Tunneling magnetoresistance and spin-valley polarization of aperiodic magnetic silicene superlattices.

Magnetic silicene superlattices (MSSLs) are versatile structures with spin-valley polarization and tunneling magnetoresistance (TMR) capabilities. However, the oscillating transport properties related to the superlattice periodicity impede stable spin-valley polarization states reachable by reversing the magnetization direction. Here, we show that aperiodicity can be used to improve the spin-valley polarization and TMR by reducing the characteristic conductance oscillations of periodic MSSLs (P-MSSLs). Using the Landauer-Büttiker formalism and the transfer matrix method, we investigate the spin-valley polarization and the TMR of Fibonacci (F-) and Thue-Morse (TM-) MSSLs as typical aperiodic superlattices. Our findings indicate that aperiodic superlattices with higher disorder provide better spin-valley polarization and TMR values. In particular, TM-MSSLs reduce considerably the conductance oscillations giving rise to two well-defined spin-valley polarization states and a better TMR than F- and P-MSSLs. F-MSSLs also improve the spin-valley polarization and TMR, however they depend strongly on the parity of the superlattice generation.

Anisakis physeteris y Pseudoterranova decipiens en el pez Mugil Curema comercializado en Tumaco, Colombia / Anisakis physeteris and Pseudoterranova decipiens in the Mugil curema fish caught in Tumaco, Colombia

RESUMEN Objetivo. Identificar nematodos de la familia Anisakidae en el pez de consumo Mugil curema. Materiales y métodos. Para este estudio, se recolectaron 16 peces Lisa (M. curema) del puerto de Tumaco, una ciudad en la costa colombiana del Pacífico. La identificación morfológica de las larvas se realizó mediante taxonomía clásica y se calculó el porcentaje de infestación de larvas. Para la identificación molecular, se realizó una PCR múltiple con cebadores para las especies Anisakis physeteris, Pseudoterranova decipiens, Anisakis simplex sensu stricto, Contracaecum osculatum, Hysterothylacium aduncum y Anisakis pegreffii. Resultados. La revisión taxonómica permitió la identificación de larvas de tipo II del género Anisakis y larvas del género Pseudoterranova. Las larvas se aislaron principalmente del intestino, donde se encontró que el 94% de los peces estaban parasitados por nematodos anisakidos. La PCR multiplex permitió la identificación de la especie A. physeteris (Larva tipo II) y P. decipiens. Conclusiones. Este estudio es el primer reporte de nematodo Anisakidae en Tumaco, Colombia. Estos resultados proporcionan una justificación convincente para un estudio adicional sobre la familia Anisakidae en Colombia, como un problema de salud pública.

ABSTRACT Objective: Identification nematodes Anisakidae family in Mugil curema fish. Materials and methods: For this study, 16 Lisa fish (Mugil curema) were obtained from the port of Tumaco, a city on the Colombian Pacific coast. Morphological identification of larvae was made by classical taxonomy and the percentage of larval infestation was calculated. For molecular identification, a multiplex PCR was carried out with primers for six species, Anisakis physeteris, Pseudoterranova decipiens, Anisakis simplex sensu stricto, Contracaecum osculatum, Hysterothylacium aduncum and Anisakis pegreffii. Results: The taxonomic revision enabled the identification of type II larvae of the genus Anisakis and larvae of the genus Pseudoterranova. The larvae were isolated mainly from the intestine, where it was found that 94% of the fish were parasitized by anisakid nematodes. The multiplex PCR enabled the identification of the species A. physeteris (Larva type II), and P. decipiens. Conclusions: This study is the first report of nematode Anisakidae on Tumaco, Colombia. These results provide a compelling justification for further study into the Anisakidae family in Colombia, as a public health problem.

Estimating the rapid haemodynamic effects of passive leg raising in critically ill patients using bioreactance.

