Flexible circumferential bioelectronics to enable 360-degree recording and stimulation of the spinal cord.

The spinal cord is crucial for transmitting motor and sensory information between the brain and peripheral systems. Spinal cord injuries can lead to severe consequences, including paralysis and autonomic dysfunction. We introduce thin-film, flexible electronics for circumferential interfacing with the spinal cord. This method enables simultaneous recording and stimulation of dorsal, lateral, and ventral tracts with a single device. Our findings include successful motor and sensory signal capture and elicitation in anesthetized rats, a proof-of-concept closed-loop system for bridging complete spinal cord injuries, and device safety verification in freely moving rodents. Moreover, we demonstrate potential for human application through a cadaver model. This method sees a clear route to the clinic by using materials and surgical practices that mitigate risk during implantation and preserve cord integrity.

The Link between Abstract Thinking Style and Subjective Well-Being: Its Impact when People are in (Real or Perceived) Financial Scarcity

Across three studies, we explored the link between an abstract mindset and subjective well-being (SWB) in participants with real and/or perceived financial scarcity. In Studies 1 and 2, samples presented real objective financial vulnerability: Adolescents from lower-middle income districts (Study 1; N = 256), and adults without higher education and with very low incomes (Study 2; N = 210). In Studies 1 and 2 participants completed a survey including measures of thinking style and SWB. In Studies 2 and 3 perception of financial difficulty and SWB were also measured. Study 3 (N = 161) used a sample of university students and employed an experimental design manipulating participants’ thinking style (i.e., concrete versus abstract mindset conditions); additionally, all participants were induced to perceive financial scarcity. Correlations revealed a significant and positive relationship between an abstract thinking style and SWB (Studies 1 and 2). Thus, these results showed that a relatively more abstract thinking style was associated with greater life satisfaction. In Studies 2 and 3 mediation analyses indicated that adults who presented a more abstract thinking style, perceived lower financial difficulties and then reported greater SWB. Overall, given that an abstract thinking style can be induced, these results offer a new intervention approach for improving the SWB of people living in situations of financial scarcity. (AU)

The Link between Abstract Thinking Style and Subjective Well-Being: Its Impact when People are in (Real or Perceived) Financial Scarcity.

Across three studies, we explored the link between an abstract mindset and subjective well-being (SWB) in participants with real and/or perceived financial scarcity. In Studies 1 and 2, samples presented real objective financial vulnerability: Adolescents from lower-middle income districts (Study 1; N = 256), and adults without higher education and with very low incomes (Study 2; N = 210). In Studies 1 and 2 participants completed a survey including measures of thinking style and SWB. In Studies 2 and 3 perception of financial difficulty and SWB were also measured. Study 3 (N = 161) used a sample of university students and employed an experimental design manipulating participants' thinking style (i.e., concrete versus abstract mindset conditions); additionally, all participants were induced to perceive financial scarcity. Correlations revealed a significant and positive relationship between an abstract thinking style and SWB (Studies 1 and 2). Thus, these results showed that a relatively more abstract thinking style was associated with greater life satisfaction. In Studies 2 and 3 mediation analyses indicated that adults who presented a more abstract thinking style, perceived lower financial difficulties and then reported greater SWB. Overall, given that an abstract thinking style can be induced, these results offer a new intervention approach for improving the SWB of people living in situations of financial scarcity.

A multivariate physiological model of vagus nerve signalling during metabolic challenges in anaesthetised rats for diabetes treatment.

Objective.This study aims to develop a comprehensive decoding framework to create a multivariate physiological model of vagus nerve transmission that reveals the complex interactions between the nervous and metabolic systems.Approach.Vagus nerve activity was recorded in female Sprague-Dawley rats using gold hook microwires implanted around the left cervical vagus nerve. The rats were divided into three experimental cohorts (intact nerve, ligation nerve for recording afferent activation, and ligation for recording efferent activation) and metabolic challenges were administered to change glucose levels while recording the nerve activity. The decoding methodology involved various techniques, including continuous wavelet transformation, extraction of breathing rate (BR), and correlation of neural metrics with physiological signals.Main results.Decrease in glucose level was consistently negatively correlated with an increase in the firing activity of the intact vagus nerve that was found to be conveyed by both afferent and efferent pathways, with the afferent response being more similar to the one on the intact nerve. A larger variability was observed in the sensory and motor responses to hyperglycaemia. A novel strategy to extract the BR over time based on inter-burst-interval is also presented. The vagus afferent was found to encode breathing information through amplitude and firing rate modulation. Modulations of the signal amplitude were also observed due to changes in heart rate in the intact and efferent recordings, highlighting the parasympathetic control of the heart.Significance.The analytical framework presented in this study provides an integrative understanding that considers the relationship between metabolic, cardiac, and breathing signals and contributes to the development of a multivariable physiological model for the transmission of vagus nerve signals. This work progresses toward the development of closed-loop neuro-metabolic therapeutic systems for diabetes.

