La producción científica del personal de enfermería en un área sanitaria de Galicia (España) / The scientific production of nursing staff in a health area of Galicia (Spain)

Objetivo principal: analizar la investigación enfermera en la producción científica del Área Sanitaria de Ferrol (ASF). Metodología: estudio descriptivo en el que se utilizó Sophos, base de datos de producción científica del Servicio Gallego de Salud para la recogida de datos. En enero de 2022, se realizó una exportación a Excel de los autores clasificados como personal de enfermería del ASF y de su producción científica en el periodo 2011-2020. Resultados principales: se identificaron 78 autores: el 24,35% trabaja en atención primaria y el 75,65% en atención hospitalaria. Se contabilizaron 169 publicaciones, clasificadas en estas categorías: artículos originales, artículos de opinión, artículos de revisión, comunicaciones a congresos, guías y otro tipo de documentos, repartidas entre 50 revistas. Se distinguen 8 redes de colaboración que publican el 82,24% de los artículos, frente al 17,75% publicado por un único autor. Conclusión principal: el análisis de las redes de colaboración muestra equipos de enfermería consolidados que colaboran tanto dentro del ASF como con otros centros del Sergas y otro personal enfermero completamente integrado en equipos de investigación de sus servicios.(AU)

Objective: To analyse nursing research in the scientific production of the Ferrol Health Area (ASF). Methods: A descriptive study in which Sophos, the scientific production database of the Galician Health Service, was used for data collection. The authors were classified as nursing staff of the ASF and their scientific production from 2011 to 2020 was exported into an Excel spreadsheet in January 2022. Results: 78 authors were identified: 24.35% work in primary care and 75.65% in hospital care. A total of 169 publications were identified, classified as: original articles, opinion articles, review articles, communications to congresses, guidelines and other types of documents; and distributed among 50 journals. Eight collaborative networks were identified, publishing 82.24% of the articles compared to 17.75 % published by a single author. Conclusions: The analysis of the collaboration networks shows consolidated nursing teams that collaborate both within the ASF and with other Sergas centres and other nursing staff fully integrated with research teams in their services.(AU)

Disponibilidad en acceso abierto de la producción científica del Servicio Gallego de Salud (Sergas) desde 2014 a 2019 / Open access availability of the Galician Health Service (SERGAS) scientific production between 2014 and 2019

Introduction: This paper studies the open access availability to the Galician Health Service (SERGAS) staff´s scientific production between2014 and 2019, its evolution through the different open access routesand the volumen of publications that could be deposited in the institutional repository.Methodology: Based on an export from Sophos, (the tool that measuresthe scientific production of the SERGAS), this paper analizes the setof publications in which at least one author with SERGAS institutionalaffiliation. The APIs of Unpaywall, DOAJ and the Find Full Text functionof EndNote were used to determine whether the article had a full-textversion available.Results: The SERGAS scientific production between 2014 and 2019,excluding conference contributions, amounts to 7,792 articles. 44.10%of those articles can be classified as real open access (gold, bronze orhybrid), 51.16% are published in journals that allow self-archiving andonly 4.75% do not support open access or do not provide informationon their access policy. These articles were published in 1,695 differentjournals, 409 of wich follow the gold open access model.Conclusions: 95% of the articles reviewed would be available to theend user through one of the open access routes and could be deposited in the institutional repository.

Introducción: Se estudia la disponibilidad en acceso abierto de la producción científica del personal del Servicio Gallego de Salud (Sergas) delos años 2014 a 2019, su evolución a través de las distintas vías de accesoy qué volumen se podría depositar en el repositorio institucional.Metodología: A partir de una exportación de Sophos, la herramienta quemide la producción científica del Sergas, se analiza el conjunto de publicaciones en las que participa al menos un autor con filiación institucionaldel Sergas. Se utilizaron las APIs de Unpaywall, DOAJ y la función FindFull Text de EndNote para determinar si el artículo tenía una versión detexto completo disponible.Resultados: La producción científica del Sergas de 2014 a 2019, excluidaslas comunicaciones a congresos, asciende a 7.792 artículos de los cualesel 44.10% de pueden clasificar como de acceso abierto real (dorado,bronce o híbrido), el 51.16% están publicados en revistas que permitenel auto-archivo y solo un 4.75% no admiten acceso abierto o no ofreceninformación sobre su política de acceso. Estos artículos se publicaron en1.695 revistas diferentes, de las cuales 409 siguen el modelo de accesoabierto dorado.Conclusiones: El 95% de los artículos revisados pueden estar disponiblespara el usuario final por alguna de las vías de acceso abierto y podríanser depositados en el repositorio institucional.

