[Birth rates evolution in Spain. Birth trends in Spain from 1941 to 2010]. / Evolución de la natalidad en España. Análisis de la tendencia de los nacimientos entre 1941 y 2010.

OBJECTIVES: The aim of this study was to analyse trends of births in Spain and its Autonomous Communities (CCAA) over a 70 year period (1941-2010). METHODS: The crude birth rates per 1,000 inhabitants/year were calculated by CCAA using Joinpoint regression models. Change points in trend and annual percentage of change (APC) were identified. RESULTS: The distribution of 38,160,305 births between 1941 and 2010 shows important changes in trends both nationally and among the CCAA. There is a general pattern for the whole country, with 5 turning points being identified with changes in trend and annual percentage change (APC). Differences are also found among regions. CONCLUSION: The analysis of trends in birth rates and the annual rates of change should enable public health authorities to properly plan pediatric care resources in our country.

Automatic detection of wakefulness and rest intervals in actigraphic signals: a data-driven approach.

Actigraphy is an useful tool for evaluating the activity pattern of a subject; activity registries are usually processed by first splitting the signal into its wakefulness and rest intervals and then analyzing each one in isolation. Consequently, a preprocessing stage for such a splitting is needed. Several methods have been reported to this end but they rely on parameters and thresholds which are manually set based on previous knowledge of the signals or learned from training. This compromises the general applicability of this methods. In this paper we propose a new method in which thresholds are automatically set based solely on the specific registry to be analyzed. The method consists of two stages: (1) estimation of an initial classification mask by means of the expectation maximization algorithm and (2) estimation of a final refined mask through an iterative method which re-estimates both the mask and the classifier parameters at each iteration step. Results on real data show that our methodology outperforms those so far proposed and can be more effectively used to obtain derived sleep quality parameters from actigraphy registries.

Moduladores cronobiológicos en la efectividad de la trombolisis prehospitalaria / Circadian modulation of effectiveness in prehospital thrombolysis

Objetivo: Investigar si la hora del día influye en la efectividad de la terapia trombolítica prehospitalaria en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Método: Estudio observacional de cohortes retrospectivo con pacientes diagnosticados de IAMCEST a quienes se les realizó trombolisis precoz prehospitalaria. Se analizaron, como variables predictoras independientes de la efectividad de la terapia trombolítica, la hora del día de administración de la terapia trombolítica (variable principal), divididos en periodos horarios de 6 h y de 12 h, la edad, el sexo, la hora inicio del dolor torácico, tiempo de evolución del infarto, los factores de riesgo cardiovascular y el área de localización del infarto. Los datos se obtuvieron de la historia clínica y del seguimiento de preavisos hospitalarios a las 24 h. Resultados: Se incluyó a 206 pacientes. Dos variables se muestran como predictores independientes de la efectividad de la trombolisis prehospitalaria: la hora del día de administración de la terapia trombolítica, en el rango de cronorriesgo cardiovascular de 6a 12 h, con respecto al resto de franjas horarias (0-6 h, 12-18 h, 18-24 h) [p = 0,005odds ratio (OR) = 2,46; intervalo de confianza (IC) del 95%, 1,30-4,64] y presentar cardiopatía isquémica previa) (p = 0,003, OR = 5,30; IC del 95%, 1,74-16,15).Conclusiones: Encontramos variaciones circadianas clínicamente significativas en la efectividad del tratamiento trombolítico prehospitalario administrado a los pacientes con IAMCEST, independientemente del agente trombolítico empleado, de manera que existe una tromborresistencia matinal (6-12 am) al tratamiento y una mayor efectividad de reperfusión coronaria cuando se administra en el resto de franjas horarias diurnas ,especialmente en la de tarde (12-18 h) (AU)

