The Y chromosome of autochthonous Basque populations and the Bronze Age replacement.

Here we report on the Y haplogroup and Y-STR diversity of the three autochthonous Basque populations of Alava (n = 54), Guipuzcoa (n = 30) and Vizcaya (n = 61). The same samples genotyped for Y-chromosome SNPs were typed for 17 Y-STR loci (DYS19, DYS385a/b, DYS398I/II, DYS390, DYS391, DYS392, DYS393, DYS437, DYS438, DYS439, DYS448, DYS456, DYS458, DYS635, Y-GATA H4) using the AmpFlSTR Yfiler system. Six major haplogroups (R, I, E, J, G, and DE) were detected, being R-S116 (P312) haplogroup the most abundant at 75.0% in Alava, 86.7% in Guipuzcoa and 87.3% in Vizcaya. Age estimates for the R-S116 mutation in the Basque Country are 3975 ± 303, 3680 ± 345 and 4553 ± 285 years for Alava, Guipuzcoa and Vizcaya, respectively. Pairwise Rst genetic distances demonstrated close Y-chromosome affinities among the three autochthonous Basque populations and between them and the male population of Ireland and Gascony. In a MDS plot, the population of Ireland segregates within the Basque cluster and closest to the population of Guipuzcoa, which plots closer to Ireland than to any of the other Basque populations. Overall, the results support the notion that during the Bronze Age a dispersal of individuals carrying the R-S116 mutation reached the Basque Country replacing the Paleolithic/Neolithic Y chromosome of the region.

Dietary changes across time: Studying the indigenous period of La Gomera using δ13 C and δ15 N stable isotope analysis and radiocarbon dating.

OBJECTIVES: This article presents new radiocarbon and isotopic data to provide further information about the diet of the indigenous population of La Gomera and its possible changes across time. MATERIALS AND METHODS: δ13 C and δ15 N of 53 human and 19 faunal samples from different sites on the island have been obtained and analyzed. Of these, 52 have been radiocarbon dated to provide insight on chronological changes. RESULTS: Human dates range from the 3rd to 15th centuries AD, while faunal dates range from the 1st to 17th centuries AD. Stable carbon and nitrogen values are significantly different between the human and goat samples and have also a trophic increase of 3.4‰. Although male and female δ15 N data are not significantly different. Both δ13 C and δ15 N values of both human and animal samples tend to discretely decrease over time. DISCUSSION: Radiocarbon dates from humans correlate with other dates obtained in the rest of the archipelago. Animal radiocarbon dates generally coincide except for one date, which requires further study. Isotopic δ15 N data suggest a mix of marine and terrestrial protein consumption in humans, the latter being more abundant given the seasonality of the first. δ13 C data also suggest a possible mixed diet in humans, with a predominance of C3 plants, like Hordeum vulgare, the only grain found in archaeological sites so far. Variations of both δ13 C and δ15 N over time suggest a slight modification on the diet, which could be related to environmental changes.

The effect of diet and sociopolitical change on physiological stress and behavior in late Roman-Early Byzantine (300-700 AD) and Islamic (902-1,235 AD) populations from Ibiza, Spain.

