Is it possible to achieve functional recovery in schizophrenia? A qualitative and quantitative analysis of psychiatrist´s opinion.

INTRODUCTION: Psychiatrist´s opinion on functional recovery (FR) of patients with schizophrenia may modulate the therapeutic expectations and how to manage the disease. OBJECTIVE: This study aims to know the opinion of psychiatrists on FR, and to analyze the relationship between functioning and symptoms. METHODS: A qualitative and quantitative, descriptive and exploratory study. Two data collection techniques were used: a) a written survey consisting of 12 questions, directly, anonymously and confidentially answered by 132 psychiatrists; b) 5 focus group discussions involving 42 psychiatrists. RESULTS: 69.8% of psychiatrists considered realistic to get FR in schizophrenia and another 30.1% chose an intermediate response. The clinical priority for the 94% is to optimize the functional outcome of their patients, but only 14.4% commonly use rating scales. 91.7 % believed that there are differences between typical and atypical antipsychotics in terms of FR, and 83.3% believed essential to implement psychosocial interventions to achieve this goal. According to psychiatrists, FR is a complex concept and a primary therapeutic goal. Negative and cognitive symptoms are the strongest predictors of poor functioning. The low functioning of a patient, even in symptomatic stability, usually requires a re-evaluation of treatment. CONCLUSION: For psychiatrists, FR is a useful concept and a clinical priority, although there are doubts about how to achieve it.

Regional differences in low birth weight in Spain: biological, demographic and socioeconomic variables.

The geographic and demographic dimensions of Spain, in terms of surface and number of inhabitants, and its heterogeneous socioeconomic development offer an adequate opportunity to study the provincial differences in birth weight from 1996 to 2010, focusing on possible factors determining the relative frequency of low birth weight. The study analysed geographic differences with regard to biological, demographic and socioeconomic factors that interfere with the female reproductive pattern. The variables considered here were: birth order, proportion of premature deliveries, mother's age, multiparity, mother's country of origin and professional qualifications. Two periods (1996-2000 and 2006-2010) were compared by means of principal components analysis. An increase in the relative frequency of deliveries weighing less than 2500 g occurred in most of the 52 geographic units studied, differences being significant in 42. Only in five cases was there a non-significant reduction in the proportion of low weight births. The first component after principal component analysis indicated that low birth weight was positively related to maternal age and to multiple deliveries, and negatively to the mother's low professional qualification. The second component related positively to the incidence of premature deliveries and to non-Spanish status and negatively in the case of primiparous mothers. The progressive increase in low birth weight incidence observed in Spain from 1996 onwards has occurred with considerable variation in each province. In part, this diversity can be attributed to the unequal reproductive patterns of immigrant mothers.

A study of multiple deliveries in Portugal: indications of an Iberian Peninsula pattern.

Information on multiple deliveries with regard to Portugal is scarce. Based on data provided by the Portuguese Institute of Statistics (INE), the rates for double and triple deliveries were calculated since 1930. The results obtained show for twins a uniform temporal pattern up to the 1970s. At this time rates decreased, but later they gradually recovered, reaching their maximum level in 2010. For triplets, the highest rates occurred between 1999 and 2002. For the period 1988-2011, the rates of multiple deliveries were related to a set of variables recorded in the INE database on live births. Significant differences (p < .001) between simple and multiple deliveries were obtained for maternal age, parity and marital status. Considering the year when the delivery occurred, significant differences (p < .001) persisted for maternal age regardless of the year. For the type of mating, significance was consistently found since the year 2002 (either by using the marital or the cohabitation criteria), and for parity since 2003. With regard to territorial variation, throughout seven periods between 1930 and 2011, the rates among the 20 administrative Portuguese territories, including the two insular districts of Açores and Madeira, were mostly stable for twinning rates, with a minimum level in 1970-1989. Regarding triplets, the greatest inter-district variation was found after 1980. The results of the Portuguese study on multiple deliveries are interpreted in the context of the Iberian Peninsula based on findings reported for Spain.

Relationship beetween Primary and Hospital Care in cardiovascular prevention and treatment of dyslipidemias. Derivation algorithm. Discharge criteria. / Relación entre Atención Primaria y Hospitalaria en la prevención cardiovascular y tratamiento de las dislipidemias. Algoritmo de derivación. Criterios de alta.

