Ranking the importance of their own diseases: A positioning analysis in rheumatic patients and their proxies.

INTRODUCTION/OBJECTIVE: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. METHODS: Subjects completed a self-administered questionnaire to rank 11 diseases from "worst" to "least bad". Then they defined the "worst" disease and ranked 10 diseases from highest to lowest importance from a list including "my rheumatic disease/my relative's disease". The lists of the included diseases represented the mindshare from a sample of healthy adults. RESULTS: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. "My disease/my relative's disease" was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. DISCUSSION AND CONCLUSIONS: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.

Ranking the importance of their own diseases: A positioning analysis in rheumatic patients and their proxies / La importancia que dan los pacientes reumáticos a sus propias enfermedades: un análisis de posicionamiento

Introduction/objective: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. Methods: Subjects completed a self-administered questionnaire to rank 11 diseases from “worst” to “least bad”. Then they defined the “worst” disease and ranked 10 diseases from highest to lowest importance from a list including “my rheumatic disease/my relative's disease”. The lists of the included diseases represented the mindshare from a sample of healthy adults. Results: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. “My disease/my relative's disease” was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. Discussion and conclusions: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.(AU)

Introducción/objetivo: Evaluar el posicionamiento que pacientes con lupus eritematoso sistémico (LES), artritis reumatoide (AR), espondilitis anquilosante (EA) y sus acompañantes dan a sus enfermedades. Métodos: Los participantes completaron un cuestionario para clasificar 11 enfermedades de «peor» a «menos mala». Luego definieron la «peor» enfermedad y el ranking de 10 enfermedades de una lista que incluía «mi enfermedad reumática/de mi familiar». Las listas de enfermedades incluidas representaron la «conciencia de marca» de un grupo de adultos sanos. Resultados: Hubo 570 encuestados (104 LES, 99 AR, 82 EA y 285 acompañantes). La AR se posicionó como la tercera peor enfermedad (en primer lugar, por el 41% de pacientes, segundo por el 49% y tercero por el 10%). La definición preferida para «peor» enfermedad fue aquella que mata. «Mi enfermedad reumática/de mi familiar» fue la cuarta más importante (primer lugar por el 41% de pacientes, segundo por el 38% y tercero por el 21%). El posicionamiento no estuvo asociado con edad, escolaridad, duración de la enfermedad ni centro de atención. Discusión y conclusiones: La mayoría de los encuestados calificaron su enfermedad reumática más abajo que otros padecimientos no reumáticos.(AU)

Ranking the Importance of Their Own Diseases: A Positioning Analysis in Rheumatic Patients and Their Proxies.

INTRODUCTION/OBJECTIVE: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. METHODS: Subjects completed a self-administered questionnaire to rank 11 diseases from "worst" to "least bad". Then they defined the "worst" disease and ranked 10 diseases from highest to lowest importance from a list including "my rheumatic disease/my relative's disease". The lists of the included diseases represented the mindshare from a sample of healthy adults. RESULTS: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. "My disease/my relative's disease" was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. DISCUSSION AND CONCLUSIONS: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.

Potential uses of an infodemiology approach for health-care services for rheumatology.

OBJECTIVES: This is a demand-based infodemiology study using the Google Trends and AdWords tools to illustrate infodemiology's potential use in rheumatology. The study investigates three questions in North American countries: (1) What terms associated with "rheumatology" and "arthritis" do people search for on Google? (2) What is the search volume for disease-modifying antirheumatic drugs (DMARDs)? and (3) What is the search volume for the term "arthritis" compared with for "hepatitis C" and "breast cancer"? METHODS: We conducted independent searches by country and search term for 2015-2017. Seventeen DMARDs were searched for 2015 through May 2018, with the turmeric remedy included for comparison. Data were exported to Excel for further analysis, adjusted by country population, and expressed as searches per 100,000 inhabitants (SpTh). RESULTS: There were approximately 550 associated terms for "arthritis" in each country, and 5679 SpTh for DMARDs across the three countries. Searches for turmeric numbered slightly lower than for all DMARDs together in Canada and the USA, but were 70% higher in Mexico. Turmeric was also searched four times more than the most-searched biological DMARD in Canada and the USA, and 60 times more in Mexico. Arthritis was more commonly searched for in Canada than hepatitis C and breast cancer, but hepatitis C was highest in the USA and breast cancer in Mexico. Monthly trends did not show expected peaks associated with arthritis awareness campaigns. CONCLUSION: Infodemiology provides preliminary information that could help in generating hypotheses, assessing health-care interventions, or even in providing patient-centered care.

