Wnt Signaling Coordinates the Expression of Limb Patterning Genes During Axolotl Forelimb Development and Regeneration.

After amputation, axolotl salamanders can regenerate their limbs, but the degree to which limb regeneration recapitulates limb development remains unclear. One limitation in answering this question is our lack of knowledge about salamander limb development. Here, we address this question by studying expression patterns of genes important for limb patterning during axolotl salamander limb development and regeneration. We focus on the Wnt signaling pathway because it regulates multiple functions during tetrapod limb development, including limb bud initiation, outgrowth, patterning, and skeletal differentiation. We use fluorescence in situ hybridization to show the expression of Wnt ligands, Wnt receptors, and limb patterning genes in developing and regenerating limbs. Inhibition of Wnt ligand secretion permanently blocks limb bud outgrowth when treated early in limb development. Inhibiting Wnt signaling during limb outgrowth decreases the expression of critical signaling genes, including Fgf10, Fgf8, and Shh, leading to the reduced outgrowth of the limb. Patterns of gene expression are similar between developing and regenerating limbs. Inhibition of Wnt signaling during regeneration impacted patterning gene expression similarly. Overall, our findings suggest that limb development and regeneration utilize Wnt signaling similarly. It also provides new insights into the interaction of Wnt signaling with other signaling pathways during salamander limb development and regeneration.

Análisis poblacional de la prescripción potencialmente inadecuada en ancianos según criterios STOPP/START (estudio STARTREC) / Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)

OBJETIVO: Racionalizar la prescripción en la población anciana es una prioridad de los sistemas sanitarios. Los criterios STOPP/START permiten detectar la prescripción potencialmente inadecuada (PPI) a nivel individual. Su aplicación a nivel poblacional permite determinar la prevalencia de PPI y su relación con diversas variables del paciente y del sistema sanitario. El objetivo de este estudio es analizar la prevalencia de PPI en población anciana a partir de bases de datos clínicos y de farmacia. DISEÑO: Estudio descriptivo transversal. Emplazamiento: Ámbito de atención primaria de la Región Sanitaria de Lleida, España. PARTICIPANTES: Se incluyen 45.408 pacientes de 70 años o más atendidos en los centros de salud como mínimo una vez en el último año. Mediciones principales: Se calcula la frecuencia de incumplimiento de 43 indicadores STOPP y 12 indicadores START, a partir de los fármacos prescritos durante un año y se ajustan modelos de regresión logística para evaluar su asociación con diversas variables. RESULTADOS: El 58% son mujeres. La edad media es de 79,7 años. El 58,1% incumplen como mínimo un criterio STOPP y/o START, relacionados principalmente con el uso de benzodiacepinas, antiinflamatorios no esteroideos e inhibidores de la bomba de protones por exceso, y los tratamientos para la osteoporosis, antiagregantes, estatinas, metformina y betabloqueantes por omisión. La PPI aumenta con la edad y la polifarmacia y es superior en pacientes ingresados en centros geriátricos y domiciliarios que en los ambulatorios. CONCLUSIONES: Los criterios STOPP/START identifican PPI en más de la mitad de pacientes ancianos de una región sanitaria española

OBJECTIVE: Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. DESIGN: Cross-sectional population study. Settings: Primary Care, Lleida Health Region, Spain. PARTICIPANTS: 45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year. METHODS: 43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS: 45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care. CONCLUSIONS: In our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria

Assessment of the length of sick leave in patients with ischemic heart disease.