Effective cardiovascular prevention requires taking advantage of all opportunities for patient contact with the Health Services in order to detect risk factors (CVRF) and global cardiovascular risk stratification (CVR). This particularly involves the Primary Care (PC) services, which must be coordinated with the Hospital Care (HC) in order to make all health resources available to the population. In addition, it is necessary to take into account the contribution of Occupational Health and Pharmacy services. There are hopeful signs as regards the possibility of overcoming the barriers that limit the necessary exchange of information between PC and HC professionals, as a basis for adequate coordination between both levels of care. This includes the implementation of referral and discharge algorithms (in this review this means those related to dyslipidaemias) accepted by professionals at both levels, and currently facilitated by the availability of new corporate tools (mobile, email, virtual consultations). The challenge lies in seizing the opportunity they offer to make their implementation effective.

Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Executive summary: Updates to the dietary treatment of prediabetes and type 2 diabetes mellitus. / Resumen ejecutivo: actualización en el tratamiento dietético de la prediabetes y la diabetes mellitus tipo 2.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity, and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis, the Spanish Diabetes Society, and the Spanish Society of Internal Medicine.

Population relationships in the Mediterranean revealed by autosomal genetic data (Alu and Alu/STR compound systems).

The variation of 18 Alu polymorphisms and 3 linked STRs was determined in 1,831 individuals from 15 Mediterranean populations to analyze the relationships between human groups in this geographical region and provide a complementary perspective to information from studies based on uniparental markers. Patterns of population diversity revealed by the two kinds of markers examined were different from one another, likely in relation to their different mutation rates. Therefore, while the Alu biallelic variation underlies general heterogeneity throughout the whole Mediterranean region, the combined use of Alu and STR points to a considerable genetic differentiation between the two Mediterranean shores, presumably strengthened by a considerable sub-Saharan African genetic contribution in North Africa (around 13% calculated from Alu markers). Gene flow analysis confirms the permeability of the Sahara to human passage along with the existence of trans-Mediterranean interchanges. Two specific Alu/STR combinations-CD4 110(-) and DM 107(-)-detected in all North African samples, the Iberian Peninsula, Greece, Turkey, and some Mediterranean islands suggest an ancient genetic background of current Mediterranean peoples.

Temporal and territorial analysis of multiple deliveries in Spain (1900-2006).

Temporal variations in the frequency of multiple maternities in many Western European countries have been described. However, within a single country, regional differences are observed. Urban industrialized regions and rural agricultural areas have experienced in recent decades a distinct decline in multiple deliveries, which in cases have been related to maternal age and parity changes. Research on multiple deliveries in Spain is scarce and none of the studies go back to the beginning of the 20th century or consider regional variation over an extended period of time. The present paper is a yearly study on multiple deliveries in Spain since 1900 including a geographical analysis. Rather than dealing with recent changes in multi-parity, this paper is concerned with Spain's long-term national variation (between 1900 and 2006). The changing pattern of double and triple deliveries was analyzed using data from the Spanish National Statistics Institute (INE). Twinning rates in Spain are low in comparison to those of equivalent periods in other countries, and the minimum rates correspond to the 1980s decade. Results were interpreted by taking into account the influence of age at maternity and reproductive variation up to 1990. A good fit between observed and predicted rates was obtained after the application of models, which besides maternal age and parity, include their interaction. Regarding territorial variability, the values corresponding to southern, northern and insular Spanish provinces are consistent with an earlier reduction of the crude birth rate in the north-east regions and latter in the southern regions and the Canary Islands.

Mate choice in Olivenza: influence of border change on Spanish-Portuguese lineages.

The mating pattern in a population determines the next generation gene pool and therefore its genetic structure. Besides socio-cultural and geographic factors, political barriers may influence the formation of couples. The present paper studies how the change of national border affected the mating pattern of Olivenza in Badajoz Province (Spain), which experienced a change of domain from Portugal to Spain in 1801. For the period analysed (1750-1850), 954 Catholic marriage records were transcribed. Data were sorted by decades in order to make a temporal study possible and analysed by means of diversity and repeated-pairs of surnames. Following the change of border the mating pattern modified. Coinciding with a larger number of mixed marriages with Spaniards, there was a progressive rise in the diversity of surnames. From 1811 to 1820 the analysis of repeated-pairs of surnames indicates the existence of preferential matings within Spanish and Portuguese lineages. After 1821 the above pattern became less clear due to the disappearance of the Spanish-Portuguese restrictions on choice of mate.

