Efectos de la nutrición y el estilo de vida en adultos que padecen síndrome metabólico: una revisión sistematizada / Effects of nutrition and lifestyle in adults with metabolic syndrome: a systematised review

JUSTIFICACIÓN: las enfermedades crónicas no transmisibles (ECNT) suponen actualmente el 71 % de las muertes globales según la Organización Mundial de la Salud. El Síndrome Metabólico es un cuadro de suma importancia en la farmacia comunitaria, pues engloba varias ECNT, tiene una alta prevalencia en sociedades occidentalizadas y creciente a nivel mundial, lo que supone un coste económico y sanitario elevado, creciente, y supone en España un gran porcentaje de las actuaciones del farmacéutico comunitario. Sin embargo, cuatro de sus mayores factores de riesgo son factores de estilo de vida modificables, propios también de otras ECNT, como enfermedad cardiovascular, trastornos metabólicos lipídicos y glucídicos, y obesidad.OBJETIVOS: en esta revisión bibliográfica sistematizada se analiza si existe relación entre Síndrome Metabólico y diversos factores nutricionales y de estilo de vida, como tabaquismo, abuso de alcohol, sedentarismo y dieta no saludable: factores en los que el farmacéutico puede impactar mediante actuaciones durante la dispensación y también mediante programas de educación o intervención.METODOLOGÍA: se realiza una búsqueda bibliográfica basada en la estrategia PICO: Pacientes: adultos que padecen Síndrome Metabólico. Intervención: factores de riesgo de Síndrome Metabólico: factores nutricionales y de estilo de vida: sedentarismo, tabaquismo, dieta poco saludable, consumo de alcohol. Comparación: se compara con prevalencia en la ausencia de dichos factores. Resultado: aumento de la prevalencia de Síndrome Metabólico si los factores estudiados están presentes o disminución de dicha prevalencia si los factores estudiados están ausentes.Se utilizan los siguientes términos Mesh: Metabolic Syndrome; Diet, Food, and Nutrition; Life Style; Sedentary Behavior; Smoking; Diet, Western; Alcohol Drinking.Se seleccionan 27 artículos de los últimos 5 años. (AU)

Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution.

OBJECTIVE: To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. MATERIAL AND METHODS: A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at Mútua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. RESULTS: After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of full-term deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. CONCLUSION: Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.

[Work commitment of middle-line managers in health-care: Manageable organizational factors]. / Compromiso laboral de los directivos intermedios en sanidad: factores organizativos gestionables.

Middle-line managers are a key element in the management of health-care organizations. Reinforcing their commitment to their job could contribute to improving the health outcomes of the population they serve. OBJECTIVE: Analyzing the work commitment of middle-line managers to the health-care organizations they work for, as well as their profile and perception of the main manageable organizational factors involved. METHODOLOGY: Descriptive multicenter study based on a questionnaire about work commitment and 20 associated manageable factors, analyzing 60 variables (scale 1-10). The theoretical framework on which it was based was adapted from the model of demands and resources, along with 2organizational commitment questionnaires. It was distributed among the professionals of 23 non-profit health-care organizations belonging to the Health and Social Care Consortium of Catalonia, in the period 2015-2019. RESULTS: A number of 2,060 surveys were obtained; 60% were answered by women; 69% declared an antiquity of more than 10 years. Cronbach's alpha coefficient was 0.974. The overall indicator of work commitment received 7.94 points. Overall, job resources received higher scores than demands (7.39 versus 6.69 points). The 3highest-scoring manageable organizational factors were demand, equality policies with 8.27 points, and 2resources: professional autonomy (7.81 points) and job stability (7.79 points). The 3lowest scoring factors were 3demands: Remuneration (5.52 points), time and personnel resources (5.74 points) and social benefits (6.10 points). Seventy-one percent of middle-line managers' work commitment to their institution was explained by 4manageable factors: Trust and coherence, professional autonomy, institutional image, and training and development. CONCLUSIONS: The middle-line managers showed a high level of work commitment to their institutions. The main predictor of this commitment was the perception of trust in the institution and coherence in the management of the centers.