3D Bioelectronics with a Remodellable Matrix for Long-Term Tissue Integration and Recording.

Bioelectronics hold the key for understanding and treating disease. However, achieving stable, long-term interfaces between electronics and the body remains a challenge. Implantation of a bioelectronic device typically initiates a foreign body response, which can limit long-term recording and stimulation efficacy. Techniques from regenerative medicine have shown a high propensity for promoting integration of implants with surrounding tissue, but these implants lack the capabilities for the sophisticated recording and actuation afforded by electronics. Combining these two fields can achieve the best of both worlds. Here, the construction of a hybrid implant system for creating long-term interfaces with tissue is shown. Implants are created by combining a microelectrode array with a bioresorbable and remodellable gel. These implants are shown to produce a minimal foreign body response when placed into musculature, allowing one to record long-term electromyographic signals with high spatial resolution. This device platform drives the possibility for a new generation of implantable electronics for long-term interfacing.

Behavior of polyether-ether-ketone (PEEK) in prostheses on dental implants. A review.

BACKGROUND: The development of new and innovative materials such as high performance polymers (PEEK) opens a wide therapeutic range in implant prostheses. They are presented as alternative materials to metal and zirconium alloys in the manufacture of structures and attachments for implant prostheses and fixed and removable dental substitutes. The objective of this review is to know the characteristics of this material and thus assess its advantages and disadvantages in its possible applications in prostheses on dental implants. MATERIAL AND METHODS: A bibliographic search was carried out through the PubMed and Scopus search engines, of articles published from 2007 to 2020, excluding all articles in which PEEK was used for tooth prostheses. The data on the sufficiency of the PEEK material were organized according to its chemical, physical and mechanical properties. RESULTS: 148 articles were found in the databases using as keywords; Polyetheretherketone; PEEK; BioHPP; healing abutments; dental prostheses; dental prosthodontics; Full-arch rehabilitation; fixed implant prosthodontics; implant-retained prostheses; implant prostheses. CONCLUSIONS: It is concluded that PEEK offers greater lightness, good aesthetics, biocompatibility, and an elastic modulus more similar to bone than other materials commonly used in implant prostheses; however, it presents a higher risk of fracture and abrasion. More long-term clinical studies will be necessary to advise its use in implant prostheses. Key words:Polyetheretherketone, PEEK, BioHPP, healing abutments, dental prostheses, dental prosthodontics,Full-arch rehabilitation, fixed implant prosthodontics, implant-retained prostheses, implant prostheses.

Analysis of fit on implants of chrome cobalt versus titanium frameworks made by cad / cam milling.

BACKGROUND: This study analyzed the degree of passive and vertical fit achieved in frameworks using either cobalt-chromium (Co-Cr) or titanium (Ti) implant-supported fixed partial dentures ( FPDs) fabricated with a CAD/CAM milling technique. MATERIAL AND METHODS: 33 3-unit FDPs, 17 of Co-Cr metal alloy (test group) and 16 of Ti (control group), were manufactured with two implants by copy milled technology. Optical microscopy was used to measure passive fit (PF) and vertical fit (VF) in all frameworks. The PF was evaluated by using the Single Screw test and the VF with the screws tightened at 20 Ncm. Descriptive and inferential analysis were performed to evaluate statistically significant differences in the tested groups for each fit. Brunner-Langer models were applied to assess potential material and implant area effects on the measurements. An ANOVA test was performed to estimate both main effects and interactions. RESULTS: The average PF values in the screwed implant were 4.43 ± 0.52 µm for Ti and 5.50 ± 1.61 µm for Co-Cr and in the non-screwed implant 5.59 ± 1.32 µm in the group Ti and 6.25 ± 1.55 µm the Co-Cr group. In this last implant, it was not observed statistically significant differences between both types of alloy (p = 0.178) nor between zones. Ti control group exhibited a significantly better VF than Co-Cr (p = 0.046) in the screwed implant but there were no differences in the implant not screwed. The VF in the non-screwed implant was better in lingual than in buccal zone. CONCLUSIONS: The PF and VF measurements observed in Co-Cr frameworks are clinically acceptable. 3-unit implant supported FPDs made with Co-Cr alloy using milling technique showed similar dimensional accuracy than those obtained with Ti. Key words:Cobalt- chromium alloy, misfit, passive fit, vertical fit, milling.

