Randomized comparison of three transducer orientation approaches for ultrasound guided internal jugular venous cannulation.

BACKGROUND: Ultrasound-guided internal jugular venous access increases the rate of successful cannulation and reduces the incidence of complications, compared with the landmark technique. Three transducer orientation approaches have been proposed for this procedure: short-axis (SAX), long-axis (LAX) and oblique-axis (OAX). Our goal was to assess and compare the performance of these approaches. METHODS: A prospective randomized clinical trial was conducted in one teaching hospital. Patients aged 18 yr or above, who were undergoing ultrasound-guided internal jugular cannulation, were randomly assigned to one of three intervention groups: SAX, LAX and OAX group. The main outcome measure was successful cannulation on first needle pass. Incidence of mechanical complications was also registered. Restricted randomization was computer-generated. RESULTS: In total, 220 patients were analysed (SAX n=73, LAX n=75, OAX n=72). Cannulation was successful on first needle pass in 51 (69.9%) SAX patients, 39 (52%) LAX patients and 53 (73.6%) OAX patients. First needle pass failure was higher in the LAX group than in the OAX group (adjusted OR 3.7, 95% CI 1.71-8.0, P=0.002). A higher mechanical complication rate was observed in the SAX group (15.1%) than in the OAX (6.9%) and LAX (4%) groups (P=0.047). CONCLUSIONS: As OAX showed a higher first needle pass success rate than LAX and a lower mechanical complications rate than SAX, we recommend it as the standard approach when performing ultrasound-guided internal jugular venous access. Further clinical studies are needed to confirm this conclusion. CLINICAL TRIAL REGISTRATION: NCT 01966354.

Sex and age differences in the achievement of control targets in patients with type 2 diabetes: results from a population-based study in a South European region.

BACKGROUND: We aimed to determine the degree to which control targets of glycaemia and cardiovascular risk factors were achieved among patients with type 2 diabetes and to investigate sex- and age-related differences in this population. METHODS: This cross-sectional, population-based study was conducted in Spain. Glycated hemoglobin (HbA1c), blood pressure, LDL-c, HDL-c, triglycerides, BMI, and smoking history were obtained from electronic clinical primary care records (n = 32,638 cases). The proportions of patients who met control targets were determined according to sex and age groups. Comparisons between groups were conducted with t-tests for continuous variables, tests for trends in proportions for categorical and ordinal variables, and Pearson's chi-square tests and binary logistic regression models for categorical variables. RESULTS: The overall proportions of patients with type 2 diabetes who met the target objectives for HbA1c (<7 %, 53 mmol/mol), blood pressure (130/80 mmHg), and LDL-cholesterol (100 mg/dl) were 60, 40 and 41 %, respectively. Women were less likely than men to meet the control targets of HbA1c (59 vs 61 %), LDL (35 vs 45 %), and HDL (58 vs 78 %). Patients under 65 years of age presented poorer control than older age groups. Only a minority of patients with type 2 diabetes met the composite target objectives for glycemic control, blood pressure, and LDL. CONCLUSIONS: There are differential gaps in the control results of female patients and younger patients, which should prompt improvements in case management and care. There is room for further improvement in the cardiometabolic control of patients with type 2 diabetes.

Erratum:Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery.

In this article published in Volume 21, issue 5, the authors' names were incorrectly stated in the Pubmed abstract as: "Ignacio Arraras J(1), Juan Illarramendi J, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Angel Dominguez M, Vera R.". The correct authors' names are: "Arraras JI(1), Illarramendi JJ, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Dominguez MA, Vera R.". This error appeared only in the PubMed database and not in the print form of the Journal.

Cutoff point for exhaled nitric oxide corresponding to 3% sputum eosinophils.