OBJECTIVES: This study evaluated chronological changes in physiological stress and levels of habitual loading of Ibizan populations from the Late Roman-Early Byzantine (LREB) to the Islamic period (300-1,235 AD) using measures of body size and bone cross-sectional properties to compare Urban LREB, Urban Medieval Islamic, and Rural Medieval Islamic groups. It also explored the effect of diet, modeled using stable isotopes, on physiological stress levels and behavior. MATERIALS AND METHODS: The sample comprised individuals from three archeological populations: Urban Late Roman- Early Byzantine (LREB) (300-700 AD), Medieval Urban Islamic (902-1,235 AD), and Medieval Rural Islamic. Bone lengths, femoral head dimensions, and cross-sectional properties, diaphyseal products and circumferences, were compared to assess differences in body size and habitual loading in 222 adult individuals. Ordinary least squares regression evaluated the correlations between these measures and carbon (δ13 C) and nitrogen (δ15 N) stable isotope ratios in 115 individuals for whom both isotope values and osteological measures are available. RESULTS: The Medieval Rural Islamic group had shorter stature and reduced lower limb cross-sectional properties compared to the two urban groups. Limb shape differs between Urban LREB and Urban Medieval Islamic groups. Measures of body size length were positively correlated with δ13 C values in all individuals and separately in the Urban LREB and Rural Medieval Islamic groups. δ15 N showed a positive correlation with left humerus shape in the Urban LREB sample. CONCLUSIONS: The low stature and cross-sectional properties of the Medieval Rural Islamic group may be an indicator of greater physiological stress, potentially due to poorer diet. Positive correlations between measures of body size and δ13 C values further suggest that greater access to C4 resources improved diet quality. Alternatively, this relationship could indicate greater body size among migrants from areas where individuals consumed more C4 resources.

Searching for a 'new magical world': the contradictions of CAM and new age therapies in the West.

Complementary and alternative medicines (CAM) and New Age therapies (NAt) are increasingly widespread in the West. Although the variety of therapies they recommend is very extensive, as is the variety of beliefs and practices, there are common ideas shared across both such as the concept of holism and the notion of energy. The case studies examined in this paper, Vittorio and Sol, both suffered from severe personal problems that caused a state of general malaise. They managed to address them through the holistic world. Through their experiences, it is possible to highlight the contradictions of CAM-NAt in the West. While, on one hand, these represent a form of resistance to capitalist culture, on the other there is a risk that CAM-NAt could end up reinforcing capitalistic logic through the establishment of an 'individualistic holism'. The only solution to this situation seems to be a focus on the exercise of personal critical faculties, and an openness to different ways of conceiving the body, the health and diseases, but without, however, being drawn into the moralistic and individualist view that sometimes accompanies these.

Praying to win this battle: Cancer Metaphors in Latina and Spanish Women's Narratives.

This study closely examines 51 breast cancer narratives Latina and Spanish women wrote for other patients to illuminate how they conceptualize their health, with insights for addressing health disparities. Using discourse analysis of the role of language and culture in health care communication, this study focuses on the use of metaphors in the narratives. This provides revelations about the cultural and linguistic aspects of how the writers conceptualize their disease. Building on past research on metaphor use in cancer discourse in the English language, this study reveals the prevalence of metaphors comparing cancer to combat, or more generally, violence (e.g., "my battle against cancer"), or a journey (e.g., "my path with cancer"). Writers used this metaphorical language to offer advice to others with cancer and to mark their membership in a larger community of people with cancer. We also find that Spanish women use metaphors more frequently than Latinas and that they differed in their metaphorical portrayals of cancer. This research uncovers culturally embedded themes that are central to how women with cancer think about the disease, such as the prominence of spirituality in Latinas' metaphorical constructions, a pattern not evident in Spanish women's narratives.

Ethnopsychopharmacology study of patients' beliefs regarding concerns about and necessity of taking psychiatric medications.

OBJECTIVE: The aim of this study was to examine whether or not cultural differences influence beliefs about the necessity of taking prescribed psychiatric drugs and concern about their adverse effects in psychiatric outpatients in Spain, Argentina, and Venezuela. METHODS: This cross-sectional study included 1,372 adult psychiatric outpatients using 2,438 psychotropic drugs and was designed to assess outpatients' beliefs about their prescribed medication. Patients completed sociodemographic, clinical questionnaires, and the Beliefs about Medicines Questionnaire Specific Scale and registered scores ranging from 1 to 5 on each of two subscales: concern and necessity. A "necessity-concern differential" was obtained by calculating the difference (range -4 to +4). RESULTS: The global score, including all drugs in the total sample, had a mean necessity score of 3.50 ± 0.95, a mean concern score of 2.97 ± 0.99, and a mean differential score of 0.54 ± 1.42. The concern and necessity mean scores varied significantly across these three culturally Hispanic countries, probably across drug classes, and were associated with treatment duration. On the other hand, age and education played a very limited role. CONCLUSIONS: Understanding the diverse effects of culture and society on these attitudes is highly relevant for the development of responsive mental health services in multicultural societies.