Variabilidad de la filiación institucional y recuperación de la producción científica de un hospital / Variability of institutional affiliation and recovery of a hospital's scientific output

OBJETIVOS: analizar la variabilidad de las afiliaciones de una institución sanitaria en la base de datos Scopus y se estudió cómo influye en la recuperación de la producción científica. MÉTODOS: se realizaron búsquedas por autores y autoras, estrategia y nombre normalizado de la institución para comparar la variabilidad de los resultados. RESULTADOS: se constató una pérdida del 44,20 % de documentos en la recuperación por el campo de afiliación normalizada de la base de datos. CONCLUSIONES: tras analizar las causas, se propuso varias medidas para corregir dicha pérdida

OBJECTIVE: The variability of the affiliations of a health institution in the Scopus database is analyzed and how it influences the recovery of scientific production is studied. METHODS: Searches were conducted by authors, strategy and standardized name of the institution to compare the variability of the results. RESULTS: There is a loss of 44.20% of documents in the recovery by the standardized affiliation field of the database. CONCLUSIONS: After analysing the causes, a number of measures are proposed to correct this loss

Effect of Hepatitis C Virus Coinfection on the Progression of Vertically Acquired Human Immunodeficiency Virus Infection During Childhood and Adolescence.

Data for a total of 57 patients vertically coinfected with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) and 365 HIV-monoinfected patients were compared until their transition to adult care. No differences regarding the dynamics of CD4 and/or CD8 T-cell counts during childhood were found. The coexistence of HCV does not increase the risk of disease progression in vertically HIV-infected patients.

Evaluación del subprograma de Atención Comunitaria al Adulto Mayor en Mantua / Evaluation of the subprograms for the Community Care of the Elderly in Mantua

RESUMEN Introducción: la evaluación de los programas en la Atención Primaria de Salud permite medir el impacto real de su aplicación, y surge como instrumento de perfección y desarrollo. Objetivo: mostrar los resultados de la evaluación del subprograma de Atención Comunitaria al Adulto Mayor, en el Policlínico Principal de Urgencias Dr. Juan Bruno Zayas, de Mantua, en el año 2017. Métodos: se realizó una Investigación en Sistemas y Servicios de Salud, de tipo observacional y analítica, el universo del estudio lo constituyeron las 4 648 personas de 60 años y más, que fueron atendidas, así como todos los médicos y enfermeras de los 27 Consultorios Médicos de la Familia; con un total de 53 prestadores. Para la selección de la muestra de los gerontes se utilizó un muestreo probabilístico aleatorio simple, a razón de ocho por consultorio hasta seleccionar 216 adultos mayores, a los cuales se les aplicó una encuesta para evaluar el nivel de satisfacción. A los prestadores se les aplicó otra encuesta diseñada con el mismo objetivo. Se utilizaron los indicadores de actividades, resultados establecidos en el subprograma y los estándares correspondientes del programa. Resultados: los tres componentes del subprograma resultaron evaluados de no satisfactorios. La mayoría de sus índices trazadores no alcanzaron los estándares deseados. Conclusiones: se evaluó el subprograma de Atención Comunitaria al Adulto Mayor, en el municipio de Mantua, lo que evidenció deficiencias en su ejecución, así como poca disponibilidad de literatura sobre el mismo.

