Prediction of ACL-tear by lower limbs muscle strength and flexibility: a prospective cohort study in 95 female soccer players.

The aims of the study were to build models using logistic regression analysis of flexibility and strength tests to prospectively predict risk factors for anterior cruciate ligament tear (ACL-tear) in female soccer (FS) players, and to determine training cut-off for risk factors of the predictive model built. A prospective cohort study of 95 female players (aged 14-33 years) was conducted. Age, anthropometric data, soccer history, lower limb range of motion (ROM) and hip maximal isometric strength (MIS) were measured. At the prospective follow-up after 12 months, 7.4% of the players had developed an ACL-tear. The model showed a significant relationship (χ2(93) = 30.531, p < 0.001) between the ACL-tear and the predictor variables (leg length, HAD-NH [hip adduction] MIS, asymmetric ROM [ankle dorsiflexion with knee extended (AD-KE) and with knee flexed (AD-KF), and HE (hip extension)], hip ROM [HIR (internal rotation) and HAB (abduction)]). The Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) for model fit were 30.24 and 51.79, respectively. The value R2 showed good model fit, 76.5% for Nagelkerke´s R2, 71.4% for McFadden´s R2 and 67.5% for Tjur´s R2. For the screening test, cut-off for leg length of ≥0.40 m, for HIR ROM of ≤44º and for asymmetry of HE ROM of ≥5° were set, which have an acceptable (AUC ≥ 0.755) discriminatory ability for the development of ACL-tear.

Barriers to implement screening for alcohol consumption in Spanish hypertensive patients.

Background: Alcohol intake and hypertension (HT) are interrelated public health problems with cost-effective interventions at the primary care level that, to date, are poorly implemented. Objective: This study aims to explore the barriers to implementing alcohol interventions for people with HT in primary care. Methods: As part of the project BASIS (Baseline Alcohol Screening and Intervention Survey), an internet survey from five European countries was developed to determine the role of alcohol in the management of HT in primary care practice. The survey contained 28 core items and 7 country-specific items. We present answers from Spanish general practitioners (GPs), who were reached through the main professional and scientific societies via e-mail and asked to take the online survey. Results: In total, 867 GPs answered the survey (65.1% women, 70.4% > 30 years old). As indicated by the Alcohol Use Disorders Identification Test-C scores, 12.4% of GPs who responded were risky drinkers (21.3% of men versus 7.1% of women). GPs reported considering alcohol relatively unimportant in HT treatment, as well as a difficult condition to deal with. The three main barriers to implement screening for alcohol consumption in HT patients were the lack of time (50.0%), considering alcohol unimportant for HT (28.4%) and stigma (16.5%). Conclusions: GPs did not consider alcohol consumption a relevant factor for HT and, additionally, found it difficult to deal with alcohol problems. Some of the barriers for alcohol screening could be overcome through structural changes in the health system, such as empowering GPs to treat alcohol use disorders (rather than a single focus on implementing preventive strategies) by enhancing training in alcohol diagnosis and treatment.

[Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin]. / Diagnóstico precoz del VIH en atención primaria en España. Resultados de una prueba piloto de cribado dirigido basado en condiciones indicadoras, criterios conductuales y de origen.

OBJECTIVES: To estimate the prevalence of HIV infection in patients diagnosed with an indicator condition (IC) for HIV and/or risk behavior for their acquisition and/or coming from high prevalence countries. To determine the acceptability and feasibility of offering HIV testing based on IC and behavioral and origin criteria in Primary Care (PC). DESIGN: Cross-sectional study in a convenience sample. LOCATION: Six PC centers in Spain. PARTICIPANTS: The inclusion criteria were: patients between 16 and 65years old who presented at least one of the proposed ICs and/or at least one of the proposed behavioral and/or origin criteria. A total of 388 patients participated. INTERVENTION: HIV serology was offered to all patients who met the inclusion criteria. MAIN MEASUREMENTS: Description of IC frequency, behavioral and origin criteria. Prevalence of HIV infection. Level of acceptability and feasibility of the HIV screening based on IC and behavioral and origin criteria. RESULTS: A total of 174 patients had an IC (44.84%). The most common behavioral criterion was: having unprotected sex at some time in life with people who did not know their HIV status (298; 76.8%). Four HIV+ patients (1.03%) were diagnosed. All had an IC and were men who had sex with men. The level of acceptability in PC was high. CONCLUSIONS: Offering HIV testing to patients with IC and behavioral criteria is feasible and effective in PC.

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union.

BACKGROUND: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. METHODS: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. RESULTS: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. CONCLUSIONS: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries.

BACKGROUND: Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. METHODS: Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. RESULTS: Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. CONCLUSIONS: While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.

Alcoholism and its treatment approach from a citizen perspective. / El alcoholismo y su abordaje desde una perspectiva ciudadana.

