Análisis de supervivencia en investigación cardiovascular (I): lo esencial / Survival analyses in cardiovascular research, part I: the essentials

Esta revisión establece una guía práctica que comprende los conceptos básicos de los análisis de supervivencia y su aplicación en el estudio de las enfermedades cardiovasculares, si bien gran parte del contenido puede extrapolarse a otras ramas de la medicina. Este es el primero de dos artículos académicos que sientan las bases para abordar las principales cuestiones metodológicas empleadas en estudios de supervivencia, y guían al lector desde los análisis más básicos hasta los más complejos. Esta revisión se centra en el tipo y la forma de los datos de supervivencia, así como en los métodos estadísticos más utilizados, como las pruebas no paramétricas, paramétricas y semiparamétricas. La interpretación y la valoración de la idoneidad de dichos métodos, así como sus ventajas e inconvenientes, se ilustran con estudios del ámbito de las enfermedades cardiovasculares. El artículo concluye aportando un conjunto de recomendaciones para guiar la estrategia del análisis de supervivencia, tanto en el contexto de un ensayo clínico aleatorizado como en el de estudios observacionales. En la segunda revisión se abordarán temas como el modelo de riesgos competitivos, el modelo de eventos recurrentes y los modelos multiestado (AU)

This review provides a practical guide to the essentials of survival analysis and their reporting in cardiovascular studies, although most of its key content can be extrapolated to other medical fields. This is the first in a series of 2 educational articles laying the groundwork to address the most relevant statistical issues in survival analyses, which will smoothly drive the reader from the most basic analyses to the most complex situations. The focus will be on the type and shape of survival data, and the most common statistical methods, such as nonparametric, parametric and semiparametric models. Their adequacy, interpretation, advantages and disadvantages are illustrated by examples from the field of cardiovascular research. This article ends with a set of recommendations to guide the strategy of survival analyses for a randomized clinical trial and observational studies. Other topics, such as competing risks, multistate models and recurrent-event methods will be addressed in the second article (AU)

Análisis de supervivencia en investigación cardiovascular (II): metodología estadística en situaciones complejas / Survival analyses in cardiovascular research, part II: statistical methods in challenging situations

Esta revisión es la segunda parte de 2 artículos sobre metodología estadística. En el primero, se describían los conceptos básicos del análisis de supervivencia y los métodos estadísticos más comúnmente utilizados y se aportaba un conjunto de recomendaciones para ayudar a establecer una estrategia de análisis de supervivencia, tanto en el contexto de un ensayo clínico aleatorizado como en el de un estudio observacional. En este segundo artículo, se introducen el modelo estratificado de Cox y el modelo de fragilidad y se ilustra el sesgo de tiempo inmortal secundario a una evaluación errónea de variables dependientes del tiempo. Para abordar el problema de la existencia de múltiples eventos clínicos, se introducen distintas aproximaciones estadísticas, como el análisis de riesgos competitivos, los modelos multiestado y el modelo de eventos recurrentes. Todos ellos se ilustran con ejemplos del campo cardiovascular, y se resumen las principales ventajas y limitaciones de cada uno de los métodos estadísticos. Por último, se presentan algunas consideraciones generales sobre métodos estadísticos alternativos, con asunciones menos restrictivas, como el método win ratio, el tiempo de supervivencia medio restringido y el modelo de tiempo de evento acelerado (AU)

This article is the second of a series of 2 educational articles. In the first article, we described the basic concepts of survival analysis, summarizing the common statistical methods and providing a set of recommendations to guide the strategy of survival analyses in randomized clinical trials and observational studies. Here, we introduce stratified Cox models and frailty models, as well as the immortal time bias arising from a poor assessment of time-dependent variables. To address the issue of multiplicity of outcomes, we provide several modelling strategies to deal with other types of time-to-event data analyses, such as competing risks, multistate models, and recurrent-event methods. This review is illustrated with examples from previous cardiovascular research publications, and each statistical method is discussed alongside its main strengths and limitations. Finally, we provide some general observations about alternative statistical methods with less restrictive assumptions, such as the win ratio method, the restrictive mean survival time, and accelerated failure time model (AU)

Has the adipokine profile an influence on the catch-up growth type in small for gestational age infants?

