Los resultados preliminares ya señalaban que la vacuna del papilomavirus protegía a las mujeres mayores de 24 años. Ahora, los datos definitivos de un estudio en el que han participado investigadores del Instituto Catalán de Oncología (ICO) confirman su gran eficacia en este grupo de féminas.
"Muchas mujeres se preguntaban qué pasaba con la vacuna, si podían ponérsela o no, y este estudio responde definitivamente a esa pregunta", explica a ELMUNDO.es Xavier Castellsagué, de la Unidad de Infecciones y Cáncer del IDIBELL-ICO (Barcelona), que ha dirigido la rama española del ensayo.
Junto con grupos de otros países, como EEUU, Francia, Colombia o Tailandia, han realizado un seguimiento de cuatro años a cerca de 4.000 mujeres entre 24 y 45 años que recibieron las tres dosis de la vacuna tetravalente del VPH (Gardasil, de Merck), que protege frente a los serotipos 6, 8, 11 y 16 del virus, o un placebo.
"Los resultados son robustos y muestran una gran eficacia, que llega hasta el 89%", subraya Castellsagué. "Además, sabemos que es inmunogénica [que genera una respuesta inmune] y segura", añade el investigador catalán.
El estudio, financiado por la farmacéutica que fabrica la vacuna, se ha publicado en la revista 'British Journal of Cancer'.
-Indicada pero no generalizada
La vacuna del VPH, comercializada en España desde finales del 2007, se destinó originalmente -y sigue siendo su principal uso- para ser administrada a adolescentes que no habían mantenido aún relaciones sexuales y que, por tanto, no habían entrado en contacto aún con el virus, que provoca la mayoría de los carcinomas de cuello de útero.
Sin embargo, en los últimos años se han sucedido los estudios con otros grupos de población, tanto mujeres mayores de 24 años como varones homosexuales, que han ampliado sus posibles usos. Tanto la Agencia Europea del Medicamento (EMA), como las autoridades sanitarias canadienses han aprobado su uso en mujeres adultas, aunque el tratamiento no se suele financiar ya que el coste-eficacia disminuye a medida que aumenta la edad de la paciente.
"Vacunando a todas las mujeres de estas edades [24 a 45 años], muchas de ellas ya estarán infectadas o habrán desarrollado una lesión preneoplásica o un cáncer y no sería eficaz", señala Castellsagué. Sin embargo, matiza el autor, "una de las contribuciones de este artículo es que incluso en aquéllas previamente expuestas al VPH, la vacuna también confiere cierto grado de protección frente a futuros contagios".
Por eso, la recomendación de los autores es que "las mujeres tomen la decisión a nivel individual. Si tienen percepción de riesgo, por cambio de pareja u otra circunstancia, es bueno que se vacunen. Si tienen una estabilidad en su vida sexual, entonces puede no ser necesario".
**Publicado en "EL MUNDO"
02 June 2011
¿Cuánto corre un futbolista durante un partido?
Aunque la distancia recorrida por un jugador de fútbol depende de variantes como la táctica que haya ordenado el entrenador, su demarcación en el campo o la intensidad del partido, la realidad es que normalmente suelen recorrer entre ocho y 14 kilómetros por encuentro. Además, no todo el tiempo corren (sólo el 18%), la mayor parte caminan (72%), el 7% esprintan y el 3% corren en posesión del balón o regateando al contrario.
Lo sabemos gracias a las estadísticas que desde 2008 ofrece la UEFA y que se suman a las ya habituales (porcentaje de posesión de balón, tiros a puerta, etc.). Por ejemplo, en el partido de Champions que enfrentó al Copenhagen frente al FC Barcelona el pasado 2 de noviembre, Dani Alves fue el culé que más distancia recorrió (11.894 metros), seguido de Busquets y Xavi Hernández. ¿Pero cómo es posible calcular este dato con tanta precisión?
Tal y como se explica en la bitácora «Ballesterismo» este tipo de medición es posible gracias a la aplicación de una tecnología militar desarrollada en Suecia en los últimos años. La empresa italiana contratada por la UEFA que la implementa se llama «Delta Tre». Dicha compañía se encarga de instalar un total de 16 cámaras en la zona alta de los estadios. Tras asignar un número y unas coordenadas a cada uno de los objetos que habrá en movimiento (22 jugadores, los 3 árbitros y el balón), estas cámaras se reparten las zonas de registro del terreno de juego y se encargan de monitorizar todo lo que acontece, para inmediatamente transmitir los datos de posición de los deportistas al software encargado de realizar los cálculos, siempre bajo una contínua supervisión de un equipo de monitores.
