Efficacy and Safety of Elafibranor in Primary Biliary Cholangitis.

BACKGROUND: Primary biliary cholangitis is a rare, chronic cholestatic liver disease characterized by the destruction of interlobular bile ducts, leading to cholestasis and liver fibrosis. Whether elafibranor, an oral, dual peroxisome proliferator-activated receptor (PPAR) α and δ agonist, may have benefit as a treatment for primary biliary cholangitis is unknown. METHODS: In this multinational, phase 3, double-blind, placebo-controlled trial, we randomly assigned (in a 2:1 ratio) patients with primary biliary cholangitis who had had an inadequate response to or unacceptable side effects with ursodeoxycholic acid to receive once-daily elafibranor, at a dose of 80 mg, or placebo. The primary end point was a biochemical response (defined as an alkaline phosphatase level of <1.67 times the upper limit of the normal range, with a reduction of ≥15% from baseline, and normal total bilirubin levels) at week 52. Key secondary end points were normalization of the alkaline phosphatase level at week 52 and a change in pruritus intensity from baseline through week 52 and through week 24, as measured on the Worst Itch Numeric Rating Scale (WI-NRS; scores range from 0 [no itch] to 10 [worst itch imaginable]). RESULTS: A total of 161 patients underwent randomization. A biochemical response (the primary end point) was observed in 51% of the patients (55 of 108) who received elafibranor and in 4% (2 of 53) who received placebo, for a difference of 47 percentage points (95% confidence interval [CI], 32 to 57; P<0.001). The alkaline phosphatase level normalized in 15% of the patients in the elafibranor group and in none of the patients in the placebo group at week 52 (difference, 15 percentage points; 95% CI, 6 to 23; P = 0.002). Among patients who had moderate-to-severe pruritus (44 patients in the elafibranor group and 22 in the placebo group), the least-squares mean change from baseline through week 52 on the WI-NRS did not differ significantly between the groups (-1.93 vs. -1.15; difference, -0.78; 95% CI, -1.99 to 0.42; P = 0.20). Adverse events that occurred more frequently with elafibranor than with placebo included abdominal pain, diarrhea, nausea, and vomiting. CONCLUSIONS: Treatment with elafibranor resulted in significantly greater improvements in relevant biochemical indicators of cholestasis than placebo. (Funded by GENFIT and Ipsen; ELATIVE ClinicalTrials.gov number, NCT04526665.).

Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness.

INTRODUCTION: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. METHODS: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. RESULTS: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. CONCLUSION: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function.

Dimensional Characterization of Groundwater Oblique Flow Problems with Heat Transport.

A dimensional study of two problems in which groundwater flow is oblique has been carried out in order to characterize the vertical profiles of temperature along the domain affected by the flow, determining an input region in which the profiles depend on the horizontal position followed by a region in which profiles only depend on the vertical component of the flow. In the first problem, the horizontal and vertical components of velocity are constant. In the second scenario, the oblique flow of groundwater is generated because in the boundary conditions, the hydraulic potentials present a constant value. From the discriminated dimensional analysis of the mathematical model (governing equations and boundary conditions), the dependencies of the unknowns of greatest interest, characteristic lengths for the development of temperature-depth profiles, velocity profiles and the temperature field, with the dimensionless groups deduced are established. Once these dependencies have been verified, they are graphically represented by means of curves and surfaces as universal solutions to these problems. Based on these universal solutions an inverse problem protocol for estimating water flows from temperature measurements is proposed. The use of universal graphs of the two proposed scenarios avoids the large number of numerical simulations that this type of problem required.