Closed-loop bioelectronic medicine for diabetes management.

Modulation of the nervous system by delivering electrical or pharmaceutical agents has contributed to the development of novel treatments to serious health disorders. Recent advances in multidisciplinary research has enabled the emergence of a new powerful therapeutic approach called bioelectronic medicine. Bioelectronic medicine exploits the fact that every organ in our bodies is neurally innervated and thus electrical interfacing with peripheral nerves can be a potential pathway for diagnosing or treating diseases such as diabetes. In this context, a plethora of studies have confirmed the important role of the nervous system in maintaining a tight regulation of glucose homeostasis. This has initiated new research exploring the opportunities of bioelectronic medicine for improving glucose control in people with diabetes, including regulation of gastric emptying, insulin sensitivity, and secretion of pancreatic hormones. Moreover, the development of novel closed-loop strategies aims to provide effective, specific and safe interfacing with the nervous system, and thereby targeting the organ of interest. This is especially valuable in the context of chronic diseases such as diabetes, where closed-loop bioelectronic medicine promises to provide real-time, autonomous and patient-specific therapies. In this article, we present an overview of the state-of-the-art for closed-loop neuromodulation systems in relation to diabetes and discuss future related opportunities for management of this chronic disease.

Factores predictores de riesgo de repetición de intento de suicidio en una muestra de pacientes ambulatorios / Relevant risk factors of repeated suicidal attempts in a sample of outpatients

INTRODUCCIÓN: El suicidio representa un problema destacado en la actualidad; una línea de prevención e intervención es la detección de los factores de riesgo. En este estudio se pretende identificar los predictores de suicidio en pacientes con repetición de intento de suicidio (RIS) en seguimiento en un programa de intervención intensiva. MATERIAL Y MÉTODOS: La muestra la forman los pacientes incluidos en el programa de intervención intensiva por intento de suicidio. Se registran las variables sociodemográficas y clínicas, los abandonos, la RIS, las faltas a consulta y los resultados obtenidos en las escalas de depresión y desesperanza de Beck a lo largo de los 12 meses de seguimiento en el programa (inicial, 6 meses y 12 meses). Análisis estadístico: La asociación entre RIS y variables cualitativas de estudio se realizó empleando Chi-Cuadrado y para las cuantitativas T-Student. Los análisis se hicieron utilizando el software SPSS 19.0. El estudio ha sido aprobado por el Comité Autonómico de Ética de la Investigación de Galicia. RESULTADOS: De la muestra de 319 pacientes, 29 (9%) realizan una RIS, 22 (76%) durante los primeros 6 meses del programa. De los pacientes con RIS, 7 (24%) tienen historia de intento previo durante un periodo inferior a 180 días al intento índice (p = 0,033). La intoxicación medicamentosa fue el método más empleado pues fue utilizada en el intento índice por 240 pacientes (76%). Veintisiete (93%) mantienen el método en la RIS (p < 0,001). CONCLUSIONES: La sobreingesta de fármacos como método de intento y reintento, y el tiempo transcurrido desde el intento previo son los factores de riesgo destacados asociados a la RIS, de ahí la importancia de identificar a los pacientes con historia de intento de suicidio para llevar a cabo una intervención más intensiva y un ajuste adecuado del tratamiento sobre todo en los primeros 180 días