BACKGROUND: The eosinophilic asthma phenotype (sputum eosinophils 3%) indicates a good response to corticosteroids and T(H)2 immunomodulators. Exhaled nitric oxide (FeNO) is rapidly measured by portable devices, and although it is not a selective marker of eosinophilic inflammation, several studies have demonstrated a strong correlation with it. We investigated which FeNO value was the best fit with 3% sputum eosinophils in asthma patients. METHODS: We included 129 consecutive, nonsmoking asthmatics who underwent skin tests, FeNO quantification (NIOX MINO), spirometry, and induced sputum analysis and completed the Asthma Control Test questionnaire. Receiver operating characteristic curves were constructed, and logistic regression analysis was performed. RESULTS: Symptoms were detected more frequently in the eosinophilic asthma group, as were higher airway obstruction and sensitivity to hypertonic saline. The FeNO cutoff point of 21 ppb was the best fit with 3% sputum eosinophilia. This value behaved better among corticosteroid-naïve patients (sensitivity, 97%; specificity, 58%; positive predictive value, 86%; negative predictive value, 88%) than among those receiving corticosteroids (sensitivity, 81%; specificity, 25%; positive predictive value, 74%; negative predictive value, 33%). CONCLUSION: FeNO ≥ 21 ppb is associated with airway eosinophilia. In corticosteroid-naïve patients, FeNO < 21 ppb enables us to rule out airway eosinophilia.

Spirometric and exhaled nitric oxide reference values in preschool children from the community of Navarra.

BACKGROUND AND OBJECTIVE: Preschool children can perform quality, reproducible spirometric maneuvers, provided appropriate equipment is used and specially trained nursing staff training are available. However, use of spirometry for the diagnosis and follow-up of preschool children with respiratory diseases remains limited in clinical practice, because consensus on test quality and acceptability criteria and reference data are lacking. We initiated the present study with the aim of developing reference equations, since tables of normal values for this age group are not available in our area. PATIENTS AND METHODS: The study population comprised healthy preschool children in our community. Normal values for exhaled nitric oxide in this age range were assessed. Regression equations were constructed using univariate and multivariate models. RESULTS: A total of 114 healthy preschool children aged 3 to 6 years were enrolled. According to the criteria of the American Thoracic Society/European Respiratory Society, 60 children were able to perform acceptable and reproducible spirometric maneuvers. The best correlations were observed for the untransformed linear regression model that included height. The correlation coefficients for forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV0.5 were 0.89, 0.88, and 0.86, respectively. The regression equations for the calculation of reference values were as follows: FVC = -2.6 + 0.036 x height, cm FEV1 = -2.04 + 0.029 x height, cm FEV0.5 = -1.53 + 0.022 x height, cm. We obtained fraction of inhaled nitric oxygen (FeNO) values for 56 children. The mean (SD) value was 11 (4.9) ppb. CONCLUSIONS: Most preschool children in our area were able to perform quality spirometry maneuvers. We obtained regression equations that allowed us to calculate the reference ranges in our population and the distribution of normal FeNO values.

Mortality in small geographical areas and proximity to air polluting industries in the Basque Country (Spain).

OBJECTIVES: To study the association between proximity to air polluting industrial facilities and mortality in the Basque Country (Spain) in the 1996-2003 period. METHODS: A cross-sectional ecological study with 1465 census sections (CS) as units of analysis with a mean population of 1257 inhabitants. Association of CS mortality with proximity of industries of the European Pollutant Emission Register was studied by type of industrial activity and adjusted for social deprivation. Two distance thresholds (1 km and 2 km) were used as proxies for exposure in a 'near versus far' analysis. Causes of mortality studied were: all causes; tracheal, bronchial, and lung cancer; haematological tumours; ischaemic heart disease; cerebrovascular diseases; chronic diseases of the lower respiratory tract; and breast cancer (in women). Poisson's generalised linear mixed models (GLMM) with two random effects (heterogeneity and structured spatial variability) were used in a fully Bayesian environment. RESULTS: Men living in sections within 1 km from energy production industries had greater mortality from tracheal, bronchial, and lung cancer [CI(90%) 6% to 53%] as compared with people living further. Women had greater mortality from ischaemic heart disease [CI(90%) 1% to 17%] and respiratory illness [CI(90%) 1% to 24%] within 2 km from metal-processing industries. On the contrary, within the 1 km buffer from mineral industries, mortality was lower for all causes [CI(90%) -20% to -6%] and for ischaemic heart disease [CI(90%) -40% to -10%] in women, and from respiratory diseases in men [CI(90%) -39% to -4%], while it was greater for breast cancer in women [CI(90%) 2% to 28%] within the 2 km buffer. CONCLUSIONS: Analysis of mortality by census sections is a helpful exploratory tool for investigating environmental risk factors and directing actions to sites and risk factors with a greater impact on health. Further epidemiological and environmental investigations around metal-processing and energy-producing plants are required.