Infants born small for gestational age (SGA) are at increased risk of perinatal morbidity, persistent short stature, and metabolic alterations in later life. Moreover, the post-natal growth pattern of SGA infants may be an important contributor to health outcomes later in life, which can be influenced by adipokines. The aims of this study were to compare plasma adipokine profiles (leptin, adiponectin, vaspin, chemerin, and nephroblastoma overexpressed (NOV/CCN3)) among SGA newborns aged 3 months, with low, normal, or high catch-up, to search for potential differences between males and females and to analyze the evolution of several adipokines in plasma from SGA newborns between 3 and 24 months. This prospective, longitudinal study was addressed in SGA Caucasian subjects at Hospital Universitario de Álava-Txagorritxu. We observed that infants with fast catch-up showed significantly lower birth weight than the other two groups. As far as adipokines are concerned, they could have an influence on catch-up type because differences among the three experimental groups were found. It may be proposed that health prognoses in infants with slow and fast catch-up are opposite, not only in adulthood but also during their first months. Finally, adipokine evolution patterns during the first 24 months of age differ, depending on the adipokine, and 24-month-old males show lower levels of leptin, adiponectin, and omentin than females.

Formación actual sobre heridas crónicas en el Grado de Enfermería de las universidades españolas / Current training on chronic wounds in the Nursing degree programs in the Spanish universities

Con el objetivo de invitar a la reflexión, se pretende describir la situación actual de la carga docente dedicada a la formación en heridas crónicas y úlceras por presión (UPP) en el Grado de Enfermería de las universidades españolas. Objetivos: Conocer los créditos docentes en heridas crónicas impartidos en nuestras universidades españolas. Métodos: Se realiza una búsqueda de los créditos docentes en heridas crónicas en las facultades de enfermería españolas. Resultados: De las 19 CC.AA., se revisan 119 universidades, de las que se excluye a aquellas que no presentan accesible la guía docente (8,4%). En el 48,6% de la muestra (109 universidades) no se concretan los créditos, la asignatura ni el curso. Del 51,4% restante, el 94,64% le dedica entre 1 y 2 créditos a esta formación, y es segundo el curso donde mayoritariamente se imparte. Conclusiones: En la mitad de las universidades españolas no están accesibles los créditos docentes dedicados a heridas crónicas. Y donde están accesibles, la mayoría le concede entre 1 y 2 créditos

With the aim to invite to reflection, this paper is intended to describe the current situation of the courses dedicated to training on chronic wounds and pressure ulcers within the Nursing degree developed in Spanish universities. Aim: To describe the total amount of credits (European Credits Transfer System) in courses on chronic wounds taught in Spanish universities. Methods: Search in the web pages of the Spanish Schools of Nursing in order to find and extract the number of credits in chronic wounds. Results: Out of the 19 Spanish autonomous regions, 119 universities have been reviewed. The universities without the teaching guides available on the web were excluded. In the final sample (109 universities) a 48.6% do not specify the number of credits, the course nor the academic year. In the remaining 51.4%, a 94.6% of universities have 1 or 2 credits (25 to 50 hours) for teaching about chronic wounds; mainly taught in the second year. Conclusions: In about a half of the Spanish universities there is no available information about the number of credits taught on chronic wounds. Within the universities with available data, most of them have 1 or 2 teaching credit

Eficacia de la intervención enfermera en la adherenciaal tratamiento en pacientes diabéticos tipo 2 / Efficacy of nursing intervention in treatment compliance for type 2 diabetic patients

