. Statistical differences were found when analyzing blastocyst rate both per injected oocyte (30.2%, 95% CI = 28.3-32.1 vs. 24.1%, 95% CI = 22.3-25.9) and per fertilized oocyte (40.8%, 95%CI = 38.5-43.1 vs. 33.2%, 95% CI = 30.8-35.5) (P < 0.0001). Delivery rate was comparable between groups (37.2%, 95% CI = 30.8-46.6 vs. 36.9%, 95% CI = 30.4-43.4; NS). CONCLUSIONS: Our data demonstrate that HPC and trehalose are suitable and safe substitutes for serum and sucrose. Therefore, the new commercial media can be used efficiently in the vitrification of human oocytes avoiding viral and endotoxin contamination risk.

Adaptación española de las Guías Europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica / Spanish adaptation of the 2016 European Guidelines on cardiovascular disease revention in clinical practice

Las VI Guías Europeas de Prevención Cardiovascular recomiendan combinar las estrategias poblacionales y de alto riesgo, con los cambios de estilo de vida como piedra angular de la prevención, y proponen la función SCORE para cuantificar el riesgo cardiovascular. Esta guía hace más hincapié en las intervenciones específicas de las enfermedades y las condiciones propias de las mujeres, las personas jóvenes y las minorías étnicas. No se recomienda el cribado de aterosclerosis subclínica con técnicas de imagen no invasivas. La guía establece cuatro niveles de riesgo (muy alto, alto, moderado y bajo), con objetivos terapéuticos de control lipídico según el riesgo. La diabetes mellitus confiere un riesgo alto, excepto en sujetos con diabetes tipo 2 con menos de 10 años de evolución, sin otros factores de riesgo ni complicaciones, o con diabetes tipo 1 de corta evolución sin complicaciones. La decisión de iniciar el tratamiento farmacológico de la hipertensión arterial dependerá del nivel de presión arterial y del riesgo cardiovascular, teniendo en cuenta la lesión de órganos diana. Siguen sin recomendarse los fármacos antiplaquetarios en prevención primaria por el riesgo de sangrado. La baja adherencia al tratamiento exige simplificar el régimen terapéutico e identificar y combatir sus causas. La guía destaca que los profesionales de la salud pueden ejercer un papel importante en la promoción de intervenciones poblacionales y propone medidas eficaces, tanto a nivel individual como poblacional, para promover una dieta saludable, la práctica de actividad física, el abandono del tabaquismo y la protección contra el abuso de alcohol (AU)

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than 10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse (AU)

[Referrals and sex of physicians and patients: a gender analysis, Andalussia, Spain]. / Derivaciones en los centros de salud de Andalucía según el sexo de profesionales y pacientes: un análisis de género.

BACKGROUND: It has been identified differences of medical care practice in primary care related to physician's sex. Simultaneously, there are gender inequalities in the assignment of health resources. Both aspects give rise to an increasing growing interest in the management and provision of health services. OBJECTIVES: To examine the differences in the referral practice made by female and male primary care physicians working in health centers in Andalusia, to consider whether there are disparities in referrals received by men and women, and to examine the interaction between patient's sex and physician's sex. METHODS: Observational, cross-sectional, and multicenter study. POPULATION: 4 health districts in Andalucía and their physicians. SAMPLE: 382 physicians. MEASUREMENTS: referral rate per visit (RV), referral rate per patient quota (RQ), patient's sex, physician: sex, age, postgraduate family medicine specialty, size of the patient quota by sex, mean number of patients/day by sex, mean age of the patient quota by sex, and proportion of men in the quota. Health center: urban / rural, size of the team, enrolled population, and postgraduate family medicine specialty's accreditation. SOURCES: databases of health districts. PERIOD OF STUDY: 2010. ANALYSIS: Bivariate and multivariate multilevel analysis of the referral rate per visit with mixed Poisson model. RESULTS: In 2010 382 physicians made 129,161 referrals to specialized care. The RQ was 23.47 and the RV was 4.92. The RQ in women and men was 27.23 and 19.78 for women physicians, being 27.37 and 19.51 for male physicians. The RV in women and men was 4.92 and 5.48 for women physicians, being 4.54 and 4.93 for male physicians. CONCLUSION: There are no differences in referral according to physician's sex. However, there are signs that might indicate the existence of gender inequality, and women patient received less referrals. There are no physician-patient's sex interaction.