[A comparative study of three systems for quantifying the spike and wave index in patients with continuous spikes and waves during slow sleep]. / Estudio comparativo entre tres sistemas de cuantificacion del indice de punta-onda en pacientes con punta-onda continua del sueño lento.

INTRODUCTION: Continuous spikes and waves during slow sleep (CSWS) is an epileptic encephalopathy of childhood with a pattern of epileptiform discharges during sleep, which, if prolonged over time, produce severe neuropsychological impairment. Quantification of the paroxysms by means of a spike and wave index (SWI) > 85% establishes a presumptive diagnosis and allows early therapy to be started to prevent such impairment. AIMS: To compare the results of the classic method for calculating the SWI against two proposals that optimise the relation between the analysis time employed and the diagnostic sensitivity. PATIENTS AND METHODS: The nocturnal electroencephalographic registers of 17 patients with CSWS were studied. Two observers calculated the SWI with the classic method, as well as with two other methods, M2 and M3, first in the active phase and then in the remission phase. The time required by each method, the individual SWI values and the agreement between methods and observers were compared. RESULTS: With M3 two of the patients failed to reach the cut-off point of SWI > 85%. Agreement in the active phase of CSWS after M2 and M3 was 0.762 and 0.704, respectively, while in the remission phase it was 0.951 and 0.830. Inter-observer agreement exceeded 0.905 in all cases. CONCLUSIONS: The two abbreviated methods can be used in both the active and the remission phases, with a substantial reduction in the analysis time that is needed. Our results support the current tendency to consider SWI > 60% as suggestive of CSWS. Method M2 yields results that are closer to those of the classic method than those of M3.

TITLE: Estudio comparativo entre tres sistemas de cuantificacion del indice de punta-onda en pacientes con punta-onda continua del sueño lento.Introduccion. La punta-onda continua del sueño lento (POCS) es una encefalopatia epileptiforme infantil con un patron de descargas epileptiformes durante el sueño que, prolongadas en el tiempo, producen un grave deterioro neuropsicologico. La cuantificacion de los paroxismos mediante el indice de punta-onda (SWI) > 85% establece un diagnostico de sospecha y permite iniciar una terapia precoz que puede evitar dicho deterioro. Objetivos. Comparar los resultados del metodo clasico de calculo del SWI con dos propuestas que optimicen la relacion entre el tiempo de analisis empleado y la sensibilidad diagnostica. Pacientes y metodos. Se estudiaron los registros electroencefalograficos nocturnos de 17 pacientes con POCS. Dos observadores calcularon el SWI con el metodo clasico, asi como con otros dos metodos, M2 y M3, primero en la fase activa y posteriormente en la fase de remision de la POCS. Se comparo el tiempo consumido por cada metodo, los valores individuales de SWI y la concordancia entre metodos y observadores. Resultados. Con el M3 dos pacientes no alcanzaron el corte del SWI > 85%. La concordancia en la fase activa de la POCS tras el M2 y el M3 fue de 0,762 y 0,704, respectivamente, mientras que en la fase de remision fue de 0,951 y 0,830. La concordancia entre observadores supero el 0,905 en todos los casos. Conclusiones. Los dos metodos abreviados se pueden utilizar tanto en la fase activa de la POCS como en la fase de remision, con una sustancial reduccion del tiempo de analisis empleado. Nuestros resultados apoyan la tendencia actual de considerar el SWI > 60% como sugestivo de POCS. El metodo M2 arroja resultados mas cercanos a los del metodo clasico que los de M3.

