Cost-effectiveness analysis of cardiac resynchronization therapy in patients with NYHA I and NYHA II heart failure in Spain

Objectives: The aim of the study was to combine clinical results from the European Cohort of the REVERSE study and costs associated with the addition of cardiac resynchronization therapy (CRT) to optimal medical therapy (OMT) in patients with mild symptomatic (NYHA I-II) or asymptomatic left ventricular dysfunction and markers of cardiac dyssynchrony in Spain. Methods: A Markov model was developed with CRT + OMT (CRT-ON) versus OMT only (CRT-OFF) based on a retrospective cost-effectiveness analysis. Raw data was derived from literature and expert opinion, reflecting clinical and economic consequences of patient"s management in Spain. Time horizon was 10 years. Both costs (euro 2010) and effects were discounted at 3 percent per annum. Results: CRT-ON showed higher total costs than CRT-OFF; however, CRT reduced the length of hospitalization in ICU by 94 percent (0.006 versus 0.091 days) and general ward in by 34 percent (0.705 versus 1.076 days). Surviving CRT-ON patients (88.2 percent versus 77.5 percent) remained in better functional class longer, and they achieved an improvement of 0.9 life years (LYGs) and 0.77 years quality-adjusted life years (QALYs). CRT-ON proved to be cost-effective after 6 years, except for the 7th year due to battery depletion. At 10 years, the results were 18,431 per LYG and 21,500 per QALY gained. Probabilistic sensitivity analysis showed CRT-ON was cost-effective in 75.4 percent of the cases at 10 years. Conclusions: The use of CRT added to OMT represents an efficient use of resources in patients suffering from heart failure in NYHA functional classes I and II.

Técnica de respiración Jacobson para reducir el estrés de enfermeras de unidades de cuidados intensivos

Problema del estudio: El sector de enfermería perteneciente a las Unidades de Cuidados Intensivos presentan estrés, y se ofrece la Técnica de respiración Jacobson como herramienta para disminuir los niveles y los problemas derivados del estrés. Objetivo general: Evaluar la eficacia de la técnica de respiración Jacobson sobre el estrés en los profesionales de enfermería de UCI. Objetivos específicos: Diseñar un taller de respiración de la técnica Jacobson, para enfermería de UCI; comparar los niveles de estrés de los enfermeros de UCI antes y después de la intervención mediante los cuestionarios STAI, NSS y NWI; y evaluar los principales factores estresantes de los enfermeros/as en su trabajo, comparando los 2 grupos de la intervención (los que realizan el programa de la Técnica de relajación Jacobson y los que no participan). Metodología: El ámbito de estudio será una planta del servicio de UCI de un Hospital de Agudos. Se trata de un ensayo clínico aleatorio y experimental, que constará de 2 grupos control; uno realizará la intervención (Grupo 1) y el otro no (Grupo 2). Los sujetos del estudio son las enfermeras/os de una planta de UCI de un Hospital de Agudos, incluidas enfermeras administrativas y gerentes. Los instrumentos que se utilizarán son: la recogida de datos personales de cada participante, Test STAI (State-Trait Anxiety Inventory), Escala de Estrés de Enfermería NSS (Nursing Stress Scale) y Escala del entorno de práctica enfermera del NWI (Nursing Work Index). Limitaciones del estudio: Pérdidas de seguimiento y la no participación de las enfermeras/os en el estudio.

Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.

Background: Limited data on a short series of patients suggest that lymphocytic enteritis (classically considered as latent coeliac disease) may produce symptoms of malabsorption, although the true prevalence of this situation is unknown. Serological markers of coeliac disease are of little diagnostic value in identifying these patients. Aims: To evaluate the usefulness of human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy for the detection of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease and to assess the clinical relevance of lymphocytic enteritis diagnosed with this screening strategy. Patients and methods: 221 first-degree relatives of 82 DQ2+ patients with coeliac disease were consecutively included. Duodenal biopsy (for histological examination and tissue transglutaminase antibody assay in culture supernatant) was carried out on all DQ2+ relatives. Clinical features, biochemical parameters and bone mineral density were recorded. Results: 130 relatives (58.8%) were DQ2+, showing the following histological stages: 64 (49.2%) Marsh 0; 32 (24.6%) Marsh I; 1 (0.8%) Marsh II; 13 (10.0%) Marsh III; 15.4% refused the biopsy. 49 relatives showed gluten sensitive enteropathy, 46 with histological abnormalities and 3 with Marsh 0 but positive tissue transglutaminase antibody in culture supernatant. Only 17 of 221 relatives had positive serological markers. Differences in the diagnostic yield between the proposed strategy and serology were significant (22.2% v 7.2%, p<0.001). Relatives with Marsh I and Marsh II¿III were more often symptomatic (56.3% and 53.8%, respectively) than relatives with normal mucosa (21.1%; p=0.002). Marsh I relatives had more severe abdominal pain (p=0.006), severe distension (p=0.047) and anaemia (p=0.038) than those with Marsh 0. The prevalence of abnormal bone mineral density was similar in relatives with Marsh I (37%) and Marsh III (44.4%). Conclusions: The high number of symptomatic patients with lymphocytic enteritis (Marsh I) supports the need for a strategy based on human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy in relatives of patients with coeliac disease and modifies the current concept that villous atrophy is required to prescribe a gluten-free diet.