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study / Implementación de un modelo de atención integral para pacientes con EPOC con agudizaciones frecuentes: un estudio prospectivo controlado

Introduction: Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. Methods: Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed. Results: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. (AU)

Introducción: La EPOC con agudizaciones frecuentes (EPOC-AF), que se asocia a ingresos hospitalarios recurrentes, presenta altas tasas de morbilidad y mortalidad, y un importante uso de los recursos sanitarios. Estos pacientes deberían ser tratados en modelos de atención integral (MAI) personalizada. Por este motivo, nuestro objetivo fue evaluar la efectividad a largo plazo de un MAI para EPOC-AF valorando las visitas a urgencias, los ingresos hospitalarios, los días de hospitalización, la mortalidad y la mejora del estado de la salud. Métodos: Estudio prospectivo controlado que analizó una cohorte de pacientes con EPOC-AF incluidos en un MAI y en seguimiento durante un máximo de 7 años en comparación con una cohorte paralela que recibió atención estándar. Todos los pacientes tenían diagnóstico confirmado de EPOC y antecedentes de ≥2 ingresos hospitalarios por agudizaciones durante el año anterior a su inclusión en el estudio. Se analizaron los cambios en la puntuación del CAT© y en la escala de disnea del MRC, en los ingresos hospitalarios, las visitas a urgencias, los días de hospitalización y la mortalidad. Resultados: Se compararon 141 pacientes incluidos en el MAI con 132 pacientes que recibieron atención estándar. El MAI redujo las hospitalizaciones en un 38,2% y las visitas a urgencias en un 69,7%, mostrando reducción de las hospitalizaciones por exacerbación de la EPOC, las visitas a urgencias y los días de hospitalización (p<0,05) en comparación con la atención estándar. Además, el estado de salud mejoró en los pacientes del grupo del MAI después de un año de seguimiento (p=0,001), un efecto que se mantuvo durante 3 años. Sin embargo, la mortalidad no fue diferente entre ambos grupos (p=0,117). Una puntuación en el CAT©>17 en el último control de seguimiento fue el factor independiente de riesgo más fuertemente asociado a la mortalidad y la hospitalización de los pacientes en el MAI. (AU)

Predicting mortality for patients with heart failure beyond oxygen consumption: a prognostic risk score.

Cardiopulmonary exercise test (CPET) is a crucial tool for the functional evaluation of cardiac patients. We hypothesized that maximal oxygen consumption (V̇o2max) and ventilatory efficiency-minute ventilation to carbon dioxide production (V̇e/V̇co2) slope are not the only parameters of CPET able to predict major cardiac events (mortality or cardiac transplantation urgently or elective). We aimed to identify the best CPET predictors of major cardiac events in patients with severe chronic heart failure and to propose an integrated score that could be applied for their prognostic evaluation. We evaluated 140 patients with chronic heart failure who underwent CPET between 2011 and 2019. Major cardiac events were evaluated during follow-up. Univariate and multivariate logistic regression analyses were applied to study the predictive value of different clinical, echocardiographic, and CPET parameters in relation to the major cardiac events. A score was generated, and c-statistic was used for the comparisons. Thirty-nine patients (27.9%) died or underwent cardiac transplantation over a median follow-up of 48 mo. Five parameters (maximal workload, breathing reserve, left ventricular ejection fraction, diastolic dysfunction, and nonidiopathic cardiomyopathy) were used to generate a risk score that had better risk discrimination than the New York Heart Association dyspnea scale, V̇o2max, V̇e/V̇co2 slope > 35 alone, and combined V̇o2max and V̇e/V̇co2 slope (P = 0.009, 0.004, <0.001, and 0.005, respectively) in predicting major cardiac events. A composite score of CPET and clinical/echocardiographic data is more reliable than the single use of V̇o2max or combined with V̇e/V̇co2 slope to predict major cardiac events.NEW & NOTEWORTHY This is a cohort study with a follow-up of maximum of 8 years of patients with chronic heart failure that demonstrates a simple integrated score consisting of CPET (breathing reserve, workload at maximal exercise), echocardiographic (LVEF, diastolic dysfunction), and clinical (etiology of cardiac disease) data. The generated score was a better predictor of major cardiac events (mortality or cardiac transplantation) than Weber classification (V̇o2max classification) or NYHA functional class as single factors.