Junto a Delta Tre, existen otras empresas que brindan este tipo de servicios tanto a clubes, como a federaciones y a televisiones. De hecho, una de ellas, aunque es francesa, tiene su sede en España. Se llama Amisco y sus cámaras son actualmente utilizadas por importantes equipos europeos como el Real Madrid, Valencia, Liverpool, Aston Villa, Marsella, etc. Merece la pena ver este reportaje emitido hace algunos meses para entender el funcionamiento del servicio.
Lo sabemos gracias a las estadísticas que desde 2008 ofrece la UEFA y que se suman a las ya habituales (porcentaje de posesión de balón, tiros a puerta, etc.). Por ejemplo, en el partido de Champions que enfrentó al Copenhagen frente al FC Barcelona el pasado 2 de noviembre, Dani Alves fue el culé que más distancia recorrió (11.894 metros), seguido de Busquets y Xavi Hernández. ¿Pero cómo es posible calcular este dato con tanta precisión?
Tal y como se explica en la bitácora «Ballesterismo» este tipo de medición es posible gracias a la aplicación de una tecnología militar desarrollada en Suecia en los últimos años. La empresa italiana contratada por la UEFA que la implementa se llama «Delta Tre». Dicha compañía se encarga de instalar un total de 16 cámaras en la zona alta de los estadios. Tras asignar un número y unas coordenadas a cada uno de los objetos que habrá en movimiento (22 jugadores, los 3 árbitros y el balón), estas cámaras se reparten las zonas de registro del terreno de juego y se encargan de monitorizar todo lo que acontece, para inmediatamente transmitir los datos de posición de los deportistas al software encargado de realizar los cálculos, siempre bajo una contínua supervisión de un equipo de monitores.
Junto a Delta Tre, existen otras empresas que brindan este tipo de servicios tanto a clubes, como a federaciones y a televisiones. De hecho, una de ellas, aunque es francesa, tiene su sede en España. Se llama Amisco y sus cámaras son actualmente utilizadas por importantes equipos europeos como el Real Madrid, Valencia, Liverpool, Aston Villa, Marsella, etc. Merece la pena ver este reportaje emitido hace algunos meses para entender el funcionamiento del servicio.
**Publicado en "BITACORAS.COM"
Dos especialistas en dermatología desmontan las leyendas sobre el origen de la leuconiquia
Casi todos hemos sufrido alguna vez en la vida leuconiquia. Quizás este nombre no le suene, pero es algo muy común: se trata de esas manchas blancas que aparecen en las uñas como pequeñas nubecitas y cuyo origen ha sido objeto de distintas leyendas urbanas. Por ejemplo, que aparecían por cada mentira que contábamos (una historia en la que dejábamos de creer casi al mismo tiempo que en los Reyes Magos) o que se debía a la falta de calcio (ésta mucho más extendida y asumida).
Pues ni la una ni la otra. Las antiestéticas e inofensivas manchitas aparecen porque «se ha producido con anterioridad un proceso inflamatorio o un traumatismo en la matriz de la uña que provoca que la queratinización sea anormal». «La uña crece un milímetro cada diez días, así que cuando vemos la mancha en mitad de la uña significa que la lesión se produjo dos o tres meses atrás», explica a ABC el doctor Pablo Unamuno, jefe del Servicio de Dermatología del Hospital Clínico de Salamanca y miembro de la Academia Española de Dermatología y Venereología (AEDV).
Morderse las cutículas o cortarlas demasiado, las manicuras agresivas, hacer manualidades, teclear con fuerza en el ordenador, toquetearse mucho las uñas o darles golpecitos contra la mesa son algunas de las prácticas que pueden provocar la aparición de manchas blancas en cualquier tipo de uña, advierte la doctora Rosa Senan, del Grupo de Dermatología y Cirugía Menor de semFYC.
No existe tratamiento para la leuconiquia. La única manera de deshacernos de las antiestéticas «nubecitas» es esperar a que la uña crezca para poder cortarla. Si tenemos prisa, podemos camuflarlas bajo una capa de esmalte.
