How to understand sports and traditional games and how to apply it to physical education. On the "Goal of Game".

Introduction: Does philosopher's stone exist in physical education? It could be said that teaching games for understanding approach (TGfU) keeps turning everything it touches into gold: its presence in the educational centers, its volume of publications, the way of teaching games and sports, its connections with other approaches, its game categories, learning transferable principles of play. But… no, all that glitters is not gold. There are TGfU issues that should be improved. For example, these categories are disconnected from each other because TGfU lacks classification criteria. The "goal of game" is a concept that has been studied, but it has not been applied to physical education. The aim of the article is to show how to deepen the understanding sports and traditional games from the "goal of game", and to propose its applicability to physical education. Methods: The traits of "goal of game" will be identified by investigating two close concepts, "prelusory goal" (formalist philosophy of sport) and "motor-goal" (motor praxeology). Results: The traits of "goal of game" concept: main-motor-problem, described in the game rules and that the players will try to solve during the game dynamics. The "goal of game" chances: (1) It allows us to understand sports and traditional games based on their internal logic (2) It allows us to classify traditional games and sports based on classification criteria and that can be useful to organize the physical education program; (3) It allows us to deepen the understanding of sporting games and their applicability to physical education: on the one hand, proposing progressively more specific goal of game options and, on the other hand, proposing a network model of intentions of play to understand the game dynamics and to design learning tasks. Conclusions: The conclusions collect some properties of the "goal of game" concept in order to propose its applicability in physical education students learning: identify and compare the main-motor-problems of the games; solve these problems during the game dynamics; transfer the procedures used to solve other games. The goal(d) of game amazes us; maybe physical education teachers are curious to continue discovering this wonderful treasure.

Zero discharge: Pilot project for biodegradation of cattle effluent by pyroclastic "lapilli" treatment for fodder irrigation.

Livestock effluents are a nutrient supply that is beneficial for crops, so their use is essential to guarantee the sustainability of the global management of farms. Zero discharge cattle effluent management to irrigate fodder crops is a mitigation option, so it is considered a key factor for adaptation to climate change. This paper presents the result of an "on site" pilot scale (three-stage, vertical flow filtration system using lapilli). This is a low-cost solution in terms of finance and energy, which does not require the addition of chemicals, to treat a cattle effluent. The effluent's quality obtained allowed it to be injected in a drip system with low risks of obstruction. And the pilot system allowed to obtain elimination values for the main parameters of effluent's quality (TSS and COD, 98% and 80% respectively) similar or greater than the ones obtained in other treatments of low cost and energy, and gives values contemplated in reclaimed water reuse guidelines of many countries. Furthermore, elimination rate for the BOD5 obtained 35 mgL-1 in treated effluent. High removal rates were obtained for N, P, K, Cu, Fe and Mn, medium for Ca, Mg and Zn and low for B and Na. These shows that the pilot system and fodder crop combination provide an optimal solution to small farms, controlling sanitary risks. The tested flow allows the use of this system by conventional small farms, which represented 94% of total cow farms in Canary Islands.

Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio / Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: data from the first 1.500 individuals included in the study

Introducción. El objetivo fue investigar prevalencias de factores de riesgo cardiovascular (FRCV), lesión de órgano diana (LOD) y enfermedad cardiovascular (ECV) en población general del Área Sanitaria de Toledo para determinar el riesgo cardiovascular (RCV). Material y métodos. Estudio epidemiológico observacional que analizó una muestra de población general ≥18años seleccionada de la base de datos de tarjeta sanitaria por muestreo aleatorio sistemático estratificado por sexo y grupos de edad. Se realizaron anamnesis, exploración clínica y pruebas complementarias, congelándose a −85°C alícuotas de sangre total y suero para valorar posibles estudios genéticos. Se realizó análisis estadístico estándar. El RCV se estimó con las escalas del Proyecto SCORE calibrada para población española y del Framingham Heart Study. Resultados. Se incluyeron a 1.500 individuos (edad media 49,1±15,8años; 55,6% mujeres). Prevalencias: dislipemia 56,9% (intervalo de confianza al 95% [IC95%]: 54,3-59,4), hipertensión arterial 33,0% (IC95%: 30,6-35,4), diabetes mellitus 8,6% (IC95%: 7,17-10,1), tabaquismo 24,2% (IC95%: 22,0-26,4), obesidad 25,3% (IC95%:23,1-27,5) y sedentarismo 39,4% (IC95%: 36,9-41,8). El 21,1% no mostró ningún FRCV y el 18,6% presentó de 3 a 5. LOD: hipertrofia ventricular izquierda electrocardiográfica 4,3%, arteriopatía periférica con eco-doppler10,1% y con dispositivo oscilométrico 15,3%, microalbuminuria 4,3%, enfermedad renal oculta 3,2% y nefropatía 3,8% (CKD-EPI). El 9,2% padecía alguna ECV. El 44,6% mostró RCV (SCORE) bajo. Conclusiones. De cada 10 personas, 6 presentan dislipemia, 4 sedentarismo, 3 hipertensión, 2 tabaquismo, 2 obesidad, y casi una diabetes. Más de la mitad de los individuos muestran RCV moderado-alto-muy alto y las prevalencias de LOD y ECV son importantes