Birth intervals and infant mortality in La Cabrera (Spain).

Family reconstitution has provided knowledge about the reproductive performance of mates from La Cabrera (northwest Spain). The analysis of 2293 reconstituted families (7872 births corresponding to parities 2 to 10) was restricted to the period 1880 to 1929. The proportion of infant deaths (younger than 1 year) was calculated regarding the preceding birth interval and the death or survival of the previous sibling. Considering as dependent variables the neo and the postneonatal mortality, a logistic regression was obtained. From the present analysis it is concluded that in La Cabrera 45% of couples have the most effective reproduction with birth intervals of 24 to 36 months. Risk factors regarding neonatals were found to be intervals shorter than 17 months, the death of the preceding sibling and male sexuality. Neither maternal age nor the accumulated number of previous sibling deaths were significant risk factors.

Child age influence on the seasonal death risk during the first year of life (Spain, 1975-1989).

Infant mortality rate reflects a population's health status, which depends on several factors, such as diseases, environment, child development, and other population characteristics that can show seasonal change throughout the year. This article deals with the relevance of child age on the probability of death in the different seasons throughout the first year of life, taking into account the illnesses causing death. The study was carried out using a file from the Spanish National Institute of Statistics. To eliminate bias related to health improvement, only the 49,761 urban deaths corresponding to capital of provinces, taking place between 1975 and 1989, were considered. The variables analyzed were: the month in which death took place, disease causing death, and the child age at death. Since many causes of death are very infrequent, the analysis was limited to a selection of the most common 45,155 death cases. The causes of death analyzed were: digestive, nervous and sensory, circulatory, and respiratory diseases, delivery difficulties, congenital anomalies, and signs and syndromes (WHO, ICD-9). The infant mortality rates are associated with the child age at death. Moreover, a general ontogenetic change of the death risk can be observed, with some particularities depending on the disease analyzed. In general, regarding all infant deaths, the obtained results suggest a higher risk of dying in winter for children surviving the first month of life, whereas a summer pattern, with a maximum mortality in June, July, and August, appeared when newborns younger than 1 week were considered.

Factors associated with recent increase of multiple births in Spain.

The increased incidence of multiple deliveries in Spain, in addition to changes in age at maternity and parity, is attributed to assisted reproductive treatments, but the relative contribution of the latter to this rise remains uncertain, due to the scarce information provided by clinics practicing those treatments. Population based data (1984-2004), including information on mother's age, nationality, marital status, date of delivery, and the characteristics of each (parity, single or multiple), and sex of newborns were provided by the Spanish Institute of Statistics. Twinning and triplet deliveries relate to maternal age, parity, and nationality. For younger ages (or= 40) rates increased after 1994. From 1984 to 2004 the percentage of twins of opposite sex increased from 24.31 to 36.58 per cent. Since 1997, Spanish and non-Spanish mothers differentiate with respect to multiple maternity at ages over 30. In addition to unmarried Spanish women, immigrants constitute a reliable reference group that determines the convenience of segregating information on multiple deliveries respecting origin. The proportion of twins and triplets of opposite sex, maternal age, and parity patterns observed are concordant with a differential access to reproductive treatments depending on the woman's age. The present norm regulating the maximum number of fertilizations per cycle and the demand for these treatments explain the high incidence of multiple deliveries in Spain. A modified logistic curve predicts a stabilization of multiple deliveries, which will probably continue to be high in Spain.

Physical activity related to forced vital capacity and strength performance in a sample of young males and females.

To identify the extent of physical performance differences between active and sedentary subjects taking into account sexual dimorphism physical activity level was recorded by interview from a sample of 319 young university students of both sexes. Anthropometric variables and physical performance values were obtained. The sex factor was the main variable explaining the differences in physical performance between active and sedentary young. Also contributors to those differences were forced vital capacity (FVC), heart rate after exercise and rest heart rate, together with the explosive component of strength (vertical jump). The effect of physical activity was shown in the increment of FVC and the decrease of resting heart rate. In the overall sample, heart rate after exercise, either in active males or active females, was lowered with respect to the sedentary subjects, showing that active females experienced a greater cardiovascular benefit following adaptation to training than sedentary.