Talus Bipartitus: A Rare Anatomical Variant Presenting as an Entrapment Neuropathy of the Tibial Nerve within the Tarsal Tunnel.

Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve within the tarsal tunnel that lies beneath the retinaculum on the medial side of the ankle. It is often underdiagnosed. Talus bipartitus is a rare anatomical variant; only a few cases have been described in medical literature. We report a case of a 36-year-old female with tarsal tunnel syndrome secondary to a talus bipartitus undergoing surgical treatment with good clinical outcome. To our knowledge, talus bipartitus presenting as tarsal tunnel syndrome has no previous reports. Image studies and physical examination are crucial to reach precise diagnosis.

Cribado del cáncer de próstata mediante antígeno prostático específico: perspectiva del médico en atención primaria y en el laboratorio clínico / Prostate cancer screening using prostate-specific antigen: The views of general and laboratory physicians

Introducción: En el cribado de cáncer de próstata con antígeno prostático específico (PSA) se recomienda ofrecer información individualizada al paciente sobre el balance riesgos-beneficios y compartir la toma de decisiones. Objetivo: Explorar la práctica habitual y la percepción de los médicos de familia y los facultativos de laboratorio sobre el cribado del cáncer de próstata mediante PSA. Material y métodos: Estudio transversal basado en un cuestionario y en las solicitudes de PSA como cribado realizadas desde atención primaria (AP) a hombres mayores de 49 años. Resultados: En 2015, la AP catalana solicitó PSA como cribado oportunista al 15,2% de los hombres. En el cuestionario participaron 114 médicos de familia y 227 facultativos de laboratorio. El 64% fueron mujeres, con 43 años de edad media y 17 de experiencia profesional. Los médicos de familia consideraron que los pacientes inducían el 61% de las solicitudes de PSA. La incertidumbre al solicitar PSA fue de 5 puntos para los médicos de familia y de 5,7 para los del laboratorio. El interés en disponer de recomendaciones clínicas recibió 7,2 puntos en atención primaria y 8,8 en el laboratorio. El conocimiento sobre las diferentes guías de práctica clínica recibió, en global, menos de 5 puntos. Conclusiones: Desde AP se realizó cribado de casi la sexta parte de los hombres mayores de 49 años sin enfermedad prostática, frecuentemente a petición del paciente e informándole de beneficios y riesgos. Los médicos de AP y del laboratorio estaban interesados en disponer de recomendaciones e información, aunque no solían consultar las guías de práctica clínica

Introduction: It is currently recommended to provide individualised information on benefit-risk balance and shared decision-making in prostate cancer screening using prostate-specific antigen (PSA). Aim: To determine the usual practice and the views of general and laboratory practitioners in the screening of prostate cancer using PSA. Material and methods: A cross-sectional study based on a questionnaire and on PSA screening requests from Primary Health Care (PHC) in men older than 49 years with no prostatic symptoms. Results: In 2015, PHC in Catalonia requested PSA on 15.2% of males. A total of 114 general practitioners and 227 laboratory practitioners participated in the questionnaire. The mean age of those who responded was 43 years with a mean of 17 years' experience, and included 64% women. According to general practitioners, 61% of PSA was performed at the patient's request. The uncertainty score when requesting PSA was 5 points for general practitioners and 5.7 for laboratory professionals. Interest in having clinical recommendations received 7.2 points in PHC, and 8.8 in the laboratory. Knowledge about the different clinical practice guidelines received was less than 5 points overall. Conclusions: General practitioners requested PSA screening in almost one-sixth of men over the age of 49 without prostate disease, often at the patient's request, and after informing them of the benefits and risks. PHC and laboratory physicians were interested in having recommendations and information, although they did not usually consult clinical practice guidelines immediately

[Prostate cancer screening using prostate-specific antigen: The views of general and laboratory physicians]. / Cribado del cáncer de próstata mediante antígeno prostático específico: perspectiva del médico en atención primaria y en el laboratorio clínico.