Estas manchas son inofensivas y no hay que darles mayor importancia. Salvo que, en lugar de un puntito aislado, aparezcan líneas blancas a lo largo de la uña, lo que significa que algo anómalo está pasando de forma permanente en la matriz. En este caso, deberíamos consultar con el dermatólogo.
También es necesario acudir al médico si notamos que las uñas se aclaran y adquieren un tono opaco. «En estos casos, el problema no está en la lámina sino en el lecho (debajo de la uña) y puede advertirnos de alguna enfermedad subyacente», advierte el doctor Unamuno.
Diagnósticos aparte, para conseguir unas uñas fuertes y sanas, los especialistas consultados recomiendan mantener una correcta higiene e hidratación de la zona, evitar los limados agresivos o el uso de cepillos o jabones muy fuertes para limpiarlas y utilizar siempre una capa de esmalte protector antes de pintarlas.
Pues ni la una ni la otra. Las antiestéticas e inofensivas manchitas aparecen porque «se ha producido con anterioridad un proceso inflamatorio o un traumatismo en la matriz de la uña que provoca que la queratinización sea anormal». «La uña crece un milímetro cada diez días, así que cuando vemos la mancha en mitad de la uña significa que la lesión se produjo dos o tres meses atrás», explica a ABC el doctor Pablo Unamuno, jefe del Servicio de Dermatología del Hospital Clínico de Salamanca y miembro de la Academia Española de Dermatología y Venereología (AEDV).
Morderse las cutículas o cortarlas demasiado, las manicuras agresivas, hacer manualidades, teclear con fuerza en el ordenador, toquetearse mucho las uñas o darles golpecitos contra la mesa son algunas de las prácticas que pueden provocar la aparición de manchas blancas en cualquier tipo de uña, advierte la doctora Rosa Senan, del Grupo de Dermatología y Cirugía Menor de semFYC.
No existe tratamiento para la leuconiquia. La única manera de deshacernos de las antiestéticas «nubecitas» es esperar a que la uña crezca para poder cortarla. Si tenemos prisa, podemos camuflarlas bajo una capa de esmalte.
Estas manchas son inofensivas y no hay que darles mayor importancia. Salvo que, en lugar de un puntito aislado, aparezcan líneas blancas a lo largo de la uña, lo que significa que algo anómalo está pasando de forma permanente en la matriz. En este caso, deberíamos consultar con el dermatólogo.
También es necesario acudir al médico si notamos que las uñas se aclaran y adquieren un tono opaco. «En estos casos, el problema no está en la lámina sino en el lecho (debajo de la uña) y puede advertirnos de alguna enfermedad subyacente», advierte el doctor Unamuno.
Diagnósticos aparte, para conseguir unas uñas fuertes y sanas, los especialistas consultados recomiendan mantener una correcta higiene e hidratación de la zona, evitar los limados agresivos o el uso de cepillos o jabones muy fuertes para limpiarlas y utilizar siempre una capa de esmalte protector antes de pintarlas.
**Publicado en "ABC"
Mother´s body size and placental size predict heart disease in men
Researchers investigating the foetal origins of chronic disease have discovered that combinations of a mother’s body size and the shape and size of her baby’s placenta can predict heart disease in men in later life. The research is published online today in the European Heart Journal.
Professor David Barker and colleagues studied 6975 men born in Helsinki (Finland) between 1934-1944 – a time when not only was the babies’ size at birth recorded but also the size of the placental surface. Other available information included details of the mothers’ height and weight in late pregnancy, age, parity, and date of last menstrual period.
They found that there were three combinations of mother’s body size and placental shape and size that predicted coronary heart disease in boys when they reached late adulthood (from about aged 40 onwards):
1. An oval-shaped placental surface in short mothers who had not been pregnant before – the narrower the placental surface in relation to its length, the more the risk of heart disease rose, increasing by 14% for each centimetre increase in the difference between the length and breadth of the surface.
2. A small placental surface in tall, heavy women (those with a body mass index (BMI) over 26 kg/m2, the middle value for the women in the study); in these men their risk of heart disease rose by a quarter (25%) per 40cm2 decrease in the surface area.
3. A large placental weight in relation to birthweight in babies born to tall mothers with a BMI below 26 kg/m2; these men had a seven percent increased risk for every one percent larger ratio of placental weight to birthweight. The associations were independent of the social class of the men or the family into which they were born.
