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Introducción: se realizó un estudio descriptivo observacional con el objetivo de conocer la prevalencia, duración y características de la lactancia materna en nuestra área sanitaria, como punto de partida para la implantación de mejoras en las prácticas de atención perinatal según la Iniciativa para la Humanización de la Asistencia al Nacimiento y la lactancia (IHAN) y monitorizar resultados a largo plazo; así como comparar con otras áreas de España. Material y métodos: se realizó una encuesta de alimentación infantil a niños de 0-2 años, con un total de 82 lactantes para conocer los indicadores de lactancia materna exclusiva antes de los seis meses, lactancia materna continuada al año y dos años de vida e índice de alimentación complementaria entre 6-8 meses. Además, se obtuvo información sobre la alimentación recibida en el día anterior de cada uno de 25 recién nacidos consecutivos que acudieron al centro, para obtener el indicador de lactancia materna exclusiva en lactantes de 0-15 días. Resultados: se obtuvo un índice de lactancia materna exclusiva en lactantes de 0-15 días de 68%, lactancia materna exclusiva antes de los seis meses de 37%, lactancia materna continuada al año y dos años de vida de 24 y 21% respectivamente. En cuanto al índice de alimentación complementaria, un 100% de niños entre 6-8 meses consumían otros sólidos, semisólidos o purés. Conclusiones: los datos de nuestro estudio se asemejan a otros datos nacionales publicados, pero distan aún mucho de las recomendaciones de la Organización Mundial de la Salud (AU)

Introduction: we conducted an observational and descriptive study with the aim of determining the prevalence, duration and characteristics of breastfeeding in our health district to establish a baseline for the implementation of improvements in perinatal care practices in adherence with the IHAN initiative, to monitor long-term results and to compare outcomes with other areas of Spain.Material and methods: we carried out a survey of nutrition in a sample of 82 children aged 0 to 2 years to calculate the indicators of exclusive breastfeeding up to 6 months; continued breastfeeding at ages 1 and 2 years and the prevalence of complementary feeding at age 6-8 months. We also collected information on the nutrition received the previous day in 25 neonates that attended the primary care centre to calculate the indicator of exclusive breastfeeding in infants aged 0 to 15 days.Results: we found a prevalence of exclusive breastfeeding of 68% in infants aged 0 to 15 days and 37% in infants aged 6 months, and a prevalence of continued BF of 24% at age 1 year and 21% at age 2 years. The proportion of infants that consumed other solid, semisolid or soft foods at ages 6 to 8 months was 100%.Conclusions: the findings of our study were similar to those of other studies in Spain, but were still far from the targets recommended by the World Health Organization. (AU)

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Introducción: En pacientes con artrosis de rodilla se ha identificado un 30% de asociación de dolor de sensibilización central (DSC). El objetivo es analizar la persistencia de DSC en pacientes tras artroplastia de rodilla y su correlación con la intensidad del dolor, funcionalidad y los factores determinantes asociados, además de evaluar la exploración física como instrumento de valoración. Material y métodos: Estudio cuasiexperimental antes-después de pacientes intervenidos de artroplastia total de rodilla. Se analiza la evolución de variables subjetivas (características del dolor, cuestionarios painDETECT, WOMAC y escala visual numérica) y de exploración física (hiperalgesia térmica, alodinia, hipoestesia, algometría y goniometría), tres meses antes y tres y seis meses después de la cirugía mediante el test de ANOVA de medidas repetidas para las cuantitativas y el Q de Cochran para las cualitativas. Se utilizó la prueba de Spearman para la correlación de los cuestionarios, del PD-Q y variables de exploración y para el modelo multivariante del PD-Q con determinantes clínicos. Resultados: Sesenta y siete pacientes completaron el estudio. La evolución de las variables cuantitativas y cualitativas fue significativa, con correlación entre cuestionarios. En el modelo multivariante lineal de PD-Q se obtuvo relación significativa de antecedentes de limitación movilidad en flexión, dolor musculoesquelético crónico y la asociación de depresión y tiempo. Conclusiones: Un porcentaje significativo de pacientes con artrosis de rodilla tras artroplastia persistieron con probable DSC, correlacionándose con intensidad y funcionalidad. La limitación de movilidad y comorbilidad crónica previas podrían ser determinantes de DSC, siendo la exploración y anamnesis, herramientas útiles en consulta.(AU)