Objetivo: evaluar si la intervención explícita dirigida a mejorar la adherencia al tratamiento farmacológico (dosis y horarios prescritos) supone una mejoría en la utilización correcta de los mismos y, como consecuencia, una mejora del control metabólico (reducción de la HbAc1)en los pacientes con diabetes tipo 2.Método: estudio cuasi experimental, antes-después de una intervención comunitaria no controlada, en los años 2010-2011, con pacientes diabéticos tipo 2 de la cartera de servicios del Centro de Salud “Las Fuentes Norte” de Zaragoza, con tratamiento farmacológico y seguimiento en la consulta de Enfermería. Para valorar el cumplimiento terapéutico delos enfermos se utilizaron métodos directos, como control de glucemia basal y HbAc1, y métodos indirectos, como las entrevistas estructuradas, a partir de una encuesta consensuada por los investigadores. Resultados: 232 pacientes estudiados, divididos al 50% entre hombres y mujeres, el 56% mayores de 70 años. Antes de la intervención, un55,2% de los mismos tenían una glucemia > 140 mg/dl; el 45,7% unaHbAc1 > 7%; el 22% tenía LDL-colesterol > 130 mg/dl y solamente un25% el IMC < del 27; y un 70,3% triglicéridos < 150 mg/dl. Se produjo un cambio de mala a buena adherencia en el 10,9% (5) de los pacientes con tratamiento de insulina, en el 49,3% (106) de los que tomaban antidiabéticos orales y en 17,2% (25) de los que tenían tratamiento con hipolipemiantes. El resto de enfermos tenían buena adherencia y la mantuvieron hasta el final del estudio. En los enfermos que han mejorado la adhesión al tratamiento se produjo una disminución significativa de HbAc1 (p ≤ 0,001) con independencia del tratamiento prescrito. Conclusiones: insistir en que la toma de los fármacos ha mejorado el control metabólico. Hay que identificar pacientes con baja adherencia y desarrollar estrategias que les ayuden a reconocer sus medicaciones y posología, como entregar una hoja personalizada con la dosificación y horarios (AU)

Objective: to assess whether a clear intervention targeted at improving pharmacological treatment compliance (prescribed doses and schedule) represents an improvement in their correct use and, consequently, an improvement in metabolic control (HbAc1 reduction) in patients with Type 2 Diabetes. Method: Quasi-experimental before-and-after study of an outpatient intervention without control arm, during 2010-2011, with Type 2 diabetic patients from the services portfolio in the “Las Fuentes Norte” Public Health Centre, Zaragoza, with pharmacological treatment and follow-up by the Nursing Unit. In order to assess treatment compliance by patients, direct methods such as basal glycemic and HbAc1 control were used, as well as indirect methods, such as structured interviews, based on a survey by consensus with investigators. Results: 232 patients were studied, with a 50-50% split between male and female, and 56% of which were over 70-year-old. Before the intervention,55.2% of patients had glycemia > 140 mg/dl; 45.7% had HbAc1> 7%; 22% had LDL-cholesterol > 130 mg/dl and only 25% had BMI<27; and 70-3% of patients had triglycerides < 150 mg/dl. There was a change from poor to good compliance in 10.9% (5) patients on insulin treatment, in 49.3% (106) of those patients taking oral antidiabetic drugs, and in 17.2% (25) of patients on treatment with hypolipemiant agents. The rest of patients showed good compliance, and this was sustained until the end of the study. In patients with improvement in treatment compliance, there was a significant reduction in HbAc1 (p ≤ 0.001) regardless of prescribed treatment. Conclusions: to insist upon the fact that taking the prescribed drugs will lead to an improvement in metabolic control. Patients with low compliance must be identified, and strategies must be developed to help them to acknowledge their medications and dosing regimen, such as handing out a personalized sheet with dosing and administration sched (AU)