Sex differences in the effort indicators during cardiopulmonary resuscitation manoeuvres on manikins.

The aims of this study were to examine sex differences in college students while they performed cardiopulmonary resuscitation (CPR) on a manikin for 20 min in (a) objective and subjective effort indicators and (b) to analyse the influence of potential confounders (age, BMI and cardiorespiratory fitness) on these sex differences. Sixty-three participants were recruited. Participants performed 20 min of CPR on a manikin. During the CPR trial, percentages of maximal heart rate levels were higher in women than in men (P<0.05) and perceived exertion increased significantly in both sexes over time (P=0.05); furthermore, at the last two time points analysed, women scored higher than men (P<0.05). However, these sex differences disappeared when controlling for age, BMI and cardiorespiratory fitness. In conclusion, indicators of exertion during CPR are higher in women than in men, but these sex differences are because of BMI and differences in physical fitness conditions.

Influencia del consumo máximo de oxígeno y de la fuerza del tren superior en la calidad de la reanimación cardiopulmonar realizada por universitarios jóvenes / Influence of maximal oxygen uptake and maximum strength of the upper body of university students in the ability to perform quality cardiopulmonary resuscitation

Objetivos: 1) analizar por sexo el porcentaje medio de la frecuencia cardiaca máxima (PFCM) alcanzado en 5 minutos de reanimación cardiopulmonar (RCP); 2) examinar la asociación del índice de masa corporal (IMC) y la forma física con la proporción de compresiones torácicas externas (CTE) correctas; y 3) establecer los puntos de corte óptimos de consumo máximo de oxígeno (VO2max), y fuerza muscular en brazos (kg) para realizar CTE correctas durante 5 minutos. Métodos: Estudio cuasi-experimental que incluyo 63 estudiantes universitarios. Se determinaron IMC, capacidad cardiorrespiratoria y fuerza muscular manual. Tras formación previa, realizaron Reanimación Cardiopulmonar en maniqui durante 5 minutos. Resultados: El PFCM alcanzado fue 64,2 en hombres y 76,9 en mujeres (p = <0,001). El porcentaje medio de CTE correctas fue mayor en participantes con normo peso/sobrepeso, alto nivel de VO2max y fuerza manual. IMC, VO2max y fuerza manual fueron predictores de adecuada profundidad de compresiones en modelos de regresión lineal múltiple controlando por edad y sexo. En curva característica de operación del receptor (ROC), el área bajo la curva normal para predecir CTE correctas fue 0,862 para VO2max, y 0,872 para la fuerza manual (puntos de corte de 44,5 ml/Kg/min y de 30,22 Kg respectivamente). Conclusiones: Las características antropométricas y la forma física influyen en la realización de CTE correctas en una RCP. Nuestros datos sugieren que una adecuada forma física aumentara la capacidad de los reanimadores para realizar RCP-Básica

Background: It has been hypothesized that fitness and body mass index of the rescuers are predictors of the adequate of external chest compressions. The aims of this study were to: 1) analyze by sex the percentage of maximum heart rate (%EMHR) reached in 5 minutes of cardiopulmonary resuscitation (CPR); 2) examine the influence of both body mass index and fitness on predicting adequate chest compressions; and 3) estimate the optimal levels of them in 5 minutes of cardiopulmonary resuscitation (CPR). Methods: Quasi-experimental study involving sixty three subjects were recruited from University of Castilla-La Mancha, Spain. We determined weight, height, cardiorespiratory (maximal oxygen uptake -VO2max) and muscular fitness (handgrip-test). After previous training, participants performed cardiopulmonary resuscitation on a mannequin during 5 minutes. Results: The %EMHR achieved was 64.2 in men and 76.9 in women. The mean percentage of adequate chest compressions was higher on the participants with normal weight/overweight (p<0.001), and on those who had a low level of cardiorespiratory (p=0.004) and muscular fitness (p=0.011). Body mass index, cardiorespiratory and muscular fitness are predictors of correct compression depth and chest compression when controlling for age and sex. The best cut-off points for predicting successful chest compressions were 44.45 ml/kg/min for VO2max, and 30.22 kg for muscular fitness. Conclusions: Anthropometric and physical fitness conditions may influence the external chest compressions performance. Our data suggest that rescuers should improve their fitness in order to increase their capacity to provide cardiopulmonary resuscitation

Recomendaciones en reanimación cardiopulmonar. Hacia la democratización de la reanimación / Recommendations in cardiopulmonary resuscitation. Towards a democratisation in the resuscitation

