Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática / Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review

El dolor lumbar crónico causa discapacidad e impacto socioeconómico. El ejercicio de alta intensidad muestra resultados positivos en otras enfermedades, pero no existe evidencia sobre esta patología. Se pretende determinar su eficacia en la calidad de vida relacionada con la salud, la discapacidad, la intensidad del dolor y la adherencia al tratamiento en personas con dolor lumbar crónico. Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus, incluyendo ensayos clínicos aleatorizados, guías de práctica clínica y revisiones sistemáticas en español, inglés o portugués (2012-2022). Además, se hace una búsqueda en bola de nieve. Se incorporan ocho ensayos clínicos aleatorizados (n=379). Se analizan diferentes modalidades de ejercicio de alta intensidad, que parecen mejorar la calidad de vida relacionada con la salud y reducir la discapacidad y la intensidad del dolor. Estos datos se deben tomar con cautela dada la poca cantidad de estudios y el riesgo de sesgo que presentan.(AU)

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.(AU)

[Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review]. / Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática.

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.

Valor pronóstico de la resonancia magnética precoz en la morbilidad y mortalidad de la lesión medular traumática / Prognostic value of early magnetic resonance imaging in the morbidity and mortality of traumatic spinal cord injury

Objetivo Valorar en individuos con lesión medular traumática (LMT) la relación en re la mortalidad y la necesidad de UCI y las alteraciones objetivadas mediante resonancia magnética (RM) precoz, analizando alteraciones parenquimatosas, disrupción de ligamentos vertebrales (DLV) y compresión del cordón medular (CCM). Diseño Estudio retrospectivo. Ámbito Hospital de tercer nivel, unidad de lesionados medulares y UCI. Pacientes Individuos con LMT aguda entre los años 2010 y 2019. Intervenciones Análisis de RM realizada en las primeras 72horas. Variables de interés Ingreso en UCI y mortalidad. Resultados Recogidos 269 casos. El patrón que se asoció a una mayor mortalidad fue la hemorragia (16,7%) por 12,5% de los edemas a un nivel y 6,5% de los edemas a múltiples niveles (p=0,125). Lo mismo aconteció con los ingresos en UCI: 69,0% en hemorragia por 60,2% en edema múltiple y 46,3% en edemas cortos (p=0,018). Con respecto a la CCM, la mortalidad fue del 13,4% con 59,2% de ingresos en UCI por 2,2% y 42,2% de quienes no presentaban compresión (p=0,020 y p=0,003). Las cifras de éxitus e ingreso en UCI en los individuos con DLV fueron del 15,0% y el 67,3%, respectivamente, por un 6,2% y 44,4% de los individuos sin DLV (p<0,001 y p=0,013). Conclusiones La presencia de hemorragia medular, CCM y DLV se asoció a una mayor necesidad de UCI. Existe un significativo aumento de la mortalidad en los casos con CCM y DLV (AU)

Objective To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). Design Retrospective study. Setting Third-level hospital, Spinal Cord Injury Unit and ICU. Patients Individuals with acute TSCI between 2010 and 2019. Interventio Analysis of MRI performed in the first 72h. Variables of interest Admission to ICU and mortality. Results 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p=0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p=0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p=0.020 and p=0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p<0.001 and p=0.013). Conclusions The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL (AU)

Continuous infusion of antibiotics using elastomeric pumps in the hospital at home setting.

OBJECTIVE: To describe the avoided costs and to analyze the effectiveness of intravenous antibiotic treatment in continuous perfusion in patients at Hospital at Home Units (HHU) administered using elastomeric infusion pumps (EIP) prepared in a Hospital Pharmacy Service (HPS). METHODS: Retrospective observational study of the number and type of EIP prepared in the HPS and of the treated patients. Study period: January 2017-December2018. Analyzed data: demographic data of patients, location of infection, responsible microorganism, medication and type of EIP, dose and duration of treatment and its effectiveness in terms of cure or non-cure or patient's death. Economic valuation considering: costs of EIP, nursing time needed for preparation and cost of HHU care. RESULTS: A total of 1,688 EIP to treat 102 patients resulted in 106 episodes of outpatient treatment of parenteral antibiotic therapy (OPAT) for 1,409 days, thereby avoiding 1,409 days of hospital admission. A total of 59.8% of the patients were men and the mean age was 70.5 ± 17 years. A 31.1% and 68.9% of the cases were empirical and pathogen-directed treatments, respectively. The most used antimicrobials were piperacillin/tazobactam (42.7%), ceftazidime (24.5%), meropenem (19.8%), ceftolozane/tazobactam (2.8%), and cloxacillin (1.9%). Mean duration of treatment was 13.29 ± 8.60 days. Location of infection: respiratory (42.5%), urinary (17.9%), skin and soft tissue (12.3%), bacteraemia (11.3%), osteomyelitis (7.5%), abdominal (3.8%) and 4.7% in other locations. The cure rate was 84%. Total avoided cost: 580,788.28€ in the 24 months studied. CONCLUSIONS: This program represents very important economic savings for the health system, and the effectiveness of the antibiotic treatment has not been compromised.

Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era / Epidemiología y pronóstico de los pacientes con VIH ingresados en la UCI en la era de tratamiento antirretroviral de gran actividad actual

PURPOSE: To describe the epidemiology of critical disease in HIV-infected patients during the current highly active antiretroviral therapy (HAART) era and to identify hospital mortality predictors. METHODS: A longitudinal, retrospective observational study was made of HIV-infected adults admitted to the ICU in two Spanish hospitals between 1 January 2000 and 31 December 2014. Demographic and HIV-related variables were analyzed, together with comorbidities, severity scores, reasons for admission and need for organ support. The chi-squared test was used to compare categorical variables, while continuous variables were contrasted with the Student's t-test, Mann-Whitney U-test or Kruskal-Wallis test, assuming an alpha level = 0.05. Multivariate logistic regression analysis was used to calculate odds ratios for assessing correlations to mortality during hospital stay. Joinpoint regression analysis was used to study mortality trends over time. RESULTS: A total of 283 episodes were included for analyses. Hospital mortality was 32.9% (95%CI: 21.2-38.5). Only admission from a site other than the Emergency Care Department (OR 3.64, 95% CI: 1.30-10.20; p = 0.01), moderate-severe liver disease (OR 5.65, 95% CI: 1.11-28.87; p = 0.04) and the APACHE II score (OR 1.14, 95% CI: 1.04-1.26; p < 0.01) and SOFA score at 72h (OR 1.19, 95% CI: 1.02-1.40; p = 0.03) maintained a statistically significant relationship with hospital mortality. CONCLUSIONS: Delayed ICU admission, comorbidities and the severity of critical illness determine the prognosis of HIV-infected patients admitted to the ICU. Based on these data, HIV-infected patients should receive the same level of care as non-HIV-infected patients, regardless of their immunological or nutritional condition

OBJETIVOS: Describir la epidemiología de la patología crítica en el paciente infectado por VIH durante la era de tratamiento antirretroviral de gran actividad actual y encontrar predictores de mortalidad hospitalaria. MÉTODOS: Estudio observacional, retrospectivo y longitudinal que incluye pacientes infectados por VIH adultos ingresados en las UCI de hospitales de Galicia, entre el 1 de enero de 2000 y el 31 de diciembre de 2014. Analizamos variables demográficas y relacionadas con la infección por el VIH, comorbilidades, puntuaciones de gravedad, motivo de ingreso y necesidad de soporte de órganos. Empleamos la prueba de la Chi-cuadrado para comparar las variables categóricas y las pruebas de la T-Student, U de Mann-Whitney o H de Kruskal-Wallis para las variables continuas, asumiendo un error a = 0,05. Utilizamos la regresión logística multivariante para calcular la OR de la asociación con la mortalidad hospitalaria. Aplicamos análisis de regresión de joinpoint para estudiar la tendencia temporal de mortalidad. RESULTADOS: Incluimos 283 episodios. La mortalidad hospitalaria fue del 32,9% (IC 95%=21,2-38,5%). El ingreso no procedente de Urgencias (OR 3,64; IC 95% = 1,30-10,20; p = 0,01), la enfermedad hepática moderada-grave (OR 5,65; IC 95% = 1,11-28,87; p = 0,04), el APACHE II (OR 1,14; IC 95%=1,04-1,26; p < 0,01) y el SOFA a las 72 h (OR 1,19; IC 95% = 1,02-1,40; p = 0,03) se relacionan con la mortalidad hospitalaria en el análisis multivariante. CONCLUSIONES: El retraso en el ingreso en UCI, las comorbilidades y la gravedad del episodio determinan el pronóstico del paciente infectado por VIH ingresado en UCI. Los pacientes con VIH deberían recibir el mismo nivel de cuidados que los pacientes no infectados por VIH, independientemente de su estado inmunológico o nutricional

Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era.

