Prevalencia de la prescripción de fármacos en la enfermedad de Alzheimer y uso de la terapia combinada / Prescription drug prevalence in Alzheimer's disease and use of combination therapy

Objetivo: La enfermedad de Alzheimer (EA) es la demencia más común, y se estima que alrededor de 47 millones de personas a nivel mundial sufren esta enfermedad. Los inhibidores de la acetilcolinesterasa (IACE) y la memantina están indicados en estadios leve-moderado, pero su relevancia clínica está en entredicho y el uso de la terapia combinada no se ha establecido. El objetivo es medir la prevalencia de prescripción de fármacos para la EA en un Área de Gestión Sanitaria (AGS) y analizar tanto la utilidad de la biterapia como su potencial retirada. Metodología: Estudio retrospectivo desarrollado por el Servicio de Farmacia de un AGS que abarca 408.788 pacientes. Los datos se recogieron utilizando diferentes plataformas electrónicas del Servicio Andaluz de Salud. Se incluyeron todos los pacientes con prescripción activa de algún fármaco para la EA. Resultados: El 0,6% de la población total del AGS tenía prescrito uno o más fármacos para la EA. Los más prescritos fueron memantina y donepezilo tanto en monoterapia como combinados. Aproximadamente un 40% de los pacientes con terapia combinada sufrieron un deterioro cognitivo desde la instauración de la doble terapia, pero los fármacos no se retiraron. Conclusión: La prevalencia de prescripción de fármacos para la EA en el AGS estudiada es similar a los datos de prevalencia publicados. Desde el inicio de la prescripción de la terapia combinada hasta la última consulta médica, un porcentaje relevante de pacientes sufre deterioro cognitivo, pero los fármacos no se retiran, por lo que es necesario revisar las pautas de deprescripción de estos medicamentos. (AU)

Objective: Alzheimer’s disease (AD) is the most common dementia, and it is estimated that around 47 million people worldwide suffer this disease. Acetylcholinesterase inhibitors (AChEi) and memantine are indicated in mild-moderate stages, but their clinical relevance is questioned and the use of the combination therapy has not been established. The objective is to evaluate the prevalence of drug prescription for AD in a Health Management Area (HMA) and to analyze the utility of the dual therapy and its potential withdrawal. Methodology: Retrospective study developed by the Pharmacy Service of an HMS that includes 408,788 patients. Data were collected using different electronic platforms of the Andalusian Health Service. All patients with an active prescription of some drug for AD were included. Results: 0.6% of the total population of the HMS had prescribed one or more drugs for AD. The most prescribed were memantine and donepezil, both in monotherapy and in combination. Approximately 40% of patients with combination therapy suffered cognitive decline since the introduction of dual therapy, but the drugs were not withdrawn. Conclusion: The prevalence of drug prescription for AD in the HMS studied is similar to the published prevalence data. From the start of the combination therapy prescription until the last medical consultation, a relevant percentage of patients suffer cognitive impairment, but the drugs are not withdrawn, so it is necessary to review the deprescription guidelines. (AU)

Estrategia formativa para perfeccionar el autocuidado en pacientes con fractura de cadera / Training strategy to improve self-care in patients with hip fracture

Introducción: Los medios de enseñanzas son los ejes vertebrales de gran parte de las acciones de enseñanzas y aprendizaje desarrolladas en cualquiera de los niveles o modalidades de la educación. Objetivos: Sistematizar y resaltar los fundamentos y ventajas de la guía de autoayuda sobre la fractura de cadera en el adulto mayor, como medio de enseñanza en la superación profesional del médico de la atención primaria. Métodos: Analítico ­ sintético, hipotético ­ deductivo, análisis documental y la entrevista. Resultados: Se elaboró una guía de autoayuda sobre fractura de cadera en el adulto mayor, a partir de falencias detectadas en la atención primaria de salud, que limitan el desempeño de los médicos de este nivel en actividades de promoción de salud en este grupo social. La guía de autoayuda fue diseñada y estructurada, como medio de enseñanza de estrategias de superación profesional, determinando las particularidades del contenido que se desea enseñar y las que se necesitan aprender por estos profesionales, para mejorar su desempeño en la promoción de salud en relación con el adulto mayor con fractura de cadera. Su creación fue concebida como elemento dinamizador del contenido unido a los demás componentes del proceso en busca de lograr los objetivos propuestos. Conclusiones: Se presenta una guía de la colección de autoayuda sobre fractura de cadera en el adulto mayor, diseñado, pensado y elaborado como medio de enseñanza a utilizar en la superación profesional del médico de la atención primaria de salud donde se resaltan los fundamentos teóricos que lo sustentan.

