Anthropogenic impacts on threatened species erode functional diversity in chelonians and crocodilians.

The Anthropocene is tightly associated with a drastic loss of species worldwide and the disappearance of their key ecosystem functions. The orders Testudines (turtles and tortoises) and Crocodilia (crocodiles, alligators, and gharials) contain numerous threatened, long-lived species for which the functional diversity and potential erosion by anthropogenic impacts remains unknown. Here, we examine 259 (69%) of the existing 375 species of Testudines and Crocodilia, quantifying their life history strategies (i.e., trade-offs in survival, development, and reproduction) from open-access data on demography, ancestry, and threats. We find that the loss of functional diversity in simulated extinction scenarios of threatened species is greater than expected by chance. Moreover, the effects of unsustainable local consumption, diseases, and pollution are associated with life history strategies. In contrast, climate change, habitat disturbance, and global trade affect species independent of their life history strategy. Importantly, the loss of functional diversity for threatened species by habitat degradation is twice that for all other threats. Our findings highlight the importance of conservation programmes focused on preserving the functional diversity of life history strategies jointly with the phylogenetic representativity of these highly threatened groups.

Assessing DESS solution for the long-term preservation of nematodes from faecal samples.

Preservation of biological samples is a relevant issue for many scientific disciplines. Although traditional preservers, such as formaldehyde or ethanol, imply major disadvantages related to health risks, DNA degradation and distortion of structures, they are widely used. Hence, the search for viable alternatives preserving morphometry and genetics seems necessary. Here we assess the suitability of DESS solution to preserve adult nematodes and their eggs in faeces. Concretely, faecal samples of terrestrial tortoises with oxyurids were used to: (i) compare the 1-month storage efficacy of eggs from different conservation protocols (faeces without preserver at -20 °C, faeces with DESS solution at room temperature, faeces with DESS solution at -20 °C and faeces with ethanol 70% at room temperature); (ii) address morphological nematode identification after 2 years of storage with DESS. We also corroborated that nematode DNA remained viable after 2 years. Overall, our results showed that DESS solution at room temperature is an advisable alternative to conserve both parasite eggs and adult nematodes for morphological identification and genetic purposes. It also offers the advantages of being low-cost, safe and suitable for fieldwork conditions and shipments without refrigeration for nematode preservation.

Efectividad del programa SolSano en los hábitos, conocimientos y actitudes en materia de fotoprotección de los universitarios / Effectiveness of SolSano Program on Sun Protection Habits, Knowledge, and Attitudes Among University Students

ANTECEDENTES Y OBJETIVO: El proyecto SolSano es un proyecto educativo escolar que se realiza en Aragón desde el año 2000 y que ha demostrado promover hábitos de protección solar y aumentar conocimientos en los niños a corto plazo. El objetivo de este estudio es valorar la efectividad del programa SolSano a largo plazo. SUJETOS Y MÉTODOS: Estudio analítico observacional de cohortes retrospectivo realizado en alumnos de la Universidad de Zaragoza durante el curso 2015-2016. El instrumento de valoración fue un cuestionario validado y adaptado para nuestro objetivo al que accedían a través de Internet. Se realizó una descripción univariante, así como un análisis bivariante y multivariante para estudiar las diferencias entre los participantes que habían estudiado Educación Primaria en un centro escolar donde se realizaba SolSano o no. RESULTADOS: Trescientos veinticuatro estudiantes universitarios participaron. La edad media fue 22,9 años, un 78% de respuestas procedieron de mujeres. El 44% había acudido a un centro donde se realizó el programa SolSano. El 50,5% de los estudiantes habían sufrido 1 o 2 quemaduras solares el verano anterior. Solo se observaron diferencias estadísticamente significativas en algunos aspectos entre los que asistieron a centros educativos donde se desarrolló el programa SolSano y los que asistieron a otros centros. CONCLUSIÓN: Es el primer estudio para valorar la efectividad de un programa educativo escolar en materia de fotoprotección a largo plazo (15 años). La falta de continuidad del programa en la adolescencia y la existencia de campañas de fotoprotección fuera de la escuela son posibles causas de la ausencia de diferencias en nuestra muestra