BACKGROUND: Rapid detection of changes in cardiac index (CI) in real time using minimally invasive monitors may be of clinical benefit. We tested whether the Starling-SV bioreactance device, which averages CI over a short 8 s period, could assess the effects of passive leg raising (PLR), a clinical test that is recommended to assess fluid responsiveness during septic shock. METHODS: In 32 critically ill patients, we measured CI by transpulmonary thermodilution (PiCCO2, CItd), pulse contour analysis (PiCCO2, CIPulse), and the Starling-SV device (CIStarling) at baseline. CIPulse and CIStarling were measured again at the end of a PLR test. In the 13 patients with a positive PLR test, CItd, CIPulse, and CIStarling were measured before and after a 500 ml saline infusion. The primary outcome was relative changes from baseline measurements in CItd, CIPulse, and CIStarling. Secondary outcomes compared absolute values measured by each method. RESULTS: Relative changes in CIPulse and CItd were significantly correlated (r=0.82; n=45; P<0.001), with an 89% concordance rate (n=45 paired measurements). Relative changes in CIStarling and CItd were also significantly correlated (r=0.59; n=45; P<0.001) with a 78% concordance rate. For absolute measures of CI (n=77 paired measurements), the bias between CIPulse and CItd was 0.01 L min-1 m-2 (limits of agreement, -0.49 and 0.51 L min-1 m-2; 15% percentage error). Bias between CIStarling and CItd was 0.03 L min-1 m-2 (limits of agreement, -1.61 and 1.67 L min-1 m-2; 48% percentage error). CONCLUSIONS: In critically ill patients, a non-invasive bioreactance device with a shorter averaging period assessed a passive leg raising test with reasonable accuracy.

Cryptosporidium spp, comparative diagnosis and geospatial distribution in diarrheic calves from dairy farms, Valdivia, Chile / Diagnóstico comparativo y distribución geoespacial de Cryptosporidium spp, en terneros diarreicos en lecherías de Valdivia, Chile

Objective. To determine the Cryptosporidium spp. infection frequency by using Ziehl-Neelsen and Auramine stains on samples obtained from diarrheic calves from milking farms of the Valdivia province. To compare both diagnostic tests and to determine the geospatial distribution of the infections caused by this protozoan. Materials and methods. 221 fecal samples of diarrheic calves of 24 milking farms of the Valdivia province were studied. The processing and analysis of the samples was done by Ziehl-Neelsen (ZN) and Auramine (AU) staining techniques, and the results were compared by McNemar statistical test and the concordance level was determined by kappa index. A map was also generated to determine the geospatial distribution of Cryptosporidium infections. Results. 57.9% of all the animals tested were classified as positive with the ZN stain test, while 55.6% of all the animals turned out positive for the AU stain test. The McNemar test showed no significant difference between both diagnostic techniques (p>0.05), while the kappa index showed proper concordance between tests (k=0.73). 100% of the farms studied showed protozoan presence demonstrating the broad distribution of the parasite, however, and considering the previous factor, it was not possible to determine geospatial associations for the parasite distribution. Conclusions. The infection frequency of Cryptosporidium is higher than 50% in the milking farms studied from the Valdivia province. No difference between the Ziehl-Neelsen and Auramine staining techniques was demonstrated showing very consistent results. It was possible to detect that the number of farms infected correspond to 100% of the farms analyzed.

