[Analysis of accidental falls and the integration in the chronicity programs of patients with amyotrophic lateral sclerosis]. / Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease. There is no curative treatment available, and these patients require multidisciplinary support to promote their comfort and quality of life. PATIENTS AND METHODS: Longitudinal descriptive study in patients registered in primary care (PC), Costa de Ponent-Barcelona Institut Catala de la Salut to analyse emergency hospital visits, use of support devices and their integration into the primary care chronicity program. Variables were sex, age and evolution time, emergency visits, patients with percutaneous gastrostomy (PEG), non-invasive or invasive ventilation (NIV/VI), integration in the primary care chronicity program. RESULTS: 81 patients, 49.4% male, mean age 65.6 years (±11.7), evolution time less than 2 years or equal to or greater than 2 years (42 and 58%, respectively). Of them, 47 (58.5%) made 107 consultations. The most frequent reasons for consultation were falls (26.8%), respiratory difficulties (23.3%), comorbidity (16.7%), eating problems (11%) and pain (10.2%) without differences by age or sex. Greater frequency (p < 0.001) was observed in patients with less than two years of evolution and significant increases in the use of NIV and PEG up to 51.9 and 35.8% respectively, as well as integration in primary care chronicity program of 61.7%. CONCLUSIONS: Accidental falls were the most frequent and potentially avoidable reason for hospital emergency visits in patients with ALS, especially in the first two years of the disease. Significant increases are detected in the use of support devices and in primary care chronicity program integration. It is necessary to increase home resources, especially in physiotherapy and occupational therapy.

TITLE: Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica.Introducción. La esclerosis lateral amiotrófica (ELA) es la enfermedad degenerativa de las motoneuronas más frecuente. No dispone de tratamiento curativo y estos pacientes requieren un soporte multidisciplinar para favorecer su confort y calidad de vida. Pacientes y métodos. Estudio descriptivo longitudinal en pacientes registrados en atención primaria, Costa de Ponent-Barcelona, Institut Català de la Salut, para analizar las visitas urgentes hospitalarias, la utilización de dispositivos de soporte y su integración en el programa de atención a la cronicidad. Las variables fueron sexo, edad y tiempo de evolución, visitas urgentes, portadores de gastrostomía percutánea (PEG), ventilación no invasiva o invasiva (VNI/VI) e integración en el programa de atención a la cronicidad. Resultados. Se incluyó a 81 pacientes, un 49,4% varones, con una edad media de 65,6 años (±11,7), y un tiempo de evolución menor de 2 años o igual o mayor de 2 años (42 y 58%, respectivamente). De ellos, 47 (58,5%) realizaron 107 consultas. Los motivos de consulta más frecuentes fueron: caídas (26,8%), dificultades respiratorias (23,3%), comorbilidad (16,7%), problemas en la alimentación (11%) y dolor (10,2%), sin diferencias por edad o sexo. Se observó una mayor frecuentación (p menor de 0,001) en pacientes con menos de dos años de evolución e incrementos significativos en la utilización de la VNI y la PEG hasta el 51,9 y el 35,8%, respectivamente, así como integración en el programa de atención a la cronicidad del 61,7%. Conclusiones. El motivo más frecuente de consulta a urgencias hospitalarias de pacientes con ELA y potencialmente evitable fueron las caídas accidentales, especialmente en los primeros dos años de enfermedad. Se detectan incrementos significativos en la utilización de dispositivos de soporte y en la integración en el programa de atención a la cronicidad. Es necesario incrementar los recursos domiciliarios, especialmente en fisioterapia y terapia ocupacional.

Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica / Analysis of accidental falls and the integration in the chronicity programs of patients with amyotrophic lateral sclerosis