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.

Nominal plural marking of nonce words in child Spanish

This study addresses the issue of Spanish plural marking considering data from three sources: existent words, loan words and nonce words. Specifically, we are interested in the role of stress placement and word-final sound in the use of /-es/ for plural formation. We present data concerning the interaction of these two features for children and adults. Our findings suggest that this phenomenon is a classic example of over generalization in acquisition. Stress does not seem a determining feature by itself. Its main effect is produced when it interacts with the structure of the syllable

Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention.

Els catéters venosos centrals són necessaris per al maneig del pacient crític però poden ser l´origen d´una bacteriemia. Aquest estudi prospectiu de cohort té com a objectiu determinar la utilitat de l´aplicació d´unes mesures bàsiques de prevenció per disminuir la incidència de bacteriemia associada a catéter. Els resultats de l´estudi confirmen que l´aplicació d´aquest sistema d´intervenció múltiple basat en l´evidencia redueix de forma significativa les bacteriemies associades a catéter a la nostra UCI.

Evidence for classification of c.1852_1853AA>GC in MLH1 as a neutral variant for Lynch syndrome

Background: Lynch syndrome (LS) is an autosomal dominant inherited cancer syndrome characterized by early onset cancers of the colorectum, endometrium and other tumours. A significant proportion of DNA variants in LS patients are unclassified. Reports on the pathogenicity of the c.1852_1853AA>GC (p.Lys618Ala) variant of the MLH1 gene are conflicting. In this study, we provide new evidence indicating that this variant has no significant implications for LS.Methods: The following approach was used to assess the clinical significance of the p.Lys618Ala variant: frequency in a control population, case-control comparison, co-occurrence of the p.Lys618Ala variant with a pathogenic mutation, co-segregation with the disease and microsatellite instability in tumours from carriers of the variant. We genotyped p.Lys618Ala in 1034 individuals (373 sporadic colorectal cancer [CRC] patients, 250 index subjects from families suspected of having LS [revised Bethesda guidelines] and 411 controls). Three well-characterized LS families that fulfilled the Amsterdam II Criteria and consisted of members with the p.Lys618Ala variant were included to assess co-occurrence and co-segregation. A subset of colorectal tumour DNA samples from 17 patients carrying the p.Lys618Ala variant was screened for microsatellite instability using five mononucleotide markers.Results: Twenty-seven individuals were heterozygous for the p.Lys618Ala variant; nine had sporadic CRC (2.41%), seven were suspected of having hereditary CRC (2.8%) and 11 were controls (2.68%). There were no significant associations in the case-control and case-case studies. The p.Lys618Ala variant was co-existent with pathogenic mutations in two unrelated LS families. In one family, the allele distribution of the pathogenic and unclassified variant was in trans, in the other family the pathogenic variant was detected in the MSH6 gene and only the deleterious variant co-segregated with the disease in both families. Only two positive cases of microsatellite instability (2/17, 11.8%) were detected in tumours from p.Lys618Ala carriers, indicating that this variant does not play a role in functional inactivation of MLH1 in CRC patients.Conclusions: The p.Lys618Ala variant should be considered a neutral variant for LS. These findings have implications for the clinical management of CRC probands and their relatives.

