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Julio 2014 PDF Imprimir E-mail
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SELECCIÓN DE REFERENCIAS BIBLIOGRÁFICAS DE LO PUBLICADO EN RELACIÓN CON ATENCIÓN PRIMARIA
Selección realizada por Antonio Manteca González
 
 
Rosen MA, Pronovost PJ. Advancing the use of checklists for evaluating performance in health care. Acad Med 2014;89:963-965 [AO,I]
AVANCES EN EL USO DE LISTAS DE COMPROBACIÓN PARA EVALUAR EL RENDIMIENTO EN ATENCIÓN SANITARIA
 
Ten Cate O. What is a 21st-century doctor? Rethinking the significance of the medical degree. Acad Med 2014;89):966-969 [AO,I]
RECONSIDERAR EL SIGNIFICADO DEL TÍTULO DE MEDICINA
 
Schmutz J, Eppich WJ, Hoffmann F, Heimberg E, Manser T. Five steps to develop checklists for evaluating clinical performance: an integrative approach. Acad Med 2014;89:996-1005 [T,I]
CINCO PASOS PARA DESARROLLAR LISTAS DE COMPROBACIÓN PARA EVALUAR EL RENDIMIENTO CLÍNICO: ABORDAJE INTEGRAL
 
Humbert AJ, Miech EJ. Measuring gains in the clinical reasoning of medical students: longitudinal results from a school-wide script concordance test. Acad Med 2014;89:1046-1050 [T,I]
MEDIR LAS GANANCIAS EN RAZONAMIENTO CLÍNICO DE LOS ESTUDIANTES DE MEDICINA: RESULTADOS LONGITUDINALES DE UNA PRUEBA DE CONCORDANCIA DE PATRONES EN EL ÁMBITO DE UNA FACULTAD
 
 
Rajbhandari R, Chung RT. Screening for hepatitis B virus infection: a public health imperative. Ann Intern Med 2014;161:76-77 [AO,I]
CRIBAJE DE LA INFECCIÓN POR EL VIRUS DE LA HEPATITIS B: IMPERATIVO DE SALUD PÚBLICA
 
Tsai AC, Lucas M, Sania A, Kim D, Kawachi I. Social integration and suicide mortality among men: 24-year cohort study of U.S. health professionals. Ann Intern Med 2014;161:85-95 [S,II]
INTEGRACIÓN SOCIAL Y MORTALIDAD POR SUICIDIO EN HOMBRES: ESTUDIO DE COHORTE DE 24 AÑOS DE PROFESIONALES SANITARIOS ESTADOUNIDENSES
 
Kesselheim AS, Bykov K, Avorn J, Tong A, Doherty M, Choudhry NK. Burden of changes in pill appearance for patients receiving generic cardiovascular medications after myocardial infarction: cohort and nested case-control studies. Ann Intern Med 2014;161:96-103 [CC,II]
CARGA DE CAMBIOS EN LA APARIENCIA DE LAS PASTILLAS EN PACIENTES QUE RECIBEN MEDICACIONES CARDIOVASCULARES GENÉRICAS TRAS EL INFARTO DE MIOCARDIO: ESTUDIOS DE COHORTE Y DE CASO-CONTROL ANIDADOS
 
Lansdorp-Vogelaar I, Gulati R, Mariotto AB, Schechter CB, de Carvalho TM, Knudsen AB, et al. Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits. Ann Intern Med 2014;161:104-112 [T,II]
PERSONALIZACIÓN POR EDAD DEL CESE DEL CRIBAJE DE CÁNCER SEGÚN COMORBILIDAD: MODELO DE ESTIMACIÓN DE BENEFICIOS Y PERJUICIOS
 
Shaw RJ, McDuffie JR, Hendrix CC, Edie A, Lindsey-Davis L, Nagi A, et al. Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Ann Intern Med 20145;161:113-121 [M,II]
EFECTOS DE LOS PROTOCOLOS MANEJADOS POR ENFERMERAS EN EL TRATAMIENTO AMBULATORIO DE ADULTOS CON ENFERMEDADES CRÓNICAS: REVISIÓN SISTEMÁTICA Y METAANÁLISIS
 
Knox K. Approaching suicide as a public health issue. Ann Intern Med 2014;161:151-152 [AO,I]
ABORDAJE DEL SUICIDIO COMO UNA CUESTIÓN DE SALUD PÚBLICA
 
Jauhar S, Battinelli D. Are nurses an answer to new primary care needs? Ann Intern Med 20145;161:153-154 [AO,I]
¿SON LAS ENFERMERAS UNA RESPUESTA A LAS NUEVAS NECESIDADES EN ATENCIÓN PRIMARIA?
 
 
Alvarez CJ, Bastarrika G, Disdier C, Fernández A, Hernández JR, Maldonado A, et al. Normativa sobre el manejo del nódulo pulmonar solitario. Arch Bronconeumol 2014;50:285-293 [M,II]
NORMATIVA SOBRE EL MANEJO DEL NÓDULO PULMONAR SOLITARIO
 
Lamas A, Ruiz M, Máiz L. Tos en el niño. Arch Bronconeumol 2014;50:294-300 [R,I]
TOS EN EL NIÑO
 
 
Sarzi-Puttini P, Atzeni F. Fibromyalgia: a never-ending story of central and peripheral pain mechanisms. Arthritis Rheumatol 2014;66:1687-1688 [AO,I]
FIBROMIALGIA: LA HISTORIA DE NUNCA ACABAR DE LOS MECANISMOS DEL DOLOR CENTRAL Y PERIFÉRICO
 
 
Bhala N, Usherwood T, George J. Non-alcoholic fatty liver disease. BMJ 2009;339:b2474 [R,I]
HÍGADO GRASO NO ALCOHÓLICO
 
Feeney ER, Chung RT. Antiviral treatment of hepatitis C. BMJ 2014;348:g3308 [R,II]
TRATAMIENTO ANTIVÍRICO DE LA HEPATITIS C
 
Steele C, Conlon N, Edgar JD. Diagnosis of immediate food allergy. BMJ 2014;349:g3695 [R,I]
DIAGNÓSTICO DE LA ALERGIA ALIMENTARIA INMEDIATA
 
Desai CS, Martin SS, Blumenthal RS. Non-cardiovascular effects associated with statins. BMJ 2014;349:g3743 [R,I]
EFECTOS NO CARDIOVASCULARES ASOCIADOS CON LAS ESTATINAS
 
Rasella D, Harhay MO, Pamponet ML, Aquino R, Barreto ML. Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data. BMJ 2014; 349:g4014 [S,I]
IMPACTO DE LA ATENCIÓN PRIMARIA DE SALUD SOBRE LA MORTALIDAD POR ENFERMEDADES CARDIACAS O CEREBROVASCULARES EN BRASIL: ANÁLISIS DE ÁMBITO NACIONAL DE DATOS LONGITUDINALES
 
Jabbar-Lopez ZK, Wu KC, Reynolds NJ. Newer agents for psoriasis in adults. BMJ 20149;349:g4026 [R,I]
NUEVOS AGENTES PARA LA PSORIASIS EN ADULTOS
 
Ensrud KE, Taylor BC, Peters KW, Gourlay ML, Donaldson MG, Leslie WD, et al; Osteoporotic Fractures in Men (MrOS) Study Group. Implications of expanding indications for drug treatment to prevent fracture in older men in United States: cross sectional and longitudinal analysis of prospective cohort study. BMJ 2014;349:g4120 [S,I]
IMPLICACIONES DE LAS INDICACIONES EN EXPANSIÓN DEL TRATAMIENTO FARMACOLÓGICO PARA PREVENIR FRACTURAS EN HOMBRES MAYORES EN ESTADOS UNIDOS: ANÁLISIS TRANSVERSAL Y LONGITUDINAL DE UN ESTUDIO PROSPECTIVO DE COHORTE
 
Hopewell S, Collins GS, Boutron I, Yu LM, Cook J, Shanyinde M, et al. Impact of peer review on reports of randomised trials published in open peer review journals: retrospective before and after study. BMJ 2014;349:g4145 [QE,I]
IMPACTO DE LA REVISIÓN POR PARES SOBRE LOS INFORMES DE ENSAYOS ALEATORIZADOS PUBLICADOS EN LAS REVISTAS CON REVISIÓN POR PARES ABIERTA: RETROSPECTIVA ANTES Y DESPUÉS DEL ESTUDIO
 
Barr JG, Al-Reefy H, Fox AT, Hopkins C. Allergic rhinitis in children BMJ 2014; 349:g4153 [R,I]
Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, et al; InterAct Consortium. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ 2014;349:g4164 [M,II]
ASOCIACIÓN ENTRE ALCOHOL Y ENFERMEDAD CARDIOVASCULAR: ANÁLISIS DE ALEATORIZACIÓN MENDELIANA SOBRE LOS DATOS INDIVIDUALES DE PARTICIPANTES
 
Peul WC, Bredenoord AL, Jacobs WC. Avoid surgery as first line treatment for non-specific low back pain. BMJ 2014;349:g4214 [R,II]
EVITE LA CIRUGÍA COMO TRATAMIENTO DE PRIMERA LÍNEA EN EL DOLOR LUMBAR INESPECÍFICO
 
Haycock PC, Heydon EE, Kaptoge S, Butterworth AS, Thompson A, Willeit P. Leucocyte telomere length and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 2014;349:g4227 [M,II]
LONGITUD DE TELÓMERO LEUCOCITARIO Y RIESGO DE ENFERMEDAD CARDIOVASCULAR: REVISIÓN SISTEMÁTICA Y METAANÁLISIS
 
Compston J. Osteoporosis in men: who should we treat? BMJ 2014;349:g4229 [AO,I]
OSTEOPOROSIS EN HOMBRES: ¿A QUIÉN DEBERÍAMOS TRATAR?
 
Deyo RA, Jarvik JG, Chou R. Low back pain in primary care. BMJ 2014;349:g4266 [R,I]
DOLOR LUMBAR EN ATENCIÓN PRIMARIA
 
Rayment M, Asboe D, Sullivan AK. HIV testing and management of newly diagnosed HIV. BMJ 2014;349:g4275 [R,I]
PRUEBA DEL VIH Y MANEJO DE VIH RECIÉN DIAGNOSTICADO
 
Tollånes MC, Wilcox AJ, Lie RT, Moster D. Familial risk of cerebral palsy: population based cohort study. BMJ 2014;349:g4294 [S,I]
RIESGO FAMILIAR DE PARÁLISIS CEREBRAL: ESTUDIO DE COHORTE POBLACIONAL
 
Tyrer P, Cooper SA, Hassiotis A. Drug treatments in people with intellectual disability and challenging behaviour. BMJ 2014;349:g4323 [AO,I]
TRATAMIENTOS FARMACOLÓGICOS EN PERSONAS CON DISCAPACIDAD INTELECTUAL Y COMPORTAMIENTO DESAFIANTE
 
Ball SJ, Pereira G, Jacoby P, de Klerk N, Stanley FJ. Re-evaluation of link between interpregnancy interval and adverse birth outcomes: retrospective cohort study matching two intervals per mother. BMJ 2014;349:g4333 [S,I]
REEVALUACIÓN DEL VÍNCULO ENTRE INTERVALO ENTRE EMBARAZOS Y RESULTADOS NATALES ADVERSOS: ESTUDIO DE COHORTE RETROSPECTIVA COMPARANDO DOS INTERVALOS POR MADRE
 
Glymour MM. Alcohol and cardiovascular disease. BMJ 2014;349:g4334 [AO,I]
ALCOHOL Y ENFERMEDAD CARDIOVASCULAR
 
Rabar S, Harker M, O'Flynn N, Wierzbicki AS; Guideline Development Group. Lipid modification and cardiovascular risk assessment for the primary and secondary prevention of cardiovascular disease: summary of updated NICE guidance. BMJ 2014;349:g4356 [III]
MODIFICACIÓN DE LOS LÍPIDOS Y VALORACIÓN DEL RIESGO CARDIOVASCULAR PARA LA PREVENCIÓN PRIMARIA Y SECUNDARIA DE LA ENFERMEDAD CARDIOVASCULAR: RESUMEN DE LA GUÍA NICE ACTUALIZADA
 
Man WD, Kon SS, Maddocks M. Rehabilitation after an exacerbation of chronic respiratory disease. BMJ 2014;349:g4370 [AO,I]
REHABILITACIÓN TRAS EXACERBACIÓN DE LA ENFERMEDAD RESPIRATORIA CRÓNICA
 
Spyridopoulos I, von Zglinicki T. Telomere length predicts cardiovascular disease. BMJ 2014;349:g4373 [AO,I]
LA LONGITUD DEL TELÓMERO PREDICE LA ENFERMEDAD CARDIOVASCULAR
 
Keene D, Price C, Shun-Shin MJ, Francis DP. Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117 411 patients. BMJ 2014;349:g4379 [M,II]
EFECTO SOBRE EL RIESGO CARDIOVASCULAR DE LOS TRATAMIENTOS FARMACOLÓGICOS CON NIACINA, FIBRATOS E INHIBIDORES DE CETP (proteína transportadora de éstes de colesterol) DIRIGIDOS A LA HDL: METAANÁLISIS DE ENSAYOS CONTROLADOS ALEATORIZADOS INCLUYENDO A 117.411 PACIENTES
 
Godlee F. Choice in matters of life and death. BMJ 2014;349:g4384 [AO,I]
ELECCIÓN EN MATERIA DE VIDA Y MUERTE
 
Yudkin JS, Montori VM. The epidemic of pre-diabetes: the medicine and the politics. BMJ 2014;349:g4485 [AO,I]
LA EPIDEMIA DE PREDIABETES: LA MEDICINA Y LA POLÍTICA
 
Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014;349:g4490 [M,II]
CONSUMO DE FRUTA Y VERDURAS Y MORTALIDAD POR CUALQUIER CAUSA, POR ENFERMEDAD CARDIOVASCULAR Y POR CÁNCER: REVISIÓN SISTEMÁTICA Y METAANÁLISIS DE RESPUESTA A LA DOSIS DE ESTUDIOS DE COHORTE PROSPECTIVOS
 
Carville S, Wonderling D, Stevens P; Guideline Development Group. Early identification and management of chronic kidney disease in adults: summary of updated NICE guidance. BMJ 2014;349:g4507 [M,II]
IDENTIFICACIÓN PRECOZ Y MANEJO DE LA ENFERMEDAD RENAL CRÓNICA EN ADULTOS: RESUMEN DE LA GUÍA NICE ACTUALIZADA
 
Rosenbaum P. What causes cerebral palsy? BMJ 2014 Jul 15;349:g4514 [AO,I]
¿QUÉ CAUSA LA PARÁLISIS CEREBRAL?
 