Introducción: La esclerosis lateral amiotrófica (ELA) es la enfermedad degenerativa de las motoneuronas más frecuente. No dispone de tratamiento curativo y estos pacientes requieren un soporte multidisciplinar para favorecer su confort y calidad de vida. Pacientes y métodos: Estudio descriptivo longitudinal en pacientes registrados en atención primaria, Costa de Ponent-Barcelona, Institut Català de la Salut, para analizar las visitas urgentes hospitalarias, la utilización de dispositivos de soporte y su integración en el programa de atención a la cronicidad. Las variables fueron sexo, edad y tiempo de evolución, visitas urgentes, portadores de gastrostomía percutánea (PEG), ventilación no invasiva o invasiva (VNI/VI) e integración en el programa de atención a la cronicidad. Resultados: Se incluyó a 81 pacientes, un 49,4% varones, con una edad media de 65,6 años (±11,7), y un tiempo de evolución menor de 2 años o igual o mayor de 2 años (42 y 58%, respectivamente). De ellos, 47 (58,5%) realizaron 107 consultas. Los motivos de consulta más frecuentes fueron: caídas (26,8%), dificultades respiratorias (23,3%), comorbilidad (16,7%), problemas en la alimentación (11%) y dolor (10,2%), sin diferencias por edad o sexo. Se observó una mayor frecuentación (p < 0,001) en pacientes con menos de dos años de evolución e incrementos significativos en la utilización de la VNI y la PEG hasta el 51,9 y el 35,8%, respectivamente, así como integración en el programa de atención a la cronicidad del 61,7%. Conclusiones: El motivo más frecuente de consulta a urgencias hospitalarias de pacientes con ELA y potencialmente evitable fueron las caídas accidentales, especialmente en los primeros dos años de enfermedad. Se detectan incrementos significativos en la utilización de dispositivos de soporte y en la integración en el programa de atención a la cronicidad. Es necesario incrementar los recursos domiciliarios, especialmente en fisioterapia y terapia ocupacional.(AU)

Introduction: Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease. There is no curative treatment available, and these patients require multidisciplinary support to promote their comfort and quality of life. Patients and methods: Longitudinal descriptive study in patients registered in primary care (PC), Costa de Ponent-Barcelona Institut Català de la Salut to analyse emergency hospital visits, use of support devices and their integration into the primary care chronicity program. Variables were sex, age and evolution time, emergency visits, patients with percutaneous gastrostomy (PEG), non-invasive or invasive ventilation (NIV/VI), integration in the primary care chronicity program. Results: 81 patients, 49.4% male, mean age 65.6 years (±11.7), evolution time less than 2 years or equal to or greater than 2 years (42 and 58%, respectively). Of them, 47 (58.5%) made 107 consultations. The most frequent reasons for consultation were falls (26.8%), respiratory difficulties (23.3%), comorbidity (16.7%), eating problems (11%) and pain (10.2%) without differences by age or sex. Greater frequency (p < 0.001) was observed in patients with less than two years of evolution and significant increases in the use of NIV and PEG up to 51.9 and 35.8% respectively, as well as integration in primary care chronicity program of 61.7%. Conclusions: Accidental falls were the most frequent and potentially avoidable reason for hospital emergency visits in patients with ALS, especially in the first two years of the disease. Significant increases are detected in the use of support devices and in primary care chronicity program integration. It is necessary to increase home resources, especially in physiotherapy and occupational therapy.(AU)

Under-reporting bicycle accidents to police in the COST TU1101 international survey: Cross-country comparisons and associated factors.

Police crash reports are often the main source for official data in many countries. However, with the exception of fatal crashes, crashes are often underreported in a biased manner. Consequently, the countermeasures adopted according to them may be inefficient. In the case of bicycle crashes, this bias is most acute and it probably varies across countries, with some of them being more prone to reporting accidents to police than others. Assessing if this bias occurs and the size of it can be of great importance for evaluating the risks associated with bicycling. This study utilized data collected in the COST TU1101 action "Towards safer bicycling through optimization of bicycle helmets and usage". The data came from an online survey that included questions related to bicyclists' attitudes, behaviour, cycling habits, accidents, and patterns of use of helmets. The survey was filled by 8655 bicyclists from 30 different countries. After applying various exclusion factors, 7015 questionnaires filled by adult cyclists from 17 countries, each with at least 100 valid responses, remained in our sample. The results showed that across all countries, an average of only 10% of all crashes were reported to the police, with a wide range among countries: from a minimum of 0.0% (Israel) and 2.6% (Croatia) to a maximum of a 35.0% (Germany). Some factors associated with the reporting levels were type of crash, type of vehicle involved, and injury severity. No relation was found between the likelihood of reporting and the cyclist's gender, age, educational level, marital status, being a parent, use of helmet, and type of bicycle. The significant under-reporting - including injury crashes that do not lead to hospitalization - justifies the use of self-report survey data for assessment of bicycling crash patterns as they relate to (1) crash risk issues such as location, infrastructure, cyclists' characteristics, and use of helmet and (2) strategic approaches to bicycle crash prevention and injury reduction.

