Attitudes of the police towards individuals with a known psychiatric diagnosis.

BACKGROUND: Police officers are increasingly required to respond to incidents involving psychiatric patients. However, few studies have assessed whether the attitude of police officers depends on prior knowledge of their specific psychiatric diagnosis. Our aim was to analyze the effects of psychiatric diagnosis on the behavior of police officers. METHODS: We utilized the Attribution Questionnaire adapted to the police context to examine the attitudes of 927 officers of the Spanish National Police Force towards persons diagnosed with either schizophrenia or depressive disorder playing the role of somebody in need of assistance, a victim of a crime, a witness, or a suspect in a criminal case. Different socio-demographic variables were also collected. RESULTS: Compared to attitudes to individuals with a known psychiatric diagnosis, police officers expressed increased willingness to help psychiatric patients and increased sympathy and attributing to them less responsibility for their actions. They also showed increased feelings of avoidance, reported a greater perception of danger and a greater need for isolation and involuntary treatment. This was especially so in the case of schizophrenia. Stigmatizing attitudes were less apparent when the person was a woman, a veteran officer, or someone with a history of work experience. CONCLUSIONS: Police officers may hold certain stigmatizing attitudes towards persons with mental illness, particularly schizophrenia, that require special attention, as they may negatively affect police action. We found several factors associated with the persistence of these stigmatizing attitudes among police officers that may guide us when implementing training programs for promoting attitude change, especially at the beginning of an officer's professional career.

Benefica chirurgia. A global surgery project focusing on hernia surgery.

BACKGROUND: The aim of international health cooperation projects is to alleviate the deficiencies in the area of health in low resource settings. Hernia surgery is a procedure that is well suited to these missions, due to its low morbidity, the fact that it can be performed on an outpatient basis, and the improvement in quality of life that it provides. OBJECTIVE: To describe the results of Benefica Chirurgia (BC), a Spanish non-profit humanitarian association in hernia pathology. METHODS: Five one-week surgical campaigns were carried out in Ecuador between 2015 and 2019, involving anesthetists, general and pediatric surgeons. Surgical and medical equipment was provided and transported by BC. ASA I/II patients underwent surgery. RESULTS: Surgery was performed on 240 patients with hernia pathology on 27 days. Sixty-three per cent of patients were male and the mean age was 48.2 years (range: 1-83). Hernia location was inguinal in 113 patients, umbilical in 101, and other in 26. The anesthetic technique used was spinal in 185 patients (77.1%), local plus intravenous sedation in 31 (12.9%), and general in 24 (10%). The surgical technique used was hernioplasty in 191 patients, herniorrhaphy in 31, incisional hernia repair in 15 and herniotomy in three. Surgery was performed on an outpatient basis in 98.4% of cases. Morbidity was 2%. Long-term postoperative evaluation is very complex. CONCLUSION: These campaigns make a significant contribution to health in low resource settings and provide great personal satisfaction for those involved. Standards achieved in the immediate postoperative period were similar to those obtained at the surgeons' centers in Europe. However, it is difficult to establish the rates of recurrence and chronic pain.

Antiretroviral treatment outcomes among late HIV presenters initiating treatment with integrase inhibitors or protease inhibitors.

OBJECTIVES: The aim of the study was to investigate the efficacy and safety of first-line antiretroviral therapy (ART) with integrase inhibitor (INI) or protease inhibitor (PI)-based regimens in patients with low CD4 cell counts and/or an AIDS-defining disease. METHODS: We conducted a retrospective, multicentre analysis to investigate discontinuation proportions and virological response in patients with CD4 cell counts < 200 cells/µL and/or AIDS-defining disease when starting first-line ART. Proportions of those discontinuing ART were compared using univariate analysis. Virological response was analysed using the Food & Drug Administration (FDA) snapshot analysis (HIV-1 RNA < 50 HIV-1 RNA copies/mL at week 48). RESULTS: Two hundred and eighteen late presenters were included in the study: 13.8% were women and 23.8% were of non-European ethnicity, and the mean baseline CD4 count was 91 cells/µL (standard deviation 112 cells/µL). A total of 131 late presenters started on INI- and 87 on PI-based treatment. It was found that 86.1% of patients treated with INIs and 81.1% of patients treated with PIs had a viral load < 50 copies/mL at week 48; proportions of discontinuation because of adverse events were 6.1% in the INI group and 11.5% in the PI group. No significant differences in discontinuation proportions were observed at week 12 or 48 between INI- and PI-based regimens (P = 0.76 and 0.52, respectively). Virological response was equally good in those receiving INIs and those receiving PIs (86.1% vs. 81.1%, respectively; P = 0.36). CONCLUSIONS: In a European cohort of late presenters starting first-line INI or PI-based ART regimens, there were no significant differences in discontinuation proportions or virological response at week 48.