Moore TJ, Cohen MR, Mattison DR. Dabigatran, bleeding, and the regulators. BMJ 2014;349:g4517 [AO,I]
DABIGATRÁN, SANGRADO Y LOS REGULADORES
 
Godlee F. Predicting Alzheimer’s and heart disease. BMJ 2014;349:g4528 [AO,I]
PREDECIR LA ENFERMEDAD CARDIACA Y LA ENFERMEDAD DE ALZHEIMER
 
DISCO study group. Subgroup analyses in randomised controlled trials: cohort study on trial protocols and journal publications. BMJ 2014;349:g4539 [S,I]
ANÁLISIS DE SUBGRUPOS EN LOS ENSAYOS CONTROLADOS ALEATORIZADOS: ESTUDIO DE COHORTE SOBRE LOS PROTOCOLOS DE ENSAYOS Y LAS PUBLICACIONES EN REVISTAS
 
Crider KS, Devine O, Hao L, Dowling NF, Li S, Molloy AM, et al. Population red blood cell folate concentrations for prevention of neural tube defects: bayesian model. BMJ 2014;349:g4554 [T,I]
CONCENTRACIONES DE FOLATO EN LA POBLACIÓN DE CÉLULAS ROJAS PARA LA PREVENCIÓN DE DEFECTOS DEL TUBO NEURAL: MODELO BAYESIANO
 
Kritharides L. Not so "good" cholesterol. BMJ 2014;349:g4664 [AO,I]
COLESTEROL NO TAN "BUENO"
 
Charlton B, Redberg R. The trouble with dabigatran. BMJ 2014;349:g4681 [AO,I]
EL PROBLEMA CON EL DABIGATRÁN
 
Goldacre B, Smeeth L. Mass treatment with statins. BMJ 2014;349:g4745 [AO,IU]
TRATAMIENTO MASIVO CON ESTATINAS
 
Scammell BE. Calcaneal fractures. BMJ 2014;349:g4779 [AO,I]
FRACTURAS DEL CALCÁNEO
 
Stanley M, O'Mahony C, Barton S. HPV vaccination. BMJ 2014;349:g4783 [AO,I]
VACUNACIÓN DEL VPH
 
Jackson T. Dabigatran and statins: faith, hype, and transparency. BMJ 2014;349:g4793 [AO,I]
Clarke R, Bennett D. Folate and prevention of neural tube defects. BMJ 201;349:g4810 [AO,I] 
DABIGATRÁN Y ESTATINAS: FÉ, BOMBO PUBLICITARIO Y TRANSPARENCIA
 
Allergic rhinitis in children. BMJ 2014;349:g4923 [R,I]
RINITIS ALÉRGICA EN LOS NIÑOS
 
 
Stringaris A, Lewis G, Maughan B. Developmental pathways from childhood conduct problems to early adult depression: findings from the ALSPAC cohort. Br J Psychiatry 2014;205:17-23 [S,I]
CAMINOS PARA EL DESARROLLO DE DEPRESIÓN PRECOZ EN EL ADULTO A PARTIR DE PROBLEMAS DE CONDUCTA EN LA INFANCIA: HALLAZGOS DE LA COHORTE ALSPAC
 
 
Fralick M, Flegel K. Physician burnout: Who will protect us from ourselves? CMAJ 2014;186:731 [AO,I]
DESGASTE PROFESIONAL EN LOS MÉDICOS: ¿QUIÉN NOS PROTEGERÁ DE NOSOSTROS MISMOS?
 
McCall SJ, Bhattacharya S. High risk of traffic crashes in pregnancy: Are there any explanations? CMAJ 2014;186:733-734 [AO,I]
ALTO RIESGO DE ACCIDENTES DE TRÁFICO EN EL EMBARAZO: ¿HAY EXPLICACIONES?
 
Redelmeier DA, May SC, Thiruchelvam D, Barrett JF. Pregnancy and the risk of a traffic crash. CMAJ 2014;186:742-750 [S,I]
EMBARAZO Y RIESGO DE ACCIDENTES DE TRÁFICO
 
Ackroyd-Stolarz S. Improving the prevention of pressure ulcers as a way to reduce health care expenditures. CMAJ 2014;186:E370-E371 [AO,I]
MEJORAR LA PREVENCIÓN DE LAS ÚLCERAS POR PRESIÓN COMO CAMINO PARA REDUCIR LOS GASTOS DE ATENCIÓN SANITARIA
 
Lim CS, Davies AH. Graduated compression stockings. CMAJ 2014;186:E391-E398 [R,I]
MEDIAS DE COMPRESIÓN GRADUAL
 
 
Spring B, Moller AC, Colangelo LA, Siddique J, Roehrig M, Daviglus ML, et al. Healthy lifestyle change and subclinical atherosclerosis in young adults: Coronary Artery Risk Development in young Adults (CARDIA) study. Circulation 2014;130:10-17 [S,II]
CAMBIO A ESTILO DE VIDA SALUDABLE Y ATEROSCLEROSIS SUBCLÍNICA EN JÓVENES: ESTUDIO CARDIA
 
Martínez-González MÁ, Toledo E, Arós F, Fiol M, Corella D, Salas-Salvadó J, et al; PREDIMED Investigators*. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevención con Dieta Mediterránea) trial. Circulation 2014;130:18-26 [EC,I]
EL CONSUMO DE ACEITE DE OLIVA VIRGEN EXTRA REDUCE EL RIESGO DE FIBRILACIÓN AURICULAR: ENSAYO PREDIMED
 
McDermott MM, Guralnik JM, Criqui MH, Liu K, Kibbe MR, Ferrucci L. Six-minute walk is a better outcome measure than treadmill walking tests in therapeutic trials of patients with peripheral artery disease. Circulation 2014;130:61-68 [R,I]
EL PASEO DE SEIS MINUTOS ES UNA MEDICIÓN MEJOR DE RESULTADO QUE LAS PRUEBAS DE CAMINAR EN CINTA EN LOS ENSAYOS TERAPÉUTICOS DE PACIENTES CON ENFERMEDAD ARTERIAL PERIFÉRICA
 
Hiatt WR, Rogers RK, Brass EP. The treadmill is a better functional test than the 6-minute walk test in therapeutic trials of patients with peripheral artery disease. Circulation 2014;130:69-78 [R,I]
LA CINTA ES UNA PRUEBA FUNCIONAL MEJOR QUE LA PRUEBA DE CAMINAR DE 6 MINUTOS EN LOS ENSAYOS TERAPÉUTICOS DE PACIENTES CON ENFERMEDAD ARTERIAL PERIFÉRICA
 
Freedman JE, Gersh BJ. Atrial fibrillation and stroke prevention in aging patients: what's good can be even better. Circulation 2014;130:129-131 [AO,I]
PREVENCIÓN DE LA FIBRILACIÓN AURICULAR Y EL ICTUS EN PACIENTES DE EDAD: LO QUE ES BUENO PUEDE SER AÚN MEJOR
 
Halperin JL, Hankey GJ, Wojdyla DM, Piccini JP, Lokhnygina Y, Patel MR, et al; ROCKET AF Steering Committee and Investigators*. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the rivaroxaban once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET AF). Circulation 2014;130:138-146 [EC,II]
EFICACIA Y SEGURIDAD DEL RIVAROXABÁN COMPARADO CON LA WARFARINA ENTRE PACIENTES MAYORES CON FIBRILACIÓN AURICULAR NO VALVULAR EN EL ENSAYO ROCKET AF
 
Kalyanasundaram A, Fedorov VV. Fibroblast growth factor 23: a novel key to find hidden substrates of atrial fibrillation? Circulation 2014;130:295-297 [AO,I]
FACTOR DE CRECIMIENTO 23 DEL FIBROBLASTO: ¿UNA NUEVA CLAVE PARA ENCONTRAR SUSTRATOS OCULTOS DE FIBRILACIÓN AURICULAR?
 
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation 2014;130:333-346 [R,I]
INSUFICIENCIA VENOSA CRÓNICA
 
Mieres JH, Gulati M, Bairey Merz N, Berman DS, Gerber TC, Hayes SN, et al; American Heart Association Cardiac Imaging Committee of the Council on Clinical Cardiology and the Cardiovascular Imaging and Intervention Committee of the Council on Cardiovascular Radiology and Intervention. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014;130:350-379 [M,II]
PAPEL DE LAS PRUEBAS NO INVASIVAS EN LA EVALUACIÓN CLÍNICA DE MUJERES CON SOSPECHA DE ENFERMEDAD CARDIACA ISQUÉMICA: DECLARACIÓN DE CONSENSO DE LA AHA
 
Leong DP, Smyth A, Teo KK, McKee M, Rangarajan S, Pais P, et al; INTERHEART Investigators*. Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study. Circulation 2014;130:390-398 [CC,II]
PATRONES DE CONSUMO DE ALCOHOL Y RIESGO DE INFARTO DE MIOCARDIO: OBSERVACIONES DE 52PAÍSES EN EL ESTUDIO DE CASOS CONTROLES INTERHEART
 
Kiechl S, Willeit J. Complex association between alcohol consumption and myocardial infarction: always good for a new paradox. Circulation 2014;130:383-386 [AO,I]
ASOCIACIÓN COMPLEJA ENTRE EL CONSUMO DE ALCOHOL Y EL INFARTO DE MIOCARDIO: SIEMPRE BUENO PARA UNA NUEVA PARADOJA
 
 
Suissa S, Azoulay L. Metformin and cancer: mounting evidence against an association. Diabetes Care 2014;37:1786-1788 [AO,I]
METFORMINA Y CÁNCER: MONTAR LAS PRUEBAS CONTRA UNA ASOCIACIÓN
 
Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D. The effects of a mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care 2014;37:1824-1830 [EC,II]
EFECTOS DE UNA DIETA MEDITERRÁNEA SOBRE LA NECESIDAD DE FÁRMACOS PARA LA DIABETES Y LA REMISIÓN DE DIABETES TIPO2 RECIÉN DIAGNOSTICADA: SEGUIMIENTO DE UN ENSAYO ALEATORIZADO
 
Yap C, Cheung NW, Gunton JE, Athayde N, Munns CF, Duke A, et al. Vitamin D supplementation and the effects on glucose metabolism during pregnancy: a randomized controlled trial. Diabetes Care 2014;37:1837-1844 [EC,I]
SUPLEMENTOS DE VITAMINA D Y EFECTOS SOBRE EL METABOLISMO DE LA GLUCOSA DURANTE EL EMBARAZO: ENSAYO CONTROLADO ALEATORIZADO
 
van Nielen M, Feskens EJ, Mensink M, Sluijs I, Molina E, Amiano P, et al; InterAct Consortium. Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct case-cohort study. Diabetes Care 2014;37:1854-1862 [S,II]
INGESTA DE PROTEÍNA EN LA DIETA E INCIDENCIA DE DIABETES TIPO 2 EN EUROPA: ESTUDIO DE CASO-COHORTE EPIC-INTERACT
 
Koskinen J, Magnussen CG, Sabin MA, Kähönen M, Hutri-Kähönen N, Laitinen T, et al. Youth overweight and metabolic disturbances in predicting carotid intima-media thickness, type 2 diabetes, and metabolic syndrome in adulthood: the cardiovascular risk in young Finns study. Diabetes Care 2014;37:1870-1877 [EC,II]
SOBREPESO Y TRASTORNOS METABÓLICOS EN LA JUVENTUD PARA PREDECIR EL ESPESOR ÍNTIMA-MEDIA DE LA CARÓTIDA, LA DIABETES TIPO 2 Y EL SÍNDROME METABÓLICO EN LA EDAD ADULTA: ESTUDIO DE RIESGO CARDIOVASCULAR EN JÓVENES FINESES
 
Ulbrecht JS, Hurley T, Mauger DT, Cavanagh PR. Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial. Diabetes Care 2014;37:1982-1989 [EC,I]
PREVENCIÓN DE LAS ÚLCERAS RECURRENTES EN EL PIE CON ORTESIS PLANTAR BASADA EN LA PRESIÓN EN EL INTERIOR DEL CALZADO: ENSAYO DE PREVENCIÓN CONTROLADO ALEATORIZADO MULTICÉNTRICO CAREFUL
 
Chiang JL, Kirkman MS, Laffel LM, Peters AL; on behalf of the Type 1 Diabetes Sourcebook Authors. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014;37:2034-2054 [M,II]
DIABETES TIPO 1 A LO LARGO DE LA VIDA: DECLARACIÓN DE POSICIONAMIENTO DE LA ADA
 
Purnell TS, Joy S, Little E, Bridges JF, Maruthur N. Patient preferences for noninsulin diabetes medications: a systematic review. Diabetes Care 2014;37:2055-2062 [M,II]
PREFERENCIAS DEL PACIENTE EN CUANTO A LAS MEDICACIONES PARA LA DIABETES NO INSULÍNICAS: REVISIÓN SISTEMÁTICA
 
 
Trauner A, Borrell S, Reither K, Gagneux S. Evolution of drug resistance in tuberculosis: recent progress and implications for diagnosis and therapy. Drugs 2014;74:1063-1072 [R,II]
EVOLUCIÓN DE LA RESISTENCIA FARMACOLÓGICA A LA TUBERCULOSIS: PROGRESOS RECIENTES E IMPLICACIONES PARA EL DIAGNÓSTICO Y EL TRATAMIENTO
 
Martin C, Frija-Masson J, Burgel PR. Targeting mucus hypersecretion: new therapeutic opportunities for COPD? Drugs 2014;74:1073-1089 [R,I]
PONER EN LA DIANA LA HIPERSECRECIÓN MUCOSA: ¿NUEVAS OPORTUNIDADES TERAPÉUTICAS PARA LA EPOC?
 