IntroductionIn patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument.Material and methodsQuasi-experimental before–after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. Results: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. Conclusions: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.(AU)

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INTRODUCTION: In patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument. MATERIAL AND METHODS: Quasi-experimental before-after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. RESULTS: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. CONCLUSIONS: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.

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OBJECTIVE: To assess the efficacy of percutaneous tibial nerve stimulation and its effectiveness over time in urge urinary incontinence. MATERIALS AND METHODS: We performed a longitudinal, observational, prospective study without a control group that included patients diagnosed with urge urinary incontinence who met the inclusion/exclusion criteria. Patients were treated with 12 sessions of percutaneous tibial nerve stimulation by electroacupuncture. Baseline and post-treatment data were collected from medical records. Patients were assessed by a telephone interview after the treatment. The variables studied were sociodemographic variables, time until interview, the Sandvick and ICIQ-SF questionnaires, daytime urinary frequency, night-time urinary frequency, use of absorbent material and drug treatment. A descriptive analysis of the variables was performed and patient outcomes were analysed with generalised linear mixed models by SPSS v. 25 statistics software. RESULTS: A total of 32 women were included (mean age 58.69±8.96). All variables significantly improved after treatment: Sandvick by 4.38 points (95% CI: 2.68-6.08, P<.001), ICIQ-SF by 8.55 points (95% CI: 5.89-11.22, P<.001), daytime urinary frequency by 2.10 points (95% CI: 1.04-3.16, P<.001) and night-time urinary frequency by 1.31 points (95%CI: 0.58-2.04, P<.001). However, 16.34±9.72 months after treatment, these improvements diminished but without reaching baseline levels. CONCLUSIONS: Percutaneous tibial nerve stimulation by electroacupuncture is effective for the treatment of urge urinary incontinence. Although its effect diminishes over time, the improvement over the baseline situation is maintained during the follow-up period.

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The development of physiologically based (PB) models to support safety assessments in the field of nanotechnology has grown steadily during the last decade. This review reports on the availability of PB models for toxicokinetic (TK) and toxicodynamic (TD) processes, including in vitro and in vivo dosimetry models applied to manufactured nanomaterials (MNs). In addition to reporting on the state-of-the-art in the scientific literature concerning the availability of physiologically based kinetic (PBK) models, we evaluate their relevance for regulatory applications, mainly considering the EU REACH regulation. First, we performed a literature search to identify all available PBK models. Then, we systematically reported the content of the identified papers in a tailored template to build a consistent inventory, thereby supporting model comparison. We also described model availability for physiologically based dynamic (PBD) and in vitro and in vivo dosimetry models according to the same template. For completeness, a number of classical toxicokinetic (CTK) models were also included in the inventory. The review describes the PBK model landscape applied to MNs on the basis of the type of MNs covered by the models, their stated applicability domain, the type of (nano-specific) inputs required, and the type of outputs generated. We identify the main assumptions made during model development that may influence the uncertainty in the final assessment, and we assess the REACH relevance of the available models within each model category. Finally, we compare the state of PB model acceptance for chemicals and for MNs. In general, PB model acceptance is limited by the absence of standardised reporting formats, psychological factors such as the complexity of the models, and technical considerations such as lack of blood:tissue partitioning data for model calibration/validation.