INTRODUCTION: Suicide is, at present, an important global public health problem; detection of risk factors can be used as a method for prevention and intervention. This study aims to identify predictors of suicide in patients with suicidal attempt retry (SAR), who are followed-up an in the Intensive Intervention Program (PII). MATERIAL AND METHODS: The sample includes patients followed up at the Intensive Intervention Program because of a previous suicidal attempt. The following variables were collected during the 12 months follow-up (baseline, 6 months and 12 months): Repeated attempts, socio-demographic and clinical variables, lack of adherence and the Beck Depression Inventory and Hopelessness Scale. Statistic analysis: The association between SAR and qualitative study variables was performed using Chi-Square and for the quantitative, T-Student was used. The analysis was carried out with the software SPSS 19.0. The study has been approved by the Research Ethics Committee of Galicia. RESULTS: Of the 319 patients, 29 (9%) of them committed a new suicidal attempt, 22 (76%) of these new attempts happened during the first 6 month of the Program. Of those who repeat the attempt, 7 (24%) have a history of a previous attempt that precede the basal attempt (P=.033) in less than 180 days. Medication overdose is the most used method, as it was used by 240 of the patients (76%). 27 (93%) kept drug overdose as their retry method, also reaching significance(P<.001). CONCLUSIONS: Overdose as a method of attempt and re-attempt, and the time elapsed from the previous attempt, are the highlighted risk factors associated with repeated suicidal attempts. For this reason, it is crucial to identify patients with a new suicide attempt so that a more intense intervention and drug treatment control is delivered during the first 180 days

Relevant risk factors of repeated suicidal attempts in a sample of outpatients. / Factores predictores de riesgo de repetición de intento de suicidio en una muestra de pacientes ambulatorios.

INTRODUCTION: Suicide is, at present, an important global public health problem; detection of risk factors can be used as a method for prevention and intervention. This study aims to identify predictors of suicide in patients with suicidal attempt retry (SAR), who are followed-up an in the Intensive Intervention Program (PII). MATERIAL AND METHODS: The sample includes patients followed up at the Intensive Intervention Program because of a previous suicidal attempt. The following variables were collected during the 12 months follow-up (baseline, 6 months and 12 months): Repeated attempts, socio-demographic and clinical variables, lack of adherence and the Beck Depression Inventory and Hopelessness Scale. STATISTIC ANALYSIS: The association between SAR and qualitative study variables was performed using Chi-Square and for the quantitative, T-Student was used. The analysis was carried out with the software SPSS 19.0. The study has been approved by the Research Ethics Committee of Galicia. RESULTS: Of the 319 patients, 29 (9%) of them committed a new suicidal attempt, 22 (76%) of these new attempts happened during the first 6 month of the Program. Of those who repeat the attempt, 7 (24%) have a history of a previous attempt that precede the basal attempt (P=.033) in less than 180 days. Medication overdose is the most used method, as it was used by 240 of the patients (76%). 27 (93%) kept drug overdose as their retry method, also reaching significance(P<.001). CONCLUSIONS: Overdose as a method of attempt and re-attempt, and the time elapsed from the previous attempt, are the highlighted risk factors associated with repeated suicidal attempts. For this reason, it is crucial to identify patients with a new suicide attempt so that a more intense intervention and drug treatment control is delivered during the first 180 days.

Predictability of short implants (< 10 mm) as a treatment option for the rehabilitation of atrophic maxillae. A systematic review

BACKGROUND: Short implants (< 10 mm) are one of the treatment options available in cases of limited vertical bone. Although such implants are now widely used, there is controversy regarding their clinical reliability. The purpose of this paper is to evaluate the predictability of short implants as an alternative to technically more complex treatments in patients with atrophic maxillae, based on a systematic review of the literature and the analysis of the implant survival rates, changes in periimplant bone level, and associated complications. It is postulated that short implants offer clinical results similar to those of longer implants. MATERIAL AND METHODS: A Medline-PubMed search was made covering the period between January 2004 and December 2014 (both included). Studies in English published in indexed journals, involving at least 20 implants and with a follow-up period of at least 12 months were considered. A manual search in four high impact journals was also conducted. RESULTS: A total of 37 studies meeting the inclusion criteria were included in this review. 9792 implants placed in over 5000 patients were analyzed. CONCLUSIONS: Based on the results of this review, short implants are seen to offer clinical results in terms of survival, bone loss and complications similar to those of longer implants

Effect of platform switching on the peri-implant bone: A finite element study.

