Factors Associated with Adherence to Clinical Practice Guidelines for Patients with Type 2 Diabetes Mellitus: Results of a Spanish Delphi Consensus.

OBJECTIVE: To assess factors associated with adherence to clinical practice guidelines (CPGs) for type 2 diabetes mellitus (T2DM). METHODS: A cross-sectional multicenter study based on a two-round Delphi survey was designed. A total of 98 endocrinologists (mean age 45 years) involved in the care of T2DM patients completed a 43-item questionnaire assessing different aspects of adherence related to CPGs. RESULTS: Most participants worked in tertiary care public hospitals. All participants used CPGs, with ADA/EASD as the most common (99%). The lack of time, establishment of an individualized management of patients, insufficient human resources, and therapeutic inertia were scored as the main reasons for not following CPGs recommendations. Participants agreed that insufficient material resources and limitations established by the healthcare system prevent adherence to CPGs. The risk of hypoglycemia was considered to be limiting factor for the patients' integral control. Also, there was consensus on the need to have the support of nursing personnel with specific training in diabetes as well as dietitians and podiatrists. There was disagreement regarding the influence on adherence to CPGs of patient's characteristics not matching those of CPGs, patient's preferences, tolerability of the action recommended, concomitant comorbidities, or pluripathological conditions. Differences according to the participant's age (≤40 years vs. >40 years) were not found. Therapeutic inertia and lack of time did not show a significant correlation. CONCLUSIONS: Nonadherence to CPGs on T2DM is a multifactorial problem but the existence multiple CPGs, the lack of time, the therapeutic inertia, and insufficient human resources have been identified as factors limiting adherence. Hypoglycemia continues to be a barrier for achievement of targets recommended by CPGs.

Fenotipo de Cintura Hipertrigliceridémica en la población con Enfermedad Renal Crónica. Cohorte NEFRONA / Hypertriglyceridaemic waist phenotype for Chronic Kidney Disease population: NEFRONA cohort

ANTECEDENTES Y OBJETIVO: El fenotipo de cintura hipertrigliceridémica (FCH) se define para población general. La Enfermedad Renal Crónica (ERC) asocia cambios en la composición corporal, elevada comorbilidad y una epidemiología reversa en relación con el colesterol y el índice de masa corporal. Nuestro objetivo fue identificar los puntos de corte en población con ERC y analizar su relación con el riesgo cardiovascular (RCV). MÉTODOS: Incluimos 2271 enfermos renales de la cohorte NEFRONA. Seleccionamos los puntos de corte de triglicéridos y cintura mediante análisis de quintiles y curvas ROC, utilizando presencia de enfermedad ateroesclerótica moderada-severa (EA2-3) como variable resultado. Analizamos la prevalencia del mismo y su asociación con otros factores de riesgo cardiovascular, incluimos análisis de regresión multivariable para medir la magnitud de su efecto frente a las variables EA2-3 y evento o muerte cardiovascular (EoMCV). RESULTADOS: Seleccionamos los puntos de corte: Triglicéridos ≥ 143mg/dl con cintura> 102cm en varones o 94cm en mujeres (Sensibilidad 26%; Especificidad 87%). La prevalencia del FCH específico fue 22.4%, sin diferencias entre estadios de ERC. Asoció aumento de riesgo independiente frente a EA2-3 (OR 1.61; IC 95%: 1.12-2.32, p = 0.011) y EoMCV (HR 3.08; IC 95%: 1.66-5.72, p = 0.000). Identificamos una interacción entre FCH y fósforo. CONCLUSIONES: Adaptar la definición del FCH en la población con ERC mejora su rendimiento diagnóstico. Identifica un RCV adicional en una población donde otros métodos de cribado no han mostrado utilidad, siendo de fácil acceso clínico. Su interacción con los niveles de fósforo podría reflejar un papel en la regulación del metabolismo óseo-mineral