BACKGROUND AND OBJECTIVE: The SolSano (HealthySun) project is a primary school sun education program that has been running in Aragon, Spain, since 2000. In the short term, it has proven to be effective at promoting sun protection behaviors and heightening awareness in childhood. The aim of this study was to evaluate the long-term effectiveness of the SolSano program. Participants and methods: Retrospective, observational, analytical, cohort study of students at the University of Zaragoza between 2015 and 2016. The students answered a previously validated, purpose-designed, online questionnaire. We calculated descriptive statistics for all variables and performed bivariate and multivariate analyses to test for differences between students who had attended a primary school that ran the SolSano program and those who had not. RESULTS: Data for 324 students were analyzed. Mean age was 22.9 years and 78% of the respondents were women. In total, 44% of the students had participated in the SolSano program at primary school. Half of the respondents (50.5%) had experienced 1 or 2 sunburn episodes the previous summer. Significant differences were only observed for some aspects addressed by the questionnaire between SolSano participants and nonparticipants. CONCLUSIONS: This is the first study to evaluate the long-term effectiveness (15 years) of a primary school sun protection program. The absence of significant differences in our sample might be explained by non-continuation of the program into adolescence and the existence of sun protection campaigns outside the school

Effectiveness of SolSano Program on Sun Protection Habits, Knowledge, and Attitudes Among University Students. / Efectividad del programa SolSano en los hábitos, conocimientos y actitudes en materia de fotoprotección de los universitarios.

BACKGROUND AND OBJECTIVE: The SolSano (HealthySun) project is a primary school sun education program that has been running in Aragon, Spain, since 2000. In the short term, it has proven to be effective at promoting sun protection behaviors and heightening awareness in childhood. The aim of this study was to evaluate the long-term effectiveness of the SolSano program. PARTICIPANTS AND METHODS: Retrospective, observational, analytical, cohort study of students at the University of Zaragoza between 2015 and 2016. The students answered a previously validated, purpose-designed, online questionnaire. We calculated descriptive statistics for all variables and performed bivariate and multivariate analyses to test for differences between students who had attended a primary school that ran the SolSano program and those who had not. RESULTS: Data for 324 students were analyzed. Mean age was 22.9 years and 78% of the respondents were women. In total, 44% of the students had participated in the SolSano program at primary school. Half of the respondents (50.5%) had experienced 1 or 2 sunburn episodes the previous summer. Significant differences were only observed for some aspects addressed by the questionnaire between SolSano participants and nonparticipants. CONCLUSIONS: This is the first study to evaluate the long-term effectiveness (15 years) of a primary school sun protection program. The absence of significant differences in our sample might be explained by non-continuation of the program into adolescence and the existence of sun protection campaigns outside the school.

[Translation, adaptation and validation in Catalan of a questionnaire about patient safety culture: The MOSPSC (Medical Office Survey on Patient Safety Culture) questionnaire]. / Traducción, adaptación y validación en catalán de un cuestionario sobre cultura de seguridad del paciente: el cuestionario MOSPSC (Medical Office Survey on Patient Safety Culture).

INTRODUCTION: Patient safety is an essential dimension of quality of care and a priority in health policies. The diffusion of the security culture is a key strategy and the questionnaire MOSPSC (Medical Office Survey on Patient Safety Culture), in its English and Spanish versions, has proved to be a good instrument to 'measure it'. The aim of this work is to translate, adapt and validate the questionnaire in Catalan. MATERIAL AND METHODS: Translation, retrotranslation and adaptation of MOSPSC questionnaire of the AHRQ (Agency for Healthcare Research and Quality). Reliability and validity analysis of the adapted questionnaire. RESULTS: It is a simple, well accepted and valued questionnaire, although extensive. Catalan version facilitates more precise comprehension and improves completion. We found small response percentages 'do not apply or do not know' in questions from Section F (At the Center) but notable in some questions referred to specific professional staff. For most items show suitable discrimination rates and both the complete questionnaire and subscales extracted after factor analysis obtain good reliability indexes. CONCLUSIONS: Final version, very similar to original and Spanish adapted, will allow comparisons as well as monitoring/follow-up after implementation of improvement strategies. Due to its length, it could be assessed using only related dimensions.