Abdomen agudo secundario a perforación de divertículo yeyunal / Acute abdomen due to jejunal perforated diverticulitis

Los divertículos yeyunoileales se encuentran en el último lugar en frecuencia de la enfermedad diverticular. En la mayoría de los casos son asintomáticos, siendo su forma de presentación más habitual alguna de sus complicaciones relacionadas, como la hemorragia,obstrucción, diverticulitis o perforación. Es fundamental plantear este posible diagnóstico en el caso de abdomen agudo para reducir en la medida de lo posible la morbilidad y mortalidad asociada a un retraso en el diagnóstico o en la indicación quirúrgica en caso de complicación asociada. Presentamos un caso de abdomen agudo secundario a perforación por diverticulitis yeyunal, con resultado satisfactorio tras tratamiento quirúrgico urgente

Jejunoileal diverticula are in last place in frequency of diverticular disease. In most cases they are asymptomatic and its most common presentation form is any of its related complications, such as bleeding, obstruction, diverticulitis or perforation. It is essential to raise this possible diagnosis in the case of acute abdomen to reduce as far as possible the morbidity and mortality associated with delayed diagnosis or surgical indication if associated complications. We report a case of acute abdomen secondary to perforation jejunal diverticulitis, with satisfactory results after emergency surgery

Benthic foraminifera show some resilience to ocean acidification in the northern Gulf of California, Mexico.

Extensive CO2 vents have been discovered in the Wagner Basin, northern Gulf of California, where they create large areas with lowered seawater pH. Such areas are suitable for investigations of long-term biological effects of ocean acidification and effects of CO2 leakage from subsea carbon capture storage. Here, we show responses of benthic foraminifera to seawater pH gradients at 74-207m water depth. Living (rose Bengal stained) benthic foraminifera included Nonionella basispinata, Epistominella bradyana and Bulimina marginata. Studies on foraminifera at CO2 vents in the Mediterranean and off Papua New Guinea have shown dramatic long-term effects of acidified seawater. We found living calcareous benthic foraminifera in low pH conditions in the northern Gulf of California, although there was an impoverished species assemblage and evidence of post-mortem test dissolution.

Nonessential metals in striped marlin and Indo-Pacific sailfish in the southeast Gulf of California, Mexico: concentration and assessment of human health risk.

Seventeen sailfish (Istiophorus platypterus; 166-246 cm long) and 13 striped marlin (Tetrapturus audax; 159-254 cm long) specimens from the southern Gulf of California were analyzed for As, Cd, Hg, and Pb concentrations. More than 20% of the As and Cd levels exceeded the guideline levels of the World Health Organization (WHO), the U.S. Food and Drug Administration, and the European Union. About 65-90% of the specimens exceeded the limit value for Hg. Pb levels in billfish were significantly lower than guideline values. The intakes of As and Cd through billfish consumption by the population represented 20-40% of the provisional tolerable weekly intake (PTWI) values as recommended by the WHO. Levels of Hg exceeded the PTWI value. Pb intake represented <5% of the PTWI through these species in all age and gender groups. The target hazard quotients (THQs) for Cd and Pb were <1 in each group of interest. In contrast, THQ values based on As and Hg showed large variations, with the highest values for children, then pregnant women, and, finally, adults. Values of THQ >1 indicate risk for As and Hg; the risk from As was estimated assuming that 20% of the total As was inorganic. These metals can affect the nervous system and intellectual and physical development of unborn children and infants. A national moratorium on billfish consumption in México is recommended for children (0-6 years old), pregnant women, and women planning pregnancy.

Hipotiroidismo subclínico en la consulta de atención primaria / Sub-clinical hypothyroidism in the primary care consultation

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La prescripción electrónica en España / Computer-aided prescribing in Spain

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[Advances in the study of immunopathology in atopic disorders]. / Avances recientes en el estudio de la inmunopatología de los padecimientos atópicos.

The atopic diseases are mediated by type I hypersensitivity. These disorders are multifactorial, although, the inherency is probably the most important cause. The disregulation of the Th1/Th2 immune response is one of the predominant factors on the generation and maintenance on the atopic process. We analyze the mechanisms of the regulation of the response Th1/Th2, the recent theories of the disregulation on this response as an etiology, the soluble factors as cytokines, chemokines and their receptors, surface cell markers and transcriptional factors recently mentioned to be important on this disregulation mechanism. Otherwise, we propose some general considerations and perspectives.