INTRODUCTION: It is currently recommended to provide individualised information on benefit-risk balance and shared decision-making in prostate cancer screening using prostate-specific antigen (PSA). AIM: To determine the usual practice and the views of general and laboratory practitioners in the screening of prostate cancer using PSA. MATERIAL AND METHODS: A cross-sectional study based on a questionnaire and on PSA screening requests from Primary Health Care (PHC) in men older than 49 years with no prostatic symptoms. RESULTS: In 2015, PHC in Catalonia requested PSA on 15.2% of males. A total of 114 general practitioners and 227 laboratory practitioners participated in the questionnaire. The mean age of those who responded was 43 years with a mean of 17 years' experience, and included 64% women. According to general practitioners, 61% of PSA was performed at the patient's request. The uncertainty score when requesting PSA was 5 points for general practitioners and 5.7 for laboratory professionals. Interest in having clinical recommendations received 7.2 points in PHC, and 8.8 in the laboratory. Knowledge about the different clinical practice guidelines received was less than 5 points overall. CONCLUSIONS: General practitioners requested PSA screening in almost one-sixth of men over the age of 49 without prostate disease, often at the patient's request, and after informing them of the benefits and risks. PHC and laboratory physicians were interested in having recommendations and information, although they did not usually consult clinical practice guidelines immediately.

Differential involvement of synovial adipokines in pain and physical function in female patients with knee osteoarthritis. A cross-sectional study.

OBJECTIVE: Adipokines have been reported to play a role in the development, progression and severity of knee osteoarthritis but the influence of the different adipokines are not well known. The aim of this study was to evaluate the association between different synovial fluid adipokines with pain and disability knee osteoarthritis patients. METHODS: Cross-sectional study with systematic inclusion of 115 symptomatic primary knee osteoarthritis female patients with ultrasound-confirmed joint effusion. Age, physical exercise, symptoms duration and different anthropometric measurements were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales and Knee injury and Osteoarthritis Outcome Score (KOOS) pain and function scales. Seven adipokines and three inflammatory markers were measured by ELISA in synovial fluid. Partial Correlation Coefficient (PCC) and corresponding 95% confidence interval were used as a measure of association. RESULTS: Leptin, osteopontin and inflammatory factors, especially TNF-alpha, were associated to pain and function. After adjustment for potential confounders including inflammatory factors and all adipokines, an association was found for adiponectin with pain (PCC 0.240 [0.012, 0.444]) and for resistin and visfatin with function (PCC 0.336 [0.117, 0.524] and -0.262 [-0.463, -0.036]). No other adipokines or inflammatory markers were statistically and independently associated. An association between physical exercise and pain and disability remained after adjustment, whereas an attenuation of the influence of anthropometric measurements was observed. CONCLUSIONS: Different patterns of association between synovial fluid adipokines were observed regarding pain and disability in knee osteoarthritis patients. Specifically, adiponectin was associated to pain while resistin and visfatin were mainly related to function.

A logistic regression model predicting high axillary tumour burden in early breast cancer patients

Purpose. As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. Methods/patients. Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. Results. Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. Conclusions. Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether (AU)

No disponible

A logistic regression model predicting high axillary tumour burden in early breast cancer patients.

PURPOSE: As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. METHODS/PATIENTS: Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. RESULTS: Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. CONCLUSIONS: Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.

Profesionalismo: valores y competencias en formación sanitaria especializada / Professionalism: values and competences in specialized medical training

Objetivo. Conocer la percepción de los profesionales sanitarios implicados en la docencia de la formación sanitaria especializada (tutores, residentes y colaboradores docentes) sobre los principales valores y competencias que desarrollan habitualmente en su trabajo. Métodos. Se diseñó un cuestionario para ser autocumplimentado, con 4 secciones y 51 variables (escala 1-10). Se distribuyó entre los profesionales de un hospital universitario y 9 centros de salud. Resultados. Respondieron 287 profesionales. Participación: 97% de los tutores (n=59), 38% de los residentes (n=61) y 56% de otros profesionales sanitarios (97 con faceta docente y 70 sin ella). El coeficiente alfa de Cronbach fue de 0,945. Los 3valores mejor puntuados fueron la responsabilidad por cumplir con el propio trabajo (8,7 puntos), la integridad ética (8,6 puntos) y el respeto hacia el equipo de profesionales con el que trabajan (8,3 puntos). Las 3competencias mejor puntuadas fueron la comunicación con pacientes y familiares (8,16 puntos), el liderazgo para motivarse a uno mismo (7,9 puntos) y el trabajo en equipo (7,8 puntos). Los valores recibieron, de media, 0,7 puntos más que las competencias (IC 95%: 0,5-0,9). No se observaron diferencias entre tutores y residentes, aunque sí entre médicos y enfermeras, y entre hombres y mujeres. Conclusiones. La percepción sobre los valores y las competencias es compartida por tutores, residentes y colaboradores docentes. Sobre esta percepción influyó la categoría profesional y el sexo, pero no la edad ni trabajar en el hospital o en atención primaria (AU)