Sentido y significado de vejez de los residentes de la calle Zanja, 2017-2019 / Sense and meaning of old age of residents in Zanja Street, 2017-2019

Introducción: En Cuba, en el 2016, las personas mayores de 60 años constituían el 19,8 por ciento de la población, y La Habana era una de las provincias más envejecidas. En 2018 aumentó a 20,4 por ciento. En la calle Zanja, residen pobladores de distintos grupos étnicos, con herencias y tradiciones culturales diversas y diferentes visiones del sentido y significado de vejez. Objetivo: Caracterizar el sentido de vejez de los adultos mayores y el significado de vejez de los niños, adolescentes, jóvenes y adultos medios, residentes en la calle Zanja. Métodos: Se realizó un estudio exploratorio, a partir de una metodología mixta: cualitativa y cuantitativa. Se utilizó el método observacional y, en consecuencia, se decidió hacer uso de las técnicas de entrevista en profundidad, la observación no participante, con sus correspondientes guías, la técnica porcentual y la triangulación de datos. Resultados: Los adultos mayores manifestaron satisfacción de las necesidades materiales y espirituales en un alto nivel; aunque el 50 por ciento de los jubilados declaró no recibir atención de las organizaciones a las que pertenecían. Un alto porcentaje de adultos medios opinaron que los adultos mayores son personas importantes y útiles, tienen experiencia y constituyen ayuda. Los niños, adolescentes y jóvenes refirieron que lo que más les gusta de sus abuelos es que los quieren y los ayudan y lo que no les gusta es que pelean y se enferman. Conclusiones: Si los adultos mayores son importantes para las familias, comunidad y sociedad, es preciso mejorar las condiciones materiales de su existencia y del entorno y que se sientan reconocidos por sus aportes(AU)

Introduction: In Cuba, in 2016, people over the age of 60 made up 19.8 percent of the population, and Havana was one of the most aged provinces. In 2018 it increased to 20.4 percent. In Zanja Street, people of different ethnic groups reside, with diverse cultural heritage and traditions and different visions of the sense and meaning of old age. Objective: Characterize the sense of old age of older adults and the old-age meaning of children, adolescents, young people and average adults, residing on Zanja Street. Methods: An exploratory study was carried out, based on a mixed methodology: qualitative and quantitative. he observational method was used and, consequently, it was decided to make use of in-depth interview techniques, non-participating observation, with their corresponding guidelines, percentage technique and data triangulation. Results: Older adults expressed satisfaction with material and spiritual needs at a high level; although 50 percent of retirees reported not receiving care from the organizations to which they belonged. A high percentage of average adults said that older adults are important and useful people, they have experience and are helpful. Children, teenagers and young people said that what they love most about their grandparents is that they love and help them and what they don't like is that they argue and get sick. Conclusions: If older adults are important to the families, communities and the society, the material conditions of their life and environment need to be improved, and so they can feel acknowledge for their contributions(AU)

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study.

INTRODUCTION: Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. METHODS: Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed. RESULTS: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. CONCLUSIONS: An ICM for fe-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study.

INTRODUCTION: Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. METHODS: Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed. RESULTS: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. CONCLUSIONS: An ICM for fe-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.

Sinergia educación, prevención, promoción de salud comunitaria desde el paradigma de la sociocultura / Synergy between education, prevention, promotion of community health from the sociocultural paradigm / Sinergia educação, prevenção, promoção da saúde comunitaria desde o paradigma socio-cultural

Objetivo: Analizar la sinergia de la educación, prevención y promoción de la salud concebida como una construcción sociocultural mediada por las prácticas culturales que desarrollan las personas de una comunidad cubana durante los años 2013-2017. Materiales y Métodos: Estudio de caso único que combina las perspectivas cuantitativa y cualitativa de investigación, con el empleo de la observación participante, cuestionarios, entrevistas en profundidad en el escenario comunitario y la consulta a expertos, además de los procedimientos teóricos analítico-sintético, así como la inducción y deducción. Resultados: Los resultados revelan la existencia de prácticas culturales comunitarias relacionadas con la salud, en las que se produce una simbiosis de la educación, prevención y promoción de salud como elementos esenciales del proceso salud-enfermedad. Conclusiones: El contexto comunitario en que se desarrolla el proceso salud-enfermedad está mediado por prácticas culturales, lo que propicia la concepción de la salud como una construcción sociocultural inherente a la actividad humana, la cual debe garantizarse mediante la educación, prevención y promoción de salud concebidas como todo un sistema integrado.