ACTN3 R577X polymorphism related to sarcopenia and physical fitness in active older women.

BACKGROUND: As the population is getting older, physical activity promotion becomes a good strategy to increase quality of life in the elderly; but genetic condition also plays an important role. The purpose of this study was to examine the association of the ACTN3 R577X polymorphism with physical fitness and muscle mass in physically active older women. METHODS: A cross-sectional study was performed with two groups of older women who practiced physical exercise regularly. The first cohort comprised 164 women (age 69.7 ± 3.2 years) and the second cohort 131 women (age 78.5 ± 3.0 years). The main outcome measures were anthropometric measures with assessment of sarcopenia and sarcopenic obesity, self-reported physical activity EXERNET questionnaire (EEPAQ), evaluation of physical fitness (muscle strength and flexibility test), and ACTN3 genotyping. RESULTS: Women above 75 years old with allele R presented a higher risk of experiencing sarcopenia compared to ACTNR XX homozygous women (odds ratio 0.356, 95% confidence interval 0.139-0.915, p = 0.026). Furthermore, statistically significant differences were found in the chair stand test (p = 0.04), as well as in the sit and reach test (p = 0.01), with better results for women below 75 years old with the ACTN3 XX genotype. CONCLUSIONS: Sarcopenia and physical fitness show differences based on the ACTN3 R577X genotype in active older women.

The muscle-bone unit in adolescent swimmers.

Most researchers adjust bone by lean mass when comparing swimmers with controls. This adjustment is done under the assumption that lean affects bone similarly in both groups. Nonetheless, we found that the muscle-bone association is uncoupled in swimmers, and consequently, researchers should avoid this adjustment when evaluating swimmers' bone. INTRODUCTION: To examine the functional and structural muscle-bone unit in adolescent swimmers. METHODS: Sixty-five swimmers (34 girls/31 boys) and 119 controls (51 girls/68 boys) participated in the study. Muscle cross-sectional area (MCSA), bone mineral content (BMC), and polar strength-strain index (SSIPOL) were measured in the non-dominant radius by peripheral quantitative computed tomography (pQCT). Subtotal BMC and lean mass were evaluated with dual-energy X-ray absorptiometry (DXA). Handgrip and isometric knee extension (IKE) tests were performed to determine muscle force. The effect of MCSA, lean and force on SSIPOL, and BMC were tested, and the functional and structural muscle-bone ratios of swimmers and controls were compared. RESULTS: Both muscle size (MCSA and lean) and muscle force (handgrip and IKE) influenced BMC and SSIPOL in swimmers and controls similarly. Swimmers presented normal MCSA and lean values for their height, but when compared with controls, swimmers presented a higher amount of lean and MCSA for the same BMC or SSIPOL (structural muscle-bone unit). For the functional muscle-bone unit, different results were found for the lower and upper limbs, as no differences were found for the upper limbs, while for the lower limbs, swimmers presented higher muscle force for the same amount of BMC. CONCLUSIONS: The contradictory results regarding BMC in swimmers found in previous studies could partly be explained with the findings of the present study that reinforce the idea that swimming is not an effective sport to practice regarding bone mass and that the muscle-bone unit is different in swimmers than in controls.

Does fitness attenuate the relationship between changes in sitting time and health-related quality of life over time in community-dwelling older adults? Evidence from the EXERNET multicenter longitudinal study.

