Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population.

OBJECTIVES: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Effect of air pollutants on ambulatory blood pressure.

BACKGROUND AND METHODOLOGY: Air pollutants have a significant impact on public health. The aim of the study was to find out the relationship between ambulatory blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) and the atmospheric pollutants that are measured regularly (PM10, PM2.5, NO2 and SO2). An observational study of temporal and geographic measurements of individual patients (case-time series design) was carried out in Primary Care Centres and Hypertension Units in the Barcelona metropolitan area. We included 2888 hypertensive patients≥18 years old, untreated, with a first valid ABPM performed between 2005 and 2014 and with at least one air pollution station within a radius of <3km. RESULTS AND CONCLUSIONS: The mean age was 54.3 (SD 14.6) years. 50.1% were women and 16.9% of the sample were smokers. Mean 24-h blood pressure (BP) was 128.0 (12.7)/77.4 (9.7) mmHg. After adjusting for mean ambient temperature and different risk factors, a significant association was found between ambulatory diastolic BP (DBP) and PM10 concentrations the day before ABPM. For each increase of 10µg/m3 of PM10, an increase of 1.37mmHg 24-h DBP and 1.48mmHg daytime DBP was observed. No relationship was found between PM2.5, NO2 and SO2 and ambulatory BP, nor between any pollutant and clinical BP. The concentration of PM10 the day before the ABPM is significantly associated with an increase in 24-h DBP and daytime DBP.

Effect of air pollutants on ambulatory blood pressure / Efectos de los contaminantes aéreos en la presión arterial ambulatoria

Background and methodology: Air pollutants have a significant impact on public health. The aim of the study was to find out the relationship between ambulatory blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) and the atmospheric pollutants that are measured regularly (PM10, PM2.5, NO2 and SO2). An observational study of temporal and geographic measurements of individual patients (case-time series design) was carried out in Primary Care Centres and Hypertension Units in the Barcelona metropolitan area. We included 2888 hypertensive patients≥18 years old, untreated, with a first valid ABPM performed between 2005 and 2014 and with at least one air pollution station within a radius of <3km. Results and conclusions: The mean age was 54.3 (SD 14.6) years. 50.1% were women and 16.9% of the sample were smokers. Mean 24-h blood pressure (BP) was 128.0 (12.7)/77.4 (9.7) mmHg. After adjusting for mean ambient temperature and different risk factors, a significant association was found between ambulatory diastolic BP (DBP) and PM10 concentrations the day before ABPM. For each increase of 10μg/m3 of PM10, an increase of 1.37mmHg 24-h DBP and 1.48mmHg daytime DBP was observed. No relationship was found between PM2.5, NO2 and SO2 and ambulatory BP, nor between any pollutant and clinical BP. The concentration of PM10 the day before the ABPM is significantly associated with an increase in 24-h DBP and daytime DBP. (AU)

Antecedentes y metodología: Los contaminantes aéreos tienen un impacto importante en la salud pública. El objetivo del estudio era conocer la relación entre la presión arterial ambulatoria medida mediante monitorización ambulatoria de la presión arterial (MAPA) de 24h y los contaminantes atmosféricos que se miden regularmente (PM10, PM2,5, NO2 y SO2). Se realizó un estudio observacional de medidas temporales y geográficas de pacientes individuales (case-time series design) en centros de atención primaria y unidades de hipertensión del área metropolitana de Barcelona. Se incluyeron 2.888 pacientes hipertensos≥18 años, no tratados, con una primera MAPA válida realizada entre 2005-2014 y al menos con una estación de contaminación atmosférica en un radio<3km. Resultados y conclusiones: La media de edad fue de 54,3 (DE 14,6) años. El 50,1% eran mujeres y el 16,9% de la muestra eran fumadores. La presión arterial (PA) de 24h fue de 128,0 (12,7)/77,4 (9,7)mmHg. Tras ajustarse por la temperatura ambiental media y por los diferentes factores de riesgo se halló una asociación significativa entre PA diastólica (PAD) ambulatoria y las concentraciones de PM10 del día anterior a la MAPA. Por cada incremento de 10μg/m3 de PM10 se observaba un aumento de 1,37mmHg PAD 24h y de 1,48mmHg PAD diurna. No se halló relación entre PM2,5, NO2 y SO2 y PA ambulatoria, ni entre ningún contaminante y PA clínica. La concentración de PM10 del día anterior a la realización de la MAPA se asocia significativamente con un aumento de PAD 24h y PAD diurna. (AU)

