[Study of the relationship between adherence to back school and coping with pain in patients with chronic low back pain]. / Estudio de la relación entre adherencia a la Escuela de la Espalda y afrontamiento del dolor en pacientes con lumbalgia crónica.

INTRODUCTION: Back School (BS) is a treatment modality for patients with chronic low back pain with educational contents associated with other therapeutic measures such as exercise. If followed, it is effective but it is well known that it is difficult to make changes to daily habits. This study evaluated whether patients completing BS had a predominance of active strategies in coping with pain, as they adhered better to the recommendations of BS. MATERIAL AND METHOD: Prospective observational study to evaluate BS adherence in patients with chronic low back pain. Adult patients attending BS were included in the study. Patients whose educational level, concomitant pathology or personal situation prevented them from completing the study were excluded. The patients were evaluated at the beginning and after the third session of BS. The variables studied were adherence to exercises and recommendations, coping with pain, pain intensity, functional disability and other sociodemographic characteristics. RESULTS: A total of 67.2% of the 116 included patients acknowledged that they did not perform the exercises and recommendations of BS every day. No relationship was established between patients with active strategies for coping with pain and adherence to BS. Functional capacity and pain intensity did not differ between adherent and non-adherent patients. CONCLUSIONS: This study did not demonstrate that adherence to the exercises and habits taught in BS is related to coping with pain strategies, pain intensity and functional capacity in patients with chronic low back pain.

Estudio de la relación entre adherencia a la Escuela de la Espalda y afrontamiento del dolor en pacientes con lumbalgia crónica / Study of the relationship between adherence to back school and coping with pain in patients with chronic low back pain

Introducción: La Escuela de la Espalda (EE) es un tratamiento en pacientes con lumbalgia crónica con contenidos educativos asociados a otras medidas terapéuticas como ejercicios. Es eficaz si se realiza y es bien conocido que las modificaciones en los hábitos diarios son difíciles de cumplir. Este trabajo de investigación evalúa si los pacientes que al terminar la EE tienen un predominio de estrategias activas en su afrontamiento del dolor se adhieren mejor a las enseñanzas de la EE. Material y método: Estudio observacional prospectivo para valorar la adherencia a la EE en pacientes con dolor lumbar crónico. Se incluyeron pacientes adultos que aceptaban realizar la EE. Se excluyeron aquellos cuyo nivel cultural, enfermedad concomitante o situación personal les impidiera completar el estudio. Los pacientes fueron evaluados al inicio y tras la tercera sesión de la EE. Las variables estudiadas fueron: adherencia a los ejercicios y recomendaciones, afrontamiento al dolor, intensidad del dolor, discapacidad funcional y características sociodemográficas. Resultados: El 67,2% de los 116 pacientes que participaron reconocen que no cumplen diariamente con los ejercicios y enseñanzas realizadas en la EE. No se ha podido establecer relación entre los pacientes con estrategias activas de afrontamiento del dolor y la adherencia a la EE. La capacidad funcional y la intensidad del dolor no difieren entre pacientes cumplidores y no cumplidores. Conclusiones: No se ha podido demostrar que la adherencia a los ejercicios y hábitos de la EE guarde relación con las estrategias de afrontamiento al dolor, la intensidad del dolor y la capacidad funcional de los pacientes con lumbalgia

Introduction: Back School (BS) is a treatment modality for patients with chronic low back pain with educational contents associated with other therapeutic measures such as exercise. If followed, it is effective but it is well known that it is difficult to make changes to daily habits. This study evaluated whether patients completing BS had a predominance of active strategies in coping with pain, as they adhered better to the recommendations of BS. Material and method: Prospective observational study to evaluate BS adherence in patients with chronic low back pain. Adult patients attending BS were included in the study. Patients whose educational level, concomitant pathology or personal situation prevented them from completing the study were excluded. The patients were evaluated at the beginning and after the third session of BS. The variables studied were adherence to exercises and recommendations, coping with pain, pain intensity, functional disability and other sociodemographic characteristics. Results: A total of 67.2% of the 116 included patients acknowledged that they did not perform the exercises and recommendations of BS every day. No relationship was established between patients with active strategies for coping with pain and adherence to BS. Functional capacity and pain intensity did not differ between adherent and non-adherent patients. Conclusions: This study did not demonstrate that adherence to the exercises and habits taught in BS is related to coping with pain strategies, pain intensity and functional capacity in patients with chronic low back pain

Fluticasone in mild to moderate atopic dermatitis relapse: a randomized controlled trial

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p = 0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD

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Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial.

