Systems Medicine and Integrated Care to Combat Chronic Noncommunicable Diseases.

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

The COPD control panel: towards personalised medicine in COPD

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease whose assessment and management have traditionally been based on the severity of airflow limitation (forced expiratory volume in 1 s (FEV1)). Yet, it is now clear that FEV1 alone cannot describe the complexity of the disease. In fact, the recently released Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2011 revision has proposed a new combined assessment method using three variables (symptoms, airflow limitation and exacerbations). Methods Here, we go one step further and propose that in the near future physicians will need a"control panel" for the assessment and optimal management of individual patients with complex diseases, including COPD, that provides a path towards personalised medicine. Results We propose that such a"COPD control panel" should include at least three different domains of the disease: severity, activity and impact. Each of these domains presents information on different"elements" of the disease with potential prognostic value and/or with specific therapeutic requirements. All this information can be easily incorporated into an"app" for daily use in clinical practice. Conclusion We recognise that this preliminary proposal needs debate, validation and evolution (eg, including"omics" and molecular imaging information in the future), but we hope that it may stimulate debate and research in the field.

Género y cultura popular

En uno de los capítulos de Los Simpson, la pequeña Lisa compra, emocionada, la última versión de Stacy Malibú (el equivalente a nuestra Barbie). La novedad consiste en que después de 50 años de existencia, la muñeca habla. Pero para consternación de Lisa, el repertorio de frases es de lo más indignante: "Me encantaría que en la escuela enseñaran a ir de compras", "¡Vamos a hornear unas galletas para los chicos!" o "No me preguntes: sólo soy una chica (risita vacua)". Obviamente, la comprometida y concienciada Lisa no puede quedarse de brazos cruzados y pide a su madre que la lleve a la fábrica de Stacy Malibú para presentar sus quejas. La conversación entre ambas es enormemente reveladora: aunque Marge apoya a su hija e insiste en que siempre defienda sus ideas, considera que quizás está yendo más allá de lo razonable en su denuncia de que toda una generación de niñas se comportará como Stacy Malibú y la tomará como modelo y, finalmente, concluye en tono conciliador: "Yo tuve una Stacy Malibú de pequeña y no me ha pasado nada.¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". La respuesta de Lisa no deja lugar a dudas; poniendo en funcionamiento a la muñeca y situándola frente a su madre, oímos a Stacy diciendo: "¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". Huelgan los comentarios.

Género y cultura popular

En uno de los capítulos de Los Simpson, la pequeña Lisa compra, emocionada, la última versión de Stacy Malibú (el equivalente a nuestra Barbie). La novedad consiste en que después de 50 años de existencia, la muñeca habla. Pero para consternación de Lisa, el repertorio de frases es de lo más indignante: "Me encantaría que en la escuela enseñaran a ir de compras", "¡Vamos a hornear unas galletas para los chicos!" o "No me preguntes: sólo soy una chica (risita vacua)". Obviamente, la comprometida y concienciada Lisa no puede quedarse de brazos cruzados y pide a su madre que la lleve a la fábrica de Stacy Malibú para presentar sus quejas. La conversación entre ambas es enormemente reveladora: aunque Marge apoya a su hija e insiste en que siempre defienda sus ideas, considera que quizás está yendo más allá de lo razonable en su denuncia de que toda una generación de niñas se comportará como Stacy Malibú y la tomará como modelo y, finalmente, concluye en tono conciliador: "Yo tuve una Stacy Malibú de pequeña y no me ha pasado nada.¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". La respuesta de Lisa no deja lugar a dudas; poniendo en funcionamiento a la muñeca y situándola frente a su madre, oímos a Stacy diciendo: "¡Vamos a olvidarnos de estos problemas con un gran bol de helado de fresa!". Huelgan los comentarios.

Traditional cockney and popular London speech

This paper gives a full description of the phonetics and phonology of Traditional Cockney and Popular London speech, treating these varieties as constituting a continuum rather than two separate dialects. Exemplification of the vowels, diphthongs and consonants is provided, both in isolate words and in connected speech, along with their range of variation. The frequencies of the vowels have been charted on the basis of the pronunciation of three elderly male speakers. Regarding the consonants, there are detailed observations on the features typically associated with the linguistic varieties examined: strong aspiration of unvoiced plosives, glottalization, H-dropping, L-vocalization and TH-fronting. A section on prosody provides coverage of lexical stress, rhythm and intonation. The paper takes into account up-to-date research on these phenomena, but does not deal with the most recent vowel shifts, some of which form part of Multi-cultural London English.

"Ojo clínico" y evidencia científica

En nuestra profesión, el ojo clínico puede definirse como el don que poseen algunos médicos para realizar diagnósticos rápidos y certeros. Este término, antaño popular, ha caído en desuso y en la actualidad se utiliza con mayor frecuencia en ambientes no médicos, para resaltar la habilidad de anticipar acontecimientos o de calibrar a simple vista aspectos ocultos de la naturaleza humana. Por el contrario, el concepto evidencia científica es claramente actual. Aplicado a la práctica de la medicina, no solo es...

A propòsit d'una cançó popular recollida per Jacint Verdaguer i enviada al seu amic Marià Aguiló

«Comiat de Vic» forma part del recull de cançons populars que Jacint Verdaguer va enviar al seu amic i erudit mallorquí Marià Aguiló. La lletra de la cançó traça un itinerari a través de la ciutat que va fent menció dels edificis religiosos que es troben durant el trajecte. L’emoció acumulada i el dolor de la partença indiquen que probablement es tracta del comiat definitiu d’un condemnat a mort.

The referendum and popular consultations in the Autonomous State

The referendum is a poorly used mechanism for direct participation in the Spanish system, at both state and regional level. The discussion on the feasibility of this system at regional level has been examined by the Constitutional Court. Influenced by the reluctance with which constituents viewed the mechanisms of direct democracy, they still have a reductive view of the referendum. The State therefore reserves the right to exercise very intensive controls on the provision and authorization of referendums and on the specific exercise of each referendum

Back to the island of calm: mallorcan human traditional medicine and ethnobotany

This study reveals that a successful ethnobotanical survey can take place still nowadays, even close to one of the hotspots of tourism in the Mediterranean coast. This is the first approach in this field entirely based on interviews with local people in Mallorca. An amount of 235 informants has been inquired from all the 53 municipalities of the island. The data collected have been analyzed from the botanical and ethnographical points of view, and managed using the online platform of our research team (details at www.etnobiofic.cat). The Mallorcan ethnopharmacopoeia includes 255 plant taxa referring more than 150 medicinal use categories. Ethnomedical queries as the one here presented contribute to the knowledge of the traditional use of plants of the island and appreciate the benefits of this knowledge, applied to the present and future of its society.

Back to the island of calm: Mallorcan human traditional medicine and ethnobotany

This study reveals that a successful ethnobotanical survey can take place still nowadays, even close to one of the hotspots of tourism in the Mediterranean coast. This is the first approach in this field entirely based on interviews with local people in Mallorca. An amount of 235 informants has been inquired from all the 53 municipalities of the island. The data collected have been analyzed from the botanical and ethnographical points of view, and managed using the online platform of our research team (details at www.etnobiofic.cat). The Mallorcan ethnopharmacopoeia includes 255 plant taxa referring more than 150 medicinal use categories. Ethnomedical queries as the one here presented contribute to the knowledge of the traditional use of plants of the island and appreciate the benefits of this knowledge, applied to the present and future of its society.