New polymorphisms associated with response to anti-TNF drugs in patients with moderate-to-severe plaque psoriasis.

Anti-tumor necrosis factor (anti-TNF) drugs are effective against psoriasis, although 20-30% of patients are nonresponders. Few pharmacogenomic studies have been performed to predict the response to anti-TNF drugs in psoriasis. We studied 173 polymorphisms to establish an association with the response to anti-TNF drugs in patients with moderate-to-severe plaque psoriasis (N=144). We evaluated the response using PASI75 at 3, 6 and 12 months. The results of the multivariate analysis showed an association between polymorphisms in PGLYR4, ZNF816A, CTNNA2, IL12B, MAP3K1 and HLA-C genes and the response at 3 months. Besides, the results for polymorphisms in IL12B and MAP3K1 were replicated at 6 months. We also obtained significant results for IL12B polymorphism at 1 year. Moreover, polymorphisms in FCGR2A, HTR2A and CDKAL1 were significant at 6 months. This is the first study to show an association with these polymorphisms. However, these biomarkers should be validated in large-scale studies before implementation in clinical practice.

Problemas laborales en pacientes dependientesdel alcohol: Evolución en un año de tratamiento / Work–related problems among alcohol–dependent patients: Development a year of alcohol treatment

Objetivo: El objetivo de este estudio es analizar la prevalencia de problemas laborales debidos al consumode alcohol en una muestra de dependientes del alcohol y su evolución durante un año de tratamiento.Material y Método: Se realizó un estudio prospectivo de una cohorte de 93 pacientes, que realizarontratamiento durante un año, diagnosticados de dependencia del alcohol según criterios DSM–IV. Se obtuvoinformación de los siguientes problemas laborales debidos al consumo de alcohol: absentismo, llamadas deatención, sanciones, accidentes laborales, despidos, desempleo o paro, ocurridos en tres momentos: durantetoda la vida, el año anterior al inicio del tratamiento y durante un año de tratamiento.Resultados: El 57% tuvieron problemas laborales a lo largo de su vida, el 35,5% el año anterior al iniciodel tratamiento, y el 23,7% durante el año de tratamiento. Los problemas mas frecuentes fueron el absentismoy el desempleo. Los problemas laborales disminuyeron (p<0,05) durante el año de tratamiento respecto alaño anterior al inicio del tratamiento.Discusión: Este estudio indica que los problemas laborales son frecuentes entre los dependientes delalcohol, y que estos disminuyen con el tratamiento de la dependencia del alcohol (AU)

Objetive: The aim of this study is to analyse the prevalence of work–related problems due to the consumptionof alcohol in a sample of alcohol–dependent patients and their evolution over twelve months of treatment.Method: A prospective study was carried out on a cohort of 93 patients diagnosed as alcohol–dependentaccording to DSM–IV criteria, who underwent treatment over a 12 month period. Information concerning thefollowing work–related problems due to the consumption of alcohol was obtained: absenteeism, warnings,sanctions, accidents at work, dismissals and unemployment, that occurred within three different time scales: thepatient’s lifetime, the 12 months prior to the start of the treatment and during the 12 months of the treatment.Results: 57% had had work–related problems during their lifetime, 35.5% in the 12 months prior tostarting treatment and 23,7% during the year of treatment. The most frequent problems during the year oftreatment were absenteeism and unemployment. Work–related problems decreased (p < 0.05) during thetreatment with respect to the year prior to the start of the treatment.Conclusion: This study indicates that work–related problems are frequent among alcohol–dependentpatients, but that such problems decrease when the dependency is treated (AU)

Curso de la red de trastornos adictivos de casos clínicos en el tratamiento de las adicciones, segunda edición* / No disponible

No disponible

Patients treated with obstructive sleep apnea syndrome and fitness to drive assessment in clinical practice in Spain at the medical traffic centers.

OBJECTIVE: To assess fitness to drive among drivers with treated obstructive sleep apnea syndrome. METHODS: A total of 5234 drivers who attended two Spanish Medical Driver Test Centers for assessment of their fitness to drive prior to renewing or issuing their driving license were included in the study. Information regarding sociodemographic aspects, patterns of driving, medical condition, medication use, and patterns of alcohol consumption was recorded. RESULTS: Eleven out of 5234 drivers (0.2%) suffered from obstructive sleep apnea syndrome, all of them being treated with continuous positive airway pressure, and they were found fit to drive with restrictions. CONCLUSIONS: A lower than expected prevalence of patients with obstructive sleep apnea syndrome was found among drivers undergoing fitness to drive assessment. Suffering from obstructive sleep apnea syndrome does not prevent driving as long as the patient is undergoing adequately controlled treatment.