Ancient genomes from North Africa evidence prehistoric migrations to the Maghreb from both the Levant and Europe.

The extent to which prehistoric migrations of farmers influenced the genetic pool of western North Africans remains unclear. Archaeological evidence suggests that the Neolithization process may have happened through the adoption of innovations by local Epipaleolithic communities or by demic diffusion from the Eastern Mediterranean shores or Iberia. Here, we present an analysis of individuals' genome sequences from Early and Late Neolithic sites in Morocco and from Early Neolithic individuals from southern Iberia. We show that Early Neolithic Moroccans (∼5,000 BCE) are similar to Later Stone Age individuals from the same region and possess an endemic element retained in present-day Maghrebi populations, confirming a long-term genetic continuity in the region. This scenario is consistent with Early Neolithic traditions in North Africa deriving from Epipaleolithic communities that adopted certain agricultural techniques from neighboring populations. Among Eurasian ancient populations, Early Neolithic Moroccans are distantly related to Levantine Natufian hunter-gatherers (∼9,000 BCE) and Pre-Pottery Neolithic farmers (∼6,500 BCE). Late Neolithic (∼3,000 BCE) Moroccans, in contrast, share an Iberian component, supporting theories of trans-Gibraltar gene flow and indicating that Neolithization of North Africa involved both the movement of ideas and people. Lastly, the southern Iberian Early Neolithic samples share the same genetic composition as the Cardial Mediterranean Neolithic culture that reached Iberia ∼5,500 BCE. The cultural and genetic similarities between Iberian and North African Neolithic traditions further reinforce the model of an Iberian migration into the Maghreb.

Social Network Analysis Applied to a Historical Ethnographic Study Surrounding Home Birth.

Safety during birth has improved since hospital delivery became standard practice, but the process has also become increasingly medicalised. Hence, recent years have witnessed a growing interest in home births due to the advantages it offers to mothers and their newborn infants. The aims of the present study were to confirm the transition from a home birth model of care to a scenario in which deliveries began to occur almost exclusively in a hospital setting; to define the social networks surrounding home births; and to determine whether geography exerted any influence on the social networks surrounding home births. Adopting a qualitative approach, we recruited 19 women who had given birth at home in the mid 20th century in a rural area in Spain. We employed a social network analysis method. Our results revealed three essential aspects that remain relevant today: the importance of health professionals in home delivery care, the importance of the mother’s primary network, and the influence of the geographical location of the actors involved in childbirth. All of these factors must be taken into consideration when developing strategies for maternal health.

The genus Datura L. (Solanaceae) in Mexico and Spain - Ethnobotanical perspective at the interface of medical and illicit uses.