El pie en la Diabetes / The foot in diabetes

Proyecto becado por el Servicio Aragonés de Salud en el año 2000, de dos años de duración. Fue presentado en el XI Congreso de la FEAED (Federación Española de Asociaciones de Educadores en Diabetes) celebrado en Valencia en el 2004. Prepara y cualifica a Enfermería para la realización de una revisión de pie diabético de calidad con una intervención educativa complementada con un estudio transversal pre post intervención. Han participado 268 enfermeros de Atención Primaria que trabajan con diabéticos en las 34 zonas básicas de salud

Nursing was qualified to carry out an in depth study on the effects diabetes has on feet by means of an educational intervention complemented by a pre- and post-intervention transversal study. 268 primary care center nurses who deal with diabetics in 34 basic health areas participated in this study. This project was sponsored by SALUD, the Aragon Health service, in 2000 and it lasted two years. This study was presented at the XI FEAED (Spanish Federation of Association of Educators in Diabetes) Congress which took place in Valencia in 2004

Estudio epidemiológico de las parasitosis intestinales 2000-2001 en población ambulatoria del Área 1 de la Comunidad de Madrid / Epidemiological study of intestinal parisitism 2000-2001 of outpatients in a health area (Madrid, Spain)

Objetivo: Conocer la prevalencia de parasitosis intestinales en población ambulatoria de nuestra Área Sanitaria de Salud. Diseño: Estudio retrospectivo observacional. Marco poblacional Área Sanitaria 1 de la Comunidad de Madrid, España. Material y métodos: Durante el período de estudio (enero 2000-diciembre 2001) han sido procesadas 6.137 muestras fecales (5.783 heces y 354 muestras para diagnóstico de oxiuros, 312 torundas vaselinizadas y 42 celos) procedentes de 3.396 pacientes. Las heces fueron procesadas mediante técnica de concentración en formol-acetato de etilo. La detección de ooquistes de coccidios se llevó a cabo mediante tinción de ácido-alcohol resistencia de Kinyoun modificada, de frotis directos y concentrados. Resultados: La prevalencia de parasitación intestinal ha sido del 13,5 per cent (827 muestras fecales positivas, pertenecientes a 464 pacientes, detectándose un total de 1.029 parásitos). La distribución de los parásitos observados y su prevalencia ha sido: Blastocystis hominis (39,3 per cent), Giardia intestinalis (19,3 per cent), Entamoeba coli y Endolimax nana (12,0 per cent cada uno), Enterobius vermicularis (6,9 per cent), Cryptosporidium parvum (3,6 per cent), Entamoeba histolytica/dispar (3,2 per cent), Trichuris trichiura (1,8 per cent), Hymenolepis nana (0,8 per cent), Taenia saginata (0,5 per cent), Ascaris lumbricoides (0,4 per cent) y Uncinarias (0,1 per cent). Los parásitos intestinales identificados más frecuentemente han sido: Giardia intestinalis (52,8 per cent), Enterobius vermicularis (18,8 per cent), Cryptosporidium parvum (9,8 per cent) y Entamoeba histolytica/dispar (8,7 per cent). Han sido analizados el origen de las muestras, edad, distribución por sexos y procedencia de los pacientes así como la incidencia estacional de los parásitos intestinales detectados. Conclusiones: Nuestros hallazgos sugieren que las infecciones parasitarias todavía constituyen un problema de salud pública. El conocimiento de la situación en cada área facilita su manejo y control (AU)

A new product with formic acid for Varroa jacobsoni Oud. control in Argentina. I. Efficacy.

An organic product based on formic acid in a gel matrix was evaluated for use in Varroa control under autumnal climatic conditions in Argentina. Twenty colonies each received two gel packets with formic acid in two applications and numbers of falling mites were registered. After this treatment colonies received two other acaricides in order to compare efficacy. Average final efficacy in colonies treated with the organic product was 92% with a low variability. The gel matrix kept an adequate formic acid concentration inside the colonies with only two applications. This product is, therefore, a good alternative for Varroa control because it is organic, easy to use and presents a low variability in final efficacy between colonies. No queen, brood, or adult honeybee mortality was registered.