BACKGROUND: The prevalence of ischemic heart disease is high. Few recent studies have investigated the periods of sick leave of these patients. Our aim is to determine the length of sick leave after an acute coronary syndrome, its costs, associated factors and to assess the use of antidepressants and/or anxiolytics. METHODS: An observational study of a retrospective cohort of patients on sick leave due to ischemic heart disease in a health region between 2008-2011, with follow-up until the first return to work, death, or end of the study (31/12/2012). MEASUREMENTS: length of sick leave, sociodemographic variables and medical prescriptions. RESULTS: Four hundred and ninety-seven patients (mean age 53 years, 90.7% male), diagnosed with acute myocardial infarction (60%), angina pectoris (20.7%) or chronic form of ischemic heart disease (19.1%). Thirty-seven per cent of patients took anxiolytics the year after diagnosis and 15% took antidepressants. The average duration of sick leave was 177 days (95% CI: 163-191 days). Patients diagnosed with acute myocardial infarction returned to work after a mean of 192 days, compared to 128 days in cases with angina pectoris. Patients who took antidepressants during the year after diagnosis returned to work after a mean of 240 days. The mean work productivity loss was estimated to be 9,673 euros/person. CONCLUSIONS: The mean duration of sick leave due to ischemic heart disease was almost six months. Consumption of psychotropic medication doubled after the event. Older age, suffering an acute myocardial infarction and taking antidepressants were associated with a longer sick leave period.

[Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)]. / Análisis poblacional de la prescripción potencialmente inadecuada en ancianos según criterios STOPP/START (estudio STARTREC).

OBJECTIVE: Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. DESIGN: Cross-sectional population study. SETTINGS: Primary Care, Lleida Health Region, Spain. PARTICIPANTS: 45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year. METHODS: 43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS: 45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care. CONCLUSIONS: In our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria.

Pacientes con el diagnóstico de insuficiencia cardiaca en Atención Primaria: envejecimiento, comorbilidad y polifarmacia / Heart failure patients in Primary Care: aging, comorbidities and polypharmacy

ObjetivoDescribir el perfil clínico y de consumo farmacológico de los pacientes con registro diagnóstico de insuficiencia cardiaca (IC) en una región sanitaria, a partir de los registros informáticos. Ver si existen diferencias por sexos.DiseñoEstudio descriptivo transversal multicéntrico.EmplazamientoRegión Sanitaria de Lleida.ParticipantesToda la población adscrita a 21 centros de salud, diagnosticada de IC (3.017 de 306.229).Mediciones principalesDatos demográficos, comorbilidades y subgrupos terapéuticos en pacientes con el diagnóstico de IC en la historia clínica.ResultadosRegistro de IC 0,99%, 59% mujeres, media de edad 80 años. Antecedentes: hipertensión 67%, fibrilación auricular (FA) 31%, diabetes (DM2) 30%, obesidad 27%, dislipemia 26,5%, asma/EPOC 26%, cardiopatía isquémica (CI) 19%, accidente vascular cerebral (AVC) 11%, e insuficiencia renal (IR) 12%. Hipertensión, dislipemia y obesidad son más frecuentes en mujeres y EPOC, CI e IR en hombres. No hay diferencias en DM2, AVC ni FA. Mediana de consumo de subgrupos terapéuticos por paciente durante el 2007 de 8 (P25=6 y P75=11). Las mujeres tienen mayor prescripción de diuréticos (76% vs 71%), glucósidos cardíacos (22% vs 19.3%) e IECA/ARAII (68% vs 64%) y los hombres de tratamiento combinado IECA/ARAII+beta bloqueantes (26,9% vs 23,5%). Hay una tendencia a mayor prescripción de estos últimos en hombres sin ser significativa.ConclusionesLos pacientes diagnosticados de IC en Atención Primaria son de edad muy avanzada, presentan pluripatología asociada y consumen muchos fármacos. Existen diferencias por sexos tanto en factores de riesgo cardiovascular y enfermedades asociadas como en el perfil de consumo farmacológico(AU)