Total L-shell X-ray production cross sections by 400-700 keV proton impact for elements with 34 < or = Z < or = 53.

Total L-shell X-ray production cross sections induced by protons with energies between 400 and 700 keV were measured for elements with atomic number Z between 34 and 53. The ECPSSR theory describes appropriately the results. This model modifies the plane wave born approximation by considering projectile energy loss (E), Coulomb deflection of the incoming ion (C), polarization and change in electron binding energies through a perturbed stationary states method (PSS) and relativistic values of target electron mass (R). A comparison is given with previously published data for proton energies below 1 MeV and 26 < or = Z < or = 53, based on a scaling obtained from a reduced velocity parameter zeta(L)R. The results show that the scaling for these atomic numbers and energy ranges is adequate and a semi-empirical expression to calculate those cross sections is proposed.

Efficacy of amiodarone for the termination of chronic atrial fibrillation and maintenance of normal sinus rhythm: a prospective, multicenter, randomized, controlled, double blind trial.

OBJECTIVE: We sought to assess the efficacy and safety of amiodarone for restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation in a prospective, randomized, double blind trial. BACKGROUND: Restoration and preservation of sinus rhythm is difficult in patients with chronic atrial fibrillation. The efficacy of oral amiodarone has not been conclusively established. METHODS: Ninety-five patients with chronic atrial fibrillation, lasting an average of 35.6 months, were randomized to either amiodarone (600 mg/d) (47 patients) or placebo (48 patients) during four weeks. Nonresponders underwent electric cardioversion, and those who reverted continued with amiodarone (200 mg/d) or placebo. End-points were successful cardioversion and sinus rhythm maintenance. RESULTS: Sixteen patients (34.04%) in the amiodarone group reverted within 27.28 +/- 8.85 days in comparison with 0% in the placebo group (P < 0.000009). The conversion rate rose to 51.72% in patients with chronic atrial fibrillation lasting less than 12 months. Twenty-eight patients in the amiodarone group and 39 in the placebo group underwent electric cardioversion, which was successful in 19 patients (67.8%) of the amiodarone group and in 15 (38.46%) of the placebo group (P = 0.017). Altogether, conversion was obtained in 79.54% of the amiodarone group patients and in 38.46% of the placebo group patients (P < 0.0001). During follow-up, atrial fibrillation relapsed in 13 (37.14%) of 35 patients of the amiodarone group within 8.84 +/- 8.57 months and in 12 (80%; P = 0.009) of 15 patients of the placebo group within 2.74 +/- 3.41 months. CONCLUSIONS: Oral amiodarone restored sinus rhythm in one third of patients with chronic atrial fibrillation, increased the success rate of electric cardioversion, decreased the number of relapses and delayed their occurrence.

[Benefits of treatment to eradicate Helicobacter pylori infection in patients with ulcer at a primary care center]. / Beneficios del tratamiento erradicador de la infección por Helicobacter pylori en pacientes ulcerosos en un centro de atención primaria.

OBJECTIVES: To evaluate the clinical evolution and the use of Primary Care health resources one year after treatment to eradicate Helicobacter pylori (Hp) infection in patients with peptic ulcers and Hp infection. DESIGN: Retrospective study on the effect of an intervention. SETTING: Urban, reformed primary care centre. PATIENTS: 102 patients with peptic ulcers and Hp infection. INTERVENTION: Treatment to eradicate Hp. MEASUREMENTS AND MAIN RESULTS: a) Total medical attendance; b) attendance for dyspepsia; c) number of ulcerous outbreaks; d) medicines taken to treat dyspepsia. 79.4% of the patients treated were male. Overall mean age was 47.8 +/- 12.4. After the intervention, total attendance (from 8.3 to 6.6, p < 0.001), attendance for dyspepsia (from 3.1 to 1.1, p < 0.00001), and ulcerous outbreaks (from 1.2 to 0.06, p < 0.00001) all dropped sharply. The mean number of medicines prescribed for dyspepsia per patient fell from 1.24 to 0.43, p < 0.0001. Ranitidine prescription fell from 72.7 to 13.8 days (p < 0.001); and omeprazol from 35.1 to 12.2 days (p < 0.03). Estimated total saving per patient was 26,792 pesetas at 1998 values. CONCLUSIONS: Treatment in primary care to eradicate Hp(+) in ulcerous patients reduced the needs of attendance and the prescription of drugs for ulcers. Just in the first year this supposed a clinical benefit for these patients and important economic savings for the public health service.

