Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care.

BACKGROUND: The successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs. METHODS: A cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire. RESULTS: More than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations. CONCLUSIONS: Most PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools.

Abdominal obesity and myocardial infarction risk - We demonstrate the anthropometric and mathematical reasons that justify the association bias of the waist-to-hip ratio.

INTRODUCTION: Antecedentes: el índice cintura-cadera (ICC) se utiliza ampliamente para evaluar la asociación de la obesidad abdominal con el infarto de miocardio (IM). Objetivo: nuestro propósito era determinar si el riesgo asociado a la ICC produce sesgo. Métodos: estudio de casos y controles en 252 varones. Usamos la estratificación como criterio para eliminar los efectos del sesgo. Creamos una covariable basal (ICC0,95-0,99) para una nueva muestra emparejada en el estrato de valores entre 0,95 y 0,99. Este estrato coincide con el área común de solapamiento de la distribución de puntos, donde todos los sujetos tienen un índice de propensión similar. Consideramos otra covariable (ICCS) condicionada en ICC < 1 y una circunferencia de cintura (CC) donde la asignación de riesgo fuera espúrea. Hipotetizamos que restando CC del valor de la cadera se calculaba otra variable aritmética (DCC) que podría ser esencial para evidenciar el efecto de confusion que genera el ICC. Resultados: IMC: ABC: 0,694, IC 95 % (0,628-0,760); OR: 3,8. CC: ABC: 0,743, IC 95 % (0,681-0,805); OR: 5,7. ICC: ABC: 0,798, IC 95 % (0,740-0,855); OR: 8,6. Índice cintura-talla (ICT): ABC: 0,782, IC 95 % (0,724-0,840); OR: 8,5. DCC: ABC: 0,204, IC 95 % (0,146-0,261); OR: 0,36. Prevalencia en los casos: ICC ≥ 0,95 (84,1 % vs. 38 %; OR: 8,6); ICC < 1 (36,3 % vs. 85,7 %; OR: 2,3); ICC ≥ 1 (63,4 % vs. 14,2 %; OR: 4,4); CC ≥ 94,4 (71,4 % vs. 30,1 %; OR: 5,7); DCC ≥ 2,2 (27,7 % vs. 75,3 %; OR: 7,9); ICCs (50 % vs. 25 %; OR: 2). Conclusiones: el ICC produce un sesgo de asociación en los casos de IM. Ello puede extrapolarse a otras poblaciones de estudio. El sesgo se explica por un error de concepto matemático que sobreestima el efecto protector de la cadera con respecto a la CC y la altura. El riesgo asociado al ICC por encima del de la CC o el ICT presenta inconsistencia antropométrica y sesgo, llegando a ser epidemiológicamente falso.

INTRODUCCIÓN: Background: the waist-to-hip ratio (WHR) is widely used to evaluate the association of abdominal obesity with myocardial infarction (MI). Objective: our aim was to determine whether WHR-associated risk provides a bias. Methods: a case-control study in 252 men. Stratification was used as an approach for removing bias effects. We created a baseline covariate (WHR0.95-0.99) from a new matched sample in the stratum between 0.95 and 0.99. This stratum coincides with the overlap area of the distribution, where all subjects have a similar propensity score. We considered other covariate (WHRS), conditioned on WHR < 1 and waist circumference (WC) being assigned a spurious risk. We hypothesized that subtracting hip circumference from WC (WHD) can be essential to observe the confounding effect provided by WHR. Results: BMI: AUC: 0.694, 95 % CI (0.628-0.760); OR: 3.8. WC: AUC: 0.743, 95 % CI (0.681-0.805); OR: 5.7. WHR: AUC: 0.798, 95 % CI (0.740-0.855); OR: 8.6. Waist-height ratio (WHtR): AUC: 0.782, 95 % CI (0.724-0.840); OR: 8.5. WHD: AUC: 0.204, 95 % CI (0.146-0.261); OR: 0.36. Prevalence in cases: WHR ≥ 0.95 (84.1 % vs. 38 %; OR: 8.6); WHR < 1 (36.3 % vs. 85.7 %; OR: 2.3); WHR ≥ 1 (63.4 % vs. 14.2 %; OR: 4.4); WC ≥ 94.4 (71.4 % vs. 30.1 %; OR: 5.7); WHD ≥ 2.2 (27.7 % vs. 75.3 %; OR: 7.9); WHRs (50 % vs. 25 %; OR: 2). Conclusions: WHR provides an association bias in MI cases. This can be extrapolated to other study populations. The bias is explained by a mathematical misconception where the protective effect of HC is overestimated concerning WC and height. The risk associated with WHR as higher than that associated with WC and WHtR entails anthropometric inconsistency and bias, to the extent of becoming epidemiologically false.