[Fitness-to-drive assessment in drivers with neurological and neuromuscular disorders at the driving test centres]. / Evaluación en los centros de reconocimiento de conductores de los pacientes con patología neurológica y neuromuscular.

INTRODUCTION: Drivers with a neurological pathology have a greater risk of involvement in traffic accidents than healthy drivers. AIM: To evaluate the fitness to drive of drivers with a neurological or neuromuscular pathology. SUBJECTS AND METHODS: 5,234 drivers attending two Medical Driver Test Centres with the aim of carrying out a medical-psychological examination to obtain or renew their driving license were included in the study. Information was obtained concerning sociodemographic aspects, driving habits, the referred pathology and consumption of medicaments and alcohol. RESULTS: 1.4% of the drivers presented a neuromuscular or neurological pathology. The most frequent were muscular disorders of a neurological origin (32.5%), a history of cerebrovascular accidents (27%) and epilepsy (24.3%). 21.6% of the drivers were considered 'fit', 77.1% were 'fit with restrictions', and only 1.3% were considered 'unfit' to drive. CONCLUSIONS: The great majority of drivers (98.7%) with a neurological pathology are considered 'fit' or 'fit with restrictions' to drive. Even though only a small percentage of divers with neurological pathologies are considered 'unfit' to drive, given their increased risk of involvement in traffic accidents, an early, individual evaluation of these patients' fitness to drive, taking into account the associated pathology, prescribed medication, consumption of alcohol and age, would seem necessary.

Demand for prior treatment in alcoholic patients.

The aim of this study is to analyze the use of health care resources by alcoholic patients. A prospective study of 176 patients (147 males, 29 females; mean age 42.9 years) diagnosed as alcohol dependent, according to criteria DSM-IV, has been carried out over one year (June 2002 to June 2003) in three centers of treatment for alcoholics in Castilla y León (Spain). Of the 176 patients, 67% had previously requested treatment for their alcoholism in other centers, mainly in mental-health (37.5%), emergency (34.1%), and primary care (31.8%). On average, they had requested treatment 2.27 times, the women more frequently than the men. The current study shows that alcohol-dependent patients frequently use health care services during the history of their dependence to treat their illness.

Joven con consumo de alcohol y cannabis y accidente de tráfico / Youth with alcohol and cannabis consumption in traffic accident

Objetivo. Examinar el caso clínico de un joven de 23 años que acude a urgencias por un accidente de tráfico después de haber consumido alcohol y cannabis. Material y métodos. Se analiza el caso clínico de un joven de 23 años que acude a un servicio de urgencias por accidente de tráfico con un importante estado de nerviosismo y agitación. Se explora el consumo de sustancias por el paciente. Resultados. El paciente conducía bajo los efectos del alcohol y del cannabis; se comenta la prevalencia de consumo de alcohol y cannabis, sobre todo entre la juventud, analizando el deterioro que puedan producir esas drogas en las capacidades para conducir un vehículo. Conclusión. Según datos de las encuestas realizadas por el Plan Nacional Sobre Drogas, el alcohol y el tabaco, seguidos del cannabis, son las drogas más consumidas en España. El uso combinado de cannabis y alcohol produce un serio deterioro en la aptitud para conducir y aumenta el riesgo de que el conductor sea responsable de un accidente comparado con conductores libres de drogas

Objective. To examine the case of a youth attending accident & emergency (A&E) following a traffic accident after consuming both alcohol and cannabis. Material and methods. A case of a 23 year old youth attending A&E following a traffic accident and in an extreme state of nervousness is analysed. The consumption of substances by the patient is explored. Results. The patient was driving under the influence of alcohol and cannabis. The prevalence of the consumption of these substances, especially among young people, is commented on, analysing the deterioration these drugs can cause in the capacity to drive a motor vehicle. Conclusions. According to data from surveys carried out by the National Plan on Drugs, alcohol and tobacco, followed by cannabis, are the most commonly consumed drugs in Spain. The combined use of alcohol and cannabis produces a serious deterioration in fitness to drive and increases the risk of the driver being responsible for an accident, as compared with drivers not under the influence of drugs

Road traffic accidents among alcohol-dependent patients: the effect of treatment.