ObjectiveTo assess heart failure prevalence, epidemiology, co-morbidities and polypharmacy in our region from electronic patient records. To evaluate gender differences in heart failure patients.DesignDescriptive, cross-sectional study.SettingPrimary care Lleida (Spain).ParticipantsAll patients from 21 primary care centers with the diagnosis of heart failure in medical records were included.Main outcome measurementsDemografic data, comorbidities and therapeutical subgroups in patients with a diagnosis of heart failure in their clinical record.ResultsHeart failure was found in 0.99% (3017 from 306229 patients), of whom 59% were women, and a mean age of 80 years. Comorbidities: hypertension 67%, diabetes 30%, hyperlipidemia 26.5%, obesity 27%, ischemic heart disease 19%, stroke 11%, atrial fibrillation 31%, COPD 26%, renal failure 12%. Hypertension, hyperlipidemia and obesity were more frequent in women, COPD, ischemic heart disease and renal failure in men. There were no differences in diabetes, stroke and atrial fibrillation. Patients were prescribed a median of 8 different therapeutic subgroups (P25=6 and P75=11). Women were more frequently prescribed diuretics (76%), cardiac glycosides (22%) and ACE inhibitors/angiotensin II receptor antagonists, and men ACE inhibitors/angiotensin II receptor antagonists in combination with beta-blockers.ConclusionsHeart failure patients in primary care are elderly, with significant co-morbidities and treated with a high number of drugs. Gender differences exist in cardiovascular risk factors, co-morbidities, and also in therapy(AU)

Influencia del sexo en la incapacidad laboral por depresión / Influence of gender in sick leave due to depression

Objetivo: Determinar si hay diferencias por sexo en la incapacidad laboral transitoria (IT) por depresión respecto a la edad, el diagnóstico, la duración y la frecuentación. Pacientes y método: Estudio descriptivo y transversal, realizado en 2004. Población diana: población de más de 15 años de la región sanitaria (RS) de Lleida, laboralmente activa, con baja por depresión. Medidas: estadística descriptiva; comparación de medias y proporciones. Resultados: De las 182.895 personas de la RS, 1.902 estuvieron de baja por depresión. El 62,7% eran mujeres. La edad media ± desviación estándar (DE) fue 40,5 años ± 11,3 años, sin diferencias significativas por sexos (mujeres, 40 años; varones, 41 años; p = 0,3188). El 50,1% presentaba un trastorno depresivo; el 48,1%, un trastorno mixto por ansiedad-depresión y el 1,8%, un trastorno bipolar. La distribución de diagnósticos por sexo mostraba un predominio del trastorno bipolar en los varones (el 3,94 frente al 0,5%) y del mixto en las mujeres (el 49,66 frente al 45,49%) (*2 = 31,86; p < 0,0001). La duración media fue de 88 ± 98 días (mediana, 46 días), con un promedio de 7 ± 7 visitas (mediana, 4 visitas), sin diferencias significativas por sexo (p = 0,3186 y p = 0,3382, respectivamente). Conclusiones: A pesar que la mayoría de casos de IT por depresión corresponden a mujeres, el sexo no determina diferencias en el proceso de IT. La distribución de diagnósticos por sexo refleja la de la población general

Objective: To determine whether there are any gender differences in sick leave due to depression in relation to age, diagnosis, duration, and attendance rates. Patients and method: A descriptive cross-sectional study was performed in 2004. Population: Population over 15 years old in the health area of Lerida, Spain, registered as active workers who took sick leave for depression. Measurements: Descriptive statistics with comparisons of means and percentages. Results: Of 182,895 people in the health area, 1,902 took sick leave due to depression. Women represented 62.7%. The mean age was 40.5 ± 11.3 years old with no significant differences by gender (women: 40 years, men: 41 years; P=.3188). A total of 50.1% had depressive disorder, 48.1% had mixed anxiety-depressive disorder, and 1.8% had bipolar disorder. The distribution of diagnoses by gender showed a predominance of bipolar disorder among men (3.94% versus 0.5%) and mixed anxiety-depressive disorder among women (49.66% versus 45.49%) (x2 = 31.86; P<.0001). The mean duration of sick leave was 88 ± 98 days (median: 46 days) with a mean attendance rate of 7 ± 7 visits (median: 4 visits) with no significant differences by gender (P=.3186 and P=.3382 respectively). Conclusions: Although women predominate among persons taking sick leave for depression, differences in sick leave are not determined by gender. The distribution of diagnoses by gender reflects that of the general population

[Evolution in consumption of anti-depressants during the years 2002 to 2004]. / Evolución en el consumo de antidepresivos durante los años 2002 a 2004.