Bounameaux H, Camm AJ. Edoxaban: an update on the new oral direct factor xa inhibitor. Drugs 2014;74:1209-1231 [R,I]
EDOXABÁN: ACTUALIZACIÓN DEL NUEVO INHIBIDOR DIRECTO ORAL DEL FACTOR XA
 
Keating GM. Sofosbuvir: a review of its use in patients with chronic hepatitis C. Drugs 2014;74:1127-1146 [R,II]
SOFOSBUVIR: REVISIÓN DE SU USO EN PACIENTES CON HEPATITIS C CRÓNICA
 
Chan K, MaassenVanDenBrink A. Glutamate receptor antagonists in the management of migraine. Drugs 2014;74:1165-1176 [R,I]
ANTAGONISTAS DEL RECEPTOR DEL GLUTAMATO EN EL TRATAMIENTO DE LA MIGRAÑA
 
Deeks ED. Nivolumab: a review of its use in patients with malignant melanoma. Drugs 2014;74:1233-1239 [R,I]
NIVOLUMAB: REVISIÓN DE SU USO EN PACIENTES CON MELANOMA MALIGNO
 
McCormack PL. Dolutegravir: a review of its use in the management of HIV-1 infection in adolescents and adults. Drugs 2014;74:1241-1252 [R,I]
DOLUTEGRAVIR: REVISIÓN DE SU USO EN EL MANEJO DE LA INFECCIÓN POR VIH-1 EN ADOLESCENTES Y ADULTOS
 
McCormack PL. Quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine (Gardasil(®)): a review of its use in the prevention of premalignant anogenital lesions, cervical and anal cancers, and genital warts. Drugs 2014;74:1253-1283 [R,II]
VACUNA RECOMBINANTE TETRAVALENTE DEL VIRUS DEL PAPILOMA HUMANO (TIPOS 6,11, 16 Y 18) (Gardasil(®)): REVISIÓN DE SU USO EN LA PREVENCIÓN DE LAS LESIONES PREMALIGNAS ANOGENITALES, CÁNCERES CERVICAL Y ANAL Y VERRUGAS GENITALES
 
 
Moreno S, Del Romero J, Del Amo J. Infección por el virus de la inmunodeficiencia humana en España: es hora de actuar. Enferm Infecc Microbiol Clin 2014;32:339-340 [AO,I]
INFECCIÓN POR EL VIRUS DE LA INMUNODEFICIENCIA HUMANA EN ESPAÑA: ES HORA DE ACTUAR
 
Folch C, Fernández-Dávila P, Ferrer L, Soriano R, Díez M, Casabona J. Conductas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres según tipo de pareja sexual. Enferm Infecc Microbiol Clin 2014;32:341-349 [T,I]
CONDUCTAS SEXUALES DE ALTO RIESGO EN HOMBRES QUE TIENEN RELACIONES SEXUALES CON HOMBRES SEGÚN TIPO DE PAREJA SEXUAL
 
Giménez-Sánchez F, Cobos-Carrascosa E, Sánchez-Forte M, López-Sánchez MÁ, González-Jiménez Y, Azor-Martínez E. Diferencias clínicas y epidemiológicas entre las infecciones por Bordetella pertussis y por virus respiratorio sincitial en lactantes: estudio de casos controles emparejados. Enferm Infecc Microbiol Clin 2014;32:359-362 [CC,I]
DIFERENCIAS CLÍNICAS Y EPIDEMIOLÓGICAS ENTRE LAS INFECCIONES POR BORDETELLA PERTUSSIS Y POR VIRUS RESPIRATORIO SINCITIAL EN LACTANTES: ESTUDIO DE CASOS CONTROLES EMPAREJADOS
 
Rodríguez-Domínguez M, Sanbonmatsu S, Salinas J, Alonso R, Gutiérrez J, Galán JC. Diagnóstico microbiológico de las infecciones por Chlamydia spp. y especies relacionadas. Enferm Infecc Microbiol Clin 2014;32:380-385 [R,I]
DIAGNÓSTICO MICROBIOLÓGICO DE LAS INFECCIONES POR CHLAMYDIA SPP. Y ESPECIES RELACIONADAS
 
 
Ruilope LM. Renin-angiotensin system blockade: time for a reappraisal? Eur Heart J 2014;35:1703-1705 [AO,I]
BLOQUEO DEL SISTEMA RENINA-ANGIOTENSINA: ¿HORA PARA REEVALUARLO?
 
Peters R, Beckett N, McCormack T, Fagard R, Fletcher A, Bulpitt C. Treating hypertension in the very elderly-benefits, risks, and future directions, a focus on the hypertension in the very elderly trial. Eur Heart J 2014;35:1712-1718 [R,I]
TRATAR LA HIPERTENSIÓN EN LOS MUY MAYORES - BENEFICIOS, RIESGOS Y FUTURAS DIRECCIONES, ENSAYO ENFOCADO A LA HIPERTENSIÓN EN EL MUY MAYOR
 
Makani H, Bangalore S, Supariwala A, Romero J, Argulian E, Messerli FH. Antihypertensive efficacy of angiotensin receptor blockers as monotherapy as evaluated by ambulatory blood pressure monitoring: a meta-analysis. Eur Heart J 2014;35:1732-1742 [M,II]
EFICACIA ANTIHIPERTENSIVA DE LOS BLOQUEANTES DE LOS RECEPTORES DE LA ANGIOTENSINA EN MONOTERAPIA EVALUADOS MEDIANTE MONITORIZACIÓN DE LA PRESIÓN ARTERIAL SANGUÍNEA: METAANÁLISIS
 
Teo KK, Pfeffer M, Mancia G, O'Donnell M, Dagenais G, Diaz R, et al; Aliskiren Prevention of Later Life Outcomes trial Investigators. Aliskiren alone or with other antihypertensives in the elderly with borderline and stage 1 hypertension: the APOLLO trial. Eur Heart J 2014;35:1743-1751 [EC,I]
ALISQUIRENO SOLO O CON OTROS ANTIHIPERTENSIVOS EN LOS ANCIANOS CON HIPERTENSIÓN LIMÍTROFE Y EN ESTADIO 1: ENSAYO APOLLO
 
Esler MD, Böhm M, Sievert H, Rump CL, Schmieder RE, Krum H, et al. Catheter-based renal denervation for treatment of patients with treatment-resistant hypertension: 36 month results from the SYMPLICITY HTN-2 randomized clinical trial. Eur Heart J 2014;35:1752-1759 [EC,II]
DENERVACIÓN RENAL MEDIANTE CATÉTER PARA EL TRATAMIENTO DE PACIENTES CON HIPERTENSIÓN RESISTENTE AL TRATAMIENTO: RESULTADOS DE 36 MESES DEL ENSAYO CLÍNICO ALEATORIZADO SIMPLICITY HTN-2
 
Sorbets E, Labreuche J, Simon T, Delorme L, Danchin N, Amarenco P, et al. Renin-angiotensin system antagonists and clinical outcomes in stable coronary artery disease without heart failure. Eur Heart J 2014;35:1760-1768 [T,I]
ANTAGONISTAS DEL SISTEMA RENINA-ANGIOTENSINA Y RESULTADOS CLÍNICOS EN LA ENFERMEDAD ARTERIAL CORONARIA ESTABLE SIN INSUFICIENCIA CARDIACA
 
Nolte CH, Endres M. The heart of the matter: a link between troponin and dementia? Eur Heart J 2014;35:1779-1781 [AO,I]
EL CORAZÓN DE LA MATERIA: ¿VÍNCULO ENTRE TROPONINA Y DEMENCIA?
 
Bangalore S, Fayyad R, Laskey R, DeMicco D, Deedwania P, Kostis JB, et al; Treating to New Targets Steering Committee and Investigators. Lipid lowering in patients with treatment-resistant hypertension: an analysis from the Treating to New Targets (TNT) trial. Eur Heart J 2014;35:1801-1808 [EC,I]
DESCENSO DE LÍPIDOS EN PACIENTES CON HIPERTENSIÓN RESISTENTE AL TRATAMIENTO: ANÁLISIS DEL ENSAYO TNT
 
Sung KC, Ryu S, Chang Y, Byrne CD, Kim SH. C-reactive protein and risk of cardiovascular and all-cause mortality in 268 803 East Asians. Eur Heart J 2014;35:1809-1816 [S,I]
PROTEÍNA C REACTIVA Y RIESGO DE MORTALIDAD CARDIOVASCULAR Y POR CUALQUIER CAUSA EN 268.803 ASIÁTICOS ORIENTALES
 
Vanassche T, Lauw MN, Connolly SJ, Eikelboom JW. Heparin bridging in peri-procedural management of new oral anticoagulant: a bridge too far? Eur Heart J 2014;35:1831-1833 [AO,I]
PUENTE CON HEPARINA EN EL MANEJO PERIOPERATORIO DE LOS NUEVOS ANTICOAGULANTES ORALES: ¿UN PUENTE DEMASIADO LEJANO?
 
Diener HC, Granger CB, Patel MR. Is there a period of liability with initiation of warfarin in patients with atrial fibrillation? Eur Heart J 2014;35:1834-1835 [AO,I]
¿HAY UN PERIODO DE CARGA CON EL INICIO DE LA WARFARINA EN PACIENTES CON FIBRILACIÓN AURICULAR?
 
Fontana P, Goldhaber SZ, Bounameaux H. Direct oral anticoagulants in the treatment and long-term prevention of venous thrombo-embolism. Eur Heart J 2014;35:1836-1843 [R,II]
ANTICOAGULANTES ORALES DIRECTOS EN EL TRATAMIENTO Y PREVENCIÓN A LARGO PLAZO DEL TROMBOEMBOLISMO VENOSO
 
Lip GY, Agnelli G. Edoxaban: a focused review of its clinical pharmacology. Eur Heart J 2014;35:1844-1855 [R,I]
EDOXABAN: REVISIÓN CENTRADA EN SU FARMACOLOGÍA CLÍNICA
 
Coppens M, Synhorst D, Eikelboom JW, Yusuf S, Shestakovska O, Connolly SJ. Efficacy and safety of apixaban compared with aspirin in patients who previously tried but failed treatment with vitamin K antagonists: results from the AVERROES trial. Eur Heart J 2014;35:1856-1863 [EC,I]
EFICACIA Y SEGURIDAD DEL APIXABAN COMPARADO CON LA ASPIRINA EN PACIENTES EN LOS QUE SE HA INTENTADO PREVIAMENTE PERO SE HA FRACASADO EN EL TRATAMIENTO CON ANTAGONISTAS DE LA VITAMINA K: RESULTADOS DEL ENSAYO AVERROES
 
Halvorsen S, Atar D, Yang H, De Caterina R, Erol C, Garcia D, et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J 2014;35:1864-1872 [EC,II]
EFICACIA Y SEGURIDAD DEL APIXABAN COMPARADO CON LA WARFARINA EN FUNCIÓN DE LA EDAD PARA LA PREVENCIÓN DE LA FIBRILACIÓN AURICULAR: OBSERVACIONES DEL ENSAYO ARISTOTLE
 
Piccini JP, Garg J, Patel MR, Lokhnygina Y, Goodman SG, Becker RC, et al; ROCKET AF Investigators. Management of major bleeding events in patients treated with rivaroxaban vs. warfarin: results from the ROCKET AF trial. Eur Heart J 2014;35:1873-1880 [EC,I]
MANEJO DE LOS ACONTECIMIENTOS DE SANGRADO IMPORTANTE EN PACIENTES TRATADOS CON RIVAROXABAN FRENTE A WARFARINA: RESULTADOS DEL ENSAYO ROCKET AF
 
Azoulay L, Dell'Aniello S, Simon TA, Renoux C, Suissa S. Initiation of warfarin in patients with atrial fibrillation: early effects on ischaemic strokes. Eur Heart J 2014;35:1881-1887 [CC,I]
INICIO DE WARFARINA EN PACIENTES CON FIBRILACIÓN AURICULAR: EFECTOS PRECOCES SOBRE LOS ICTUS ISQUÉMICOS
 
Beyer-Westendorf J, Gelbricht V, Förster K, Ebertz F, Köhler C, Werth S, et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 2014;35:1888-1896 [T,I]
MANEJO PERIOPERATORIO DE LOS NUEVOS ANTICOAGULANTES ORALES EN LA ATENCIÓN DIARIA: RESULTADOS DEL REGISTRO PROSPECTIVO DRESDEN NOAC
 
Dorian P, Kongnakorn T, Phatak H, Rublee DA, Kuznik A, Lanitis T, et al. Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation. Eur Heart J 2014;35:1897-1906 [CE,II]
RENTABILIDAD DEL APIXABAN FRENTE AL ESTÁNDAR ACTUAL DE ATENCIÓN EN LA PREVENCIÓN DEL ICTUS EN PACIENTES CON FIBRILACIÓN AURICULAR
 
 
Lawson PJ, Smith S, Mason MJ, Zyzanski SJ, Stange KC, Werner JJ, et al. Creating a culture of inquiry in family medicine. Fam Med 2014;46:515-521 [QE,I]
CREAR UNA CULTURA DE INDAGACIÓN EN LA MEDICINA DE FAMILIA
 
Maxfield H, Kennedy M, Delzell JE Jr, Paolo AM. Performance of third-year medical students on a rural family medicine clerkship. Fam Med 2014;46:536-538 [T,I]
RENDIMIENTO DE LOS ESTUDIANTES DE MEDICINA DE TERCER AÑO EN UNA ROTACIÓN DE MEDICINA DE FAMILIA RURAL
 
Prunuske J, Chang L, Mishori R, Dobbie A, Morley CP. The extent and methods of public health instruction in family medicine clerkships. Fam Med 2014;46:544-548 [T,I]
ALCANCE Y MÉTODOS DE LA ENSEÑANZA EN SALUD PÚBLICA EN LAS ROTACIONES DE MEDICINA DE FAMILIA
 
 
Boldo E, Querol X. Nuevas políticas europeas de control de la calidad del aire: ¿un paso adelante para la mejora de la salud pública? Gac Sanit 2014;28:263-266 [AO,I]
NUEVAS POLÍTICAS EUROPEAS DE CONTROL DE LA CALIDAD DEL AIRE: ¿UN PASO ADELANTE PARA LA MEJORA DE LA SALUD PÚBLICA?
 
March S, Jordán M, Montaner I, Benedé CB, Elizalde L, Ramos M; el grupo del Proyecto frAC. ¿Qué hacemos en el barrio? Descripción de las actividades comunitarias de promoción de la salud en atención primaria: Proyecto frAC1. Gac Sanit 2014;28:267-273 [T,I]
¿QUÉ HACEMOS EN EL BARRIO? DESCRIPCIÓN DE LAS ACTIVIDADES COMUNITARIAS DE PROMOCIÓN DE LA SALUD EN ATENCIÓN PRIMARIA: PROYECTO FRAC1
 
Rodríguez GJ, Escolar-Pujolar A, Córdoba-Doña JA. Evolución de las desigualdades sociales en la mortalidad general de la ciudad de Cádiz (1992–2007) Gac Sanit 2014;28:313-315 [T,II]
EVOLUCIÓN DE LAS DESIGUALDADES SOCIALES EN LA MORTALIDAD GENERAL DE LA CIUDAD DE CÁDIZ (1992–2007)
 
Font-Ribera L, García-Continente X, Davó-Blanes MC, Ariza C, Díez E, García Calvente M del M, et al; Grupo de Determinantes Sociales de la Sociedad Española de Epidemiología. El estudio de las desigualdades sociales en la salud infantil y adolescente en España. Gac Sanit 2014;28:316-325 [R,II]
EL ESTUDIO DE LAS DESIGUALDADES SOCIALES EN LA SALUD INFANTIL Y ADOLESCENTE EN ESPAÑA
 
 
Silver J. Drugs for macular degeneration, price discrimination, and Medicare’s responsibility not to overpay. JAMA 2014;312:23-24 [AO,I]
FÁRMACOS PARA LA DEGENERACIÓN MACULAR, DISCRIMINACIÓN POR PRECIO Y LA RESPONSABILIDAD DE MEDICARE DE NO PAGAR EN EXCESO
 
Herr NR, Williams JW Jr, Benjamin S, McDuffie J. Does this patient have generalized anxiety or panic disorder?: The Rational Clinical Examination systematic review. JAMA 2014;312:78-84 [M,II]
¿TIENE ESTE PACIENTE ANSIEDAD GENERALIZADA O TRASTORNO DE PÁNICO?
 