INTRODUCTION: The main objective of the study is to describe alcohol consumption in the general Spanish population, to discover citizens' opinion on their alcohol consumption, on alcoholism and on treatment approaches.   METHODS: In 2015 a cross-sectional study was carried out by means of a telephone survey. A representative sample was selected. Participants were asked about their alcohol consumption, their perception of risk regarding their pattern of alcohol consumption, about their opinion on alcoholism, alcohol consequences and the treatment approach. A questionnaire was designed. The Alcohol Use Disorders Identification Test-C was used to define the pattern of alcohol intake. A descriptive and an statistical inference analysis were done. RESULTS: 22.1% were classified as risky drinkers, with a higher proportion in young males. The majority of individuals think that alcoholism is an illness, and more than 75% agree that alcohol has negative consequences on health, social functioning, occupational functioning and family relationships. Furthermore, the perception of risk that citizens have regarding their own drinking pattern is high (37.6%). 67.7% considered that the general practitioner can manage alcoholism, with females and older people believing this most strongly. CONCLUSIONS: Alcohol consumption is very prevalent in the Spanish population, especially in young people (31.8%). The perception of alcohol risk is high. The majority agree with the fact that general practitioners are well prepared for treating alcohol problems.

Introducción: El objetivo del estudio es describir el consumo de alcohol de la población general española, conocer la opinión que tienen los ciudadanos de su consumo, del alcoholismo y de su abordaje terapéutico.Métodos: Estudio descriptivo transversal mediante encuesta telefónica  que se realizó en mayo de 2015. Se seleccionó una muestra representativa de la población adulta española a quien se le preguntó acerca de su patrón de consumo de alcohol, percepción de riesgo, opinión acerca del alcoholismo,  y consecuencias del consumo, y abordaje terapéutico. Se diseñó un cuestionario ad hoc utilizando el AUDIT-C para determinar el patrón de consumo. Se realizó un análisis descriptivo e inferencial según las características socio-demográficas.Resultados:  El 22,1% presentan un consumo de riesgo, siendo mayor en los hombres y los jóvenes. Mayoritariamente el alcoholismo es considerado una enfermedad y más del 75% de los ciudadanos coinciden que el alcohol tiene consecuencias negativas en la salud  a nivel sociolaboral y familiar. La percepción de riesgo que tienen los ciudadanos de su consumo es mayor de lo esperado (37,6%). El 67,7% considera  al médico de familia capacitado para atender los problemas relacionados con el consumo de alcohol, sobre todo entre las mujeres y los ciudadanos de mayor edad.Conclusiones: El consumo de riesgo es muy prevalente entre los ciudadanos españoles sobre todo entre los  jóvenes (31,8%). Existe una alta autopercepción de riesgo del consumo de alcohol. La mayoría de ciudadanos coinciden que el médico de familia está capacitado para tratar el alcoholismo.

Surgical Tracheostomies in COVID-19 Patients: Indications, Technique, and Results in a Second-Level Spanish Hospital.

OBJECTIVE: The main purpose of this work is to describe the sociodemographic and clinical characteristics of intensive care unit (ICU) patients in a second-level hospital in Madrid, Spain, focusing in those who underwent surgical tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic. The surgical technique and associated complications are also detailed. STUDY DESIGN: Observational and historical cohort. SETTING: Single center. METHODS: Eighty-three intubated COVID-19 patients were analyzed. Thirty bedside surgical tracheostomies had been performed following our safety protocol. RESULTS: Data from 83 patients admitted to the ICU in Infanta Leonor University Hospital were collected; 74.7% were male. The average age was 59.7 years. The main comorbidities found were hypertension in 51.8%, diabetes mellitus in 25.3%, asthma in 7.2%, and chronic obstructive pulmonary disease in 3.6%. A surgical tracheostomy was carried out in 36.1% of patients who needed a prolonged intubation. The most frequent complication of the surgical procedure, bleeding, occurred in 30%, but the majority were mild and ceased with compression only. The most relevant complication was local infection, which occurred in 26.7% of patients. There were statistically significant differences in the time from the beginning of mechanical ventilation until weaning between tracheostomized and nontracheostomized patients. The mortality rate of patients who underwent tracheostomy was 56.7%. Despite severe acute respiratory syndrome coronavirus 2 being highly contagious and tracheostomy being considered a high-risk procedure, our rate of infected ear, nose, and throat specialists was only 11.8%. CONCLUSION: In our experience, bedside surgical tracheostomy is a safe procedure in COVID-19 patients when safety protocols are followed.

The Human Laryngeal Innervation Revisited-The Role of the Neural Connections.

In spite that vascular inconvenients or immunological rejections have been solved in relation with larynx transplant, a successful functional reinnervation has not been achieved. Some studies have suggested that laryngeal nerve connection may contain motor fibers, which could explain unexpected evoked responses in electromyographic studies or the different positions adopted of the vocal folds after similar nerve lesions. Ten patients with unexpected evoked responses after laryngeal nerve stimulation were selected. All the patients underwent a total laryngectomy due to oncological causes. In every case, laryngeal nerve connections were observed. All of them were morphologic and histologic processed for choline-acetyltransferase immunohistochemistry. The presence of motor axons in the nerve connections has been demonstrated, which would explain that the motor innervation to the laryngeal muscles could be dual through these variable connections. This also would justify the difficulty of carrying out laryngeal nerve reinnervation procedures. Anat Rec, 302:646-651, 2019. © 2018 Wiley Periodicals, Inc.