Improved prediction of coronary heart disease with markers of atherosclerosis and of inflammation in older adults?

Background: Several markers of atherosclerosis and of inflammation have been shown to predict coronary heart disease (CHD) individually. However, the utility of markers of atherosclerosis and of inflammation on prediction of CHD over traditional risk factors has not been well established, especially in the elderly. Methods: We studied 2202 men and women, aged 70-79, without baseline cardiovascular disease over 6-year follow-up to assess the risk of incident CHD associated with baseline noninvasive measures of atherosclerosis (ankle-arm index [AAI], aortic pulse wave velocity [aPWV]) and inflammatory markers (interleukin-6 [IL-6], C-reactive protein [CRP], tumor necrosis factor-a [TNF-a]). CHD events were studied as either nonfatal myocardial infarction or coronary death ("hard" events), and "hard" events plus hospitalization for angina, or the need for coronary-revascularization procedures (total CHD events). Results: During the 6-year follow-up, 283 participants had CHD events (including 136 "hard" events). IL-6, TNF-a and AAI independently predicted CHD events above Framingham Risk Score (FRS) with hazard ratios [HR] for the highest as compared with the lowest quartile for IL-6 of 1.95 (95%CI: 1.38-2.75, p for trend <0.001), TNF-a of 1.45 (95%CI: 1.04-2.02, p for trend 0.03), of 1.66 (95%CI: 1.19-2.31) for AAI 0.9, as compared to AAI 1.01-1.30. CRP and aPWV were not independently associated with CHD events. Results were similar for "hard" CHD events. Addition of IL-6 and AAI to traditional cardiovascular risk factors yielded the greatest improvement in the prediction of CHD; C-index for "hard"/total CHD events increased from 0.62/0.62 for traditional risk factors to 0.64/0.64 for IL-6 addition, 0.65/0.63 for AAI, and 0.66/0.64 for IL-6 combined with AAI. Being in the highest quartile of IL-6 combined with an AAI 0.90 or >1.40 yielded an HR of 2.51 (1.50-4.19) and 4.55 (1.65-12.50) above FRS, respectively. With use of CHD risk categories, risk prediction at 5 years was more accurate in models that included IL-6, AAI or both, with 8.0, 8.3 and 12.1% correctly reclassified, respectively. Conclusions: Among older adults, markers of atherosclerosis and of inflammation, particularly IL-6 and AAI, are independently associated with CHD. However, these markers only modestly improve cardiovascular risk prediction beyond traditional risk factors.

A new rating scale to evaluate the potential benefit of therapeutic drug monitoring

Aims: Therapeutic Drug Monitoring (TDM) is an established tool to optimize thepharmacotherapy with immunosupressants, antibiotics, antiretroviral agents, anticonvulsantsand psychotropic drugs. The TDM expert group of the Association ofNeuropsychopharmacolgy and Pharmacopsychiatry recommended clinical guidelinesfor TDM of psychotropic drugs in 2004 and in 2011. They allocate 4 levelsof recommendation based on studies reporting plasma concentrations and clinicaloutcomes. To evaluate the additional benefit for drugs without direct evidence forTDM and to verify the recommendation levels of the expert group the authorsbuilt a new rating scale. Methods: This rating scale included 28 items and wasdivided in 5 categories: Efficacy, toxicity, pharmacokinetics, patient characteristicsand cost effectiveness. A literature search was performed for 10 antidepressants,10 antipsychotics, 8 drugs used in the treatment of substance related disordersand lithium, thereafter, a comparison with the assessment of the TDMexpert group was carried out. Results: The antidepressants as well as the antipsychoticsshowed a high and significant correlation with the recommendations inthe consensus guidelines. However, meanderings could be detected for the drugsused in the therapy of substance related disorders, for which TDM is mostly notestablished yet. The result of the antidepressants and antipsychotics permits aclassification of the reachable points; upper 13 - TDM strongly recommended10 to 13 - TDM recommended, 8 to 10 - TDM useful and below 8 - TDMpotentially useful. Conclusion: These results suggest this rating scale is sensitiveto detect the appropriateness of TDM for drug treatment. For those drugs TDM isnot established a more objective estimation is possible, thus the scoring helps tofocus on the most likely drugs to require TDM.