Introduction: Teaching media are the backbone of a large part of the teaching and learning actions developed at every educational level or modality. Objectives: To systematize and highlight the rationale and advantages of the self-help guide for hip fracture in the elderly, considered as a teaching tool in the professional improvement of primary health care ( PHC). Methods: Analytical - synthetic, hypothetical - deductive, documentary analysis and interview. Results: A self-help guide for hip fracture in the elderly was developed, based on deficiencies detected on PHC, which limit the performance of doctors at this level in health promotion activities for the mentioned social group. The self-help guide was designed and structured as a means of teaching professional improvement strategies by determining the content particularities to be taught and those to be learned by these professionals, in order to improve their performance in health promotion for the elderly with hip fracture. This self- help guide was conceived as a dynamic element of the content, that relates to the other components of the process in search of achieving the proposed objectives. Conclusions: We present a self-help collection guide for hip fracture in the elderly, designed, conceived, and elaborated as a teaching tool to be used in the professional improvement of the PHC, and we highlight theoretical foundations

Small RNA populations reflect the complex dialogue established between heterograft partners in grapevine.

Grafting is an ancient method that has been intensively used for the clonal propagation of vegetables and woody trees. Despite its importance in agriculture the physiological and molecular mechanisms underlying phenotypic changes of plants following grafting are still poorly understood. In the present study, we analyse the populations of small RNAs in homo and heterografts and take advantage of the sequence differences in the genomes of heterograft partners to analyse the possible exchange of small RNAs. We demonstrate that the type of grafting per se dramatically influences the small RNA populations independently of genotypes but also show genotype specific effects. In addition, we demonstrate that bilateral exchanges of small RNAs, mainly short interfering RNAs, may occur in heterograft with the preferential transfer of small RNAs from the scion to the rootstock. Altogether, the results suggest that small RNAs may have an important role in the phenotype modifications observed in heterografts.

Effects of grape pomace supplementation on the diet of lactating ewes as compared to vitamin E on the meat shelf life of suckling lambs.

Forty-eight Churra ewes and their suckling lambs were assigned to four dietary treatments: control (CTRL), VIT-E (500 mg kg-1 TMR vitamin E), GP-5 (5% grape pomace) and GP-10 (10% grape pomace). After slaughter (11.5 kg live weight), longissimus muscle of lambs was sliced, packaged under modified atmosphere (80,20%/O 2:CO 2) and stored in retail conditions. At each sampling point (0, 3, 7, 10, 14 days), microbiological, physicochemical and sensory characteristics were analysed. Vitamin E and GP-5 were found to be effective (p < 0.05) at preventing enterobacteria growth as of day 10. After day 10, vitamin E and grape pomace in the ewe's supplementation reduced metmyoglobin (p < 0.05) lipid oxidation (p < 0.05) and sensory spoilage throughout the storage period. An effect of the grape pomace dosage was observed, with the supplementation at 5% being more effective. Therefore, we can conclude that grape pomace was just as effective as vitamin E in preventing spoilage during retail storage.

Shape Changes in the Mirror Nuclei

We studied the proton-rich T_{z}=-1 nucleus ^{70}Kr through inelastic scattering at intermediate energies in order to extract the reduced transition probability, B(E2;0^{+}→2^{+}). Comparison with the other members of the A=70 isospin triplet, ^{70}Br and ^{70}Se, studied in the same experiment, shows a 3σ deviation from the expected linearity of the electromagnetic matrix elements as a function of T_{z}. At present, no established nuclear structure theory can describe this observed deviation quantitatively. This is the first violation of isospin symmetry at this level observed in the transition matrix elements. A heuristic approach may explain the anomaly by a shape change between the mirror nuclei ^{70}Kr and ^{70}Se contrary to the model predictions.

Updated Summation Model: An Improved Agreement with the Daya Bay Antineutrino Fluxes.

A new summation method model of the reactor antineutrino energy spectrum is presented. It is updated with the most recent evaluated decay databases and with our total absorption gamma-ray spectroscopy measurements performed during the last decade. For the first time, the spectral measurements from the Daya Bay experiment are compared with the antineutrino energy spectrum computed with the updated summation method without any renormalization. The results exhibit a better agreement than is obtained with the Huber-Mueller model in the 2-5 MeV range, the region that dominates the detected flux. A systematic trend is found in which the antineutrino flux computed with the summation model decreases with the inclusion of more pandemonium-free data. The calculated flux obtained now lies only 1.9% above that detected in the Daya Bay experiment, a value that may be reduced with forthcoming new pandemonium-free data, leaving less room for a reactor anomaly. Eventually, the new predictions of individual antineutrino spectra for the ^{235}U, ^{239}Pu, ^{241}Pu, and ^{238}U are used to compute the dependence of the reactor antineutrino spectral shape on the fission fractions.