PURPOSE: To describe the epidemiology of critical disease in HIV-infected patients during the current highly active antiretroviral therapy (HAART) era and to identify hospital mortality predictors. METHODS: A longitudinal, retrospective observational study was made of HIV-infected adults admitted to the ICU in two Spanish hospitals between 1 January 2000 and 31 December 2014. Demographic and HIV-related variables were analyzed, together with comorbidities, severity scores, reasons for admission and need for organ support. The chi-squared test was used to compare categorical variables, while continuous variables were contrasted with the Student's t-test, Mann-Whitney U-test or Kruskal-Wallis test, assuming an alpha level=0.05. Multivariate logistic regression analysis was used to calculate odds ratios for assessing correlations to mortality during hospital stay. Joinpoint regression analysis was used to study mortality trends over time. RESULTS: A total of 283 episodes were included for analyses. Hospital mortality was 32.9% (95%CI: 21.2-38.5). Only admission from a site other than the Emergency Care Department (OR 3.64, 95%CI: 1.30-10.20; p=0.01), moderate-severe liver disease (OR 5.65, 95%CI: 1.11-28.87; p=0.04) and the APACHE II score (OR 1.14, 95%CI: 1.04-1.26; p<0.01) and SOFA score at 72h (OR 1.19, 95%CI: 1.02-1.40; p=0.03) maintained a statistically significant relationship with hospital mortality. CONCLUSIONS: Delayed ICU admission, comorbidities and the severity of critical illness determine the prognosis of HIV-infected patients admitted to the ICU. Based on these data, HIV-infected patients should receive the same level of care as non-HIV-infected patients, regardless of their immunological or nutritional condition.

Predictor of enhanced mortality in patients with multimorbidity and atrial fibrillation in an acute hospital setting.

BACKGROUND: Patients with atrial fibrillation (AF) admitted to hospital commonly have comorbidities. Few studies have attempted to determine factors prognostic of mortality in hospitalized AF patients with multimorbidity. AIM: To identify factors associated with mortality in hospitalized AF patients. DESIGN: Retrospective cohort study. METHODS: Patients with multimorbidity (≥2 chronic diseases), with or without AF, discharged from Lugo hospital (Spain) between 1 January 2000 and 31 December 2015. Data were extracted from hospital medical records. RESULTS: Of 74 220 patients (170 978 hospitalizations), 52 939 had multimorbidity (14 181 had AF; 38 758 no AF) and were included in our study. Patients with AF were older (mean ± standard deviation 78.6 ± 10.0 vs. 71.9 ± 14.2 years) and had a higher mortality rate (27.1 vs. 20.5%) than those without AF. Gender (female), age, stroke and congestive heart failure (CHF), but not AF, were independently associated with mortality. AF significantly increased the mortality risk in women [relative risk (RR) 1.091; 95% confidence interval (CI) 1.021-1.165; P = 0.010] and in those aged >80 years (RR 1.153; 95% CI, 1.1-1.2; P < 0.001). CHF independently increased the risk of mortality across all age groups (RR 1.496; 95% CI 1.422-1.574; P < 0.001). CONCLUSIONS: Hospitalized patients with AF have a higher mortality rate than those without AF. The prognostic significance of AF changes with age and gender while CHF is associated with the greatest risk of death.

Effectiveness and safety of daclatasvir/sofosbuvir with or without ribavirin in genotype 3 hepatitis C virus infected patients. Results in real clinical practice.

