Programa piloto de cribado de riesgo cardiovascular en la mujer perimenopáusica desde la farmacia comunitaria: proyecto ‘MENOVASC’ / Pilot programme for screening perimenopausal women for cardiovascular risk from community pharmacy: MENOVASC Project

Introducción: desde hace más de 20 años, las enfermedades cardiovasculares constituyen la primera causa de muerte en el mundo. Generalmente, son poco usuales en las mujeres premenopáusicas debido a la protección cardiovascular de los estrógenos endógenos, por lo que tradicionalmente se ha subestimado el riesgo cardiovascular en estas.Objetivos: realizar un cribado de riesgo vascular en mujeres perimenopáusicas desde la farmacia comunitaria.Material y métodos: estudio descriptivo a partir de una muestra oportunista en una farmacia comunitaria de mujeres entre 45 y 55 años. Previa cita se les tomó los niveles de colesterol y tensión arterial, peso y altura. Se recopiló información sobre factores de riesgo cardiovasculares mayores y específicos de la mujer, medicación que tomaban, actividad física y tabaquismo. Con estos datos se estimó su riesgo cardiovascular mediante tablas SCORE. Resultados: se recogieron 18 formularios, con una edad media de las demandantes de 49 (DE 3) años. El 38,9 % (IC95 %: 17,3 a 64,3) presentaba hipertensión arterial y el 44,4 % (IC95 %: 21,5 a 69,2) presentaba niveles de colesterol iguales o superiores a 190 mg/ml. Todas las participantes tenían al menos un factor de riesgo mayor o específico de la mujer.Conclusiones: Se constata la utilidad del cribado de riesgo vascular en mujeres perimenopáusicas. Todo ello pone en valor la intervención del farmacéutico comunitario en la detección y gestión de factores de riesgo cardiovascular. (AU)

Programa piloto de cribado de riesgo vascular en la mujer perimenopáusica desde la farmacia comunitaria: Proyecto MENOVASC / Pilot programme for vascular risk screening in perimenopausal women in community pharmacies: MENOVASC Project

JUSTIFICACIÓN: desde hace más de 20 años las enfermedades cardiovasculares se mantienen como la primera causa de muerte en todo el mundo. Por lo general, son poco frecuentes en la mujer premenopáusica debido a la protección cardiovascular que les confieren los estrógenos endógenos, por lo que tradicionalmente se ha subestimado el riesgo cardiovascular en las mujeres.OBJETIVO: establecer un protocolo de cribado de riesgo vascular en mujeres durante la perimenopausia desde la farmacia comunitaria.MATERIAL Y MÉTODOS: muestra oportunista de pacientes por reclutamiento a través de una intervención educativa previa en el Centro de la Mujer y por comunicación por redes sociales. Los criterios de inclusión en el estudio son ser mujer y tener entre 45 y 55 años, según los criterios de la Organización Mundial de la Salud. Materiales: documento de consentimiento informado, formulario de recogida de datos. Métodos: Se citó a las participantes en la farmacia y se les midieron los niveles de colesterol y presión arterial, el peso y la altura. Además, se recopiló información sobre factores de riesgo vascular generales y específicos de la mujer, medicación que tomaban y hábito tabáquico. Todos estos datos se recopilaron en un formulario de recogida de datos y con ellos se estimó el riesgo cardiovascular de las participantes mediante tablas SCORE. Una vez calculado, se les proporcionaba información sobre los factores de riesgo hallados de manera oral y escrita.RESULTADOS: se recogieron un total de 16 formularios, con una edad media de las demandantes de 49±3 años. El 43,75% presentaba niveles altos de presión arterial, tomando solo una de las participantes medicación para ello, y el 68,75% presentaban sobrepeso. El 43,75% presentaba niveles de colesterol iguales o superiores a 190 mg/ml. El 31,25% declararon que hacía dos años o más que se habían realizado la última analítica. (AU)

New ICT-based index for beach quality management.

Beach management is based on administering technical, environmental, social and political issues to solve coastal problems. To assist coastal management, quality systems have evolved from Beach Certifications Schemes to indicator systems that take into account the three beach functions -natural, protection and recreation-. This study analyses: i) The usefulness of current indices for management decision making; ii) whether the beach user can both access information and participate in beach management; iii) whether the beach indices are dynamic, providing up-to-date information on the status quo of beach or is it merely a snapshot in time; iv) whether beach indices deliver the same result when used by different beach technicians. The results show that the current systems are subjective and based on static criteria, since most of them are obtained through expert opinion, visual inspection and/or interpretation of user surveys. Furthermore, most of the indices focus on the study of the recreational function leaving aside the other beach functions (especially protection). Therefore, the values obtained through these indices are more addressed to the beach user than to the beach manager, so (in general) they do not serve the beach manager in decision-making. Finally, to address the problems described above, a conceptual model based on ICT (Information and Communication Technologies) is proposed for the management and monitoring of beach quality. The computerization and automation of beach management, can be rendered more efficient and effective due to technological advances that can offer an integrated solution for the management of beaches.

Modelling of Escherichia coli concentrations in bathing water at microtidal coasts.

Monitoring of the quality of bathing water in line with the European Commission bathing water directive (Directive 2006/7/EC) is a significant economic expense for those countries with great lengths of coastline. In this study a numerical model based on finite elements is generated whose objective is partially substituting the microbiological analysis of the quality of coastal bathing waters. According to a study of the concentration of Escherichia coli in 299 Spanish Mediterranean beaches, it was established that the most important variables that influence the concentration are: monthly sunshine hours, mean monthly precipitation, number of goat cattle heads, population density, presence of Posidonia oceanica, UV, urbanization level, type of sediment, wastewater treatment ratio, salinity, distance to the nearest discharge, and wave height perpendicular to the coast. Using these variables, a model with an absolute error of 10.6±1.5CFU/100ml is achieved. With this model, if there are no significant changes in the beach environment and the variables remain more or less stable, the concentration of E. coli in bathing water can be determined, performing only specific microbiological analyses to verify the water quality.