ETHNOPHARMACOLOGICAL RELEVANCE: The different species of the genus Datura have been used traditionally by some pre-Columbian civilizations, as well as in medieval rituals linked to magic and witchcraft in both Mexico and Europe. It is also noteworthy the use of different alkaloids obtained from the plants for medicinal purposes in the treatment of various groups of diseases, especially of the respiratory and muscularskeletal systems. AIM OF THE STUDY: A review of the ethnobotanical uses of the genus Datura in Mexico and Spain has been conducted. We focus on the medicinal and ritualistic uses included in modern ethnobotanical studies, emphasizing the historical knowledge from post-colonial American Codices and medieval European texts. Datura's current social emergency as a drug of recreation and leisure, as well as its link to crimes of sexual abuse is also considered. The work is completed with some notes about the distribution and ecology of the different species and a phytochemical and pharmacological review of Datura alkaloids, necessary to understand their arrival in Europe and the ethnobotanical uses made since then MATERIALS AND METHODS: A literature review and compilation of information on traditional medicinal uses of the genus has been carried out from the main electronic databases. Traditional volumes (codices) have also been consulted in libraries of different institutions. Consultations have been made with the National Toxicological Services of Spain and Mexico for toxicological data. RESULTS: A total of 118 traditional uses were collected in both territories, 111 medicinal ones to be applied in 76 conditions or symptoms included in 13 pathological groups. Although there are particular medicinal uses in the two countries, we found up to 15 similar uses, of which 80% were previously mentioned in post-Colonial American codices. Applications in the treatment of asthma and rheumatism are also highlighted. Apart from medicinal uses, it is worth noting their cultural and social uses, in the case of Mexico relating to diseases such as being scared, astonishment or falling in love, and in the case of Spain, as a recreational drug and lately, for criminal purposes. CONCLUSIONS: This review highlights the variety of uses traditionally given to the different species in both territories. The fact that most of the coincident or similar uses in both countries also appear in the classical codices can be found an example of the flow, not only of the plants from America to Europe, but also of their associated information. It is also relevant that particular uses have derived in both countries, reflecting the difference in the cultural factors and traditions linked to rituals and cultural practices. Finally, the significant growth of Datura consumption in recent years as a drug of leisure and recreation, as well as in crimes of sexual submission, should be considered as research of maximum relevance in the field of forensic botany and toxicology.

Talking about intimate partner violence in multi-cultural antenatal care: a qualitative study of pregnant women's advice for better communication in South-East Norway.

BACKGROUND: Intimate partner violence (IPV) against women constitutes a major public health problem. Antenatal care is considered a window of opportunity to disclose and to communicate about IPV. However, little is known about how women from different ethnic backgrounds wish to communicate about their experiences with IPV during pregnancy in antenatal care. The aim of the present study was to explore how women from different ethnic backgrounds experienced IPV and what their recommendations were about how midwives should communicate about IPV in antenatal care. METHODS: Qualitative individual interviews with eight women who had experienced IPV during pregnancy were conducted and analysed using thematic analysis. The participants were purposively recruited from three crisis shelters in South-East Norway. RESULTS: The participants either had immigrant backgrounds (n = 5) or were ethnic Norwegians (n = 3). All participants received antenatal care by a midwife. Although none of the participants were asked about IPV during antenatal care, they wished to talk about their experiences. Most participants felt that it would be important for the midwife to make them aware that they were victims of violence. Participants offered different suggestions on how and when midwives should talk about IPV. Facilitators to talk about IPV with the midwife were a good relationship with and the trustworthiness of the midwife, information about possible negative health outcomes for the newborn owing to IPV and knowing that the midwife could help them. The main barriers to talk about IPV with the midwife were that the participants were accompanied by their husbands during antenatal care, fear that the Child Welfare Service would take away their children after disclosure and cultural acceptance of violence. Participants with immigrant backgrounds also experienced difficulties in talking about IPV owing to their limited language skills. They thought that professionally trained interpreters with experience of IPV could overcome this barrier. CONCLUSION: Even though none of the participants were asked about IPV in antenatal care, they offered different suggestions on how and when midwives should talk about IPV. Participants irrespective of their ethnical backgrounds perceived antenatal care as a key area to facilitate disclosure of IPV. Midwives' communication and strategic skills to address IPV are crucial for help-seeking women. Training midwives' skills in culture-sensitive communication might help to overcome cultural barriers to talk about violence.