BACKGROUND: There exists a relation between the presence and location of the micro-gap and the loss of peri implant bone. Several authors have shown that the treatments based on the use of platform switching result in less peri-implant bone loss and an increased tissue stability. The purpose of this study was to analyse the effect of the platform switching on the distribution of stresses on the peri-implant bone using the finite element method. MATERIAL AND METHODS: A realistic 3D full-mandible finite element model representing cortical bone and trabecular bone was used to study the distribution of the stress on the bone induced by an implant of diameter 4.1 mm. Two abutments were modelled. The first one, of diameter 4.1 mm, was used in the reference model to represent a conventional implant. The second one, of diameter 3.2 mm, was used to represent the implant with platform switching. Both models were subjected to axial and oblique masticatory loads. RESULTS: The analyses showed that, although no relevant differences can be found for the trabecular bone, the use of platform switching reduces the maximum stress level in the cortical bone by almost 36% with axial loads and by 40% with oblique loads. CONCLUSIONS: The full 3D Finite Element model, that can be used to investigate the influence of other parameters (implant diameter, connexion type, …) on the biomechanical behaviour of the implant, showed that this stress reduction can be a biomechanical reasons to explain why the platform switching seems to reduce or eliminate crestal bone resorption after the prosthetic restoration. KEY WORDS: Dental implant, platform switching, finite element method.

Fractographic Study of the Interface Between Zirconia Y-TZP and Its Veneering Ceramic After Shear Strength Testing.

This study analyzed the shear strength and fracture characteristics of the interface between zirconia samples and their veneering ceramic compared with a metal-ceramic and a lithium disilicate glass-ceramic control group together with an assessment of the possible relationship between the fracture characteristics and the recorded shear strength. The greatest shear strengths corresponded to the lithium disilicate glass-ceramic control group followed by the metal-ceramic control group, with lesser strengths in the zirconia groups. Since the fractographic study showed cohesive-type failure to predominate in the zirconia samples, it is concluded that improvements are needed in the veneering ceramic and liner used in zirconia restorations.

Morbilidad por infecciones respiratorias agudas en menores de 5 años / Morbidity due to acute respiratory infections in children under 5 years

Se realizó un estudio descriptivo y transversal de 253 pacientes menores de 5 años de edad, ingresados con diagnóstico de infecciones respiratorias agudas en el Hospital Distrital de Sayaxché, desde enero a septiembre de 2012, con vistas a caracterizar la morbilidad. En la serie predominaron el sexo masculino (55,7 por ciento), los niños menores de 1 año (55,3 por ciento), la exposición al humo pasivo como principal factor de riesgo asociado (75 por ciento), la fiebre como manifestación clínica al ingreso (98 %), así como la neumonía/bronconeumonía en este mismo grupo de edades (88,6 por ciento), de los cuales 58,7 por ciento recibió tratamiento con ceftriaxone. La estadía hospitalaria fue generalmente de 4 a 6 días y la mayoría de los afectados egresaron mejorados(AU)

A descriptive and cross sectional study of 253 patients under 5 years of age, admitted with the diagnosis of acute respiratory infections in the District Hospital of Sayaxché, was carried out from January to September, 2012, with the aim of characterizing morbidity. Male sex (55.7 percent), children under 1 year (55.3 percent), exposure to passive smoke as main associated risk factor (75 percent), fever as clinical manifestation at admission (98 percent) prevailed in the series, as well as pneumonia/bronchopneumonia in this same age group (88.6 percent), of which 58.7 percent received treatment with ceftriaxone. The hospital stay was 4-6 days and most of the patients affected were better at discharge(AU)

Morbilidad por infecciones respiratorias agudas en menores de 5 años / Morbidity due to acute respiratory infections in children under 5 years

Se realizó un estudio descriptivo y transversal de 253 pacientes menores de 5 años de edad, ingresados con diagnóstico de infecciones respiratorias agudas en el Hospital Distrital de Sayaxché, desde enero a septiembre de 2012, con vistas a caracterizar la morbilidad. En la serie predominaron el sexo masculino (55,7 %), los niños menores de 1 año (55,3 %), la exposición al humo pasivo como principal factor de riesgo asociado (75 %), la fiebre como manifestación clínica al ingreso (98 %), así como la neumonía/bronconeumonía en este mismo grupo de edades (88,6 %), de los cuales 58,7% recibió tratamiento con ceftriaxone. La estadía hospitalaria fue generalmente de 4 a 6 días y la mayoría de los afectados egresaron mejorados.