Objetivo. Determinar la frecuencia de infección por Cryptosporidium spp., mediante las tinciones de Ziehl-Neelsen y Auramina en terneros diarreicos de predios lecheros de la provincia de Valdivia. Comparar ambas pruebas diagnósticas y determinar la distribución geoespacial de las infecciones causadas por este protozoo. Materiales y métodos. Se estudiaron 221 muestras fecales de terneros diarreicos pertenecientes a 24 predios de la provincia de Valdivia. El procesamiento y análisis de las muestras se realizó mediante tinción de Ziehl-Neelsen (ZN) y Auramina (AU); y ambas técnicas se compararon mediante la prueba estadística de McNemar y su nivel de concordancia se determinó mediante índice kappa. Se generó además un mapa para determinar la distribución geoespacial de las infecciones por Cryptosporidium. Resultados. Del total de animales muestreados, 57.9% resultaron positivos a ZN, mientras que 55.6% fueron positivo para AU. En la prueba de McNemar no hubo diferencia significativa entre los métodos diagnósticos estudiados (p>0.05), en tanto el índice kappa determinó una concordancia buena entre ambas pruebas (k=0.73). Del total de predios georeferenciados el 100% resultó positivo a la presencia del protozoo; demostrándose que ésta parasitosis tiene una amplia distribución; sin embargo, dado este factor, no fue posible determinar asociaciones geoespaciales sobre la distribución de éste. Conclusiones. La frecuencia de infección por Cryptosporidium supera el 50% en los predios lecheros de la provincia de Valdivia. No hubo diferencia entre las técnicas Ziehl-Neelsen y Auramina con resultados concordantes. Fue posible detectar que el número de predios infectados corresponde al 100% de los predios analizados.

Coste del asma en pediatría en España: un modelo de evaluación de costes basado en la prevalencia / Cost of childhood asthma in Spain: a cost evaluation model based on the prevalence

Introducción: El asma es la enfermedad crónica más frecuente en la infancia, disminuye la calidad de vida de los niños y sus familiares, y produce elevados costes sociales y sanitarios que en España no se conocen. Objetivo: Estimar el coste del manejo del asma en pediatría en España y estudiar su variabilidad en función de la gravedad. Pacientes y métodos: Se estimó el coste del manejo del asma en menores de 16 años en 2008, construyendo un modelo de evaluación de costes considerando los factores de los que depende: prevalencia, distribución de la gravedad, edad, frecuencia de utilización de recursos según la gravedad, y coste de cada recurso. Se realizó un análisis de sensibilidad para evaluar la incertidumbre subyacente dependiente de la variabilidad en los estimadores de utilización de recursos, del coste unitario de cada recurso y de la prevalencia. Resultados: El coste total del asma en pediatría en España es de unos 532 millones de euros, pudiendo oscilar entre 392 y 693 millones de euros. Los costes directos (costes sanitarios) representan el 60% del coste total y los costes indirectos (tiempo de cuidador) el 40%. El coste medio anual por niño asmático es 1.149 euros, y oscila entre 403 euros para la categoría de gravedad más leve y 5.380 euros para la más grave. Conclusiones: El coste del asma en pediatría en España es muy elevado y depende de la gravedad de la enfermedad. Los costes más importantes son los del sistema sanitario, pero los costes indirectos no son despreciables (AU)

Introduction: Asthma is the most common chronic disease in childhood, reduces the quality of life of children and their families, and produces high social and health care costs. In Spain, the cost of managing paediatric asthma is unknown. Objective: To estimate the cost of managing paediatric asthma in Spain and to examine its variability depending on asthma severity. Patients and methods: The cost of asthma in children under 16 years in 2008 was estimated by building a costs assessment model including the factors that influence the cost of asthma in children: prevalence, distribution of disease severity, age, frequency of resources use depending on severity, and the cost of each resource. A sensitivity analysis was conducted to evaluate the underlying uncertainty depending on the variability of the estimators of resource use, the unit cost of each resource, and the prevalence. Results: According to the model, the total cost of paediatric asthma in Spain is around 532 million euros, with a range of 392 to 693 million euros. Direct costs (health care costs) represent 60% of the total costs, and indirect costs (carer time), 40%. The mean annual cost per child with asthma is 1,149 euros, ranging from 403 euros for the mildest category of the disease to 5,380 euros for the most severe. Conclusions: The cost of paediatric asthma in Spain is very high and depends on disease severity. Although the most important costs are for the health care system, indirect costs are not negligible (AU)

[Cost of childhood asthma in Spain: a cost evaluation model based on the prevalence]. / Coste del asma en pediatría en España: un modelo de evaluación de costes basado en la prevalencia.