Disseny i implementació d'un sistema web de geolocalització i promoció d'events

Degut a la falta d'informació, de temps, no saber a on buscar. . . moltes vegades no ens assabentem, o ho fem massa tard, d'events als que ens hauria agradat assistir, com podrien ser concerts,conferències, activitats esportives, etc. L'objectiu d'aquest projecte serà aprofitar les capacitats de les xarxes socials per crear un lloc web que permeti enviar i geolocalitzar events que podran ser revisats i promoguts pels usuaris, de forma que es pugui suplir aquesta mancança. La solució implementada haurà de proporcionar les següents funcionalitats: enviament d'events (permetrà afegir les dades principals d'un event i geolocalitzar-lo en el mapa); organització de la informació (es disposarà de categories i metacategories per agrupar els events, a més d'un sistema d'etiquetes que facilitarà les cerques en el contingut del web); exploració dels events existents (mitjançant el mapa es podrà veure les dades de qualsevol event); sistema de votació (atorgarà la capacitat per poder decidir quina informació és més rellevant); agenda personal (servirà per registrar events i d'aquesta manera poder rebre notificacions que informin de canvis o simplement que serveixin com a recordatori); comunicació entre usuaris (es realitzarà a través de comentaris al peu dels events i/o d'un xat intern); sindicació web (distribuirà el contingut utilitzant l'estàndard RSS; disponibilitat d'una API simple (permetrà l'accés a certa informació des d'aplicacions externes)

Influence of low-protein dietetic foods consumption on quality of life and levels of B vitamins and homocysteine in patients with chronic renal failure.

OBJECTIVE The aim of the study was to determine whether the consumption of low protein dietetic foods improved the quality of life and nutritional status for vitamins B and homocysteine in patients with chronic renal failure. METHODOLOGY This nutritional-intervention involved 28 men and 21 women, divided into two groups. The control-group consumed a low-protein diet prescribed, and the experimental-group consumed a diet in which some commonly used foods were replaced by low-protein dietetic foods. The study lasted 6 months. Food consumption was assessed by 24-h recall. Vitamin B6 as alphaEAST was measured in blood. Creatinine, urea, vitamin B12, folate and homocysteine were measured in plasma. The impact on the patients' quality of life from consuming the dietetic foods was assessed via the SF-36 questionnaire. RESULTS After 6 months, the protein intake among the experimental-group had decreased by 40%, and the urea/creatinine ratio and alphaEAST activity were also lower. The results of the SF-36 questionnaire show that the patients in the experimental-group obtained higher scores in the categories of general health and physical status. CONCLUSIONS The dietetic foods were very well accepted by all patients and their use allowed a better control of the protein intake, improved B6 status and a better quality of life.

Estudio longitudinal del Índice de masa corporal (IMC) en pacientes en diálisis

Chronic renal failure is commonly related to hyponutrition, affecting approximately on third of patients with advanced renal failure. We carried out a longitudinal study to assess nutritional evolution of 73 patients on a regular hemodialysis program, assessing changes in the anthropometrical parameter body mass index (BMI) and its correspondence to biochemical nutritional parameters such as total protein (TP) levels and serum albumin (Alb). Every three months plasma TP and albumin levels were collected and BMI was calculated by the standard formula: post-dialysis weight in kg/height in m2. For classifying by BMI categories, overweight and low weight were defined according to the WHO Expert Committee. Studied patients had a mean age of 53 years, 43 were male and 30 were female patients. BMI in women was lower than that in men (p < 0.001), as well as TP (p < 0.001) and Alb (p < 0.001) levels. Mean BMI was 29.3 kg/m2. Three point two percent of the determinations showed low weight, 12.16% overweight, and 83.97% normal BMI. TP were normal in 90.76% and decreased in 9.24%. Alb was normal in 82.2% and low in 17.78%. After the follow-up time (21.6 months, minimum 18 months, maximum 53 months), the Kruskal-Wallis test did not show a statistically significant change for BMI but it did show a change for the biochemical parameters albumin and total proteins (p < 0.05): nutritional impairment in CRF patients is manifested on biochemical parameters (TP and Alb) with no reflection on anthropometrical data.

Multiple miscarriages are associated with the risk of ovarian cancer: results from the European Prospective Investigation into Cancer and Nutrition.

While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR(≥4vs.0): 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR(≥4vs.0): 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR(≥4vs.0): 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.

Análisis de la producción científica visible en internet de los técnicos de salud ambiental del Servicio Andaluz de Salud

Internet it is a powerful interactive communication channel with world scope, through which can be multiplied the visibility of the research of the professionals whose scientific production has a difficult diffusion by the conventionals media. It is presented an analysis of the scientific publications observed in the web in order to understand the different communication processes accomplished by the superior corps of environmental health technical of the Andalusian Health Service. Using the nominal relationship of the professionals, we used Google ‘search engine’ for all scientific publications located in the internet; we were made different bibliometric indicators as of the recovered records and was analyzed the time evolution of the scientific production, documental categories, geografic distribution, language, coauthors and institutional collaboration. It was identified a growing trend in the productivity of the publications in the last decade, mainly through communications to congresses (70.4%) and journals articles (16.9%). The publications mainly are located in spanish journals, that they are indexed on national and international databases. In all the Andalusian provinces was identified some published scientific communication. The indicator of coauthors is very high (95.77%) although the institutional participation is limited mainly to the primary attention districts, occupational centers of each professional (85.21%). The scientific publication patterns visualized in the web represent an important contribution for the knowledge of the characteristics of the environmental health professionals of the Andalusian health service, what provides avaluable information for the support of the information systems in public health.