Beneficios del tratamiento erradicador de la infección por Helicobacter pylori en pacientes ulcerosos en un centro de atención primaria / Benefits of treatment to eradicate Helicobacter pylori infection in patients with ulcers attending a primary care centre

Objetivo. Evaluar la evolución clínica y la utilización de recursos sanitarios en atención primaria un año después del tratamiento erradicador de Helicobacter pylori (Hp) en pacientes con úlcera péptica e infección por Hp. Diseño. Estudio retrospectivo sobre el efecto de una intervención. Ámbito del estudio. Centro de atención primaria urbano y reformado. Pacientes. Ciento dos pacientes con enfermedad ulcerosa péptica e infección por Hp. Intervención. Tratamiento erradicador de Hp. Mediciones y resultados principales. a) número de visitas totales (VT); b) visitas por dispepsia (VD); c) número de brotes ulcerosos (BU), y d) fármacos consumidos para tratamiento de la dispepsia. De los pacientes tratados un 79,4 por ciento era varón. La edad media global fue de 47,8 ñ 12,4 años. Después de la intervención, disminuyeron significativamente las VT (de 8,3 a 6,6; p < 0,001), las VD (3,1 a 1,1; p < 0,00001), y los BU (de 1,2 a 0,06; p < 0,00001). El número medio de fármacos prescritos para la dispepsia por paciente disminuyó de 1,24 a 0,43 (p < 0,0001). La prescripción de ranitidina pasó de 72,7 a 13,8 días (p < 0,001) y la de omeprazol disminuyó de 35,1 a 12,2 días (p < 0,03). El ahorro total estimado por paciente fue de 26.792 pts. con valores económicos de 1998. Conclusiones. En nuestro medio el tratamiento erradicador en pacientes ulcerosos Hp (+) disminuye las necesidades de asistencia y la prescripción de medicamentos antiulcerosos. Ya durante el primer año esto supone un beneficio clínico para estos pacientes y un ahorro económico importante para la sanidad pública (AU)

El médico de familia y los medicamentos del bienestar / General practitioners and the medicines of well-being

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[Cell surface markers in patients with allergic rhinitis versus Der p and Der f challenge]. / Estudio de marcadores de superficie celular en pacientes con rinitis alérgica frente a reto con Der p y Der f.

The allergic condition is determined genetically and they affect of the general population's 20-30% in developed countries, in the last decade have been increased the prevalence. Inside the imbalance that is manifested in the atopic patients it is on one hand the antigen-presenting cells (monocytes and B cells) and on the other hand, the lymphocytes T CD4+. The association of molecules like CD80, CD 86 (co-stimulatory molecules) in monocytes and B cells and CD30, CD62L, ALL, CD11a, CD28, CD124 and CD152 in CD4+, they have shown to be of particular interest in allergic sufferings. However we don't find a difference statistically significant among patient and controls and among nasal challenges with saline solution with specific allergen. For what we suggest that the changes in the activation, proliferation and cooperation are given in the les ion place, without an apparent repercussion in cells of peripheral blood.

Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia.

To assess the effect of a high monounsaturated fatty acids (MFA) diet on serum lipids, 30 healthy adult normolipidemic volunteers and 37 adult patients with mild hypercholesterolemia (5.4-9.3 mmol/l), 15 of them also with hypertriglyceridemia (2.3-4.8 mmol/l), were studied. Fifteen healthy and 30 hypercholesterolemic subjects (15 of them with associated type 2 diabetes mellitus) received an avocado enriched diet (2000 Kcal, lipids 53% MFA 49 g saturated/unsaturated ratio 0.54), and seven non-diabetic hypercholesterolemic individuals received an isocaloric control diet (MFA 34 g, saturated/unsaturated ratio 0.7). Serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride concentrations were measured before and after a 7-day diet period. In healthy individuals a 16% decrease of serum total cholesterol level followed the high MFA diet, while it rose after the control diet (p < 0.001 between diets). In hypercholesterolemic subjects a significant (p < 0.01) decrease of serum total cholesterol (17%), LDL-cholesterol (22%) and triglycerides (22%), and increase of HDL-cholesterol (11%) levels occurred with the avocado diet, while no significant changes were noticed with the control diet. High lipid, high MFA-avocado enriched diet can improve lipid profile in healthy and especially in mild hypercholesterolemic patients, even if hypertriglyceridemia (combined hyperlipidemia) is present.