BACKGROUND AND OBJECTIVE: The hypertriglyceridaemic waist (HTW) phenotype is defined for the general population. Chronic kidney disease (CKD) tends to bring on changes in body composition, is associated with higher comorbidity than the general population and, furthermore, shows reverse epidemiology with related prognostic variables like cholesterol and body mass index. Our objective was to identify cut-off points in the population with CKD and to analyse its relationship with cardiovascular risk (CVR). METHODS: We included 2271 CKD patients from the NEFRONA cohort. Triglyceride and waist cut-off points were selected through quintiles analysis and receiver operating characteristic (ROC) curves evaluation, using the presence of moderate to severe atherosclerosis score (AS 2-3) as outcome variable. Then, we analysed HTW prevalence and its association with other cardiovascular risk factors, and we measured the magnitude of its effect on AS 2-3 and cardiovascular event or death (CVEoD) by multivariate regression analysis. RESULTS: We selected the cut-off points: triglyceride concentrations ≥143 mg/dl with waist circumference values>102cm in men and 94cm in women (sensitivity 26%; specificity 87%). Specific HTW prevalence was 22.4%, without significative differences between CKD stages. The multivariate regression analysis shows specific HTW as an independent AS 2-3 (OR 1.61; 95% CI: 1.12-2.32, p = 0.011) and CVEoD (HR 3.08; 95% CI: 1.66-5.72, p = 0.000) risk factor. An interaction between phosphorus level and specific HTW was identified. CONCLUSIONS: Adapting the HTW definition might improve specificity to assess cardiovascular risk in the population with CKD. It identifies an additional CVR in a population in which other screening methods have not proven to be useful, and it is easily clinically accessible. Its interaction with phosphorus levels suggests an association between HTW and bone-mineral metabolism regulation

Hypertriglyceridaemic waist phenotype for Chronic Kidney Disease population: NEFRONA cohort. / Fenotipo de Cintura Hipertrigliceridémica en la población con Enfermedad Renal Crónica. Cohorte NEFRONA.

BACKGROUND AND OBJECTIVE: The hypertriglyceridaemic waist (HTW) phenotype is defined for the general population. Chronic kidney disease (CKD) tends to bring on changes in body composition, is associated with higher comorbidity than the general population and, furthermore, shows reverse epidemiology with related prognostic variables like cholesterol and body mass index. Our objective was to identify cut-off points in the population with CKD and to analyse its relationship with cardiovascular risk (CVR). METHODS: We included 2271 CKD patients from the NEFRONA cohort. Triglyceride and waist cut-off points were selected through quintiles analysis and receiver operating characteristic (ROC) curves evaluation, using the presence of moderate to severe atherosclerosis score (AS 2-3) as outcome variable. Then, we analysed HTW prevalence and its association with other cardiovascular risk factors, and we measured the magnitude of its effect on AS 2-3 and cardiovascular event or death (CVEoD) by multivariate regression analysis. RESULTS: We selected the cut-off points: triglyceride concentrations ≥143 mg/dl with waist circumference values>102cm in men and 94cm in women (sensitivity 26%; specificity 87%). Specific HTW prevalence was 22.4%, without significative differences between CKD stages. The multivariate regression analysis shows specific HTW as an independent AS 2-3 (OR 1.61; 95% CI: 1.12-2.32, p=0.011) and CVEoD (HR 3.08; 95% CI: 1.66-5.72, p=0.000) risk factor. An interaction between phosphorus level and specific HTW was identified. CONCLUSIONS: Adapting the HTW definition might improve specificity to assess cardiovascular risk in the population with CKD. It identifies an additional CVR in a population in which other screening methods have not proven to be useful, and it is easily clinically accessible. Its interaction with phosphorus levels suggests an association between HTW and bone-mineral metabolism regulation.

Iron deficiency and safety of ferric carboxymaltose in patients with acute heart failure. AHF-ID study.

INTRODUCTION: The presence of iron deficiency (ID) in patients with acute heart failure (AHF) is high. There are few studies on the characteristics of these patients and the safety of ferric carboxymaltose administration (FCM). OBJECTIVE: Study the differences among patients with AHF based on the presence and type of ID as well as the safety of FCM administration in these patients. METHOD: The AHF-ID study is a multicentre, analytical, prospective follow-up cohort including patients admitted to six Spanish hospitals for AHF. ID was defined as serum ferritin <100 µg/L (group A) or ferritin 100-299 µg/L with a TSAT <20% (group B). In cases receiving FCM the appearance of adverse events was analysed. Adjusted Cox regression was used to determine the association with 30-days reattendance for AHF after discharge. RESULTS: A total of 221 patients were recruited; 191 (86.4%) presented ID, 121 (63.4%) group A and 70 (36.6%) group B. There were scarce differences between the groups analysed. No differences were found in 30-days reattendance for AHF. FCM was administered to 158 (71.5%) patients, with 8 (5.1%) presenting adverse events, the most frequent being digestive alterations. Treatment was not discontinued in any case. CONCLUSIONS: There are scarce differences between the presence and the type of ID in patients with AHF. The administration of FCM in patients with ID and AHF is safe.

