Maternal and foetal complications of pregestational and gestational diabetes: a descriptive, retrospective cohort study.

Gestational diabetes is characterized by hyperglycaemia diagnosed during pregnancy. Gestational and pregestational diabetes can have deleterious effects during pregnancy and perinatally. The baby's weight is frequently above average and might reach macrosomia (≥ 4 kg), which can reduce pregnancy time causing preterm births, and increase foetal-pelvic disproportion which often requires delivery by caesarean section. Foetal-pelvic disproportion due to the baby's weight can also cause foetal distress resulting in lower Apgar scores. To analyse the association between pregestational and gestational diabetes with maternal and foetal risk. We conducted a retrospective cohort study in women pregnant between 2012 and 2018 in the region of Lleida. Regression coefficients and 95% confidence intervals (CI) were used. The multivariate analysis showed statistically significant associations between pregestational diabetes and: prematurity (OR 2.4); caesarean section (OR 1.4); moderate (OR 1.3), high (OR 3.3) and very high (OR 1.7) risk pregnancies; and birth weight ≥ 4000 g (macrosomia) (OR 1.7). In getational diabetes the multivariate analysis show significant association with: caesarean section (OR 1.5); moderate (OR 1.7), high (OR 1.7) and very high (OR 1.8) risk pregnancies and lower 1-minuto Apgar score (OR 1.5). Pregestational and gestational diabetes increase: pregnancy risk, caesarean sections, prematurity, low Apgar scores, and macrosomia.

Target enrichment sequencing coupled with GWAS identifies MdPRX10 as a candidate gene in the control of budbreak in apple.

The timing of floral budbreak in apple has a significant effect on fruit production and quality. Budbreak occurs as a result of a complex molecular mechanism that relies on accurate integration of external environmental cues, principally temperature. In the pursuit of understanding this mechanism, especially with respect to aiding adaptation to climate change, a QTL at the top of linkage group (LG) 9 has been identified by many studies on budbreak, but the genes underlying it remain elusive. Here, together with a dessert apple core collection of 239 cultivars, we used a targeted capture sequencing approach to increase SNP resolution in apple orthologues of known or suspected A. thaliana flowering time-related genes, as well as approximately 200 genes within the LG9 QTL interval. This increased the 275 223 SNP Axiom® Apple 480 K array dataset by an additional 40 857 markers. Robust GWAS analyses identified MdPRX10, a peroxidase superfamily gene, as a strong candidate that demonstrated a dormancy-related expression pattern and down-regulation in response to chilling. In-silico analyses also predicted the residue change resulting from the SNP allele associated with late budbreak could alter protein conformation and likely function. Late budbreak cultivars homozygous for this SNP allele also showed significantly up-regulated expression of C-REPEAT BINDING FACTOR (CBF) genes, which are involved in cold tolerance and perception, compared to reference cultivars, such as Gala. Taken together, these results indicate a role for MdPRX10 in budbreak, potentially via redox-mediated signaling and CBF gene regulation. Moving forward, this provides a focus for developing our understanding of the effects of temperature on flowering time and how redox processes may influence integration of external cues in dormancy pathways.

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

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

[Use of primary care resources by immigrants and the autochthonous persons who contact the care services in the city of Lleida, Spain]. / Utilización de recursos de atención primaria por parte de inmigrantes y autóctonos que han contactado con los servicios asistenciales de la ciudad de Lleida.