It is well known that driving under the influence of alcohol increases the risk of traffic accidents. Alcohol-dependent patients are responsible for two-thirds of motor vehicle crashes involving alcohol. Studies carried out on the general population have shown a relation between alcohol dependence and traffic accidents. The aim of the study is to analyse the effect on traffic accidents of treatment of patients with alcohol-related problems. To do so, the prevalence of traffic problems in a sample of patients with a diagnosed dependence on alcohol was assessed for three periods: during their lifetime, in the year preceding the start of treatment and over the year of treatment. A prospective study was carried out of 176 patients (147 males, 29 females; mean age 42.9 years) diagnosed as alcohol dependent according to the DSM-IV criteria in three alcoholic treatment centres in Castilla y León, Spain. 36.9% of the alcohol-dependent patients had had some kind of traffic problem during their life and 8.5% in the year prior to starting treatment. The most frequent problem was positive breath tests, followed by accidents with damage to the vehicle. Sixty-nine of the 176 patients were still receiving treatment after a year. The prevalence of traffic problems among those patients who followed treatment for 1 year (4.3%) was lower than in the year before treatment (15.9%). The study showed that the treatment is also effective in reducing traffic problems.

Varón dependiente del alcohol / Alcohol dependent male

Objetivo: Analizar el caso clínico de un varón de 38 años, dependiente del alcohol en sus vertientes de diagnóstico, consejo para el tratamiento y tratamiento del problema. Material y métodos: El caso clínico analizado corresponde al de un paciente varón, se registran las pautas de consumo de alcohol así como la problemática social, laboral, familiar y de tráfico que ese consumo le ha producido. Resultados: Se analizan los pasos dirigidos al diagnóstico sistematizado (criterios DSM-IV, cuestionarios diagnósticos de dependencia del alcohol y marcadores biológicos) y el tratamiento realizado en dicha patología, tanto farmacológico como psicosocial. Conclusiones: La dependencia del alcohol es un problema médico que se presenta frecuentemente en los servicios de urgencias y en atención primaria, patología que en muchos casos deberá ser tratada por servicios especializados, tanto en sus formas iniciales (síndrome de abstinencia) como posteriormente en tratamientos de deshabituación y rehabilitación

Objectives: To analyse a clinical case of an alcohol dependent male in the aspects of diagnosis, advice for treatment and treatment of the problem. Material and methods: The case analysed is that of a 38 year old male patient. The pattern of alcohol consumption, as well as the social, labour, family and traffic problems produced by this consumption are registered. Results: We analyse the steps taken for a systematic diagnosis (DSM-IV criteria, diagnostic surveys of alcohol dependence and biological markers) and the treatment given for the said pathology, both pharmacological and psychosocial. Conclusions: Alcohol dependence is a medical problem that is frequently seen in primary care and A&E services. In many cases, it is a pathology that should be treated by specialised services, both in its initial forms (abstinence syndrome) and later treatment for habit loss and rehabilitation

Alcohol y prevención de los problemas relacionados con el consumo de alcohol en el ámbito laboral / No disponible

La importancia del alcohol en el medio laboral es indiscutible ya que el alcohol es la droga más consumida entre los trabajadores. Los problemas detectados más frecuentemente en el trabajo por consumo de alcohol han sido: absentismo, incremento de las bajas laborales, mayor accidentabilidad, disminución del rendimiento, mayor conflictividad, incumplimiento de la jornada laboral, comisión de más errores, aumento de expedientes disciplinarios, aumento de despidos y como consecuencia más paro. Se ha relacionado el tener problemas con el alcohol con el tipo de de trabajo y con el incremento de la oferta/disponibilidad de bebidas alcohólicas. Los costes económicos que producen a las empresas y a los países los consumidores de alcohol son importantes, en España los costes debidos a bajas laborales por consumo de alcohol ascienden a 72.854 millones de €/año. Algunas empresas además de las normas sobre consumo proporcionan ayuda a los empleados que tienen problemas con la bebida, realizando programas de prevención primaria (información), prevención secundaria (tratamiento), prevención terciaria (reinserción laboral). Son necesarias políticas de prevención relacionadas con el consumo de alcohol en la empresa ya que se ha demostrado que los servicios de prevención producen más ahorro que coste requiere el programa y es menos costoso que el tratamiento de los trabajadores con adicción al alcohol