Validation interne de la version française du NEO-PI-R et influence de l'âge, du sexe et de la profession

We have examined the internal validity of the French translation of the NEO PI-R personality test which measures the « big five » (Rolland, 1993). The impact of age, gender and professional categories on the NEO PI-R scales was assessed. A large sample (n=731) of subjects of different age, gender and profession and a sample of Swiss students (n=261) responding anonymously were used. Factor analyses confirmed the structure of the instrument (5 domains) and the structures of the domains in terms of facets (six facets within each domain). On the other hand, the age has a significant impact on all the domains of the NEO PI-R; the gender has an impact on the scores on N (neuroticism), O (openness) and A (agreeableness), and the profession has an impact on the domains E (extraversion), O (openness) and A (agreeableness). The scores on several facets are also affected by those three variables. Our study gives the researchers and the practitioner a reference score table according to the studied variables.

Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison.

BACKGROUND: Pharmacy-based case mix measures are an alternative source of information to the relatively scarce outpatient diagnoses data. But most published tools use national drug nomenclatures and offer no head-to-head comparisons between drugs-related and diagnoses-based categories. The objective of the study was to test the accuracy of drugs-based morbidity groups derived from the World Health Organization Anatomical Therapeutic Chemical Classification of drugs by checking them against diagnoses-based groups. METHODS: We compared drugs-based categories with their diagnoses-based analogues using anonymous data on 108,915 individuals insured with one of four companies. They were followed throughout 2005 and 2006 and hospitalized at least once during this period. The agreement between the two approaches was measured by weighted kappa coefficients. The reproducibility of the drugs-based morbidity measure over the 2 years was assessed for all enrollees. RESULTS: Eighty percent used a drug associated with at least one of the 60 morbidity categories derived from drugs dispensation. After accounting for inpatient under-coding, fifteen conditions agreed sufficiently with their diagnoses-based counterparts to be considered alternative strategies to diagnoses. In addition, they exhibited good reproducibility and allowed prevalence estimates in accordance with national estimates. For 22 conditions, drugs-based information identified accurately a subset of the population defined by diagnoses. CONCLUSIONS: Most categories provide insurers with health status information that could be exploited for healthcare expenditure prediction or ambulatory cost control, especially when ambulatory diagnoses are not available. However, due to insufficient concordance with their diagnoses-based analogues, their use for morbidity indicators is limited.

Hybrids and Regulation in the Global Political Economy

While regulation theory literature has made important contributions to the much-debated domain of globalisation by focusing on various aspects of post-Fordism, it has not yet fully engaged with the implications that can be drawn from critical approaches in international political economy. Recent studies have explored the transnational bases of new patterns and agents of change beyond states, firms and institutions traditionally involved in regulatory practices. Hybrid is often used as a default attribute reflecting lack of clear understanding of the breadth of this new type of influence and the opacity of the means involved. Drawing on the insights of philology and mythology, the paper argues that the notion of hybrid is relevant in elucidating the ontological ambiguity between imaginary and real aspects of globalisation. Furthermore, it specifies the categories involved in the analysis of emerging forms of hybrid regulation. Recent scholarship on globalisation tends to focus on the private-public nexus of the subjects involved in new forms of institutional arrangements and authority. Here, subjects, objects and space are analysed as joint issues. By focusing particularly on transformations affecting the role of the state, forms of competition, and their rescaling on a transnational basis, the concept of global hybrid is seen as complementary to the emancipation of regulation approaches from early emphasis on national levels of compromises.

El arte que traduce. 1995-2010: la traducción como mediación cultural en los procesos de transmisión y recepción de las obras de arte