OBJECTIVE: To evaluate and compare the use of the different primary care (PC) services between immigrants and the indigenous population. DESIGN: Cross-sectional observation study of a population seen in (PC). SETTING: Patients seen by 15 PC doctors, in 5 basic health areas (BHA) in the city of Lleida, Spain, from March to August 2005. PARTICIPANTS: All immigrants (1,599 patients of immigrant origin) who seen during the study period were included. A random sample of 300 patients was taken from each of the 15 participating clinics (4,156 autochthonous patients). The autochthonous was considered as those whose country of origin is Spain and the immigrant population those who come from low and medium income countries, regardless of the time of residence in the BHA. PRIMARY MEASUREMENTS: Age, sex, type of visit made, and referrals made. Multinomial regression models were used to calculate the relative risk (RR) of having made visits. RESULTS: Immigrants have a higher probability to make 3 visits than the indigenous population, who would make 1 or 2 visits (RR, 1.23; 95% confidence interval, 1.04-1.91). The estimation of the RR of having made visits is higher in the immigrants for all categories, except nursing. CONCLUSIONS: Immigrants who come into contact with PC, make more frequent visits to the family doctor and gynaecology, and also have more complementary tests done. However, the frequency of use of the immigrant group for nursing visits seems to be less.

Utilización de recursos de atención primaria por parte de inmigrantes y autóctonos que han contactado con los servicios asistenciales de la ciudad de Lleida / Use of primary care resources by immigrants and autochthonous persons who contact the care services in the city of Lleida

Objetivo. Evaluar y comparar la utilización de recursos en los distintos servicios de atención primaria (AP) entre inmigrantes y autóctonos. Diseño. Estudio observacional transversal en población visitada en AP. Emplazamiento. Personas atendidas por 15 médicos de AP en 5 áreas básicas de salud (ABS) de la ciudad de Lleida de marzo a agosto de 2005. Participantes. Se incluyó a todos los inmigrantes atendidos durante el período de estudio (1.599 pacientes de origen inmigrante). Se realizó un muestreo aleatorio de 300 pacientes en cada una de las 15 consultas participantes (4.156 pacientes de origen autóctono). Se consideró población autóctona aquella cuyo país de origen es España y población inmigrante aquella que proviene de los países de renta baja y media, independientemente del tiempo de asistencia al ABS. Mediciones principales. Edad, sexo, tipo de visitas realizadas y las derivaciones efectuadas. Se utilizaron modelos de regresión multinomial para estimar el riesgo relativo (RR) de haber realizado las visitas. Resultados. Los inmigrantes tienen una probabilidad superior a los autóctonos de realizar más de 3 visitas, frente a 1 o 2 visitas (RR = 1,23; intervalo de confianza [IC] del 95%, 1,04-1,91%). La estimación del RR de haber realizado visitas es superior en los inmigrantes para todas las categorías, excepto en enfermería (RR = 0,59; IC del 95%, 0,5-0,71%). Conclusiones. Los inmigrantes que contactan con AP lo hacen con mayor frecuencia en las consultas de medicina de familia y de ginecología, y además se realizan más pruebas complementarias. Sin embargo, la frecuentación del colectivo inmigrante a las consultas de enfermería parece ser inferior

Objective. To evaluate and compare the use of the different primary care (PC) services between immigrants and the indigenous population. Design. Cross-sectional observation study of a population seen in (PC). Setting. Patients seen by 15 PC doctors, in 5 basic health areas (BHA) in the city of Lleida, Spain, from March to August 2005. Participants. All immigrants (1599 patients of immigrant origin) who seen during the study period were included. A random sample of 300 patients was taken from each of the 15 participating clinics (4156 autochthonous patients). The autochthonous was considered as those whose country of origin is Spain and the immigrant population those who come from low and medium income countries, regardless of the time of residence in the BHA. Primary measurements. Age, sex, type of visit made, and referrals made. Multinomial regression models were used to calculate the relative risk (RR) of having made visits. Results. Immigrants have a higher probability to make 3 visits than the indigenous population, who would make 1 or 2 visits (RR, 1.23; 95% confidence interval, 1.04-1.91). The estimation of the RR of having made visits is higher in the immigrants for all categories, except nursing. Conclusions. Immigrants who come into contact with PC, make more frequent visits to the family doctor and gynaecology, and also have more complementary tests done. However, the frequency of use of the immigrant group for nursing visits seems to be less

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

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

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

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

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