Young MJ, Scheinberg E, Bursztajn H. Direct-to-patient laboratory test reporting: balancing access with effective clinical communication. JAMA 2014;312:127-128 [AO,I]
INFORME DIRECTO AL PACIENTE DE LAS PRUEBAS DE LABORATORIO: EQUILIBRAR EL ACCESO CON LA COMUNICACIÓN CLÍNICA EFECTIVA
 
Koegelenberg CF, Noor F, Bateman ED, van Zyl-Smit RN, Bruning A, O'Brien JA, et al. Efficacy of varenicline combined with nicotine replacement therapy vs varenicline alone for smoking cessation: a randomized clinical trial. JAMA 2014;312:155-161 [EC,I]
EFICACIA DE LA VARENICILINA COMBINADA CON EL TRATAMIENTO SUSTITUTIVO DE NICOTINA FRENTE A LA VARENICILINA SOLA PARA EL ABANDONO TABÁQUICO: ENSAYO CLÍNICO ALEATORIZADO
 
Moore A, Wiffen P, Kalso E. Antiepileptic drugs for neuropathic pain and fibromyalgia. JAMA 2014;312:182-183 [AO,I]
FÁRMACOS ANTIEPILÉPTICOS EN EL DOLOR NEUROPÁTICO Y LA FIBROMIALGIA
 
Ohl ME, Rosenthal GE. Advancing telecare for pain treatment in primary care. JAMA 2014;312:235-236 [AO,I]
AVANCES EN TELEASISTENCIA PARA EL TRATAMIENTO DEL DOLOR EN ATENCIÓN PRIMARIA
 
Sacco RL, Dong C. Declining stroke incidence and improving survival in US communities: evidence for success and future challenges. JAMA 2014;312:237-238 [AO,I]
DESCENSO EN LA INCIDENCIA DE ICTUS Y MEJORÍA DE LA SUPERVIVENCIA EN LAS COMUNIDADES ESTADOUNIDENSES: PRUEBAS DEL ÉXITO Y RETOS FUTUROS
 
Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA 2014;312:259-268 [S,II]
INCIDENCIA DEL ICTUS Y TENDENCIAS DE MORTALIDAD EN LAS COMUNIDADES ESTADOUNIDENSES, 1987 A 2011
 
Jørgensen ME, Torp-Pedersen C, Gislason GH, Jensen PF, Berger SM, Christiansen CB, et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014;312:269-277 [S,II]
TIEMPO TRANSCURRIDO TRAS EL ICTUS ISQUÉMICO Y RIESGO DE ACONTECIMIENTOS CARDIOVASCULARES ADVERSOS Y MORTALIDAD TRAS CIRUGÍA ELECTIVA NO CARDIACA
 
Fauci AS, Marston HD, Folkers GK. An HIV cure: feasibility, discovery, and implementation. JAMA 2014;312:335-336 [AO,I]
UNA CURA PARA EL VIH: VIABILIDAD, DESCUBRIMIENTO Y PUESTA EN MARCHA
 
Cohen IG, Feigenbaum J, Adashi EY. Reconsideration of the lifetime ban on blood donation by men who have sex with men. JAMA 2014;312:337-338 [AO,I]
RECONSIDERACIÓN DE LA PROHIBICIÓN DE POR VIDA DE DONACIÓN DE SANGRE PARA HOMBRES QUE PRACTICAN SEXO CON HOMBRES
 
Chi BH, Thirumurthy H, Stringer JS. Maximizing benefits of new strategies to prevent mother-to-child HIV transmission without harming existing services. JAMA 2014;312:341-342 [AO,I]
MAXIMIZAR LOS BENEFICIOS DE LAS NUEVAS ESTRATEGIAS PARA PREVENIR LA TRANSMISIÓN DEL VIH DE MADRE A HIJO SIN PERJUDICAR LOS SERVICIOS EXISTENTES
 
Saag MS. Quantum leaps, microeconomics, and the treatment of patients with hepatitis C and HIV coinfection. JAMA 2014;312:347-348 [AO,I]
SALTOS ESPECTACULARES, MICROECONOMÍA Y TRATAMIENTO DE LOS PACIENTES CON HEPATITIS C Y COINFECCIÓN CON VIH
 
Mathers BM, Cooper DA. Integrating HIV prevention into practice. JAMA 2014;312:349-350 [AO,I]
INTEGRAR LA PREVENCIÓN DEL VIH EN LA CONSULTA
 
Smith JM. HIV/AIDS: gaining ground and forging forward. JAMA 2014;312:351-352 [AO,I]
VIH/SIDA: GANAR TERRENO Y SEGUIR ADELANTE
 
Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, et al; International Antiviral Society-USA Panel. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014;312:390-409 [M,II]
PREVENCIÓN DEL VIH EN EL ÁMBITO DE LA ATENCIÓN CLÍNICA: RECOMENDACIONES 2014 DE LA SOCIEDAD ANTIVÍRICA INTERNACIONAL-COMITÉ DE EE UU
 
Günthard HF, Aberg JA, Eron JJ, Hoy JF, Telenti A, Benson CA, et al; International Antiviral Society-USA Panel. Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014;312:410-425 [M,II]
TRATAMIENTO ANTIRRETROVÍRICO DE LA INFECCIÓN POR VIH EN EL ADULTO: RECOMENDACIONES 2014 DE LA SOCIEDAD ANTIVÍRICA INTERNACIONAL-COMITÉ DE EE UU
 
 
McCarthy AM, Armstrong K. The role of testing for BRCA1 and BRCA2 mutations in cancer prevention. JAMA Intern Med 2014;174:1023-1024 [AO,II]
PAPEL DE LA PRUEBA DE MUTACIONES BRCA1 Y BRCA2 EN LA PREVENCIÓN DEL CÁNCER
 
Smith-McCune K. Choosing a screening method for cervical cancer: Papanicolaou testing alone or with human papillomavirus testing. JAMA Intern Med 2014;174:1027-1028 [AO,I]
ELEGIR UN MÉTODO DE CRIBAJE DEL CÁNCER DE CÉRVIX: PRUEBA DE PAPANICOLAU SOLAMENTE O JUNTO A LA PRUEBA DEL VIRUS DEL PAPILOMA HUMANO
 
Feldman S. Can the new cervical cancer screening and management guidelines be simplified? JAMA Intern Med 2014;174:1029-1030 [AO,I]
¿SE PUEDEN SIMPLIFICAR LAS NUEVAS PAUTAS DE CRIBADO Y MANEJO DEL CÁNCER DE CÉRVIX?
 
Carnovale C, Venegoni M, Clementi E. Allopurinol overuse in asymptomatic hyperuricemia: a teachable moment. JAMA Intern Med 2014;174:1031-1032 [AO,I]
EXCESO DE USO DEL HALOPURINOL EN LA HIPERURICEMIA ASINTOMÁTICA: MOMENTO DE ENSEÑANZA
 
Strewler A, Conroy R, Kao H. Approach to overuse of herbal and dietary supplements: a teachable moment. JAMA Intern Med 2014;174:1033-1034 [AO,I]
ABORDAJE DEL EXCESO DE USO DE SUPLEMENTOS DIETÉTICOS Y PRODUCTOS DE HERBORISTERÍA: MOMENTO DE ENSEÑANZA
 
Rohrhoff NJ, McNeill DB, Boggan JC. An adverse reaction to a medication given to treat an adverse reaction: a teachable moment. JAMA Intern Med 2014;174:1035-1036 [AO,I]
REACCIÓN ADVERSA A UNA MEDICACIÓN DADA PARA TRATAR UNA REACCIÓN ADVERSA: MOMENTO DE ENSEÑANZA
 
Sugiyama T, Tsugawa Y, Tseng CH, Kobayashi Y, Shapiro MF. Different time trends of caloric and fat intake between statin users and nonusers among US adults: gluttony in the time of statins? JAMA Intern Med 2014;174:1038-1045 [T,I]
DIFERENTES TENDENCIAS TEMPORALES DE INGESTA CALÓRICA Y DE GRASAS ENTRE USUARIOS Y NO USUARIOS DE ESTATINAS EN ADULTOS ESTADOUNIDENSES: ¿GLOTONERÍA EN EL TIEMPO DE LAS ESTATINAS?
 
Bao W, Tobias DK, Bowers K, Chavarro J, Vaag A, Grunnet LG, et al. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. JAMA Intern Med 2014;174:1047-1055 [S,II]
ACTIVIDAD FÍSICA Y COMPORTAMIENTOS SEDENTARIOS ASOCIADOS CON EL RIESGO DE PROGRESIÓN DE DIABETES MELLITUS GESTACIONAL HACIA DIABETES MELLITUS TIPO 2: ESTUDIO DE COHORTE PROSPECTIVO
 
Joffe H, Guthrie KA, LaCroix AZ, Reed SD, Ensrud KE, Manson JE, et al. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Intern Med 2014;174:1058-1066 [EC,I]
ESTRADIOL EN DOSIS BAJAS Y EL INHIBIDOR DE LA RECAPTACIÓN DE LA SEROTONINA-NOREPINEFRINA VENLAFAXINA PARA LOS SÍNTOMAS VASOMOTORES: ENSAYO CLÍNICO ALEATORIZADO
 
Semba RD, Ferrucci L, Bartali B, Urpí-Sarda M, Zamora-Ros R, Sun K, et al. Resveratrol levels and all-cause mortality in older community-dwelling adults. JAMA Intern Med 2014;174:1077-1084 [S,I]
NIVELES DE RESVERATROL Y MORTALIDAD POR CUALQUIER CAUSA EN LOS ANCIANOS RESIDENTES EN LA COMUNIDAD
 
Auriemma CL, Nguyen CA, Bronheim R, Kent S, Nadiger S, Pardo D, et al. Stability of end-of-life preferences: a systematic review of the evidence. JAMA Intern Med 2014;174:1085-1092 [M,II]
ESTABILIDAD DE LAS PREFERENCIAS PARA EL FINAL DE LA VIDA: REVISIÓN SISTEMÁTICA DE LA EVIDENCIA
 
Wu HY, Peng YS, Chiang CK, Huang JW, Hung KY, Wu KD, et al. Diagnostic performance of random urine samples using albumin concentration vs ratio of albumin to creatinine for microalbuminuria screening in patients with diabetes mellitus: a systematic review and meta-analysis. JAMA Intern Med 2014;174:1108-1115 [M,II]
RENDIMIENTO DIAGNÓSTICO DE LAS MUESTRAS ALEATORIAS DE ORINA USANDO LA CONCENTRACIÓN DE ALBÚMINA FRENTE AL COCIENTE DE ALBÚMINA/CREATININA PARA EL CRIBADO DE MICROALBUMINURIA EN LOS PACIENTES CON DIABETES MELLITUS: REVISIÓN SISTEMÁTICA Y METAANÁLISIS
 
Bauer DC, Schwartz A, Palermo L, Cauley J, Hochberg M, Santora A, et al. Fracture prediction after discontinuation of 4 to 5 years of alendronate therapy: the FLEX study. JAMA Intern Med 2014;174:1126-1134 [EC,II]
PREDICCIÓN DE FRACTURA TRAS INTERRUPCIÓN DEL TRATAMIENTO CON ALENDRONATO DESPUÉS DE 4 A 5 AÑOS: ESTUDIO FLEX
 
Keyserling TC, Sheridan SL, Draeger LB, Finkelstein EA, Gizlice Z, Kruger E, et al. A comparison of live counseling with a web-based lifestyle and medication intervention to reduce coronary heart disease risk: a randomized clinical trial. JAMA Intern Med 2014;174:1144-1157 [EC,I]
COMPARACIÓN DE CONSEJO VITAL E INTERVENCIÓN SOBRE MEDICACIÓN Y ESTILO DE VIDA MEDIANTE WEB PARA REDUCIR EL RIESGO DE ENFERMEDAD CARDIACA CORONARIA: ENSAYO CLÍNICO ALEATORIZADO
 
 
Cuijpers P. Combined pharmacotherapy and psychotherapy in the treatment of mild to moderate major depression? JAMA Psychiatry 2014;71:747-748 [AO,I]
¿FARMACOTERAPIA Y PSICOTERAPIA COMBINADAS EN EL TRATAMIENTO DE LA DEPRESIÓN MAYOR MODERADA?
 
Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry 201;71:821-826 [T,Q,II]
LA CARA CAMBIANTE DEL USO DE LA HEROÍNA EN LOS ESTADOS UNIDOS: ANÁLISIS RETROSPECTIVO DE LOS PASADOS 50 AÑOS
 
 
Cave AJ, Atkinson LL. Asthma in preschool children: a review of the diagnostic challenges. J Am Board Fam Med 2014;27:538-548 [R,I]
ASMA EN PREESCOLARES: REVISIÓN DE LOS RETOS DIAGNÓSTICOS
 
Kruse-Jarres R, Singleton TC, Leissinger CA. Identification and basic management of bleeding disorders in adults. J Am Board Fam Med 2014;27:549-564 [R,I]
IDENTIFICACIÓN Y MANEJO BÁSICO DE LOS TRASTORNOS DE SANGRADO EN ADULTOS
 
 
García A, Ene G, Miranda C, Vidal R, Mata R, Llamas MP. Asociación entre enfermedad tromboembólica venosa y dislipidemia. Med Clin (Barc) 2014;143:1-5 [T,I]
ASOCIACIÓN ENTRE ENFERMEDAD TROMBOEMBÓLICA VENOSA Y DISLIPIDEMIA
 
Turró-Garriga O, Conde-Sala JL, Reñé-Ramírez R, López-Pousa S, Gascón-Bayarri J, Garre-Olmo J. Prevalencia de anosognosia en la enfermedad de Alzheimer. Med Clin (Barc) 2014;143:13-19 [T,I]
PREVALENCIA DE ANOSOGNOSIA EN LA ENFERMEDAD DE ALZHEIMER
 
Páramo JA. Trombosis venosa y arterial: semejanzas e implicaciones clínicas. Med Clin (Barc) 2014;143:20-21 [AO,I]
TROMBOSIS VENOSA Y ARTERIAL: SEMEJANZAS E IMPLICACIONES CLÍNICAS
 
Admetlla M, Fusté J. Cuidados postagudos. Med Clin (Barc) 2014;143:29-33 [R,I]
CUIDADOS POSTAGUDOS
 
Brito B, Alemán JJ, Cabrera A. Frecuencia cardiaca en reposo y enfermedad cardiovascular. Med Clin (Barc) 2014;143:34-38 [R,I]
FRECUENCIA CARDIACA EN REPOSO Y ENFERMEDAD CARDIOVASCULAR
 
Pérez-Martín A, Horrillo-Sánchez de Ocaña L, Satué-Bartolomé JA, Belinchón J, Gonzalo-Pascua S, Marrero-Francés J, et al. Ancho de distribución eritrocitario como predictor de mortalidad tras el alta hospitalaria en mayores de 70 años. Med Clin (Barc) 2014;143:49-56 [T,I]
ANCHO DE DISTRIBUCIÓN ERITROCITARIO COMO PREDICTOR DE MORTALIDAD TRAS EL ALTA HOSPITALARIA EN MAYORES DE 70 AÑOS
 