Turn back crime: medicamentos ilegales y papel del farmacéutico comunitario / Turn back crime: illicit products and the role of the community pharmacist

El objetivo del presente trabajo fue describir y analizar la situación en España de los productos de venta ilícita, tanto medicamentos como complementos alimenticios, poniendo en conocimiento las principales acciones realizadas en los últimos meses y su contextualización a nivel mundial. Asimismo, servir de alerta sobre la magnitud del problema y la importancia del papel del farmacéutico comunitario. Se realizó una búsqueda de información tanto a nivel nacional como internacional y se realizó un análisis descriptivo de las Notas Informativas de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) (medicamentos ilegales, uso humano, 2015). Los productos de venta ilícita representan un problema grave para la salud pública que no ha parado de aumentar. En España, en 2015 se publicaron 20 notas donde se prohibió y retiró un total de 35 productos. Dichos productos estaban comercializados como complemento alimenticio y presentaban un principio activo en cantidad suficiente para conferirle legalmente la condición de medicamento. El 86% se dirigía a la disfunción eréctil. Para minimizar este problema, es imprescindible la colaboración internacional, siendo la última y más importante operación PANGEA VIII, en junio del 2015, implicando a 115 países. En enero del 2016 entró en vigor la Convención Medicrime, tratado internacional sobre la falsificación de productos médicos y delitos similares. Por otro lado, también es necesario concienciar a la ciudadanía y dotarla de mecanismos para identificar el riesgo potencial. Los productos adquiridos fuera de los canales legales de distribución no aseguran el cumplimiento de las normas de correcta fabricación, distribución, ni posterior conservación y carecen de la información adecuada (AU)

The objective of this article was to describe and analyze the situation of illicit products in Spain, both medicines and dietary supplements, notifying main actions taken in recent months and their worldwide contextualization. Also serve as a warning about the magnitude of the problem and the importance of the role of the community pharmacist. Searches of information were looked at a national and international level. A descriptive analysis of the Information Notes published by the Spanish Agency of Medicines and Medical Devices (AEMPS, Illegal Drugs, Human Use, 2015) was also conducted. Illicit sale products constitute a major problem for public health that has not stopped increasing. Specifically, in Spain, 20 Notes were published in 2015. These included the prohibition and withdrawal of a total of 35 products. Marketed as dietary supplement, they contained an active ingredient enough to be legally considered as a medicine. 86% were aimed at treating erectile dysfunction. It is essential international collaboration to minimize this issue. The last and most important operation was PANGEA VIII in June 2015, which involved 115 countries. In January 2016, the «Medicrime Convention» entered into force, an international agreement on counterfeiting of medical products and similar crimes. In addition, it is necessary to raise awareness and provide the citizens with mechanisms to identify potential risks inherent to the illicit sale products. Products purchased outside the permitted distribution channels do not ensure compliance with good manufacturing practice, distribution or subsequent storage, and they lack of adequate information (AU)

Efectos positivos del entrenamiento de karate en las capacidades cognitivas asociadas a la edad / Possitive effects of continuous practice of karate in cognitive capacity associtated to the age

El envejecimiento está asociado con la disminución de las capacidades cognitivas de las personas y, en muchos casos, va acompañado de un descenso de la calidad de vida. El objetivo de este trabajo de investigación consiste en identificar los efectos que un entrenamiento adaptado y continuado en karate puede tener en las capacidades cognitivas de personas de más de cuarenta años. Para ello se obtuvo una muestra incidental de 275 sujetos. Se llevó a cabo un trabajo empírico descriptivo y correlacional. La variable investigada es la velocidad de anticipación, medida mediante la puntuación obtenida en el test Kelvin (KCC). Las variables controladas son la edad, sexo y la práctica continuada de karate. El entrenamiento regular en karate ha tenido efectos positivos en la velocidad de anticipación de las personas mayores de cuarenta años, lo que implica una mejora en la atención y otras capacidades cognitivas de estas personas. En los sujetos no practicantes de Karate, al llevar a cabo la comparación de medias entre mayores y menores de 40 años, sí se han encontrado diferencias significativas. Por tanto, el entrenamiento adaptado de karate puede ser una opción interesante para mantener las capacidades cognitivas a lo largo de los procesos envejecimiento (AU)