Psychology in Catalonia: 1996-2002

En aquest article es presenta el resum del Report de la Recerca en Psicologia a Catalunya durant el període 1996-2002, publicat l'any 2004 per l'Institut d'Estudis Catalans. A partir de informacions diverses, procedents especialmentd'institucions educatives de nivell universitari, Administració de Catalunya (Departament d'Universitats, Recercai Societat de la Informació, DURSI), i els propis coordinadors de Grups de Recerca -prèviament detectats mitjançant laelaboració d'un qüestionari ad hoc-, s'ha perfilat un mapa de la recerca en Psicologia a Catalunya durant el períodeestudiat, el qual inclou investigadors procedents de les sis Universitats catalanes en les quals s'imparteixen estudis dePsicologia (o, en el cas de la Universitat de Lleida, de Psicopedagogia). Els eixos organitzadors de la informació hanestat les Àrees de Coneixement i les Universitats. La informació recollida s'ha articulat al voltant de diversesqüestions cabdals relatives als Grups de Recerca: Projectes de recerca obtinguts per part de diversos organismes subvencionants, la productivitat contemplada des de la vessant de la publicació d'articles científics, el finançament obtingut per part de diverses Administracions i entitats privades, la infrastructura amb la que compten, les característiques d'arranjament d'aquests Grups, i, finalment, les condicions, valoracions, expectatives i gestió dels recursos dels Grups de Recerca.

Phylogenetic studies in Gnaphalieae (Compositae): The genera Phagnalon Cass. and Aliella Qaiser & Lack

The precise generic delimitation of Aliella andPhagnalon, and their closest relatives within the Gnaphalieae are discussed in this review. Among the main results obtained, wehave found that the genera Aliella and Phagnalon are nested withinthe “Relhania clade” and Anisothrix, Athrixia and Pentatrichia aretheir closest relatives. Macowania is also part of the “Relhaniaclade”, whereas the subtribal affinities of Philyrophyllum liewithin the “crown radiation clade”. The monophyly of Aliellaand Phagnalon is not supported statistically. In addition,Aliella appears to be paraphylethic in most of the analysesperformed. The resulting phylogeny suggests an African origin forthe ancestor of Aliella and Phagnalon and identifies three mainclades within Phagnalon that constitute the following naturalgroups on a geographic basis: (1) the Irano-Turanian clade; (2) the Mediterranean-Macaronesian clade; and (3) the Yemen-Ethiopian clade. Some endemics to Yemen and Ethiopia appeared merged in the Mediterranean-Macaronesian clade, providing new evidence of the phytogeographical links betweenMacaronesia, Eastern Africa and Southern Arabia. Incongruities between thechloroplast and nuclear molecular data and the lack of resolution in some clades mayindicate that hybridization could have played an important role in the evolution anddiversification of both Phagnalon and Aliella.

In & Out – 180 habitatges per a gent jove i gent gran Camí Antic de València al Poblenou

Estratègies d’ordenació: L’ordenació proposada vol recollir la hibridesa i complexitat d’espais típica del Poble Nou. Caracteritzat pels espais lliures de mida intermèdia –a cavall entre els dels teixits i els del eixamples – i per la riquesa en les seves articulacions (mitjançant passatges, a través d’edificis,…) ; per la permeabilitat cap a l’interior de l’illa: la connexió dels buits interiors amb els carrers i espais públics annexes o per la variabilitat del gra edificat.És per això que l’edificació no s’entén com una sèrie de blocs aïllats sinó que està concebuda com una gran peça articulada, amb una alçada constant en el volum a carrer i una lleugera variabilitat volumètrica en altura en els diferents volums interiors de igual mòdul i de gra menor, homòleg al del seu context urbà més pròxim.És essencial al projecte la definició de l’espai buit interior de l’illa en relació als habitatges, i la seva relació –a una escala major- amb els espais lliures de l’entorn. L’ordenació proposada configura dos paisatges diferents: un pati més urbà, delimitat en planta baixa per un equipament del barri i al que s’hi aboquen els habitatges per a joves i un altre més tranquil i més tou, un jardí per als més grans, accessible des del carrer i des de l’espai públic contiguEl volum més llarg afegeix una nova inflexió a les que ja té el carrer, ampliant-lo amb un espai amb funció de vestíbul i recuperant així, a partir d’una traça parcel•laria històrica, la direcció de l’Eixample.Els diferents volums es relacionen/articulen mitjançant corredors i espais col•lectius de distintes mesures i qualitats. Espais de relació, de dimensió variable, en diferents situacions relatives –respecte al ple, al sòl- i amb distints caràcters, que van del privat al públic...passant pel col•lectiu.Les galeries i els corredors d'accés als habitatges, protagonistes d'aquests espais híbrids (privats-semiprivats-col•lectius/ interiors-exteriors/ tancats-oberts), es converteixen gràcies a la flexibilitat en el tancament de la unitat d'habitació en espais d'intercanvi, on la variabilitat en l'ús permet diferents apropiacions de l'espai col•lectiu.La superposició en altura d'aquests espais funciona com una estructura lleugera adossada a la façana, és una epidermis complexa amb aparença de bastida.L’edificació té la voluntat de tancar-se a carrer amb una façana poc perforada, que llisca indiferent al carrer, i d’obrir-se a l’interior de l’illa, a sud, on es torna complexa, amb successives pells i tamisos...