Publisher's Note: Experimental Neutron Capture Rate Constraint Far from Stability [Phys. Rev. Lett. 116, 242502 (2016)].

This corrects the article DOI: 10.1103/PhysRevLett.116.242502.

Large Impact of the Decay of Niobium Isomers on the Reactor ν[over ¯]_{e} Summation Calculations.

Even mass neutron-rich niobium isotopes are among the principal contributors to the reactor antineutrino energy spectrum. They are also among the most challenging to measure due to the refractory nature of niobium, and because they exhibit isomeric states lying very close in energy. The ß-intensity distributions of ^{100gs,100m}Nb and ^{102gs,102m}Nb ß decays have been determined using the total absorption γ-ray spectroscopy technique. The measurements were performed at the upgraded Ion Guide Isotope Separator On-Line facility at the University of Jyväskylä. Here, the double Penning trap system JYFLTRAP was employed to disentangle the ß decay of the isomeric states. The new data obtained in this challenging measurement have a large impact in antineutrino summation calculations. For the first time the discrepancy between the summation model and the reactor antineutrino measurements in the region of the shape distortion has been reduced.

Synthesis and characterization of silica-chitosan hybrid materials as antibacterial coatings for titanium implants.

To avoid dental implant-related infections and to promote the osseointegration of titanium implants, the application of silicon and chitosan containing coatings is proposed. Silicon is a well-known osteogenic element and chitosan was selected to confer the antibacterial properties. The synthesis of hybrid silica-chitosan coatings using the sol-gel process is presented and the characterization using 29Si-NMR to verify the correct formation of the network is discussed. The 13C NMR spectroscopy was used to confirm the covalent union between chitosan and the silicon network. Hydrolytic degradation and silicon release studies showed the effective silicon release from the hybrids and, hence, the possibility to promote bone formation. The introduction of different amounts of chitosan and tetraethyl orthosilicate (TEOS) modulated the Si release. The analysis of cell cultures in vitro demonstrated that the hybrid coatings were not cytotoxic and promoted cell proliferation on their surfaces. The coatings containing 5%-10% chitosan had substantial antibacterial properties.

Wellbeing of gay fathers with children born through surrogacy: a comparison with lesbian-mother families and heterosexual IVF parent families.

STUDY QUESTION: Are there differences in levels of parental wellbeing (parental stress, psychological adjustment and partner relationship satisfaction) between gay-father families with infants born through surrogacy, lesbian-mother families with infants born through donor insemination, and heterosexual-parent families with infants born through IVF? SUMMARY ANSWER: There were no differences in parental wellbeing. WHAT IS KNOWN ALREADY: The only other study of parental wellbeing in gay-father families formed through surrogacy (mean age children: 4 years old) found no difference in couple relationship satisfaction between these families and lesbian-mother families formed through donor insemination and heterosexual-parent families formed without assisted reproductive technologies. STUDY DESIGN, SIZE, DURATION: This cross-sectional study is part of an international research project involving 38 gay-father families, 61 lesbian-mother families and 41 heterosexual-parent families with 4-month-olds. In each country (the UK, the Netherlands and France), participants were recruited through several sources, such as specialist lawyers with expertise in surrogacy (for the recruitment of gay fathers), lesbian and gay parenting support groups, fertility clinics (for the recruitment of lesbian and heterosexual parents), and/or online forums and magazines. PARTICIPANTS/MATERIALS, SETTING, METHODS: During a home visit when their infants were between 3.5 and 4.5 months old, participants completed standardized measures of parental stress, parental psychological adjustment (anxiety and depression) and partner relationship satisfaction. MAIN RESULTS AND THE ROLE OF CHANCE: All parents reported relatively low levels of parental stress, anxiety and depression, and were all relatively satisfied with their intimate relationships. After controlling for caregiver role (primary or secondary caregiver role), there were no significant family type differences in parental stress, P = 0.949, depression, P = 0.089, anxiety, P = 0.117, or relationship satisfaction, P = 0.354. LIMITATIONS, REASONS FOR CAUTION: The findings cannot be generalized to all first-time ART parents with infants because only families from relatively privileged backgrounds participated. WIDER IMPLICATIONS OF THE FINDINGS: Our findings may have implications for the development of policy and legislation in relation to these new family forms, as well as the regulation of surrogacy in the Netherlands and France. In addition, our findings might encourage professional organizations of obstetricians and gynecologists in these countries to recommend that requests for assisted reproduction should be considered regardless of the applicants' sexual orientation. STUDY FUNDING/COMPETING INTEREST(S): This research was supported, under the auspices of the Open Research Area (Application BO 3973/1-1; Principal Investigator, Michael E Lamb), by grants from the UK Economic and Social Research Council (ESRC; Grant ES/K006150/1; Principal Investigator, Michael E. Lamb), The Netherlands Organisation for Scientific Research (NWO; Grant NWO 464-11-001, Principal Investigator, Henny W.M. Bos) and the French Agence Nationale de Recherche (ANR; Grant ANR-12-ORAR-00005-01, Principal Investigator, Olivier Vecho) whose support is gratefully acknowledged. There were no competing interests.