Objective. To determine the perception of healthcare professionals (tutors, residents and teaching collaborators) involved in specialist medical training on the core values and skills to develop their tasks. Methods. A tailor-made questionnaire aimed at healthcare professionals in 9health care centres and a referral hospital. Questionnaire: 4 sections and 51 variables (scale 1-10). Results. A total of 287 professionals participated, which included 97% tutors (n=59), 38% residents (n=61), and 56% others (97 teaching collaborators and 70 not associated with teaching). The alfa Cronbach coefficient was 0.945. Best rated values were work compliance (8.7 points), ethics in professional practice (8.6 points), and respect for their team (8.3 points). The best rated competence was communication with patients and families (8.1 points), followed by self-motivating leadership (7.9 points), and the practical application of medical and healthcare theoretical knowledge (7.8 points). The values received, on average, 0.7 points above competences (95% CI: 0.5-0.9). There were no differences between tutors and residents, although differences were found between doctors and nurses, and between males and females. Conclusion. Most of the professionals (tutors, residents, and teaching collaborators) share the same perception of the values and competencies that influence their professional development. This perception was influenced by the professional category and gender, but not age or working in a hospital or primary health care (AU)

Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients

Purpose. Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement. Methods/patients. Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required. Results. 1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%. Conclusion. We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients (AU)

No disponible

[Professionalism: Values and competences in specialized medical training]. / Profesionalismo: valores y competencias en formación sanitaria especializada.

OBJECTIVE: To determine the perception of healthcare professionals (tutors, residents and teaching collaborators) involved in specialist medical training on the core values and skills to develop their tasks. METHODS: A tailor-made questionnaire aimed at healthcare professionals in 9health care centres and a referral hospital. Questionnaire: 4 sections and 51 variables (scale 1-10). RESULTS: A total of 287 professionals participated, which included 97% tutors (n=59), 38% residents (n=61), and 56% others (97 teaching collaborators and 70 not associated with teaching). The alfa Cronbach coefficient was 0.945. Best rated values were work compliance (8.7 points), ethics in professional practice (8.6 points), and respect for their team (8.3 points). The best rated competence was communication with patients and families (8.1 points), followed by self-motivating leadership (7.9 points), and the practical application of medical and healthcare theoretical knowledge (7.8 points). The values received, on average, 0.7 points above competences (95% CI: 0.5-0.9). There were no differences between tutors and residents, although differences were found between doctors and nurses, and between males and females. CONCLUSION: Most of the professionals (tutors, residents, and teaching collaborators) share the same perception of the values and competencies that influence their professional development. This perception was influenced by the professional category and gender, but not age or working in a hospital or primary health care.

Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients.

PURPOSE: Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement. METHODS/PATIENTS: Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required. RESULTS: 1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%. CONCLUSION: We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.

The appropriate axillary procedure after a positive sentinel node in breast cancer patients: the 'Hôpital Tenon' score revisited. A two-institution study

Introduction. Until recently, completion ALND has been considered the standard of care after a positive SN in breast cancer patients. However, most patients will not display further axillary involvement. The Tenon score is a simple nomogram that can be used intraoperatively to avoid completion ALND in low-risk patients. We aimed at validating the Tenon score on a SN-positive patient sample that had been preoperatively selected using axillary US examination. Patients and method. We used a retrospective analysis of our bicentric database that included 246 breast cancer patients with a positive SN. We calculated sensitivity, specificity, as well as positive and negative predictive values for each cut-off point. ROCs were constructed and corresponding AUC values were calculated as a measure of discriminative capacity. Results. At least one non-SN was positive in 52 patients (21.1 %). 118 patients (48 %) had a score up to 5. Among them, three had at least one positive non-SN. NPV was 97.5 %. Using that threshold, the ROCs analysis showed an AUC of 0.822 (95 % CI 0.764-0.880). Conclusion. Use of preoperative axillary US examination led to a modification of the proposed Tenon cut-off value from 3.5 to 5 to attain good predictive power for non-SN status. Straightforward intraoperative use of the Tenon score may be considered an advantage over other available nomograms (AU)