Participación de enfermeros(as) de la Región de las Américas en una capacitación virtual sobre liderazgo / Participation of nurses from the Region of the Americas in a leadership virtual training / Participação de enfermeiros(as) da Região das Américas em uma capacitação virtual sobre liderança

Resumen Objetivo Analizar la participación de los enfermeros(as) de la Región de las Américas en la iniciativa para desarrollar el liderazgo de enfermería en la Región, a través de un curso virtual de autoaprendizaje. Método Estudio descriptivo, cuantitativo con descripciones cualitativas de datos obtenidos del Campus Virtual de Salud Pública de la OPS/OMS por medio de la Encuesta de calidad del CVSP - cursos de autoaprendizaje del Curso Virtual de Liderazgo en Enfermería: Empoderamiento de los (las) enfermeros(as) líderes en Latinoamérica. Se calcularon medidas de estadística descriptiva. Resultados Participaron en este curso de agosto de 2015 a julio del 2018, tres mil 348 enfermeros. Del total, Ecuador, México y Colombia representan juntos el 83.1% de la participación. Solamente, 8.7% de los participantes en el curso reportaron específicamente que tienen cargos de liderazgo. El curso fue útil para las personas que tienen barreras relacionadas con el acceso a la educación permanente. Discusión La mayor participación en algunos países puede deberse a mayor difusión de estos cursos o del acceso a la plataforma virtual. El entorno virtual tiene beneficios y puede colaborar con el entrenamiento del recurso humano en salud, ya que muchos de ellos tienen barreras físicas para desarrollar sus habilidades profesionales. Conclusiones El entorno virtual colaboró, de forma significativa en la práctica de estos profesionales. Además, fue una iniciativa de fortalecimiento de la enfermería con enfoque en la formación de líderes y puede ser aprovechado para la formulación de futuros programas de educación.

Abstract Objective To analyze the participation of nurses from the Region of the Americas in a nursing leadership development initiative which uses a self-learning virtual training. Method This is a descriptive and quantitative study with qualitative descriptions on data obtained from the Virtual Campus for Public Health PAHO/WHO (VCPH) with the VCPH quality survey - self-learning courses of the Virtual Training of Nursing Leadership: empowerment of nurse leaders in Latin-America. Descriptive statistics were calculated. Results 3348 nurses participated in this course from august 2015 to july 2018. The nurses from Ecuador, Mexico, and Colombia represented 83.1% of the total participation. Only 8.7% reported having a leadership position specifically. The course was found useful among those persons with barriers related to the access to a permanent education. Discussion The larger participation in some countries could be the result of the broader diffusion and access to virtual platforms. The advantages of using a virtual environment include the possibility to further strengthen the training of health human resources, particularly of those with physical barriers related to the development of professional skills. Conclusions The training in a virtual environment strengthened the practice skills of the professionals enrolled in the course. Further education programs can take advantage of this kind of platforms to better prepare the future nursing leaders.

Resumo Objetivo Analisar a participação dos enfermeiros(as) da Região das Américas na iniciativa de desenvolver a liderança de enfermagem na Região, através de um curso virtual de autoaprendizagem. Método Estudo descritivo, quantitativo com descrições qualitativas de dados obtidos do Campus Virtual de Saúde Pública da OPS/OMS por meio da Enquete de qualidade do CVSP - cursos de autoaprendizagem do Curso Virtual de Liderança em Enfermagem: Empoderamento dos(as) enfermeiros(as) líderes na América Latina. Calcularam-se medidas de estatística descritiva. Resultados Participaram neste curso de agosto de 2015 a julho de 2018, três mil 348 enfermeiros. Do total, o Equador, o México e a Colômbia representam juntos o 83.1% da participação. Somente, 8.7% dos participantes no curso reportaram especificamente que têm cargos de liderança. O curso foi útil para as pessoas que têm barreiras relacionadas com o acesso à educação permanente. Discussão A maior participação em alguns países pode se dever a maior difusão destes cursos ou do acesso à plataforma virtual. O entorno virtual tem benefícios e pode colaborar com o treinamento do recurso humano em saúde, já que muitos deles têm barreiras físicas para desenvolver suas habilidades profissionais. Conclusões O entorno virtual colaborou, de forma significativa na prática destes profissionais. Aliás, foi uma iniciativa de fortalecimento da enfermagem com enfoque na formação de líderes e pode ser aproveitado para a formulação de futuros programas de educação.

Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática / Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review

INTRODUCCIÓN: El síndrome del túnel carpiano (STC) es la neuropatía periférica más común. Consiste en la compresión del nervio mediano a nivel de túnel carpiano. Tiene una alta prevalencia y genera una situación muy discapacitante desde las primeras fases. En los casos graves el tratamiento suele ser quirúrgico, mientras que en los leves y moderados el tratamiento es conservador. El objetivo de esta revisión es conocer los tratamientos conservadores, así como su efectividad, en pacientes con STC leve y moderado, en los 15 últimos años. DESARROLLO: Se realizó una revisión sistemática según los criterios de PRISMA. Se emplearon las bases de datos Medline, PEDro y Cochrane. Se seleccionaron aquellos ensayos clínicos controlados y aleatorizados que analizasen los efectos del tratamiento conservador sobre los síntomas y la función en pacientes con STC leve o moderado. Se incluyeron 32 ensayos clínicos. Existe evidencia sobre la efectividad de los fármacos orales aunque las infiltraciones parecen ser más efectivas. El uso de férulas ha mostrado ser efectivo y asociado a otras técnicas no farmacológicas también. Las técnicas de electroterapia no han mostrado resultados concluyentes sobre la efectividad de forma aislada. Otras técnicas de tejido blando también han mostrado buenos resultados pero es escasa la evidencia en este campo. También se han propuesto varias combinaciones de tratamiento farmacológico con no farmacológico sin resultados concluyentes. CONCLUSIONES: Existen varios tratamientos conservadores capaces de mejorar los síntomas y la función de los pacientes con STC leve y moderado. Estos incluyen el uso de férulas, fármacos orales, infiltraciones, técnicas de electroterapia, técnicas manuales específicas y ejercicios de deslizamiento neural, así como la combinación de varias de ellas. No ha sido posible describir la mejor técnica o combinación de técnicas debido a las limitaciones de los estudios, por lo que es necesario realizar más estudios con una calidad metodológica adecuada

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. METHODS: A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. CONCLUSIONS: Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed

Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy: a feasibility study.

BACKGROUND: We conducted this study to test whether pulse-oximetry hemoglobin saturation (SpO2 ) can personalize the implementation of an open-lung approach during laparoscopy. Thirty patients with SpO2  ≥ 97% on room-air before anesthesia were studied. After anesthesia and capnoperitoneum the FIO2 was reduced to 0.21. Those patients whose SpO2 decreased below 97% - an indication of shunt related to atelectasis - completed the following phases: (1) First recruitment maneuver (RM), until reaching lung's opening pressure, defined as the inspiratory pressure level yielding a SpO2 ≥ 97%; (2) decremental positive end-expiratory (PEEP) titration trial until reaching lung's closing pressure defined as the PEEP level yielding a SpO2  < 97%; (3) second RM and, (4) ongoing ventilation with PEEP adjusted above the detected closing pressure. RESULTS: When breathing air, in 24 of 30 patients SpO2 was < 97%, PaO2 /FIO2  Ë‚ 53.3 kPa and negative end-expiratory transpulmonary pressure (PTP-EE ). The mean (SD) opening pressures were found at 40 (5) and 33 (4) cmH2 O during the first and second RM, respectively (P < 0.001; 95% CI: 3.2-7.7). The closing pressure was found at 11 (5) cmH2 O. This SpO2 -guided approach increased PTP-EE (from -6.4 to 1.2 cmH2 O, P < 0.001) and PaO2 /FIO2 (from 30.3 to 58.1 kPa, P < 0.001) while decreased driving pressure (from 18 to 10 cmH2 O, P < 0.001). SpO2 discriminated the lung's opening and closing pressures with accuracy taking the reference parameter PTP-EE (area under the receiver-operating-curve of 0.89, 95% CI: 0.80-0.99). CONCLUSION: The non-invasive SpO2 monitoring can help to individualize an open-lung approach, including all involved steps, from the identification of those patients who can benefit from recruitment, the identification of opening and closing pressures to the subsequent monitoring of an open-lung condition.

Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. / Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. METHODS: A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. CONCLUSIONS: Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed.