OBJECTIVE: To assess the relationship between fitness levels and components, sitting time and health-related quality of life (HRQoL), over time among community-dwelling older adults. METHODS: Three different sitting trajectories were calculated: (i) no change; (ii) decrease; and (iii) increase in ST, between baseline and follow-up. Fitness was assessed using the aerobic capacity, upper and lower limb strength, and total fitness. Participants were classified into higher (75th percentile or above) or lower (below 75th percentile) fitness levels, using the fitness tests. HRQoL scores at follow-up were compared to the three different sitting time trajectories within and across both the higher and the lower fitness groups for each of the three fitness indexes. RESULTS: Greater HRQoL scores were observed in those participants that decreased their ST as compared with those increasing their sitting time over time for participants classified in the lower end of their aerobic capacity or total fitness index. No differences were detected in HRQoL scores in people classified in the higher fitness level group for any of the fitness indexes. Participants that increased or did not change their sitting time and who were classified in the higher fitness end of aerobic capacity and total fitness index self-reported higher HRQoL scores when compared with those in the lower fitness end. CONCLUSION: Increased sitting time over time is associated with poorer HRQoL in older adults. Higher fitness levels could help attenuate the negative impact of sitting over time.

Vigorous physical activity patterns affect bone growth during early puberty in boys.

This study aims to analyze the impact of participation in vigorous physical activity as it can promote a healthy bone development. Adolescents who increased their participation in vigorous physical activity showed higher improvements in bone parameters compared to those who did not, which highlights the relevance of vigorous physical activity engagement. INTRODUCTION: The main purpose of the study was to analyze the effects of different patterns of vigorous physical activity (VPA) on bone development. METHODS: One-week accelerometry registers and dual-energy X-ray absorptiometry scans at the whole body, hip, and lumbar spine of 140 healthy male adolescents (11-13 years, at baseline) were performed twice with a 1-year interval between measurements. Four patterns of VPA evolution ("low-low," "low-high," "high-low," and "high-high") and three patterns of bone growth ("optimal," "mean," and "reduced") were defined according to the median participation in VPA and a cluster analysis of the longitudinal changes in BMC and BMD in all sites measured, respectively. Bone mineral parameters were adjusted for skeletal age and body weight prior to statistical comparison among groups. RESULTS: Participants in the "low-high" group had greater adjusted BMD increases at both the femoral neck and lumbar spine when compared to the "low-low" group (estimated mean (95% CI) 0.066 (0.047-0.085) vs. 0.034 (0.021-0.047) g/cm2 and 0.074 (0.054-0.093) vs. 0.049 (0.035-0.062) g/cm2 respectively, both p < 0.05). Femoral neck BMD adjusted increase was also different between the "high-high" and the "high-low" groups (0.053 (0.041-0.066) vs. 0.030 (0.011-0.049) g/cm2, p < 0.05). Additionally, a higher percentage of "optimal" growth was found in the "low-high" group than in the "low-low" and "high-low" categories (36.3, 12.5 and 13.6% respectively, p < 0.05). CONCLUSIONS: Engaging in VPA as well as maintaining high levels of VPA during puberty is associated with greater gains in bone mass, which can have an impact in future bone health.

Sustained State-Independent Quantum Contextual Correlations from a Single Ion.

We use a single trapped-ion qutrit to demonstrate the quantum-state-independent violation of noncontextuality inequalities using a sequence of randomly chosen quantum nondemolition projective measurements. We concatenate 53×10^{6} sequential measurements of 13 observables, and unambiguously violate an optimal noncontextual bound. We use the same data set to characterize imperfections including signaling and repeatability of the measurements. The experimental sequence was generated in real time with a quantum random number generator integrated into our control system to select the subsequent observable with a latency below 50 µs, which can be used to constrain contextual hidden-variable models that might describe our results. The state-recycling experimental procedure is resilient to noise and independent of the qutrit state, substantiating the fact that the contextual nature of quantum physics is connected to measurements and not necessarily to designated states. The use of extended sequences of quantum nondemolition measurements finds applications in the fields of sensing and quantum information.