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Different types of computational models have been developed for predicting the biokinetics, environmental fate, exposure levels and toxicological effects of chemicals and manufactured nanomaterials (MNs). However, these models are not described in a consistent manner in the scientific literature, which is one of the barriers to their broader use and acceptance, especially for regulatory purposes. Quantitative structure-activity relationships (QSARs) are in silico models based on the assumption that the activity of a substance is related to its chemical structure. These models can be used to provide information on (eco)toxicological effects in hazard assessment. In an environmental risk assessment, environmental exposure models can be used to estimate the predicted environmental concentration (PEC). In addition, physiologically based kinetic (PBK) models can be used in various ways to support a human health risk assessment. In this paper, we first propose model reporting templates for systematically and transparently describing models that could potentially be used to support regulatory risk assessments of MNs, for example under the REACH regulation. The model reporting templates include (a) the adaptation of the QSAR Model Reporting Format (QMRF) to report models for MNs, and (b) the development of a model reporting template for PBK and environmental exposure models applicable to MNs. Second, we show the usefulness of these templates to report different models, resulting in an overview of the landscape of available computational models for MNs.

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OBJECTIVE: To analyze venous thrombotic complications in transplanted patients as a function of their body mass index (BMI). MATERIALS AND METHODS: This single-center, observational retrospective study of individuals undergoing liver transplantation between January 2008 and December 2014 analyzed the frequency of pretransplant portal thrombosis, post-transplant venous complications (early and late portal thrombosis), deep vein thrombosis, pulmonary thromboembolism and the survival outcomes as a function of World Health Organization BMI class. RESULTS: Liver transplantation was performed in 208 patients during the study period. No statistically significant differences in study variables were found as a function of BMI in bivariate analyses (P < .05), and Kaplan-Meier survival analysis results were also nonsignificant. CONCLUSION: No differences in the rate of venous thrombotic complications or survival were found as a function of the BMI class of these liver transplant recipients. These findings are in line with previous reports that complication rates are not higher in obese patients and support the proposal that obesity should not be considered a contraindication for liver transplantation based on the risk of venous complications.

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BACKGROUND: We describe the results of our liver transplantation (LT) patients for hepatocellular carcinoma (HCC) in 2004 to 2012 to determine the differences on the basis of time on the waiting list to establish the risk of recurrence of liver disease. METHODS: Clinical variables were recorded for both donors and recipients as well as variables of diagnosis, the use of transarterial chemoembolization during the waiting list time (WLT), complications, re-transplantation, and exitus. Fifty-eight patients were analyzed. Mean age was 57 ± 8 years (men, 83%; 48 patients). Viral etiology of HCC was 50% (n = 29); alcoholic, 26% (n = 15); and others, 24% (n = 14). RESULTS: Exitus was established in 24 patients (41%); only 5 patients (7%) were attributable to HCC. In the cohort of patients with less than 6 months of WLT, we registered both higher rates of downstaging protocols (10.7% vs 7.5%) and tumor size (3 cm vs 2 cm) compared with the other group. Bivariate studies were conducted according to the WLT (WLT <6 months, WLT ≥6 months), finding differences in recurrence of liver disease (P < .05). This fact was confirmed after a binary logistic regression. CONCLUSIONS: Our results in a subgroup of less than 6 months of WLT included patients with increased tumor size or presentation of multiple nodes, with a worse prognosis and therefore to be prioritized in the treatment of LT. Therefore, in our population there is a significant risk of tumor recurrence in patients with less WLT for LT, but it cannot be overestimated to all type of patients with HCC.