Egg consumption and cardiovascular disease according to diabetic status: The PREDIMED study.

BACKGROUND: Eggs are a major source of dietary cholesterol and their consumption has been sometimes discouraged. A relationship between egg consumption and the incidence of cardiovascular disease (CVD) has been suggested to be present exclusively among patients with type2 diabetes. AIMS: To assess the association between egg consumption and CVD in a large Mediterranean cohort where approximately 50% of participants had type 2 diabetes. METHODS: We prospectively followed 7216 participants (55-80 years old) at high cardiovascular risk from the PREDIMED (PREvención con DIeta MEDiterránea) study for a mean of 5.8 years. All participants were initially free of CVD. Yearly repeated measurements of dietary information with a validated 137-item food-frequency questionnaire were used to assess egg consumption and other dietary exposures. The endpoint was the rate of major cardiovascular events (myocardial infarction, stroke or death from cardiovascular causes). RESULTS: A major cardiovascular event occurred in 342 participants. Baseline egg consumption was not significantly associated with cardiovascular events in the total population. Non-diabetic participants who ate on average >4 eggs/week had a hazard ratio (HR) of 0.96 (95% confidence interval, 0.33-2.76) in the fully adjusted multivariable model when compared with non-diabetic participants who reported the lowest egg consumption (<2 eggs/week). Among diabetic participants, the HR was 1.33 (0.72-2.46). There was no evidence of interaction by diabetic status. HRs per 500 eggs of cumulative consumption during follow-up were 0.94 (0.66-1.33) in non-diabetics and 1.18 (0.90-1.55) in diabetics. CONCLUSIONS: Low to moderated egg consumption was not associated with an increased CVD risk in diabetic or non-diabetic individuals at high cardiovascular risk. This trial was registered at controlled-trials.com as ISRCTN35739639.

FOXO3a and the MAPK p38 are activated by cetuximab to induce cell death and inhibit cell proliferation and their expression predicts cetuximab efficacy in colorectal cancer.

BACKGROUND: Cetuximab, a monoclonal antibody against EGFR used for the treatment of colorectal cancer (CRC), is ineffective in many patients. The aim of this study was to identify the signalling pathways activated by cetuximab in CRC cells and define new biomarker of response. METHODS: We used in vitro, in vivo models and clinical CRC samples to assess the role of p38 and FOXO3a in cetuximab mechanism of action. RESULTS: We show that cetuximab activates the MAPK p38. Specifically, p38 inhibition reduced cetuximab efficacy on cell growth and cell death. At the molecular level, cetuximab activates the transcription factor FOXO3a and promotes its nuclear translocation via p38-mediated phosphorylation, leading to the upregulation of its target genes p27 and BIM and the subsequent induction of apoptosis and inhibition of cell proliferation. Finally, we found that high FOXO3a and p38 expression levels are associated with better response rate and improved outcome in cetuximab-treated patients with CRC harbouring WT KRAS. CONCLUSIONS: We identify FOXO3a as a key mediator of cetuximab mechanism of action in CRC cells and define p38 as its activator in this context. Moreover, high FOXO3a and p38 expression could predict the response to cetuximab in patients with CRC harbouring WT KRAS.

Recogida de orina en el lactante febril para el diagnóstico de la infección urinaria en Urgencias / Collection of urine in febrile infants for diagnosis of urinary tract infection in the Emergencies’ room

Introducción: la infección del tracto urinario (ITU) es una enfermedad frecuente en niños. Resulta fundamental una adecuada recogida de orina para evitar falsos positivos, minimizando procedimientos invasivos. La recogida de orina al acecho es una técnica incruenta, con baja tasa de contaminación, por lo que se estableció como método de elección al actualizar nuestro protocolo clínico. Material y métodos: estudio prospectivo longitudinal descriptivo y analítico, realizado en el Servicio de Urgencias de un hospital terciario, en dos periodos, antes y después de la actualización del protocolo. Se analizaron: edad, sexo, tiempo en Urgencias, método de recogida, sedimento y cultivo de orina y diagnóstico, en pacientes febriles menores de tres años. Resultados: hubo 140 pacientes en 2012 y 180 en 2011, sin diferencias en distribución por sexo y edad. Las medias etarias fueron 12 y 14 meses respectivamente. El 35,7% se recogieron por acecho en 2012, frente al 7,8% de 2011 (p<0,001). En 2011 fueron necesarias más confirmaciones: 20,5% frente a 10,7% en 2012. No hubo diferencias significativas en el número de sospechas de ITU ni en el de muestras contaminadas en ambos años. Tampoco entre las muestras recogidas por acecho o sondaje en 2012. El tiempo medio de estancia en Urgencias en 2011 fue 221 minutos, siendo 190 en 2012 (p<0,05). Conclusiones: la recogida de orina mediante el acecho constituye un método sencillo y no invasivo, que generalmente no precisa confirmación, por lo que reduce el tiempo de espera en el Servicio de Urgencias. No se ha objetivado un aumento de falsos diagnósticos de ITU en pacientes con muestra recogida por acecho (AU)