Human leucocyte antigen (HLA)-DQB1*03:02 and HLA-A*02:01 have opposite patterns in their effects on susceptibility to HIV infection.

OBJECTIVES: The objective of this study was to seek correlates of immune protection in HIV infection. We sought to elucidate the association between the presence of human leucocyte antigen (HLA) alleles, as well as killer immunoglobulin receptor (KIR) genotypes, and the susceptibility to HIV infection in a Spanish cohort of HIV-exposed seronegative (HESN) individuals. METHODS: A total of 152 individuals were evaluated: 29 HESN individuals in stable heterosexual relationships with an HIV-infected partner admitting high-risk sexual intercourse for at least 12 months prior to inclusion in the study, 61 HIV-infected patients and 62 healthy controls. HLA class I and II alleles and KIR genotypes were assessed in genomic DNA from all individuals in the study by polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) using bead array technology. RESULTS: HESN individuals showed a higher prevalence of HLA-A3 (62%) and HLA-B44 (83%) supertypes compared with HIV-infected individuals (42% and 66%, respectively). Regarding specific HLA alleles, HESN individuals had a higher prevalence of HLA-A*33:01, DRB1*04 and DQB1*03:02 alleles (14%, 34% and 31%, respectively) and a lower prevalence of the HLA-A*02:01 allele (27%) than HIV-infected patients (3%, 15%, 11% and 52%, respectively; P < 0.05). Interestingly, in a multivariate analysis, only the presence of DQB1*03:02 and the absence of A*02:01 alleles were independently associated with HESN status [odds ratio (OR) 3.4 (95% confidence interval (CI) 1.1-10.5) and 0.4 (95% CI: 0.1-0.9), respectively; P < 0.05]. No KIR genotype was associated with susceptibility to HIV infection. CONCLUSIONS: Our data showed that the presence of the HLA class II allele DQB1*03:02 was a correlate of immune protection against HIV infection, while the presence of the HLA class I allele A*02:01 was associated with being infected with HIV.

Effect of composition and coating on the interparticle interactions and magnetic hardness of MFe2O4 (M = Fe, Co, Zn) nanoparticles.

Single domain superparamagnetic ferrite nanoparticles with the composition MFe2O4 (M = Fe, Co, Zn) have been prepared by thermal decomposition of metal acetylacetonates in diphenyl ether or dibenzyl ether, using oleic acid in the presence of oleylamine as a stabilizing agent. The Fe, Co and Zn ferrite nanoparticles are monodisperse with diameters of 4.9, 4.4 and 4.7 nm, respectively. The TG and IR results indicate that four or six carboxylate groups per nm2 are bonded at the surface of the particles acting as chelating and/or bridging bidentate ligands depending on the composition. The oleate groups minimize the interparticle interactions in Fe and Zn ferrite samples, while in the Co ferrite sample dipolar interactions produce broad maxima in the ZFC and energy barriers distribution curves. The inversion degree has been estimated from the Raman spectra and the obtained x values have been used to calculate the saturation magnetization and compare them with the experimental MS values. Compared to bulk materials, the magnetization value is higher for the Zn ferrite sample due to its mixed spinel cation distribution. For the Co ferrite sample, and probably for the Fe one, the low value of saturation magnetization seems to be due to the surface disordered layer of canted spins. Compared to non-coated nanoparticles with the same composition and similar size, the oleate groups, covalently bonded to the superficial cations, increase the anisotropy field and decrease the magnetization.

Sleep disturbance, obesity, physical fitness and quality of life in older women: EXERNET study group.