OBJECTIVE: To analyse the use of antidepressants from 2002 to 2004 and the length of treatment. DESIGN: Cross-sectional, descriptive study of antidepressant drugs prescribed through the National Health System during 2002-2004. SETTING: Lleida Health Region, Spain. PARTICIPANTS: A total of 54,890 patients received an antidepressant drug between 2002 and 2004. MEASUREMENTS: Age, sex, medicine, prescription period, centre. RESULTS: The prevalence of antidepressant treatment was: 8.4% in 2002 (368,976 inhabitants); 8.6% in 2003 (376,638 inhabitants); and 8.7% in 2004 (388,148 inhabitants). The increase in antidepressant treatment in 2004 over 2002 was 9.4%. Prevalence among men was 5.4% and women, 12.7%. The distribution according to antidepressant classes was: selective serotonin reuptake inhibitors, 73.7%; tricyclic antidepressants, 26.2%; heterocyclic antidepressants, 10%, and monoamine oxidase inhibitors, 0.1%. The duration of treatment was 1 to 3 months (43%), 4 to 12 months (22.7%), 13 to 24 months (14.4%), and over 24 months (19.9%). CONCLUSIONS: A steady increase in the use of antidepressants is being observed, predominantly new drugs. Regarding the length of treatment, a high proportion of patients are treated for under 4 months, which does not follow recent recommendations in the scientific literature for treatment of depression. This is a major element of inefficiency in the health system.

Evolución en el consumo de antidepresivos durante los años 2002 a 2004 / Evolution in consumption of anti-depressants during the years 2002 to 2004

Objetivo. Analizar el consumo de fármacos antidepresivos y la duración del tratamiento antidepresivo durante los años 2002 a 2004. Diseño. Estudio descriptivo, transversal, de las dispensaciones de medicamentos antidepresivos realizadas mediante receta del Sistema Nacional de Salud. Emplazamiento. Región Sanitaria de Lleida. Participantes. Han participado 54.890 individuos que han recibido algún fármaco antidepresivo durante los años 2002 a 2004. Mediciones principales. Edad, sexo, medicamento, período de dispensación, centro. Resultados. La prevalencia anual de tratamiento antidepresivo ha sido del 8,4% en 2002 (368.976 habitantes), del 8,6% en 2003 (376.638 habitantes) y del 8,7% en 2004 (388.148 habitantes). El incremento en el porcentaje de pacientes en tratamiento en 2004 respecto al 2002 es de un 9,4%. La prevalencia en los varones es del 5,4% y en las mujeres del 12,7%. La distribución por grupos de fármacos antidepresivos es la siguiente: inhibidores selectivos de la recaptación de serotonina un 73,7%, antidepresivos tricíclicos un 26,2%, heterocíclicos un 10% e inhibidores de la monoaminooxidasa un 0,1%. La duración del tratamiento ha sido de 1-3 meses en el 43%, 4-12 meses en el 22,7%, 13-24 meses en el 14,4% y > 24 meses en el 19,9%. Conclusiones. Hay un incremento progresivo en las prescripciones de antidepresivos, con predominio de nuevas moléculas. Respecto a la duración del tratamiento, un porcentaje elevado de individuos realiza tratamientos < 4 meses, hecho contradictorio con las recomendaciones de la literatura científica para el tratamiento de la depresión. Este hecho conlleva una importante ineficiencia del sistema sanitario