Consensus document of the Spanish Society of Arteriosclerosis (SEA) for the prevention and treatment of cardiovascular disease in type 2 diabetes mellitus. / Documento de consenso de la Sociedad Española de Arteriosclerosis (SEA) para la prevención y tratamiento de la enfermedad cardiovascular en la diabetes mellitus tipo 2.

A consensus document of the Diabetes working group of the Spanish Society of Arteriosclerosis (SEA) is presented, based on the latest studies and conceptual changes that have appeared. It presents the cardiovascular risk in type 2 diabetes mellitus (T2DM) and the action guidelines for the prevention and treatment of cardiovascular disease (CVD) associated with T2DM. The importance of lipid control, based on the objective of LDL-C and non-HDL-C when there is hypertriglyceridemia, and the blood pressure control in the prevention and treatment of CVD is evaluated. The new hypoglycemic drugs and their effects on CVD are reviewed, as well as the treatment and control guidelines of hyperglycemia. Likewise, the use of antiplatelet agents is considered. Emphasis is placed on the importance of global and simultaneous action on all risk factors to achieve a significant reduction in cardiovascular events. This supplement is sponsored by Laboratorios Esteve, S.A.

Usefulness of plant sterols in the treatment of hypercholesterolemia / Utilidad de los esteroles vegetales en el tratamiento de la hipercolesterolemia

A consumption of 2 grams per day of plant sterols produces an inhibition of intestinal absorption of cholesterol and reduces the plasma concentration of c-LDL (cholesterol associated with low-density lipoprotein) by around 10%, which has determined its incorporation into different food products like margarines or dairy. The plant sterols develop their action in the intestine, where they reduce the absorption of cholesterol increasing their elimination fecal. In clinical practice, the use of functional foods with plant sterols at the recommended doses can be considered as a complement to lifestyle modifications, in individuals with hypercholesterolemia and low cardiovascular risk but who do not require hypocholesterolemic pharmacological treatment, and also in those patients receiving pharmacological treatment with lipid-lowering drugs and who do not get the therapeutic goals of c-LDL. The hypocholesterolemic effect of plant sterols is additive to that achieved with changes in lifestyle and/or other lipid-lowering agents. Coadministration with statins generates a hypocholesterolemic effect usually greater than that obtained when the statin dose is doubled.

Un consumo de 2 gramos diarios de esteroles vegetales produce una inhibición de la absorción intestinal de colesterol y reduce la concentración plasmática de c-LDL (colesterol asociado a lipoproteínas de baja densidad) alrededor de un 10%, lo que ha determinado su incorporación a diferentes productos alimenticios como margarinas o lácteos. Los esteroles vegetales desarrollan su acción en el intestino, donde dificultan la absorción del colesterol aumentando su eliminación a través de las heces.En la práctica clínica, la utilización de alimentos funcionales con esteroles vegetales a las dosis recomendadas se puede considerar como complemento de las modificaciones del estilo de vida, en individuos con hipercolesterolemia y riesgo cardiovascular global bajo, pero que no precisen tratamiento farmacológico hipocolesterolemiante, y también en aquellos pacientes que reciben tratamiento farmacológico con hipolipemiantes y que no alcanzan los objetivos terapéuticos de c-LDL. El efecto hipocolesterolemiante de los esteroles vegetales es aditivo al alcanzado con los cambios del estilo de vida y/o con otros hipolipemiantes. La coadministración con estatinas genera un efecto hipocolesterolemiante habitualmente superior al obtenido cuando se dobla la dosis de estatina.

Consensus on the Statin of Choice in Patients with Impaired Glucose Metabolism: Results of the DIANA Study.