Objective: To study whether time of day influences the effectiveness of prehospital thrombolysis in patients who have had acute myocardial infarction with ST-segment elevation (STEMI).Methods: Observational study of retrospective cohorts. We included patients diagnosed with STEMI who received early application of prehospital thrombolytic therapy. The main variable studied as an independent predictor of effectiveness was the time of day the thrombolytic agent was administered; this variable was studied in 6-hour periods and 12-hourperiods. Additional independent variables were patient age and sex, onset of chest pain, duration of pain from onset until administration of the thrombolytic agent, cardiovascular risk factors, and location of infarction. Data were extracted from patient records and ambulance pre-alert calls in the next 24 hours. Results: Two hundred six patients were studied. The 2 independent variables that predicted the effectiveness of prehospital thrombolysis were administration of the thrombolytic agent at a time of day within the period of greatest cardiovascular risk (6 AM to 12 noon) in comparison with the other time frames (12 midnight to 6 AM, 12 noon to 6 PM and 6 PM to midnight) (odds ratio [OR], 2.46; 95% CI, 1.30-4.64; P=.005) and history of ischemic heart disease (OR,5.30; 95% CI, 1.74-16.15; P=.003).Conclusions: We found that circadian rhythm had a clinically significant effect on the effectiveness of prehospital thrombolysis in STEMI patients. The effect was present regardless of which thrombolytic agent was used. The greatest resistance to therapy was observed in the morning hours between 6 AM and 12 noon. The response was greater in the remaining time frames and greatest in the hours between noon and 6 PM (AU)

Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario / Circadian rhythm and time variations in out-hospital sudden cardiac arrest

Objetivos: Analizar las características cronobiológicas y las variaciones temporales del paro cardiaco extrahospitalario (PCEH). Diseño: Estudio descriptivo retrospectivo. Pacientes: Todos los casos de PCEH de origen cardíaco registrados en la base de datos del servicio de emergencias médicas (SEM) de la Comunidad Autónoma de Castilla y León (España) durante 18 meses. Variables de interés principales: Edad, sexo, recuperación de la circulación espontánea, primer ritmo monitorizado (desfibrilable /no desfibrilable), lugar de alerta [(hogar, lugar público, centro atención primaria (AP)], testigo (familiar, transeúnte, fuerzas de seguridad, personal AP), hora de alerta (0-8; 8-16; 16-24), hora de activación del equipo de emergencias, hora de atención y día de la semana. Análisis univariante mediante Chi2, varianza y tests no paramétricos. Análisis cronobiológico mediante transformada rápida de Fourier y test Cosinor. Resultados: Se estudiaron 1.286 casos registrados entre enero 2007 y junio 2008. Se observaron diferencias estadísticas significativas en menor edad (p<0,05), mayor incidencia en el hogar (p<0,001) y mayor frecuencia de familiares-convivientes como testigos (p<0,001) en el periodo de 0-8h. El análisis cronobiológico mostró ritmo diario (circadiano) con acrofase a las 11:16h (p<0,001) y ritmo semanal (circaseptano) con acrofase en miércoles (p<0,05). Las medianas de intervalos alerta-atención y activación-atención fueron respectivamente 11,7min y 8,0min, sin diferencias entre periodos horarios. Conclusiones: Se demuestra la presencia de un ritmo diario de aparición del PCEH con pico matinal y un ritmo semanal con pico en miércoles. Estos resultados orientan al ajuste preventivo y a la planificación de recursos y mejoras en la respuesta, en determinados periodos horarios (AU)

Objectives: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). Design: A retrospective descriptive study was made. Patients: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous Community of Castilla y León (Spain) were evaluated. Variables analyzed: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. Results: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16h (p<0.001) and weekly rhythm (circaseptan) with acrophase on Wednesday (p<0.05). The median alert time-care time interval and emergency team activation time-care time were 11.7min and 8.0min, respectively, without differences between periods. Conclusions: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods (AU)

Características generales de la parada cardiaca extrahospitalaria registrada por un servicio de emergencias médicas / General characteristics out of hospital cardiac arrest of cardiac origin recorded by an emergency medical service