Inter-observer and intra-observer variability in reporting vaginal dose points for cervical cancer in high-dose-rate brachytherapy.

PURPOSE: The ICRU 89 recommends reporting a set of vaginal dose points for cervical cancer treatments in order to quantify the goodness of implant. This vaginal dose reporting method for combined external beam radiotherapy and brachytherapy has been adopted by the EMBRACE II study protocol. Large variations in dose between patients and centers have been reported. The aim of this study was to determine possible discrepancies with consensus observers from the same institution. Therefore, the inter- and intra-observer variability were analyzed. MATERIAL AND METHODS: For five patients, five experienced observers reported dose at the proposed vaginal points twice. The effect of inter- and intra-observer variations on total dose was analyzed by estimating biologically equivalent dose EQD2 (α/ß = 3 Gy). Coefficient of variation (CV) was used to provide a measure of data dispersion as a proportion to the mean. RESULTS: The maximum inter-observer deviation among all patients and all points ranged from 0.5 Gy to 24.1 Gy in EQD2. The higher inter-observer discrepancies were found at points at 3 o'clock and at 6 o'clock, with respect to ovoids. In case of the maximum intra-observer deviation, it ranged from 0.5 Gy to 14.2 Gy, with higher deviation points at 12 o'clock and 9 o'clock, with respect to ovoids. CONCLUSIONS: There is a need to ensure consistency in vaginal points reporting. The impact of the dosimetric inter- and intra-observer variability should also be considered when dealing with dose tolerances and limits due to the potential dose gradient.

Reflexión estratégica de la Sociedad Española de Endocrinología y Nutrición sobre el futuro de la especialidad en el periodo 2018-2022 / Strategic reflections of the Spanish Society of Endocrinology and Nutrition on the future of the speciality in the period 2018-2022

Las enfermedades endocrinas están experimentando un importante incremento de su prevalencia, debido a causas de diversa índole, entre ellas la epidemia de obesidad y de desnutrición, el envejecimiento de la población, pero también el efecto de los disruptores endocrinos, entre otros. Por otra parte, las nuevas tecnologías, tanto a nivel de analítica molecular y genética, de imagen y de nuevos dispositivos terapéuticos, obligan a que la comunidad profesional endocrina en España tenga que estar en constante formación. La conexión con los pacientes a través de sus asociaciones, cada vez más activas, y con la sociedad civil en general, el compromiso profesional y la demanda de diversos colectivos sociales de una atención moderna y equitativa, y a llevar a cabo investigación que facilite la consecución de avances para los pacientes, obligan al especialista en Endocrinología y Nutrición, y a la Sociedad Española de Endocrinología y Nutrición (SEEN), a posicionarse y dar respuesta a todos estos retos. En el presente documento, la SEEN expone sus propuestas y su estrategia hasta el 2022

Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022

Strategic reflections of the Spanish Society of Endocrinology and Nutrition on the future of the speciality in the period 2018-2022. / Reflexión estratégica de la Sociedad Española de Endocrinología y Nutrición sobre el futuro de la especialidad en el periodo 2018-2022.

Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022.

Restructuring of Welfare States: quantitative and qualitative changes: the case of Spain / Reestructuración de los Estados del Bienestar: cambios cuantitativos y cualitativos: el caso de España

This paper examines a possible paradigm shift from protective welfare states to investment welfare states, using Spain as a case study. Methodologically, a historical-institutionalist approach to paradigm change was adopted, and three dimensions of analysis were studied: problems to be solved, objectives to be achieved and policies to be used. The main findings indicated there has been a quantitative change in Spain that recommodifies living conditions, and a qualitative reorientation is underway that individualizes risks and social protection.

En este trabajo se examina el posible cambio de paradigma desde el Estado del Bienestar Protector hacia un Estado del Bienestar Inversor, tomando a España como estudio de caso. Metodológicamente se adopta un enfoque histórico-institucionalista sobre el cambio de paradigmas, y se aplican tres dimensiones de análisis: problemas a resolver, objetivos a conseguir y políticas a emplear. El principal resultado es que en España se ha producido un cambio cuantitativo que remercantiliza las condiciones de vida, y está en marcha una reorientación cualitativa que individualiza los riesgos y la protección social.

High-Yielding Green Hydrothermal Synthesis of Ruthenium Nanoparticles and Their Characterization.