Introduction: urinary tract infection (UTI) in children is a common process. It is essential to find an adequate method to collect urine, to avoid false positives, minimizing invasive procedures. Clean catch urine (CCU) is a noninvasive technique, with low contamination rate, so it has been established as the recommended method for urine collection to update our clinical protocol. Material and methods: a prospective longitudinal descriptive and analytical study was conducted in a tertiary hospital in the Emergencies’ room (ER) in two periods, before and after the update protocol. Age, sex, time in the ER, collection method, sediment and urine culture and diagnosis in febrile patients <3 years were analyzed. Results: there were 140 patients in 2012 and 180 in 2011, with no differences in age and sex distribution. The mean ages were 12 and 14 months respectively. 35.7% of the samples were collected by CCU in 2012, compared to 7.8% in 2011 (p<0.001). In 2011 more confirmations of urine analysis were necessary: 20.5% vs. 10.7% in 2012. There were no significant differences between the number of suspected UTI or the contaminated samples in both years. Neither did between samples collected by catheterization or CCU in 2012. The average length of stay in the ER in 2011 was 221 minutes, while 190 in 2012 (p<0.05). Conclusions: urine collection by CCU is a simple and noninvasive method, which usually does not require confirmation, thereby reducing the wait time in the ER. There has not been an objectified increased of false diagnosis of UTI in patients with sample collected by CCU (AU)

From service quality in organisations to self-determination at home.

BACKGROUND: In our proposed model, family members' perceptions of service quality in organisations improve communication about self-determination. In turn, family perceptions of communication openness have a positive relationship with self-determination attitudes of family members. Finally, these attitudes predict self-determination behaviours of individuals with intellectual disability, as reported by family members. METHOD: We tested this model with a sample of 625 family members (196 using 'day care services' and 429 using 'occupational services'). RESULTS: Multi-sample structural equation modelling (SEM) supported the model. Communication and attitudes fully mediated the link from service quality to self-determination behaviours. CONCLUSIONS: Improving family members' perceptions of service quality and opening channels of communication between professionals and family members are useful strategies to facilitate parents' positive attitudes and increase the frequency of self-determination behaviours at home.

Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial.

BACKGROUND AND AIM: Hypertension is one of the main cardiovascular risk factors in the elderly. The aims of this work were to evaluate if a one-year intervention with two Mediterranean diets (Med-diet) could decrease blood pressure (BP) due to a high polyphenol consumption, and if the decrease in BP was mediated by plasma nitric oxide (NO) production. METHODS AND RESULTS: An intervention substudy of 200 participants at high cardiovascular risk was carried out within the PREDIMED trial. They were randomly assigned to a low-fat control diet or to two Med-diets, one supplemented with extra virgin olive oil (Med-EVOO) and the other with nuts (Med-nuts). Anthropometrics and clinical parameters were measured at baseline and after one year of intervention, as well as BP, plasma NO and total polyphenol excretion (TPE) in urine samples. Systolic and diastolic BP decreased significantly after a one-year dietary intervention with Med-EVOO and Med-nuts. These changes were associated with a significant increase in TPE and plasma NO. Additionally, a significant positive correlation was observed between changes in urinary TPE, a biomarker of TP intake, and in plasma NO (Beta = 4.84; 95% CI: 0.57-9.10). CONCLUSIONS: TPE in spot urine sample was positively correlated with plasma NO in Med-diets supplemented with either EVOO or nuts. The statistically significant increases in plasma NO were associated with a reduction in systolic and diastolic BP levels, adding to the growing evidence that polyphenols might protect the cardiovascular system by improving the endothelial function and enhancing endothelial synthesis of NO.