A descriptive and cross sectional study of 253 patients under 5 years of age, admitted with the diagnosis of acute respiratory infections in the District Hospital of Sayaxché, was carried out from January to September, 2012, with the aim of characterizing morbidity. Male sex (55.7%), children under 1 year (55.3%), exposure to passive smoke as main associated risk factor (75%), fever as clinical manifestation at admission (98%) prevailed in the series, as well as pneumonia/bronchopneumonia in this same age group (88.6%), of which 58.7% received treatment with ceftriaxone. The hospital stay was 4-6 days and most of the patients affected were better at discharge.

Narrow-diameter implants: Are they a predictable treatment option? A literature review

OBJECTIVE: To evaluate the predictability of narrow-diameter implants as a treatment option in routine clinical practice. A literature review was performed of studies reporting clinical results obtained with these implants. Survival rates, peri-implant bone loss and related complications were evaluated. The working hypothesis was that narrow-diameter implants offer clinical results similar to those obtained with implants of greater diameter. MATERIAL AND METHODS: A Medline-PubMed search covering the period between 2002 and 2012 was carried out. Studies published in English and with a follow-up period of at least 12 months were considered for inclusion. A manual search was also conducted in different journals with an important impact factor. RESULTS: Twenty-one studies meeting the screening criteria were included in the literature review. A total of 2980 narrow-diameter implants placed in 1607 patients were analyzed. CONCLUSIONS: The results obtained from the literature indicate that narrow-diameter implants are a predictable treatment option, since they afford clinical results comparable to those obtained with implants of greater diameter

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Narrow-diameter implants: are they a predictable treatment option? A literature review.

OBJECTIVE: To evaluate the predictability of narrow-diameter implants as a treatment option in routine clinical practice. A literature review was performed of studies reporting clinical results obtained with these implants. Survival rates, peri-implant bone loss and related complications were evaluated. The working hypothesis was that narrow-diameter implants offer clinical results similar to those obtained with implants of greater diameter. MATERIAL AND METHODS: A Medline-PubMed search covering the period between 2002 and 2012 was carried out. Studies published in English and with a follow-up period of at least 12 months were considered for inclusion. A manual search was also conducted in different journals with an important impact factor. results: Twenty-one studies meeting the screening criteria were included in the literature review. A total of 2980 narrow-diameter implants placed in 1607 patients were analyzed. CONCLUSIONS: The results obtained from the literature indicate that narrow-diameter implants are a predictable treatment option, since they afford clinical results comparable to those obtained with implants of greater diameter.

Evaluation of an intensive intervention program in suicidal behaviour.

INTRODUCTION: Suicide is a public health problem. Consumed suicides reach 1 million cases per year worldwide and it is estimated that the number of suicide attempts is 10 to 20 times higher. The aim of this study was to evaluate the effectiveness in reducing repeat suicide attempts in a program for the prevention of suicidal behavior: Intensive Intervention Program (IIP). METHODS: We performed a study that compared a cohort of patients exposed to IIP intervention with another cohort of patients exposed to conventional therapy. The sample was made up of 191 patients, 89 in the treatment group and 102 patients in conventional treatment group, with a 12-month follow-up. RESULTS: Relapse occurred in 20.6% of patients receiving conventional treatment relapse compared with 10% in the treatment group (p=0.047). Patients treated in the program had a 2.88 times lower risk of relapse (p=0.015), this being independent of the number of previous attempts, age, gender, need for admission after the index attempt and aggregated diagnosis. CONCLUSIONS: The results show that subjects who are treated in the IIP relapse less, need fewer admissions and the time elapsed between the treatment and the first repeat suicide attempt is greater.