Plausibility of a Neural Network Classifier-Based Neuroprosthesis for Depression Detection via Laughter Records.

The present work explores the diagnostic performance for depression of neural network classifiers analyzing the sound structures of laughter as registered from clinical patients and healthy controls. The main methodological novelty of this work is that simple sound variables of laughter are used as inputs, instead of electrophysiological signals or local field potentials (LFPs) or spoken language utterances, which are the usual protocols up-to-date. In the present study, involving 934 laughs from 30 patients and 20 controls, four different neural networks models were tested for sensitivity analysis, and were additionally trained for depression detection. Some elementary sound variables were extracted from the records: timing, fundamental frequency mean, first three formants, average power, and the Shannon-Wiener entropy. In the results obtained, two of the neural networks show a diagnostic discrimination capability of 93.02 and 91.15% respectively, while the third and fourth ones have an 87.96 and 82.40% percentage of success. Remarkably, entropy turns out to be a fundamental variable to distinguish between patients and controls, and this is a significant factor which becomes essential to understand the deep neurocognitive relationships between laughter and depression. In biomedical terms, our neural network classifier-based neuroprosthesis opens up the possibility of applying the same methodology to other mental-health and neuropsychiatric pathologies. Indeed, exploring the application of laughter in the early detection and prognosis of Alzheimer and Parkinson would represent an enticing possibility, both from the biomedical and the computational points of view.

Obesity and risk of myocardial infarction in a sample of European males. Waist to-hip-ratio presents information bias of the real risk of abdominal obesity / Obesidad y riesgo de infarto de miocardio en una muestra de varones europeos. El índice cintura-cadera sesga el riesgo real de la obesidad abdominal

Background: Obesity is a coronary risk factor associated to myocardial infarction although waist to-hip-ratio has shown higher predictive power. Objective: The aim of this study was a Receiver Operating Characteristic anthropometric analysis in infarcted males to identify the strength of association for simple measurements, obesity and indicators such as, waist to-hip-ratios, waist to-height-ratios and conicity index. Methods:Case-control study of myocardial infarction in European males. One hundred and twelve cases and 112 controls aged 30-74 years were enrolled. We measured weight, height, waist circumference, umbilical waist circumference and hip circumference. We calculated various anthropometric indicators. We obtained the areas under the ROC curves, the odds ratio and correlations for measurements and anthropometric indicators. Results: Body mass index [AUC: 0.686, 95% CI (0.616-0.755); OR: 3.3], waist circumference [AUC: 0.734, 95% CI (0.668-0.800); OR: 5.7], height [AUC: 0.623, 95% CI (0.550-0.696); OR: 2.3], hip circumference [AUC: 0.555, 95% CI (0.479-0.631); OR: 1], waist to-hip-ratio [AUC: 0.796, 95% CI (0.737-0.855); OR: 9.9], umbilical waist to-hip-ratio [AUC: 0.830, 95% CI (0.729-0.847); OR: 5.5], umbilical waist to-height-ratio [AUC: 0.788, 95% CI (0.729-0.847); OR: 7.5], conicity index [AUC: 0.795; 95% CI (0.738-0.853); OR: 9]. The correlations for waist to-height-ratios and conicity index were strong (all r ≥ 0.85; p < 0.001). Conclusions: Waist and height are measurements of associated independent risk. Hip circumference does no show discriminatory power. Obesity and waist-ratios are associated to myocardial infarction with different strength. Between other indicators, general obesity is more weakly associated. Waist to-hip-ratios present the best ROC curves but it occur information bias of their predictive power of risk. Umbilical waist to-height-ratio and conicity index present high discriminatory power and the best anthropometric risk correlations that support its use for the identification of obesity as risk factor associated to myocardial infarction and in all strategies for coronary health promotion.