Normally, aging has been associated to the decrease of people’s cognitive capacity and, in several cases, related to a decrease in the quality of life. The objective of this research work is the identification of the effects that an adapted and continuous practice of karate would have in the cognitive capacity of people having more than 40 years old. To achieve this aim, 275 subjects were analysed through an empirical and correlational approach. The dependent variable analysed was the anticipation speed measured by he points obtained by the participants in the Kelvin test (KCC). The independent variables considered were age, gender and the continuous practice of karate. The results obtained indicate that the regular and adapted karate training have positive effects in the anticipation speed of people having more than 40 years old. In this group the anticipation speed has not relevant differences between people having less and more than 40 years old. There were relevant differences between both subsets in the case of subjects that were not karate practitioners. In this sense, the continuous practice of karate could be an interesting option to maintain the cognitive capacities throughout aging processes (AU)

Evaluación de la adherencia al tratamiento con calcio y vitamina D en ancianos de una zona básica de salud / Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area

Introducción y objetivo. El déficit de vitamina D en los ancianos es elevado. Complementar con suplementos de calcio y vitamina D es una práctica habitual en individuos con riesgo de caídas y/o fracturas que, sin embargo, obtiene un bajo grado de cumplimiento. El objetivo es determinar la adherencia al calcio y vitamina D en ancianos con hipovitaminosis D en una zona urbana de Madrid. Pacientes y métodos. Estudio de intervención en 438 individuos ≥ 65 años con hipovitaminosis D procedentes de la «Cohorte Peñagrande». Se les pautó calcio y vitamina D y se valoró la adherencia a los 3 y 12 meses mediante el test de Morisky-Green y el recuento de recetas prescritas. Resultados. Se analizaron 413 de los 438 individuos con hipovitaminosis D (18 casos no se trataron por contraindicaciones y 7 se perdieron). A los 3 y 12 meses el 63,9 y el 47,2%, respectivamente, fueron adherentes. El 19,3% de los no adherentes a los 3 meses fueron buenos cumplidores al año tras una intervención educativa breve. La comorbilidad se asoció con menor adherencia al año (46,3% versus 35,2%, p = 0,027). La principal causa de no adherencia al calcio fue la intolerancia digestiva, y a la vitamina D, los olvidos. Se observó concordancia entre valorar la adherencia con el test de Morisky y recuento de recetas prescritas (índice Kappa = 69,8%). Conclusiones. La falta de adherencia a tratamientos crónicos con calcio y vitamina D es un problema relevante en ancianos. Es importante evaluar la adherencia y aplicar estrategias de educación sanitaria en la práctica clínica (AU)

Background and objective. The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. Patients and methods. Intervention study performed on 438 individuals ≥ 65 years from the ‘Peñagrande Cohort’ with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. Results. A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P = .027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index = 69.8%). Conclusions. Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice (AU)

[High frequency of ancestral allele of the TJP1 polymorphism rs2291166 in Mexican population, conformational effect and applications in surgery and medicine]. / Alta frecuencia del alelo ancestral del polimorfismo rs2291166 de TJP1 en población mexicana, efecto conformacional así como las aplicaciones en cirugía y medicina.

BACKGROUND: TJP1 gene encodes a ZO-1 protein that is required for the recruitment of occludins and claudins in tight junction, and is involved in cell polarisation. It has different variations, the frequency of which has been studied in different populations. In Mexico there are no studies of this gene. These are required because their polymorphisms can be used in studies associated with medicine and surgery. Therefore, the aim of this study was to estimate the frequency of alleles and genotypes of rs2291166 gene polymorphism TJP1 in Mexico Mestizos population, and to estimate the conformational effect of an amino acid change. MATERIAL AND METHODS: A total of 473 individuals were included. The rs2291166 polymorphism was identified PASA PCR-7% PAGE, and stained with silver nitrate. The conformational effect of amino acid change was performed in silico, and was carried out with servers ProtPraram Tool and Search Database with Fasta. RESULTS: The most frequent allele in the two populations is the ancestral allele (T). A genotype distribution similar to other populations was found. The polymorphism is in Hardy-Weinberg, p>0.05. Changing aspartate to alanine produced a conformational change. CONCLUSIONS: The study reveals a high frequency of the ancestral allele at rs2291166 polymorphism in the Mexican population.