ABSTRACT Introduction: the evaluation of programs in Primary Health Care allows measuring the true impact of their application and arises as an instrument of accuracy and development. Objective: to show the results of the evaluation of the subprogram for the Community Care of the elderly at Dr. Juan Bruno Zayas Main Emergency Polyclinic in Mantua during 2017. Methods: an observational and analytical Research on Health Systems and Services was carried out. The target group of the study was comprised of 4648 people 60 years of age and older who were attended, as well as all the doctors and nurses of the 27 Family Physician Offices, with a total of 53 providers. For the selection of the sample of geronts, a simple random probability sampling was used, at a rate of eight per clinic until 216 old people were chosen, to whom a survey was applied to evaluate the level of satisfaction. Providers were given another survey designed for the same purpose. The indicators of activities, results established in the subprogram and the corresponding program standards were applied. Results: the three components of the subprograms were evaluated as unsatisfactory. Most of its tracer indicators of hospital management did not meet the desired standards. Conclusions: the subprogram of community care to the elderly was evaluated in the municipality of Mantua, which evidenced deficiencies in its implementation, as well as limited availability of medical literature concerning this topic.

Riesgo de fractura calculado con el índice FRAX en pacientes con osteoporosis tratados y no tratados / Fracture risk calculated with the FRAX index in patients with osteoporosis treated and untreated

Fundamento y objetivo: Conocer el riesgo de fractura estimado con el aplicativo FRAX® en pacientes tratados y no tratados según la práctica clínica habitual. Pacientes y método: De una base de datos sobre factores de riesgo de osteoporosis y fractura, que incluye determinaciones densitométricas, se seleccionó a todos los pacientes que cumplían los siguientes criterios: 1) edad entre 40 y 90 años; 2) disponer del peso y la talla; 3) tener el primer estudio densitométrico por densitometría ósea de rayos X de doble energía después de septiembre de 2005; 4) conocer la intervención terapéutica realizada después de la densitometría ósea, y 5) no haber realizado tratamiento previo a la primera densitometría. El cálculo del riesgo de fractura se realizó con la aplicación disponible en la web durante el mes de junio de 2008. Resultados: Se incluyó a 192 personas (45 varones), de las que 81 recibieron tratamiento después de la densitometría. Los pacientes tratados tenían mayor número de factores de riesgo (media [DE] de 1,06 [0,97] e intervalo de confianza [IC] del 95%: 0,88–1,24 frente a 1,49 [1,03] e IC del 95%: 1,27–1,71; p=0,003). El riesgo de fractura fue superior en los pacientes tratados en todos los grupos (fractura mayor y fractura del fémur, con y sin densitometría). En todos los casos, el riesgo de fractura fue mayor cuando no se utilizó el valor densitométrico. En pacientes menores de 65 años, el riesgo de fractura fue significativamente inferior al de los pacientes de más de 64 años en todos los casos (AU)

Background and objective: To estimate the fracture risk with the FRAX® in patients treated and not treated in clinical practice. Material and methods: From a database of risk factors for osteoporosis and fracture, that included absorptiometry measurements, we selected all patients who met the following criteria: 1) Age between 40 and 90 years, 2) to have the weight and size, 3) To have the first study by DXA scan after September 2005, 4) To know the therapeutic intervention made after bone densitometry, and 5) Not have done any treatment before the first densitometry. The calculation of the fracture risk was achieved with the application available on the Web during June 2008. Results: One hundred and ninety two people (45 men) were included, 81 of which received treatment after densitometry. Treated patients had more risk factors (1,06±0,97 [IC 95% 0,88–1,24] vs. 1,49±1,03 [IC 95% 1,27–1,71], p=0,003). Fracture risk was higher in treated patients in all groups (major osteoporotic fracture and hip fracture, with and without bone absorptiometry). In all cases, fracture risk was lower when using the densitometric value. In patients younger than 65 years, the fracture risk was significantly lower than in patients over 64 years in all cases. Conclusions: The risk of fracture measured by the FRAX® is higher in patients receiving treatment, although there is a significant overlap between the two groups (AU)

[Fracture risk calculated with the FRAX index in patients with osteoporosis treated and untreated]. / Riesgo de fractura calculado con el índice FRAX en pacientes con osteoporosis tratados y no tratados.