Objective: To analyze the synergy between education, prevention and promotion of health conceived as a sociocultural construction mediated by the cultural practices developed by people of a Cuban community during the years 2013-2017. Materials and Methods: Single case study that combines the quantitative and qualitative perspectives of research with the use of participant observation, questionnaires, indepth interviews in the community setting and the consultation to experts, besides the analytic-synthetic theoretical procedures, as well as induction and deduction. Results: The results reveal the existence of community cultural practices related to health in which a symbiosis between education, prevention and promotion of health as essential elements of the health-disease process is produced. Conclusions: The community context in which the health-disease process takes place is mediated by cultural practices which favors the conception of health as an sociocultural construction inherent to the human activity, which must be guaranteed through education, prevention and promotion of health conceived as an entire integrated system.

Objetivo: Analisar a sinergia da educação, prevenção e promoção da saúde concebida como uma construção sociocultural mediada pelas práticas culturais que desenvolvem as pessoas duma comunidade cubana durante os anos 2013-2017. Materiais e Métodos: Estudo de caso único que mistura as perspectivas quantitativa e qualitativa de pesquisa, com o emprego da observação participante, questionários, entrevistas em profundidade no cenário comunitário e a consulta a expertos, além dos procedimentos teóricos analítico-sintético, assim como a indução e dedução. Resultados: Os resultados revelam a existência de práticas culturais comunitárias relacionadas com a saúde, nas que se produze uma simbioses da educação, prevenção e promoção de saúde como elementos essenciais do processo saúde- doença. Conclusões: O contexto comunitário no que se desenvolve o processo saúde-doença está mediado por práticas culturais, o que propicia a concepção da saúde como uma construção sociocultural inerente à atividade humana, a qual deve garantir-se mediante a educação, prevenção e promoção de saúde concebidas como um sistema integrado.

Sinergia educación, prevención, promoción de salud comunitaria desde el paradigma de la sociocultura / Synergy between education, prevention, promotion of community health from the sociocultural paradigm / Sinergia educação, prevenção, promoção da saúde comunitaria desde o paradigma socio-cultural

Resumen Objetivo: Analizar la sinergia de la educación, prevención y promoción de la salud concebida como una construcción sociocultural mediada por las prácticas culturales que desarrollan las personas de una comunidad cubana durante los años 2013-2017. Materiales y Métodos: Estudio de caso único que combina las perspectivas cuantitativa y cualitativa de investigación, con el empleo de la observación participante, cuestionarios, entrevistas en profundidad en el escenario comunitario y la consulta a expertos, además de los procedimientos teóricos analítico-sintético, así como la inducción y deducción. Resultados: Los resultados revelan la existencia de prácticas culturales comunitarias relacionadas con la salud, en las que se produce una simbiosis de la educación, prevención y promoción de salud como elementos esenciales del proceso salud-enfermedad. Conclusiones: El contexto comunitario en que se desarrolla el proceso salud-enfermedad está mediado por prácticas culturales, lo que propicia la concepción de la salud como una construcción sociocultural inherente a la actividad humana, la cual debe garantizarse mediante la educación, prevención y promoción de salud concebidas como todo un sistema integrado.

Abstract Objective: To analyze the synergy between education, prevention and promotion of health conceived as a sociocultural construction mediated by the cultural practices developed by people of a Cuban community during the years 2013-2017. Materials and Methods: Single case study that combines the quantitative and qualitative perspectives of research with the use of participant observation, questionnaires, in- depth interviews in the community setting and the consultation to experts, besides the analytic-synthetic theoretical procedures, as well as induction and deduction. Results: The results reveal the existence of community cultural practices related to health in which a symbiosis between education, prevention and promotion of health as essential elements of the health-disease process is produced. Conclusions: The community context in which the health-disease process takes place is mediated by cultural practices which favors the conception of health as an sociocultural construction inherent to the human activity, which must be guaranteed through education, prevention and promotion of health conceived as an entire integrated system.