Efecto de las técnicas de inducción miofascial en la reducción del dolor en pacientes con dolor miofascial pélvico crónico / Effect of myofascial induction techniques on pain reduction in patients with myofascial chronic pelvic pain

Introducción y objetivo El dolor miofascial pélvico crónico es una patología con una elevada prevalencia, y de etiología muy diversa, al igual que su tratamiento. No se ha establecido un protocolo de tratamiento, y hasta el momento, se recomienda un abordaje multidisciplinar. El objetivo es evaluar el efecto de un protocolo basado en 10 sesiones de técnicas de inducción miofascial (TIM) en pacientes con dolor miofascial pélvico crónico (DMPC). Material y métodos Se realizó un estudio cuasi experimental (antes-después), con una intervención basada en TIM adaptadas a la localización del dolor de los pacientes. Se evaluó la intensidad del dolor mediante la escala visual analógica (EVA) y la calidad de vida, tanto física como mental, mediante el cuestionario de salud SF-12v2. Para valorar el efecto de las TIM, se compararon los resultados preintervención-postintervención mediante la prueba t de Student para datos apareados y el test no paramétrico de Wilcoxon. Resultados Se incluyeron 50 pacientes en el estudio (27 mujeres y 23 hombres), con una edad media de 44,8 años (desviación estándar [DE] 12,1) y una duración media de los síntomas de 58,3 meses (DE 60,5). El análisis por protocolo mostró que la intensidad del dolor disminuyó en 3,99 puntos al final de la intervención y la calidad de vida mejoró en los sumatorios físico y mental en 5,45 y 5,87 puntos, respectivamente (p < 0,05). El 86,7% de los pacientes completó el protocolo de tratamiento. Conclusiones En un grupo de pacientes con dolor miofascial pélvico crónico, las TIM parecen tener un efecto beneficioso significativo, reduciendo el dolor y mejorando la calidad de vida (AU)

Introduction and objective Myofascial Chronic Pelvic Pain (MCPP) is a pathology with a high prevalence, and an aetiology as diverse is its treatment. A treatment protocol has not yet been established and a multidisciplinary approach is currently recommended. The aim is to evaluate the effect of a Myofascial Induction Techniques (MIT) protocol based on 10 sessions in patients with Myofascial Chronic Pelvic Pain. Material and methods A quasi-experimental study (before-after) was carried out, with an intervention based on MIT adapted to the location of the pain. Pain intensity was evaluated using the Visual Analogue Scale and quality of life, both physical and mental, was assessed using the SF-12v2 Health Survey questionnaire. To assess the effect of MIT, the pre-intervention and post-intervention results were compared using the Student's t test for paired data, and the non-parametric Wilcoxon test. Results 50 patients were included in the study (27 women and 23 men), with a mean age of 44.8 years (SD 12.1), and a mean duration of symptoms of 58.3 months (SD 60.5). The protocol analysis showed that pain intensity decreased by 3.99 points at the end of the intervention and quality of life improved in the physical and mental scores by 5.45 and 5.87 points, respectively (p < 0.05). Of the patients, 86.7% completed the treatment protocol. Conclusions In a group of patients with myofascial chronic pelvic pain, MIT appear to have a significant beneficial effect, reducing pain and improving quality of life (AU)

Efficacy of capacitive resistive monopolar radiofrequency in the physiotherapeutic treatment of chronic pelvic pain syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder that affects 5.7% to 26.6% of women and 2.2% to 9.7% of men, characterized by hypersensitivity of the central and peripheral nervous system affecting bladder and genital function. People with CPPS have much higher rates of psychological disorders (anxiety, depression, and catastrophizing) that increase the severity of chronic pain and worsen quality of life. Myofascial therapy, manual therapy, and treatment of trigger points are proven therapeutic options for this syndrome. This study aims to evaluate the efficacy of capacitive resistive monopolar radiofrequency (CRMRF) at 448 kHz as an adjunct treatment to other physiotherapeutic techniques for reducing pain and improving the quality of life of patients with CPPS. METHODS: This triple-blind (1:1) randomized controlled trial will include 80 women and men with CPPS. Participants will be randomized into a CRMRF activated group or a CRMRF deactivated group and receive physiotherapeutic techniques and pain education. The groups will undergo treatment for 10 consecutive weeks. At the beginning of the trial there will be an evaluation of pain intensity (using VAS), quality of life (using the SF-12), kinesiophobia (using the TSK-11), and catastrophism (using the PCS), as well as at the sixth and tenth sessions. DISCUSSION: The results of this study will show that CRMRF benefits the treatment of patients with CPPS, together with physiotherapeutic techniques and pain education. These results could offer an alternative conservative treatment option for these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT03797911 . Registered on 8 January 2019.