BACKGROUND AND OBJECTIVE: To estimate the fracture risk with the FRAX in patients treated and not treated in clinical practice. MATERIAL AND METHODS: From a database of risk factors for osteoporosis and fracture, that included absorptiometry measurements, we selected all patients who met the following criteria: 1) Age between 40 and 90 years, 2) to have the weight and size, 3) To have the first study by DXA scan after September 2005, 4) To know the therapeutic intervention made after bone densitometry, and 5) Not have done any treatment before the first densitometry. The calculation of the fracture risk was achieved with the application available on the Web during June 2008. RESULTS: One hundred and ninety two people (45 men) were included, 81 of which received treatment after densitometry. Treated patients had more risk factors (1,06 + or - 0,97 [IC 95% 0,88-1,24] vs. 1,49 + or - 1,03 [IC 95% 1,27-1,71], p=0,003). Fracture risk was higher in treated patients in all groups (major osteoporotic fracture and hip fracture, with and without bone absorptiometry). In all cases, fracture risk was lower when using the densitometric value. In patients younger than 65 years, the fracture risk was significantly lower than in patients over 64 years in all cases. CONCLUSIONS: The risk of fracture measured by the FRAX is higher in patients receiving treatment, although there is a significant overlap between the two groups.

Primary gastric lymphoma with florid granulomatous reaction.

Epithelioid cell granulomas are more commonly seen in Hodgkin's disease and T cell lymphomas. Rarely florid granulomatous reaction with necrosis may be a prominent feature in lymphoma. To the best of our knowledge, a total of 11 cases of Burkitt's lymphoma with florid necrotizing granulomas have been reported in the English literature. None of these cases have previously had the stomach involved. Here we report a gastric Burkitt's lymphoma with florid granulomatous reaction diagnosed following a partial gastrectomy. The initial gastric biopsy showed granulomatous gastritis but the radiological and endoscopic appearance was that of a gastric stromal tumour. We conclude that in the presence of a mass lesion, the finding of epithelioid granulomas should warrant re-biopsy to establish an accurate diagnosis and exclude a concurrent malignant process. Hence, major surgery and postoperative complications can be avoided and appropriate treatment regimen can be initiated.

Efecto de la coexistencia de fibromialgia en el índice DAS28 en mujeres con artritis reumatoide / No disponible

Objetivo: Evaluar el efecto de la coexistencia de fibromialgia y artritis reumatoide en el valor del índice DAS28 en mujeres. Pacientes y método: Se incluyó a 53 mujeres con artritis reumatoide (9 con fibromialgia y 44 sin fibromialgia) visitadas de forma consecutiva en una consulta extrahospitalaria de reumatología. Se recogieron la velocidad de sedimentación globular (VSG), la PCR, el número de articulaciones dolorosas y tumefactas, la valoración general de las pacientes mediante escala visual analógica y otros parámetros referentes a la enfermedad articular y el estado funcional y emocional de las pacientes. Resultados: No se encontraron diferencias significativas en la edad de las pacientes, la duración de la artritis, el número de articulaciones tumefactas, la VSG y la PCR; por el contrario, hubo diferencias en el número de articulaciones dolorosas, la evaluación global de la enfermedad por las pacientes y en aspectos funcionales y emocionales. El DAS28 fue mayor en las mujeres que tenían fibromialgia asociada (5,55 ± 0,78 frente a 3,39 ± 1,15; p = 0,000). Conclusiones: La coexistencia de fibromialgia en mujeres con artritis reumatoide se asocia a un mayor valor del DAS28 (AU)

Objective: To compare the effect of coexisting fibromyalgia in DAS28 in RA female patients. Patients and method: Fifty-three RA women seen consecutively in an outpatient rheumatology clinic were included and classified according to the presence (9 women) or absence (44 women) of fibromyalgia. ESR, number of tender and swollen joints, and global assessment by the patient through a visual analogue scale were recorded, as well as other functional and emotional variables. Results: There were no differences in age, time since onset of the arthritis, number of swollen joints, ESR, and CRP. Number of tender joints, global assessment by the patient, and functional and emotional aspects were worse in patients with fibromyalgia. DAS28 was higher when fibromyalgia was associated to RA (5.55±0.78 vs 3.39± 1.15; P=.000). Conclusions: Coexistence of fibromyalgia increases DAS28 in women with RA (AU)

[Effect of the Coexistence of Fibromyalgia in the DAS28 Index in Women With Rheumatoid Arthritis]. / Efecto de la coexistencia de fibromialgia en el índice DAS28 en mujeres con artritis reumatoide.