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Polystyrene/divinylbenzene (PS-DVB) macroporous monoliths obtained using highly concentrated emulsions as templates show a superhydrophobic behaviour, restricting their potential technological applications, especially those related to adhesion and wetting. Air plasma treatments were carried out in order to modulate wetting properties, modifying the surface chemical composition of macroporous polystyrene/divinylbenzene materials. The superhydrophobic behaviour was rapidly suppressed by air plasma treatment, greatly reducing the water contact angle, from approximately 150 degrees to approximately 90 degrees, in only 10 seconds of treatment. The new surface chemical groups, promoted by plasma active species, were characterized by surface analysis techniques with different depth penetration specificity (contact angle, XPS, FTIR and SEM). Results demonstrated that very short treatment times produced different chemical functionalities, mainly C-O, C=O, O-C=O and C-N, which provide the materials with predominantly acidic surface properties. However, plasma active species did not penetrate deeply through the interconnected pores of the material. FTIR analysis evidenced that the new hydrophilic surface groups promoted by plasma active species are in a negligibly concentration compared to bulk chemical groups, and are located in a very thin surface region on the PS-DVB monolith surface (significantly below 2 microm). XPS analysis of treated monoliths revealed a progressive increase of oxygen and nitrogen content as a function of plasma treatment time. However, oxidation of the PS-DVB monoliths surface prevails over the incorporation of nitrogen atoms. Finally, SEM studies indicated that the morphology of the plasma treated PS-DVB does not significantly change even for the longest air plasma treatment time studied (120 s).

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Objetivos: el objetivo principal de esta revisión es conocer los diagnósticos enfermeros relacionados con cuidados paliativos a través de la revisión electrónica y manual de trabajos publicados. Material y métodos: revisión sistemática de la literatura basada en la búsqueda bibliográfica electrónica y manual de artículos escritos en castellano que relacionen diagnósticos de enfermería con cuidados paliativos. Las bases de datos consultadas fueron BDENF y Cuiden y las palabras claves utilizadas fueron NANDA, diagnósticos enfermería y paliativos. En la búsqueda manual, se revisaron las comunicaciones y ponencias presentadas en los congresos nacionales de cuidados paliativos y las publicaciones en la revista Medicina Paliativa desde enero de 2004 hasta diciembre de 2009. Resultados: se seleccionaron 8 trabajos que cumplían con los criterios de inclusión: 3 descriptivos, 2 comunicaciones pósteres y 3 ponencias en congresos. Se excluyeron 2 estudios. Se describen las características principales de cada uno de los trabajos. Todos ellos concluyen con un listado de diagnósticos enfermeros prevalentes para utilizar en los planes de cuidados aplicables en diferentes niveles asistenciales (domicilio, unidad de cuidados paliativos o ambos). Conclusiones: el escaso número de trabajos, las limitaciones propias de los artículos retrospectivos y el bajo número de registros de pacientes incluidos, no permiten interpretar como definitivos estos resultados. Todos los autores tienen la clara intención de realizar una lista con los diagnósticos más prevalentes en cuidados paliativos oscilando en número desde 9 hasta 14. La suma de diagnósticos hace referencia tanto a la esfera física (21 de 35), emocional (9 de 35), sociofamiliar (3/35) y espiritual (2 de 35). En conjunto, por tanto, estos trabajos responden a la visión multidimensional propia de los cuidados paliativos (AU)

Objectives: the main objective of this review was to know the nursing diagnoses related to palliative care through the electronic and manual review of published relevant papers. Material and methods: a systematic review of the literature based on an electronic and manual bibliographical search of Spanish written papers relating nursing diagnoses and palliative care. The searched databases were BDENF and Cuiden. Key words inc1uded NANDA, nursing diagnoses, and palliative. On the manual search, oral communications and major Spanish palliative care meetings were reviewed, Papers published in the Medicina Paliativa journal from January 2004 to December 2009 were reviewed too. Results: eight papers according to the inclusion criteria were selected: 3 of them were descriptive, 2 were poster communications, and 3 were plenary session proceedings. Two papers were excluded. The main characteristics of each paper are described. All papers include a list of prevalent nursing diagnoses to be used in care plans with application at all levels (home, palliative care unit or both). Conclusions: we cannot take these results as definitive due to the limitations of retrospective papers, the small number of studies found, and the small number of patients included. The authors have a clear aim of making a checklist (9 to 14 diagnoses) with the most prevalent diagnoses in palliative care. The diagnoses recorded refer to the physical (21 of 35), emotional (9 of 35), social and family (3 of 35), and spiritual (2 of 35) domains. Regarding the papers included, they provide an overview of the multidimensional approach required in palliative care (AU)