Ribot B, Isern R, Hernández-Martínez C, Canals J, Aranda N, Arija V. Impacto del tabaquismo, la exposición pasiva al tabaco y el dejar de fumar sobre la salud del recien nacido. Med Clin (Barc) 2014;143:57-63 [[S,I]
IMPACTO DEL TABAQUISMO, LA EXPOSICIÓN PASIVA AL TABACO Y EL DEJAR DE FUMAR SOBRE LA SALUD DEL RECIEN NACIDO
 
De Luca-Monasterios F, Chimenos-Küstner E, López-López J2. Efecto de masticar chicle sobre la halitosis. Med Clin (Barc) 2014;143:64-67 [T,I]
EFECTO DE MASTICAR CHICLE SOBRE LA HALITOSIS
 
Bascones-Martinez A. Halitosis: un problema médico y social. Med Clin (Barc) 2014;143:68-69 [AO,I]
HALITOSIS: UN PROBLEMA MÉDICO Y SOCIAL
 
Pichini S, García-Algar O. Consumo de tabaco durante la gestación. Med Clin (Barc) 2014;143:70-71 [AO,I]
CONSUMO DE TABACO DURANTE LA GESTACIÓN
 
Gea J, Martínez-Llorens J, Barreiro E. Alteraciones nutricionales en la enfermedad pulmonar obstructiva crónica. Med Clin (Barc) 2014;143:78-84 [R,I]
ALTERACIONES NUTRICIONALES EN LA ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA
 
Alegre EJ, Fénix S, Castaño R, Sierra F. Evaluación y posicionamiento de medicamentos como alternativas terapéuticas equivalentes. Med Clin (Barc) 2014;143:85-90 [R,I]
EVALUACIÓN Y POSICIONAMIENTO DE MEDICAMENTOS COMO ALTERNATIVAS TERAPÉUTICAS EQUIVALENTES
 
Tardon A. Polimorfismos genéticos y riesgo de cáncer de pulmón. Med Clin (Barc) 2014;143:113-114 [AO,I]
POLIMORFISMOS GENÉTICOS Y RIESGO DE CÁNCER DE PULMÓN
 
Robles NR. Guías de hipertensión: Muchas y mal avenidas. Med Clin (Barc) 2014;143:115-116 [AO,I]
GUÍAS DE HIPERTENSIÓN: MUCHAS Y MAL AVENIDAS
 
Ascaso JF. Diabetes mellitus tipo 2: nuevos tratamientos. Med Clin (Barc) 2014;143:117-123 [R,I]
DIABETES MELLITUS TIPO 2: NUEVOS TRATAMIENTOS
 
Mearin F, Montoro M. Síndrome del intestino irritable, enfermedad celíaca y gluten: «Una cosa es predicar y otra dar trigo». Med Clin (Barc) 2014;143:124-129 [R,I]
SÍNDROME DEL INTESTINO IRRITABLE, ENFERMEDAD CELÍACA Y GLUTEN: «UNA COSA ES PREDICAR Y OTRA DAR TRIGO»
 
Gómez-Huelgas R, Martínez-Sellés M, Formiga F, Alemán JJ, Camafort M, Galve E, et al. Tratamiento de los factores de riesgo vascular en el paciente mayor de 80 años. Med Clin (Barc) 2014;143:134.e1-134.e11 [M,II]
TRATAMIENTO DE LOS FACTORES DE RIESGO VASCULAR EN EL PACIENTE MAYOR DE 80 AÑOS
 
 
Pacheco-Pantoja EL, Alvarez-Nemegyei J. Estatinas y osteoporosis: una promesa latente. Reumatol Clin 2014;10:201-203 [AO,I]
ESTATINAS Y OSTEOPOROSIS: UNA PROMESA LATENTE
 
 
Gili M, Ramírez G, Béjar L, López J, Franco D, Sala J. Trastornos por cocaína e infarto agudo de miocardio, prolongación de estancias y exceso de costes hospitalarios. Rev Esp Cardiol 2014;67:545-551 [T,I]
TRASTORNOS POR COCAÍNA E INFARTO AGUDO DE MIOCARDIO, PROLONGACIÓN DE ESTANCIAS Y EXCESO DE COSTES HOSPITALARIOS
 
 
Addressing global dementia. Lancet 2014;383:2185 [AO,I]
ABORDAR LA DEMENCIA EN EL MUNDO
 
Palace J, Robertson N. Modifying disability in progressive multiple sclerosis. Lancet 2014;383:2189-2191 [AO,I]
MODIFICAR LA DISCAPACIDAD EN LA ESCLEROSIS MÚLTIPLE PROGRESIVA
 
Cacoub PP. Colchicine for treatment of acute or recurrent pericarditis. Lancet 2014;383:2193-2194 [AO,I]
COLCHICINAPARA EL TRATAMIENTO DE LA PERICARDITIS AGUDA O RECURRENTE
 
Chataway J, Schuerer N, Alsanousi A, Chan D, MacManus D, Hunter K, et al. Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive multiple sclerosis (MS-STAT): a randomised, placebo-controlled, phase 2 trial. Lancet 2014;383:2213-2221 [EC,I]
EFECTO DE LA SIMVASTATINA A DOSIS ALTAS SOBRE LA ATROFIA CEREBRAL Y LA DISCAPACIDAD EN LA ESCLEROSIS MÚLTIPLE PROGRESIVA SECUNDARIA
 
Imazio M, Belli R, Brucato A, Cemin R, Ferrua S, Beqaraj F, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet 2014;383:2232-2237 [EC,I]
EFICACIA Y SEGURIDAD DE LA COLCHICINA PARA EL TRATAMIENTO DE LAS RECURRENCIAS MÚLTIPLES DE LA PERICARDITIS (CORP-2): ENSAYO ALEATORIZADO CONTROLADO POR PLACEBO, DOBLE CIEGO, MULTICÉNTRICO
 
Jaffe HW, Frieden TR. Improving health in the USA: progress and challenges. Lancet 2014;384:3-5 [AO,I]
MEJORAR LA SALUD EN LOS EE UU: PROGRESOS Y RETOS
 
Chescheir NC, Goodnight W. Improving livebirth rates: a role for preconception aspirin? Lancet 2014384:5-6 [AO,I]
MEJORAR LAS TASAS DE NACIDOS VIVOS: ¿PAPEL PARA LA ASPIRINA PRECONCEPCIONAL?
 
Schisterman EF, Silver RM, Lesher LL, Faraggi D, Wactawski-Wende J, Townsend JM, et al. Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial. Lancet 2014;384:29-36 [EC,II]
ASPIRINA PRECONCEPCIONAL A BAJAS DOSIS Y RESULTADOS DEL EMBARAZO: RESULTADOS DEL ENSAYO ALEATORIZADO EAGeR
 
Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 2014;384:45-52 [R,II]
PREVENCIÓN DE LA ENFERMEDAD CRÓNICA EN EL SIGLO 21: ELIMINACIÓN DE LAS PRINCIPALES CAUSAS DE MUERTE PREMATURA Y DISCAPACIDAD EN EE UU
 
Khabbaz RF, Moseley RR, Steiner RJ, Levitt AM, Bell BP. Challenges of infectious diseases in the USA. Lancet 2014;384:53-63 [R,I]
RETOS DE LAS ENFERMEDADES INFECCIOSAS EN EE UU
 
Haegerich TM, Dahlberg LL, Simon TR, Baldwin GT, Sleet DA, Greenspan AI, et al. Prevention of injury and violence in the USA. Lancet 2014;384:64-74 [R,I]
PREVENCIÓN DE LAS HERIDAS Y DE LA VIOLENCIA EN EE UU
 
Palliative care: more than one chance to get it right. Lancet 2014;384:103 [AO,I]
CUIDADOS PALIATIVOS: MÁS QUE UNA OPORTUNIDAD PARA HACERLO BIEN
 
Nijs J, Ickmans K. Chronic whiplash-associated disorders: to exercise or not? Lancet 2014;384:109-111 [AO,I]
TRASTORNOS ASOCIADOS AL LATIGAZO CERVICAL CRÓNICO: ¿EJERCICIO O NO?
 
Michaleff ZA, Maher CG, Lin CW, Rebbeck T, Jull G, Latimer J, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet 2014;384:133-141 [EC,I]
PROGRAMA DE EJERCICIOS DE FISIOTERAPIA INTEGRAL O CONSEJO PARA EL LATIGAZO CERVICAL CRÓNICO (PROMISE): ENSAYO CONTROLADO ALEATORIZADO PRAGMÁTICO
 
HIV: science and stigma. Lancet 2014;384:207 [AO,I]
VIH: CIENCIA Y ESTIGMA
 
 
Scott KW, Jha AK. Putting quality on the global health agenda. N Engl J Med 2014;371:3-5 [AO,I]
PONER LA CALIDAD EN LOS PLANES MUNDIALES DE SALUD
 
Anderson WH, Mackay IR. Gut reactions--from celiac affection to autoimmune model. N Engl J Med 2014;371:6-7 [AO,I]
REACCIONES INTESTINALES -- DE LA AFECCIÓN CELÍACA AL MODELO AUTOINMUNE
 
Curran KA. Too much information--the ethics of self-disclosure. N Engl J Med 2014;371:8-9 [AO,I]
DEMASIADA INFORMACIÓN -- LA ÉTICA DE LA AUTODIVULGACIÓN
 
Liu E, Lee HS, Aronsson CA, Hagopian WA, Koletzko S, Rewers MJ, et al; TEDDY Study Group. Risk of pediatric celiac disease according to HLA haplotype and country. N Engl J Med 2014;371:42-49 [S,I]
RIESGO DE ENFERMEDAD CELIACA PEDIÁTRICA SEGÚN EL HAPLOTIPO HLA Y EL PAÍS
 
Weyand CM, Goronzy JJ. Clinical practice. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med 2014;371:50-57 [R,I]
PRÁCTICA CLÍNICA. ARTERITIS DE CÉLULAS GIGANTES Y POLIMIALGIA REUMÁTICA
 
Howard DH. Drug companies' patient-assistance programs--helping patients or profits? N Engl J Med 2014;371:97-99 [AO,I]
PROGRAMAS DE AYUDA AL PACIENTE POR PARTE DE LAS COMPAÑÍAS FARMACOLÓGICAS ¿AYUDAR A LOS PACIENTES O BENEFICIARSE?
 
Rugo HS. Hormone therapy in premenopausal women with early-stage breast cancer. N Engl J Med 2014;371:175-176 [AO,I]
TERAPIA HORMONAL EN MUJERES PREMENOPÁUSICAS CON CÁNCER DE MAMA EN ESTADIO PRECOZ
 
Kessler DA. Toward more comprehensive food labeling. N Engl J Med 2014;371:193-195 [AO,I]
HACIA UN ETIQUETADO ALIMENTARIO MÁS COMPLETO
 
Sylvetsky AC, Dietz WH. Nutrient-content claims--guidance or cause for confusion? N Engl J Med 2014;371:195-198 [AO,I]
DECLARACIONES DEL CONTENIDO EN NUTRIENTES ¿ORIENTACIÓN O CAUSA DE CONFUSIÓN?
 
Greenwood B. Treatment of malaria--a continuing challenge. N Engl J Med 2014;371:474-475 [AO,I]
TRATAMIENTO DE LA MALARIA -- UN RETO CONTINUO
 
ACADEMIC MEDICINE
 
Patients frequently do not receive recommended therapies because performance expectations are often unclear. Clinical guidelines provide exhaustive details and recommendations, but this information is not formatted in a way that supports decision making or bedside translation of therapies. When performance expectations are unclear, it is difficult for clinicians to assess their own or others' competence. Checklists offer hope because they codify interventions, remove ambiguity, and increase reliability of care processes. Schmutz and colleagues developed a robust methodology to create a checklist for evaluating clinical performance, which is described in this issue of Academic Medicine.In this commentary, the authors offer several points to consider as checklists become more prevalent in medical education and clinical practice. First, culture is a much larger part of the equation than the checklist; understanding what all stakeholders expect to gain will help engage checklist use. Second, the construction, validation, and maintenance of checklist evaluation tools is labor intensive, requiring innovative dissemination approaches to ensure maximum access and use of checklists. Third, integrated systems that evaluate technically specified and adaptive performance are needed because some aspects of clinical performance cannot be captured on a checklist. Fourth, checklists provide an opportunity to evaluate and improve an individual's performance concurrently with the context in which it is delivered. A tighter connection between education and training activities and process improvement strategies will accelerate improvements in safety and quality. Schmutz and colleagues have provided advancements in performance evaluation that will help health care achieve higher-quality and safer care.
This approach integrates published evidence and the knowledge of domain experts. A robust development process is a necessary prerequisite of valid performance checklists. Establishing a widely recognized standard for developing evaluation checklists will likely support the design of appropriate measurement tools and move the field of performance assessment in health care forward.
Medical students made statistically significant gains in their performance on an SCT over a two-year period. These findings demonstrate same-student gains in clinical reasoning over time as measured by the SCT and suggest that the SCT as a standardized instrument can help to evaluate growth in clinical reasoning skills.
The undergraduate medical degree, leading to a license to practice, has traditionally been the defining professional milestone of the physician. Developments in health care and medical education and training, however, have changed the significance of the medical degree in the continuum of education toward clinical practice. The author discusses six questions that should lead us to rethink the current status and significance of the medical degree and, consequently, that of the physician. These questions include the quest for core knowledge and competence of the doctor, the place of the degree in the education continuum, the increasing length of training, the sharing of health care tasks with other professionals, and the nature of professional identity in a multitasking world. The author concludes by examining ways to redefine what it means to be a "medical doctor."
Academic Medicine's 2013 Question of the Year (QOTY) asked, "What is a doctor? What is a nurse?" In this commentary, after analyzing the published responses to the 2013 QOTY, the authors offer an assessment of the evolution of the interprofessional interaction between physicians and nurses. Finally, they examine the role of health professions education in shaping the future professional roles and scopes of practice for physicians and nurses. The authors intend to carry the discussion from the present tense (What is a doctor? What is a nurse?) into the future (What will the future team of health care professionals require?) to provide a discussion of challenges to academic medicine and academic nursing in preparing the next generation of health professionals.
 
ANNALS OF INTERNAL MEDICINE
 
A team approach that uses nurse-managed protocols may have positive effects on the outpatient management of adults with chronic conditions, such as diabetes, hypertension, and hyperlipidemia.
Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions.
Men who were socially well-integrated had a more than 2-fold reduced risk for suicide over 24 years of follow-up.
Variation in the appearance of generic pills is associated with nonpersistent use of these essential drugs after MI among patients with cardiovascular disease.
 