OBJECTIVES: To investigate the association between physical fitness, obesity, health related quality of life (HRQoL) and sleep disturbance in 463 community-dwelling older Spanish women (66-91 years of age). STUDY DESIGN: Cross-sectional study. METHOD: Sleep disturbance was assessed with the Jenkins Sleep Scale. Active and sedentary behaviors were recorded by standardized questionnaires. HRQoL was assessed with the EuroQoL-5D. Anthropometric measurements were obtained using standardized techniques. Body fat was measured using bioelectrical impedance. Physical fitness was evaluated by a set of eight tests. RESULTS: Sleep disturbance was reported by 45.1% of women, being associated with higher body mass index (p < 0.05) and waist circumference (p < 0.01). Presence of insomnia was inversely associated with physical fitness. Women in the upper tertile of fitness index had 92.0% lower risk of sleep disturbance as compared to the lower tertile (p = 0.08), while women in the highest tertile of upper body strength had 76.4% lower risk of sleep disturbance as compared to the lower tertile (p < 0.05). Women without sleep disturbance showed better HRQoL. CONCLUSION: Sleep disturbance was associated with central obesity, lower physical fitness and reduced HRQoL. Interventions involving weight management and improvement of physical fitness may contribute to better sleep quality in older women.

Swimming and bone: Is low bone mass due to hypogravity alone or does other physical activity influence it?

UNLABELLED: Swimming during adolescence has shown neutral or even negative effects on bone mass. Nevertheless, it is still unknown if these effects are due to swimming or to other factors, such as sedentary behaviors. INTRODUCTION: Three objectives were described (1) to measure objective physical activity (PA) additional to swimming performed by adolescent swimmers (SWI) and compare it to that performed by normo-active controls (CG), (2) to describe the relationship between objectively measured PA and bone mass, and (3) to compare bone mass of swimmers that meet the World Health Organization PA guidelines (active) WHO and those that do not (inactive). METHODS: A total of 71 SWI (33 females) and 41 CG (17 females) wore an accelerometer for at least 4 days. PA was expressed as the amount of time (minutes/day) in each intensity [sedentary/light/moderate or vigorous (VPA), and the sum of moderate and vigorous (MVPA)]. Using the cutoff points proposed by Vanhelst et al. SWI were classified as active or inactive according to whether they reached 60 min of weight-bearing MVPA per day or not. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry, and bone strength values were calculated with peripheral quantitative computed tomography. Differences in PA intensities were calculated between SWI and CG. The relation of VPA to bone mass was studied in the SWI. RESULTS: Male-SWI spend less time in VPA and MVPA than male-GC, which partly explains the lower BMD values in SWI than CG. CONCLUSION: Swimming may displace weight-bearing VPA with serious implications on bone health.

Effect of whole-body vibration training on bone mass in adolescents with and without Down syndrome: a randomized controlled trial.

UNLABELLED: Whole-body vibration training (WBV) attracts great interest as osteoporosis prevention strategy. Twenty-six adolescents with and without Down syndrome (DS) (13 DS; 12-18 years) performed 20 weeks of WBV. The results indicate that WBV seems to provoke a lesser response in adolescents with DS than in those without DS. INTRODUCTION: This study aims to observe the differences between adolescents with and without DS in the effects of 20 weeks of WBV training, on bone mineral content (BMC) and density (BMD). METHODS: Twenty-six adolescents (13 DS; 12-18 years) were measured with dual-energy X-ray absorptiometry before and after the intervention (3/week, 10 repetitions (30-60 s) and 1-min rest, frequency 25-30 Hz and peak-to-peak displacement of 2 mm (peak acceleration 2.5-3.6 g)). Both, an intention-to-treat (ITT) analysis designed to assess the effects on bone mass and a per-protocol analysis, designed to compare poor and high compliers, were performed. RESULTS: The ITT analysis revealed significant increases in all BMC and BMD parameters (dz = 0.66 to 1.64; all p < 0.05) in the non-DS group, whilst DS group improved whole-body, subtotal (whole-body less head), upper limbs (ULIMBS), pelvis, lower limbs (LLIMBS) and spine BMC (dz = 0.75 to 1.76; all p < 0.05) and subtotal, pelvis, LLIMBS and spine BMD (dz = 0.73 to 1.28; all p < 0.05). Significantly greater increases were evident in the absolute and percent changes of the non-DS group over DS group (d = 0.88 to 3.85; all p < 0.05). ULIMBS BMD showed a tendency towards an interaction (f = 0.41 and p = 0.086) with higher increase for non-DS group. When a per-protocol analysis was considered, high-complier adolescents had 8.1 versus 5.3 % of gains in the spine BMC over poor-complier adolescents (d = 0.93; p < 0.05). CONCLUSIONS: Twenty weeks of WBV training may improve BMC and BMD in clinically relevant skeletal sites in both groups. Nevertheless, this type of training seems to provoke a lesser response in adolescents with DS than in those without DS.