Missing patients in "Major Trauma Registry" of Navarre: incidence and pattern.

BACKGROUND: Trauma registries (TR) collect information about trauma patients according to inclusion criteria, and it helps to establish protocols to improve care. However, all TR deal with incompleteness. The aim of this study is to assess the number of patients not included despite fulfilling inclusion criteria in our regional TR and identifying the predictors for being missing. METHODS: The sample was randomly selected. Two months of each year from 2010 to 2014 (5 years) were selected, and medical files of all patients attended in the emergency department room during those months were studied. Patients who were already correctly included in the TR were assigned to the 'included' group, and patients who should have been but were not to the 'missing' group. The multivariable logistic regression analysis was performed to identify predictors for being missed from the TR. RESULTS: Of a total of 200, 79 (40 % approximately) were identified as missing. We defined the characteristic profiles of missing patients and found that the hospital RTS and the number of injuries are independent predictors to be missing in our trauma registry, with an adjusted odds ratio of 1844 [95 % (1092-3114) and 0.574 (95 % CI 0.428-0.770)], respectively. CONCLUSIONS: Overall, 40 % of the patients who met the inclusion criteria of the TR were not included in the registry. Our results can be generalized to other trauma records based on Utstein style, because we think probably that this fact is also happening in other databases.

Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study.

BACKGROUND: The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR) + TME. METHODS: We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2 years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0-20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V 20, V 30, V 40, V 50, mean dose (D mean), minimum dose (D min), D 90 (dose received by 90% of the sphincter) and D 98. STATISTICAL ANALYSIS: The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann-Whitney test. RESULTS: Mean Wexner score was 5.5 points higher in those patients with V 20 > 0 compared to those for which V 20 = 0 (p = 0.008). In a multivariate regression model, results suggest that the effect of V 20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42. CONCLUSIONS: In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy.

Insomnia in patients admitted to psychiatric hospital departments / Insomnio en pacientes que ingresan en unidades de hospitalización psiquiátricas.

Background. The aim of this study is to estimate the prevalence of insomnia in patients requiring admittance to short-stay hospital psychiatric units. Methodology. A descriptive observational study was designed with the participation of 16 units for brief adult psychiatric hospitalization in Spain. The Athens Insomnia Scale was the instrument used. Results. Four hundred and twenty-five patients were included, with an average value on the global score of the Athens Insomnia Scale of 8.56 (SD: 5.78). The item that obtained the highest average score concerned the presence of waking up during the night, followed by that concerning the time needed to fall asleep. The estimated prevalence of insomnia is 53% (CI 95%). Conclusions. Insomnia is a problem with a high prevalence in psychiatric hospitalization units. The greatest difficulties are found in inducing sleep and staying asleep.

The concentration-response relation between air pollution and daily deaths.

Studies on three continents have reported associations between various measures of airborne particles and daily deaths. Sulfur dioxide has also been associated with daily deaths, particularly in Europe. Questions remain about the shape of those associations, particularly whether there are thresholds at low levels. We examined the association of daily concentrations of black smoke and SO(2) with daily deaths in eight Spanish cities (Barcelona, Bilbao, Castellón, Gijón, Oviedo, Valencia, Vitoria, and Zaragoza) with different climates and different environmental and social characteristics. We used nonparametric smoothing to estimate the shape of the concentration-response curve in each city and combined those results using a metasmoothing technique developed by Schwartz and Zanobetti. We extended their method to incorporate random variance components. Black smoke had a nearly linear association with daily deaths, with no evidence of a threshold. A 10 microg/m(3) increase in black smoke was associated with a 0.88% increase in daily deaths (95% confidence interval, 0.56%-1.20%). SO(2) had a less plausible association: Daily deaths increased at very low concentrations, but leveled off and then decreased at higher concentrations. These findings held in both one- and two-pollutant models and held whether we optimized our weather and seasonal model in each city or used the same smoothing parameters in each city. We conclude that the association with particle levels is more convincing than for SO(2), and without a threshold. Linear models provide an adequate estimation of the effect of particulate air pollution on mortality at low to moderate concentrations.