Objetivo: Analizar las características generales de la parada cardiaca extrahospitalaria(PCEH) en una comunidad autónoma y los factores asociados a la recuperación de la circulación espontánea (RCE).Método: Estudio descriptivo retrospectivo de las PCEH de origen cardiaco incluidas en la base de datos del servicio de emergencias (SEM) de Castilla y León en un periodo de18 meses. El objetivo primario fue la RCE. Las variables analizadas fueron la edad, sexo, ritmo desfibrilable (DF), lugar del paro, testigo, intervalo alerta-atención inicial e intervalo despacho SEM-atención inicial. Resultados: Se estudiaron 1.286 PCEH, que representan 0,34 casos/1.000 habitantes/año. La mediana de edad fue de 73,0 años (rango intercuartílico 21,0), y el66,5% fueron hombres. Se consiguió RCE en el 22,2%. Las características de la PCEH fueron: ritmo DF 15,3%; en el hogar 72,2%, en un lugar público 21,3%, en un centro atención primaria (AP) 6,5%; presenciada por un familiar 49,1%, por un transeúnte 31,6%, por fuerzas seguridad 2,6% y por personal AP 15,7%. Fueron variables independientes asociadas a la RCE: edad inferior a 50 años [OR 1,6 (IC 95%: 1,03; 2,4)],ritmo DF [OR 3,8 (IC 95%: 2,7; 5,3)], lugar del paro en centro AP [OR 2,7 (IC 95%:1,4; 4,9)] y en lugar público [OR 1,8 (IC 95%: 1,2; 2,7)].Conclusiones: La incidencia de PCEH fue similar a otras series europeas. Destaca el bajo porcentaje de ritmos DF. Se confirma el hogar como lugar de más frecuente presentación, y una menor edad, la presencia de ritmos DF y la presentación en lugares públicos o centros sanitarios, como factores independientes asociados a RCE (AU)

Objective: To analyze the general characteristics out of hospital cardiac arrest (OHCA) including the frecuency of return of spontaneous circulation and related factors. Methods: Retrospective descriptive analysis of cases of OHCA in the records of the emergency medical service of Castile-Leon covering a period of 18 months. The main independent outcome analyzed was return of spontaneous circulation. Independent variables analyzed were age, sex, presence of shockable rhythm, location of cardiac arrest, witness, time between emergency call and initiation of care, and time between ambulance dispatch and initiation of care. Results: The EMS attended a total of 1286 cases of OHCA, representing an annual incidence of 0.34 cases per 1000 population. The median age (interquartile range) was 73.0 (21.0) years; 66.5% of the patients were men, spontaneous circulation returned in 22.2%, and a shockable rhythm was present in 15.3%. Cardiac arrest occurred in the home in72.2% of the cases, in a public place in 21.3%, and at a primary health care clinic in 6.5%. Witnesses were a familymember (49.1%), a passer-by (31.6%), a member of a security force (2.6%), and a primary care staff member (15.7%).Independent variables related to return of spontaneous circulation were age under 50 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.03-2.4), presence of a shockable rhythm (OR, 3.8; 95% CI, 2.7-5.3); cardiac arrest at a primary health care clinic (OR, 2.7; 95% CI, 1.4-4.9) or in a public place (OR, 1.8; 95% CI, 1.2-2.7).Conclusions: The incidence of OHCA was similar to that reported for other European series. The low percentage of shockable rhythm was noteworthy. The home was confirmed as the most common setting for cardiac arrest; lower age, presence of shockable rhythm, occurrence of cardiac arrest in a public place or at a primary care clinic were confirmed as variables independently associated with return of spontaneous circulation (AU)

[Circadian rhythm and time variations in out-hospital sudden cardiac arrest]. / Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario.