Using hydrothermal techniques, a novel synthetic approach to prepare ruthenium nanoparticles has been developed. At 180 degrees C and under autogenous pressure, starting from an aqueous solution of ruthenium trichloride, the method yielded nanoparticles whose form and size both depended on the reducing agent: sodium citrate (hexagonal shaped nanocrystals, 1-20 nm), ascorbic acid (spherical nanoparticles, 3-5 nm) and succinic acid (spherical nanoparticles, 1-120 nm). Depending on the reaction variables, the nature and concentration of partially reduced species determines the characteristics of the final products. HRTEM image analysis along with the simulation techniques were stabilized preferential growth of nanoparticles on specific directions. Ruthenium samples have been investigated by Temperature-Programmed Reduction (TPR) showing that the reduction temperature of nanoparticles is correlated to their nanocrystalline size.

Percepciones de pacientes y profesionales sobre la calidad de la atención a personas con enfermedad pulmonar obstructiva crónica / Perceptions of patients and health professionals about the quality of care provided to chronic obstructive pulmonary disease patients

Objetivo: Explorar la percepción y el conocimiento de pacientes y profesionales sanitarios sobre factores que influyen en la calidad de los cuidados prestados en atención primaria (AP) a personas con enfermedad pulmonar obstructiva crónica (EPOC). Diseño: Estudio cualitativo realizado entre febrero y marzo de 2010. Emplazamiento: Centros de salud urbanos. Participantes: Profesionales médicos y de enfermería de AP y pacientes con EPOC. Métodos: Muestreo intencional no probabilístico con criterios de representatividad del discurso. Se realizaron 2 entrevistas grupales y 6 individuales. Las entrevistas fueron grabadas, transcritas literalmente e interpretadas mediante el análisis social del discurso. Resultados: Los pacientes no identifican bien la sintomatología ni asumen la importancia de la EPOC hasta estadios avanzados. La falta de conocimiento sobre la evolución de la enfermedad y el impacto en la calidad de vida dificulta la adopción de los cambios necesarios. Los profesionales refieren problemas con la realización de espirometrías. Entre los médicos se identifica escepticismo respecto a la efectividad de las intervenciones dirigidas al cambio de conductas. Como factores organizativos destacan la existencia de Guías de Práctica Clínica (GPC), la coordinación entre profesionales y el alineamiento de prioridades entre gestores y profesionales. Conclusiones: Los factores identificados sugieren la posibilidad de mejorar la asistencia sanitaria, adecuando la comunicación con los pacientes para motivarlos a adoptar las modificaciones conductuales necesarias y mejorar la adherencia a los tratamientos. Para ello puede mejorarse la concienciación y la formación de los profesionales, la coordinación asistencial, la implementación de GPC y la utilización de indicadores en un proceso de evaluación de la calidad (AU)

Objective: To explore the understanding and knowledge of patients and health professionals about factors that influence the quality of care provided in Primary Care to people with Chronic Obstructive Pulmonary Disease (COPD). Design: Qualitative study performed between February and March 2010. Location: Primary Care Centers. Participants: Medical and nursing professionals and patients with COPD. Methods: Non-probabilistic intentional sampling with representation criterion of the discourse. Two group (focus group) and 6 individual interviews were performed. The interviews were recorded, literally transcribed and interpreted by social discourse analysis. Results: Patients neither identify properly the symptomatology nor they assume the COPD importance until advanced states. The lacks of knowledge about the evolution of the disease and the impact on quality of life hinders the necessary changes. Professionals reports problems with performing spirometry. Among doctors, scepticism regarding to the effectiveness of the interventions aimed at change of behaviour is identified. The existence of Clinical Guides, the improvement of the coordination between professionals and the alignment of priorities between managers and professionals stand out as organizational factors. Conclusions: The identified factors suggest the possibility of improving the health care through improved communication to motivate them to take the recommended changes and to increase the adherence to treatments. To this effect, the awareness and training of professionals, the healthcare coordination, the implementation of Clinical Guides and the use of indicators in a process of quality assessment (AU)