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.

Masa corporal, disnea y calidad de vida como predictores de éxito en la cirugía de reducción de volumen en el enfisema / Body mass, dyspnea, and quality of life as success predictors in emphysema surgery for reduction of pulmonary volume

Objetivos. La cirugía de reducción de volumen se ha introducido recientemente como tratamiento paliativo del enfisema evolucionado. Algunos pacientes mejoran y otros permanecen en la misma situación; sin embargo, los factores que predicen la mejoría están todavía en debate. El propósito de este trabajo es encontrar qué factores discriminan que un paciente responda positivamente con esta cirugía. Material y métodos. Se han comparado en nuestra serie de cirugía de reducción de volumen (12 pacientes) a los respondedores (7 pacientes) y los no respondedores (5 pacientes). Se definió la respuesta a la cirugía como un delta FEV, >= 15 por ciento, índice transicional de disnea (escala de Mahler) >= 3 y mejoría en la puntuación del cuestionario de calidad de vida para enfermedad respiratoria crónica (Guyatt y Güell) >= 1,5 a los 3 meses de la cirugía. Se han comparado los valores basales del FEV1, FEF50/FIF50 por ciento, grado de hiperinsuflación, heterogeneidad, PaO2, PaCO2, tipo de cirugía, índice de masa corporal, índice basal de disnea y puntuación del cuestionario de calidad de vida. Resultados. Los no respondedores se han diferenciado de los respondedores únicamente porque partían de un índice de masa corporal, índice basal de disnea y puntuación del cuestionario de calidad de vida menores. El resto de parámetros estudiados (si bien la población era bastante homogénea) no mostró diferencias significativas entre los dos grupos. Conclusiones. Los pacientes con mayor afectación subjetiva (disnea y calidad de vida) y más desnutridos son lo que menos se benefician de la cirugía de reducción de volumen (AU)

[Four-year results after lung volume reduction surgery for emphysema]. / Resultados a los 4 años de la cirugía de reducción de volumen en el enfisema.

OBJECTIVES: While the short-term results of lung volume reduction surgery are known, follow-up over several years has not often been described. The purpose of the present study was to describe results in terms of functional improvement, dyspnea, quality of life, and mortality over a 4-year period in patients with advanced emphysema. PATIENTS AND METHODS: Fourteen successive patients were enrolled between 1996 and 2000 and studied prospectively for 4 years. All patients served as their own controls and initially received pulmonary rehabilitation and medication. Preoperative data were used as baseline and were compared to postoperative data over 4 years. The data analyzed were: functional improvement (forced expiratory volume in 1 second [FEV1]), quality of life, dyspnea, and patient loss due to death or referral to a lung transplantation program. RESULTS: Patients with advanced emphysema (mean FEV1 [SD]: 22.8% [11%] of predicted) were studied. Postoperative mortality was 14%. Overall mortality (postoperative plus deaths due to respiratory insufficiency) was 28% at 1 year and 35% at 4 years. Two patients died of cancer and 5 were referred for transplantation. At 3 months, FEV1 had improved more than 15% in 9 patients (64%); the improvement was maintained in 43% of patients at 1 year and 7% at 4 years. Improvement in dyspnea paralleled improvement in FEV1. Overall, at 3 months mean FEV1 had improved 41.9% (68%), transitional dyspnea index 2.7 (3), and quality of life questionnaire score 1 (0.9). Thus, improvements were considerable, but there was great variation. Preoperative mean decrease in FEV1 was 50 (32) mL/y, and postoperative decrease 194 (70) mL/y. CONCLUSIONS: With the inclusion criteria used, there was considerable variation in the results. Significant overall functional improvement was maintained in 50% of the patients 1 year following surgery and in 7% 4 years after surgery. Given such results, together with a surgical mortality rate of 14% and overall mortality of 28% in the first year, we believe that the criteria for using lung reduction surgery should be revised.