Evaluation of coastal management: Study case in the province of Alicante, Spain.

The beaches are complex systems that can be studied from different points of view and meet more than a mission to protect the coast. Their management consists of assigning solutions to problems and for this to be correct all factors involved have to be taken into account. In order to understand how management is done on the coast of the province of Alicante, surveys have been conducted among the managers of the 19 coastal municipalities of Alicante coast, covering the 91 beaches. The aim of the surveys is to try to know the problems and situations relating to the management, depending on different factors such as the level of urbanization and type of sediment. In addition, it has been investigated whether this management is aimed to protect the coastline, maintain the flora and fauna or is just a recreational management since the main economic activity is tourism. The beaches are conceived of as products offered to the user, which is what most concerns its economic importance in an area where the sun and beach tourism has a special share of the GDP. The ignorance as to the major problems regarding their physical functioning and the inability to solve them is due to a complex administrative system with which the coastal system is regulated inefficiently. The integral approach is essential for a complete and effective management of the coastal environment.

Evaluation of the quality of coastal bathing waters in Spain through fecal bacteria Escherichia coli and Enterococcus.

Sun. and beach tourism is very important to the economy of Spain, so the control of the quality of the environment on the beaches is essential. Therefore, the analysis and control of the quality of bathing water is necessary, which is defined by the European Directive 2006/7/EC as excellent, good or sufficient depending on the presence of microbiological contamination or other organisms or waste presenting a risk to bathers' health. For that, 1392 beaches of the Iberian Peninsula and its islands were analysed, taking into account: fecal bacteria (Escherichia coli and Enterococcus), physical characteristics of sediment, level of urbanization, climatic and anthropogenic factors, and maritime climate. Thus, it was observed that urban sand beaches located in seas with fewer hours of sunshine and important tide have higher concentrations of E. coli and Enterococcus. There is also an indirect relationship between these microorganisms with salinity (R(2) 0.746 for E. coli and 0.606 for Enterococcus), temperature (R(2) 0.743 for E. coli and 0.604 for Enterococcus) and hours of sunshine (R(2) 0.781 for E. coli and 0.706 for Enterococcus), while this relationship is direct with rainfall (R(2) 0.640 for E. coli and 0.607 for Enterococcus) or wave height (R(2) 0.769 for E. coli and 0.601 for Enterococcus). From all this, it follows that the Directive 2006/7/EC should define more specific criteria as to the place and time of sampling, and take into account the different environment variables that influence the survival of bacteria, so that the results may reflect reality, and avoid staff responsible for sampling freely choose the place and time of sampling.

Influence of bevacizumab, sunitinib and sorafenib as single agents or in combination on the inhibitory effects of VEGF on human dendritic cell differentiation from monocytes.

Vascular endothelial growth factor (VEGF) inhibits differentiation and maturation of dendritic cells (DC), suggesting a potential immunosuppressive role for this proangiogenic factor. Bevacizumab, sorafenib and sunitinib target VEGF-mediated angiogenesis and are active against several types of cancer, but their effects on the immune system are poorly understood. In this study, VEGF and supernatants of renal carcinoma cell lines cultured under hypoxia were found to alter the differentiation of human monocytes to DC. Resulting DC showed impaired activity, as assessed by the alloreactive mixed T-lymphocyte reaction. Bevacizumab and sorafenib, but not sunitinib, reversed the inhibitory effects of VEGF, but not of those mediated by tumour supernatants. Dendritic cells matured under the influence of VEGF expressed less human leukocyte antigen-DR (HLA-DR) and CD86, and this effect was restored by bevacizumab and sorafenib. Finally, tumour-cell supernatants decreased interleukin-12 (IL-12) production by mature DC, and such inhibition was not restored by any of the tested drugs, delivered either as single agents or in combination. The deleterious effects of tumour-cell supernatants were mainly mediated by thermostable molecules distinct from VEGF. These results indicate that inhibition of the differentiation of monocytes to DC is a multifactorial effect, and that they support the development of combinations of angiogenesis inhibitors with immunological modulators.

A comparative study of the accuracy of Ranawat's and Pierchon's methods to determine the centre of rotation in bilateral coxopathy.

OBJECTIVE: The objective of the study was to compare two methods (Ranawat's and Pierchon's) used to determine the centre of rotation of the hip and establish which method calculates a position nearer to the real centre of rotation. PATIENTS AND DESIGN: We selected 24 patients with unilateral osteoarthritis of the hip. The centre of rotation of the healthy hip was determined in two consecutive radiographic studies by superimposing a template of circles and using two axes as the reference lines (X-axis=teardrop line; Y-axis=a line perpendicular to the X-axis, drawn from the intersection of the ilio-ischiatic line and the teardrop line). After ensuring the stability of these references, both methods were applied to the same radiograph to determine which one established a centre of rotation nearer to the anatomical centre identified by the template of circles. RESULTS: When the values for the healthy hip are compared with those obtained using Ranawat's method, highly significant differences are observed for both X (P<0.0001) and Y (P<0.0001). When the results for the healthy hip are compared with the values obtained using Pierchon's method, neither the X (P=0.722 ) nor the Y values (P=0.112) show any significant differences. It would be advisable to use Pierchon's method to determine the centre of rotation during the preoperative planning for a total hip arthroplasty when the anatomical alteration is bilateral.