Prevention of unintended pregnancies by using emergency contraception: the differences between levonorgestrel and ulipristal acetate. A theoretical model using data from a survey on the use of emergency contraception in Spain, 2017.

Objective: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC). Design: Cross-sectional study. Setting: Survey carried out in Spain. Participants: 1000 Spanish women reporting unprotected sex in 2017. Main measurements: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided. Results: 39% of Spanish women having had unprotected sex used EC. 61% of those women did not use EC and 11% did not know the existence of this resource. In 2017 the use of EC prevented 101,271 unintended pregnancies. If instead of using LNG every woman had used UPA another 15,979 additional pregnancies could have been prevented. Conclusions: If all Spanish women having unprotected sex used EC we could expect a significant decrease in the number of unintended pregnancies and abortions. Using UPA instead of LNG would have a greater impact on that reduction with the corresponding benefit for women and society as a whole.

Magnetic resonance spectroscopy of normal appearing white matter in early relapsing-remitting multiple sclerosis: correlations between disability and spectroscopy.

BACKGROUND: What currently appears to be irreversible axonal loss in normal appearing white matter, measured by proton magnetic resonance spectroscopy is of great interest in the study of Multiple Sclerosis. Our aim is to determine the axonal damage in normal appearing white matter measured by magnetic resonance spectroscopy and to correlate this with the functional disability measured by Multiple Sclerosis Functional Composite scale, Neurological Rating Scale, Ambulation Index scale, and Expanded Disability Scale Score. METHODS: Thirty one patients (9 male and 22 female) with relapsing remitting Multiple Sclerosis and a Kurtzke Expanded Disability Scale Score of 0-5.5 were recruited from four hospitals in Andalusia, Spain and included in the study. Magnetic resonance spectroscopy scans and neurological disability assessments were performed the same day. RESULTS: A statistically significant correlation was found (r = -0.38 p < 0.05) between disability (measured by Expanded Disability Scale Score) and N-Acetyl Aspartate (NAA/Cr ratio) levels in normal appearing white matter in these patients. No correlation was found between the NAA/Cr ratio and disability measured by any of the other disability assessment scales. CONCLUSIONS: There is correlation between disability (measured by Expanded Disability Scale Score) and the NAA/Cr ratio in normal appearing white matter. The lack of correlation between the NAA/Cr ratio and the Multiple Sclerosis Functional Composite score indicates that the Multiple Sclerosis Functional Composite is not able to measure irreversible disability and would be more useful as a marker in stages where axonal damage is not a predominant factor.

[New data on secondary prevention of myocardial infarction in Spain. Results of the PREVESE II study]. / Nuevos datos sobre la prevención secundaria del infarto de miocardio en España. Resultados del estudio PREVESE II.

Introduction and objectives. The PREVESE Study reported the situation of secondary prevention after myocardial infarction in Spain. Similar surveys conducted in Europe have also shown that the implementation of secondary prevention is not adequate. The aim of this second PREVESE study was to compare the situation in Spain four years after the first study.Patients and method. We included retrospectively 2,054 patients discharged after myocardial infarction from 74 Spanish hospitals. We studied the available information recorded in medical records after discharge, the prevalence of risk factors, procedures performed, and medical treatment before admission and at discharge. We compared the data collected with those from the first PREVESE study because the data collection methodology was similar.Results. The information recorded in the hospital medical records was satisfactory in relation to the most important risk factors (hypertension 94.8%; dyslipidemia and diabetes 97.9%; and smoking 89.2%). Compared with the previous study, there was a significant decrease in the percentage of smokers (46.1 vs. 35.4%). The echocardiogram was performed more frequently (60.1 vs. 85.6%) and there were also significant differences related to drug treatment at discharge, with an important increase in the prescription of beta-blockers (33.5 vs. 45.1%), ACE inhibitors (32.5 vs. 46.4%), and lipid-lowering drugs (6.7 vs 30.5%).Conclusions. This study shows some improvement in the management of myocardial infarction patients after a four-year period, mainly due to more prescription of cardioprotective drugs at hospital discharge.

Nuevos datos sobre la prevención secundaria del infarto de miocardio en España. Resultados del estudio PREVESE II / New data on secondary prevention of myocardial infarction in Spain. Results of the PREVESE II study

Introducción y objetivos. El estudio PREVESE dio a conocer la situación de la prevención secundaria del infarto de miocardio tras el alta hospitalaria en España. Registros europeos similares pusieron de manifiesto que las medidas de prevención secundaria no se aplican correctamente. El objetivo de este segundo estudio PREVESE ha sido constatar la situación 4 años después del primero.Pacientes y método. Se han registrado en el momento del alta 2.054 pacientes de 74 hospitales españoles y se ha estudiado retrospectivamente la cumplimentación de las historias clínicas, la prevalencia de los factores de riesgo, los procedimientos diagnósticos y terapéuticos utilizados y el tratamiento previo al ingreso y al alta. Se han comparado los datos con los del estudio PREVESE precedente y se ha seguido la misma metodología para la recogida de datos. Resultados. La cumplimentación de la historia clínica ha sido buena para los factores de riesgo de primer orden (los antecedentes de hipertensión se hallaban registrados en el 94,8 por ciento de las historias, los de dislipemia y de diabetes en el 97,9 por ciento y los de tabaquismo en el 89,2 por ciento).En cuanto a la prevalencia de factores de riesgo con relación al estudio anterior, se ha encontrado una disminución significativa del tabaquismo (46,1 frente a 35,4 por ciento). La ecocardiografía se ha utilizado con mayor frecuencia (60,1 frente a 85,6 por ciento) y se han producido cambios significativos en cuanto a la terapéutica al alta, con incrementos en la prescripción de bloqueadores beta (33,3 frente a 45,1 por ciento), IECA (32,5 frente a 46,4 por ciento) y, sobre todo, de hipolipemiantes (6,7 frente a 30,5 por ciento).Conclusiones. El tratamiento del infarto de miocardio en nuestro país ha mejorado en algunos aspectos en un intervalo de 4 años, sobre todo en lo referente a la prescripción de fármacos con mejor perfil cardioprotector en el momento del alta hospitalaria (AU)