Nasal versus oronasal mask in home mechanical ventilation: the preference of patients as a strategy for choosing the interface.

INTRODUCTION: In home mechanical ventilation (HMV), the mask is a key factor for patient comfort and therapeutic adherence. There is no evidence on the best strategy for choosing the mask in HMV. OBJECTIVE: To explore patient preference when prescribing the mask for HMV treatment and assess its relationship with effectiveness. METHODS: A prospective study with repeated measures in stable patients receiving home nocturnal ventilation. Alternating oronasal mask (ONM) and nasal mask (NM) were tested in day and overnight sessions, with arterial blood gas measured and S(pO(2)) monitored. At the end of each evening session, patients rated interface comfort using a visual analog scale. At 3 months we evaluated adherence and effectiveness of the treatment. RESULTS: Twenty-nine subjects (mean ± SD age 65 ± 13 y, 44% male) completed the study. Initial functional values were P(CO(2)) 57.4 ± 5.2 mm Hg and time with S(pO(2)) < 90% (T90) 81.5 ± 9.5%. Both ONM and NM significantly decreased P(CO(2)) and T90. Over a third (38%) of our subjects preferred ONM, while NM was deemed more comfortable in general. At 3 months, effectiveness and adherence showed no differences between those treated with NM or ONM. CONCLUSIONS: Patient choice is an effective criterion for selecting the interface in HMV treatment.

Assembling the Dead, Gathering the Living: Radiocarbon Dating and Bayesian Modelling for Copper Age Valencina de la Concepción (Seville, Spain).

The great site of Valencina de la Concepción, near Seville in the lower Guadalquivir valley of southwest Spain, is presented in the context of debate about the nature of Copper Age society in southern Iberia as a whole. Many aspects of the layout, use, character and development of Valencina remain unclear, just as there are major unresolved questions about the kind of society represented there and in southern Iberia, from the late fourth to the late third millennium cal BC. This paper discusses 178 radiocarbon dates, from 17 excavated sectors within the c. 450 ha site, making it the best dated in later Iberian prehistory as a whole. Dates are modelled in a Bayesian statistical framework. The resulting formal date estimates provide the basis for both a new epistemological approach to the site and a much more detailed narrative of its development than previously available. Beginning in the 32nd century cal BC, a long-lasting tradition of simple, mainly collective and often successive burial was established at the site. Mud-vaulted tholoi appear to belong to the 29th or 28th centuries cal BC; large stone-vaulted tholoi such as La Pastora appear to date later in the sequence. There is plenty of evidence for a wide range of other activity, but no clear sign of permanent, large-scale residence or public buildings or spaces. Results in general support a model of increasingly competitive but ultimately unstable social relations, through various phases of emergence, social competition, display and hierarchisation, and eventual decline, over a period of c. 900 years.

Incidència de la hipersensibilitat a llet de vaca en el primer any de vida a la Catalunya Centra / Incidencia de la hipersensibilidad a leche de vaca en el primer año de vida en la Cataluña Central / Incidence of cow's milk allergy in the first year of life in central Catalonia