Introduction. The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. Material and methods. Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at −85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. Results. A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. Conclusions. Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant

Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo) / Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study

Introducción. El objetivo principal es conocer en la población del Área Sanitaria de Toledo las prevalencias de factores de riesgo cardiovascular (FRCV), lesión de órgano diana (LOD) y enfermedad cardiovascular (ECV), así como los hábitos de vida (ejercicio físico y consumo de alcohol y de dieta mediterránea), para determinar el riesgo cardiovascular (RCV). Material y métodos. Estudio epidemiológico observacional que analizará una muestra de población general≥ 18 años seleccionada de la base de datos de tarjeta sanitaria por muestreo aleatorio sistemático estratificado por sexo y grupos de edad. Se realizarán anamnesis, exploración clínica y pruebas complementarias, y se congelarán a -85°C alícuotas de sangre total y suero para valorar futuros estudios genéticos. El RCV se estimará con las escalas del proyecto SCORE calibrada para población española y del Framingham Heart Study. Alcanzado el tamaño muestral estimado y transcurridos al menos 5 años de la inclusión, se realizará seguimiento de la muestra final de sujetos, analizando la evolución de FRCV, LOD, ECV y del control de FRCV, y los eventos sucedidos mortales y no mortales. Discusión. El estudio RICARTO pretende conocer las prevalencias de los principales FRCV, LOD y ECV, para determinar el RCV de la población general del Área Sanitaria de Toledo, y realizar un seguimiento de la muestra final de individuos cuando hayan transcurrido al menos 5 años de la inclusión para analizar la incidencia de eventos cardiovasculares y la evolución temporal de los estilos de vida, las prevalencias de FRCV, LOD y ECV

Introduction. The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). Material and methods. Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of -85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. Discussion. The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD

[Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study]. / Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo).

INTRODUCTION: The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). MATERIAL AND METHODS: Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of-85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. DISCUSSION: The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD.

[Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: Data from the first 1,500 individuals included in the study]. / Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio.

INTRODUCTION: The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. MATERIAL AND METHODS: Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at -85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. RESULTS: A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. CONCLUSIONS: Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant.

Clouds homogenize shoot temperatures, transpiration, and photosynthesis within crowns of Abies fraseri (Pursh.) Poiret.

Multiple studies have examined the effects of clouds on shoot and canopy-level microclimate and physiological processes; none have yet done so on the scale of individual plant crowns. We compared incident photosynthetically active radiation (PAR), leaf temperatures, chlorophyll fluorescence, and photosynthetic gas exchange of shoots in three different spatial locations of Abies fraseri crowns on sunny (clear to partly cloudy) versus overcast days. The field site was a Fraser fir farm (1038 m elevation) in the Appalachian mountains, USA. Ten saplings of the same age class were marked and revisited for all measurements. Sunny conditions corresponded with 5-10× greater sunlight incidence on south-facing outer shoots compared to south-facing inner and north-facing outer shoots, which were shaded and received only indirect (diffuse) sunlight. Differences in spatial distribution of irradiance were mirrored in differences in shoot temperatures, photosynthesis, and transpiration, which were all greater in south-facing outer shoots compared to more shaded crown locations. In contrast, overcast conditions corresponded with more homogeneous sunlight distribution between north and south-facing outer shoots, and similar shoot temperatures, chlorophyll fluorescence (ΦPSII), photosynthesis, and transpiration; these effects were observed in south-facing inner shoots as well, but to a lesser extent. There was no significant difference in conductance between different crown locations on sunny or overcast days, indicating spatial differences in transpiration under sunny conditions were likely driven by leaf temperature differences. We conclude that clouds can affect spatial distribution of sunlight and associated physiological parameters not only within forest communities, but within individual crowns as well.