OBJECTIVE: Direct-acting antivirals have shown high efficacy in all hepatitis C virus (HCV) genotypes, but genotype 3 (G3) treatments continue to be a challenge, mainly in cirrhotic patients. The aim of this study is to analyse effectiveness and safety of daclatasvir associated with sofosbuvir with or without ribavirin in G3-HCV infected patients in real clinical practice. METHODS: An observational, prospective, cohort study over 2.5 years, in G3-HCV infected adult patients, in all fibrosis stages including patients with decompensated cirrhosis. Treatment was a combination of sofosbuvir 400 mg/day + daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacy endpoint was sustained virologic response rates 12 weeks after therapy (SVR12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. RESULTS: A total of 111 patients were enrolled, 32.4% cirrhotics and 29.9% treatment-experienced. The global SVR12 rate was 94.6%, while the SVR12 rate in F3-4 fibrosis stage patients was 90.8% versus 100% in patients with F0-2 fibrosis (p=0.03). In cirrhotic patients, SVR12 was 100% versus 40% depending on whether ribavirin was added or not to daclatasvir/sofosbuvir (p=0.001). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. CONCLUSIONS: Daclatasvir/sofosbuvir ± ribavirin is highly effective in G3-HCV infected patients. Advanced degrees of fibrosis significantly decrease the effectiveness of this treatment, which motivates the need for the addition of ribavirin in cirrhotic patients. The regimen was safe and well tolerated.

Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas / Sedation and analgesia practices among Spanish neonatal intensive care units

INTRODUCCIÓN: El manejo del dolor y la sedación es una prioridad de los cuidados intensivos neonatales. Se diseñó un estudio con el objetivo de determinar la práctica clínica actual en relación con la sedación y la analgesia en unidades de cuidados intensivos neonatales en España e identificar factores asociados al uso de fármacos sedantes o analgésicos. MÉTODO: Estudio multicéntrico, observacional, longitudinal y prospectivo. RESULTADOS: Participaron 30 unidades neonatales y se reclutó a 468 neonatos. De estos, 198 (42,3%) recibieron medicación sedante o analgésica. En total, se usaron durante el período de estudio 19 fármacos distintos, de los cuales el más utilizado fue el fentanilo. Solo fentanilo, midazolam, morfina y paracetamol se usaron al menos en un 20% de los neonatos que recibieron sedación y/o analgesia. Se usaron 14 pautas distintas de fármacos en perfusión, siendo las más frecuentes la infusión de fentanilo y la combinación de fentanilo y midazolam. Las variables asociadas a recibir sedación y/o analgesia fueron el haber precisado ventilación invasiva (p = < 0,001; OR = 23,79), un score de CRIB>3 (p = 0,023; OR = 2,26), la existencia en la unidad de guías de evaluación del dolor (p < 0,001; OR = 3,82) y de un líder de dolor (p = 0,034; OR = 2,35). CONCLUSIONES: Casi la mitad de los neonatos ingresados en cuidados intensivos recibe medicación sedante y/o analgésica. Existe una importante variabilidad entre las unidades neonatales españolas en relación con las pautas de sedación y analgesia. Nuestros resultados permiten conocer el «estado del arte» y pueden servir de base para la elaboración de guías de práctica clínica a nivel nacional

INTRODUCTION: Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. METHOD: A multicenter, observational, longitudinal and prospective study. RESULTS: Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader(P=.034; OR=2.35). CONCLUSIONS: Almost half of the neonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the 'state of the art', and could serve as the basis of preparing clinical practice guidelines at a national level

[Sedation and analgesia practices among Spanish neonatal intensive care units]. / Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas.

INTRODUCTION: Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. METHOD: A multicenter, observational, longitudinal and prospective study. RESULTS: Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader (P=.034; OR=2.35). CONCLUSIONS: Almost half of the neonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level.

Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis.

BACKGROUND: A wide variety of follow-up strategies are used for patients with colorectal cancer (CRC) after curative surgery. The aim of this study is to review the evidence of the impact of different follow-up strategies in patients with nonmetastatic CRC after curative surgery, in relation to overall survival and other outcomes. PATIENTS AND METHODS: A systematic search of PubMed, EMBASE, SCOPUS and ISI Web of Knowledge up to June 2014 was carried out. Eligible studies were all randomized clinical trials comparing the effectiveness of different follow-up strategies after curative resection in nonmetastatic CRC. RESULTS: Eleven studies with n = 4055 participants were included in a meta-analysis. A significant improvement in overall survival was observed in patients with more intensive follow-up strategies [hazard ratio = 0.75; 95% confidence interval (CI) 0.66-0.86]. A higher probability of detection of asymptomatic recurrences [relative risk (RR) = 2.59; 95% CI 1.66-4.06], curative surgery attempted at recurrences (RR = 1.98; 95% CI 1.51-2.60), survival after recurrences (RR = 2.13; 95% CI 1.24-3.69), and a shorter time in detecting recurrences (mean difference = -5.23 months; 95% CI -9.58 to -0.88) was observed in the intervention group. There were no significant differences in the total tumor recurrences, nor in the mortality related to disease. CONCLUSION: Intensive follow-up strategies improve overall survival, increase the detection of asymptomatic recurrences and curative surgery attempted at recurrence, and are associated with a shorter time in detecting recurrences. This more intensive follow-up could not be associated with an improvement in cancer-specific survival nor with an increased detection of total tumor recurrences. Follow-up with serum carcinoembryonic antigen and colonoscopies are related to an increase in overall survival.