ARCHIVOS DE BRONCONEUMOLOGIA
 
Las recomendaciones que se proponen pretenden ser un instrumento que facilite la toma de decisiones en pacientes con nódulo pulmonar solitario (NPS). Para una decisión óptima hay que incorporar la accesibilidad a las distintas técnicas diagnósticas y las preferencias del paciente.
La primera valoración, que incluye la tomografía computarizada torácica, separa a un grupo de pacientes con neoplasia extrapulmonar o muy alto riesgo quirúrgico que requieren manejo individualizado. Otros 2 grupos son los pacientes con NPS de hasta 8 mm y los que tienen NPS subsólido, para los que se establecen recomendaciones específicas.
Los NPS mayores de 8 mm se clasifican según su probabilidad de malignidad en baja (menor del 5%) donde se recomienda observación, alta (mayor del 65%) que se manejan con el diagnóstico de presunción de carcinoma en estadio localizado, e intermedia, donde la tomografía de emisión de positrones tiene gran rendimiento para reclasificarlos en alta o baja probabilidad. En los casos de probabilidad de malignidad intermedia o alta puede ser una opción la punción o biopsia transbronquial del nódulo.
Se recomienda la observación radiológica con tomografía computarizada de baja radiación y sin contraste en el NPS con baja probabilidad de malignidad, y la resección con videotoracoscopia en los casos no diagnosticados y con probabilidad de malignidad intermedia o alta.
La tos en la infancia es un síntoma muy frecuente, y constituye uno de los motivos de consulta más comunes en la práctica pediátrica diaria. Las causas de tos en el niño son diferentes a las del adulto y se deben seguir las guías específicas de la edad pediátrica para su diagnóstico y tratamiento. En la mayoría de casos la causa son infecciones respiratorias banales que producen una «tos normal o esperada», pero todo niño con tos que persiste más allá de las 4 a 8 semanas se considera que tiene «tos crónica» y debe ser evaluado para descartar patologías específicas que abarcan todo el espectro de la neumología pediátrica. El tratamiento de la tos debe realizarse en función de la etiología. Con un abordaje adecuado se puede identificar la misma hasta en el 80% de los casos y el tratamiento será efectivo en el 90% de ellos. En algunos casos de «tos crónica inespecífica», tos en la que se ha descartado patología subyacente, se puede realizar un tratamiento empírico en función de las características de la tos. No hay evidencia científica que justifique el empleo de tratamientos sintomáticos que alivien la tos, como jarabes antitusivos, mucolíticos y/o antihistamínicos, ya que pueden tener efectos secundarios potencialmente graves, por lo que no se deben emplear.
 
BRITISH MEDICAL JOURNAL
 
Statins form the pharmacologic cornerstone of the primary and secondary prevention of atherosclerotic cardiovascular disease. In addition to beneficial cardiovascular effects, statins seem to have multiple non-cardiovascular effects. Although early concerns about statin induced hepatotoxicity and cancer have subsided owing to reassuring evidence, two of the most common concerns that clinicians have are myopathy and diabetes. Randomized controlled trials suggest that statins are associated with a modest increase in the risk of myositis but not the risk of myalgia. Severe myopathy (rhabdomyolysis) is rare and often linked to a statin regimen that is no longer recommended (simvastatin 80 mg). Randomized controlled trials and meta-analyses suggest an increase in the risk of diabetes with statins, particularly with higher intensity regimens in people with two or more components of the metabolic syndrome. Other non-cardiovascular effects covered in this review are contrast induced nephropathy, cognition, cataracts, erectile dysfunction, and venous thromboembolism. Currently, systematic reviews and clinical practice guidelines indicate that the cardiovascular benefits of statins generally outweigh non-cardiovascular harms in patients above a certain threshold of cardiovascular risk. Literature is also accumulating on the potential non-cardiovascular benefits of statins, which could lead to novel applications of this class of drug in the future.
Hepatitis C virus (HCV) infection is a substantial health problem worldwide. Most patients infected with HCV remain chronically infected, with an increased risk of cirrhosis and hepatocellular carcinoma. Although they are associated with toxicities and low sustained viral response rates, interferon alfa and ribavirin have been the mainstay of treatment until recently. New direct acting antivirals, specifically designed to inhibit three viral proteins (the NS3/4A protease, the NS5A protein, and the NS5B RNA dependent RNA polymerase) are now becoming available. The NS3/4A inhibitor simeprevir and NS5B inhibitor sofosbuvir have recently been licensed and can reduce the length of antiviral treatment, improve response rates, and allow for interferon-free regimens for some HCV genotypes. Several other newer direct acting antivirals have shown promise in clinical studies and are likely to be licensed soon. These agents seem to facilitate the use of shortened courses of combination interferon-free therapy, which are associated with high (>95%) sustained response rates and relatively few toxicities. These regimens have also been successful in patients who were previously difficult to treat, including those with cirrhosis, HIV coinfection, and those who have undergone liver transplantation. The high cost of these agents may be the biggest challenge to their implementation worldwide.
Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.
This study questions the causal effect of short interpregnancy intervals on adverse birth outcomes and points to the possibility of unmeasured or inadequately specified maternal factors in previous studies.
Neither niacin, fibrates, nor CETP inhibitors, three highly effective agents for increasing high density lipoprotein levels, reduced all cause mortality, coronary heart disease mortality, myocardial infarction, or stroke in patients treated with statins. Although observational studies might suggest a simplistic hypothesis for high density lipoprotein cholesterol, that increasing the levels pharmacologically would generally reduce cardiovascular events, in the current era of widespread use of statins in dyslipidaemia, substantial trials of these three agents do not support this concept.
Subgroup analyses are insufficiently described in the protocols of randomised controlled trials submitted to research ethics committees, and investigators rarely specify the anticipated direction of subgroup effects. More than one third of statements in publications of randomised controlled trials about subgroup prespecification had no documentation in the corresponding protocols. Definitive judgments regarding credibility of claimed subgroup effects are not possible without access to protocols and analysis plans of randomised controlled trials.
Peer reviewers fail to detect important deficiencies in reporting of the methods and results of randomised trials. The number of these changes requested by peer reviewers was relatively small. Although most had a positive impact, some were inappropriate and could have a negative impact on reporting in the final publication.
Available observational data show an inverse association between leucocyte telomere length and risk of coronary heart disease independent of conventional vascular risk factors. The association with cerebrovascular disease is less certain.
People born into families in which someone already has cerebral palsy are themselves at elevated risk, depending on their degree of relatedness. Elevated risk may extend even to third degree relatives (first cousins). The patterns of risk suggest multifactorial inheritance, in which multiple genes interact with each other and with environmental factors. These data offer additional evidence that the underlying causes of cerebral palsy extend beyond the clinical management of delivery.
This meta-analysis provides further evidence that a higher consumption of fruit and vegetables is associated with a lower risk of all cause mortality, particularly cardiovascular mortality.
Comprehensive and community based primary health care programmes, such as the FHP in Brazil, acting through cardiovascular disease prevention, care, and follow-up can contribute to decreased cardiovascular disease morbidity and mortality in a developing country such as Brazil.
Choice of definition of osteoporosis and use of NOF derived FRAX intervention thresholds have major effects on the proportion of older men identified as warranting drug treatment to prevent fracture. Among men identified with osteoporosis by WHO criteria, who comprised 2% of the study population, actual observed fracture probabilities during 10 years of follow-up were highest and exceeded FRAX predicted fracture probabilities. On the basis of findings from randomized trials in women, these men are most likely to benefit from treatment. Expanding indications for treatment beyond this small group has uncertain value owing to lower observed fracture probabilities and uncertain benefits of treatment among men not selected on the basis of WHO criteria.
A threshold for "optimal" population RBC folate concentration for the prevention of neural tube defects could be defined (for example, approximately 1000 nmol/L). Population based RBC folate concentrations, as a biomarker for risk of neural tube defects, can be used to facilitate evaluation of prevention programs as well as to identify subpopulations at elevated risk for a neural tube defect affected pregnancy due to folate insufficiency.
 
BRITISH JOURNAL OF PSYCHIATRY
 
Early-life conduct problems are robustly associated with later depressive disorder and may be useful targets for early intervention.
 
CANADIAN MEDICAL ASSOCIATION JOURNAL
 
Pregnancy is associated with a substantial risk of a serious motor vehicle crash during the second trimester. This risk merits attention for prenatal care.
 
CIRCULATION
 
Elderly patients had higher stroke and major bleeding rates than younger patients, but the efficacy and safety of rivaroxaban relative to warfarin did not differ with age, supporting rivaroxaban as an alternative for the elderly.
Healthy lifestyle changes during young adulthood are associated with decreased risk and unhealthy lifestyle changes are associated with increased risk for subclinical atherosclerosis in middle age.
In most participants, low levels of alcohol use are associated with a moderate reduction in the risk of MI; however, the strength of this association may not be uniform across different countries. An episode of heavy drinking is associated with an increased risk of acute MI in the subsequent 24 hours, particularly in older individuals.
In the absence of proven interventions for the primary prevention of atrial fibrillation, this post hoc analysis of the PREDIMED trial suggests that extravirgin olive oil in the context of a Mediterranean dietary pattern may reduce the risk of atrial fibrillation.
 
DRUGS
 
Nivolumab (Opdivo(®)) is a fully human monoclonal antibody against programmed death receptor-1, a negative regulatory checkpoint molecule with a role in immunosuppression. The drug is administered intravenously and is approved for the treatment of unresectable malignant melanoma in Japan. The potential for intravenous nivolumab to be used in the treatment of advanced malignancies such as melanoma was initially demonstrated in phase I dose-ranging trials. Subsequently, in a noncomparative, open-label, phase II trial, almost one-quarter of Japanese patients with previously treated stage III/IV melanoma (recurrent or unresectable) achieved a partial tumour response with intravenous nivolumab 2 mg/kg every 3 weeks. The clinical benefit of the drug was durable, with patients surviving free from progression for a median of 172 days and median overall survival not yet reached. Nivolumab had an acceptable tolerability profile in this trial, with fewer than 18 % of patients experiencing grade 3 or 4 adverse events related to the drug, the most common of which was increased ?-glutamyl transferase. Thus, nivolumab is an emerging, promising option for the treatment of malignant melanoma.
Drug-resistant tuberculosis is a growing threat to global public health. Recent efforts to understand the evolution of drug resistance have shown that changes in drug-target interactions are only the first step in a longer adaptive process. The emergence of transmissible drug-resistant Mycobacterium tuberculosis is the result of a multitude of additional genetic mutations, many of which interact, a phenomenon known as epistasis. The varied effects of these epistatic interactions include compensating for the reduction of the biological cost associated with the development of drug resistance, increasing the level of resistance, and possibly accommodating broader changes in the physiology of resistant bacteria. Knowledge of these processes and our ability to detect them as they happen informs the development of diagnostic tools and better control strategies. In particular, the use of whole genome sequencing combined with surveillance efforts in the field could provide a powerful instrument to prevent future epidemics of drug-resistant tuberculosis.
Dolutegravir (Tivicay(®)) is a new-generation HIV-1 integrase strand transfer inhibitor recently approved in the EU and Japan for the treatment of HIV-1 infection in adolescents and adults in combination with other antiretroviral drugs. It is suitable for once-daily administration and achieves therapeutic concentrations without the need for pharmacokinetic boosting. It has a high barrier to resistance and is generally active against viral strains resistant to first-generation integrase inhibitors. In well-designed clinical trials in treatment-naive or treatment-experienced, integrase inhibitor-naive patients, dolutegravir-based combinations were shown to be noninferior or superior to raltegravir-based combinations, an efavirenz-based combination and ritonavir-boosted darunavir-based combinations with respect to virological suppression (plasma HIV-1 RNA <50 copies/mL) at week 48. Dolutegravir was also effective in a high proportion of patients failing on raltegravir- or elvitegravir-based therapy as a result of integrase resistance mutations. Dolutegravir was generally well tolerated, with the vast majority of adverse events being mild or moderate in intensity; serious adverse events were uncommon. Therefore, dolutegravir is an important new addition to the expanding list of antiretroviral drugs for treating HIV-1 infection in adults and adolescents.
Sofosbuvir (Sovaldi(®)) is a nucleotide hepatitis C virus (HCV) NS5B polymerase inhibitor that has pangenotypic antiviral activity and a high genetic barrier to resistance. This article reviews the clinical efficacy and tolerability of sofosbuvir in patients with chronic hepatitis C and summarizes its pharmacological properties. Interferon-free treatment with sofosbuvir plus ribavirin achieved high sustained virological response (SVR) rates in treatment-naïve and treatment-experienced patients with HCV genotype 2 or 3 infection, and also had efficacy in patients with HCV genotype 1 infection. Sofosbuvir plus ribavirin was also effective in patients co-infected with HCV and HIV, and sofosbuvir plus ribavirin administered prior to liver transplantation prevented recurrent HCV infection in the majority of patients who had HCV RNA levels below the limit of quantification at the time of transplantation. Sofosbuvir plus peginterferon-a-2a and ribavirin achieved high SVR rates in patients with HCV genotype 1 infection, and also appeared effective in patients with HCV genotype 4, 5 or 6 infection. Oral sofosbuvir was generally well tolerated in patients with chronic hepatitis C. The most commonly reported adverse events and laboratory abnormalities were consistent with those expected with ribavirin and peginterferon-a. In conclusion, sofosbuvir represents an important advance in the treatment of chronic hepatitis C.
Airway mucus has a key role in protective innate immune responses, but excessive mucus production and secretion in proximal and in distal airways are associated with disabling symptoms (cough and sputum), lung function decline, exacerbations and mortality in patients with chronic obstructive pulmonary disease (COPD). Cellular and molecular mechanisms leading to mucin production and secretion have largely been identified using cultured epithelial cells and animal models. Cigarette smoke and microbial products are potent triggers of mucin production, which involves recognition of specific molecular patterns by cognate receptors and activation of metalloproteases at the epithelial cell surface, leading to epidermal growth factor receptor activation and mucin mRNA and protein synthesis. After mucin synthesis has occurred, mucins are tightly packed into intracytoplasmic granules. Many stimuli induce secretion of mucin granules from epithelial cells, but neutrophil serine proteases are the most potent inducers of mucin secretion. Neutrophils recruited to the airway epithelium also promote mucin production via neutrophil proteases and oxidative stress. Several drugs currently available for the treatment of COPD patients reduced mucus hypersecretion in preclinical models relevant to COPD, but their effects on mucus hypersecretion in humans have not been assessed. Testing the effects of these drugs and of novel molecules designed for reducing mucus production and/or secretion will require performing specifically designed clinical trials. These trials will be necessary to explore the hypothesis that reducing mucus hypersecretion is beneficial in COPD patients.
Quadrivalent human papillomavirus (HPV) [types 6, 11, 16, 18] recombinant vaccine (Gardasil(®); Silgard(®)) is composed of virus-like particles formed by self-assembly of recombinant L1 capsid protein from each of HPV types 6, 11, 16 and 18. It is indicated for use from the age of 9 years as a two- or three-dose vaccination course over 6 months for the prevention of premalignant anogenital lesions, cervical and anal cancers, and genital warts caused by the vaccine HPV types. In placebo-controlled trials, quadrivalent HPV vaccine provided high-level protection against infection or disease caused by the vaccine HPV types over 2-4 years in females aged 15-45 years who were negative for the vaccine HPV types, and provided a degree of cross-protection against certain non-vaccine HPV types. The vaccine also provided high-level protection against persistent infection, anogenital precancerous lesions and genital warts caused by the vaccine HPV types over 3 years in susceptible males aged 16-26 years. Protection has been demonstrated for up to 8 years. In subjects who were negative for the vaccine HPV types, high seroconversion rates and high levels of anti-HPV antibodies were observed in females of all age ranges from 9 to 45 years and in males aged 9-26 years. The vaccine was generally well tolerated and was usually predicted to be cost effective in girls and young women. Therefore, quadrivalent HPV vaccine offers an effective means to substantially reduce the burden of HPV-related anogenital disease in females and males, particularly cervical cancer and genital warts.
Edoxaban is a once-daily oral anticoagulant that rapidly and selectively inhibits factor Xa in a concentration-dependent manner. This review describes the extensive clinical development program of edoxaban, including phase III studies in patients with non-valvular atrial fibrillation (NVAF) and symptomatic venous thromboembolism (VTE). The ENGAGE AF-TIMI 48 study (N = 21,105; mean CHADS2 score 2.8) compared edoxaban 60 mg once daily (high-dose regimen) and edoxaban 30 mg once daily (low-dose regimen) with dose-adjusted warfarin [international normalized ratio (INR) 2.0-3.0] and found that both regimens were non-inferior to warfarin in the prevention of stroke and systemic embolism in patients with NVAF. Both edoxaban regimens also provided significant reductions in the risk of hemorrhagic stroke, cardiovascular mortality, major bleeding and intracranial bleeding. The Hokusai-VTE study (N = 8,292) in patients with symptomatic VTE had a flexible treatment duration of 3-12 months and found that following initial heparin, edoxaban 60 mg once daily was non-inferior to dose-adjusted warfarin (INR 2.0-3.0) for the prevention of recurrent VTE, and also had a significantly lower risk of bleeding events. Both studies randomized patients at moderate-to-high risk of thromboembolic events and were further designed to simulate routine clinical practice as much as possible, with edoxaban dose reduction (halving dose) at randomisation or during the study if required, a frequently monitored and well-controlled warfarin group, a well-monitored transition period at study end and a flexible treatment duration in Hokusai-VTE. Given the phase III results obtained, once-daily edoxaban may soon be a key addition to the range of antithrombotic treatment options.
Migraine is a neurovascular disorder that is associated with severe headache and neurologic symptoms. The pathogenesis of migraine is believed to involve trigeminovascular system activation with the primary dysfunction located in brainstem. Glutamate, the major excitatory neurotransmitter in the central nervous system, and its receptors have since long been suggested in migraine pathophysiology. Different preclinical studies have confirmed their potential role in migraine. Moreover, several glutamate receptor modulators have been studied in clinical studies, some with promising results. In this review, we will give an overview of what is known about the role of glutamate in the pathogenesis of migraine, which will be followed by an overview of available efficacy, safety and tolerability data for glutamate receptor inhibitors in clinical development for the treatment of migraine.
 