Derivaciones en los centros de salud de Andalucía según el sexo de profesionales y pacientes. Un análisis de género / Referrals and sex of physicians and patients. A gender analysis, Andalussia, Spain

Fundamento: En atención primaria se han identificado diferencias de práctica según sexo del profesional y, simultáneamente, existen des- igualdades de género en la asignación de recursos sanitarios, aspectos ambos que suscitan un interés creciente en la gestión y provisión de servicios de salud. El objetivo del estudio es conocer si existen diferencias de práctica en las derivaciones sanitarias realizadas por médicas y médicos de familia (MF) de centros de salud de Andalucía, si existen desigualdades en las derivaciones recibidas por hombres y mujeres, y si existe inter- acción sexo de profesional sexo de paciente. Métodos: Estudio transversal y multicéntrico. Población: MF de 4 distritos sanitarios (DDSS). Muestra: 382 MF. Variables: tasa de derivaciones por visita (TDxV), tasa de derivaciones por cupo (TDxC), sexo de paciente; sexo, edad, y formación postgraduada en medicina familiar de MF, tamaño del cupo por sexo, media de visitas /paciente por sexo, edad media del cupo por sexo, y proporción de hombres en el cupo; centro de salud urbano/rural, tamaño del equipo, población adscrita y acreditación docente. Fuentes: bases de datos de los DDSS. Análisis estadístico: descriptivo. Bivariante y multivariante mediante análisis multinivel de la TDxV con modelo mixto de Poisson. Resultados: En 2010 los/as 382 MF realizaron 129.161 derivaciones a especialistas. La TDxC fue 23,47 y la TDxV es 4,92. Las TDxC de las médicas fue 27,23 en mujeres y 19,78 en hombres y las de los médicos 27,37 en mujeres y 19,51 en hombres. La TDxV de las médicas fueron 4,92 en mujeres y 5,48 en hombres y para los médicos 4,54 y 4,93 respectivamente. Conclusiones: No existen diferencias en las derivaciones según sexo de las mujeres son menos derivadas. No existe interacción sexo profesional-sexo paciente (AU)

Background: It has been identified differences of medical care practice in primary care related to physician’s sex. Simultaneously, there are gender inequalities in the assignment of health resources. Both aspects give rise to an increasing growing interest in the management and provi- sion of health services. Objectives: To examine the differences in the referral practice made by female and male primary care physicians working in health centers in Andalusia, to consider whether there are disparities in referrals received by men and women, and to examine the interaction bet- ween patient’s sex and physician’s sex. Methods: Observational, cross-sectional, and multicenter study. Population: 4 health districts in Andalucía and their physicians. Sample: 382 physicians. Measurements: referral rate per visit (RV), referral rate per patient quota (RQ), patient's sex, physician: sex, age, postgraduate family medicine specialty, size of the patient quota by sex, mean number of patients/day by sex, mean age of the patient quota by sex, and proportion of men in the quota. Health center: urban / rural, size of the team, enrolled population, and postgraduate family medicine specialty's accreditation. Sources: databases of health districts. Period of study: 2010. Analysis: Bivariate and multivariate multilevel analysis of the referral rate per visit with mixed Poisson model. Results: In 2010 382 physicians made 129,161 referrals to specialized care. The RQ was 23.47 and the RV was 4.92. The RQ in women and men was 27.23 and 19.78 for women physicians, being 27.37 and 19.51 for male physicians. The RV in women and men was 4.92 and 5.48 for women physicians, being 4.54 and 4.93 for male physicians. Conclusion: There are no differences in referral according to physician´s sex. However, there are signs that might indicate the existence of men patient received less referrals. There are no physician-patient's sex interaction (AU)

Outcomes of vitrified early cleavage-stage and blastocyst-stage embryos in a cryopreservation program: evaluation of 3,150 warming cycles.