Objective. To analyse the use of antidepressants from 2002 to 2004 and the length of treatment. Design. Cross-sectional, descriptive study of antidepressant drugs prescribed through the National Health System during 2002-2004. Setting. Lleida Health Region, Spain. Participants. A total of 54 890 patients received an antidepressant drug between 2002 and 2004. Measurements. Age, sex, medicine, prescription period, centre. Results. The prevalence of antidepressant treatment was: 8.4% in 2002 (368 976 inhabitants); 8.6% in 2003 (376 638 inhabitants); and 8.7% in 2004 (388 148 inhabitants). The increase in antidepressant treatment in 2004 over 2002 was 9.4%. Prevalence among men was 5.4% and women, 12.7%. The distribution according to antidepressant classes was: selective serotonin reuptake inhibitors, 73.7%; tricyclic antidepressants, 26.2%; heterocyclic antidepressants, 10%, and monoamine oxidase inhibitors, 0.1%. The duration of treatment was 1 to 3 months (43%), 4 to 12 months (22.7%), 13 to 24 months (14.4%), and over 24 months (19.9%). Conclusions. A steady increase in the use of antidepressants is being observed, predominantly new drugs. Regarding the length of treatment, a high proportion of patients are treated for under 4 months, which does not follow recent recommendations in the scientific literature for treatment of depression. This is a major element of inefficiency in the health system

[Estimate of hypothyroidism prevalence in Lleida, Spain, based on thyroid hormone prescription]. / Estimación de la prevalencia de hipotiroidismo en lleida a partir de la prescripción de hormonas tiroideas.

BACKGROUND: Hypothyroidism is a common disease sometimes showing no specific symptoms, thus being difficult to diagnose. This study is aimed at estimating the prevalence of hypothyroidism in Lleida by way of thyroid hormone prescriptions and comparing the results with those from other regions. METHODS: A retrospective observational study. A total of 2,854 individuals undergoing thyroid hormone treatment through Social Insurance prescriptions. Moths of October-December 2001. VARIABLES: age, sex and healthcare region. RESULT: The prevalence of hypothyroidism for 2001 is 8.4 cases per 1000 inhabitants/day (IC 95%: 9.23-7.47). Average age: 60 (DS <:16.6). Age spread: 2.4@1000 among males and 12.4@1000 among females. By age groups: Under age 15:3., 6@1000, 15-64 age group, 6.8@1000 and those over age 64, 12.5@1000. The highest figures were found in the rural areas (Seu d'Urgell: 10.5@1000), and the lowest in urban areas (Example: 5.8@1000, Balafia: 5.4@1000) CONCLUSIONS: Hypothyroidism under treatment figure is, as in other studies, higher among females and predominant among those over 64 years of age. We however found prevalence values lower than the data from a prior populational study for the same region, indicating a possible underdiagnosing of this disease.

Estimación de la prevalencia de hipotiroidismo en Lleida a partir de la prescripción de hormonas tiroideas / Estimate of hypothyroidism prevalence in Lleida, Spain, based on thyroid hormone prescription

Fundamento: El hipotiroidismo es una enfermedad frecuente, que cursa con una sintomatología, en ocasiones inespecífica, lo que dificulta el diagnóstico. El objetivo del estudio es estimar la prevalencia de hipotiroidismo en Lleida a través de las prescripciones de la hormona tiroidea y comparar los resultados con los de otras regiones. Métodos: Estudio observacional retrospectivo. 2.854 personas que reciben tratamiento con hormona tiroidea mediante receta de la Seguridad Social. Meses de octubre a diciembre del 2001. Variables: la edad, el sexo y región sanitaria. Resultados: La prevalencia de hipotiroidismo en el 2001 es de 8,4 casos por 1.000 habitantes día (IC 95 por ciento:9,23-7,47). La edad media es de 60 años (DS<:16,6). La distribución por sexo: 2,4 en hombres y 12,4 en mujeres. Por grupos de edad: Menores de 15 años un 3,6, entre 15 y 64 años de 6,8 y en mayores de 64 de 12,5. Las cifras más elevadas se encuentran en las áreas rurales (Seu d'Urgell:10,5 )y las inferiores en áreas urbanas(Eixample:5,8 , Balafia:5,4) Conclusiones: La cifra de hipotiroidismo en tratamiento es, como en otros estudios, superior en mujeres y predomina en los mayores de 64 años. Sin embargo, observamos valores de prevalencia inferiores en relación a los datos de un estudio poblacional previo de la misma región, indicando un posible infradiagnóstico de la enfermedad (AU)