Respuesta clínica al tratamiento con hormona de crecimiento en niños con retraso de crecimiento intrauterino sin recuperación posnatal de talla en Castilla y León / Clinical response to growth hormone in children with intrauterine growth retardation without catch-up growth in Castilla y León (Spain)

Introducción y objetivos: La hormona de crecimiento recombinante humana (rhGH) se utiliza en niños con crecimiento intrauterino retardado sin recuperación posnatal de talla. En 2010 se inició el Comité Asesor de Castilla y León para aplicar de forma homogénea los criterios de utilización de la rhGH. El objetivo es valorar la evolución antropométrica y clínica de niños sometidos a tratamiento. Pacientes y métodos: Estudio retrospectivo, longitudinal, con pacientes de Castilla y León diagnosticados de crecimiento intrauterino retardado sin crecimiento recuperador a partir del año 2010, con al menos 3 años de tratamiento. Se evaluaron las modificaciones en diferentes parámetros antropométricos, clínicos y analíticos. Resultados: Se incluyeron 43 niños con una edad media de 6,06 años (58,14%<5 años), tratados con una dosis media de 0,038mg/kg/día. Se observó un aumento significativo en la talla (−3,05 hasta −1,58DE). El peso se incrementó durante todo el estudio, así como el IMC (14,51 hasta 15,80kg/m2). La velocidad de crecimiento alcanzó su pico máximo durante el primer año de tratamiento (0,74DE). Los valores de IGF-1 se incrementaron durante todo el estudio (99,96 hasta 392,88ng/ml). Se observaron incrementos significativos de la glucohemoglobina en el primer año y de la glucemia y de la insulinemia basal durante el segundo año, así como un descenso en el cociente LDL/HDL (1,70 hasta 1,50). Conclusión: El tratamiento con hormona de crecimiento favorece el crecimiento de niños con crecimiento intrauterino retardado, observándose su máximo efecto en los primeros 12 meses, siendo mayor si la edad de comienzo es anterior a los 5 años de edad

Introduction and objectives: Growth hormone (rhGH) is used in children with intrauterine growth retardation without catch-up growth. The Advisory Committee of Castilla y León was implemented in 2010 to watch for consistent application of the criteria for using rhGH. The aim is to assess anthropometric and clinical changes in children treated with growth hormone. Patients and methods: A retrospective, longitudinal study of patients diagnosed with intrauterine growth retardation without catch-up growth in Castilla y León since 2010 who have received treatment for at least 3 years. Changes in anthropometric, clinical, and laboratory parameters were assessed. Results: Forty-three children with a mean age of 6.06 years (58.14%<5 years) were enrolled and treated with a mean dose of 0.038mg/kg/day. A significant increase was seen in height (−3.05 to −1.58SD). Both weight and BMI (14.51 to 15.80kg/m2) increased throughout the study. Growth rate peaked during the first year of treatment (0.74SD). IGF-1 levels increased throughout the study (99.96 to 392.88ng/mL). There were significant increases in glycosylated hemoglobin levels in the first year, and in basal blood glucose and insulin levels during the second year. The LDL/HDL ratio decreased during the study period (1.70 to 1.50). Conclusion: Treatment with rhGH promotes growth in children with intrauterine growth retardation. Peak effect occurs in the first 12 months of treatment, and is greater when growth hormone is started before the age of 5 years

Clinical response to growth hormone in children with intrauterine growth retardation without catch-up growth in Castilla y León (Spain). / Respuesta clínica al tratamiento con hormona de crecimiento en niños con retraso de crecimiento intrauterino sin recuperación posnatal de talla en Castilla y León.