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Objetivo: conocer si la intervención de un equipo de soporte hospitalario (UFISS), mejora la calidad de vida de los pacientes atendidos según la escala Palliative Outcome Scale (POS). Sujetos y método: estudio prospectivo mediante la aplicación de la escala POS al ingreso y alta de los pacientes atendidos por el equipo de Cuidados Paliativos del Hospital Universitario Arnau de Vilanova entre octubre 2006 y enero 2007. Criterios exclusión: sólo una sola valoración; intervención inferior a cinco días; pacientes en situación agónica; evaluaciones con falta de datos. Otras variables estudiadas: edad, sexo y servicio de procedencia. Análisis estadístico con test no paramétrica de la U de Mann-Whitney y diferencia antes y después con test de signos de Wilcoxon. Significación de p < 0,05. Resultados: de los 115 pacientes valorados, 50 cumplían los criterios de inclusión. El 60% eran hombres. Media de edad de 67,5 años (16). Los pacientes provenían de servicios médicos (86%). El resultado global del POS mejora de forma significativa tras la intervención de la UFISS(p < 0,05). También mejoran: dolor (p < 0,01), otros síntomas (p < 0,05),información (p < 0,05), tiempo perdido con tratamientos (p < 0,05), y la manera en cómo se han abordado los asuntos pendientes (p < 0,05). Corregido cada ítem del POS por sexo, edad (menor y mayor de 70 años) y servicio que los deriva, encontramos que los resultados son similares, exceptuando el caso de paciente > 70 años, en los cuales mejora significativamente su nivel de angustia. Conclusiones: la intervención del equipo de UFISS de Cuidados Paliativos mejora significativamente la calidad de vida de los pacientes atendidos. Las áreas que mejoran son el dolor, otros síntomas, la información, el tiempo perdido y la forma de tratar los asuntos pendientes (AU)

Objective: to describe whether an intervention by a Palliative Care Supportive Team in a University Hospital can improve quality of life (QL)as assessed by the Palliative Outcome Scale (POS). Patients and methods: a longitudinal, prospective survey using POS during the first visit and at discharge in all patients treated by our palliative care team (October 2006 to January 2007). Exclusion criteria:1) patients with only one assessment, (survival less than 1 week or first assessment prior to the study period). 2) Assessments with any missing data. 3) Patients in their last hours of life. 4) Assessments with missing data. Other variables we analyzed were: age, sex, and referring department. For patient analyses by groups we used the Mann-Whitney non parametrical U-test, and to establish differences before and after the intervention we used Wilcoxon's test. The level of significance we used was p < 0.05. Results: during the study, of all 115 newly treated patients, 50 were selected for the analysis; 60% were men, average age was 67.5; 86% were referred by medical specialists. Global POS improvement was significant after the palliative care intervention (p < 0.05). The dimensions that improved most were: pain (p < 0.01); other symptoms (p < 0.05); information(p < 0.05), wasted time (p < 0.05), and the way problems were resolved(p < 0.05). A POS analysis by sex, age (younger or older than 70), and ward of origin showed no differences except for anxiety, which improved especially among patients over 70, even though this item did not affect final results. Conclusions: a) a palliative care intervention by a supportive team improves QL for patients; and b) pain, other symptoms, information, waste of time, and the way outstanding matters were dealt with are the QL dimensions that improved most (AU)

