Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

Background: Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

Background:Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil.Objective:Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF.Methods:Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events.Results:A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included.Conclusion:The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.

Maternal Factors and Adverse Perinatal Outcomes in Women with Preeclampsia in Maceió, Alagoas

Abstract Background: Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations. Objective: To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió. Methods: Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant. Results: We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 - 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 - 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery. Conclusion: Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries.

Los Efectos del sistema electoral europeo en España: los partidos políticos de ámbito no estatal

A lo largo de este artículo se analizan los efectos del sistema electoral europeo en España sobre los partidos políticos de ámbito no estatal. Por un lado, se estudia el funcionamiento de la normativa electoral española, subrayando la sobrerepresentación de unos partidos políticos y la infrarepresentación de otros en función del ámbito territorial organizativo de la formación política. Por otro lado, se presentan datos sistemáticos y comparados que demuestran esta distorsión de la representación política –fruto de la normativa electoral-, y dibujamos la estrategia electoral que los partidos políticos afectados negativamente desarrollan: las coaliciones electorales. Pero, ¿en base a qué criterios se organizan tales coaliciones electorales? El enfoque multivariable –la circunscripción, la magnitud electoral y el número de eurodiputados españoles- nos va permitir responder a esta y otras preguntas. El objetivo es ahondar en el debate sobre la normativa electoral en la arena política europea.

El Comportament electoral dels espanyols al referèndum de la Constitució Europea

Aquest paper tracta dels resultats del referèndum sobre la Constitució Europea que es va celebrar a Espanya el 20 de febrer de 2005. Hi trobem un panorama general del context en el qual se celebrà la consulta, i, a través de l’anàlisi d’enquestes postelectorals, analitza la composició del vot afirmatiu i del negatiu, la posició dels diferents partits polítics i el comportament electoral dels diversos actors socials, dividits per classe social, religió, edat, gènere, territori, etc. També hi ha una anàlisi de l’abstenció i de la participació a Espanya en aquest cas.

Transition modes and institutional outcomes in El Salvador and Guatemala

Institutions affect key dimensions of the political process –policy, stability, and conflict. The choice of institutions is thus consequential. I argue that transition modes affect the choice of institutions in predictable and systematic ways. The more balanced power is between the two main bargaining forces –regime elite and opposition– the likelier that the resulting institutions will be pluralistic. Contrarily, the more unbalanced power is in favour of regime elites vis a vis the opposition, the likelier that institutions will be majoritarian. The argument is tested for El Salvador and Guatemala.

Bidding for the surplus: realizing efficient outcomes in general economic environments

In this paper, we consider two classes of economic environments. In the first type, agents are faced with the task of providing local public goods that will benefit some or all of them. In the second type, economic activity takes place via formation of links. Agents need both to both form a network and decide how to share the output generated. For both scenarios, we suggest a bidding mechanism whereby agents bid for the right to decide upon the organization of the economic activity. The subgame perfect equilibria of this game generate efficient outcomes.

El Sistema electoral a Austràlia: convivència en la complexitat democràtica

L’objectiu d’aquestes pàgines és descriure el desenvolupament del sistema electoral a Austràlia des de la perspectiva que comporta tant la seva complexitat com flexibilitat. Una complexitat a què s’ha acostumat el ciutadà australià fruit de la naturalesa federal del país. En comptes que les modificacions en les regles del joc democràtic facin perillar la credibilitat del poder polític, Austràlia sempre ha conservat una ferma evolució política a partir dels eixos de buscar la millor representació ciutadana. Aquesta diversitat i sofisticació constant no han portat a la ciutadania a una desinhibició de les regles democràtiques, sinó que s’ha combinat amb una participació electoral obligada dels ciutadans que els implica directament amb el seu sistema polític.

Freedom of choice as control over outcomes

As interactions between individuals are introduced into the freedom of choice literature by the mean of game forms, new issues appear. In particular, in this paper it is argued that individuals face uncertainty with respect to outcomes as they lose the control they implicitely exert over options in the opportunity set framework. A criterion is proposed as to compare alternative game forms in terms of the control they offer to individuals. The CardMin criterion suggests that any game form should be judged on the basis of the strategy offering the lowest number of pairwise different outcomes. An axiomatic characterization is provided in the case of two individuals.