No disponible

Promoción de hábitos alimentarios saludables en adolescentes desde la atención primaria / Promoting healthy eating habits for adolescents in primary care

No disponible

The appropriate axillary procedure after a positive sentinel node in breast cancer patients: the "Hôpital Tenon" score revisited. A two-institution study.

INTRODUCTION: Until recently, completion ALND has been considered the standard of care after a positive SN in breast cancer patients. However, most patients will not display further axillary involvement. The Tenon score is a simple nomogram that can be used intraoperatively to avoid completion ALND in low-risk patients. We aimed at validating the Tenon score on a SN-positive patient sample that had been preoperatively selected using axillary US examination. PATIENTS AND METHOD: We used a retrospective analysis of our bicentric database that included 246 breast cancer patients with a positive SN. We calculated sensitivity, specificity, as well as positive and negative predictive values for each cut-off point. ROCs were constructed and corresponding AUC values were calculated as a measure of discriminative capacity. RESULTS: At least one non-SN was positive in 52 patients (21.1 %). 118 patients (48 %) had a score up to 5. Among them, three had at least one positive non-SN. NPV was 97.5 %. Using that threshold, the ROCs analysis showed an AUC of 0.822 (95 % CI 0.764-0.880). CONCLUSION: Use of preoperative axillary US examination led to a modification of the proposed Tenon cut-off value from 3.5 to 5 to attain good predictive power for non-SN status. Straightforward intraoperative use of the Tenon score may be considered an advantage over other available nomograms.

Centralización de servicios sanitarios en atención primaria en verano: opinión de usuarios y profesionales durante 2 años consecutivos / Centralization of health services in primary care in summer: patients and professionals view during two consecutive years

La atención primaria española, pilar del sistema sanitario, dispone cada vez de recursos más limitados por la crisis económica. Objetivo. Conocer la opinión de usuarios y profesionales sobre la centralización de servicios sanitarios de 7 centros de salud en 2 centros de salud, durante agosto de 2011-2012. Método. Se diseñaron 2 cuestionarios: una encuesta telefónica a una muestra aleatoria de usuarios y un cuestionario de autocumplimiento para la población de profesionales sanitarios. Puntuación de las variables: escala 1-10. Resultados. Coeficiente α-Cronbach > 0,84. Respondieron 1.293 personas. Los usuarios (n = 836) puntuaron en 2011 la satisfacción con 6,7 puntos en agosto y 7,3 puntos el resto del año (p < 0,001), y en 2012 con 7,7 puntos en agosto y 8,1 puntos el resto del año (p < 0,001). La satisfacción de los usuarios fue, de media, un punto mayor en agosto de 2012 versus 2011. El tiempo de espera fue la única variable mejor puntuada en agosto frente al resto del año. La percepción de la solución del motivo de consulta no varió. Satisfacción, señalización, atención y trato recibieron mayor puntuación en el centro habitual que en el centro que centralizó la asistencia en agosto (p < 0,001). Los profesionales sanitarios (n = 357) valoraron su satisfacción con 6,8 puntos en 2011 y 7,3 puntos en 2012. Conclusiones. Centralizar la asistencia en períodos de menor demanda permite disminuir costes manteniendo la calidad. La experiencia de centralizar los servicios de Atención Primaria durante agosto fue percibida como aceptable y mejoró el segundo año. Los usuarios mostraron una discreta, pero significativa, preferencia por su centro de atención primaria habitual (AU)