Registro español de cirugía de Mohs (REGEMOHS). El primer paso de un proyecto ambicioso / A Spanish Mohs surgery registry (REGEMOHS). The first step in an ambitious project

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Modificación de la dosis de terapias biológicas en psoriasis moderada-grave: análisis descriptivo en condiciones de práctica clínica / Dose Modification in Biologic Therapy for Moderate to Severe Psoriasis: A Descriptive Analysis in a Clinical Practice Setting

INTRODUCCIÓN: La modificación de dosis de biológicos en pacientes con psoriasis en remisión adecuadamente seleccionados podría reducir el riesgo de exposición al fármaco y su carga económica. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal en 112 pacientes con psoriasis moderada-grave tratados con biológicos durante ≥6 meses en enero de 2014. El objetivo consistió en alcanzar y mantener una respuesta PASI 75. Los pacientes iniciaron el tratamiento con la pauta estándar; en aquellos que cumplieron el objetivo se redujo la dosis, y cuando no alcanzaron la respuesta con la pauta estándar esta se intensificó. RESULTADOS: Un 42,9% siguió la pauta estándar, un 50% la reducida y un 7,1% la intensificada. El fármaco con el que más se redujo la dosis fue adalimumab (57,7%) y los que más se intensificaron fueron ustekinumab e infliximab (17,9% y 12,5%). Los pacientes que recibieron dosis reducidas presentaron una psoriasis de más evolución (p = 0,049) y llevaban más tiempo en tratamiento con el mismo biológico (p = 0,009) (diferencias significativas). Hubo una proporción significativamente superior de pacientes con artritis psoriásica entre los no aptos a reducir dosis (p = 0,023). El ahorro del gasto fue del 21,5% con adalimumab, 13,8% con etanercept, 0,9% con ustekinumab y 0,55% con infliximab. CONCLUSIONES: Presentaron una probabilidad de reducción de dosis significativamente mayor aquellos pacientes con más tiempo de evolución y más tiempo bajo el mismo tratamiento biológico. Entre los pacientes sin reducción de dosis hubo mayor proporción con artritis psoriásica. El ahorro global con este algoritmo de modificación de dosis fue del 13%. Se requieren estudios controlados que ayuden a definir el perfil de paciente más adecuado para reducir la dosis sin pérdida de eficacia del tratamiento

INTRODUCTION: In biologic therapy, dose modification in carefully selected patients when psoriasis is in remission could reduce treatment costs and the risks associated with drug exposure. MATERIAL AND METHODS: Observational, descriptive, crosssectional study, performed in January 2014, of 112 patients with moderate to severe psoriasis who had been on biologic therapy for at least 6 months. The therapeutic objective in all cases was to achieve and maintain a 75% reduction in Psoriasis Area and Severity Index (PASI 75). All the patients had started treatment with the standard regimen. During treatment, the dose had been reduced in patients who achieved the therapeutic objective and escalated in those who failed to respond adequately to standard doses. RESULTS: At the time of the study, 42.9% of the patients were receiving the standard dose, 50% were on a reduced dose, and 7.1% were on an escalated regimen. The agent with which the dose was most often reduced was adalimumab (57.7%), and the agents with which therapy was most often escalated were ustekinumab (17.9%) and infliximab (12.5%). Patients who received reduced doses had significantly longer-standing disease (P=.049) and longer treatment duration with the same biologic agent (P=.009). In the group that did not fulfill the criteria for dose reduction, the proportion of patients with psoriatic arthritis was significantly higher (P=.023). Cost savings were as follows: 21.5% with adalimumab, 13.8% with etanercept, .9% with ustekinumab, and .55% with infliximab. CONCLUSIONS: Patients with longer-standing disease and longer treatment duration with the same biologic agent were significantly more likely to be candidates for dose reduction. The proportion of patients with psoriatic arthritis was greater in the group of patients who did not fulfill the conditions for dose reduction. The overall cost saving achieved using the dose modification algorithm described in this study was 13%. Controlled studies are needed to define the profile of the patients best suited for dose reduction strategies without loss of treatment efficacy