Two-Proton Radioactivity of

In an experiment with the BigRIPS separator at the RIKEN Nishina Center, we observed two-proton (2p) emission from ^{67}Kr. At the same time, no evidence for 2p emission of ^{59}Ge and ^{63}Se, two other potential candidates for this exotic radioactivity, could be observed. This observation is in line with Q value predictions which pointed to ^{67}Kr as being the best new candidate among the three for two-proton radioactivity. ^{67}Kr is only the fourth 2p ground-state emitter to be observed with a half-life of the order of a few milliseconds. The decay energy was determined to be 1690(17) keV, the 2p emission branching ratio is 37(14)%, and the half-life of ^{67}Kr is 7.4(30) ms.

Experimental Neutron Capture Rate Constraint Far from Stability.

Nuclear reactions where an exotic nucleus captures a neutron are critical for a wide variety of applications, from energy production and national security, to astrophysical processes, and nucleosynthesis. Neutron capture rates are well constrained near stable isotopes where experimental data are available; however, moving far from the valley of stability, uncertainties grow by orders of magnitude. This is due to the complete lack of experimental constraints, as the direct measurement of a neutron-capture reaction on a short-lived nucleus is extremely challenging. Here, we report on the first experimental extraction of a neutron capture reaction rate on ^{69}Ni, a nucleus that is five neutrons away from the last stable isotope of Ni. The implications of this measurement on nucleosynthesis around mass 70 are discussed, and the impact of similar future measurements on the understanding of the origin of the heavy elements in the cosmos is presented.

First Measurement of Several ß-Delayed Neutron Emitting Isotopes Beyond N=126.

The ß-delayed neutron emission probabilities of neutron rich Hg and Tl nuclei have been measured together with ß-decay half-lives for 20 isotopes of Au, Hg, Tl, Pb, and Bi in the mass region N≳126. These are the heaviest species where neutron emission has been observed so far. These measurements provide key information to evaluate the performance of nuclear microscopic and phenomenological models in reproducing the high-energy part of the ß-decay strength distribution. This provides important constraints on global theoretical models currently used in r-process nucleosynthesis.

Osteoma frontoetmoidal con extensión intraorbitaria. A propósito de un caso / Frontoethmoidal osteoma with orbital extension. A case report

CASO CLÍNICO: Presentamos el caso de un osteoma frontoetmoidal derecho con invasión intraorbitaria en un varón de 43 años que comenzó como un cuadro de dolor retroocular con proptosis, inflamación peripalpebral y diplopía binocular por limitación del recorrido muscular. Se realizó cirugía abierta mediante abordaje subcraneal anterior, con extirpación de varios fragmentos de osteoma, cuyo análisis histológico confirmó el diagnóstico. DISCUSIÓN: Los osteomas son tumores benignos formadores de hueso de crecimiento lento. Habitualmente son asintomáticos, hasta que producen complicaciones por efecto masa en el cerebro o en la órbita, o a nivel local, hasta que obstruyen el drenaje del seno donde asientan, generando mucoceles

CASE REPORT: A case is presented of a right frontoethmoidal osteoma with intraorbital invasion in a 43-year-old male, who was seen in the clinic with a proptosis, retro-orbital pain, peri-palpebral inflammation, and binocular diplopia due to muscular route limitation. Open surgery was performed using a subcranial approach, with removal of several fragments of osteoma. Histological analysis confirmed the diagnosis. DISCUSSION: Osteomas are benign bone-forming tumours with slow growth. They are usually asymptomatic until mass effect complications occur in the brain or in the orbit, or locally, generating mucoceles due to sinus drainage obstruction

Frontoethmoidal osteoma with orbital extension. A case report. / Osteoma frontoetmoidal con extensión intraorbitaria. A propósito de un caso.