Prof Barker, who is Professor of Clinical Epidemiology at the University of Southampton (UK) and Professor in Cardiovascular Medicine at Oregon Health and Science University (USA), has already discovered that there is a link between placental weight and heart disease in later live, but placental weight does not indicate the size of the surface that is available for absorbing and delivering nutrients for the growing baby. “Due to the fact that the shape and size as well as the weight of the placenta were routinely measured at the birth of this group of men, we have been able to show for the first time that a combination of the mother’s body size and the shape and size of the placental surface predicts later heart disease,” he said.
For each of the three combinations, the babies that developed heart disease in later life tended to be thinner than average, which indicated that they were undernourished at birth.
Prof Barker said that he thought the explanation for the first combination (oval placental surface in women who have not been pregnant before) is that “an oval placental surface is an indication that the implantation of the placenta was disrupted in early pregnancy, leading to foetal under-nutrition, which, in turn, programmes coronary heart disease in later life”. The mechanisms that may play a role in disrupting the implantation of the placenta are not yet fully understood.
For the second combination (small placental surface in tall, heavy women), Prof Barker said: “Although the mother is tall and has a BMI of over 26 kg/m2, indicating that she was wellnourished at the time of her pregnancy, placental growth depends on the structure and function of the mother’s uterine wall, which is established during her own foetal life. Therefore, her own foetal experience necessarily affects placentation in her offspring. Foetal growth depends on the availability of nutrients. Restricted placental growth may, paradoxically, have a greater effect in babies who are growing rapidly because their mothers are well-nourished. We think that these babies were able to grow rapidly at first, but the small placenta started to restrict their growth mid-gestation, so that by the time they were born, they were undernourished.”
For the third combination (large placental weight in relation to birthweight in babies born to tall women below the average weight), Prof Barker believes the explanation lies in what the mother ate during pregnancy. “Tallness indicates good nutrition before pregnancy, but their low body mass index indicates poor nutrition during pregnancy,” he said.
Prof Barker says that this research is further evidence of the long-term effect of foetal development. “Chronic disease is the product of a mother’s lifetime nutrition and the early growth of her child. It is not simply a consequence of poor lifestyles in later life. Rather it is a result of variations in the normal processes of human development.”
Now the researchers plan to study the diets and body characteristics (body size and shape, fat and lean mass) of pregnant women, the growth patterns of their babies before birth using ultrasound, and the placentas of their offspring. They hope to discover the links between the mother, her baby’s placenta and the development of the baby’s cardiovascular system in ways that lead to poor liver and vascular function – two of the primary culprits for heart disease in later life.
Professor David Barker and colleagues studied 6975 men born in Helsinki (Finland) between 1934-1944 – a time when not only was the babies’ size at birth recorded but also the size of the placental surface. Other available information included details of the mothers’ height and weight in late pregnancy, age, parity, and date of last menstrual period.
They found that there were three combinations of mother’s body size and placental shape and size that predicted coronary heart disease in boys when they reached late adulthood (from about aged 40 onwards):
1. An oval-shaped placental surface in short mothers who had not been pregnant before – the narrower the placental surface in relation to its length, the more the risk of heart disease rose, increasing by 14% for each centimetre increase in the difference between the length and breadth of the surface.
2. A small placental surface in tall, heavy women (those with a body mass index (BMI) over 26 kg/m2, the middle value for the women in the study); in these men their risk of heart disease rose by a quarter (25%) per 40cm2 decrease in the surface area.
3. A large placental weight in relation to birthweight in babies born to tall mothers with a BMI below 26 kg/m2; these men had a seven percent increased risk for every one percent larger ratio of placental weight to birthweight. The associations were independent of the social class of the men or the family into which they were born.
Prof Barker, who is Professor of Clinical Epidemiology at the University of Southampton (UK) and Professor in Cardiovascular Medicine at Oregon Health and Science University (USA), has already discovered that there is a link between placental weight and heart disease in later live, but placental weight does not indicate the size of the surface that is available for absorbing and delivering nutrients for the growing baby. “Due to the fact that the shape and size as well as the weight of the placenta were routinely measured at the birth of this group of men, we have been able to show for the first time that a combination of the mother’s body size and the shape and size of the placental surface predicts later heart disease,” he said.