Introducción: la obesidad es un factor de riesgo asociado al infarto de miocardio aunque el índice cintura-cadera ha mostrado mayor poder predictivo. Objetivo: análisis antropométrico Receiver Operating Characteristic (ROC) en infartados para identificar la fuerza discriminatoria de mediciones, obesidad, ratios cintura-cadera, ratios cintura-talla e índice de conicidad. Métodos: estudio caso-control de infarto miocárdico en varones europeos. Ciento doce casos/112 controles de 30-74 años fueron reclutados. Se midieron: peso, talla, cintura, cintura umbilical y cadera. Se obtuvieron las áreas bajo la curva (ABC), las odds ratio y correlaciones de medidas e indicadores. Resultados: IMC [ABC: 0,686 (0,616-0,755); OR: 3,3], cintura [ABC: 0,734 (0,668-0,800); OR: 5,7], talla [ABC: 0,623 (0,550-0,696); OR: 2,3], cadera [ABC: 0,555 (0,479-0,631); OR: 1], cintura-cadera [ABC: 0,796 (0,737-0,855); OR: 9,9]; cintura umbilical-cadera [ABC:0,830 (0,775-0,885); OR: 5,5], cintura umbilical-talla [ABC: 0,788 (0,729-0,847); OR: 7,5]; conicidad [ABC: 0,795 (0,738-0,853); OR:9]. Cintura-talla y conicidad presentaron altas correlaciones de riesgo (todas r ≥ 0,85; p < 0,001). Conclusiones: cintura y talla son medidas con riesgo independiente asociado. La circunferencia de cadera no es discriminatoria. Obesidad e índices de cintura están asociados al infarto con diferente fuerza. La obesidad presenta una asociación débil. Los índices cintura-cadera presentan las mejores curvas ROC, pero sesgadas en su poder predictivo de riesgo. Cintura umbilical-talla y conicidad presentan alto poder discriminatorio y mejores correlaciones antropométricas de riesgo, por lo que se recomienda su uso en la identificación de la obesidad como factor asociado al infarto de miocardio y en todas las estrategias de promoción de la salud coronaria.

High-level overproduction of His-tagged Tth DNA polymerase in Thermus thermophilus.

A new plasmid for the overexpression of His-tagged thermozymes in Thermus thermophilus was developed. With this plasmid, soluble and active histidine-tagged DNA polymerase from T. thermophilus was overproduced in larger amounts in the thermophile than in Escherichia coli. The protein purified from the thermophile was active in PCR.

Comparación del efecto del extracto de Valeriana prionophylla Standl versus placebo sobre la ansiedad de 30 pacientes en tratamiento de quimioterapia por cáncer de mama, durante 4 semanas, en hospital de cancerología Incan Guatemala / Comparison of the effect of the extract of Valeriana prionophylla Standl versus placebo on the anxiety of 30 patients undergoing chemotherapy treatment for breast cancer, for 4 weeks, at the hospital of cancerology Incan Guatemala

Las pacientes con cáncer de mama desde su diagnóstico inicial experimentan diversos de grados de ansiedad, lo cual puede corroborarse al hacer un sondeo en las clínicas de atención de pacientes.(4) Partiendo de una evaluación inicial, mediante el Test de Hamilton para ansiedad, se pudo evidenciar la existencia de ansiedad en el 100% de pacientes con cáncer de mama que acuden a su tratamiento de quimioterapia. Fueron evaluadas inicialmente 40 pacientes a quienes se les proporciono, como tratamiento extracto de Valeriana prionophylla a 20 pacientes, así como extracto de maíz, como placebo a las otras 20 escogidas al azar, se conservo la información del contenido de los frascos para el final del estudio, con el objeto de hacerlo doble ciego controlado (ni el autor, ni el paciente conocieron si no hasta el final el tipo de tratamiento tomado). Se administro un extracto de Valeriana prionophylla guatemalteca, preparado por Laboratorio Farmaya en dilusion 1:5, a dosis de 30 gotas por la mañana y 30 gotas por la tarde, equivalentes a 600mg diarios. Finalizaron el estudio 30 pacientes, 15 de tratamiento y 15 placebo, quienes fueron reevaluados vía telefónica nuevamente mediante el Test de Hamilton. Se elaboró una base de datos, a la cual se le practico la Prueba exacta de Fisher asi como el Test de Chi Cuadrado, como análisis estadístico. Las conclusiones del estudio fueron las siguientes: 1. Todas las pacientes bajo tratamiento de quimioterapia por cáncer de mama manifiestan algún grado de ansiedad. 2. El extracto de Valeriana, redujo el nivel de ansiedad a valores normales en todas las pacientes bajo tratamiento, evidenciando un efecto positivo y beneficioso en la calidad de vida de este tipo de pacientes, confirmando lo que indica la literatura.(9,10.11,12) 3. El extracto de Valeriana supero el efecto placebo del extracto de maíz en las pacientes bajo tratamiento.