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Las enfermedades atópicas aparcen en las primeras décadas de la vida y están directamente ligadas a la maduración del sistema inmune. La dermatitis atópica (DA) es la primera manifestación de estas enfermedades en el individuo atópico, es frecuente en la infancia y alcanza su prevalencia más alta durante los tres primeros años de vida. Se trata de una enfermedad en aumento que ha duplicado su prevalencia en las tres últimas décadas en los países industrializados. Aunque el eccema se suele considerar un problema menos, distintas investigaciones demuestran que puede causar importantes alteraciones en la vida de los niños y suponer un coste nada despreciable para las familias y los sistemas de salud. Un tercio de los niños con DA tienen IgE específica para algún alimento y otros muestran pruebas del parche positivas frente a estos alergenos. Muchos padres y pediatras asumen que la sensibilización a alimentos es la causa de eccema, un enfoque que impide un apropiado tratamiento de la piel y tiene consecuencias negativas que incluyen pruebas innecesarias, carencias nutricionales y costes económicos. La cuestión es si la IgE específica o las pruebas del parche positivas frente a alimentos tienen un papel etiológico en la aparición del eccema. Cuando estas pruebas son negativas tienen un alto valor predictivo, descartando a los alimentos como alergenos sospechosos. Sin embargo, las pruebas positivas a menudo no se correlacionan con síntomas clínicos. El efecto causal de cada unos de estos alimento sen el desarrollo del eccema debe ser comprobado mediante prueba de provocación controlada y dieta de eliminación. La evitación de los alimentos implicados en las pruebas de provocación controlada debe conducir a una mejoría clínica. En este artículo se revisan la patogénesis y el tratamiento de la dermatitis atópica y se concluye la participación etiológica de la alergia a alimentos debe ser comprobada mediante pruebas de provocación controlada en cada paciente antes de instaurar una dieta de eliminación prolongada

Atopic diseases appear in the first decade of lige and are directly linked to the maturation of the immune system. Atopic dermatitis (AD) is usually the first manifestation, with the highest prevalence during the first 3 years. Prevalence of this disease has increases by two o three-fold during the past three decades in industrialised countries. While eczema is often seen to be a minor problem, research has shown than it can cause considerable disruption to the lives of children and their career, and can incur significant cost for the family and the healthcare system. Roughly one third of children with AD have specific food igE and some researches detect positive patch tests with these allergens. Most parents and paediatricians assume foods also cause the eczema, a focus that diverts proper skin therapy and has negative outcomes including nutritional deficiency, costly referrals, and unnecessary testing. The question is whether specific food IgE or positive patch test are of pathogenic importance in the causation of lesions of anatomic exzema. Negative skin prick of patch tests or serum allergen specific IgE have a high predictive value for ruling out suspected allergens. However, positive tests often donot correlated with clinical sumptoms and should be confirmed with controlled food challenges and elimination diets. Avoidance of foods implicated in controlled challenges should result in clinical improvement. We review the pathogeneses and treatment of AD and conclude thta the etiologically participation of food allergy could be confirmed in each patient with and adequate food challenge test before begining a diet

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INTRODUCTION: Flu vaccination (FV) in elderly patients at risk is linked to a 50%-60% reduction in hospital admissions and up to an 80% drop in deaths from complications arising from the illness. Equally clear benefits have been found for other risk groups, such as patients with chronic cardiovascular or respiratory diseases. The vaccine is cost-effective for both the elderly and other risk groups. Despite this, vaccination rates are low, even among health staff. OBJECTIVES: To update our knowledge of FV by means of a review of the bibliography and to describe a series of interventions that have proved successful in increasing vaccination rates. PROGRAMME: To discover procedures, the following factors were analysed: the environment, patients and health professionals that condition vaccination, the characteristics of the health-care organisation for the vaccination campaign, and the clinical organisation of risk groups required. DISCUSSION: After this analysis, certain communicated strategies that manage to increase vaccination coverage and others that could be introduced into primary care were discussed. We conclude that, given the clinical evidence available and the ease of introducing certain other interventions, improvement of flu vaccination procedures and increased vaccine coverage of patients at risk is not only advisable, but is an ethical imperative. Improvements that are within the possibilities of every primary care clinic could be introduced.