[Frequency of chest X-ray suggestive of SARS-CoV-2 involvement from March to May 2020 in the population of an urban health area]. / Frecuencia de Rx de tórax indicativas de afectación por SARS-CoV-2 de marzo a mayo de 2020 en la población de un área de salud urbana.

OBJECTIVE: Know the number and percentage of chest X-rays (CXR) referred to a Primary Care Imaging Center and Primary Care Emergency Center to rule out lung involvement due to SARS-CoV-2 from March 16 to May 15, 2020, in an urban health area of about 400,000 reference population inhabitants. To determine the percentage of cases suggestive of pulmonary involvement due to SARS-CoV-2 CXR and the percentage of cases without pulmonary involvement of the total CXR derived in the reference population from March 16 to May 15, 2020. MATERIAL AND METHODS: Design observational descriptive study. The radiological criteria to classify probable pulmonary infection by SARS-CoV-2 (RxT[+]) are: 1) focal opacity; 2) faint focal opacity; 3) faint diffuse increase in density; 4) focal or diffuse interstitial pattern, and 5) focal or diffuse interstitial alveolus pattern. RESULTS AND CONCLUSIONS: Maintain CXR as a useful screening method in the middle stages of the disease, when CXR is more sensitive to detect lung involvement due to SARS-CoV-2. Our graph of affectation by SARS-CoV-2 does not present assessable differences with the expected curve in an epidemic.

Which DSM validated tools for diagnosing depression are usable in primary care research? A systematic literature review.

INTRODUCTION: Depression occurs frequently in primary care. Its broad clinical variability makes it difficult to diagnose. This makes it essential that family practitioner (FP) researchers have validated tools to minimize bias in studies of everyday practice. Which tools validated against psychiatric examination, according to the major depression criteria of DSM-IV or 5, can be used for research purposes? METHOD: An international FP team conducted a systematic review using the following databases: Pubmed, Cochrane and Embase, from 2000/01/01 to 2015/10/01. RESULTS: The three databases search identified 770 abstracts: 546 abstracts were analyzed after duplicates had been removed (224 duplicates); 50 of the validity studies were eligible and 4 studies were included. In 4 studies, the following tools were found: GDS-5, GDS-15, GDS-30, CESD-R, HADS, PSC-51 and HSCL-25. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value were collected. The Youden index was calculated. DISCUSSION: Using efficiency data alone to compare these studies could be misleading. Additional reliability, reproducibility and ergonomic data will be essential for making comparisons. CONCLUSION: This study selected seven tools, usable in primary care research, for the diagnosis of depression. In order to define the best tools in terms of efficiency, reproducibility, reliability and ergonomics for research in primary care, and for care itself, further research will be essential.

[Impact of caring for grandchildren on the perceived health and social support of the grandmothers]. / Impacto del cuidado de los nietos en la salud percibida y el apoyo social de las abuelas.

OBJECTIVE: To find out the impact on health related quality of life and social support perceived by grandmothers caring for their grandchildren part time. DESIGN: Observational cross-sectional study. SETTING: Semi-urban primary care health area, in the metropolitan area of Barcelona, Spain. PARTICIPANTS: Women aged more than 55, randomised from the assigned population. Caregivers were grandmothers who took care of their grandchildren aged less than 8 years old, at least 4 hours a day, for 5 or more days a week without remuneration. VARIABLES: Perceived health was obtained by means of an SF-12 questionnaire and social support by a Duke-UNC questionnaire. Educational level, chronic illness, and characteristics associated with the care of grandchildren were recorded. RESULTS: Of the 129 participants, 44 were caregivers. Mean age was 62.4 (6.3) years. Social support was significantly higher in the group of caregivers than in the remainder (48.5 [40.2-53.7] vs 42.0 [36.0-47.0]; P=.006). No differences in health related quality of life between both groups were found. Perceived mental health was better when parents' work originated the need for care. Social support was greater when the parents were those who demanded the care. CONCLUSION: Grandchildren care improves perceived social support in grandmothers and it has no effect on perceived health status.