OBJECTIVE: To compare the effect of coexisting fibromyalgia in DAS28 in RA female patients. PATIENTS AND METHOD: Fifty-three RA women seen consecutively in an outpatient rheumatology clinic were included and classified according to the presence (9 women) or absence (44 women) of fibromyalgia. ESR, number of tender and swollen joints, and global assessment by the patient through a visual analogue scale were recorded, as well as other functional and emotional variables. RESULTS: There were no differences in age, time since onset of the arthritis, number of swollen joints, ESR, and CRP. Number of tender joints, global assessment by the patient, and functional and emotional aspects were worse in patients with fibromyalgia. DAS28 was higher when fibromyalgia was associated to RA (5.55 ± 0.78 vs 3.39 ± 1.15; P = .000). CONCLUSIONS: Coexistence of fibromyalgia increases DAS28 in women with RA.

Social network as a predictor of hospital readmission and mortality among older patients with heart failure.

BACKGROUND: This study examines the relationship between social network and hospital readmission and mortality in older patients with heart failure. METHODS AND RESULTS: Prospective study conducted with 371 patients, age 65 and older, admitted for heart failure-related emergencies at 4 Spanish hospitals. Social network was measured at baseline with a 4-item questionnaire that ascertained whether subjects were married, lived with another person(s), saw or had telephone contact with family members daily or almost daily, and were at home alone for less than 2 hours per day. Social network was deemed "high" where all 4 items were present, "moderate" where 3 were present, and "low" where 2 or fewer were present. Analyses were performed using Cox models, and adjusted for the main confounders. A total of 55% of patients had high or moderate social networks. During a median follow-up of 6.5 months, 135 (36.4%) patients underwent a first emergency rehospitalization and 68 (18.3%) died. Compared with patients with high social network, hospital readmission was more frequent among those who had moderate (hazard ratio [HR] 1.87; 95% confidence interval [CI] 1.06-3.29; P < .05) and low social networks (HR 1.98; 95% CI 1.07-3.68; P < .05). This relationship showed a positive dose-response (p for linear trend 0.042). The magnitude of this association was comparable to that of other important predictors of readmission, such as previous hospitalization. No relationship was observed between social network and death. CONCLUSION: A very simple questionnaire measuring social network can identify patients with a higher short-term risk of hospital readmission.

[Prevalence of depression and associated medical and psychosocial factors in elderly hospitalized patients with heart failure in Spain]. / Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España.

INTRODUCTION AND OBJECTIVES: This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. METHODS: The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. RESULTS: In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for > or =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). CONCLUSIONS: Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España / Prevalence of Depression and Associated Medical and Psychosocial Factors in Elderly Hospitalized Patients With Heart Failure in Spain

Introducción y objetivos. En este trabajo se estima la prevalencia de depresión y se identifican los factores biomédicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en España. Métodos. Se estudió a 433 pacientes ≥ 65 años ingresados de urgencia en 4 hospitales españoles desde enero de 2000 hasta junio de 2001, con diagnóstico principal o secundario de insuficiencia cardiaca. Se consideró que había depresión ante la presencia de 3 síntomas en la Escala de Depresión Geriátrica de 10 ítems. Resultados. Del total de pacientes estudiados, 210 (48,5%) presentaron depresión. Las cifras correspondientes fueron 71 (37,6%) en varones y 139 (57,0%) en mujeres. La depresión fue más frecuente en los pacientes con las siguientes características: grado funcional III-IV de la NYHA (odds ratio ajustada [ORa] = 2,00; intervalo de confianza [IC] del 95%, 1,23-3,24); peor puntuación en los aspectos físicos de la calidad vida (ORa = 3,14; IC del 95%,1,98-4,99); dependencia en 1 o 2 actividades básicas de la vida diaria (ABVD) (ORa = 2,52; IC del 95%, 1,41-4,51); dependencia en 3 o más ABVD (ORa = 2,47; IC del 95%, 1,20-5,07); limitación en alguna actividad instrumental de la vida diaria (ORa = 2,20; IC del 95%, 1,28- 3,79); hospitalización previa por insuficiencia cardiaca (ORa = 1,71; IC del 95%, 1,93-5,45); estaban solos en casa más de 2 h al día (ORa = 3,24; IC del 95%, 1,93- 5,45); menor satisfacción con el médico de atención primaria (ORa = 1,90; IC del 95%, 1,14-3,17). Conclusiones. La depresión es muy frecuente en los ancianos hospitalizados con insuficiencia cardiaca, y se asocia con varios factores biomédicos y psicosociales. Esta elevada frecuencia, el peor pronóstico de la insuficiencia cardiaca en presencia de síntomas depresivos y la existencia de instrumentos diagnósticos sencillos y un tratamiento eficaz apoyan el cribado sistemático de la depresión en estos pacientes (AU)