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Introducción. La vacunación antigripal (VAG) en ancianos de riesgo se asocia con una reducción del 50-60% de las hospitalizaciones y hasta el 80% de los fallecimientos derivados de las complicaciones de la enfermedad. Se han descrito igualmente claros beneficios para otros grupos de riesgo, como los pacientes con enfermedades crónicas cardiovasculares o respiratorias. La vacuna tiene una buena relación coste-beneficio, tanto en ancianos como en otros grupos de riesgo. Pese a ello, se observan bajas tasas de vacunación, incluso entre el propio personal sanitario. Objetivos. Actualizar los conocimientos sobre la VAG mediante una revisión de la bibliografía y describir una serie de intervenciones que han sido ensayadas con éxito para aumentar las tasas de esta vacunación. Programa. Para conocer el proceso se analizan los factores del entorno, de los pacientes y de los profesionales sanitarios que condicionan la vacunación, las características de la organización asistencial que disponemos para la campaña vacunal, y la necesaria organización clínica sobre los grupos de riesgo. Discusión. Tras este análisis es posible la discusión de algunas estrategias comunicadas que han conseguido incrementar la vacunación, y proponer otras que serían posibles en el ámbito de nuestra atención primaria. Nuestra conclusión es que, dada la evidencia clínica disponible y la alta aplicabilidad en la práctica de algunas intervenciones implementadoras es, además de aconsejable, éticamente exigible abordar la mejora del proceso de vacunación antigripal y el aumento de las coberturas vacunales en pacientes de riesgo, pudiendo introducir mejoras dentro de las posibilidades de cada puesto asistencial de atención primaria

Introduction. Flu vaccination (FV) in elderly patients at risk is linked to a 50%-60% reduction in hospital admissions and up to an 80% drop in deaths from complications arising from the illness. Equally clear benefits have been found for other risk groups, such as patients with chronic cardiovascular or respiratory diseases. The vaccine is cost-effective for both the elderly and other risk groups. Despite this, vaccination rates are low, even among health staff. Objectives. To update our knowledge of FV by means of a review of the bibliography and to describe a series of interventions that have proved successful in increasing vaccination rates. Programme. To discover procedures, the following factors were analysed: the environment, patients and health professionals that condition vaccination, the characteristics of the health-care organisation for the vaccination campaign, and the clinical organisation of risk groups required. Discussion. After this analysis, certain communicated strategies that manage to increase vaccination coverage and others that could be introduced into primary care were discussed. We conclude that, given the clinical evidence available and the ease of introducing certain other interventions, improvement of flu vaccination procedures and increased vaccine coverage of patients at risk is not only advisable, but is an ethical imperative. Improvements that are within the possibilities of every primary care clinic could be introduced

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OBJECTIVE: To determine the proportion of older patients (>or= 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the 2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. DESIGN: Observational, descriptive, retrospective study. SETTING: The urban health center serving Area 19 in the Community of Valencia (eastern Spain). PARTICIPANTS: Of the 29757 inhabitants served by this center (10.4% >or= 65 years), we included 3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853 older patients with chronic diseases who were not vaccinated. MAIN MEASURES: Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. RESULTS: The vaccination rates were 52.12% (95% CI, 50.4-53.9) for older patients, 26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17% came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for nonvaccination was recorded for only 10.4%. CONCLUSIONS: Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good.