Impacto del cuidado de los nietos en la salud percibida y el apoyo social de las abuelas

Objetivo. Cono cer la repercusión del cuidado a tiempo parcial de los nietos sobre la calidad de vida relacionada con la salud y el apoyo social percibido por las abuelas cuidadoras. Diseño. Estudio observacional, transversal. Emplazamiento. Área básica de salud semiurbana, en el área metropolitana de Barcelona. Participantes. Muestra aleatoria de mujeres > 55 años. Eran cuidadoras las que se hacían cargo de sus nietos < 8 años, al menos 4h diarias durante 5 días por semana y sin recibir remuneración económica. Mediciones principales. La salud percibida se obtuvo mediante el cuestionario SF-12 y el apoyo social mediante el cuestionario de Duke-UNC. Se registraron el nivel de estudios, la presencia de enfermedades crónicas y las características relacionadas con el cuidado de los nietos. Resultados. De las 129 participantes, 44 eran cuidadoras. La edad media de la muestra fue 62,4 ± 6,3 años. El apoyo social percibido fue significantemente mayor en el grupo de cuidadoras que en el resto (48,5 [40,2-53,7] frente a 42,0 [36,0-47,0]; p=0,006). No se encontraron diferencias en la calidad de vida relacionada con la salud entre los 2 grupos. La salud mental percibida fue mejor cuando el motivo que originó el cuidado era el trabajo de los padres y el apoyo social fue mayor cuando la iniciativa del cuidado partió de los padres y peor cuando los nietos dormían en casa de la abuela. Conclusión. El cuidado de los nietos costituye un elemento favorecedor del apoyo social percibido por las abuelas y no tiene una repercusión significativa sobre su salud.(AU)

Impacto del cuidado de los nietos en la salud percibida y el apoyo social de las abuelas / Impact of caring for grandchildren on the perceived health and social support of the grandmthers

Objetivo. Conocer la repercusión del cuidado a tiempo parcial de los nietos sobre la calidad de vida relacionada con la salud y el apoyo social percibido por las abuelas cuidadoras. Diseño. Estudio observacional, transversal. Emplazamiento. Área básica de salud semiurbana, en el área metropolitana de Barcelona. Participantes. Muestra aleatoria de mujeres > 55 años. Eran cuidadoras las que se hacían cargo de sus nietos < 8 años, al menos 4 h diarias durante 5 días por semana y sin recibir remuneración económica. Mediciones principales. La salud percibida se obtuvo mediante el cuestionario SF-12 y el apoyo social mediante el cuestionario de Duke-UNC. Se registraron el nivel de estudios, la presencia de enfermedades crónicas y las características relacionadas con el cuidado de los nietos. Resultados. De las 129 participantes, 44 eran cuidadoras. La edad media de la muestra fue de 62,4 ± 6,3 años. El apoyo social percibido fue significativamente mayor en el grupo de cuidadoras que en el resto (48,5 [40,2-53,7] frente a 42,0 [36,0-47,0]; p = 0,006). No se encontraron diferencias en la calidad de vida relacionada con la salud entre los 2 grupos. La salud mental percibida fue mejor cuando el motivo que originó el cuidado era el trabajo de los padres y el apoyo social fue mayor cuando la iniciativa del cuidado partió de los padres y peor cuando los nietos dormían en casa de la abuela. Conclusión. El cuidado de los nietos constituye un elemento favorecedor del apoyo social percibido por las abuelas y no tiene una repercusión significativa sobre su salud

Objective. To find out the impact on health related quality of life and social support perceived by grandmothers caring for their grandchildren part time. Design. Observational cross-sectional study. Setting. Semi-urban primary care health area, in the metropolitan area of Barcelona, Spain. Participants. Women aged more than 55, randomised from the assigned population. Caregivers were grandmothers who took care of their grandchildren aged less than 8 years old, at least 4 hours a day, for 5 or more days a week without remuneration. Variables. Perceived health was obtained by means of an SF-12 questionnaire and social support by a Duke-UNC questionnaire. Educational level, chronic illness, and characteristics associated with the care of grandchildren were recorded. Results. Of the 129 participants, 44 were caregivers. Mean age was 62.4 (6.3) years. Social support was significantly higher in the group of caregivers than in the remainder (48.5 [40.2-53.7] vs 42.0 [36.0-47.0]; P=.006). No differences in health related quality of life between both groups were found. Perceived mental health was better when parents' work originated the need for care. Social support was greater when the parents were those who demanded the care. Conclusion. Grandchildren care improves perceived social support in grandmothers and it has no effect on perceived health status

Ofuji papuloerythroderma evolving to cutaneous T-cell lymphoma.