El trabajo de investigación realizado durante los tres últimos años de beca se centra en las teorías críticas y en las prácticas artísticas contemporáneas que utilizan la traducción como mediación cultural en los procesos de transmisión y recepción de las obras de arte contemporáneo. En el contexto artistico contemporáneo la traducción es entendida como intercambio, adaptación, traslado o transacción. Tomando como referentes conceptuales las teorías nacidas en el marco interdisciplinar de los Estudios Visuales y de los Estudios de Traducción, dicha investigación se ha centrado en el análisis del fenómeno de la traducción en la producción artística. A partir de este análisis se han investigado las conexiones entre estas disciplinas humanísticas y la práctica artística, así como la problemática que éstas conllevan en la formulación de nuevos criterios y nuevas categorías de la Historia del Arte actual. En la práctica artística cuestiones relativas a la traducción se han podido integrar al arte visual: por un lado como práctica indispensable para la comprensión e interpretación de la obra de arte entre diferentes contextos geográficos o culturales, y por otro, como elemento “formal” indispensable para la realización de los artefactos artísticos que, a su vez, quieren interpretar diferentes realidades sociales, antropológicas o políticas. Sobretodo a partir de la serie On Translation del artista catalán Antoni Muntadas, así como de otros artistas de varios contextos geográficos y culturales, se han analizado las dinámicas prácticas y teóricas de la traducción que acompañan el proceso de la realización de los artefactos artísticos. Muchas de estas obras de arte contemporáneo asimilando los significantes propios del contexto cultural, social, político, económico, y utilizando elementos formales variados (sobretodo tecnológicos) necesitan de un análisis interdisciplinar.

Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism.

BACKGROUND: The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE. METHODS: In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥ 65 years with acute VTE. The outcome was a first major bleeding at 90 days. We classified patients into three categories of bleeding risk (low, intermediate and high) according to each score and dichotomized patients as high vs. low or intermediate risk. We calculated the area under the receiver-operating characteristic (ROC) curve, positive predictive values and likelihood ratios for each score. RESULTS: Overall, 28 out of 663 patients (4.2%, 95% confidence interval [CI] 2.8-6.0%) had a first major bleeding within 90 days. According to different scores, the rate of major bleeding varied from 1.9% to 2.1% in low-risk, from 4.2% to 5.0% in intermediate-risk and from 3.1% to 6.6% in high-risk patients. The discriminative power of the scores was poor to moderate, with areas under the ROC curve ranging from 0.49 to 0.60 (P = 0.21). The positive predictive values and positive likelihood ratios were low and varied from 3.1% to 6.6% and from 0.72 to 1.59, respectively. CONCLUSION: In elderly patients with VTE, existing bleeding risk scores do not have sufficient accuracy and power to discriminate between patients with VTE who are at a high risk of short-term major bleeding and those who are not.

Pàgina web per a una entitat esportiva

El projecte que es presenta es basa en la creació d’una pàgina web per a una entitat esportiva, a partir d’un gestor de continguts de nom Joomla, basat en llenguatges PHP, SQL, HTML, Javascript i CSS, amb servidors Apache i base de dades MySQL. Aquesta web permet consultar informació general de l’equip i de l’entitat, dades actualitzades de totes les categories del club, inscripcions al club, i tot això mitjançant un registre a la web, el qual pot ser més o menys restrictiu segons la categoria.

Conocimientos de la Enfermedad de Chagas por parte de los profesionales sanitarios de tres hospitales en la provincia de Almería

Background: Health professionals who care for patients with imported diseases often lack enough training. The aim of the study is to assess the knowledge of Chagas disease among doctors and nurses attending at-risk pregnant women in our province. Method: descriptive study through a performed anonymous and voluntary knowledge questionnaire for 278 physicians and nurses working at maternity and children's health services in the three hospitals in the province. In Poniente Hospital was established in 2007 a program of screening for the disease in pregnant women. For statistical analysis, quantitative variables were described using the mean and standard deviation. For comparison of qualitative variables we used the chi-square test or Fisher exact test as appropriate. Differences in age and years of experience depending on the hospital were measured by Brown-Forsythe robust test. Results: 116 (41.7%) professionals agreed to participate in the study. 80 (69%) were women and 36 (31%)men,mean age 36.78 years. By professional categories, physicians have a mean of 73.9% correct responses, the nurses 50.7%. Poniente Hospital had the highest percentage of correct answers on aspects of the geographical distribution of the disease (73.7%), the mechanisms of transmission (86%) and diagnosis (82.5%). Conclusions: The Poniente Hospital professionals generally have a better Knowledge about Chagas disease compared with two other professionals hospitals, which probably is related to the existence of the screening program for the disease.

Fortalezas y amenazas en torno a la seguridad del paciente según la opinión de los profesionales de enfermería

The aim of this research is to know the barriers and opportunities that nursing professionals detect in their clinical practice in order to develop the culture of patient safety and to identify future research lines. This qualitative study is based on the DELPHI method, with a group of 19 nursing professionals from education and care practice, involving both primary and specialized care. Weaknesses and threats revolve around five categories: profession, organization and infrastructure; indicators; communication and safety culture; and safety training. Opportunities to improve safety cover six categories: organizational change; promotion of the safety culture, professional training and development; relationship with the patients; research; and strategic planning. Work is needed to improve safety and nursing should be ready to assume this leadership.