INTRODUCTION AND OBJECTIVES: Despite the recognized clinical benefit of statins on cardiovascular prevention, providing correct management of hypercholesterolaemia, possible adverse effects of their use cannot be disregarded. Previously published data shows that there is a risk of developing diabetes mellitus or experiencing changes in glucose metabolism in statin-treated patients. The possible determining factors are the drug characteristics (potency, dose), patient characteristics (kidney function, age, cardiovascular risk and polypharmacy because of multiple disorders) and the pre-diabetic state. METHODS: In order to ascertain the opinion of the experts (primary care physicians and other specialists with experience in the management of this type of patient) we conducted a Delphi study to evaluate the consensus rate on diverse aspects related to the diabetogenicity of different statins, and the factors that influence their choice. RESULTS: Consensus was highly significant concerning aspects such as the varying diabetogenicity profiles of different statins, as some of them do not significantly worsen glucose metabolism. There was an almost unanimous consensus that pitavastatin is the safest statin in this regard. CONCLUSIONS: Factors to consider in the choice of a statin regarding its diabetogenicity are the dose and patient-related factors: age, cardiovascular risk, diabetes risk and baseline metabolic parameters (which must be monitored during the treatment), as well as kidney function.

Isonymic analysis of population structure in Gredos, Spain.

For the period 1875-1975 an isonymic analysis was made based on 41,696 marriages celebrated in three valleys (Tormes, Alberche and Tietar) from Gredos (Spain). Total inbreeding (Ft) was lower in the Tietar valley (0.0103- 0.0136), followed by the Tormes (0.0125-0.0255) and the Alberche (0.0153-0.0200). In the latter, random inbreeding (Fr) surpassed non random (Fn). Correlation coefficients were obtained to confirm an association of inbreeding from isonymy with valley and village endogamy rates, locality census, altitude, and alpha inbreeding. Fn correlated positively with average valley endogamy and village endogamy and with altitude, but inversely with census size. Contrarily, Fr related significantly to village endogamy. The non-random component from isonymy related positively to inbreeding from dispensations. Except for village endogamy, both variables show the same relationships to variables, such as altitude, which reflect limitations to mobility; or valley endogamy indicating the disposability of potential mates which in turn depends on the census size.

Biodemographic Analysis of Factors Related to Perinatal Mortality in Portugal (1988-2011).

Background. The purpose of this paper is to determine the relative mortality risks at delivery and during the first week of life with regard to maternal and foetal characteristics. Methods. Yearly individual digital records on live births and early neonatal mortality were used to infer the possible factors involved in perinatal deaths. Results. The results show that the number of births per year declined with time throughout the period studied. At the same time, rates decreased in 66.4% for stillbirths and in 70.2% for early neonatal mortality. Logistic regressions modelled the interaction of the two mortality indicators and covariables such as birth weight and the duration of gestation. Conclusions. This research provides a first biodemographic approach to the knowledge of factors influencing perinatal mortality in Portugal based on a set of foetal and maternal variables. Although the magnitude of the different perinatal mortality rates may be affected by the criteria used for selecting cases (multiple-singletons; minimum birth weight or minimum duration of gestation), one of the conclusions of the present analysis is that the relationship among the maternal and foetal variables that determine the relative risk remains unaltered. Certain resemblance with the factors determining negative birth outcomes in Spain is appreciated.

Determinants of birth weight in Portugal: 1988 to 2011.

The objective of this paper is to analyse temporal birth weight variation, its relationship to the frequency of premature births in Portugal, and the influence of native and immigrant mothers' characteristics as well as to determine the possible existence of a pattern of temporal change in birth weight in the Iberian Peninsula as a whole. Individual mother-child data from the Portuguese National Institute of Statistics regarding live births (N = 2,661,542) permitted an analysis, for the first time, of weight at birth in Portugal from a bio-demographic perspective. The results obtained show that from 1988 to 2011 there was a gradual decline in the average weight at birth in Portugal that may be related to shifts in the duration of gestation. An initial rapid decline in the relative frequency of post-term births took place, followed by small variations from 1995 on. Logistic regressions indicated a pattern unaffected by maternal origin or the sex of the newborn. With regard to weeks of gestation, the odds values obtained were < 1 when the reference category was < 28 weeks. For this factor, no significant differences were found in relation to the mother's origin. Portuguese mothers over 35 years were associated with a higher incidence of low birth weight. Regardless of maternal origin, being a newborn of parity 1, and with the mother not in a couple, resulted in unfavourable outcomes with regard to low birth weight. On the other hand, long gestation periods and having secondary or university education constituted a protective factor.

[Using plant sterols in clinical practice: From the chemistry to the clinic]. / La utilización de los esteroles vegetales en la práctica clínica: de la química a la clínica.

This paper describes what are plant sterols, the chemical structure to understand their mechanism of cholesterol-lowering action, and indications and contraindications in clinical practice.