Ofuji papuloerythroderma is an uncommon entity of unknown aetiology, characterized by a pruritic eruption of widespread, red-brown, flat papules that leads to spare skin folds. A number of cases have been described associated with tumour pathology, mainly cutaneous T-cell lymphomas. We report a new case of Ofuji papuloerythroderma evolving to cutaneous T-cell lymphoma in an 85-year-old woman who had been previously diagnosed with papuloerythroderma 7 years previously.

[Ofujis papuloerythroderma. Presentation of 3 cases and review of its concept and etiology]. / Papuloeritrodermia de Ofuji. Presentación de tres casos y revisión de su concepto y etiología.

Ofuji's papuloerythroderma is not a specific clinical entity, but a concequence of numerous inflammatory dermatoses and neoplasms. Some authors advocate that it is possible to find this erupcion in elderly patients with different types of erythroderma of known or unknown origin. It is necessary to recognize this condition since these patients can develop a lymphoma in the future. In this article three atopic patients are described with clinical lesions of papuloerythroderma respecting the cutaneous folds, with eosinophilia, increase of the IgE levels and histological characteristics of atopic eczema. We think that atopic dermatitis should be considered in the etiologic study of patients with papuloerythroderma.

Neumonía nosocomial por Hafnia alvei / Nosocomial pneumonia caused by Hafnia alvei

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Papuloeritrodermia de Ofuji. Presentación de tres casos y revisión de su concepto y etiología / Ofuji´s papuloerythroderma. Presentation of 3 cases and review of its concept and etiology

La papuloeritrodermia de Ofuji no es una entidad clínica específica, sino consecuencia de numerosas dermatosis inflamatorias y neoplasias. Algunos autores sostienen que es posible encontrar esta erupción en pacientes ancianos con diferentes tipos de eritrodermia de origen conocido o desconocido. Debe reconocerse, ya que estos pacientes pueden desarrollar un linfoma en el futuro. Describimos tres pacientes atópicos con lesiones clínicas de papuloeritrodermia que respetaban los pliegues corporales, con eosinofilia, aumento de la IgE y características histológicas de eczema atópico. Pensamos que la dermatitis atópica debe considerarse en el estudio etiológico de pacientes con papuloeritrodermia (AU)

Sebaceus naevi: a clinicopathologic study.

OBJECTIVE: To analyse sebaceus naevus (SN) incidence, associated malignancies, and developmental defects in a retrospective study. METHODS: We retrospectively analysed all cases of SN excised in our Department over a 20-year period. All cases of epidermal naevus syndrome (Schimmelpenning syndrome) associated with SN were recorded, as well as all patients with histological changes suggesting degeneration of the initial SN. RESULT: A total 226 patients with SN were included in the study. Stage II was the most common (65%), and the parietal area was the most common location of SN (42%), with only 7% located in non-scalp areas. Syringocystadenoma papilliferum and trichoblastoma were the most common tumours arising on SN. We only found five patients with basal cell carcinoma arising on previous SN. Epidermal naevus syndrome associated with SN was diagnosed in 16 patients, and this was the most common neurocutaneous association. CONCLUSION: The incidence of malignancy arising on SN was very low, indicating that prophylactic surgery of NS in children is not recommendable. Developmental defects should be investigated in order to evidence possible epidermal naevus syndrome associated with SN.

Acanthosis nigricans: a new cutaneous sign in severe atopic dermatitis and Down syndrome.

Acanthosis nigricans (AN) occurs associated with many different systemic diseases, such as endocrine disorders and internal malignant neoplasms. To our knowledge, the association of AN with severe atopic dermatitis (AD) or Down syndrome has not been described before. This 82-month retrospective study included 1038 patients: AN was present in 4.9% of atopic patients and 50.9% of subjects with Down syndrome. AN was more frequent in patients with severe AD and in 100% of cases of hand dermatitis and juvenile plantar dermatosis, located on the interphalangeal and metacarpophalangeal joints, whereas in Down syndrome other flexures were also affected. The pathogenesis of AN in AD is unknown, but in Down syndrome it seems to be related to obesity. Possible insulin resistance underlyng the pathogenesis of AN in these patients is still unknown.