DIABETES CARE
 
While metabolic risk factors associated with overweight increase future risk for MetS, T2DM, and increased IMT, overweight in isolation is also a risk factor. Therefore, overweight should be prevented and treated wherever possible.
HD vitamin D supplementation commencing at a mean of 14 weeks' gestation does not improve glucose levels in pregnancy. However, in women with baseline levels <32 ng/mL, 5,000 IU per day was well tolerated and highly effective at preventing neonatal vitamin D deficiency.
We conclude that shape- and barefoot plantar pressure-based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions.
Various clinical and quality of life-related factors influence patient preferences for noninsulin diabetes medications. Treatment efficacy with regard to glycemic control and weight loss/control and the risk of treatment-related hypoglycemia and gastrointestinal effects are reported to be important drivers of patient treatment selections. Future work is needed to identify practical methods for incorporating patient preferences into treatment decision making and patient-centered care.
High total and animal protein intake was associated with a modest elevated risk of type 2 diabetes in a large cohort of European adults. In view of the rapidly increasing prevalence of type 2 diabetes, limiting iso-energetic diets high in dietary proteins, particularly from animal sources, should be considered.
In patients with newly diagnosed type 2 diabetes, an LCMD resulted in a greater reduction of HbA1c levels, higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet.
 
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
 
Entre los HSH la prevalencia de conductas sexuales de alto riesgo es alta, tanto con la PE como con las PO. Los factores asociados a la PANP de alto riesgo varían según el tipo de pareja sexual (p. ej., tener el VIH con una carga viral indetectable), factores que tienen que considerarse para plantear estrategias de prevención primaria y secundaria.
Hasta fechas muy recientes eran muy pocos los genomas de Chlamydia trachomatis disponibles, a pesar de su importancia en salud pública. Actualmente se están secuenciando 66 genomas completos de C. trachomatis. Esta revolución genómica está permitiendo comprender su biología, mejorar la sensibilidad y especificidad en el diagnóstico o desarrollar herramientas epidemiológicas no solo de C. trachomatis sino también de especies relacionadas, como C. pneumoniae o C. psittaci. El diagnóstico basado en cultivo celular, serología o microinmunofluorescencia está siendo progresivamente sustituido por técnicas de amplificación de ácidos nucleicos, al superarse los inconvenientes de escaso rendimiento o reacciones cruzadas y mejorar la estandarización entre laboratorios. Por otra parte, el desarrollo de técnicas de tipificación (MLST y VNTR) aplicadas a Chlamydiae ha aumentado el conocimiento de la epidemiología local y global aportando información sobre cómo esas bacterias evolucionan, causan brotes o adquieren mecanismos de resistencia. Esta revisión se centra en los grandes avances alcanzados en el conocimiento de las diferentes especies de Chlamydia, en parte debido a la innovación tecnológica aplicada a la genómica como una aproximación para explicar la revolución que, tanto en el diagnóstico como en su epidemiología, se ha observado en este grupo de bacterias en los últimos años.
La presentación clínica de la tos ferina en lactantes es similar a la infección por VRS, aunque existen algunas características que pueden ayudar a diferenciar ambos cuadros clínicos.
 
EUROPEAN HEART JOURNAL
 
Although the number of individuals reaching 80 who are considered to be healthy is increasing, the very elderly are likely to have long-term conditions, to report symptoms and/or be taking at least one regular medication. The impact of antihypertensive treatment has to be taken into account in this context. The treatment regimen in Hypertension in the Very Elderly Trial with a goal blood pressure of <150/80 mmHg has been shown to provide benefits in terms of a reduction in risk of total mortality, stroke, and cardiovascular events with potential benefits and no evidence of increased risk for fracture, dementia, depression, and quality-of-life outcomes. Questions remain as to the level of benefit that would be accrued in the frailer elderly and those at extreme age, for example, over 90.
Among high-risk patients with atrial fibrillation who experienced major bleeding in ROCKET AF, the use of FFP and PCC was less among those allocated rivaroxaban compared with warfarin. However, use of PRBCs and outcomes after bleeding were similar among patients randomized to rivaroxaban or to warfarin.
Use of ACEI/ARB was not associated with better outcomes in stable CAD outpatients without HF. The benefit of ACEI/ARB seen in randomized clinical trials was not replicated in this large contemporary cohort, which questions their value in this specific subset.
Continuation or short-term interruption of NOAC is safe strategies for most invasive procedures. Patients at cardiovascular risk undergoing major procedures may benefit from heparin bridging, but bleeding risks need to be considered.
In subjects with TRH, intensive lipid lowering with atorvastatin 80 mg is associated with a significant reduction in cardiovascular events.
The benefits of apixaban vs. warfarin were consistent in patients with AF regardless of age. Owing to the higher risk at older age, the absolute benefits of apixaban were greater in the elderly.
Patients initiating warfarin may be at an increased risk of stroke during the first 30 days of treatment, supporting the biological plausibility of a transient hypercoagulable state at the start of the treatment, although additional studies are needed to confirm these findings.
C-reactive protein concentrations are substantially lower in Koreans than reported for whites populations. Nonetheless, C-reactive protein levels are associated with CVD and all-cause mortality in Korean men. Standard cut points for C-reactive protein may under-represent Asians at risk for CVD.
The efficacy and safety of apixaban compared with aspirin is consistent in subgroups of patients who have previously attempted but failed VKA therapy, irrespective of the reason for discontinuation.
S24510637
Direct oral anticoagulants (DOACs) specifically target factor IIa or Xa and represent a major step forward in the treatment of acute- and long-term prevention of venous thrombo-embolism (VTE). They are at least as effective and as safe as conventional therapy (heparins and vitamin-K inhibitors) and have practical advantages, such as fixed dosing and no need for laboratory monitoring. These antithrombotic agents introduce a new paradigm for the day-to-day management of VTE. Direct oral anticoagulants should streamline the management of most patients with VTE and will facilitate care in the outpatient setting. Nevertheless, it remains uncertain how to select specific DOACs for particular profiles of patients, and the optimal management of bleeding complications is evolving.
Long-term anticoagulation treatment with warfarin has been associated with a number of limitations in clinical practice and there is a need for more convenient long-term anticoagulation treatment. One of the non-vitamin K oral anticoagulants in development is edoxaban, a factor Xa inhibitor that is administered once daily. The pharmacological properties of edoxaban have various advantages in anticoagulant therapy. Edoxaban quickly reaches peak plasma concentrations in 1.5 h, has a half-life of 10-14 h, has relatively high bioavailability of 62% and exhibits highly selective, competitive, concentration-dependent inhibition of human factor Xa. The plasma concentrations of edoxaban are also closely correlated with suppression of thrombin generation and a range of platelet activation parameters (fragment 1+2, thrombin-antithrombin complex, and ß-thromboglobulin), which edoxaban has been shown to rapidly inhibit. The anticoagulant activity of edoxaban is not affected by food intake or ethnicity and a number of drug-drug interaction studies have been performed. Co-administration of edoxaban with strong P-glycoprotein inhibitors, such as dronedarone, quinidine, and verapamil requires edoxaban dose-reduction by 50% to avoid the risk of over-exposure. The exposure of edoxaban may also increase in patients with a body weight =60 kg and moderate renal impairment. This meant a dose-reduction strategy in patients at risk of over-exposure was utilized in Phase III clinical studies. In conclusion, the pharmacological properties of edoxaban provide rapid and specific inhibition of factor Xa, which is closely related to plasma concentrations. Given the limitations with long-term warfarin therapy, once-daily edoxaban may provide a convenient long-term alternative for patients.
Sizeable reductions in BP, with potential for substantial CVD reduction, can be safely achieved using combinations of BP drugs in the elderly with normal high and Stage 1 hypertension.
Renal denervation resulted in sustained lowering of blood pressure at 3 years in a selected population of subjects with severe, treatment-resistant hypertension without serious safety concerns.
In this comprehensive analysis of the antihypertensive efficacy of ARBs by 24 h ABP, we observed a shallow dose-response curve, and uptitration marginally enhanced the antihypertensive efficacy. Blood pressure reduction with losartan at starting dose and at max dose was consistently inferior to the other ARBs.
Based on randomized trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in VKA suitable and VKA unsuitable patients with AF, respectively.
 
FAMILY MEDICINE
 
There is variability in how FMC are addressing PH instruction. Future research should qualitatively explore pedagogical methods and seek consensus on the competencies and best practices in PH instruction most suited to FMC.
The CI fellowship represents a highly replicable program to connect committed and interested clinicians to research mentors with the goal of increasing scholarship and creating a growing culture of inquiry in family medicine.
Students who completed a rural family medicine clerkship are not at an academic disadvantage. There are many possible explanations for better clinical evaluations, and a comparison of performance on the clinical skills assessment would be useful to determine whether the increased clinical experience during the rural option created a difference in clinical skills.
 
GACETA SANITARIA
 
Se aprecia variabilidad entre comunidades autónomas en los tipos y formas de aplicación de las actividades comunitarias realizadas por atención primaria, así como en el reconocimiento institucional y la implicación comunitaria en el desarrollo y la evaluación de la actividad.
A pesar de observar una tendencia decreciente, las desigualdades sociales son un elemento sustantivo en la distribución de la mortalidad general en la ciudad de Cádiz.
Se ha detectado una gran diversidad en la medición de los determinantes sociales y una falta de estudios especialmente en edades preescolares y con diseños longitudinales. Se confirman las desigualdades sociales en algunos aspectos de salud.
 
JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
 
Family physicians face many challenges when diagnosing asthma in preschool children. These diagnostic challenges are compounded by variations in the natural history of early stage asthma, which are not fully understood, since early childhood wheezing and asthma are heterogeneous disorders with many phenotypic and variable expressions. Since no standard definition for the type, severity, or frequency of symptoms exist for this age group, clear evidence-based recommendations are lacking. Without adequate guidance, family physicians are left to make diagnostic and treatment decisions, which can lead to undertreatment of asthmatics and overtreatment of transient wheezers. New guidelines that specifically address the challenges of diagnosing asthma in this particular age group (Global Initiative for Asthma, British Thoracic Society/Scottish Intercollegiate Guidelines Network) have recently been published, and researchers are actively seeking new methods and techniques through epidemiological studies to assist primary care clinicians in the diagnostic process. This review has wide application in primary care. By recognizing the diagnostic challenges and understanding the related best practices, family physicians will be better placed to treat, manage, and control asthma symptoms, resulting in lower morbidity rates and reduced health system costs, as well as enhancing the overall quality of life and well-being of the children affected.
Adults with bleeding disorders may present to their family physician with minor bleeding symptoms or hematologic laboratory abnormalities discovered during evaluation for surgery or another purpose. Identifying the small proportion of adults who have an underlying bleeding disorder as the cause for such signs or symptoms may be challenging. In cases of asymptomatic hematologic laboratory abnormalities, the particular abnormality should narrow down the potentially affected hemostatic component(s), ideally streamlining subsequent investigation. In patients presenting with bleeding symptoms, a thorough history and physical examination are critical for first identifying bleeding as pathologic, then performing the appropriate diagnostic evaluation after excluding identifiable causes. Knowledge of the pathophysiologic processes contributing to impaired hemostasis in any given bleeding disorder ensures proper treatment and avoids therapies that are unnecessary or even contraindicated. Management is further determined by bleeding phenotype and, for invasive procedures, the anticipated risk for bleeding. Consultation with a hematologist may facilitate proper evaluation and treatment, particularly in adults with rare bleeding disorders or no identifiable cause for bleeding. This article reviews the diagnostic approach to hematologic laboratory abnormalities and abnormal bleeding in adults, as well as basic preventive care and hemostatic management of adults with bleeding disorders.
 