Resumo Objetivo: Analisar a sinergia da educação, prevenção e promoção da saúde concebida como uma construção sociocultural mediada pelas práticas culturais que desenvolvem as pessoas duma comunidade cubana durante os anos 2013-2017. Materiais e Métodos: Estudo de caso único que mistura as perspectivas quantitativa e qualitativa de pesquisa, com o emprego da observação participante, questionários, entrevistas em profundidade no cenário comunitário e a consulta a expertos, além dos procedimentos teóricos analítico-sintético, assim como a indução e dedução. Resultados: Os resultados revelam a existência de práticas culturais comunitárias relacionadas com a saúde, nas que se produze uma simbioses da educação, prevenção e promoção de saúde como elementos essenciais do processo saúde- doença. Conclusões: O contexto comunitário no que se desenvolve o processo saúde-doença está mediado por práticas culturais, o que propicia a concepção da saúde como uma construção sociocultural inerente à atividade humana, a qual deve garantir-se mediante a educação, prevenção e promoção de saúde concebidas como um sistema integrado.

A CROSS-SECTIONAL STUDY OF THE ASSOCIATION BETWEEN THE 1-HOUR ORAL GLUCOSE TOLERANCE TEST AND THE METABOLIC SYNDROME IN A HIGH-RISK SAMPLE WITH IMPAIRED FASTING GLUCOSE.

Objective: The aim of this study was to evaluate the association between the 1-hour oral glucose tolerance test (OGTT) (≥155 mg/dL) and metabolic syndrome (MS) in a sample with previous impaired fasting glucose (IFG). Methods: Three hundred and twenty four Peruvian subjects with a history of IFG ≥100 mg/dL were selected for a cross-sectional study. They underwent a 75 g OGTT and were assigned to different groups according to the result. We evaluated the association between 1-hour OGTT and MS. Results: The mean age was 56.5 ± 12.6 years and 191 (61.5%) were female. During the OGTT, we found 28 (8.6%) subjects with diabetes, 74 (22.8%) with IGT, and 222 (68.5%) with a normal glucose tolerance test with a 2-hour glucose <140 mg/dL (NGT). In the NGT group, 124 (38.3%) had 1-hour glucose levels <155 mg/dL, while 98 (30.2%) had 1-hour glucose levels ≥155 mg/dL. Evaluating the association between the 1-hour value in the OGTT and MS, we found that subjects with a 1-hour glucose ≥155 mg/dL were more than twice as likely to have MS as those with a 1-hour glucose <155 mg/dL (odds ratio = 2.64, 95% confidence interval: 1.52 to 4.57). In addition, body mass index, fasting glycemia, triglycerides, and waist circumferences were significantly higher in subjects with 1-hour glucose levels ≥155 mg/dL compared to those with 1-hour glucose levels <155 mg/dL (P<.05). Conclusion: Among subjects with IFG, performing an OGTT was helpful to identify subjects with 1-hour glucose levels ≥155 mg/dL and NGT who were significantly more likely to have MS and a worse cardiometabolic risk profile. Abbreviations: AST = aspartate aminotransferase; BMI = body mass index; CI = confidence interval; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; LDL = low-density lipoprotein; MS = metabolic syndrome; NGT = normal glucose tolerance; OGTT = oral glucose tolerance test; OR = odds ratio; T2DM = type 2 diabetes; TG = triglycerides.

Increased rate of FEV1 decline in HIV patients despite effective treatment with HAART.