[Body mass, dyspnea, and quality of life as success predictors in emphysema surgery for reduction of pulmonary volume]. / Masa corporal, disnea y calidad de vida como predictores de éxito en la cirugía de reducción de volumen en el enfisema.

OBJECTIVES: Lung volume reduction surgery has recently been proposed as a palliative treatment for advanced emphysema. Some patients improve and others remains the same, being debated at this time the factors that predict improvement. The purpose of this work is to find predictive factors for positive response in patients operated with this surgery. MATERIAL AND METHODS: Patients with positive response (7 patients) and patients without positive response (5 patients) have been compared in our series of lung volume reduction surgery (12 patients). Positive response to surgery was defined as Delta FEV1 > or = 15%, dyspnea transitional index (Mahler scale) > or = 3, and improvement in the scoring surgery of quality of life for chronic respiratory disease questionnaire (Guyatt and Güell) > or = 1.5 3 months after the surgery. Basal values of FEV1, FEF50/FIF50%, hyperinsufflation degree, heterogeneity, PaO2, PaCO2, type of surgery, body mass index (BMI), dyspnea basal index (DBI) and quality of life questionnaire score (QLQS). RESULTS: Patients without and with positive response were different only because their baseline BMI, DBI and QLQS were lower. Other parameters studied (although the population was rather homogeneous) did not show significant differences between the two groups. CONCLUSIONS: Patients with higher subjective problems (dyspnea and quality of life) and more malnourished are those with less benefit from surgery for pulmonary volume reduction.

Characteristics of histamine tachyphylaxis in rat uterine smooth muscle.

OBJECTIVE AND DESIGN: To study both the desensitisation induced by short-term exposure to histamine and the mechanism responsible in the isolated rat uterus. MATERIAL: Precontracted isolated uterus (37 mM KCl) from oestrogenised Wistar rats were used. TREATMENT: Repetitive responses to histamine (10(-6), 10(-5), 10(-4), 10(-3) M), dimaprit and clonidine (10(-4) M) were tested at 15, 30, 45 and 105 min., with their modifications by (5 mg/kg, 24 h before sacrifice) reserpine, 10(-7) M propranolol, 10(-8) M atropine, and 10(-6) M indomethacin. Dose-response curves for adrenaline were carried out as standard protocol. METHODS: In vitro techniques (de Jalon's solution, 31 degrees C, carbogen, isotonic registration, resting tension 1 g). Levels of cAMP were studied in response to histamine, adrenaline and isoproterenol by radioassay. RESULTS: Repeated histamine produced a rapid loss of inhibitory uterine response depending on the number of exposures and increase in concentration. The tachyphylaxis phenomenon is not modified by the different pretreatments used. Dimaprit, but not clonidine or adrenaline, produced tachyphylaxis. The second exposition to 10(-3) M histamine produced a 38.8% reduction in cAMP production. CONCLUSION: Histamine appears to induce homologous and probably cAMP-dependent desensitisation of H2-receptors.

[Consumption of medicinal herbs and medicines]. / Consumo de hierbas medicinales y medicamentos.

OBJECTIVE: Given the possibility of adverse side-effects, interactions with medicines and poisoning by contaminants among herbal medicine consumers (HM), we aimed to describe the consumption of HM by health centre users being treated with medicines. DESIGN: Cross-sectional, observational study.Setting. Thirteen health centres in the Community of Valencia. PATIENTS AND OTHER PARTICIPANTS: Users of either sex, over 14, chosen for a study of use of medicines to find differences between the sexes. MEASUREMENTS AND MAIN RESULTS: The study variables, age, gender, education, consumption of medicines and use of HM, were gathered from the clinical records, the long-treatment card and an ad hoc structured survey. 801 out of 812 users took medicines. 159 took HM (19.6%; 95% CI, 16.9-22.3); average age 55.8 (SD, 16.5); women 58.5% (95% CI, 50.8-66.1). They took 226 HM (mean of 1.42; 95% CI, 1.32-1.52). Men consumed more HM (p < 0.05). There were no differences in consumption of HM for age, educational background or number of medicines taken. 42.8% (95% CI, 35.1-50.2) of those who took HM attended for consultation over 10 times in the previous year. 96.9% (95% CI, 93.7-98.4) of HM were taken by self-medication. They were consumed: <> by 36.7% (95% CI, 30.4-43.0); stomach problems, 19.5% (95% CI, 14.3-24.6); nerves/depression, 12.8% (95% CI, 8.5-17.2); intestinal disorders, 10.6% (95% CI, 6.6-14.6); insomnia 5.8% (95% CI, 3.1-9.6). 49.1% (95% CI, 42.6-52.6) were manufactured HM. CONCLUSIONS: One of every five patients being treated with medicines is also taking HM by self-medication. The health authorities and doctors should advise of the risks to health and of the counter-indications of these products.