Pasados más de cuarenta años desde que se estandarizaron las modernas técnicasde reanimación cardiopulmonar (RCP) y la homogeneización en lo referentea su aplicación y enseñanza tanto al personal sanitario como a la población en general,los esfuerzos para actualizar las recomendaciones en reanimación cardiopulmonardieron lugar a que en el año 2005 la European Resuscitation Councilpublicara sus Guidelines for Resuscitation, centradas en aumentar el número dereanimaciones iniciadas por el primer testigo, para de este modo conseguir unmayor número de reanimaciones exitosas. Para ello, se simplificaron los algoritmosdirigidos a la población general y primeros intervinientes, se sigue insistiendoen la recomendación de disponer de una Desfibrilación Automática Externa(DEA) en aquellos lugares públicos con riesgo de que alguien pudiera tener unaparada cardiorrespiratoria (PCR) y se modificó la secuencia de RCP a 30:2 para,de este modo, aumentar el número de compresiones conseguidas en un minuto.Siguen indicándose el uso de dispositivos de apertura de vía aérea alternativos yla alerta precoz a los Servicios de Emergencia. En la Reanimación Avanzada (RA)los principales cambios aparecen en la secuencia de desfibrilación, supeditando éstaa la realización de masaje/ventilación. Por todo ello, el objetivo de este artículoes recordar los principales puntos de atención de estas recomendaciones y actualizaralgunos otros

Over 40 years have gone by since modern cardiopulmonary resuscitation (CPR)techniques and homogenisation in what refers to their application and teachingto healthcare personnel and the general population were standardised. Effortsmade to update the original recommendations led to the issuing in 2005 of newGuidelines for Resuscitation by the European Resuscitation Council. These newrecommendations focused on an increase in CPR actions initiated by the first witnessso that a higher number of successful resuscitations were achieved. To thisend, algorithms aimed at the general population and first rescuers, continue to insiston the availability of an Automatic External Defibrillation (AED) in public placeswhere subjects could be at risk of cardiac arrest. The CPR sequence was also modifiedto 30:2 to increase the number of compressions achieved in one singleminute.The use of devices that open the airway continues to be indicated as well as theearly notification to Emergency Services. In advanced CPR, the main changes arein the sequence of defibrillations making the sequence dependent on cardiac massage/ventilation. Because of this, the objective of this article is to refresh the mostimportant points of these recommendations and to update some other points (AU)

Long-term immune response after liver transplantation in patients with spontaneous or post-treatment HCV-RNA clearance.

Recurrent HCV infection after liver transplantation is universal and sustained clearance of HCV-RNA rarely occurs. The aim of this study was to characterize cell-mediated immunity and cytokine production in HCV-infected patients after liver transplant. The study included 6 pretransplantation patients (PT) and 15 liver transplanted patients, including 5 with spontaneous HCV-RNA clearance (SC group), 5 with sustained virological response after antiviral treatment (SVR group), and 5 no response (NR group). The control group included 5 HCV-RNA negative, anti-HCV negative healthy individuals. This study examines proliferative T-cell response and cytokine production (gamma-interferon and IL-10) after HCV specific and phytohemagglutinin (PHA) stimulation in cultured peripheral blood mononuclear cells (PBMCs) from each group. Multispecific proliferative responses to HCV antigens (mean Stimulation Index; SI) were higher in the SVR group (mean SI 7.4 +/- 2) and SC group, as compared with the NR group (P <.05, vs SVR) and PT group (P <.05, vs SVR and SC). After PHA stimulation, gamma-interferon levels were similar to controls (4330 +/- 640 pg/ml) in the SC (4474 +/- 300 pg/mL) and SVR groups (3647 +/- 300 pg/mL), but were significantly lower than controls in the PT (401 +/- 331 pg/mL; P <.02) and NR groups (546 +/- 360 pg/mL; P <.01). IL-10 production after PHA stimulation was similar in SC, SVR, and controls (647 +/- 279 pg/mL, 674 +/- 310 pg/mL and 841 +/- 294 pg/mL, respectively), but was lower in PT patients (232 +/- 94 pg/mL). The NR group showed high basal IL-10 production with little increase after stimulation. In conclusion, liver post-transplantation patients with spontaneous clearance of HCV-RNA and those with sustained viral response after therapy showed an immune response despite immunosuppression that might have contributed to their favorable outcome.