Características de los pacientes y abordaje terapéutico de la fibrilación auricular en atención primaria en España: Estudio FIATE / Patients’ characteristics and clinical management of atrial fibrillation in primary healthcare in Spain: FIATE Study

Fundamento y objetivos: El principal objetivo terapéutico en la fibrilación auricular (FA) es la prevención del ictus. Estudiamos la adecuación del tratamiento antitrombótico y la estrategia terapéutica adoptada respecto a las Guías Clínicas, así como las características de los pacientes atendidos en atención primaria. Pacientes y métodos: Estudio transversal, multicéntrico, en pacientes atendidos en centros de salud de toda España. Muestreo bietápico por comunidades y centros de salud. Participaron 185 médicos de familia, cuyos pacientes fueron seleccionados aleatoriamente. Resultados: De 3.759 pacientes con FA aleatorizados centralizadamente, se evaluaron 2.070 (entrevista e historia clínica) con una edad media de 74 (11) años (50,7% mujeres), presentando la mayoría (78%) FA permanente asociada a frecuente comorbilidad (hipertensión 75%, obesidad 30%, diabetes 27%, insuficiencia cardiaca 20%, cardiopatía isquémica 17% y riesgo social 15%). En atención primaria se diagnosticaron más pacientes asintomáticos (36%; p < 0,001) que en el ámbito hospitalario. Se adoptó una estrategia de control de frecuencia en 4 de cada 5 pacientes. Se observó una amplia utilización de la anticoagulación oral (84%), mayor en pacientes con FA permanente frente a no permanente (91 frente al 60%; p < 0,001). El seguimiento era principalmente realizado en atención primaria (72%), presentando un 66% de los pacientes su último international normalized ratio (INR, «razón normalizada internacional») en rango terapéutico, que descendía al 33% al considerar los 3 últimos INR (p < 0,001). Conclusiones: La proporción de pacientes con FA que reciben anticoagulación en atención primaria es elevada, sin embargo, el control del INR resulta subóptimo. La estrategia adoptada es el control de frecuencia en la mayoría de los casos. La estratificación del riesgo embólico debería sustituir al tipo de arritmia en la decisión terapéutica (AU)

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Evaluación de un Programa de Intervención Intensiva en Conducta Suicida / Evaluation of an Intensive Intervention Program in Suicidal Behaviour

Introducción: El suicidio es un problema de salud pública. El suicidio consumado asciende a 1 millón de casos al año en el mundo y se estima que el número de intentos de suicidio es 10 o 20 veces superior. El objetivo del presente trabajo es la evaluación de la efectividad en la reducción de reintentos de suicidio en un Programa de prevención de conducta suicida: el Programa de Intervención Intensiva (PII). Metodología: Se realiza un estudio en el que se compara una cohorte de pacientes expuestos a la intervención en PII con otra cohorte de pacientes expuestos a terapia convencional. La muestra está formada por un total de 191 pacientes, 89 del grupo de tratamiento en PII y 102 pacientes del grupo de tratamiento convencional. Con un seguimiento de 12 meses. Resultados: un 20,6% de los pacientes que recibe tratamiento convencional recaen frente al 10% del grupo de tratamiento en PII (p=0,047). Los pacientes atendidos en el programa presentaron un riesgo menor 2,88 veces de recaída (p=0,015), esto es independiente del número de intentos previos, edad, sexo, necesidad de ingreso tras el intento índice y diagnóstico agregado. Conclusiones: Los resultados muestran que los sujetos que reciben tratamiento en el PII tiene menos reintentos, necesitan ingresar menos, y el tiempo trascurrido desde el inicio del tratamiento y el primer reintento es mayor (AU)

Introduction: Suicide is a public health problem. Consumed suicides reach 1 million cases per year worldwide and it is estimated that the number of suicide attempts is 10 to 20 times higher. The aim of this study was to evaluate the effectiveness in reducing repeat suicide attempts in a program for the prevention of suicidal behavior: Intensive Intervention Program (IIP). Methods: We performed a study that compared a cohort of patients exposed to IIP intervention with another cohort of patients exposed to conventional therapy. The sample was made up of 191 patients, 89 in the treatment group and 102 patients in conventional treatment group, with a 12-month follow-up. Results: Relapse occurred in 20.6% of patients receiving conventional treatment relapse compared with 10% in the treatment group (p=0.047). Patients treated in the program had a 2.88 times lower risk of relapse (p=0.015), this being independent of the number of previous attempts, age, gender, need for admission after the index attempt and aggregated diagnosis. Conclusions: The results show that subjects who are treated in the IIP relapse less, need fewer admissions and the time elapsed between the treatment and the first repeat suicide attempt is greater (AU)