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Objetivo. Determinar la proporción de pacientes ancianos (≥ 65 años) adscritos al centro de salud estudiado, con alguna enfermedad crónica y que no fueron vacunados en la campaña antigripal 2001-2002, y conocer el porqué. Diseño. Observacional, descriptivo, retrospectivo. Emplazamiento. Centro de salud urbano del Área 19 de la Comunidad Valenciana. Participantes. De los 29.757 habitantes adscritos (10,4% ancianos), se incluyó a3.868 pacientes registrados en los programas de crónicos y a 2.980 en el de vacunación antigripal (VAG), y se encontró a 853pacientes crónicos ancianos no vacunados. Mediciones principales. Tasa de VAG en crónicos, ancianos y crónicos ancianos. Auditoría de historias clínicas para conocerlas causas de la falta de vacunación en estos últimos. Resultados. La tasa de VAG en los pacientes ancianos fue del 52,12% (intervalo de confianza [IC] del 95%, 50,4-53,9), en los pacientes crónicos fue del 26,96% (IC del95%, 25,6-28,4) y en los pacientes ancianos crónicos del 54,43% (IC del 95%, 51,4-57,5).De los 853 ancianos crónicos no vacunados, el 48,17% acudió al menos una vez al centro de salud durante la campaña de vacunación. El 27,34% hacía más de 1 año que no acudía al centro de salud y sólo en el 10,4%se había documentado la causa de la falta de vacunación. Conclusiones. La cobertura de VAG en ancianos y crónicos es baja. Es posible intervenir en grupos accesibles de pacientes para incrementar la tasa de vacunación

Objective. To determine the proportion of older patients (≥ 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. Design. Observational, descriptive, retrospective study. Setting. The urban health center serving Area19 in the Community of Valencia (eastern Spain).Participants. Of the 29 757 inhabitants served by this center (10.4% ≥ 65 years), we included3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853older patients with chronic diseases who were not vaccinated. Main measures. Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. Results. The vaccination rates were 52.12%(95% CI, 50.4-53.9) for older patients,26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17%came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for non-vaccination was recorded for only 10.4%.Conclusions. Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good

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INTRODUCTION: The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied. OBJECTIVES: To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure. PATIENTS AND METHODS: We studied the patients with non traumatic rhabdomyolysis (creatinkinase > 1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others. RESULTS: We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%. CONCLUSION: CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.

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Introduction. The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied. Objectives. To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure. Patients and methods. We studied the patients with non traumatic rhabdomyolysis (creatinkinase >1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others. Results. We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%. Conclusion. CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.(AU)

Introducción. El pronóstico de la rabdomiólisis depende del desarrollo de fracaso renal agudo, el cual depende a su vez de la rapidez en instaurar medidas preventivas. El diagnóstico de certeza de rabdomiólisis se basa en el hallazgo de cifras elevadas de creatinquinasa en plasma, y el de sospecha suele recaer en los antecedentes inmediatos, como traumatismos. Habitualmente las rabdomiólisis de origen no traumático carecen de un antecedente llamativo, y la sospecha debería recaer en la clínica que presenten los pacientes, pero ésta ha sido escasamente estudiada. Objetivos. Describir la semiología asociada a cuadros de rabdomiólisis no traumáticas e identificar los síntomas que motivaron a los enfermos a acudir a urgencias, para facilitar la sospecha diagnóstica. Pacientes y métodos. Pacientes diagnosticados de rabdomiólisis no traumática (creatinquinasa >1.000 UI/l) en un servicio de urgencias externas hospitalarias a lo largo de un año. Obtuvimos información acerca de los síntomas padecidos, y del síntoma en concreto que los motivó a acudir a urgencias. Los síntomas referidos fueron clasificados en cuatro grupos: musculares, urinarios, neurológicos y otros. Resultados. Entrevistamos a 49 pacientes. Los grupos de síntomas aparecieron en los enfermos con las siguientes frecuencias relativas: musculares 51%, urinarios 18%, neurológicos 67% y otros 47%. Representaron el motivo principal de consulta con las siguientes frecuencias absolutas: musculares 16%, urinarios 2%, neurológicos 48%, otros 22%, musculares y neurológicos asociados 6%, neurológicos y otros asociados 6%. Conclusión. Debería determinarse la CK en todos aquellos pacientes que acudan a urgencias afectos de algún trastorno neurológico (AU)

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