Hacia el consenso en la enseñanza de resucitación cardiopulmonar / Towards a consensus in teaching of cardiopulmonary resuscitation

Se implementa un estudio multicéntrico en las carreras de Enfermería de España y de Argentina para valorar los niveles de aprendizaje referente a la reanimación cardiopulmonar de la American Heart Association (AHA) y del European Resuscitation Council (ERC), en 308 alumnos de la asignatura Enfermería Médicoqurúrgica. Conclusiones: conocer un método de resucitación cardiopulmonar básico no interfiere en el aprendizaje de otro método, y no existe diferencia en la formación de la AHA y del ERC

Hacia el consenso en la enseñanza de resucitación cardiopulmonar / Towards a consensus in teaching of cardiopulmonary resuscitation

Se implementa un estudio multicéntrico en las carreras de Enfermería de España y de Argentina para valorar los niveles de aprendizaje referente a la reanimación cardiopulmonar de la American Heart Association (AHA) y del European Resuscitation Council (ERC), en 308 alumnos de la asignatura Enfermería Médicoqurúrgica. Conclusiones: conocer un método de resucitación cardiopulmonar básico no interfiere en el aprendizaje de otro método, y no existe diferencia en la formación de la AHA y del ERC

Reanimación cardiopulmonar básica / Basic cardiopulmonary resuscitation

Desde que en la década de los 60 se introdujeron las modernas técnicas de reanimación cardiopulmonar (RCP) se planteó la necesidad de homogeneizar su aplicación y enseñanza tanto del personal sanitario como de la población en general. El ILCOR (Comité de Enlace para las Maniobras de Reanimación), en el intento de simplificar las técnicas de reanimación, lanza unas recomendaciones que en agosto de 2000 son asumidas por las grandes organizaciones encargadas de la difusión de las maniobras de Soporte Vital, AHA y ERC entre otras. En ellas se incorporan diferentes niveles de atención dependiendo de la cualificación de la persona que las realice. Como principales cambios aparecen la necesidad de la activación de los servicios de emergencias médicas rápidamente; pautas en caso de uno o dos reanimadores; en la ventilación de salvamento, nuevos volúmenes según se utilice o no oxígeno; se aceptan dispositivos de apertura de vía aérea alternativos; recomendaciones en cuanto a la pertinencia o no de verificar el pulso dependiendo de la cualificación de quien lo haga; técnica del masaje cardiaco; RCP con sólo compresiones torácicas y desfibrilación automática externa (AU)

[Basic cardiopulmonary resuscitation]. / Reanimación cardiopulmonar básica.

Since the introduction of the modern techniques for cardiopulmonary resuscitation in the 1960s, professionals have discussed the need to standardize its application and teaching both among health care professionals and the general public. The "ILCOR", Committee to Coordinate Resuscitation Techniques, in an effort to simplify resuscitation techniques, set out some recommendations in August 2000 which were adopted by the leading organizations such as AHA and ERC, in charge of diffusing Vital Suport techniques. In these, different levels of attention have been incorporated depending on the qualifications which the person has who is provide this treatment. The most important changes are the necessity to put Emergency Medical Services into action rapidly; the techniques to follow if there are one or two persons apply resuscitation techniques; for artificial resuscition emergency care, new volumes depending on the use or non-use of oxygen; the acceptance of devices to open up alternate air passageways; recommendations whether or not it is pertinent to check on a patient's pulse depending on the qualifications of the person attending that patient; heart message techniques exterpulmonary resuscition woth only thorax compression and automatic external defibrillation.

6 fármacos en RCP (y II). Características y nuevas tendencias / Cardio-pulmonary resuscitation (RCP). Pharmaceuticals (II). Characteristics and new tendencies

En la segunda parte de este artículo se trata extensamente el tema de las características y nuevas tendencias en el uso de los fármacos empleados en reanimación cardiopulmonar. Concretamente de los simpaticomiméticos, la atropina, los antiarrítmicos y los alcalinizantes, se explica su mecanismo de acción, sus indicaciones y sus efectos, dando también unas pinceladas acerca de su composición química. En unas breves conclusiones se especifica cuál o cuáles de ellos deben utilizarse en las diferentes situaciones ocurridas ante un paro (AU)

[Measurement of aggressiveness and its direction in patients with duodenal ulcer. A double-control study]. / La medida de la agresividad y su dirección en pacientes con ulcus duodenal. Un estudio de doble control.

We measure aggressivity in 36 patients with DUD (duodenal ulcer disease). We use two control groups as sample: normal population and other group of chronic organic pathologies. The results denote that the autoaggression-inhibition factor is the best discriminate variable to our group of duodenal ulcer patients of both sexes.