A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia.

BACKGROUND: Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, there is little evidence with which to assess the risk and benefits of this treatment in elderly patients with renal dysfunction. OBJECTIVE: To determine the efficacy and safety of angiotensin inhibitor reduction in patients with heart failure, chronic kidney disease and anaemia. STUDY DESIGN: Open randomized controlled clinical trial. SETTING: Complexo Hospitalario Universitario A Coruña (Spain). PATIENTS: Patients ≥ 50 years old, with heart failure, haemoglobin (Hb) < 12 mg/dl and creatinine clearance <60 ml/min/1.73 m(2) admitted to hospital, in treatment with angiotensin inhibitors. Informed consent and Ethical Review Board approval were obtained. INTERVENTION: A 50% reduction of angiotensin inhibitor dose of the basal treatment on admission (n = 30) in the intervention group. Control group (n = 16) with the standard basal dose. MAIN OUTCOME MEASURE: Primary outcome was difference in Hb (gr/dl), creatinine clearance (ml/min/1.73 m(2) ) and protein C (mg/dl) between admission and 1-3 months after discharge. Secondary outcome was survival at 6-12 months after discharge. RESULTS: Patients in the intervention group experienced an improvement in Hb (10.62-11.47 g/dl), creatinine clearance (32.5 ml/min/1.73 m(2) to 42.9 ml/min/1.73 m(2) ), and a decrease in creatinine levels (1.98-1.68 mg/dl) and protein C (3.23 mg/dl to 1.37 mg/dl). There were no significant differences in these variables in the control group. Survival at 6 and 12 months in the intervention and control group was 86.7% vs. 75% and 69.3% vs. 50%, respectively. CONCLUSION: The reduction of the dose of angiotensin inhibitors in the intervention group resulted in an improvement in anaemia and kidney function, decreased protein C and an increased survival rate. TRIAL REGISTRATION: EudraCT: 2008-008480-10.

Cáncer de próstata: ¿tratar o no tratar? / Prostate cancer: Treat or not treat?

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Impacto de una intervención educativa sobre asma en los profesores / Impact of an asthma educational intervention programme on teachers

Objetivo: Determinar el impacto de una intervención educativa en el nivel de conocimientos de los profesores sobre el asma y su manejo. Material y método: Estudio cuasiexperimental, de tipo antes y después, con grupo control, de una intervención educativa (IE) dirigida a mejorar el grado de conocimientos sobre el asma infantil y su manejo en profesores de centros escolares de San Sebastián (Gipuzkoa). Se utilizó como elemento de medida el cuestionario de conocimientos Newcastle Asthma Knowledge Questionnaire (NAKQ) y como intervención educativa, una adaptación del programa Asma, Deporte y Salud. Se utilizó el test de los rangos con signo de Wilcoxon para comparar la puntuación total en el cuestionario antes y después de la intervención, el test de McNemar para comparar el porcentaje de respuestas correctas a cada ítem y el test U de Mann-Whitney para la comparación en la puntuación basal y a los 3 meses entre el grupo de intervención y el grupo control. Se estudiaron el tamaño del efecto y la respuesta media estandarizada. Resultados: Participaron 138 docentes de 6 centros elegidos aleatoriamente (grupo estudio) y 43 en el grupo control. En el grupo estudiado la puntuación media del cuestionario de conocimientos de asma NAKQ antes de la realización de la intervención educativa fue de 16,1±3,4 puntos, con una mediana de 16 (rango 7-23). Tras la intervención educativa, la puntuación ascendió a 22,3±4,1 con una mediana de 23 (rango 6-29), siendo la diferencia media en la puntuación global de conocimientos de 7,0±4,2 puntos, con una mediana de 8 (rango -2; 17), tamaño del efecto de 2,0(>0,8) siendo la respuesta media estandarizada de 1,7. A los 3 meses de la intervención, la puntuación media del cuestionario fue de 21,4±3,0 puntos, con una mediana de 22 (rango 12-29), significativamente superior al momento previo a la intervención (p<0,001) y algo menor que el inmediatamente posterior a la misma, suponiendo un tamaño del efecto de 1,6 y una respuesta media estandarizada de 1,2. En el grupo control no se modificó el nivel de conocimientos, permaneciendo más bajo que el grupo intervenido (p<0,001). Conclusiones: Una intervención educativa dirigida a los profesores aumenta significativamente el nivel de conocimientos sobre el asma. Además, el incremento disminuye algo pero se mantiene elevado durante al menos 3 meses. Algunos aspectos del conocimiento, aunque mejoran con la intervención educativa, no son óptimos (AU)