The Spanish primary health care, gateway and pillar of the Health Care System has his resources increasingly constrained by current crisis. Objective. To know the opinion of users and professionals on two primary care centers which centralized in August 2011 and 2012 the attendance of seven primary care centers. Methods. Two questionnaires were designed: a telephone survey of a random sample of users and a self-completed questionnaire for health care professionals. The variables were scored on a scale of 1-10 (low to high). Results. Cronbach's coefficient α > 0,84. 1293 people responded (836 users and 357 professionals). Users rated, in 2011, the satisfaction with 6.7 points in August and 7.3 points the rest of the year (P < .001). And, in 2012, with 7.7 points in August and 8.1 points the rest of the year (P < .001). Health care professionals, rated their satisfaction with 6.8 points in 2011 and 7.3 points in 2012. The waiting time was the only variable best scores in August that the rest of the year. The perception of the solution given in consultation did not change. Satisfaction, marking, care and treatment were highest rated in the regular center than in the reference center (P < .001). Conclusions. The centralization of primary health care during periods of reduced demand could reduce costs while maintaining quality. The experience of centralizing primary care services during August was perceived as acceptable and improved over time. Users showed a slight, but significant, preference for their usual primary care center (AU)

Luminescent pentafluorophenyl-cycloplatinated complexes: synthesis, characterization, photophysics, cytotoxicity and cellular imaging.

Luminescent mono(pentafluorophenyl) cycloplatinated complexes [Pt(C^N-κC,N)(HC^N-κN)(C6F5)] [HC^N = Hthpy (2-(2-thienyl)pyridine) 2a, Hbt (2-phenylbenzothiazole) 2b, Hpq (2-phenylquinoline) 2c] have been prepared by C­H activation of a HC^N ligand in the corresponding [Pt(HC^N-κN)2(C6F5)2] (1a, 1b, 1c) complexes. Complexes 2 evolve in DMSO solution into solvate complexes and we present here successful routes for the synthesis of [Pt(C^N)(C6F5)(DMSO)] (C^N = thpy 3a, bt 3b). They have been fully characterized (X-ray for 1a, 1c, 2b, 3a and 3b), their electronic absorption and emission properties have been investigated and DFT and TD-DFT calculations for 1a, 1c, 2b and 3a have been carried out. Complexes 3a, 3b and [Pt(ppy)(C6F5)(DMSO)] 4 (Hppy = 2-phenylpyridine) show remarkable stability in a mixed DMSO-cellular medium and their cytotoxicity towards the human lung tumor (A549) and bronchial epithelial non-tumorigenic (NL20) cell lines has been evaluated by MTS assays. Their cellular localization in A549 and NL20 human cells and in mouse embryonic fibroblasts obtained from lungs (LMEFs) has also been investigated by fluorescence microscopy.

Using microbubble sonographic contrast agent to enhance the effect of high intensity focused ultrasound for the treatment of uterine fibroids.

OBJECTIVE: To evaluate the effects of the ultrasound contrast agent SonoVue in enhancing the ablative effects of Ultrasound-Guided high-intensity focused ultrasound (HIFU) on different sub-types of uterine fibroids. MATERIALS AND METHODS: In this study, 390 fibroids from 319 patients were retrospectively evaluated, among which 155 were treated with SonoVue and 235 were without SonoVue during HIFU ablation. The efficacy of HIFU was evaluated using magnetic resonance scanning (MRI) in all patients. RESULTS: The total ablation time to achieve the same non-perfused volume was significantly shortened with SonoVue. The average energy used and the acoustic energy for treating 1 mm(3) (EEF) was less when SonoVue is used as enhancing agent. The non-perfused volume (NPV) was measured by post-HIFU MRI and the mean fractional ablation was calculated. Mean NPV was 74% (range: 15%-100%) in the HIFU-only group and 75% (range: 17%-100%) in the HIFU+ SonoVue group. However, for T2 MRI low intensity signal fibroids, NPV in the SonoVue group reached 83% (range: 20%-100%) that was significantly higher than in the HIFU-only group, which was 76% (range: 15%-100%). No differences in adverse events were observed between the two groups. CONCLUSIONS: Our observations demonstrate that the use of therapeutic SonoVue during the HIFU procedure can significantly decrease the ablation time and the energy requirement for the treatment of the same fibroid volume in all types of fibroids.