Heidi Wiki: Información e interfaz de datos sobre la salud en Europa

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública, Inclusión y Calidad de Vida de la Consejería de Salud y Bienestar Social

Clinical presentation and time-course of postoperative venous thromboembolism: Results from the RIETE Registry

There is little literature about the clinical presentation and time-course of postoperative venous thromboembolism (VTE) in different surgical procedures. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic acute VTE. In this analysis, we analysed the baseline characteristics, thromboprophylaxis and therapeutic patterns, time-course, and three-month outcome of all patients with postoperative VTE. As of January 2006, there were 1,602 patients with postoperative VTE in RIETE: 393 (25%) after major orthopaedic surgery (145 elective hip arthroplasty, 126 knee arthroplasty, 122 hip fracture); 207 (13%) after cancer surgery; 1,002 (63%) after other procedures. The percentage of patients presenting with clinically overt pulmonary embolism (PE) (48%, 48%, and 50% respectively), the average time elapsed from surgery to VTE (22 +/- 16, 24 +/- 16, and 21 +/- 15 days, respectively), and the three-month incidence of fatal PE (1.3%, 1.4%, and 0.8%, respectively), fatal bleeding (0.8%, 1.0%, and 0.2%, respectively), or major bleeding (2.3%, 2.9%, and 2.8%, respectively) were similar in the three groups. However, the percentage of patients who had received thromboprophylaxis (96%, 76% and 52%, respectively), the duration of prophylaxis (17 +/- 9.6, 13 +/- 8.9, and 12 +/- 11 days, respectively) and the mean daily doses of low-molecular-weight heparin (4,252 +/- 1,016, 3,260 +/- 1,141, and 3,769 +/- 1,650 IU, respectively), were significantly lower in those undergoing cancer surgery or other procedures. In conclusion, the clinical presentation, time-course, and three-month outcome of VTE was similar among the different subgroups of patients, but the use of prophylaxis in patients undergoing cancer surgery or other procedures was suboptimal.

New aspects in celiac disease

Celiac disease (CD) is a common autoimmune disorder characterized by an immune response to ingested gluten and has a strong HLA association with HLA-DQ2 and HLA-DQ8 molecules, but human HLA-DQ risk factors do not explain the entire genetic susceptibility to gluten intolerance. CD is caused by the lack of immune tolerance (oral tolerance) to wheat gluten. In this sense, the expression of soluble HLA-G in CD is of special interest because the molecule plays an important role in the induction of immune tolerance. The enhanced expression of soluble HLA-G found in CD may be part of a mechanism to restore the gluten intolerance. In this editorial, we review recent progress in understanding CD in relation to its prevalence, diagnosis and possible mechanisms of pathogenesis.

Diagnostic accuracy of the Eurotest for dementia: a naturalistic, multicenter phase II study

BACKGROUND Available screening tests for dementia are of limited usefulness because they are influenced by the patient's culture and educational level. The Eurotest, an instrument based on the knowledge and handling of money, was designed to overcome these limitations. The objective of this study was to evaluate the diagnostic accuracy of the Eurotest in identifying dementia in customary clinical practice. METHODS A cross-sectional, multi-center, naturalistic phase II study was conducted. The Eurotest was administered to consecutive patients, older than 60 years, in general neurology clinics. The patients' condition was classified as dementia or no dementia according to DSM-IV diagnostic criteria. We calculated sensitivity (Sn), specificity (Sp) and area under the ROC curves (aROC) with 95% confidence intervals. The influence of social and educational factors on scores was evaluated with multiple linear regression analysis, and the influence of these factors on diagnostic accuracy was evaluated with logistic regression. RESULTS Sixteen neurologists recruited a total of 516 participants: 101 with dementia, 380 without dementia, and 35 who were excluded. Of the 481 participants who took the Eurotest, 38.7% were totally or functionally illiterate and 45.5% had received no formal education. Mean time needed to administer the test was 8.2+/-2.0 minutes. The best cut-off point was 20/21, with Sn = 0.91 (0.84-0.96), Sp = 0.82 (0.77-0.85), and aROC = 0.93 (0.91-0.95). Neither the scores on the Eurotest nor its diagnostic accuracy were influenced by social or educational factors. CONCLUSION This naturalistic and pragmatic study shows that the Eurotest is a rapid, simple and useful screening instrument, which is free from educational influences, and has appropriate internal and external validity.

Lung function in idiopathic pulmonary fibrosis--extended analyses of the IFIGENIA trial.