INTRODUCTION: Asthma is the most common chronic disease in childhood, reduces the quality of life of children and their families, and produces high social and health care costs. In Spain, the cost of managing paediatric asthma is unknown. OBJECTIVE: To estimate the cost of managing paediatric asthma in Spain and to examine its variability depending on asthma severity. PATIENTS AND METHODS: The cost of asthma in children under 16 years in 2008 was estimated by building a costs assessment model including the factors that influence the cost of asthma in children: prevalence, distribution of disease severity, age, frequency of resources use depending on severity, and the cost of each resource. A sensitivity analysis was conducted to evaluate the underlying uncertainty depending on the variability of the estimators of resource use, the unit cost of each resource, and the prevalence. RESULTS: According to the model, the total cost of paediatric asthma in Spain is around 532 million euros, with a range of 392 to 693 million euros. Direct costs (health care costs) represent 60% of the total costs, and indirect costs (carer time), 40%. The mean annual cost per child with asthma is 1,149 euros, ranging from 403 euros for the mildest category of the disease to 5,380 euros for the most severe. CONCLUSIONS: The cost of paediatric asthma in Spain is very high and depends on disease severity. Although the most important costs are for the health care system, indirect costs are not negligible.

Calidad de vida en lactantes nacidos prematuros según ingresos por infección respiratoria / Quality of life of preterm infants and admissions due to respiratory infections

Introducción: Estudio de la calidad de vida relacionada con la salud (CVRS) en lactantes nacidos prematuros de 32–35 semanas de gestación según su ingreso por infección respiratoria del tracto inferior. Métodos: Estudio transversal anidado en el estudio FLIP-2 sobre 216 progenitores/prematuros de 32–35 semanas, seleccionados concurrentemente en la entrevista final del estudio FLIP-2. Se midió la CVRS del prematuro con la escala QUALIN modificada, la del progenitor se midió con el cuestionario SF-12 y con escalas visuales. Se valoró la sobrecarga del cuidador con escalas directas (Zarit modificada) y medidas indirectas. Se hizo un estudio descriptivo y de asociación multivariante. Resultados: El 33% (71 niños) ingresó por causa respiratoria. Ingresaron significativamente más los nacidos en partos triples y los residentes en hogares con más de 5 habitantes. El 47% de los progenitores de los pacientes ingresados causó baja laboral para atender al niño, frente al 18% del otro grupo. Los padres de los pacientes ingresados tienen mayor sobrecarga y menor puntuación en el componente físico del cuestionario SF-12. El modelo multivariante asocia a la CVRS del prematuro con mayor edad gestacional, tener hermanos de 0–3 años, recibir profilaxis del virus respiratorio sincitial (VRS) cuando está recomendada por tener factores de riesgo, menor sobrecarga del cuidador, mayor CVRS del cuidador en la escala mental del cuestionario SF-12 y no haber perdido jornadas laborales. Conclusiones: Haber ingresado por infección respiratoria no se asocia a diferente CVRS en los prematuros, aunque sí a diferente CVRS y sobrecarga en los cuidadores. La CVRS en los lactantes está asociada a la de sus cuidadores y a su sobrecarga, y a recibir profilaxis del VRS cuando la presencia de factores de riesgo la haría recomendable (AU)

Introduction: Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32–35 weeks of gestational age. Methods: Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements). Results: From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0–3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care. Conclusions: Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it (AU)

[Quality of life of preterm infants and admissions due to respiratory infections]. / Calidad de vida en lactantes nacidos prematuros según ingresos por infección respiratoria.

INTRODUCTION: Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32-35 weeks of gestational age. METHODS: Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements). RESULTS: From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0-3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care. CONCLUSIONS: Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it.

Non-cardiac arterial disease in Catalonia: patient profiles and quality of clinical records by characteristics of the Vascular Surgery Unit.