INTRODUCTION: Previous studies have reported that the rate of FEV1 decline over time is increased in HIV patients but the mechanisms underlying this observation are unclear. Since current HIV treatment with Highly Active Antiretroviral Therapy (HAART) results in very good immune-viral control, we hypothesized that HAART should normalize the elevated rate of FEV1 decline previously reported in HIV patients if it was somehow related to the immune alterations caused by HIV, particularly in never smokers or quitters, since smoking is a well established risk factor for accelerated FEV1 decline in the general population. METHODS: We explored this hypothesis in a prospectively recruited cohort of 188 HIV (smoker and non-smoker) patients treated with HAART in Palma de Mallorca (Spain) and followed-up for 6 years. The cross-sectional characteristics of this cohort have been published elsewhere. RESULTS: We found that: (1) HAART resulted in good immune-viral control; (2) the rate of FEV1 decline remained abnormally elevated, even in non-smokers and quitters; and, (3) alcohol abuse during follow-up was related to FEV1 decline in these patients. DISCUSSION: Despite adequate immune-viral control by HAART, lung function decline remains increased in most HIV patients, even in non-smokers and quitters. Alcohol abuse is a preventable risk factor to decrease the accelerated FEV1 decline in this population.

La tríada salud-trabajo-ambiente y su impacto en los trabajadores / The health-work-environment triad and its impact on workers

La dinámica del mundo de hoy requiere de nuevos conocimientos para hacer análisis de los problemas en el área de salud, trabajo y ambiente mediante nuevas dimensiones. El objetivo del presente artículo original de revisión crítica y conceptual, es describir y producir conocimientos acerca de cómo interactuan salud- trabajo-ambiente como construcción que se desarrolla desde la perspectiva de la sociocultural y cómo impacta esta en los trabajadores. Para ello, se siguió una metodología consistente en la revisión bibliográfica y la aplicación de entrevistas y cuestionarios. Los resultados y conclusiones revelan reflexiones, conceptualizaciones y teorizaciones, que evidencian que la tríada en cuestión existe en interacción como resultado no solo de factores económicos, sino también socioculturales, por lo que requiere que el debate se asuma, además, desde la dimensión cultural, para tener un conocimiento y comprensión más integral acerca de su impacto en los trabajadores(AU)

The dynamics of today's world requires new knowledge that allows the analysis of problems in health, work and environment by means of new dimensions. The objective of this critical and conceptual review is to describe and generate knowledge on the interaction between health, work and environment, as a construct developed from a sociocultural perspective and how it impacts workers. We combined a literature review with interviews and surveys. The results and conclusions reveal reflections, conceptualizations and theories that evidence the existence of this triad as a result of interactions not limited only to economic factors, but also sociocultural. For this reason, the debate should incorporate a cultural dimension, in order to achieve better knowledge and a more holistic understanding of its impact on workers(AU)

Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: beyond oxygen consumption.

OBJECTIVES: Patients with poor lung function usually undergo cardiopulmonary exercise testing (CPET) and those with a predicted postoperative maximal oxygen consumption (VO2 max) of >10 ml/kg/min undergo lung resection surgery and still some complications are observed. We aimed to determine other parameters beyond VO2 able to predict postoperative complications in patients undergoing lung resection surgery. METHODS: This is an observational study with longitudinal follow-up. Patients with forced expiratory volume in 1 second (FEV1) or diffusing capacity for carbon monoxide of <40% underwent CPET and those with VO2 max of >10 ml/kg/min were considered fit for surgery. Patients were followed up prospectively for 12 months and postoperative complications and survival were recorded. Physiological parameters obtained during CPET and pulmonary function tests were analysed. RESULTS: Eighty-three chronic obstructive pulmonary disease (COPD) patients were evaluated for surgery between 2010 and 2015. Twenty-four patients were considered unfit for surgery and received an alternative therapy. Fifty-five patients had a VO2 max of >10 ml/kg/min and underwent lung surgery. Among them, 4% died and 41% developed complications postoperatively. Baseline minute ventilation to carbon dioxide output (VE/VCO2) slope was significantly higher among those who developed postoperative complications or died (P = 0.047). Furthermore, VE/VCO2 slope of >35 (at maximal exercise) was the single parameter most strongly associated with the probability of mortality and postoperative complications (hazard ratio 5.14) with a survival probability of 40% after 1 year of follow-up. In a multivariable model, VO2, VE/VCO2 slope of >35 and work load were independently associated with the probability of having an event. CONCLUSIONS: VO2 is not the unique parameter to consider when CPET is performed to evaluate the postoperative risk of lung cancer surgery in COPD patients. The signs of ventilatory inefficiency such as VE/VCO2 slope predict complications better than VO2 does.