Effect of whole body vibration training on bone mineral density and bone quality in adolescents with Down syndrome: a randomized controlled trial.

UNLABELLED: Adolescents with Down syndrome (DS) have poorer bone health than their peers without DS. Twenty-five adolescents with DS were randomly assigned to whole-body vibration training (WBV) or control groups. The results indicate that a 20-week WBV might be useful to improve subtotal bone mineral content and density in adolescents with DS. INTRODUCTION: This study aims to determine the effects of 20 weeks of whole body vibration training (WBV) on bone mineral content (BMC), density (BMD), and structure variables in adolescents with Down syndrome (DS). METHODS: This randomized controlled trial of 25 adolescents (12-18 years) with DS (8 females) generated 2 non-equal groups, WBV group (n = 11) and CON group (n = 14). Using an efficacy analysis, the primary outcomes were BMC and BMD by dual-energy X-ray absorptiometry and the secondary were bone structure variables by peripheral quantitative computed tomography. A synchronous vibration platform (PowerPlate®) was used (3/week, 10 repetitions (30-60 s) 1-min rest, frequency of 25-30 Hz, and peak-to-peak displacement of 2 mm (peak acceleration 2.5-3.6 g)). RESULTS: WBV group improved whole body BMC 2.8%, 95% CI [3.5, 2.1], subtotal area, BMC, and BMD by 2.8, 4.8, and 2%, respectively, 95% confidence intervals (CIs) [3.4, 2.1], [6.5, 3.1], and [2.8, 1.1], respectively (all, p < 0.05), showing group by time interactions in BMC and BMD (both p < 0.05). Lumbar spine BMC and BMD also increased in the WBV group by 6.6 and 3.3% both p < 0.05, 95 % CIs [8.6, 4.7], and [4.9, 1.7], respectively. Regarding bone structure, WBV group showed improvements in tibial BMC at 4 % (2.9 %, 95 % CI [3.0, 2.8]) and in volumetric BMD (vBMD), cortical vBMD, and cortical thickness at 66% of the radius (by 7.0, 2.4, and 10.9%; 95% CIs [7.4, 6.7], [2.6, 2.3], and [12.4, 9.3], respectively) (all, p < 0.05). CONCLUSIONS: A 20-week WBV, with this protocol, might be useful to improve subtotal BMC and BMD in adolescents with DS.

The effects of swimming training on bone tissue in adolescence.

The aim was to analyze bone mineral content (BMC) and density (BMD) in regular swimming trained adolescents and the interaction that weigh-bearing sports may have on these values. Bone mass was evaluated by dual energy x-ray absorptiometry (DXA) and quantitative ultrasound (QUS) in 77 swimmers (34 females/43 males) and 52 normoactive controls (CG; 23 females/29 males) from 11 to 18 years. Swimmers who had performed or were performing other sports (OSP; 11 females/20 males) were compared with pure swimmers (PSW; 23 females/23 males). Both groups were compared with CG. Bone values were compared using analyses of covariance adjusting for height, calcium intake, subtotal lean (whole body lean minus head), and pubertal status. Male PSW showed lower BMD and BMC at several sites than male CG. However, for male OSP, only lumbar spine BMC was lower in OSP than male CG. Male PSW showed lower BMD and BMC when compared with male OSP. Female PSW showed higher arm BMD and lower leg BMC than female CG, while female OSP only presented lower leg BMC than female CG. Contrary to males, female-PSW presented higher BMD and BMC than female OSP. No differences in QUS values were found between swimmers and CG. To summarize, although more information is needed for females, it seems that for males, swimming is associated with lower BMC and BMD.

Comparison of effectiveness between different interventions in postconcussive symptoms in adolescents and young people: a literature review.