[Education by participating in a diabetic food contest]. / Educar y participar a través de un concurso. Comida para diabéticos.

In order to investigate new methods to use to educate the general public and to foster changes in diet, a cooking course was organized by the "Las Fuentes Norte" Health Center in Zaragoza open to the entire population. 42.1% of the menus selected were prepared by diabetics. In these, their average composition was: 488.3 +/- 114 calories containing 30.7% proteins, 38.8% lipids, and 32.5% carbohydrates. 42.1% of the menus selected were prepared by people in families having no diabetics. In these, their average composition was: 332.8 +/- 114.4 calories containing 25% proteins, 29.9% lipids, and 50.1% carbohydrates. The remaining 15.8% of the menus selected were prepared by relatives of diabetics. In these, their average composition was: 528.1 +/- 237.9 calories containing 40.6% proteins, 45.3% lipids, and 14.1% carbohydrates. There was no finding bearing statistical importance among these groups which prepared these dishes. Analysis of the 1998 contest discovered that calories increased in the menus prepared by diabetics or their relatives; calories increased 101.1 and 330.7 respectively, and this bears statistical importance. In these same groups, lipids increased 11.2 and 25% respectively while carbohydrates dropped 11.2 and 29.6% respectively. In those menus prepared by persons having no diabetics in their families, lipids decreased 4.3% while carbohydrates increased 15.9%. The average number of calories in the 19 menus prepared was 1758.8 +/- 20.7. These menus contained an average of 20.8% proteins, 25.5% lipids, and 53.7% carbohydrates.

Comida para diabéticos

No disponible

Congenital anomalies of the small intestine, colon, and rectum.

Congenital anomalies of the gastrointestinal tract are a significant cause of morbidity in children and, less frequently, in adults. These abnormalities include developmental obstructive defects of the small intestine, anomalies of the colon, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. Neonates with complete high intestinal obstruction do not usually require further radiologic evaluation following radiography, whereas those with complete low obstruction should undergo a contrast material enema examination. An upper gastrointestinal series must be performed in all patients with incomplete intestinal obstruction because management is different in each case. In low intestinal obstruction, ultrasonography (US) may help differentiate between small bowel obstruction and colonic obstruction. In addition, US can help correctly identify meconium ileus and meconium peritonitis and is useful in the diagnosis of enteric duplication cysts. In malrotation and anorectal anomalies, computed tomography (CT) and magnetic resonance (MR) imaging can provide superb anatomic detail and added diagnostic specificity. Intestinal duplications manifest as an abdominal mass at radiography, contrast enema examination, or US. At CT, most duplications manifest as smoothly rounded, fluid-filled cysts or tubular structures with thin, slightly enhancing walls. At MR imaging, the intracystic fluid has heterogeneous signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weighted images. Familiarity with these gastrointestinal abnormalities is essential for correct diagnosis and appropriate management.

Congenital anomalies of the upper gastrointestinal tract.

A wide spectrum of congenital anomalies may affect the upper gastrointestinal tract, including anomalies of the esophagus (e.g., atresia, fistulas, webs, duplications, vascular rings), stomach (e.g., congenital gastric outlet obstruction, duplications), and duodenum (e.g., atresia, annular pancreas, duplications, malrotation). The evaluation of affected patients can require multiple imaging modalities for diagnosis and surgical planning. Radiography is often diagnostic and specific and can usually provide important clues to help determine the optimal diagnostic procedure. Neonates with complete gastric or upper intestinal obstruction do not usually require further radiologic evaluation after radiography: Barium studies are usually contraindicated, and complementary procedures (e.g., ultrasound [US], computed tomography [CT]) are not usually helpful and may even delay surgery, resulting in death. Nevertheless, US has become important in the evaluation of the pediatric gastrointestinal tract and is being used in an increasing number of applications. CT and magnetic resonance imaging are unsuitable for general screening but provide superb anatomic detail and added diagnostic specificity. They are especially useful in demonstrating esophageal duplications and vascular rings as well as associated abnormalities. However, the decision to perform a given imaging examination should be considered carefully to avoid inconvenience or unnecessary radiation exposure to the patient or delays in surgical correction. Quality control programs should be in place to ensure safe, effective radiologic practice through use of up-to-date equipment and good imaging technique.