Blood lead levels in 2- to 3-year-old children in the Greater Bilbao Area (Basque Country, Spain): relation to dust and water lead levels.

The objectives of this study were to determine blood lead levels in 2-y-old children in the Greater Bilbao Area (Basque Country, Spain) and to compare those levels with the lead content of different media (i.e., house dust, park dust and soil, and water) in the child's environment. Between May and September of 1992, 138 children, aged 2 to 3 y, were studied. All children were attended by pediatricians within the public health-care network, and their parents volunteered for the study. A venous blood sample was drawn from each child and was analyzed for lead level, and the parents answered a questionnaire that addressed the socioeconomic background and habits of the children. The environment was investigated in 42 cases. Blood lead levels exceeded 15 micrograms/dl in 2% of the children, and 14% of the children had levels that exceeded 10 micrograms/dl (geometric mean = 5.7 micrograms/dl [4.7-6.7 micrograms/dl]. Blood lead levels were higher among (a) children whose mothers worked outside the home, (b) children whose fathers had only a primary-level education, and (c) children who lived in houses constructed prior to 1950. The geometrical averages of lead in house dust, park soil, and park dust were 595, 299, and 136 micrograms/g, respectively. Statistically significant linear correlation was found between blood lead level and lead content in park dust, a finding that explained a 9% variation in blood lead level; a subgroup of these children was also found to have a strong linear association between blood lead and lead content in house dust.

Lead and cadmium exposure from contaminated soil among residents of a farm area near an industrial site.

In this study, the authors determined the degree of lead and cadmium exposure in a population that resided in an area with contaminated soil. The extent of exposure from soil pollution was also assessed. Lead and cadmium concentrations in blood of children and adults who resided in the contaminated area were measured, and cadmium concentration in urine of adults was also determined. An adult control group was recruited from a nonpolluted area. The mean blood lead level in adults who resided in the polluted area was 9.8 microg/dl, compared with a mean level of 6.8 microg/dl in controls (p = .004). Urinary cadmium levels were well below the level associated with onset of symptoms, but the differences between levels in residents of the contaminated area (0.54 microg/gm creatinine) and levels in the controls (0.37 microg/gm creatinine) indicated that life-long cadmium exposure had been higher among the residents of the contaminated area (p = .086). The mean blood lead level and mean blood cadmium level in children were 5.2 microg/dl (maximum = 7.90 microg/dl) and 0.10 microg/l, respectively. Lead in soil accounted in large part for the differences in blood lead levels in children; however, blood cadmium levels were not associated with soil cadmium levels, but, rather, with consumption of home-grown vegetables.

[Establishing maximum permissible values in soil for health protection with the Lur model]. / Establecimiento de valores máximos admisibles en suelo para la protección de la salud con el modelo Lur.

OBJECTIVE: Environmental pollution can be the origin of health problems and it is seen by populations as a hazard. Therefore, when environmental maximum levels of contaminants are set it is necessary to guarantee public health protection and to promote a healthy environment. In the Basque Autonomous Community (Spain) the establishment of maximum levels of contaminants in soil has followed the model named LUR, based on the risk assessment methodology. These values are levels of pollutant that are supposed not to represent an unacceptable risk for human beings. METHODS: Maximum levels of contaminants in soil arise from establishing a maximum tolerable risk and assessing toxicity information and human exposure in relation to land uses. The model has considered 5 land uses for exposure: children playground, residential with garden, residential, public park and industrial/commercial. The routes of exposure taken into account have been soil ingestion, consumption of home-grown vegetables, soil particle and vapour inhalation and dermal absorption. When inhalation and dermal absorption contribute largely to contaminant intake, standards are less robust because uncertainty in exposure assessment in these cases is high. RESULTS AND CONCLUSIONS: The results of applying this methodology to the case of two contaminants are presented: cadmium, as a non carcinogenic inorganic contaminant, and benzo(a)pyrene, as a carcinogenic organic contaminant. Limitations of the methodology are discussed.