Patologías congénitas de la comunicación según el DSM-V: actualizaciones en neuropsicología infantil / Congenital diseases of communication according to the DSM-V: updates child neuropsychology

En el presente artículo, se describen las actualizaciones relacionadas con las patologías de la comunicación, estrictamente de carácter congénito, según las últimas revisiones publicadas por la American Psychiatric Association en su quinta edición, las cuales consideran las principales contribuciones de las neurociencias, a partir de las investigaciones realizadas en torno a la temática de los trastornos del neurodesarrollo que, durante las dos últimas décadas, han suscitado un amplio escenario de posibilidades para una mayor comprensión de las distintas alteraciones en esta esfera del desarrollo psicológico, redefiniendo y esclareciendo con mayor precisión aquellas características relevantes de los diversos cuadros clínicos afines. Asimismo, estos estudios han contribuido con reveladores hallazgos, tanto a nivel sintomatológico como sindrómico, para un mejor entendimiento de estas patologías del desarrollo temprano, siendo estos aportes de gran relevancia dentro del campo de la neuropsicología infantil, cuya integración de estrategias tanto clínicas como educativas ha favorecido su pertinente participación en el tratamiento en estas dificultades, fortaleciendo así tanto el ejercicio del diagnóstico diferencial como de aquellos procedimientos de rehabilitación, cuya rigurosidad se fundamenta en el uso de métodos controlados y modernos enfoques afines a esta disciplina mencionada.

In this article, updates related to communication disorders, strictly congenital character, are described, according to the latest reviews published by the American Psychiatric Association in its fifth edition, which considered the main contributions of neuroscience, based on the research conducted around the theme of neurodevelopmental disorders, which during the past two decades, have attracted widespread scenario of possibilities for greater understanding of the various changes in the area of psychological development, redefining and clarifying more precisely those relevant characteristics of the various related clinical conditions. Furthermore, these studies have contributed to revealing findings, both syndromic and symptomatic level, for a better understanding of these early development disorders, being highly relevant contributions in the field of child neuropsychology, which integration of clinical and educational strategies has favored its relevant participation in treatment on these difficulties, thereby strengthening the exercise of differential diagnosis and rehabilitation of those procedures, which rigor is based on the controlled use of modern methods and approaches related to this discipline.

Identification of airway bacterial colonization by an electronic nose in Chronic Obstructive Pulmonary Disease.

BACKGROUND: Airway bacterial colonization by potentially pathogenic microorganisms occurs in a proportion of patients with Chronic Obstructive Pulmonary Disease (COPD). It increases airway inflammation and influences outcomes negatively. Yet, its diagnosis in clinical practice is not straightforward. The electronic nose is a new non-invasive technology capable of distinguishing volatile organic compound (VOC) breath-prints in exhaled breath. We aim to explore if an electronic nose can reliably discriminate COPD patients with and without airway bacterial colonization. METHODS: We studied 37 clinically stable COPD patients (67.8 ± 5.2 yrs, FEV1 41 ± 10% ref.) and 13 healthy controls (62.8 ± 5.2 yrs, FEV1 99 ± 10% ref.). The presence of potentially pathogenic microorganisms in the airways of COPD patients (n = 10, 27%) was determined using quantitative bacterial cultures of protected specimen brush. VOCs breath-prints were analyzed by discriminant analysis on principal component reduction, resulting in cross-validated accuracy values. Area Under Receiver Operating Characteristics (AUROC) was calculated using multiple logistic regression. RESULTS: Demographic, functional and clinical characteristics were similar in colonized and non-colonized COPD patients but their VOC breath-prints were different (accuracy 89%, AUROC 0.92, p > 0.0001). Likewise, VOCs breath-prints from colonized (accuracy 88%, AUROC 0.98, p < 0.0001) and non-colonized COPD patients (accuracy 83%, AUROC 0.93, p < 0.0001) were also different from controls. CONCLUSIONS: An electronic nose can identify the presence of airway bacterial colonization in clinically stable patients with COPD.