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
 
After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.
Two screening instruments, the GAD-7 for GAD and the Patient Health Questionnaire for panic disorder, have good performance characteristics and are feasible for use in primary care. However, further validation of these instruments is needed because neither instrument was replicated in more than 1 primary care population.
Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
In a multicenter cohort of black and white adults in US communities, stroke incidence and mortality rates decreased from 1987 to 2011. The decreases varied across age groups, but were similar across sex and race, showing that improvements in stroke incidence and outcome continued to 2011.
Varenicline in combination with NRT was more effective than varenicline alone at achieving tobacco abstinence at 12 weeks (end of treatment) and at 6 months. Further studies are needed to assess long-term efficacy and safety.
CLINICAL QUESTION:
Are antiepileptic drugs associated with reduced pain intensity in patients with neuropathic pain or fibromyalgia?
BOTTOM LINE:
In treating diabetic neuropathy and postherpetic neuralgia compared with placebo, gabapentin and pregabalin are associated with a modest increase in the number of patients experiencing meaningful pain reduction. In treating fibromyalgia, compared with placebo, pregabalin alone is associated with a small increase in the number of patients experiencing meaningful pain reduction. There is insufficient evidence for other antiepileptics.
A history of stroke was associated with adverse outcomes following surgery, in particular if time between stroke and surgery was less than 9 months. After 9 months, the associated risk appeared stable yet still increased compared with patients with no stroke. The time dependency of risk may warrant attention in future guidelines.
 
JAMA INTERNAL MEDICINE
 
Both intervention formats reduced CHD risk through 12-month follow-up. The web format was less expensive.
The UAC and the ACR yielded high sensitivity and specificity for the detection of microalbuminuria. Because the diagnostic performance of the UAC is comparable to that of the ACR, our findings indicate that the UAC of random urine samples may become the screening tool of choice for the population with DM, considering the rising incidence of DM and the constrained health care resources in many countries.
Caloric and fat intake have increased among statin users over time, which was not true for nonusers. The increase in BMI was faster for statin users than for nonusers. Efforts aimed at dietary control among statin users may be becoming less intensive. The importance of dietary composition may need to be reemphasized for statin users.
Low-dose oral estradiol and venlafaxine are effective treatments for VMS in women during midlife. While the efficacy of low-dose estradiol may be slightly superior to that of venlafaxine, the difference is small and of uncertain clinical relevance.
Among postmenopausal women who discontinue alendronate therapy after 4 to 5 years, age and hip BMD at discontinuation predict clinical fractures during the subsequent 5 years. Follow-up measurements of DXA 1 year after discontinuation and of BAP or NTX 1 to 2 years after discontinuation are not associated with fracture risk and cannot be recommended.
In older community-dwelling adults, total urinary resveratrol metabolite concentration was not associated with inflammatory markers, cardiovascular disease, or cancer or predictive of all-cause mortality. Resveratrol levels achieved with a Western diet did not have a substantial influence on health status and mortality risk of the population in this study.
Considerable variability among studies in the methods of preference assessment, the time between assessments, and the definitions of stability preclude meta-analytic estimates of the stability of patients' preferences and the factors influencing these preferences. Although more seriously ill patients and those who engage in advance care planning most commonly have stable preferences for future treatments, further research in real-world settings is needed to confirm the utility of advance care plans for future decision making.
Increasing physical activity may lower the risk of progression from GDM to T2DM. These findings suggest a hopeful message to women with a history of GDM, although they are at exceptionally high risk for T2DM, promoting an active lifestyle may lower the risk.
 
JAMA PSYCHIATRY
 
Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.
 
MEDICINA CLINICA
 
Los cuidados de las personas mayores después de una enfermedad aguda o accidente han adquirido una gran relevancia en el coste sanitario, debido tanto al envejecimiento de la población como al cambio en la estructura sociofamiliar.
El objetivo principal de los cuidados postagudos (CPA) es restituir la capacidad funcional del paciente después de un episodio agudo, puesto que este determinará su evolución y contactos posteriores con el sistema sanitario. Nos hemos propuesto revisar los siguientes aspectos de los CPA: a) objetivos; b) cuantificación de las necesidades e indicadores de acceso, y c) estrategias de transferencia desde los cuidados agudos. Para ello se ha realizado una revisión sistemática de la literatura médica desde el año 1990 hasta el 2011.
Se concluye que los CPA son un instrumento eficiente para mejorar la calidad de vida de los pacientes y para la sostenibilidad del sistema sanitario público. En la selección de los candidatos hay que manejar un conjunto de indicadores tanto sanitarios como sociales. La visión transversal de todo el proceso es fundamental para evitar un incremento en los costes totales.
La enfermedad pulmonar obstructiva crónica asocia alteraciones del estado nutricional, con prevalencia variable (2-50%) dependiendo de la zona geográfica y el diseño del estudio. Entre los instrumentos diagnósticos destacan la antropometría, la impedancia bioeléctrica, la radioabsorciometría de doble energía y la dilución de deuterio, siendo los índices de masa corporal y de masa magra las variables más utilizadas. Las consecuencias más importantes de las alteraciones nutricionales son la disfunción muscular y la limitación al ejercicio, y los factores que se han implicado en su aparición incluyen el desequilibrio entre ingesta y consumo calórico, así como entre hormonas anabólicas y catabólicas, la inflamación, el tabaco, la escasa actividad física, la hipoxemia, algunos fármacos y el envejecimiento-comorbilidades. El mecanismo molecular más importante parece ser la pérdida del equilibrio entre síntesis y destrucción proteicas. Entre las medidas terapéuticas destacan la mejora en los hábitos de vida y el soporte nutricional, aunque el uso de fármacos anabolizantes, como las secretagogas de la hormona de crecimiento, está abriendo prometedoras opciones.
Existe una asociación entre la dislipidemia y la ETEV, siendo el riesgo de trombosis casi 4 veces mayor en individuos con esta enfermedad. Las alteraciones del perfil lipídico también están relacionadas con una mayor prevalencia de recurrencia y síndrome postrombótico.
El presente estudio aporta nuevas evidencias de asociación del ADE con mortalidad en una cohorte de pacientes ancianos que sobreviven a un ingreso hospitalario. El ADE fue el único parámetro de laboratorio analizado que mejoraba la capacidad pronóstica de mortalidad a un año.
La frecuencia cardiaca refleja la actividad del sistema nervioso autónomo. Numerosos estudios han demostrado que la frecuencia cardiaca elevada en reposo se asocia con la morbimortalidad cardiovascular como factor de riesgo independiente. Se ha evidenciado una relación entre balance autonómico cardiaco e inflamación, de tal forma que la frecuencia cardiaca elevada produce una respuesta microinflamatoria e interviene en la patogénesis de la disfunción endotelial. A su vez, la disminución de la frecuencia se asocia a beneficios en insuficiencia cardiaca congestiva, infarto de miocardio, fibrilación auricular, obesidad, hiperinsulinemia, resistencia a la insulina y aterosclerosis. La alteración de otros parámetros relacionados con la frecuencia cardiaca, tales como su variabilidad y su recuperación tras realizar ejercicio, se asocia con riesgo de episodios cardiovasculares. Los fármacos que reducen la frecuencia (betabloqueantes, antagonistas del calcio e inhibidores de canales If) tienen el potencial de reducir sucesos cardiovasculares. Aunque en sujetos sanos no se recomienden intervenciones para la reducción de la frecuencia cardiaca, en determinadas enfermedades constituye un objetivo terapéutico razonable.
Se revisan los efectos beneficiosos y los problemas relacionados con los fármacos hipoglucemiantes tradicionales y se analizan los nuevos medicamentos de esta clase relacionados con el efecto incretina: análogos del péptido similar al glucagón tipo 1 e inhibidores de las dipeptidil peptidasas tipo 4. Ambos producen, de forma dependiente de la glucosa, una reducción de la glucemia, no se relacionan con la hipoglucemia y no aumentan el peso. Otro nuevo grupo son los inhibidores del cotransportador sodio-glucosa tipo 2, que disminuyen la glucemia con bajo riesgo de hipoglucemia y con discreta pérdida de peso. Los efectos beneficiosos a largo plazo y la prevención cardiovascular no están demostrados.
Disponemos cada vez de más y mejores fármacos. Por otra parte, el tratamiento farmacológico hipoglucemiante debe ser personalizado, considerando los valores de hemoglobina glucosilada, el riesgo-beneficio, el riesgo de hipoglucemia, los cambios en el peso y el estado cardiovascular, entre otros factores.
No tenemos el hipoglucemiante ideal y no debemos olvidar que, junto al control de la hiperglucemia, el tratamiento precoz e intensivo de la dislipidemia y de la hipertensión es fundamental en la prevención cardiovascular del paciente con diabetes tipo 2.
La prevalencia de halitosis fue del 36,7%. El uso de chicle como adyuvante en casos de halitosis disminuye los CVS, mejorando la percepción de terceros y del propio paciente.
La exposición activa o pasiva de la madre al tabaco durante la gestación y los menores valores de hemoglobina se asocian a mayor riesgo de partos prematuros y menor peso al nacer. El abandono del tabaco evita estos efectos perjudiciales.
La anosognosia se incrementa con el mayor deterioro. En los pacientes en fase leve las variables predictoras fueron la apatía, la desinhibición y los trastornos motores.
Los sujetos muy ancianos, de 80 o más años de edad, constituyen el grupo etario de más rápido crecimiento demográfico en los países desarrollados. Las enfermedades cardiovasculares son la principal causa de muerte, representan una importante causa de discapacidad y generan una enorme carga económica en este grupo de edad. Sin embargo, son muy escasas las evidencias científicas disponibles que respaldan la toma de decisiones sobre prevención cardiovascular en dichos sujetos. Las escalas de riesgo actualmente disponibles no son aplicables en los ancianos, y, además, están centradas en el riesgo de muerte cardiovascular y no aportan información sobre factores que han mostrado ser de capacidad pronóstica relevante en esta población (incapacidad funcional, demencia). Los ancianos forman un grupo muy heterogéneo de pacientes, con diferentes grados de comorbilidad y de capacidad funcional y cognitiva. Además, los cambios fisiológicos propios del envejecimiento y la frecuente presencia de polimedicación incrementan el riesgo de efectos adversos medicamentosos en los ancianos, por lo que la indicación de fármacos en esta población debe considerar siempre la relación riesgo/beneficio. Por tanto, la toma de decisiones terapéuticas en pacientes muy ancianos debe ser un proceso individualizado basado en un adecuado juicio clínico y en una valoración geriátrica integral. El presente documento de consenso tiene como objetivo proponer unas pautas de actuación prácticas de prevención cardiovascular primaria y secundaria en la población de 80 y más años de edad, realizando una serie de recomendaciones sobre la modificación del estilo de vida y el tratamiento farmacológico de los principales factores de riesgo cardiovascular.
Durante muchos años se ha considerado que el síndrome del intestino irritable (SII) y la enfermedad celíaca (EC) eran 2 entidades completamente diferentes: la segunda relacionada con una intolerancia permanente a la ingesta de gluten, y la primera, sin ninguna relación con esta. El problema estriba en que los síntomas del SII y la EC pueden ser indistinguibles, en especial cuando predominan la diarrea, la hinchazón o el dolor abdominal. Durante la última década diversos estudios han comprobado que la separación entre la EC y el SII no es tan clara. Puede haber pacientes que habiendo sido diagnosticados de SII en realidad tienen una EC. Aún más, parece existir un grupo de enfermos que sin tener una EC presentan una sensibilidad al gluten con manifestaciones digestivas semejantes al SII. La sensibilidad al gluten se define como el conjunto de aquellos trastornos morfológicos, inmunológicos o funcionales que responden a la exclusión de gluten. Este concepto incorpora una serie de manifestaciones histológicas, inmunológicas y clínicas en ausencia de alteraciones morfológicas evidentes. Por tanto, es necesario establecer de una manera científica qué sujetos se podrán beneficiar de una dieta sin gluten, y en cuáles no está justificada.
 
REVISTA ESPAÑOLA DE CARDIOLOGIA
 
Hay una asociación entre los trastornos por cocaína y el infarto agudo de miocardio. Estos trastornos prolongan las estancias hospitalarias y aumentan los costes de los pacientes hospitalizados. La interrupción del uso de la droga debe ser uno de los principales objetivos terapéuticos tras el alta del paciente.
 
THE LANCET
 
In the USA, infectious diseases continue to exact a substantial toll on health and health-care resources. Endemic diseases such as chronic hepatitis, HIV, and other sexually transmitted infections affect millions of individuals and widen health disparities. Additional concerns include health-care-associated and foodborne infections--both of which have been targets of broad prevention efforts, with success in some areas, yet major challenges remain. Although substantial progress in reduction of the burden of vaccine-preventable diseases has been made, continued cases and outbreaks of these diseases persist, driven by various contributing factors. Worldwide, emerging and reemerging infections continue to challenge prevention and control strategies while the growing problem of antimicrobial resistance needs urgent action. An important priority for control of infectious disease is to ensure that scientific and technological advances in molecular diagnostics and bioinformatics are well integrated into public health. Broad and diverse partnerships across governments, health care, academia, and industry, and with the public, are essential to effectively reduce the burden of infectious diseases.
Colchicine added to conventional anti-inflammatory treatment significantly reduced the rate of subsequent recurrences of pericarditis in patients with multiple recurrences. Taken together with results from other randomised controlled trials, these findings suggest that colchicine should be probably regarded as a first-line treatment for either acute or recurrent pericarditis in the absence of contraindications or specific indications.
We have shown that simple advice is equally as effective as a more intense and comprehensive physiotherapy exercise programme. The need to identify effective and affordable strategies to prevent and treat acute through to chronic whiplash associated disorders is an important health priority. Future avenues of research might include improving understanding of the mechanisms responsible for persistent pain and disability, investigating the effectiveness and timing of drugs, and study of content and delivery of education and advice.
High-dose simvastatin reduced the annualised rate of whole-brain atrophy compared with placebo, and was well tolerated and safe. These results support the advancement of this treatment to phase 3 testing.
In the first three decades of life, more individuals in the USA die from injuries and violence than from any other cause. Millions more people survive and are left with physical, emotional, and financial problems. Injuries and violence are not accidents; they are preventable. Prevention has a strong scientific foundation, yet efforts are not fully implemented or integrated into clinical and community settings. In this Series paper, we review the burden of injuries and violence in the USA, note effective interventions, and discuss methods to bring interventions into practice. Alliances between the public health community and medical care organisations, health-care providers, states, and communities can reduce injuries and violence. We encourage partnerships between medical and public health communities to consistently frame injuries and violence as preventable, identify evidence-based interventions, provide scientific information to decision makers, and strengthen the capacity of an integrated health system to prevent injuries and violence.
Preconception-initiated low-dose aspirin was not significantly associated with livebirth or pregnancy loss in women with one to two previous losses. However, higher livebirth rates were seen in women with a single documented loss at less than 20 weeks' gestation during the previous year. Low-dose aspirin is not recommended for the prevention of pregnancy loss.
With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors--including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia--that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessible and direct care, and focus the health-care system on improving population health.
Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.
 
THE NEW ENGLAND JOURNAL OF MEDICINE
 
Children with the HLA haplotype DR3-DQ2, especially homozygotes, were found to be at high risk for celiac disease autoimmunity and celiac disease early in childhood. The higher risk in Sweden than in other countries highlights the importance of studying environmental factors associated with celiac disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).
 
 
 
 

                      

XXVIII Congreso de Comunicación y Salud

 

 

21 Jor. Residentes y Tutores semFYC

 


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