INTRODUCTION AND OBJECTIVES: Growth hormone (rhGH) is used in children with intrauterine growth retardation without catch-up growth. The Advisory Committee of Castilla y León was implemented in 2010 to watch for consistent application of the criteria for using rhGH. The aim is to assess anthropometric and clinical changes in children treated with growth hormone. PATIENTS AND METHODS: A retrospective, longitudinal study of patients diagnosed with intrauterine growth retardation without catch-up growth in Castilla y León since 2010 who have received treatment for at least 3 years. Changes in anthropometric, clinical, and laboratory parameters were assessed. RESULTS: Forty-three children with a mean age of 6.06 years (58.14%<5 years) were enrolled and treated with a mean dose of 0.038mg/kg/day. A significant increase was seen in height (-3.05 to -1.58SD). Both weight and BMI (14.51 to 15.80kg/m2) increased throughout the study. Growth rate peaked during the first year of treatment (0.74SD). IGF-1 levels increased throughout the study (99.96 to 392.88ng/mL). There were significant increases in glycosylated hemoglobin levels in the first year, and in basal blood glucose and insulin levels during the second year. The LDL/HDL ratio decreased during the study period (1.70 to 1.50). CONCLUSION: Treatment with rhGH promotes growth in children with intrauterine growth retardation. Peak effect occurs in the first 12 months of treatment, and is greater when growth hormone is started before the age of 5 years.

Impacto del consumo de tabaco sobre la mortalidad en España en el año 2012 / Smoking impact on mortality in Spain in 2012

Antecedentes y objetivo: El tabaquismo constituye un importante problema de salud pública, siendo una de las principales causas de morbimortalidad evitable y prematura. El objetivo del estudio es describir la mortalidad atribuible al consumo de tabaco en España en 2012, y compararla con resultados de años anteriores. Pacientes y métodos: Estudio descriptivo, transversal, realizado en población española de más de 18 años. Las fuentes de los datos fueron la encuesta nacional de salud 2011-2012 y las estadísticas vitales del Instituto Nacional de Estadística. Se calculó la proporción de muertes atribuibles al tabaco por sexo y grupo de edad a partir de la fracción etiológica poblacional. Asimismo, se calcularon los años potenciales de vida perdidos (APVP) y la media de años potenciales de vida perdidos (MAPVP). Resultados: La prevalencia global del tabaquismo en 2012 ha sido del 23,62%, y ha provocado 60.456 muertes. El 15,23% de las muertes ocurridas en España en 2012 son atribuibles al consumo de tabaco. El cáncer de tráquea-bronquios-pulmón en varones y otras cardiopatías en mujeres fueron las que más contribuyeron a dicha mortalidad. Los APVP fueron 184.426, y la MAPVP fue de 3,25 años en varones y de 2,42 en mujeres. Conclusiones: En el año 2012 han muerto al día 125 varones y 40 mujeres por causas atribuibles al consumo de tabaco. La prevalencia global del tabaquismo ha disminuido con respecto a años anteriores, mientras que el número y el porcentaje de muertes atribuibles al tabaquismo han aumentado en los últimos 20 años (AU)

Background and objective: Smoking is an important public health problem, and is one of the main avoidable causes of morbidity and early mortality. The aim was to estimate the mortality attributable to smoking and its impact on premature mortality in Spain in the year 2012. Patients and methods: Descriptive, cross-sectional study, carried out on the Spanish population aged ≥ 18 years in 2012. The prevalence of smoking by age and sex was obtained from the National Health Survey 2011-2012, and the number of deaths by age, sex and cause was obtained from the vital statistics of the National Institute of Statistics. The proportion of deaths attributable to smoking was calculated according to sex and age group, from the etiological fraction of the population. Likewise, loss of potential years of life lost (PYLL) and the mean potential years of life lost (MPYLL) were also calculated. Results: In 2012, smoking caused 60,456 deaths which accounted for 15.23% of all deaths. Trachea-bronchial-lung cancer in men and other cardiopathies in women mostly contributed to this mortality. The PYLL were 184,426, and the MPYLL were 3.25 years in men and 2.42 years in women. Conclusions: In 2012, every day, 125 men and 40 women die from smoking-related conditions. The smoking prevalence has diminished in comparison with previous years and the number and percentage of deaths attributable to the smoking have increased in the last 20 years (AU)

[Smoking impact on mortality in Spain in 2012]. / Impacto del consumo de tabaco sobre la mortalidad en España en el año 2012.