Trends in the prevalences of congenital anomalies and age at motherhood in a Southern European region: a population-based study.

OBJECTIVES: To estimate the prevalences of the main groups of congenital anomalies and to assess their trend over time. DESIGN: Population-based study of prevalences. SETTING: The Basque Country, Spain. PARTICIPANTS: All births and all congenital anomalies diagnosed prenatally, at birth or during the first year of age, in all hospitals of the country, from 1999 to 2008. MAIN OUTCOMES MEASURES: Total diagnosed prevalences and prevalences at birth of all chromosomal and non-chromosomal anomalies, Down's syndrome, anomalies of the nervous system, urinary, limbs, digestive system and congenital heart defects. RESULTS: Mean age (SD) of women at childbirth and the proportion of them over 35 years of age shifted from 32.1 (4.5) years, with 18.3% in 1999-2001, to 32.3 (4.7) years, with 23.9% in 2006-2008. Between 1999 and 2008, 991 cases of chromosomal anomalies and 3090 of non-chromosomal anomalies were diagnosed, which yields, respectively, total prevalences of 5.2‰ and of 16.2‰. Among chromosomal anomalies, Down's syndrome is the most frequent (2.9‰). With marginal statistical significance, the results point at an increasing trend in total diagnosed chromosomal anomalies, but a decreasing one in prevalences at birth. Among non-chromosomal congenital anomalies, congenital heart defects are the most frequent (5.2‰) one. Rates of all non-chromosomal, urinary and limb anomalies grew during the study period, whereas those of congenital heart defects and anomalies of the digestive system did not change significantly. CONCLUSIONS: In the Basque Country, rates of chromosomal anomalies are higher than the overall estimated prevalence in European countries, and continue to increase slightly, which may be related to the rise in maternal age. Rates of non-chromosomal anomalies are within the European frequent range of values, and the increases observed need to be checked in the following years.

[Incidence of type 1 diabetes in Navarre, 2009-2012]. / Incidencia de la diabetes tipo 1 en Navarra, 2009-2012.

BACKGROUND: A north-south gradient for the incidence of type 1 diabetes (DM1) has been described in Europe, with higher incidence in the northern countries. The aim of this study is to describe the incidence data for DM1 in Navarre from 2009-2012, regardless of age at diagnosis, including geographical distribution and age and sex characteristics. PATIENTS AND METHODS: Prospective study, based on one primary and three secondary sources. Completeness of records was assessed, using the capture-recapture method, at 98.42%. Incidence was compared between different gender and age groups by estimating the incidence ratio using Poisson regression methods. To compare the incidence between the different geographical areas, adjustments were made to the values obtained by the indirect standardization method. RESULTS: A total of 216 cases were detected (incidence: 8.4/100,000 population/year; 95 % CI: 7.3-9.5). Incidence was higher in children than in adults, although the number of new cases was highest in those aged over 15. The age group with the highest incidence was 10 to 14 years; however, the highest percentage of patients fell in the 15 to 29-year-old group. Incidence was higher in men than in women. The incidence rates in the three southern regions were generally higher than the mean for Navarre. CONCLUSIONS: Navarre has a very high incidence of DM1 in children and adults aged 15 to 29. DM1 is more common in men and shows some geographic variability.

Influence of age at diagnosis on glycaemic control evolution in patients with type 1 diabetes.

AIM: The objective of this study was to describe the relationship between age at onset, with no age limits, and glycaemic control evolution from the time of onset in patients with type 1 diabetes (T1D). METHODS: This observational retrospective follow-up study included 716 patients with T1D onset between 1990 and 2008 treated at the Navarre Hospital Complex. The mean (SD) follow-up lasted 10.1 (5.3) years. Information on their HbA(1c) levels was collected at onset and every year thereafter. Generalized additive mixed models and linear models were used, with patients' annual HbA1c levels as the response variable and the number of years since onset together with age at onset as covariates. RESULTS: The evolution of glycaemic control is not linear and differs across all age groups. Children reach their highest values in adolescence, while patients with onset at ages 10-15 years stabilize their HbA(1c) values after 7 or 8 years. In adults, it is notable that an age of onset ≥ 45 years is associated with the worst control. CONCLUSION: A non-linear increase in HbA(1c) levels can be observed from the time of T1D diagnosis, with significant differences across all age groups.