Introduction and objectives. This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. Methods. The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. Results. In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for ≥3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). Conclusions. Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients (AU)

Safety and antiviral response at 12 months of lopinavir/ritonavir therapy in human immunodeficiency virus-1-infected children experienced with three classes of antiretrovirals.

INTRODUCTION: Many human immunodeficiency virus type 1 (HIV-1)-infected children have already failed treatment with 2 or even 3 classes of antiretrovirals. Coformulation of lopinavir with low dose ritonavir exhibits a potent antiretroviral effect. However, the data in heavily pretreated children are still scarce. This study evaluated the safety and effectiveness of combination therapy including lopinavir/ritonavir in children with prior exposure to all classes of oral antiretrovirals. METHODS: This was an open label multicenter observational study, in which data were reviewed according to a standardized protocol. The study population included all HIV-1-infected children with virologic failure (HIV-1 RNA >5000 copies/mL) followed in 12 Spanish hospitals for >12 months, experienced with the 3 classes of oral antiretrovirals, in whom a lopinavir/ritonavir-containing regimen was started. RESULTS: By March 2003, 45 patients had been treated with lopinavir/ritonavir for a median of 18 months (range, 3-28). The median age at baseline was 9.7 years (range, 4.3-17.1). The median times of prior treatment were 88 months (range, 31-145) with nucleoside reverse transcription inhibitors and 42 months (range, 19-63) with protease inhibitors. Twenty-five patients were classified as Centers for Disease Control and Prevention clinical category C. Median values for absolute and percentage CD4 at baseline were 501 (range, 6-1512) and 19% (range, 0.5-49), respectively, and plasma HIV-RNA was 5.0 log10 copies/mL (range, 4.1-6.1). During follow-up, 11 (24%) children switched from liquid to solid formulation. At 48 weeks, the median values for absolute and percentage CD4 increased by 199 cells/microL and 3%, respectively, and median plasma viral load declined 1.75 log10 copies/mL. Forty-two percent of children achieved a plasma RNA of <400 copies/mL (intent to treat analysis). Baseline genotypic resistance was available in 40 children. Nonresponders had 7.0 +/- 1.6 protease inhibitor-associated mutations at baseline compared with 4.8 +/- 1.7 in children achieving virologic suppression (P = 0.06). Adverse events were described in 18 children. Three children permanently discontinued and 4 transiently withdrew lopinavir/ritonavir. At 12 months, there were mild but not significant increases in plasma cholesterol and triglycerides. CONCLUSIONS: Lopinavir/ritonavir when given as part of salvage regimen is well-tolerated, although switching to pills is frequently required. The regimen has a potent and durable antiretroviral activity in most heavily pretreated children, despite the presence of multiple mutations to all classes of oral antiretrovirals.

Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure.