CASE REPORT: A case is presented of a right frontoethmoidal osteoma with intraorbital invasion in a 43-year-old male, who was seen in the clinic with a proptosis, retro-orbital pain, peri-palpebral inflammation, and binocular diplopia due to muscular route limitation. Open surgery was performed using a subcranial approach, with removal of several fragments of osteoma. Histological analysis confirmed the diagnosis. DISCUSSION: Osteomas are benign bone-forming tumours with slow growth. They are usually asymptomatic until mass effect complications occur in the brain or in the orbit, or locally, generating mucoceles due to sinus drainage obstruction.

Effects of grape pomace in growing lamb diets compared with vitamin E and grape seed extract on meat shelf life.

The effect of dietary treatment (CTRL, control; VIT-E, 500 mg kg(-1) vitamin E; GSE, 50 mg grape seed extract kg(-1); GP-5, 5% dried red grape pomace kg(-1)) on shelf life of lamb meat was studied. After slaughter (27 kg LBW), m. longissimus thoracis et lumborum was sliced, packaged under modified atmosphere (80:20%/O2:CO2) and stored in retail conditions for 14 days. At each sampling day (0, 4, 7, 11, 14), microbiological, physico-chemical and sensory characteristics were analysed. Meat from VIT-E presented lower microbial counts than CTRL, GSE and GP-5, without differences between polyphenol treatments (GSE and GP-5) and CTRL. Vitamin E reduced meat discoloration and lipid oxidation (TBARS values) from day 7 with respect to the other treatments. Although not significant, an improvement in TBARS values of about 20% was observed for GSE and GP-5, compared with CTRL, from day 7 of storage. VIT-E dietary treatment was more effective in preventing sensory spoilage than the other treatments.

Evaluation of different strategies to mask boar taint in cooked sausage.

The use of smoking and/or spices was evaluated for their ability to mask boar taint in frankfurters manufactured from entire pigs with high levels of androstenone. Five frankfurter types were considered: control, smoked, flavouring+smoked, spicy and spicy+smoked. A trained panel in androstenone perception carried out a sensory profile on the different sausages. The highest scores for androstenone perception (odour, flavour and aftertaste) were found in frankfurters that included no masking strategy which indicated the effectiveness of the evaluated strategies. Regarding masking strategies, the contribution of spices and smoking to sensory perception of frankfurters was detected by the panellists. Smoking was the best strategy to mask androstenone odour, while the use of spices masked androstenone odour to a greater extent than androstenone flavour. Only the combined use of spices and smoking was able to eliminate the perception of androstenone. The application of this strategy in frankfurters could be an alternative in the commercialization of entire pigs.

Recomendaciones sobre la prevención de intoxicaciones / Recommendations for the prevention of poisoning

Las intoxicaciones constituyen la quinta causa de muerte por una lesión no intencionada en la región europea de la OMS, si bien España se encuentra en el grupo con una menor tasa. La mayoría de las intoxicaciones no voluntarias se dan en niños pequeños, en su casa, por la ingesta de medicamentos o productos del hogar. De estos últimos un porcentaje importante se almacena en recipientes no originales o al alcance de los niños. En el presente artículo, el Comité de Seguridad y Prevención de Lesiones No Intencionadas en la Infancia de la Asociación Española de Pediatría proporciona una serie de recomendaciones tanto educativas como legales para prevenir este tipo de lesiones

Poisoning is the fifth leading cause of death from unintentional injury in the WHO European region, while Spain is in the group with a lower rate. Most involuntary poisonings occur in young children while they are at the home, due to unintentional ingestion of therapeutic drugs or household products. Of these, a large percentage is stored in non-original containers and/or within reach of children. In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Pediatrics provides a series of recommendations, educational as well as legal, to prevent such cases

Nonquenched Isoscalar Spin-M1 Excitations in sd-Shell Nuclei.

Differential cross sections of isoscalar and isovector spin-M1 (0(+)→1(+)) transitions are measured using high-energy-resolution proton inelastic scattering at E(p)=295 MeV on (24)Mg, (28)Si, (32)S, and (36)Ar at 0°-14°. The squared spin-M1 nuclear transition matrix elements are deduced from the measured differential cross sections by applying empirically determined unit cross sections based on the assumption of isospin symmetry. The ratios of the squared nuclear matrix elements accumulated up to E(x)=16 MeV compared to a shell-model prediction are 1.01(9) for isoscalar and 0.61(6) for isovector spin-M1 transitions, respectively. Thus, no quenching is observed for isoscalar spin-M1 transitions, while the matrix elements for isovector spin-M1 transitions are quenched by an amount comparable with the analogous Gamow-Teller transitions on those target nuclei.