BACKGROUND AND OBJECTIVE: Smoking is an important public health problem, and is one of the main avoidable causes of morbidity and early mortality. The aim was to estimate the mortality attributable to smoking and its impact on premature mortality in Spain in the year 2012. PATIENTS AND METHODS: Descriptive, cross-sectional study, carried out on the Spanish population aged ≥ 18 years in 2012. The prevalence of smoking by age and sex was obtained from the National Health Survey 2011-2012, and the number of deaths by age, sex and cause was obtained from the vital statistics of the National Institute of Statistics. The proportion of deaths attributable to smoking was calculated according to sex and age group, from the etiological fraction of the population. Likewise, loss of potential years of life lost (PYLL) and the mean potential years of life lost (MPYLL) were also calculated. RESULTS: In 2012, smoking caused 60,456 deaths which accounted for 15.23% of all deaths. Trachea-bronchial-lung cancer in men and other cardiopathies in women mostly contributed to this mortality. The PYLL were 184,426, and the MPYLL were 3.25 years in men and 2.42 years in women. CONCLUSIONS: In 2012, every day, 125 men and 40 women die from smoking-related conditions. The smoking prevalence has diminished in comparison with previous years and the number and percentage of deaths attributable to the smoking have increased in the last 20 years.

Prescripción por principio activo como herramienta para el uso racional de los medicamentos. Estrategia de implantación y experiencia en Castilla y León / No disponible

No disponible

Normas técnicas sobre tratamiento farmacológico en la cartera de servicios de atención primaria / Technical norms on drug treatment in the catalogue of services in primary care

El objetivo de este trabajo es describir el procedimiento seguido para el diseño de normas técnicas de tratamiento (NTT) para su inclusión en la cartera de servicios de atención primaria, presentar la redacción de las 4 normas incluidas y los resultados del estudio de concordancia en su evaluación. Se recogió el fundamento científico técnico del contenido de la norma en un informe técnico que incluyó un repertorio bibliográfico y una copia de los principales artículos. La propuesta inicial de las normas se publicó en un número especial del boletín Ojo de Markov, dirigido a profesionales sanitarios. Se promovió un debate entre los profesionales, tanto acerca del contenido como de la pertinencia de este tipo de normas. Las opiniones y sugerencias se recogieron mediante una encuesta. Se realizó un estudio para valorar la concordancia en la evaluación de las normas entre 3 observadores independientes, en una muestra de 300 historias clínicas. Un grupo de expertos valoró el respaldo científico, las sugerencias de los profesionales y redactó la versión final de las normas. La propuesta de inclusión de NTT en la cartera de servicios de atención primaria como herramienta de calidad y de apoyo a las decisiones clínicas se recibió por los profesionales con distinto nivel de acuerdo. El cuerpo de la norma define el tratamiento de elección, y como aclaraciones a la evaluación se incluyen otras variantes clínicas admitidas en los consensos. Las NTT propuestas han mostrado buena concordancia entre evaluadores

This study aims to describe the procedure followed to design treatment technical norms (TTN) to be included in the catalogue of services in primary care, the wording of the four TTN included, and interobserver agreement. The technical-scientific bases of the TTN were written in a technical report that included a list of references and a copy of the most important articles. The initial proposals were published in a special issue of the bulletin Ojo de Markov (Markov's Eye), which is aimed at health professionals. Simultaneously, a debate among professionals was fostered on both the contents and the pertinence of this kind of norms. Suggestions and opinions were collected by means of a poll. A study to estimate the level of agreement among three independent observers was performed in a sample of 300 clinical records. The scientific evidence and health professionals' suggestions were evaluated by panel of experts who wrote the final version of the TTN. The proposal to include the TTN in the catalogue of services in primary care as a tool for measuring quality and supporting clinical decisions was received by health professionals with different degrees of agreement. The main part of each norm defines the treatment of choice, while other clinical situations based on guidelines were included as an explanation for the evaluation. The NTT defined showed good interobserver agreement