Objective: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. Material and method: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. Results: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<0.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<0.001). Conclusions: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal (AU)

[Impact of an asthma educational intervention programme on teachers]. / Impacto de una intervención educativa sobre asma en los profesores.

OBJECTIVE: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. MATERIAL AND METHOD: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. RESULTS: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001). CONCLUSIONS: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.

Sexual dimorphism on growth hormone secretion after oral glucose administration.

Sexual dimorphism of GH secretion is unclear in humans. There is evidence that oral glucose (OG) administration initially decreases and subsequently stimulates GH secretion. Our aim was to study fasting GH concentrations and their response to OG administration in obese and healthy women and men, in order to elucidate the mechanism of sexual dimorphism of GH secretion and the possible contribution of ghrelin. We selected 33 women and 11 men as obese and healthy subjects. After an overnight fast, 75 g of oral glucose were administered; glucose, insulin, ghrelin, and PYY1-36 were obtained at baseline and during 300 min. Fasting GH (µg/l) was higher in women than men; 1.3 ± 0.3 vs. 0.2 ± 0.1, p=0.009, for women and men, respectively. The area under the curve between 0 and 150 min (AUC) of GH (µg/l · min) was higher in women than men; 98.2 ± 25.9 vs. 41.5 ± 28.6, p=0.002, for women and men, respectively. The AUC of total ghrelin (pg/ml · min, mean ± SEM) between 0 and 150 min was borderline and significantly higher in women than men; 128 562.3 ± 8 335.9 vs. 98 839.1 ± 7 668.6, p=0.069, for women and men, respectively. Several initial time points were higher in women than men. Glucose, insulin, and PYY1-36 were similar in women and men after OG. There were significant correlations between indices of post-oral glucose GH and ghrelin secretion. Fasting and initial GH secretion is higher in women than men, in contrast to peak and late GH secretion, which is similar in both cases. Sexual dimorphism in the regulation of GH secretion probably involves ghrelin.

Growth hormone, ghrelin and peptide YY secretion after oral glucose administration in healthy and obese women.

The mechanism of the altered GH secretion in obesity is unclear. There is evidence that oral glucose (OG) administration initially decreases and subsequently stimulates GH secretion. Ghrelin is a peptide that displays strong growth hormone-releasing activity. Its physiological importance on GH regulation is unclear. Our aim was to study fasting GH concentrations and their response to OG administration in relation with ghrelin secretion in obese and healthy women, in order to elucidate the hypothetical participation of ghrelin on post-oral glucose GH secretion. 36 women were included in the study. After an overnight fast, 75 g of oral glucose was administered; glucose, insulin, ghrelin, and PYY (1-36) were obtained at baseline and during 300 min. The area under the curve between 0 and 300 min (AUC) of GH µ/l·min) was lower in obese patients than in controls; 262.5±57.5 vs. 534.9±95.6, p=0.01, for obese and controls respectively. GH peak (µg/l) was lower in obese patients than in controls; 3.7±0.7 vs. 7.1±1.0, p=0.012, for obese and controls, respectively. The AUC of total ghrelin (pg/ml·min) was lower in obese patients than in controls; 233,032±12,641 vs. 333,697±29,877, p=0.004, for the obese patients and controls respectively. PYY (1-36) was similar in obese and healthy women after OG. There were significant correlations between the different indices of post-oral glucose GH and ghrelin secretion. These data suggest that ghrelin is a physiological regulator of GH in the post-oral glucose state, and the decreased ghrelin secretion could be one of the mechanisms responsible for the altered GH secretion in obesity.

Influence of early graft function after renal transplantation and its impact on long-term graft and patient survival.