Insomnio en pacientes que ingresan en unidades de hospitalización psiquiátricas / Insomnia in patients admitted to psychiatric hospital departments

Fundamento: El objetivo de este estudio es estimar la prevalencia de insomnio en pacientes que precisaron ingresar en unidades psiquiátricas hospitalarias de corta estancia. Metodología: Se diseñó un estudio observacional descriptivo en el que tomaron parte 16 unidades de hospitalización psiquiátrica breve de adultos de España. El instrumento utilizado fue la Escala Atenas de Insomnio. Resultados: Se reclutó a 425 pacientes, obtuvieron un valor medio de la puntuación global de la Escala Atenas de Insomnio de 8,56 (DE: 5,78). El ítem para el que se obtuvo mayor puntuación media fue el relativo a la presencia de despertares durante la noche, seguido del relativo al tiempo que lleva quedarse dormido. La prevalencia de insomnio estimada es del 53% (IC 95%). Conclusiones: El insomnio es un problema de elevada prevalencia en las unidades de hospitalización psiquiátricas. Las mayores dificultades se dan en la inducción y el mantenimiento del sueño (AU)

Background: The aim of this study is to estimate the prevalence of insomnia in patients requiring admittance to short-stay hospital psychiatric units. Methodology: A descriptive observational study was designed with the participation of 16 units for brief adult psychiatric hospitalization in Spain. The Athens Insomnia Scale was the instrument used. Results: Four hundred and twenty-five patients were included, with an average value on the global score of the Athens Insomnia Scale of 8.56 (SD: 5.78). The item that obtained the highest average score concerned the presence of waking up during the night, followed by that concerning the time needed to fall asleep. The estimated prevalence of insomnia is 53% (CI 95%). Conclusions: Insomnia is a problem with a high prevalence in psychiatric hospitalization units. The greatest difficulties are found in inducing sleep and staying asleep (AU)

Cutoff point for exhaled nitric oxide corresponding to 3% sputum eosinophils

Background: The eosinophilic asthma phenotype (sputum eosinophils ≥3%) indicates a good response to corticosteroids and TH2 immunomodulators. Exhaled nitric oxide (FeNO) is rapidly measured by portable devices, and although it is not a selective marker of eosinophilic inflammation, several studies have demonstrated a strong correlation with it. We investigated which FeNO value was the best fit with 3% sputum eosinophils in asthma patients. Methods: We included 129 consecutive, nonsmoking asthmatics who underwent skin tests, FeNO quantification (NIOX MINO), spirometry, and induced sputum analysis and completed the Asthma Control Test questionnaire. Receiver operating characteristic curves were constructed, and logistic regression analysis was performed. Results: Symptoms were detected more frequently in the eosinophilic asthma group, as were higher airway obstruction and sensitivity to hypertonic saline. The FeNO cutoff point of 21 ppb was the best fit with 3% sputum eosinophilia. This value behaved better among corticosteroid-naïve patients (sensitivity, 97%; specificity, 58%; positive predictive value, 86%; negative predictive value, 88%) than among those receiving corticosteroids (sensitivity, 81%; specificity, 25%; positive predictive value, 74%; negative predictive value, 33%). Conclusion: FeNO ≥21 ppb is associated with airway eosinophilia. In corticosteroid-naïve patients, FeNO (AU)