[Diabetic food competition. Another way of teaching]. / Concurso de comida para diabéticos. Otra forma de educar.

OBJECTIVE: To employ a different and appetizing method of food education. DESIGN: A descriptive, crossover, observational study. SETTING: Las Fuentes Norte Health Centre, Zaragoza, jointly with a civic centre in the neighbourhood. PARTICIPANTS: 54 people out of a population of 492,521 (over 15). One was excluded and 21 dishes were chosen. INTERVENTION: Composing posters with a day's complete menu, including one of the dishes chosen in each menu. Choice of the three best dishes presented. RESULTS: 18.8% of the dishes selected were proposed by diabetics (with a mean of 387.22 +/- 150.72 calories, SD 171.95, with 30.74% proteins, 25.59% lipids and 43.65% CH). 24.5% were proposed by carers (mean of 378.1 +/- 103.86 calories, SD 118.65, with 30.89% proteins, 31.11% lipids and 37.99% CH). 30% were proposed by members of diabetics' families (mean of 197.43 mame 149.33 calories, SD 152.38, with 36.3% proteins, 20.07% lipids and 43.61% CH). 26.5% of dishes bore no relationship to this disease (mean of 422.15 +/- 148.09 calories, SD 199.91 and 31.15% proteins, 34.23% lipids and 34.6% CH), with no statistical significance between the different groups. Using the data of the means calculated as a basis, we obtained a meal of 1,141.3 calories with 29.3% proteins, 29.6% lipids and 41.1% CH. CONCLUSIONS: Combining the results in one meal would not only give a high amount of calories, but a high proportion of proteins, mainly at the expense of CH.

Síndromes de Smith-Lemli-Optiz en dos hermanos. Presentación del caso / Smith-Lemli-Optiz Syndrome in two brothers. Case presentation

El síndrome de Smith-Lemli-Opitz es una entidad de etiología autosómica recesiva, que cursa con malformaciones congénitas, retraso del crecimiento y desarrollo pre y posnatal y es causa de muerte a temprana edad. No se conoce tratamiento, por lo que solamente se cuenta con el asesoramiento genético para evitar la aparición de nuevos casos.Se presenta el caso de dos hermanos, hijos de padres consanguíneos. Ambos fueron detectados desde el nacimiento y aun cuando se diagnosticaron al mes de vida, el asesoramiento genético proporcionando a los padres no fue efectivo, ya que después del primer hijo afectado tuvieron dos embarazos más, resultando afectado el producto del segundo de éstos. Se ha encontrado una deficiencia en la síntesis de colesterol, por lo que es posible hacer el diagnóstico prenatal en las mujeres que tienen antecedentes de gestas previas con esta enfermedad

[Ambulatory aerosol therapy in the treatment of chronic pathology of the O.R.L. region]. / La aerosolterapia ambulatoria en el tratamiento de la patología crónica en la esfera O.R.L.

This study considers the efficacity of the ambulatory aerosol therapy in chronic cases of the ENT area. A nebulizer, air-jet type, of 4 microns MMAD, was the device employed, and an ample spectre antibiotic (cefotaxime) a mucolytic (N-acetyl-cysteine) plus a corticoid (methyl-prednisolone) the associated drugs. The antibiotic was discarded when otitis were the problem. The results have been favourable in 75 percent of the cases whilst negative in the resting 24 percent of the treated subjects.