Inverse association between habitual polyphenol intake and incidence of cardiovascular events in the PREDIMED study.

BACKGROUND AND AIMS: Epidemiologic and biological evidence supports an inverse association between polyphenol consumption and the risk of cardiovascular disease (CVD). However, no previous studies have prospectively evaluated the relationship between polyphenol intake and the incidence of CVD in such a comprehensive way. The aim was to evaluate the association between intakes of total polyphenol and polyphenol subgroups, and the risk of major cardiovascular events (myocardial infarction, stroke or death from cardiovascular causes) in the PREDIMED study. METHODS AND RESULTS: The present work is an observational study within the PREDIMED trial. Over an average of 4.3 years of follow-up, there were 273 confirmed cases of CVD among the 7172 participants (96.3%) who completed a validated 137-item food frequency questionnaire (FFQ) at baseline. Polyphenol consumption was calculated by matching food consumption data from the FFQ with the Phenol-Explorer database on polyphenol content of each reported food. After multivariate adjustment, a 46% reduction in risk of CVD risk was observed comparing Q5 vs. Q1 of total polyphenol intake (HR = 0.54; 95% confidence interval [CI] = 0.33-0.91; P-trend = 0.04). The polyphenols with the strongest inverse associations were flavanols (HR = 0.40; CI 0.23-0.72; P-trend = 0.003), lignans (HR = 0.51; CI 0.30-0.86; P-trend = 0.007), and hydroxybenzoic acids (HR = 0.47; CI 0.26-0.86; P-trend 0.02). CONCLUSION: Greater intake of polyphenols, especially from lignans, flavanols, and hydroxybenzoic acids, was associated with decreased CVD risk. Clinical trials are needed to confirm this effect and establish accurate dietary recommendations.

Dietary intake and major food sources of polyphenols in a Spanish population at high cardiovascular risk: the PREDIMED study.

BACKGROUND AND AIMS: Epidemiological data have shown an inverse association between the consumption of polyphenol-rich foods and the risk of cardiovascular disease or overall mortality. A comprehensive estimation of individual polyphenol intake in nutritional cohorts is needed to gain a better understanding of this association. The aim of this study was to estimate the quantitative intake of polyphenols and the major dietary sources in the PREDIMED (PREvención con DIeta MEDiterránea) cohort using individual food consumption records. METHODS AND RESULTS: The PREDIMED study is a large, parallel-group, multicentre, randomised, controlled 5-year feeding trial aimed at assessing the effects of the Mediterranean diet on the primary prevention of cardiovascular disease. A total of 7200 participants, aged 55-80 years, completed a validated 1-year food frequency questionnaire (FFQ) at baseline. Polyphenol consumption was calculated by matching food consumption data from the FFQ with the recently developed Phenol-Explorer database on polyphenol content in foods. The mean total polyphenol intake was 820 ± 323 mg day⁻¹ (443 ± 218 mg day⁻¹ of flavonoids and 304 ± 156 mg day⁻¹ of phenolic acids). Hydroxycinnamic acids were the phenolic group with the highest consumption and 5-caffeoylquinic acid was the most abundantly ingested individual polyphenol. The consumption of olives and olive oil was a differentiating factor in the phenolic profile of this Spanish population compared with other countries. CONCLUSION: In Mediterranean countries, such as Spain, the main dietary source of polyphenols is coffee and fruits, but the most important differentiating factor with respect to other countries is the consumption of polyphenols from olives and olive oil.

Gazpacho consumption is associated with lower blood pressure and reduced hypertension in a high cardiovascular risk cohort. Cross-sectional study of the PREDIMED trial.