Análisis diacrónico de la comunicación motriz de los juegos y deportes tradicionales canarios / Diachronic analiysis of motor comunication in traditional games and sports of the canary island

Se realiza un análisis diacrónico de la comunicación motriz en tres grupos de juegos y deportes tradicionales canarios ('juegos aborígenes', 'juegos tradicionales', y 'deportes tradicionales') para deducir pautas sociales que encierran estas prácticas. Se analizan y categorizan la red de comunicación motriz y la interacción motriz siguiendo criterios de la praxiología motriz. Bajo el significado del enfrentamiento como función lúdica principal, la estructura dualista se muestra de manera hegemónica, en detrimento de otras formas de comunicación motriz. También, se desvela que la diversificación de la interacción motriz del grupo 'juegos tradicionales' no es equivalente en los otros grupos estudiados, mostrando aquel grupo significados etnomotores hetereogéneos para una misma actividad. Las prácticas motrices estudiadas dan idea de la complejidad de la construcción de la tradición lúdica canaria (AU)

A diachronic analysis of motor communication in three groups of traditional Canary Island games (‘aboriginal games’, ‘traditional games’, and ‘traditional sports’) was carried out in order to detect and define their social models. Both motor communication and motor interaction were analyzed and categorized according to motor praxeology criteria. When confrontation was the main function of the game, the dual structure was dominant over other forms of motor communication. The motor interaction diversification in the ‘traditional games’ group was not comparable to the other two groups due to the various ethno-motor modes used for the same activity. The motor study allows us to form an idea of the complexity of the construct of traditional Canary games (AU)

[Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008]. / Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008.

INTRODUCTION AND OBJECTIVES: To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. METHODS: Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. RESULTS: 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8±12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0±43.4, LDL-cholesterol 115±38.0, HDL-cholesterol 44.1±12.3, and triglyceride 145.3±92.4mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3±37.8 vs 111.6±38.5mg/dL; p=0.04) and HDL-cholesterol (42.3±11.6 vs 48.4±13.2mg/dL; p=0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1±43.1 and 174.5±44.1 (p<0.05), LDL-cholesterol 116.5±38.4 and 110±36.5 (p=0.007), HDL-cholesterol 44.1±12.2 and 44.2±12.9 (p<0.05), and triglyceride 141.2±81.7 and 158.5±119.7 (p=0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. CONCLUSIONS: While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control.

Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008 / Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008

Introducción y objetivos. Evaluar el perfil lipídico de los pacientes ingresados por síndrome coronario agudo en Toledo entre 2005 y 2008. Métodos. Se estudiaron los niveles de colesterol total, colesterol unido a las lipoproteínas de baja densidad (cLDL), colesterol unido a las lipoproteínas de alta densidad (cHDL) y triglicéridos. Se realizó estadística descriptiva y comparación de medias. Resultados. De los 3.986 ingresados por síndrome coronario agudo, 1.381 pacientes tenían perfil lipídico completo. El 76,3% eran primeros episodios. La edad media fue 67,8 ± 12,9 años (72,4% hombres). El colesterol total medio (± DE) fue 180,0 ± 43,4, cLDL 115 ± 38,0, cHDL 44,1 ± 12,3, y triglicéridos 145,3 ± 92,4 mg/dl, con diferencias significativas entre hombres y mujeres en el cLDL (116,3 ± 37,8 vs 111,6 ± 38,5 mg/dl; p = 0,04) y cHDL (42,3 ± 11,6 vs 48,4 ± 13,2 mg/dl; p = 0,0001). En primeros episodios y episodios recurrentes se halló, respectivamente, colesterol total 179,1 ± 43,1 y 174,5 ± 44,1 (p < 0,05), cLDL 116,5 ± 38,4 y 110,0 ± 36,5 (p = 0,007), cHDL 44,1 ± 12,2 y 44,2 ± 12,9 (p < 0,05), y triglicéridos 141,2 ± 81,7 y 158,5 ± 119,7 mg/dl (p = 0,03). Se observaron niveles óptimos de cLDL y cHDL en el 14,1 y en el 11,6%, respectivamente, de los episodios recurrentes. Conclusiones. Aunque la mayoría de pacientes ingresados por primeros episodios de síndrome coronario agudo presenta un perfil lipídico adecuado, solo el 10% de pacientes con episodios recurrentes muestran niveles óptimos de c-LDL y c-HDL, lo que sugiere la necesidad de ser más rigurosos en el control lipídico (AU)

Introduction and objectives. To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. Methods. Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. Results. 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8 ± 12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0 ± 43.4, LDL-cholesterol 115 ± 38.0, HDL-cholesterol 44.1 ± 12.3, and triglyceride 145.3 ± 92.4 mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3 ± 37.8 vs 111.6 ± 38.5 mg/dL; p = 0.04) and HDL-cholesterol (42.3 ± 11.6 vs 48.4 ± 13.2 mg/dL; p = 0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1 ± 43.1 and 174.5 ± 44.1 (p < 0.05), LDL-cholesterol 116.5 ± 38.4 and 110 ± 36.5 (p = 0.007), HDL-cholesterol 44.1 ± 12.2 and 44.2 ± 12.9 (p < 0.05), and triglyceride 141.2 ± 81.7 and 158.5 ± 119.7 (p = 0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. Conclusions. While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control (AU)

[Strategies for effective control of arterial hypertension in Spain. Consensus document]. / Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso.