Reunión anual del grupo de trabajo «islotes pancreáticos» de la Sociedad Española de Diabetes / Annual meeting of the working group "pancreatic islet" of the Spanish Society of Diabetes

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Terapia asistida con perros en pacientes con demencia y SPCd institucional en el centro residenciales de Toledo, España / No disponible

Los síntomas psicológicos y conductuales de la demencia (SPCD) generan un sufrimiento sobreañadido en el anciano y en el cuidador, agravan el deterioro cognitivo y funcional y precipitan la institucionalización del anciano (1,2). En los últimos años se ha investigado acerca de La Terapia Asistida con Animales de Compañía (TAAC) como terapia no farmacológica para el control dichos síntomas, demostrando ser una buena alternativa coste- efectiva para el tratamiento. El presente estudio valora la efectividad de la terapia para el control de síntomas conductuales en pacientes con Demencia institucionalizados. Se realizó un estudio prospectivo, multicéntrico, de manera simultánea en 2 residencias de la Provincia de Toledo, con un total de 36 pacientes, 24 con deterioro cognitivo moderado-severo y SPCD, y 12 pacientes sin demencia con trastornos afectivos. De forma aleatorizada se distribuyeron los pacientes con demencia en un grupo de intervención con TAAC (12) y un grupo control sin TAAC (12), además del grupo de sanos (12). La intervención consistía en 16 sesiones, 2 sesiones cada semana de 35 minutos de duración. La medición se realizó con las escalas de MMSE, Barthel Modificado, Cornell, Quality Scale, NPI y MOPI, antes de iniciar las terapias y al finalizar las sesiones. La terapia asistida con animales resultó eficaz tras reducir agitación y agresividad según la puntuación de NPI (P0.004) y mejoró la calidad de vida según la escala Quality of Life (P 0,004), de los pacientes con TAAC

The psychological and behavioral symptoms of dementia (SPCD) generate additional suffering in the elderly and caregiver, exacerbate cognitive and functional impairment and precipitate the institutionalization of the elderly (1,2). In recent years, research has been conducted in Animal-Assisted Therapy (AAT) as a non-drug therapy to control the symptoms, proving to be a good cost-effective alternative for treatment. Our study aims to assess the effectiveness of therapy to control behavioral symptoms [RR1] in institutionalized patients with dementia. A prospective multicenter study is performed simultaneously at two residences in the province of Toledo, with a total of 36 patients, 24 with moderate-severe cognitive impairment and SPCD, and 12 patients without dementia and affective disorders. Dementia patients were randomly divided into an intervention group with TAAC (12) and a control group without AAT (12), besides the healthy group (12). The intervention consisted of 16 sessions, 2 sessions per week for 35 minutes in duration. The measurement was performed with MMSE scales, Modified Barthel, Cornell, Quality Scale, NPI and MOPI before starting the therapies and at the end of the sessions. The animal-assisted therapy was effective after reducing agitation and aggressiveness according to an NPI score (P0.004) and improved quality of life according to the Quality of Life Scale (P 0.004), for the patients with AAT

Alteración anatómica orbitaria en Retrato de familia. Adriaen Thomasz Key. Museo Nacional del Prado, Madrid / Orbital anatomical changes in Retrato de familia. Adriaen Thomasz Key. El Prado National Museum, Madrid

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Santa Lucía en el Museo Nacional del Prado (VI). Retablo de la Virgen del Maestro de Torralba. Donación Várez Fisa / Saint Lucy in El Prado Museum (VI). Retablo de la Virgen by the maestro of Torralba. Várez Fisa donation

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