BACKGROUND AND AIM: Hypertension is a major public health problem and a leading cause of death and disability in both developed and developing countries, affecting one-quarter of the world's adult population. Our aim was to evaluate whether the consumption of gazpacho, a Mediterranean vegetable-based cold soup rich in phytochemicals, is associated with lower blood pressure (BP) and/or reduced prevalence of hypertension in individuals at high cardiovascular risk. METHODS AND RESULTS: We selected 3995 individuals (58% women, mean age 67 y) at high cardiovascular risk (81% hypertensive) recruited into the PREDIMED study. BP, weight, and dietary and physical activity data were collected. In multivariate linear regression analyses, after adjustment, moderate and high gazpacho consumption categories were associated with reduced mean systolic BP of -1.9 mm Hg [95% confidence interval (CI): -3.4; -0.6] and -2.6 mm Hg (CI: -4.2; -1.0), respectively, and reduced diastolic BP of -1.5 mm Hg (CI: -2.3; -0.6) and -1.9 mm Hg (CI: -2.8; -1.1). By multiple-adjusted logistic regression analysis, gazpacho consumption was associated with a lower prevalence of hypertension, with OR = 0.85 (CI: 0.73; 0.99) for each 250 g/week increase and OR = 0.73 (CI: 0.55; 0.98) for high gazpacho consumption groups compared to the no-consumption group. CONCLUSIONS: Gazpacho consumption was inversely associated with systolic and diastolic BP and prevalence of hypertension in a cross-sectional Mediterranean population at high cardiovascular risk. The association between gazpacho intake and reduction of BP is probably due to synergy among several bioactive compounds present in the vegetable ingredients used to make the recipe.

Changes in bread consumption and 4-year changes in adiposity in Spanish subjects at high cardiovascular risk.

The effects of bread consumption change over time on anthropometric measures have been scarcely studied. We analysed 2213 participants at high risk for CVD from the PREvención con DIeta MEDiterránea (PREDIMED) trial to assess the association between changes in the consumption of bread and weight and waist circumference gain over time. Dietary habits were assessed with validated FFQ at baseline and repeatedly every year during 4 years of follow-up. Using multivariate models to adjust for covariates, long-term weight and waist circumference changes according to quartiles of change in energy-adjusted white and whole-grain bread consumption were calculated. The present results showed that over 4 years, participants in the highest quartile of change in white bread intake gained 0·76 kg more than those in the lowest quartile (P for trend = 0·003) and 1·28 cm more than those in the lowest quartile (P for trend < 0·001). No significant dose-response relationships were observed for change in whole-bread consumption and anthropometric measures. Gaining weight (>2 kg) and gaining waist circumference (>2 cm) during follow-up was not associated with increase in bread consumption, but participants in the highest quartile of changes in white bread intake had a reduction of 33 % in the odds of losing weight (>2 kg) and a reduction of 36 % in the odds of losing waist circumference (>2 cm). The present results suggest that reducing white bread, but not whole-grain bread consumption, within a Mediterranean-style food pattern setting is associated with lower gains in weight and abdominal fat.

Lumbalgia aguda con imagen «en suelta de globos» en la radiografía simple de tórax / Low back pain with a "detachable balloons" image in a simple chest X-ray

La imagen «en suelta de globos» en la radiografía simple de tórax no es muy común en atención primaria. Presentamos el caso de un paciente que consulta por lumbalgia no complicada. La radiografía de columna es indicativa de artrosis. Dentro del Programa de Actividades Preventivas PAPPS se le solicita análisis de sangre que muestra una anemia moderada. Durante el estudio posterior se descubre una imagen de nódulos pulmonares múltiples («en suelta de globos») en la radiografía simple de tórax. El paciente es remitido al hospital donde se detecta un probable carcinoma de células renales en la tomografía computarizada (TC) toracoabdominal. Finalmente, el síntoma inicial (lumbalgia) era debido a metástasis óseas pero se necesitó la posterior información para continuar con el proceso diagnóstico. La anemia y la imagen «en suelta de globos» fueron claves para el diagnóstico final (AU)

The "detachable balloons" image in simple chest-X-ray is not very common in Priamry Care. We present the case of patient who consulted for uncomplicated low back pain. The spine X-ray was suggestive of arthrosis. A blood analysis was requested within the Preventive Activities Programme, which showed moderate anaemia. The patient was referred to the Hospital where a probable renal cell carcinoma was detected in the thoraco-abdominal Computed Axial Tomography. Finally, the initial symptom (low back pain) was due to bone metastasis, but further information was required to continue with the diagnostic process. The anaemia and the "detachable balloons" image were key factors in the final diagnosis (AU)