[Perceptions of patients and health professionals about the quality of care provided to chronic obstructive pulmonary disease patients]. / Percepciones de pacientes y profesionales sobre la calidad de la atención a personas con enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To explore the understanding and knowledge of patients and health professionals about factors that influence the quality of care provided in Primary Care to people with Chronic Obstructive Pulmonary Disease (COPD). DESIGN: Qualitative study performed between February and March 2010. LOCATION: Primary Care Centers. PARTICIPANTS: Medical and nursing professionals and patients with COPD. METHODS: Non-probabilistic intentional sampling with representation criterion of the discourse. Two group (focus group) and 6 individual interviews were performed. The interviews were recorded, literally transcribed and interpreted by social discourse analysis. RESULTS: Patients neither identify properly the symptomatology nor they assume the COPD importance until advanced states. The lacks of knowledge about the evolution of the disease and the impact on quality of life hinders the necessary changes. Professionals reports problems with performing spirometry. Among doctors, scepticism regarding to the effectiveness of the interventions aimed at change of behaviour is identified. The existence of Clinical Guides, the improvement of the coordination between professionals and the alignment of priorities between managers and professionals stand out as organizational factors. CONCLUSIONS: The identified factors suggest the possibility of improving the health care through improved communication to motivate them to take the recommended changes and to increase the adherence to treatments. To this effect, the awareness and training of professionals, the healthcare coordination, the implementation of Clinical Guides and the use of indicators in a process of quality assessment.

Tris(bipyridine)Metal(II)-Templated Assemblies of 3D Alkali-Ruthenium Oxalate Coordination Frameworks: Crystal Structures, Characterization and Photocatalytic Activity in Water Reduction.

A series of 3D oxalate-bridged ruthenium-based coordination polymers with the formula of {[ZII(bpy)3][MIRu(C2O4)3]}n (ZII = Zn2+ (1), Cu2+ (3, 4), Ru2+ (5, 6), Os2+ (7, 8); MI = Li⁺, Na⁺; bpy = 2,2'-bipyridine) and {[ZnII(bpy)3](H2O)[LiRu(C2O4)3]}n (2) has been synthesized at room temperature through a self-assembly reaction in aqueous media and characterized by single-crystal and powder X-ray diffraction, elemental analysis, infrared and diffuse reflectance UV⁻Vis spectroscopy and thermogravimetric analysis. The crystal structures of all compounds comprise chiral 3D honeycomb-like polymeric nets of the srs-type, which possess triangular anionic cages where [ZII(bpy)3]2+ cationic templates are selectively embedded. Structural analysis reveals that the electronic configuration of the cationic guests is affected by electrostatic interaction with the anionic framework. Moreover, the MLCT bands gaps values for 1⁻8 can be tuned in a rational way by judicious choice of [ZII(bpy)3]2+ guests. The 3D host-guest polymeric architectures can be used as self-supported heterogeneous photocatalysts for the reductive splitting of water, exhibiting photocatalytic activity for the evolution of H2 under UV light irradiation.

Reuniones periódicas de gastroenterología y hepatología con atención primaria. Motivos de consulta / Periodic gastroenterology and hepatology meetings with primary care. Reasons for consultation

Introducción: la presión asistencial, el envejecimiento poblacional y el aumento de enfermedades crónicas incrementan las derivaciones desde atención primaria, pudiendo sobrecargar el sistema sanitario. Se han efectuado diversas intervenciones que intentan mejorar estos aspectos. Objetivos: valorar motivos de consulta más frecuentes de los médicos generales, tanto en consultas compartidas como en sesiones clínicas realizadas conjuntamente con un especialista consultor en atención primaria, en medios urbano y rural, y su repercusión sobre las derivaciones a primeras consultas de gastroenterología. Material y métodos: se efectúa una intervención de tipo fundamentalmente formativo, consistente en reuniones periódicas en dos centros de atención primaria (urbano y rural), con consultas compartidas y sesiones clínicas en relación con pacientes y temas de gastroenterología. El periodo de intervención (dividido en dos subperiodos) se comparó con un periodo control. Resultados: los problemas más comentados corresponden al tracto digestivo inferior, seguido de patología hepática y del tracto digestivo superior. Se encontraron diferencias significativas en la distribución de diagnósticos entre los dos centros en las consultas compartidas. Se detectó un descenso relativo o porcentual de las derivaciones a nivel global en ambos subperiodos, significativo solo en el primero (51,45 %), así como a nivel rural (45,24 %). Conclusión: los motivos de consulta habituales fueron similares en los medios urbano y rural, con cierto predominio del tracto digestivo inferior. La mayoría pueden ser resueltos desde atención primaria, con el apoyo del consultor especialista. Hay repercusión en las derivaciones a las consultas externas de la especialidad, sobre todo a nivel rural (AU)

Introduction: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. Objectives: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. Material and methods: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. Results: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). Conclusion: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting (AU)

One-pot direct C-H arylation of arenes in water catalysed by RuCl3·nH2O-NaOAc in the presence of Zn.