OBJECTIVE: To determine whether early graft function after transplantation impacted graft and patient survivals. MATERIALS AND METHODS: Between 1981 and 2008, we performed 1308 renal transplantations. Poor early graft function was defined as a Cockroft-Gault glomerular filtration rate<60 mL/min or less at 1 and 3 months posttransplant. Patients who lost their kidney or died within the first 12 months after transplantation were excluded from the study. Multivariate statistical analysis used Cox proportional hazards models. RESULTS: Of the 1308 patients 994 (78.8%) displayed poor early graft function at 1 month after transplantation (glomerular filtration rate<60 mL/min), while 268 (21.2%) showed normal function (glomerular filtration rate≥60 mL/min). The 2- and 6-year graft survival rates among the poor early graft function group were 96.8% and 85.8%, respectively, while those among the control group were 97.0% and 88.3%, respectively. The 2- and 6-year patient survival rates in the poor early graft function were 98.5% and 89.8% versus 98.9% and 96.3% in the control group. Similar results were observed at 3 months posttransplant. Controlling for patient age, donor age, HLA-AB and -DR mismatches, cold ischemia time, acute rejection episodes, cyclosporine therapy, and waiting time for transplantation, we did not observe early graft function to be a risk factor for graft survival or patient survival. Glomerular filtration rate at 2, 5, and 6 years after kidney transplantation was significantly lower in the poor early graft function than in the control group. CONCLUSION: This study suggested that the quality of early graft function had no significant effect on graft and patient survival rate, but did have a significant influence on long-term renal function.

Accidentes de circulación: impacto en un registro de trauma infantil en la Comunidad Autónoma de Galicia / Traffic accidents: impact on a child trauma registry in the Autonomous Community of Galicia

Objetivo: Estudiar el impacto de los accidentes de circulación en un registro autonómico de trauma pediátrico (RTP). Material y método: Recogida de datos prospectiva, sistemática y multicéntrica durante el año 2009, de pacientes pediátricos con ingreso hospitalario en Galicia. Se analizaron 398 pacientes, 66% varones, con edad media de 7 años y peso medio 30 kg. El 34% fueron accidentes de tráfico. Recibieron asistencia prehospitalaria un 53%, y por personal médico un 38,5%. Resultados: Traslados en ambulancia no medicalizada un 30,8%, medicalizada el 13,8%, medio particular el 53,8%, por propio pie el 1,5%. En ambulancia medicalizada un 38,5% no llevaban vía intravenosa, y un 77,6 % no portaban collarín cervical. De los trasladados en coche un 6,4% llegaron con un Índice de Trauma Pediátrico (ITP)<8. En accidentes de automóvil viajaban sin sistema de retención el 62,5% de los casos, y en los de moto el 30% sin casco. Los sistemas más afectados fueron el aparato locomotor (61,5%), y el área craneofacial (58%). El 73% de los accidentes ocurrió en ciudad y la mayoría entre las 17 y las 20 horas. Conclusiones: Mayor riesgo en varones, mayor frecuencia de accidentes en ciudad y en horario de tarde, afectación mayoritaria del aparato locomotor. La incidencia de ingresos aumenta según disminuye el ITP (AU)

Objetive: To assess the impact of traffic accidents in a regional pediatric trauma registry (PTR). Methods: During 2009 we collected data prospectively, systematic, multi-hospital, in a secure Web database from 398 patients, 66% male, mean age 7 years, and mean weight 30 kg. Of this group received 53% prehospital care and by medical personnel only 38,5%. Inclusion criteria: pediatric patient admited at hospital by accident. Results: Transfer in non medicalised ambulance in 30,8%, medicalized in 13,8%, passenger car in a 53,8% or even walking at 1,5%. Those who were taken by ambulances to a 38,5% had no intravenous and 77,6% did not bring a cervical collar. Of the car moved, 6,4% came with ITP <8 (Pediatric Trauma Index). In car accidents, children had no restraint in 62.5%, and the motorcycle, 30% not wearing a helmet. Most affected systems, highlights the locomotor 61,5% and the craniofacial area with 58%. In the study of the site highlights the city, 73%, and the highway, 20% of the total. For slots, the majority of accidents occurred between 17 and 20 hours. Conclusions: The RTP shows a bleak picture in terms of initial support to pediatric trauma is concerned, and specifically in road accidents (AU)