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved.

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso / Strategies for effective control of arterial hypertension in Spain. Consensus document

El control de las cifras de presión arterial (PA) en los hipertensos tratados en España es insuficiente, no alcanza al 40% de los pacientes tratados y las causas son múltiples. Las posibles soluciones al problema han sido repetidamente sugeridas por grupos de expertos desde hace años, a pesar de lo cual las tasas de control siguen siendo inadecuadas, lo que repercute negativamente en la morbilidad y mortalidad de los pacientes. El objeto del presente documento ha sido analizar medidas concretas efectivas que mejoren el control de la hipertensión en España. Tales medidas afectan a los profesionales de la salud (médicos, profesionales de enfermería y farmacéuticos), a la administración sanitaria y a los propios pacientes. Este documento resume los resultados de esta conferencia de consenso en cinco grandes grupos: a) medidas para mejorar la metodología habitual en la medición de la PA en la consulta; b) medidas para mejorar el cumplimiento terapéutico por el paciente; c) medidas para clarificar el objetivo de PA que el médico debe fijar; d) medidas para optimizar el tratamiento y control de la hipertensión arterial; y e) aspectos de formación continuada. El documento enfatiza la recomendación de los cambios del estilo de vida en todos los pacientes hipertensos, tanto su acción beneficiosa sobre la hipertensión como por lo que implica en la corrección de otros factores de riesgo y en el aumento de la efectividad del tratamiento farmacológico. Los profesionales deben actuar conforme a guías terapéuticas o algoritmos que obliguen a modificar la conducta en los casos en que los objetivos pautados para cada paciente no hayan sido alcanzados

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / Strategies for an effective control of arterial hypertension in Spain. Consensus Document

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Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / No disponible

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Responsabilidad por malpraxis médica: la via extrajudicial / Medical responsibillity for malpraxis: the extrajuclicial channel

En este trabajo se hace un estudio crítico de la respuesta a la responsabilidad por malpraxis médica por vía extrajudicial. Se consideran en principio algunos de los problemas que tiene la vía judicial ordinaria, que pueden aconsejar otros métodos, que en ningún caso la excluyen, y el estado de la cuestión en diversos países, que han sido pioneros en la implantación de estos sistemas extrajudiciales, prestando atención especial a los de la Unión Europea y Estados Unidos.Se examinan después estos procedimientos en nuestro país, con especial atención a la mediación, conciliación y arbitraje, haciendo un estudio conceptual y valoración de las ventajas e inconvenientes de su aplicación en la práctica, y finalmente una crítica de los mismos (AU)

[Treatment of pain and anxiety in terminal oncologic patients in the Castilla-La Mancha community]. / Tratamiento del dolor y la ansiedad en el paciente oncológico terminal en la comunidad de Castilla-La Mancha.

OBJECTIVE: To find what palliative treatment, in particular for pain and anxiety, terminal cancer patients in the Community of Castilla La Mancha receive. DESIGN: A descriptive, retrospective study by means of a questionnaire. SETTING: Primary Care. Autonomous Community of Castilla La Mancha. PATIENTS AND OTHER PARTICIPANTS: A survey of 157 doctors with data referring to their last cancer patient deceased in the period from January to August, 1994. MEASUREMENTS AND MAIN RESULTS: Data on 157 patients were received. Of all the tumours, lung cancer was the most common (22.93%). Pain was the symptom most often mentioned (92.91%); anxiety appeared in 70.06%. The most commonly used non-opiate analgesic was Paracetamol (58.22%). Morphine was used in 46.48%, for an average period of 2.35 months (SD = 2.21). Side-effects due to morphine appeared in 22.06%. Complementary drugs to treat pain were used in 13.01% of cases. 12% were referred to specialists for analgesic control. Doctors used pain measurement tables in 5.48% of cases. 19.09% of patients suffering anxiety received no type of treatment. CONCLUSIONS: We think that analgesic tables to monitor the treatment should be used. Attention should be paid to the appearance of side-effects of morphine, the circulation of pain graduation tables and the evaluation of anxiety in this category of patient.