AIM: Non-cardiac arterial disease (NCAD) is a frequent cause of hospital admission. The aim of this study was to investigate differences in patient profiles and clinical records as a function of the size of the Vascular Surgery Unit (VSU). METHODS: Retrospective observational study. Stratified cluster sampling and selection of patients hospitalized for NCAD. ANALYSIS: 1) description of patient profiles, quality of clinical records, and VSU [availability of diagnostic (DR) and therapeutic (TR) resources, and of written protocols (WP)]; 2) association between these variables and size of VSU. RESULTS: The sample consisted of 14 hospitals, 6 with a VSU of 15 or fewer beds (VSU < or = 15B) and 8 with >15 beds (VSU >15B). The mean number of DRs, TRs and WPs was 9, 2.8 and 2 in VSUs < or = 15B, and 11.5, 6.5 and 3.3 in VSUs >15B. The proportion of patients older than 70, female, with ischemic disease, or with coexisting diabetes was significantly higher in VSUs < or = 15B (67%, 31%, 95% and 57%, respectively) than in VSUs >15B (58%, 22%, 69% and 48%). Comorbid conditions and treatment during admission and at discharge were documented significantly less frequently in the clinical records in VSUs < or = 15B. Risk factors were under-reported in the clinical records of both types of VSU. CONCLUSION: Patient profiles and the quality of clinical records vary by size of VSU. Under-reporting of risk factors may hinder the implementation of prevention and treatment measures.

Superoxide dismutase, catalase, and glutathione peroxidase in the testis of the Mexican big-eared bat (Corynorhinus mexicanus) during its annual reproductive cycle.

The reproductive physiology of Corynorhinus mexicanus includes a testes growth-involution cycle. Testis recrudescence begins in May-June, peaks in August and then undergoes a profound involution being totally regressed in November. Adult, male individuals were captured monthly during one year and ROS scavenging enzyme activities were measured in testes and expressed per total wet-weight and per mg protein. SOD total activity is very low from October to February; increases sharply one full month before testes recrudescence starts, and in August, when testis activity was at its peak, SOD is 3-4 times lower than in July. Catalase total activity is bimodal. The main peak of activity occurs during testicular recrudescence with an additional smaller peak, two months before the onset of recrudescence. Glutathione peroxidase total activity parallels almost exactly the testis growth cycle, increases in July, reaches a peak in August and decreases through September to almost disappear in October. SOD specific activity shows a pre-testicular increase of activity, maintains its activity from March to July and then descends drastically to almost nil in August, maintaining these low values until February. Catalase specific activity is particularly important during the period of testicular regression. GPX specific activity is low from March to July, months of testicular recrudescence; whereas its activity increases in August and peaks in November, when testes regression occurs. Our data show that ROS-scavenging enzymes may play a very important role during testes involution-recrudescence in C. mexicanus, and we believe their participation could be equally important in all seasonally breeding mammals.

Anisakiasis en un paciente portadora de una pequeña hernia hiatal: Caso clínico / Anisakiasis in a patient with a small hiatal hernia: Report of one case

We describe the presence of anisakiasis in a patient who had a small hiatal hernia. A 60 year-old women presented general malaise, burning pain, flatulence, persistent nausea and abdominal distension during five days before consulting. She referred that she ate a dish of marinated raw fish with lemon and pepper ("cebiche") and after a few hours the symptoms began. An esophagogastroscopy showed a white colour larva of approximately three cm with the cephalic end partially adhered and localized in the mucosa of the hiatal hernia. During the procedure the worm was easily extracted. The morphologic study of the specimen identified it as a stage IV larva of Pseudoterranova sp. The clinical condition of the patient improved after the extraction of the parasite.

[The efficiency (cost-effectiveness) of palivizumab as prophylaxis against respiratory syncytial virus infection in premature infants with a gestational age of 32-35 weeks in Spain]. / La eficiencia (coste-efectividad) de palivizumab como profilaxis para la infección por virus respiratorio sincitial en prematuros de 32-35 semanas en España.