INTRODUCTION: Currently, concussion considers a problem of great magnitude, adolescents and young people being the population at risk, since it is in the process of maturation. Our goal has been to compare the effectiveness of different interventions (exercise therapy, vestibular rehabilitation and rest) in adolescents and young people with concussion. DEVELOPMENT: A bibliographic search was carried out in the main databases. Once the inclusion/exclusion criteria and the PEDro methodological scale were applied, 6 articles were reviewed. The results support the use of exercise and vestibular rehabilitation in the initial stages to reduce post-concussion symptoms. According to most authors, therapeutic physical exercise and vestibular rehabilitation report greater benefits, although a protocol that unifies assessment scales, study variables and analysis parameters would be needed to be able to make the inference in the target population. CONCLUSIóN: From the moment of hospital discharge, the combined application of exercise and vestibular rehabilitation could be the best option to reduce post-concussion symptoms.

Cortical and trabecular bone at the radius and tibia in male and female adolescents with Down syndrome: a peripheral quantitative computed tomography (pQCT) study.

UNLABELLED: We aimed to describe the structure and strength of the tibia and radius of adolescents with Down syndrome. We observed that despite higher levels of volumetric bone mineral density in determined skeletal sites, they are at higher risk of developing osteoporotic fractures in the future due to their lower bone strength indexes. INTRODUCTION: The aims of the study were to describe the cortical and trabecular volumetric bone mineral density (vBMD), bone mineral content (BMC), area, and bone strength in adolescents with Down syndrome (DS) and to compare them with adolescents without disabilities. METHODS: Thirty adolescents (11 girls) with DS and 28 without disabilities (10 girls) participated in the study. Peripheral quantitative computed tomography measurements were taken at proximal and distal sites of the tibia and radius. Values of total, trabecular, and cortical BMC; vBMD; and area were obtained of each scan. Cortical thickness and endosteal and periosteal circumferences were also measured, and different bone strength indexes were calculated. Student's t tests were applied between groups. RESULTS: The DS group showed greater vBMD at distal radius, BMC at proximal radius, and total and cortical vBMD at proximal tibia. The non-DS group showed higher total and trabecular area at the distal radius and total, cortical, and trabecular BMC and area at distal tibia. Higher values of periosteal and endosteal circumference and bone strength were also found in non-DS group. CONCLUSIONS: From these results, it can be believed that even with higher vBMD in determined skeletal sites, adolescents with DS are at higher risk of suffering bone fractures due to an increased fragility by lower resistance to load bending or torsion.

Implementation of clinical practice guidelines for acute ischaemic stroke in specialist care centres.

INTRODUCTION: Cerebrovascular disease is associated with high morbidity and mortality. In 2008, the Spanish Ministry of Health published its Clinical Practice Guidelines for stroke prevention, but implementation of that document has not yet been assessed. Our study aims to investigate compliance with the Guidelines by analysing control over vascular risk factors, antithrombotic treatment and lipid lowering treatment in patients who had suffered an acute ischaemic stroke and who were under the care of neurologists or internists. METHODS: Cross-sectional study based on data from clinical reports (vascular risk factors, diagnosis and treatment), blood pressure readings and laboratory tests pertaining to 203 patients diagnosed with acute ischaemic stroke and admitted to a medium-to-long stay hospital for rehabilitation and care. RESULTS: The mean patient age was 75 ± 10 years; 56% were women. The most common risk factors were hypertension (68%) and diabetes mellitus (40%). Intravenous fibrinolytic therapy had been administered to 8.9% of the patients. Of the patients with thrombotic cerebral infarction, 91.7% received antiplatelet agents; 59.4% of patients with embolic infarction received anticoagulants. Statins were prescribed to 65% of patients with thrombotic infarction. Laboratory tests upon admission showed that 23% of patients had total cholesterol levels above 175 mg/dl and 26.6% had plasma glucose levels above 126 mg/dl. Of the patient total, 70% received antihypertensive therapy, but 47.5% had blood pressure levels above 130/80 mm Hg. CONCLUSIONS: In our opinion, secondary prevention of acute cerebrovascular disease could be improved, mainly by increasing the percentage of patients treated with antiplatelet or anticoagulant drugs (depending on aetiology), increasing prescription of statins, and improving blood pressure control.