Fonament: l'al•lèrgia a proteïnes de llet de vaca és l'al•lèrgia alimentària més freqüent en lactants. La prevalença real és difícil d'establir, donada la gran variabilitat metodològica dels estudis publicats. Objectiu: conèixer la incidència durant el primer any de vida de reaccions d'hipersensibilitat, en concret les mediades per IgE, a proteïnes de llet de vaca en una població de lactants que van fer seguiment en àrees bàsiques d'atenció primària de la Catalunya Central. Valorar si existien diferències de reaccions en lactants segons el trimestre de naixement. Mètode: estudi multicèntric, observacional i prospectiu. Àmbit: àrees bàsiques d'atenció primària del Bages i el Solsonès. Es van incloure els nascuts durant el primer i l'últim trimestre del 2012, i se'n va fer el seguiment durant un any. En cas de sospita de reacció d'hipersensibilitat (RHS) al•lèrgica, es van remetre a l'al•lergòleg. Resultats: durant el primer trimestre van néixer 153 infants, i 125 el darrer trimestre. Van completar el seguiment 139 i 119 lactants, respectivament. En el primer grup es va sospitar RHS en 3/124 (2,4%) alimentats amb fórmula artificial (FA). No es va confirmar cap cas mediat per IgE. En el segon grup, van rebre FA 111 lactants. En cinc es va sospitar una RHS (4,5%) i en quatre es va confirmar RHS al•lèrgica: 2/111 mediada per IgE (1,8%) i 2/111 no me-diada per IgE (1,8%). Els dos pacients amb al•lèrgia mediada per IgE van patir reacció en iniciar l'FA. Conclusions: de 235 infants que van rebre FA, es va sospitar RHS en cinc (2,1%), i es va confirmar mecanisme IgE en dos (0,9 %), tots dos nascuts el darrer trimestre

Fundamento. La alergia a proteínas de leche de vaca es la alergia alimentaria más frecuente en lactantes. La prevalencia real es difícil de establecer, dada la gran variabilidad metodológica de los estudios publicados. Objetivo. Conocer la incidencia durante el primer año de vida de reacciones de hipersensibilidad, en concreto las mediadas por IgE, a proteínas de leche de vaca en una población de lactantes que hacen seguimiento en áreas básicas de atención primaria de Cataluña Central. Valorar si existen diferencias según el trimestre de nacimiento. Método. Estudio multicéntrico, observacional y prospectivo. Ámbito: áreas básicas de atención primaria del Bages y el Solsonès. Se incluyeron los recién nacidos durante el primer y el último trimestre de 2012, y se hizo seguimiento durante un año. En caso de sospecha de reacción de hipersensibilidad (RHS) alérgica, se remitieron al alergólogo. Resultados. Durante el primer trimestre nacieron 153 niños, y 125 en el último trimestre. Completaron el seguimiento 139 y 119 lactantes, respectivamente. En el primer grupo se sospechó RHS en 3/124 (2,4%) alimentados con fórmula artificial (FA). No se confirmó ningún caso mediado por IgE. En el segundo grupo, 111 lactantes recibieron FA. En cinco se sospechó una RHS (4,5%) y en cuatro se confirmó RHS alérgica: 2/111 mediada por IgE (1,8%) y 2/111 no mediada por IgE (1,8%). Los dos niños con alergia mediada por IgE sufrieron reacción al iniciar la FA. Conclusiones. De 235 niños que recibieron FA, se sospechó RHS en cinco (2,1%), y se confirmó mecanismo IgE en dos (0,9%), ambos nacidos en el último trimestre (AU)

Background. Cow's milk allergy is the most frequent food allergy in infants; however, given the methodological variability in published studies, its real prevalence is difficult to ascertain. Objective. To determine the incidence of hypersensitivity reactions, specifically those IgE mediated, to cow’s milk proteins in a population of infants seen in primary health care centers in Central Catalonia, and to assess differences in reactions according to the trimester of birth. Method. Multicenter, observational, prospective study conducted in primary healthcare centers of the Bages and Solsones. Infants born during the first and last trimesters of 2012 were included. In case of suspected allergic hypersensitivity reaction (AHR), they were referred to an allergologist for confirmation. Results. 153 infants were born during the first trimester and 125 during the last trimester; full one-year follow-up was completed in 139 and 119 infants, respectively. In the first group, an AHR was suspected in three of 124 (2.4%) children fed with artificial formula (AF). In the second group, 111 infants received AF, and an AHR was suspected in five of them (4.5%). AHR was confirmed in four, with two of them being IgE mediated. Both children with IgE-mediated allergy developed an allergic reaction upon initiation of AF. Conclusions. Of 235 children receiving AF, five (2.1%) had an AHR, which was confirmed to be IgE-mediated in two (0.9%), both born in the last trimester of the year (AU)