Consumo de hierbas medicinales y medicamentos / Consumption of medicinal herbs and medicines

Objetivo. Dada la posibilidad de efectos adversos, interacciones con medicamentos e intoxicaciones por contaminantes entre consumidores de hierbas medicinales (HM), nuestro objetivo es describir el consumo de HM en usuarios de los centros de salud en tratamiento con medicamentos. Diseño. Estudio observacional, transversal. Emplazamiento. Trece centros de salud de la Comunidad Valenciana. Pacientes u otros participantes. Usuarios, de sexo indistinto, mayores de 14 años, seleccionados para un estudio de utilización de medicamentos para encontrar diferencias entre sexos. Mediciones y resultados principales. Las variables de estudio, edad, sexo, nivel educativo, consumo de medicamentos y uso de HM se recogieron desde la historia clínica, tarjeta de largo tratamiento y encuesta estructurada ad hoc. De los 812 usuarios, 801 consumen medicamentos. Toman HM, 159 (19,6 por ciento; IC del 95 por ciento, 16,9-22,3); edad media, 55,8 años (DE, 16,5); mujeres, 58,5 por ciento (IC del 95 por ciento, 50,8-66,1). Consumen HM, 226 (media, 1,42; IC del 95 por ciento, 1,32-1,52); los varones consumen más HM (p < 0,05). No existen diferencias de consumo de HM por edad, nivel educativo o número de medicamentos consumidos. Un 42,8 por ciento (IC del 95 por ciento, 35,1-50,2) de los que consumen HM acudieron a la consulta más de 10 veces en el último año. El 96,9 por ciento (IC del 95 por ciento, 93,7-98,4) de las HM se consumen por automedicación. Se consumen: 'por gusto', 36,7 por ciento (IC del 95 por ciento, 30,4-43,0); problemas de estómago, 19,5 por ciento (IC del 95 por ciento, 14,3-24,6); nervios/depresión, 12,8 por ciento (IC del 95 por ciento, 8,5-17,2); trastornos intestinales, 10,6 por ciento (IC del 95 por ciento, 6,614,6); insomnio, 5,8 por ciento (IC del 95 por ciento, 3,1-9,6). Un 49,1 por ciento (IC del 95 por ciento, 42,6-52,6) es HM manufacturadas. Conclusiones. Uno de cada 5 pacientes en tratamiento con medicamentos consume HM por automedicación. La administración sanitaria y los médicos deberían informar de los riesgos para la salud y las contraindicaciones de estos productos (AU)

[An analysis of the information in the Medicom International Vade Mecum with respect to drugs with vitamin A]. / Análisis de la información del Vademécum Internacional Medicom respecto a los medicamentos con vitamina A.

OBJECTIVE: Determination of whether rational drug use is facilitated by the quality of the information provided by the Medicom International Vademecum on drugs containing vitamin A as active component. DESIGN: Descriptive study. SETTING: Primary, specialized and hospital health care within the national context. SUBJECTS: Total drugs containing vitamin A, included in the 1995 Medicom International Vademecum. MEASUREMENTS: Systematic analysis of the information contained in the technical note on drugs containing vitamin A included in the Medicom International Vademecum, with respect to several parameters. RESULTS: The Medicom International Vademecum lists a total of 37 drugs containing vitamin A (35 in combination). A total of 112 different indications are given; 74 are not accepted in the literature, and 29 are related to the active components present in combination with vitamin A. CONCLUSIONS: The analysis of the technical information provided by the Medicom International Vademecum on medications containing vitamin A reveals major deficiencies in the parameters investigated.