The importance of alcohol at work is undeniable as it is the drug most commonly consumed by workers. The most frequently detected problems in the labor field due to the consumption of alcohol are: absenteeism, an increase in absense due to illness, a greater number of accidents, lower performance levels, higher levels of conflict, not complying with the required number of work hours, a higher percentage of errors, an increase in disciplinary proceedings, an increase in the number of workers fired and consequently higher unemployment. Having problems with alcohol has been related to certain types of work and to the increase in the supply/availability of alcoholic beverages. The economic costs caused by consumers of alcohol that companies and countries have to face are sizeable. In Spain, the costs from loss of working days due to the consumption of alcohol has reached 72.854 million €/year. Apart from rules concerning consumption of alcohol, some companies provide assistance for employees who have problems with alcohol, carrying out primary prevention programs (information), secondary prevention (treatment), and tertiary prevention (work rehabilitation). Preventive policies concerning the consumption of alcohol at work are necessary as it has been proved that prevention services save more money than the cost of the programs themselves, and that it is less costly than the treatment of alcohol dependent workers

Evolución del consumo de alcohol de los españoles entre 1993, 1995 y 1997, a partir de los datos de la encuesta nacional de salud / Trends in alcohol consumption among spaniards between 1993, 1995 and 1997, from national health survey data

Objetivo: El objetivo del presente estudio es comparar las pautas de consumo de alcohol de la población general entre 1993, 1995 y 1997, a partir de los datos de la Encuesta Nacional de Salud de dichos años. Metodología: Se analizó el consumo de alcohol en las Encuestas Nacionales de Salud realizadas por el Ministerio de Sanidad y Consumo de 1993, 1995 y 1997. Se analiza la frecuencia de bebedores semanales y diarios, y cantidad absoluta de alcohol en gr/día. Los bebedores se clasificaron en bajo consumo, consumo moderado, alto consumo. Resultados: Ha disminuido la frecuencia de consumidores diarios de alcohol en 1995 (23,4%) y 1997 (23,7%) respecto a 1993 (24,8%), aumentando la frecuencia de consumidores semanales en los años 1995 (52,3%) y 1997 (53,2%) respecto a 1993 (46,4%). La cantidad media absoluta de alcohol (gr/día) de los bebedores semanales ha sufrido un descenso desde 1993 (27,84 gr/día) hasta 1995 (22,43 gr/día) y 1997 (22,59 gr/día), no se han apreciado cambios en la cantidad (gr/día) consumida por los bebedores diarios. Se observa una disminución en los años 1995 y 1997 respecto a 1993 del porcentaje de bebedores de alto consumo y un aumento de los bebedores de bajo consumo. Conclusión: El presente estudio muestra cambios en las pautas de consumo de alcohol en el período estudiado. Hay que destacar que una cuarta parte de la población mayor de 16 años bebe alcohol a diario con una media de 40,73 gr/día de alcohol

Objective: The aim of this study is to compare the patterns of alcohol consumption in the general population between 1993, 1995 and 1997, using data from the National Health Surveys for those years. Methodology: The consumption of alcohol in the National Health Surveys, carried out by the Ministry of Health, from 1993, 1995 and 1997 was analyzed. Specifically, we analysed the frequency of weekly and daily drinkers, and the quantity of absolute alcohol consumed in gr/day. Drinkers were classified as low, moderate or high consumers. Results: The frequency of daily alcohol drinkers decreased in 1995 (23.4%) and 1997 (23.7%) in comparison with 1993 (24.8%). However, the frequency of weekly drinkers increased in 1995 (52.3%) and 1997 (53.2%) compared with 1993 (46.4%). The mean absolute of alcohol (gr/day) of weekly drinkers decreased from 1993 (27.84 gr/day) to 1995 (22.43 gr/ day) and 1997 (22.59 gr/day). There was no appreciable change in the amount (gr/day) consumed by daily drinkers. A decrease can be observed in 1995 and 1997 with respect to 1993 in the percentage of high consumption drinkers and an increase in that of low consumption drinkers. Conclusion: The present study shows changes in the consumption patterns of alcohol in the period studied. It should be pointed out that a quarter of the population over the age of 16 drinks alcohol on a daily basis, with an average of 40.73 gr/day of alcohol