OBJECTIVE: To assess the outcomes achieved after Cryotop vitrification of both early cleavage and blastocyst-stage embryos and to determine whether the embryo developmental stage and embryo quality as well as the origin of the embryos (ovum donation cycles, patients' own oocytes) and the endometrial preparation for the embryo transfer had any effect on the final outcome. DESIGN: Observational study. SETTING: Private university-affiliated IVF center. PATIENT(S): Women undergoing 3,150 warming cycles whose embryos were vitrified due to various reasons. INTERVENTION(S): Vitrification by the Cryotop open device. MAIN OUTCOME MEASURE(S): Delivery rate (DR) per warming cycle. RESULT(S): Survival rate was 95% (5,722 out of 6,019 embryos). The percentage of intact embryos at warming showing 100% blastomere survival was 93% (95% CI 90.1%-95.3%) for day 2 and 95% (95% CI 94.3%-95.7%) for day 3; 3,057 embryo transfers were performed (3% cancellation rate). The DR/warming cycle was 32.5% (95% CI 30.9%-34.2%). Slight differences in survival rate were found [94.9% (95% CI 93.0%-96.8%) for day 2, 94.2% (95% CI 93.4%-94.9%) for day 3, 95.7% (95% CI 94.5%-96.9%) for day 5, and 97.6% (95% CI 96.9%-98.6%) for day 6]. Overall implantation, clinical pregnancy, ongoing pregnancy, and live birth rates per warming cycle were 35.5% (95% CI 33.5%-38.5%), 41.7% (95% CI 39.9%-43.4%), 32.6% (95% CI 31.0%-34.2%), and 38.1% (95% CI 36.4%-39.8%) respectively. The linear regression model considering embryo developmental stage, ovum donation or patient's own oocytes, and hormonal replacement therapy or natural cycle for endometrial preparation (odds ratio 1.179; 95% CI 0.912-1.277) showed no impact on the DR. CONCLUSION(S): Highly successful cryopreservation of all embryo developmental stages is possible with the use of the Cryotop system. There are no variables clearly exerting a negative effect on the survival and delivery rates.

[Epidemic outbreak of acute gastroenteritis due to norovirus with possible hydric origin]. / Brote epidémico de gastroenteritis aguda por norovirus con posible origen hídrico.

INTRODUCTION: To describe the clinical, microbiological and epidemiological investigations performed after an outbreak of acute gastroenteritis in a wedding. METHOD: A descriptive, case-control study was performed. An epidemiological survey (45 cases-28 controls) and inspection were carried out. RESULTS: Affected individuals had diarrhea and vomiting. Water and ice were contaminated. Norovirus was isolated in only one stool sample. Statistically significant differences in water consumption were found in bivariate analysis (p = 0.02; ORc = 10.6; 95% CI: 1.20-220.05) and multivariate analysis (p = 0.04; ORa = 8.93; 95% CI: 1.03-77.41). CONCLUSIONS: The clinical and epidemiological characteristics and laboratory results indicate that the most probable cause of the outbreak was norovirus.

Brote epidémico de gastroenteritis aguda por norovirus con posible origen hídrico / Epidemic outbreak of acute gastroenteritis due to norovirus with possible hydric origin

Describir la investigación clínica, epidemiológica y microbiológica de un brote de gastroenteritis aguda dado en una boda. Método. Estudio descriptivo y casos y controles. Se realizó encuesta epidemiológica (45 casos-28 controles) e inspección. Resultados. Diarrea y vómitos. Contaminación del agua e hielo. Sólo un coprocultivo positivo a norovirus. En análisis bivariante (p = 0,02; ORc = 10,6; IC 95%; 1,20-220,05) y multivariante (p = 0,04; ORa = 8,93; IC 95%: 1,03-77,41) existen diferencias estadísticamente significativas para el consumo de agua. Conclusiones. Las características clínicas, epidemiológicas y los resultados de laboratorio hacen altamente probable la etiología de este brote por norovirus (AU)

To describe the clinical, microbiological and epidemiological investigations performed after an outbreak of acute gastroenteritis in a wedding. Method. A descriptive, case-control study was performed. An epidemiological survey (45 cases-28 controls) and inspection were carried out. Results. Affected individuals had diarrhea and vomiting. Water and ice were contaminated. Norovirus was isolated in only one stool sample. Statistically significant differences in water consumption were found in bivariate analysis (p = 0.02; ORc = 10.6; 95% CI: 1.20-220.05) and multivariate analysis (p = 0.04; ORa = 8.93; 95% CI: 1.03-77.41). Conclusions. The clinical and epidemiological characteristics and laboratory results indicate that the most probable cause of the outbreak was norovirus (AU)