OBJECTIVES: To evaluate the efficiency (cost-effectiveness) of palivizumab in preventing severe respiratory syncytial virus (RSV) infection in premature infants with a gestational age of 32-35 weeks (GA 32-35) and two or more risk factors (RF) in Spain. DESIGN: decision tree model using data from the scientific literature and the FLIP I and FLIP II studies (cohort of 326 infants with GA 32-35 and two or more RF who received palivizumab) sponsored by the Spanish Society of Neonatology. Main effectiveness measure: quality-adjusted life years (QALY) gained. PERSPECTIVES: the national health service (NHS), which includes direct costs (administration of palivizumab and hospital admissions), and the societal perspective, which also includes indirect costs (the child's future lost productivity). Discount: 3 % annually for effectiveness and indirect costs. Sensitivity analysis: construction of 37 scenarios modifying variables related to effectiveness and costs. RESULTS: Prophylaxis with palivizumab in premature infants with GA 32-35 and two or more RF produced an incremental cost-effectiveness ratio (ICER) of 13,849 euro/QALY from the NHS perspective, and an ICER of 4,605 euro/QALY from the societal perspective. In the sensitivity analysis, from the NHS perspective the ICER ranged from 5,351 euro/QALY (most favorable scenario) to 23,276 euro/QALY (least favorable scenario). CONCLUSIONS: Palivizumab is a cost-effective therapy as prophylaxis against RSV in infants with GA 32-35 and two or more RF. Its use is efficient from the NHS perspective, since the cost of a QALY, even in the least favorable scenarios, is lower than the threshold of 30,000 Euro/QALY considered socially acceptable in Spain.

La eficiencia (coste-efectividad) de palivizumab como profilaxis para la infección por virus respiratorio sincitial en prematuros de 32-35 semanas en España / The efficiency (cost-effectiveness) of palivizumab as prophylaxis against respiratory syncytial virus infection in premature infants with a gestational age of 32-35 weeks in Spain

Objetivos Evaluar la eficiencia (coste-efectividad) de palivizumab para prevenir la infección grave por virus respiratorio sincitial (VRS) en prematuros de edad gestacional de 32 a 35 semanas (EG 32-35) y dos o más factores de riesgo (FR) en España. Métodos Diseño: modelo de decisión alimentado con datos de la literatura científica y de los estudios FLIP I y FLIP II (cohorte de 326 niños con EG 32-35 y dos o más FR que recibieron palivizumab) promovidos por la Sociedad Española de Neonatología. Medida de efectividad principal: años de vida ajustados por calidad (AVAC) ganados. Perspectivas: la del Sistema Nacional de Salud (SNS), que incluye los costes directos (administración de palivizumab e ingresos hospitalarios), y la perspectiva social, que incluye además los costes indirectos (futura productividad perdida del niño). Descuento: 3 % anual para la efectividad y costes indirectos. Análisis de sensibilidad: construcción de 37 escenarios modificando variables relacionadas con la efectividad y los costes. Resultados La profilaxis con palivizumab en prematuros de EG 32-35 y dos o más FR produce una relación de coste-efectividad incremental (CEI) de 13.849 euros/AVAC con la perspectiva del SNS, y de 4.605 euros/AVAC con la perspectiva social. En el análisis de sensibilidad, con la perspectiva del SNS, el CEI osciló de 5.351 euros/AVAC (escenario más favorable) a 23.276 euros/AVAC (escenario menos favorable). Conclusiones Palivizumab es una terapia coste-efectiva como profilaxis frente a VRS en niños de EG 32-35 y dos o más FR. Su uso es eficiente desde la perspectiva del SNS, al conseguir un AVAC, incluso en los escenarios menos favorables, por debajo del umbral de 30.000 euros/AVAC, considerado en España como socialmente aceptable