BACKGROUND: We sought to examine the relationship between health-related quality of life (HRQL) and a first emergency rehospitalization and mortality in patients with heart failure (HF) having a wide variation in ventricular ejection fraction and functional status. METHODS: Prospective study conducted with 394 patients admitted for HF-related emergencies at 4 Spanish hospitals. Baseline HRQL was measured with a generic questionnaire, the Medical Outcomes Study 36-item Short Form Survey (SF-36), and with an HF-specific instrument, the Minnesota Living With Heart Failure (MLWHF) questionnaire. Cox proportional hazards models were used to calculate hazard ratios (HRs) for hospitalization and death on the basis of HRQL scores. RESULTS: During a median follow-up of approximately 6 months, 138 patients (35.0%) underwent a first emergency rehospitalization and 70 (17.8%) died. After adjustment for biomedical, psychosocial, and health care variables, the frequency of hospital readmission was higher in patients with worse scores on the SF-36 physical functioning (HR, 1.65; 95% confidence interval [CI], 1.11-2.44; P = .01), general health (HR, 1.73; 95% CI, 1.19-2.52; P = .003), and mental health (HR, 1.65; 95% CI, 1.10-2.47; P = .02) subscales. Results were similar for the mortality end point. For the MLWHF questionnaire, worse overall and worse physical and emotional summary scores were associated with higher mortality. CONCLUSIONS: Worse HRQL is associated with hospital readmission and death in patients with HF. The magnitude of this association, for both physical and mental HRQL components, is comparable to that for other well-known predictors of hospital readmission and death, such as personal history of diabetes, previous hospitalizations, and treatment with angiotensin-converting enzyme inhibitors.

[Recommendations of the CEVIHP/SEIP/AEP/PNS on antiretroviral treatment in HIV-infected children and teenagers]. / Recomendaciones CEVIHP/SEIP/AEP/PNS respecto al tratamiento antirretroviral en niños y adolescentes infectados por el VIH.

OBJECTIVE: To update antiretroviral recommendations in antiretroviral therapy (ART) in HIV-infected children and adolescents. METHODS: Theses guidelines have been formulated by a panel of members of the Plan Nacional sobre el SIDA (PNS) and the Asociacion Espanola de Pediatria (AEP) by reviewing the current available evidence of efficacy, safety, and pharmacokinetics in pediatric studies. Three levels of evidence have been defined according to the source of data: Level A: randomized and controlled studies; Level B: Cohort and case-control studies; Level C: Descriptive studies and experts' opinion. RESULTS: When to start ART should be made on an individual basis, discussed with the family, considering the risk of progression according to age, CD4 and viral load, the ART-related complications and adherence. The ART goal is to reach a maximum and durable viral suppression. This is not always possible, even with clinical and immunologic improvement. The difficulties of permanent adherence and side-effects are resulting in a more conservative trend to initiate ART, and to less toxic and simpler strategies. Currently, combinations of at least three drugs are of first choice both in acute and chronic infection. They must include 2 NA 1 1 NN or 2 NA 1 1 PI. ART is recommended in all symptomatic patients and, with few exceptions, in all infants in the first year of life. Older asymptomatic children should start ART according to CD4 count, especially CD4 percentage, that vary with age. Despite potent salvage therapies, it is common not to reach viral undetectability. Therapeutical options when ART fails are scarce due to cross-resistance. The cause of failure must be identified. Occasionally, there exists clinical and/or immunological progression, and a change of therapy with at least two new drugs still active for the patient, is warranted with the aim of increasing the CD4 count to a lower level of risk. Toxicity and adherence must be regularly monitored. Some aspects about post exposure prophylaxis and coinfection with HCV or HBV are discussed. CONCLUSIONS: A higher level of evidence with regard to ART effectiveness and toxicity in pediatrics is currently available, leading to a more conservative and individualized approach. Clinical symptoms and CD4 count are the main determinants to start and change ART.

El reto del trabajo interdisciplinar: ¿hasta dónde hemos llegado? / No disponible

Este trabajo se propone investigar como está distribuida la asunción de tareas asistenciales entre los profesionales de salud mental de la Comunidad de madrid, fundamentalmente psiquiatras y psicólogos. A la luz de estos datos, analiza hasta donde se refrenda y potencia el modelo comunitario de atención, supuestamente basado en la interdisciplinariedad y las responsabilidades compartidas(AU)

The objective of this article is to research how the clinical work (diagnosis, treatments, etc) is distributed among the mental health professionals of the Community of Madrid, mainly between psychiatrist and psychologists. the community mental health based ont he interdisciplinary team is also analyzed(AU)