BACKGROUND The randomized placebo-controlled IFIGENIA-trial demonstrated that therapy with high-dose N-acetylcysteine (NAC) given for one year, added to prednisone and azathioprine, significantly ameliorates (i.e. slows down) disease progression in terms of vital capacity (VC) (+9%) and diffusing capacity (DLco) (+24%) in idiopathic pulmonary fibrosis (IPF). To better understand the clinical implications of these findings we performed additional, explorative analyses of the IFGENIA data set. METHODS We analysed effects of NAC on VC, DLco, a composite physiologic index (CPI), and mortality in the 155 study-patients. RESULTS In trial completers the functional indices did not change significantly with NAC, whereas most indices deteriorated with placebo; in non-completers the majority of indices worsened but decline was generally less pronounced in most indices with NAC than with placebo. Most categorical analyses of VC, DLco and CPI also showed favourable changes with NAC. The effects of NAC on VC, DLco and CPI were significantly better if the baseline CPI was 50 points or lower. CONCLUSION This descriptive analysis confirms and extends the favourable effects of NAC on lung function in IPF and emphasizes the usefulness of VC, DLco, and the CPI for the evaluation of a therapeutic effect. Most importantly, less progressed disease as indicated by a CPI of 50 points or lower at baseline was more responsive to therapy in this study.

Andalucía reduce a la mitad la mortalidad por accidentes de tráfico en carretera en el período 2001-2010

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries.

OBJECTIVE To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis. SETTING Twenty-seven centres in 10 European countries participating in the EPIC project. SUBJECTS In total, 35 955 subjects (13 031 men and 22 924 women), aged 35-74 years, randomly selected from each EPIC cohort. RESULTS The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both genders. These differences were more evident for fruits, particularly citrus. However, slightly different patterns arose for some sub-groups of vegetables, such as root vegetables and cabbage. Adjustment for body mass index, physical activity, smoking habits and education did not substantially modify the mean intakes of vegetables and fruits. CONCLUSIONS Total vegetable and fruit intake follows a south-north gradient in both genders, whereas for several sub-groups of vegetables a different geographic distribution exists. Differences in mean intake of V&F by centre were not explained by lifestyle factors associated with V&F intake.

Trends in self-reported past alcoholic beverage consumption and ethanol intake from 1950 to 1995 observed in eight European countries participating in the European Investigation into Cancer and Nutrition (EPIC).

OBJECTIVE To describe the trends of self-reported past consumption of alcoholic beverages and ethanol intake from 1950 to 1995 within the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN Data on consumption of beer/cider, wine and liqueur/spirits were obtained retrospectively at age 20, 30 and 40 years to calculate average consumption and ethanol intake for the time periods 1950-1975 (at age 20), 1960-1985 (at age 30) and 1970-1995 (at age 40). Regression analysis was conducted with the time period data to assess trends in past alcoholic beverage consumption and ethanol intake with time. SETTING The EPIC project. SUBJECTS In total, 392 064 EPIC participants (275 249 women and 116 815 men) from 21 study centres in eight European countries. RESULTS Generally, increases in beer/cider consumption were observed for most EPIC centres for 1950-1975, 1960-1985 and 1970-1995. Trends in wine consumption differed according to geographical location: downward trends with time were observed for men in southern European EPIC centres, upward trends for those in middle/northern European study centres. For women, similar but less pronounced trends were observed. Because wine consumption was the major contributor to ethanol intake for both men and women in most study centres, time trends for ethanol intake showed a similar geographical pattern to that of wine consumption. CONCLUSION The different trends in alcoholic beverage consumption and ethanol intake suggest that information depicting lifetime history of ethanol intake should be included in analyses of the relationship between ethanol and chronic diseases, particularly in multi-centre studies such as EPIC.

Management of bleeding following major trauma: an updated European guideline.

INTRODUCTION Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. RESULTS Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. CONCLUSIONS This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.

Análisis de la renovación urbana como estrategia de recuperación del centro histórico de bogotá : estudio de caso barrio Santa Bárbara Colonial (Nueva Santa Fé), en el periodo 1976-2000

El presente estudio de caso se propuso analizar la renovación urbana como estrategia de recuperación del centro histórico de Bogotá, utilizando como objeto de investigación, el proceso de renovación urbana que atravesó el Barrio Santa Bárbara Colonial, hoy conocido como Nueva Santa Fe, en el período 1976 (fecha de planteamiento del proyecto) a 2000 (año en el que se implementa el P.O.T), lo que significa nuevas condiciones en términos urbanos para ejecutar proyectos dentro de la ciudad), para lo cual se va a utilizar el concepto de vivienda, dentro de la renovación urbana, como variable que servirá de hilo conductor en el desarrollo del tema. El concepto de renovación que concierne a esta investigación está enmarcado en la década de los 70s y 80s, para lo cual se hace una breve referencia a la década de los 50s y 60s como antecedente de la creciente tendencia que tuvo la renovación urbana en Europa, continente que ha marcado una fuerte influencia en Latinoamérica y a su vez en Colombia. Con base a dicha estructuración, se da cuenta del tipo de investigación a desarrollar, una investigación cualitativa interesada en reflexionar sobre la forma en que se desarrolló la renovación urbana en el sector, haciendo evidente sus falencias y más adelante, los errores que se siguen cometiendo en los planteamientos actuales que tienen que ver con este tratamiento.

Futebol: o caminho de África até à Europa

Similarly to its past, Africa plays a similar role in the football world as it did during History, if we look at the creation of some of the most powerful empires in the world (the Portuguese, French or English, for example) – as an almost unlimited workforce ‘supplier’. Africa is still searching for its own place in the football world map. With a recent history filled with social conflicts, civil wars and racial discrimination, it was possibly in this continent that the sport was first seen as a means towards social evolution and as ‘peacemaker’. Although these problems also exist in African stadiums, supporters all over the continent go to matches to celebrate and socialize; in a reality constantly shrouded in conflicts and oppression, football is like a ‘light at the end of the tunnel’ to those who believe in a continent sustained by healthy political relations between countries, democratic values and a socially fair ‘use’ of a country’s potential – and always for the profit of its own people. But while see the attempt to use football with that objective, others see it as their ticket out of their country, to avoid getting involved in military conflicts and seek better life conditions for themselves and their families (both those who accompany them and those who remain in Africa). Others, still, try to make the most of others’ will to leave a less favourable social reality; Portugal, for its past as a colonizing country, also saw in the African players a way to develop the football phenomenon in its European territory. This article attempts to analyze the influence of Portuguese colonialism in the emigration of African players to Europe, since Portugal presents itself as one of the biggest ‘importers’ of these players.

Europa als ulls dels Annales (1093-1933)

During this first third of this century, the continent of Europe witnessed far-reaching territorial transformations in the nineteenth century model. To some extent, the setting wich had inspired the epistemological structure of the French regional school was being replaced by one in which -at least to externa1 appearances- the relationship between the physical environment and human activities was much less evident. The adaptation of the theoretical and methodological context to the new Europe seems to take the form of a non-lineal evolution, for in the latter years of the period examined, evolutionary tendencies indicate a return to the more classical model. In this way, the growing interest which the publication had shown in Atlantic Europe and topics of a more economic nature, was truncated. The traditional settings --especially the Mediterranean- came to the fore again and interest in rural societies was renewed. Likewise, the monographic studies which had demonstrated distinct functional objectives in the midtwenties, recovered elements of ecological explanation, and the search for the relationship between environment and society

A IURD e suas estratégias litúrgicas na Europa: reflexões a partir de Roma, Madri e Barcelona

Com base em pesquisas de campo, este trabalho analisa as estratégias litúrgicas da Igreja Universal do Reino de Deus (IURD) nas cidades de Roma, Madri e Barcelona. O foco da análise se encontra nas formas como a instituição, em suas diversas atividades (que se definem como "curativas" e que prometem sanar qualquer tipo de problema - seja de ordem social, física ou espiritual), viabiliza a inteligibilidade de conceitos e práticas para grupos de fiéis que são compostos, majoritariamente, por imigrantes das mais diversas nacionalidades, e também por membros das sociedades locais. Os dados etnográficos sugerem que os sentidos terapêuticos e de eficácia simbólica que costumam ser atribuídos por tais grupos de fiéis às atividades da IURD devem-se, em especial, à capacidade desta instituição em dialogar com públicos heterogêneos (tanto em termos socioculturais, quanto de origens nacionais e de experiências religiosas prévias), porém que em diversos casos apresentam importantes semelhanças: concepções de sagrado que são vinculadas a elementos que provêm de crenças e ritos relacionados com esoterismo, xamanismo e "bricolagens religiosas individuais". As estratégias analisadas evidenciam não apenas a interculturalidade de uma igreja neopentecostal brasileira atuante na Europa, mas também a ocorrência de dinâmicas da esfera religiosa nesse continente, antes só exportador de instituições e doutrinas religiosas e hoje, também um território fértil para o trabalho missionário.

Europa.

El CEIP Manuel Pérez de Bollullos Par del Condado (Huelva) ha recibido el Primer Premio de Páginas Web Educativas de la Junta de Andalucía, y ha sido galardonado con la Medalla de Oro al Mérito Educativo

Les situacions de minorització lingüística a Europa. 'Las situaciones de minorización lingüística en Europa'.

La minorización lingüística no es un fenómeno exclusivo de Europa; si se entiende la noción de minorización como aquella situación de una lengua que ve reducidos sus usos sociales y la presencia en diferentes ámbitos de tal manera que queda impedida o frenada la normalización, esta situación se encuentra extendida por todo el mundo y aún de manera más acentuada fuera de nuestro continente.