Antecedentes: El fenotipo de asma eosinofílica (eosinófilos en esputo ≥3%) es un marcador de buena respuesta a corticosteroides y fármacos Th2 inmunomoduladores. La Fracción Exhalada de Óxido Nítrico (FENO) se puede medir de forma rápida y sencilla con dispositivos portátiles, y si bien no es un marcador selectivo de inflamación eosinofílica, numerosos estudios han mostrado que guarda una buena relación con ella. En el presente estudio, hemos evaluado qué valor de FENO discrimina mejor la eosinofilia en esputo ≥3%. Métodos: Incluimos 129 asmáticos no fumadores consecutivos a quienes se realizaron pruebas cutáneas, medición de FENO (Niox Mino), espirometría forzada e inducción de esputo. Los pacientes autocompletaron el Test de Control de Asma (ACT). Se realizaron curvas ROC y estudio estadístico de regresión logística. Resultados: El grupo con asma eosinofílica tenía más síntomas, mayor obstrucción basal y mayor sensibilidad bronquial al salino hipertónico. El valor de FENO de 21 ppb fue el punto de corte que mejor se ajustaba a la eosinofilia en esputo del 3%. Este indicador se comportaba mejor entre los pacientes sin tratamiento esteroideo (sensibilidad 97%, especificidad 58%, VPP 86%, VPN 88%) que entre los que recibían corticosteroides (sensibilidad 81%, especificidad 25%, VPP 74%, VPN 33%). Conclusión: Los valores de FENO ≥21 ppb se asocian a eosinofilia en esputo. En sujetos que no reciben tratamiento esteroideo, valores de FENO (AU)

Incidencia de la diabetes tipo 1 en Navarra, 2009-2012 / Incidence of type 1 diabetes in Navarre, 2009-2012

Fundamento: En Europa se ha descrito un gradiente norte-sur en la incidencia de diabetes tipo 1 (DM1), con mayor incidencia en los países del norte. El objetivo del presente trabajo consiste en conocer los datos de incidencia de DM1 en Navarra, sin límite de edad al diagnóstico, durante el período 2009-2012, su distribución geográfica y sus características en cuanto a edad y sexo. Pacientes y métodos: Estudio prospectivo, con una fuente primaria y tres secundarias. La exhaustividad del registro se evaluó mediante el método captura-recaptura y fue del 98,42%. La comparación de la incidencia entre los diferentes grupos de género y edad, se ha realizado estimando la razón de incidencia a partir de métodos de regresión de Poisson. Para comparar las incidencias entre las distintas áreas, se ajustaron los valores obtenidos por el método de estandarización indirecta. Resultados: Se detectaron 216 casos (incidencia: 8,4/100.000 habitantes-año; IC 95%: 7,3-9,5). La incidencia en niños fue mayor que en adultos, aunque el número de debuts fue mayor en mayores de 15 años. El grupo de edad con mayor incidencia fue el de 10 a 14 años; en cambio, el mayor porcentaje de pacientes pertenece al grupo de 15 a 29 años. La incidencia en varones fue mayor que en mujeres. Los valores de incidencia en las 3 regiones del sur tienden a superar la media de la Comunidad. Conclusiones: Navarra presenta una incidencia muy alta de DM1 en niños y adultos de 15 a 29 años. La DM1 predomina en varones y muestra cierta variabilidad geográfica (AU)

Background: A north-south gradient for the incidence of type 1 diabetes (DM1) has been described in Europe, with higher incidence in the northern countries. The aim of this study is to describe the incidence data for DM1 in Navarre from 2009-2012, regardless of age at diagnosis, including geographical distribution and age and sex characteristics. Patients and methods: Prospective study, based on one primary and three secondary sources. Completeness of records was assessed, using the capture-recapture method, at 98.42%. Incidence was compared between different gender and age groups by estimating the incidence ratio using Poisson regression methods. To compare the incidence between the different geographical areas, adjustments were made to the values obtained by the indirect standardization method. Results: A total of 216 cases were detected (incidence: 8.4/100,000 population/year; 95 % CI: 7.3-9.5). Incidence was higher in children than in adults, although the number of new cases was highest in those aged over 15. The age group with the highest incidence was 10 to 14 years; however, the highest percentage of patients fell in the 15 to 29-year-old group. Incidence was higher in men than in women. The incidence rates in the three southern regions were generally higher than the mean for Navarre. Conclusions: Navarre has a very high incidence of DM1 in children and adults aged 15 to 29. DM1 is more common in men and shows some geographic variability (AU)