The inexpensive and commercially available catalytic system RuCl3·nH2O-NaOAc-Zn is active in water for the direct C-H arylation of arenes with aryl/heteroaryl chlorides. The reaction can be accelerated by the use of microwave irradiation and can also be scaled up to a multi-gram scale with excellent isolated yields.

Synthesis and reactivity of new rhenium(I) complexes containing iminophosphorane-phosphine ligands: application to the catalytic isomerization of propargylic alcohols in ionic liquids.

[ReBr(CO)5] reacts with the iminophosphorane-phosphine ligands Ph2PCH2P(═NR)Ph2 (R = P(═O)(OEt)2 (1a), P(═O)(OPh)2 (1b), P(═S)(OEt)2 (1c), P(═S)(OPh)2 (1d), 4-C6F4CHO (1e), 4-C6F4CN (1f), 4-C5F4N (1g)) affording the neutral complexes [ReBr(κ(2)-P,X-Ph2PCH2P{═NP(═X)(OR)2}Ph2)(CO)3] (X = O, R = Et (2a), Ph (2b); X = S, R = Et (2c), Ph (2d)) and [ReBr{κ(2)-P,N-Ph2PCH2P(═NR)Ph2}(CO)3] (R = P(═O)(OEt)2 (3a), P(═O)(OPh)2 (3b), 4-C6F4CHO (3e), 4-C6F4CN (3f), 4-C5F4N (3g)). The reactivity of the cationic complex [Re(κ(3)-P,N,S-Ph2PCH2P{═NP(═S)(OPh)2}Ph2)(CO)3][SbF6] (4d) has been explored allowing the synthesis of the cationic [Re(L)(κ(2)-P,S-Ph2PCH2P{═NP(═S)(OPh)2}Ph2)(CO)3][SbF6] (L = acetone (5a), CH3C≡N (5b), pyridine (5c), PPh3 (5d)) and the neutral [ReY(κ(2)-P,S-Ph2PCH2P{═NP(═S)(OPh)2}Ph2)(CO)3] (Y = Cl (6a), I (6b), N3 (6c)) complexes. The catalytic activity of complex 4d in the regioselective isomerization of terminal propargylic alcohols HC≡CCR(1)R(2)(OH) into α,ß-unsaturated aldehydes R(1)R(2)C═CHCHO or ketones R(3)R(4)C═CR(1)COMe (if R(2) = CHR(3)R(4)) under neutral conditions in ionic liquids has being studied. Isolation and X-ray characterization of the key intermediate rhenium(I) oxocyclocarbene complex [Re{═C(CH2)3O}(κ(2)-P,S-Ph2PCH2P{═NP(═S)(OPh)2}Ph2)(CO)3][SbF6] (5e) seems to indicate that the catalytic reaction proceeds through tautomerization of the terminal alkynols to yield vinilydene-type species.

Series of 2D heterometallic coordination polymers based on ruthenium(III) oxalate building units: synthesis, structure, and catalytic and magnetic properties.

A series of 2D ruthenium-based coordination polymers with hcb-hexagonal topology, {[K(18-crown-6)]3[M(II)3(H2O)4{Ru(ox)3}3]}n (M(II) = Mn (1), Fe (2), Co (3), Cu (4), Zn (5)), has been synthesized through self-assembly reaction. All compounds are isostructural frameworks that crystallize in the monoclinic space group C2/c. The crystal packing consists of a 2D honeycomb-like anionic mixed-metal framework intercalated by [K(18-crown-6)](+) cationic template. Dehydration processes take place in the range 40-200 °C exhibiting two phase transitions. However, the spontaneous rehydration occurs at room temperature. Both hydrated and dehydrated compounds were tested as Lewis acids heterogeneous catalysts in the acetalyzation of benzaldehyde achieving high yields with the possibility to be recovered and reused. All the investigated materials do not show any long-range magnetic ordering down to 2 K. However, the Fe-based compound 2 presents a magnetic irreversibility in the ZFC-FC magnetization data below 5 K, which suggest a spin-glass-like behavior, characterized also by short-range ferromagnetic correlations. The coercive field increases as the temperature is lowered below 5 K, reaching a value of 1 kOe at 2 K. Alternating current measurements obtained at different frequencies confirm the freezing process that shows weak frequency dependence, being characteristic of a system exhibiting competing magnetic interactions.

Periodic gastroenterology and hepatology meetings with primary care. Reasons for consultation.

INTRODUCTION: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. OBJECTIVES: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. MATERIAL AND METHODS: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. RESULTS: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). CONCLUSION: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting.