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En este artículo se resumen los objetivos, la metodología y las primeras conclusiones del proyecto «Compromiso por la calidad de las sociedades científicas en España», coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad, la Sociedad Española de Medicina Interna y el Instituto Aragonés de Ciencias de la Salud, en el que participan 48 sociedades científicas. Los objetivos de este proyecto son: disminuir la utilización de intervenciones médicas innecesarias, que son las que no han demostrado eficacia, tienen escasa o dudosa efectividad, o no son coste-efectivas; disminuir la variabilidad en la práctica clínica; difundir entre médicos y pacientes el compromiso con el uso adecuado de recursos sanitarios y, por último, promover la seguridad clínica. En el documento se incluyen 135 recomendaciones finales de «no hacer» elaboradas por 30 sociedades científicas españolas (AU)

This article summarises the objectives, methodology and initial conclusions of the project «Commitment to Quality of the Spanish Scientific Societies», coordinated by the Ministry of Health, Social Services and Equality, the Spanish Society of Internal Medicine and the Aragon Institute of Health Sciences, in which 48 scientific societies participate. This project's objectives are to decrease the use of unnecessary medical interventions, which are those that have shown no efficacy, have little or questionable effectiveness or are not cost-effective; decrease variability in clinical practice; promote the commitment among physicians and patients to properly use healthcare resources; and to promote clinical safety. The document includes 135 final recommendations for what not to do, prepared by 30 Spanish scientific societies (AU)

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This article summarises the objectives, methodology and initial conclusions of the project "Commitment to Quality of the Spanish Scientific Societies", coordinated by the Ministry of Health, Social Services and Equality, the Spanish Society of Internal Medicine and the Aragon Institute of Health Sciences, in which 48 scientific societies participate. This project's objectives are to decrease the use of unnecessary medical interventions, which are those that have shown no efficacy, have little or questionable effectiveness or are not cost-effective; decrease variability in clinical practice; promote the commitment among physicians and patients to properly use healthcare resources; and to promote clinical safety. The document includes 135 final recommendations for what not to do, prepared by 30 Spanish scientific societies.

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UNLABELLED: Our study identified pre-fracture variables, such as home status or function, that are directly or indirectly associated with frailty status before fracture. The prevention in the deterioration of those variables would improve the prognosis of those hip fractured, being this an important issue for the societies with increasingly aging population. INTRODUCTION: This study was designed to identify predictors of pain and declines in function among elderly patients following a fall-related hip fracture. METHODS: Patients aged 65 or older with a fall-related hip fracture retrospectively completed pre-fracture status questionnaires (T0; n = 740) and were then prospectively followed for 6 months (T1; n = 546). Of these, 474 were randomly selected to complete an additional 18 months of follow-up (T2; n = 356). Primary outcome measures were changes in the pain and function dimensions of the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire's short form (WOMAC-SF). Potential predictors included sociodemographic variables, in-hospital and clinical pre- and post-fracture data, and activities of daily living at baseline and follow-up. Multivariate logistic regression was used for analysis. RESULTS: Predictors of worsening pain at T1 and/or T2 included living in a home care situation or nursing home before the fracture (OR at T1, 1.515; OR at T2, 2.749), and low pre-fracture pain (OR at T1, 1.028; OR at T2, 1.027). Predictors of deterioration in function at T1 and/or T2 included age ≥85 years (OR at T1, 2.714; OR at T2, 4.762), lower income (OR at T1, 1.755), high pre-fracture hip function (OR at T1, 1.029; OR at T2, 1.028), referral to rehabilitation upon discharge (OR at T1, 2.378; OR at T2, 2.881), and longer delay between fall and surgery (OR at T1, 1.133; OR at T2, 1.124). CONCLUSIONS: Frailty before hip fracture is a predictor of greater post-fracture pain and deterioration in function. Given that exercise programs help prevent frailty, promoting exercise in elderly may improve the prognosis of hip fracture.

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Una nutrición balanceada es fundamental para mantener la salud en general. Como ya se ha demostrado, puede ayudar a prevenir enfermedad cardiovascular, diabetes, obesidad, algunos tipos de cáncer y muchas otras enfermedades. También el funcionamiento normal y la apariencia de la piel dependen de lo que se come y bebe. Por otro lado, la constante búsqueda por reducir o limitar el envejecimiento y con esto mejorar la apariencia estética, ha dado lugar al consumo de suplementos de todo tipo para contrarrestarlo. El envejecimiento cutáneo es un proceso dinámico y complejo, en el que están involucrados múltiples factores: genéticos, hormonales y ambientales. En la alimentación, la nutrición es la principal fuente de oligoelementos, vitaminas, aminoácidos, péptidos, proteínas, agua, antioxidantes. Esto se encuentra principalmente en frutas, verduras, legumbres, cereales y hortalizas. Estos alimentos bloquean el efecto perjudicial de los radicales libres.

A balanced nutrition is the corner stone for a good health. Cardiovascular disease, diabetes, obesity and cancer can be prevented with a balanced nutrition. Normal functioning and the appearance of the skin also depend about we eat and drink. On the other hand, human´s constant search for aesthetic improvement and delaying skin aging has led to the use of supplements to obtain balance. The skin aging is a dynamic and complex process that involves many factors such as genetics, hormonal and environmental determinants.

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Una nutrición balanceada es fundamental para mantener la salud en general. Como ya se ha demostrado, puede ayudar a prevenir enfermedad cardiovascular, diabetes, obesidad, algunos tipos de cáncer y muchas otras enfermedades. También el funcionamiento normal y la apariencia de la piel dependen de lo que se come y bebe. Por otro lado, la constante búsqueda por reducir o limitar el envejecimiento y con esto mejorar la apariencia estética, ha dado lugar al consumo de suplementos de todo tipo para contrarrestarlo. El envejecimiento cutáneo es un proceso dinámico y complejo, en el que están involucrados múltiples factores: genéticos, hormonales y ambientales. En la alimentación, la nutrición es la principal fuente de oligoelementos, vitaminas, aminoácidos, péptidos, proteínas, agua, antioxidantes. Esto se encuentra principalmente en frutas, verduras, legumbres, cereales y hortalizas. Estos alimentos bloquean el efecto perjudicial de los radicales libres.(AU)

A balanced nutrition is the corner stone for a good health. Cardiovascular disease, diabetes, obesity and cancer can be prevented with a balanced nutrition. Normal functioning and the appearance of the skin also depend about we eat and drink. On the other hand, human´s constant search for aesthetic improvement and delaying skin aging has led to the use of supplements to obtain balance. The skin aging is a dynamic and complex process that involves many factors such as genetics, hormonal and environmental determinants.(AU)

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OBJECTIVE: Epidemiological evidence suggests an association between psychological factors and functional dyspepsia (FD). Yet few randomized controlled trials (RCTs) of psychological interventions have been conducted for FD. We conducted an RCT to evaluate the efficacy of psychotherapy among chronic FD. METHODS: One hundred fifty-eight consecutive patients with FD were randomized to medical therapy plus psychotherapy consisted in 8 group and 2 individual sessions focused on teaching techniques for coping with FD (intensive treatment (IT); n=76) or medical therapy alone (conventional treatment (CT); n=82). Patients completed validated self-reported questionnaires before and after the 10-week treatment and 6 months later. Linear mixed-effects models were used, in intention-to-treat analysis. RESULTS: At the end of treatment period, statistically significant improvements were observed for IT compared with CT for dyspepsia-related quality of life (DRQoL). DRQoL mean changes of 6.09 and 3.54 were obtained in IT and CT patients, respectively (p=<0.0001); and SS mean changes of 11.55 and 4.57 were obtained in IT and CT patients, respectively (p=0.0013). Those improvements, measured by minimum clinically important difference (MCID), were clinically significant (DRQoL: 77% of the IT patients exceeded the MCID vs. the 45% of the CT; SS: 75% vs. 48%). Six months after treatment, those statistically significant improvements persisted for DRQoL (p=0.0067) and for SS (p=0.0405). Clinical improvements persisted for SS (63% vs. 41%). CONCLUSIONS: These findings suggest that adding psychotherapy to standard medical therapy improves short-term outcomes in patients with FD and may have long-term effects as well. The cost-effectiveness of intensive therapy needs to be evaluated. Registration number and name of trial registry: NCT01802710.

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El nevo verrucoso epidérmico es un desorden hamartomatoso del desarrollo epidérmico. Presentamos el caso de un varón de 9 años, quien consulta por una placa verrucosa en la cara interna del tobillo derecho. La histopatología demostró un nevo verrucoso epidérmico. Se realizó extirpación quirúrgica sin complicaciones ni recidivas. Existen múltiples variedades clínicas y opciones terapéuticas del mismo, dependiendo de la extensión de la lesión.

Verrucous epidermal nevus is a hamartroma disorder of the ectodermal development. We report a 9 years old male that developed a verrucous plaque on the internal part of the right ankle. Histopathological study reveled verrucous epidermal nevus. A surgical removal was performed without complications or recurrence. There are multiple clinical variations and treatments options, depending on the extension of the lesions.

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Se presenta una niña de 16 meses de edad, con una lesión de catorce meses de evolución que consistía en una única placa eritematosa, en forma de L, bien delimitada, localizada en la parte superior de la espalda. El signo de Darier fue positivo. La histopatología mostró edema intersticial y en la tinción con Giemsa, se observaron mastocitos. Se realizó el diagnóstico de un mastocitoma solitario. El mastocitoma solitario es una lesión tumoral benigna, que representa aproximadamente el 15% de la mastocitosis cutánea.

We report a 16 month years old female, with a 14 months history of a single erythematous, L shaped well-delimited plaque located on her upper back. Darier sign was positive. Histopathology revealed interstitial edema. The Giemsa staining showed mast cells. The diagnosis of a solitary mastocytoma was performed. Solitary mastocytoma is a benign tumoral lesion, that represents approximately 15% of cutaneous mastocytosis.

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El nevo verrucoso epidérmico es un desorden hamartomatoso del desarrollo epidérmico. Presentamos el caso de un varón de 9 años, quien consulta por una placa verrucosa en la cara interna del tobillo derecho. La histopatología demostró un nevo verrucoso epidérmico. Se realizó extirpación quirúrgica sin complicaciones ni recidivas. Existen múltiples variedades clínicas y opciones terapéuticas del mismo, dependiendo de la extensión de la lesión.(AU)

Verrucous epidermal nevus is a hamartroma disorder of the ectodermal development. We report a 9 years old male that developed a verrucous plaque on the internal part of the right ankle. Histopathological study reveled verrucous epidermal nevus. A surgical removal was performed without complications or recurrence. There are multiple clinical variations and treatments options, depending on the extension of the lesions.(AU)

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Se presenta una niña de 16 meses de edad, con una lesión de catorce meses de evolución que consistía en una única placa eritematosa, en forma de L, bien delimitada, localizada en la parte superior de la espalda. El signo de Darier fue positivo. La histopatología mostró edema intersticial y en la tinción con Giemsa, se observaron mastocitos. Se realizó el diagnóstico de un mastocitoma solitario. El mastocitoma solitario es una lesión tumoral benigna, que representa aproximadamente el 15% de la mastocitosis cutánea.(AU)

We report a 16 month years old female, with a 14 months history of a single erythematous, L shaped well-delimited plaque located on her upper back. Darier sign was positive. Histopathology revealed interstitial edema. The Giemsa staining showed mast cells. The diagnosis of a solitary mastocytoma was performed. Solitary mastocytoma is a benign tumoral lesion, that represents approximately 15% of cutaneous mastocytosis.(AU)

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BACKGROUND: The impact of hip fracture because of a fall on health-related quality of life (HRQoL) and activities of daily living (ADL) have not been well established. AIM: To evaluate changes in HRQoL and the ability to conduct ADL among patients with hip fracture because of a fall and to compare these changes with patients who did not fall and break a hip, adjusting by gender and age. METHODS: Adults aged 65 or more who attended the emergency departments of seven public hospitals were recruited in a prospective double-cohort study (fracture cohort, n = 776; non-fracture cohort, n = 115). ADL and HRQoL were assessed at baseline (during the postfall hospitalisation or by telephone afterwards) and 6 months later using the Barthel Index and the Lawton Brody Index for ADL, and the Short Form Health Survey (SF-12) and Western Ontario and McMaster Universities Osteoarthritis Index short form (WOMAC-SF) for HRQoL. RESULTS: Adjusting by gender, age and baseline status, a hip fracture was a strong predictor of decline in all outcomes measured except for mental quality of life among men (measured by SF-12). Hip fracture patients younger than 74 years reported significantly more pain (measured by WOMAC-SF) than the comparison group (p = 0.02), but this difference was not observed among older patients (p = 0.19 for 75-84 years; p = 0.39 for ≥ 85 years). DISCUSSION: Hip fractures have profound effects on HRQoL and ADL in both men and women, regardless of age. This indicates the need for special follow-up care of elderly hip fracture patients in the immediate and late postfracture periods.

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AIMS: To evaluate health-related quality of life (HRQoL) and functionality among older men and women who suffered a wrist fracture because of a fall and to identify postfracture consequences. METHODS: Observational, prospective cohort study of patients recruited in the emergency departments (ED) of six public hospitals of the Basque Health Service and one of the Catalan Health Service. Two groups of adults aged 65 or older were recruited: 960 with wrist fractures because of falls (fracture cohort) and 119 without fall-related wrist fractures in the previous year (non-fracture cohort). We collected sociodemographical and clinical data; general and specific HRQoL data measured by the 12-Item Short Form Health Survey (SF-12) and a short version of the Disabilities of the Arm, Shoulder, and Hand instrument (QuickDASH); and data about basic (BADL) and instrumental (IADL) activities of daily living, measured by the Barthel Index and the Lawton and Brody Index (LBI). RESULTS: Women with wrist fractures exhibited greater declines than men 6 months after the fall in all questionnaires except the LBI, and greater declines than those in the non-fracture cohort independent of gender. Patients aged 80 years and older presented with worse baseline scores in all the outcome measures and lost more HRQoL and functionality after wrist fractures. DISCUSSION: Women and older individuals experienced the greatest reductions in HRQoL and functionality after a fall-related wrist facture, suggesting that they might merit special attention in clinical care and public health policy. CONCLUSIONS: Specific prevention strategies may be needed to avoid or reduce the consequences of fall-related wrist fractures.

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En 1992, la Academia Americana de Pediatría lanzó la campaña “Backto sleep” para la prevención de la muerte súbita del lactante, con la recomendaciónde poner a los bebés a dormir tumbados boca arriba. Estapropuesta ha resultado eficaz para la prevención de la muerte súbita,que se ha reducido en un 40%, pero como consecuencia negativa ha generadoun aumento considerable de los casos de plagiocefalia posturalo deformidad craneal debido a la postura. La clave para una evoluciónfavorable del lactante con una deformidad craneal posicional es el diagnósticoy el tratamiento precoz, por ello, desde la consulta de Enfermeríapediátrica del Centro de Salud Gazalbide de Vitoria-Gasteiz, se decidióllevar a cabo una intervención de educación sanitaria con el objetivode informar y enseñar a los padres en la prevención de la DeformidadCraneal Postural (DCP) desde los primeros 15 días de vida del niño hastapasados los seis meses. Para ello, se elaboró un pequeño tríptico coninstrucciones para facilitar la labor de los progenitores y para ayudarlesa tomar conciencia de la importancia que tienen estas pequeñas accionescotidianas para sus hijos. Después de un año realizando este trabajo,el resultado es que, salvo pequeñas excepciones, los niños atendidosen ese período de 0 a 1 año no presentan signos significativos de plagiocefaliapostural (AU)

In 1992, the American Academy of Paediatrics launched a campaigncalled Back to Sleep for the prevention of sudden infant death syndrome,with the recommendation of putting infants on their backs and faceup for sleep. This recommendation has proven to be effective to preventsudden infant death that has been reduced by a 40%. However, a negativeconsequence of this measure has generated a considerable increasein the number of cases of postural plagiocephaly or cranial deformitycaused by posture. The key for a favourable outcome of the infant witha positional head deformity is early diagnosis and treatment. Becauseof this, from the paediatrics office of the Gazalbide health centre of Vitoria-Gasteiz, it was decided to conduct a health education interventionwith the aim of informing and training parents on the prevention of PosturalCranial Deformity (PCD) from the first 15 days of life of the infantuntil past the six months of life. For this purpose, a small brochure wasdeveloped with instructions to facilitate the work of the parents and tohelp them to become aware of the importance that these little daily actionshave on their children. After one year of implementation of thiswork, the results show that, with few exceptions, the children followedup in that period of time from 0 to 1 year of age do not present significantsigns of postural plagiocephaly (AU)

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Juxtapapillary duodenal diverticula and their possible complications are not frequent findings. We present the case of a woman with a giant juxtapapillary diverticulum, complicated by diverticulitis and areas of perforation of the wall that required urgent surgical treatment. We present the preoperative findings on computed tomography and magnetic resonance imaging.

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The mutation rate at 54 perfect (uninterrupted) dinucleotide microsatellite loci is estimated by direct genotyping of 96 Arabidopsis thaliana mutation accumulation lines. The estimated rate differs significantly among motif types with the highest rate for AT repeats (2.03 x 10(-3) per allele per generation), intermediate for CT (3.31 x 10(-4)), and lowest for CA (4.96 x 10(-5)). The average mutation rate per generation for this sample of loci is 8.87 x 10(-4) (s.e.=2.57 x 10(-4)). There is a strong effect of initial repeat number, particularly for AT repeats, with mutation rate increasing with the length of the microsatellite locus in the progenitor line. Controlling for motif and initial repeat number, chromosome 4 exhibited an elevated mutation rate relative to other chromosomes. The great majority of mutations were gains or losses of a single repeat. Generally, the data are consistent with the stepwise mutation model of microsatellite evolution. Several lines exhibited multiple step changes from the progenitor sequence, but it is unclear whether these are multi-step mutations or multiple single-step mutations. A survey of dinucleotide repeats across the entire Arabidopsis genome indicates that AT repeats are most abundant, followed by CT, and CA.

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BACKGROUND: Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials. AIM: To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain. METHODS: Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population. RESULTS: The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%. CONCLUSION: If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.

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Gas-producing infections are related to anaerobic bacteria and usually associated with immunosuppressive pathologies such as diabetes and have a fulminating course. We present the clinical course of a patient with diabetes whose infection progressed rapidly and ended in her dramatic death in a short period; surgical therapy was impossible, and the disease behaved similarly to type I emphysematous pyelonephritis.

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Objetivo. Conocer de forma cuantitativa la actividad investigadora de los médicos de nuestra área, describir su actitud hacia la investigación y valorar las dificultades encontradas para el desarrollo de la investigación. Diseño. Estudio descriptivo transversal. Emplazamiento. Área 7 de atención primaria de Madrid. Participantes. Médicos del Área 7. Mediciones principales. Se diseñó un cuestionario anónimo autoadministrado en el que se recogieron la edad, el sexo, los datos profesionales, la formación en metodología de investigación, la actividad investigadora, las preguntas de un cuestionario previamente validado para conocer la actitud hacia la investigación (puntuación entre 0 y 80) y una pregunta con 6 dificultades para realizar actividades investigadoras para asignar un valor. Resultados. Se recibieron 174 cuestionarios (49,4% de respuestas). El 65,9% de los que respondieron fue mujer, con una edad media de 43,23 ± 7,33 años, y el 55,5% era especialista en medicina familiar y comunitaria (MFyC). En los últimos 5 años, el 49,4% había publicado un trabajo científico y el 38% había presentado comunicaciones a congresos. La media de la actitud hacia la investigación fue 53,49 ± 10,59. Las dificultades para la investigación a las que otorga un mayor valor fueron, en orden decreciente, la presión asistencial, la escasez de tiempo, las deficiencias estructurales, la ausencia de líneas de investigación multicéntricas, la falta de incentivación y preparación, y la ausencia de motivación. Conclusiones. La actividad investigadora de nuestros médicos es semejante a la de otros estudios. La actitud hacia la investigación es sólo aceptable. Las principales dificultades declaradas son la presión asistencial y la escasez de tiempo (AU)

Objectives. To discover how much research doctors in our area do; to describe their attitudes to research; and to evaluate the hindrances to developing research that they found. Design. Cross-sectional, descriptive study. Setting. Area 7 of Primary Care, Madrid. Participants. Area 7 doctors. Main measurements. An anonymous self-administered questionnaire was designed in order to gather the following information: age, gender, professional details, training in research methodology, research activity, questions from a previously validated questionnaire for finding attitudes towards research (scores from 0 to 80), and a question for assigning a value to 6 hindrances to research. Results. 174 were returned (49.4% response). 65.9% of the doctors were women, with an average age of 43.23±7.33 years; and 55.5% were specialists in Family and Community Medicine. Over the last 5 years, 49.4% had published a scientific paper and 38% had given reports at congresses. The mean score on attitudes to research was 53.49±10.59. Hindrances to research were given in the following order, from greatest to least: case-load, lack of time, structural deficiencies, absence of multi-centred research lines, lack of incentives, lack of training, no motivation. Conclusions. The research activity of our doctors is similar to that found in other studies. Attitude to research is no better than "acceptable." The main hindrances stated were: case-load and lack of time (AU)

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