Cobertura y desamparo: garantías jurídicas de los españoles en el Perú (1870-1945) = Coverage and helplessness: legal guarantees of the spanish in Peru (1870-1945)

The archives of the Prefecture of the Peruvian Ministry of Foreign Affairs provide a perspective from which to reconstruct the broad range of legal circumstances in which Spanish residents in various regions of the country find themselves immersed (assets of relatives who have died without wills or family in Peru, political conflicts, legal problems -whether criminal or civil as a result of business activities- or the requested intervention ofconsular authorities when decisions considered detrimental to their compatriots are made by prefects and sub-prefects). The legal framework protecting Spanish nationals in Peru is analysed to understand the mechanisms of immigration in the country and the mechanisms that led them to keep their Spanish nationality, even after establishing wide-reaching family and business interests

Systematics and phylogeography of the Dysdera erythrina species complex (Araneae, Dysderidae) in Sardinia

Sardinia is the second largest island in the Mediterranean and, together with Corsica and nearby mainland areas, one of the top biodiversity hotspots in the region. The origin of Sardinia traces back to the opening of the western Mediterranean in the late Oligocene. This geological event and the subsequent Messinian Salinity Crisis and Pleistocene glacial cycles have had a major impact on local biodiversity. The Dysdera woodlouse hunter spiders are one of the most diverse ground-dweller groups in the Mediterranean. Here we describe the first two species of this genus endemic to Sardinia: Dysdera jana sp. n. and Dysdera shardana sp. n. The two species show contrasting allopatric distribution: D. jana sp. n. is a narrow endemic while D. shardana sp. n. is distributed throughout most of the island. A multi-gene DNA sequence phylogenetic analys based on mitochondrial and nuclear genes supports the close relationships of the new species to the type species of the genus Dysdera erythrina. Age estimates reject Oligocene origin of the new Dysdera species and identify the Messinian Salinity Crises as the most plausible period for the split between Sardinian endemics and their closest relatives. Phylogeographic analysis reveals deep genetic divergences and population structure in Dysdera shardana sp. n., suggesting that restriction to gene flow probably due to environmental factors could explain local speciation events. Taxonomy, phylogeny, DNA sequencing, Mediterranean biogeography, phylogeography

Risk factors for colorectal cancer in subjects with family history of the disease.

The relationship between lifestyle factors, past medical conditions, daily meal frequency, diet and the risk of 'familial' colorectal cancer has been analysed using data from a case-control study conducted in northern Italy. A total of 1584 colorectal cancer patients and 2879 control subjects were admitted to a network of hospitals in the Greater Milan area and the Pordenone province. The subjects included for analysis were the 112 cases and the 108 control subjects who reported a family history of colorectal cancer in first-degree relatives. Colorectal cancer cases and control subjects with family history were similarly distributed according to sex, age, marital status, years of schooling and social class. Familial colorectal cancer was associated with meal frequency, medical history of diabetes (relative risk, RR = 4.6) and cholelithiasis (RR = 5.2). Significant positive trends of increasing risk with more frequent consumption were observed for pasta (RR = 2.5, for the highest vs the lowest intake tertile), pastries (RR = 2.4), red meat (RR = 2.9), canned meat (RR = 1.9), cheese (RR = 3.5) and butter (RR = 1.9). Significant inverse associations and trends in risk were observed for consumption of poultry (RR = 0.4), tomatoes (RR = 0.2), peppers (RR = 0.3) and lettuce (RR = 0.3). Significant inverse trends in risk with increasing consumption for beta-carotene and ascorbic acid were observed (RR = 0.5 and 0.4 respectively, highest vs lowest intake tertile). These results suggest that risk factors for subjects with a family history of colorectal cancer in first-degree relatives are not appreciably different from recognized risk factors of the disease in the general population.

Pathétique Sonata : a study of musical aspects in subjection of aesthetic aims

This study makes an attempt to capture some of the aesthetic ideas prospering in the latter half of the eighteenth century and investigates in what way these are possibly being manifested in different musical aspects in Beethoven's early work, and most specifically in his eight sonata, often referred to as the Pathétique sonata. Beginning the first chapter with an introduction to aesthetic notions in Beethoven's age, the second chapter is mostly concerned with anecdotes regarding the Pathétique sonata. Further the third chapter exhibits possible influences between Cherubini, Beethoven and Wagner, and the last three chapters treat different musical and aesthetic aspects like Beethoven's relation to the C minor tonality, the German Sturm und Drang movement, and finally some parallels that can be found between literature and music.