Objectives To evaluate the efficiency (cost-effectiveness) of palivizumab in preventing severe respiratory syncytial virus (RSV) infection in premature infants with a gestational age of 32-35 weeks (GA 32-35) and two or more risk factors (RF) in Spain. Methods Design: decision tree model using data from the scientific literature and the FLIP I and FLIP II studies (cohort of 326 infants with GA 32-35 and two or more RF who received palivizumab) sponsored by the Spanish Society of Neonatology. Main effectiveness measure: quality-adjusted life years (QALY) gained. Perspectives: the national health service (NHS), which includes direct costs (administration of palivizumab and hospital admissions), and the societal perspective, which also includes indirect costs (the child's future lost productivity). Discount: 3 % annually for effectiveness and indirect costs. Sensitivity analysis: construction of 37 scenarios modifying variables related to effectiveness and costs. Results Prophylaxis with palivizumab in premature infants with GA 32-35 and two or more RF produced an incremental cost-effectiveness ratio (ICER) of 13,849 euros/QALY from the NHS perspective, and an ICER of 4,605 euros/QALY from the societal perspective. In the sensitivity analysis, from the NHS perspective the ICER ranged from 5,351euros/QALY (most favorable scenario) to 23,276 euros/QALY (least favorable scenario). Conclusions Palivizumab is a cost-effective therapy as prophylaxis against RSV in infants with GA 32-35 and two or more RF. Its use is efficient from the NHS perspective, since the cost of a QALY, even in the least favorable scenarios, is lower than the threshold of 30,000 euros/QALY considered socially acceptable in Spain

[Anisakiasis in a patient with a small hiatal hernia. Report of one case]. / Anisakiasis en un paciente portadora de una pequeña hernia hiatal. Caso clínico.

We describe the presence of anisakiasis in a patient who had a small hiatal hernia. A 60 year-old women presented general malaise, burning pain, flatulence, persistent nausea and abdominal distension during five days before consulting. She referred that she ate a dish of marinated raw fish with lemon and pepper ("cebiche") and after a few hours the symptoms began. An esophagogastroscopy showed a white colour larva of approximately three cm with the cephalic end partially adhered and localized in the mucosa of the hiatal hernia. During the procedure the worm was easily extracted. The morphologic study of the specimen identified it as a stage IV larva of Pseudoterranova sp. The clinical condition of the patient improved after the extraction of the parasite.

[Prevalence of urinary incontinence and linked factors in men and women over 65]. / Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años.

OBJECTIVES: To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes. DESIGN: Population survey. SETTING: Leganés (Madrid). PARTICIPANTS: Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150). MAIN MEASUREMENTS: Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables. RESULTS: The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem. CONCLUSIONS: Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.

Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años / Prevalence of urinary incontinence and linked factors in men and women over 65

Objetivos. Estimar la prevalencia de la incontinencia urinaria e identificar los factores asociados en una población de personas mayores que viven en sus domicilios. Diseño. Encuesta poblacional. Emplazamiento. Leganés (Madrid).Participantes. Muestra representativa de las personas mayores de 65 años empadronadas en Leganés (n = 1.560). Se realizaron dos entrevistas en el domicilio, y durante la segunda se incluyó un examen médico. La tasa de respuesta fue del 75 por ciento (n = 1.150).Mediciones principales. Frecuencia de pérdidas involuntarias de orina y utilización de fármacos y absorbentes, estado de salud, uso de diuréticos y oxibutinina y variables demográficas y sociales. Resultados. La prevalencia de incontinencia urinaria fue del 14 por ciento (intervalo de confianza [IC] del 95 por ciento, 11-17) en varones y 30 por ciento (IC del 95 por ciento, 26-34) en mujeres. La edad avanzada está asociada a una mayor prevalencia en los varones pero no en las mujeres. En el análisis multivariado, los factores asociados a la incontinencia urinaria son la comorbilidad y el déficit cognitivo; en las mujeres se añaden, además, el índice de masa corporal elevado y las limitaciones graves de movilidad. El 20 por ciento de las mujeres y el 5 por ciento de los varones mayores de 65 años utilizan absorbentes. La utilización de diuréticos y el bajo número de pacientes con tratamiento específico en personas con incontinencia urinaria sugieren una baja detección de este problema. Conclusiones. La incontinencia urinaria es frecuente y podría ser mejor detectada y tratada en la atención primaria. La prevención de la incontinencia urinaria en las mujeres debería comenzar antes de la vejez (AU)

Distribución de los urólogos en España: situación actual y estimación de necesidades futuras mediante un modelo predictivo

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