OBJECTIVES: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). DESIGN: A retrospective descriptive study was made. PATIENTS: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous Community of Castilla y León (Spain) were evaluated. VARIABLES ANALYZED: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8 hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. RESULTS: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8 hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16 h (p<0.001) and weekly rhythm (circaseptan) with acrophase on Wednesday (p<0.05). The median alert time-care time interval and emergency team activation time-care time were 11.7 min and 8.0 min, respectively, without differences between periods. CONCLUSIONS: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods.

Variabilidad en la hospitalización de lactantes con gastroenteritis / Variability among infants admitted to the hospital with gastroenteritis

Introducción: El estudio tiene como objetivo analizar la variabilidad de presentación de las gastroenteritis agudas en nuestro medio. Pacientes y métodos: La población de estudio estuvo constituida por 2.309 pacientes menores de 24 meses de edad, ingresados con diagnóstico de gastroenteritis. Se realizó un cultivo de heces en todos los casos y fueron clasificados, según la etiología, mediante la CIE-9-MC, como infecciosas, víricas, bacterianas y no infecciosas. Se tuvieron en cuenta las siguientes variables: sexo (hombre/mujer), edad (meses), días de estancia, fecha de ingreso y fallecimiento. Se llevó a cabo un análisis descriptivo y, además, el test de Kolmogorov-Smirnov, la prueba de la t de Student y de la ji al cuadrado con prueba exacta de Fisher. El análisis ritmométrico se llevó a cabo mediante la transformada rápida de Fourier, con ajuste de modelos mediante método cosinor con varios armónicos. Resultados: Ingresaron por gastroenteritis el 18,9% de los pacientes; eran de tipo infecciosa el 35% y vírica el 25,5%.La edad media de presentación de las gastroenteritis víricas fue de 10,84 meses, mientras que en las no víricas fue de11,74 meses, con un día más de estancia hospitalaria en el primer grupo. El análisis cosinor muestra un componente rítmico con un periodo de 12 meses en el global de las gastroenteritis, subgrupo de víricas y no víricas, con acrofase a finales de marzo. Conclusiones: Las gastroenteritis presentan un patrón estacional, con ritmo circanual y periodo de 12 meses, más patente en las gastroenteritis víricas que en las no víricas(AU)

Background: The aim of this study was to analyze the variability of epidemiological and clinical findings in gastroenteritis in our setting. Methods: We studied 2,309 patients, aged between 0 and24 months, admitted with a diagnosis of acute gastroenteritis. Stools were cultured and examined for a variety of enteropathogens, which were classified as infectious, viral, bacterial and noninfectious (CIE-9-MC). We considered the following variables: sex (male/female), age (months), hospital stay (days),date of admission and mortality. A descriptive analysis was carried out, and the Kolmogorov-Smirnov test, Student’s t test and the chi-square test with Fisher’s exact test were applied. Rhythmicity was analyzed using fast Fourier transform, and variations in rhythm were assessed by the cosinor model, with different harmonics. Results: Overall, 18.9% of the hospital admissions were dueto gastroenteritis (35% of infectious etiology and 25.5% of viral etiology). The mean age of infants with viral gastroenteritis was10.84 months, whereas in cases produced by non viral pathogens, it was 11.74 months. Patients with viral gastroenteritis were hospitalized one day longer than those with gastroenteritis due to non viral agents. The cosinor analysis revealed the presence of a rhythmic component, with 12-month duration in overall cases of gastroenteritis, and in viral and non viral gastroenteritis. The acrophase was around the 12th week of the year. Conclusions: Gastroenteritis exhibits a seasonal pattern, with a 12-month circannual rhythm, which is more evident in viral gastroenteritis than in cases produced by non viral pathogens (AU)

Rabdomiólisis por neurolépticos: ¿puede hablarse de síndrome neuroléptico maligno? / Rhabdomyolysis in neuroleptics: are we talking of neuroleptic malignant syndrome?

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La píldora del día después: una segunda oportunidad ¿para quién? / The morning-after pill: a second chance, who for?

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