For each of the three combinations, the babies that developed heart disease in later life tended to be thinner than average, which indicated that they were undernourished at birth.
Prof Barker said that he thought the explanation for the first combination (oval placental surface in women who have not been pregnant before) is that “an oval placental surface is an indication that the implantation of the placenta was disrupted in early pregnancy, leading to foetal under-nutrition, which, in turn, programmes coronary heart disease in later life”. The mechanisms that may play a role in disrupting the implantation of the placenta are not yet fully understood.
For the second combination (small placental surface in tall, heavy women), Prof Barker said: “Although the mother is tall and has a BMI of over 26 kg/m2, indicating that she was wellnourished at the time of her pregnancy, placental growth depends on the structure and function of the mother’s uterine wall, which is established during her own foetal life. Therefore, her own foetal experience necessarily affects placentation in her offspring. Foetal growth depends on the availability of nutrients. Restricted placental growth may, paradoxically, have a greater effect in babies who are growing rapidly because their mothers are well-nourished. We think that these babies were able to grow rapidly at first, but the small placenta started to restrict their growth mid-gestation, so that by the time they were born, they were undernourished.”
For the third combination (large placental weight in relation to birthweight in babies born to tall women below the average weight), Prof Barker believes the explanation lies in what the mother ate during pregnancy. “Tallness indicates good nutrition before pregnancy, but their low body mass index indicates poor nutrition during pregnancy,” he said.
Prof Barker says that this research is further evidence of the long-term effect of foetal development. “Chronic disease is the product of a mother’s lifetime nutrition and the early growth of her child. It is not simply a consequence of poor lifestyles in later life. Rather it is a result of variations in the normal processes of human development.”
Now the researchers plan to study the diets and body characteristics (body size and shape, fat and lean mass) of pregnant women, the growth patterns of their babies before birth using ultrasound, and the placentas of their offspring. They hope to discover the links between the mother, her baby’s placenta and the development of the baby’s cardiovascular system in ways that lead to poor liver and vascular function – two of the primary culprits for heart disease in later life.
Fear of dying during a heart attack is linked to increased inflammation
Intense distress and fear of dying, which many people experience when suffering the symptoms of a heart attack, are not only fairly common emotional responses but are also linked to biological changes that occur during the event, according to new research published online today in the European Heart Journal . These changes, in turn, are associated with other biological processes during the following weeks that can predict a worse outcome for patients.
Acute coronary syndrome (ACS) is a medical emergency arising from blockage of the coronary arteries, resulting either in a myocardial infarction (heart attack) or unstable angina. The symptoms are varied, but often include pain in the chest, shortness of breath, sweating, nausea and vomiting. ACS patients are at risk of further heart problems and a worse quality of life in the future.
Researchers in London (UK) set out to discover whether there was an association between the intense emotional responses of patients suffering ACS and levels of a cell-signalling molecule – tumour necrosis factor alpha (TNF alpha) – that is involved in inducing systemic inflammation. They also wanted to see whether the emotional response and TNF alpha correlated with indicators of worse biological function (and, therefore, worse prognosis) three weeks later.
A total of 208 patients admitted to St George’s Hospital (London, UK) between June 2007 and October 2008, with a diagnosis of ACS were included in the study. The researchers assessed the patients’ level of distress and fear of dying and measured levels of TNF alpha within two to three days of hospital admission. Around three to four weeks after the hospital admission researchers made a home visit to record heart rate variability (HRV) and the stress hormone cortisol. Low levels of cortisol may lead to a failure to control inflammation, while low HRV indicates that the heart is functioning poorly and is a predictor of future cardiac problems.
Professor Andrew Steptoe, Head of the Department of Epidemiology and Public Health and British Heart Foundation Professor of Psychology at University College London (UK), said: “We found that, first of all, fear of dying is quite common among patients suffering a heart attack; it was experienced by one in five patients. Although survival rates have improved tremendously over the last few decades, many patients remain quite frightened during the experience.
“Secondly, fear of dying is not just an emotional response, but is linked into the biological changes that go on during acute cardiac events. Large inflammatory responses are known to be damaging to the heart, and to increase the risk of longer-term cardiac problems such as having another heart attack. We found that, when compared with a low fear of dying, intense
fear was associated with a four-fold increased risk of showing large inflammatory responses, measured by raised levels of TNF alpha. Interestingly, this was independent of demographic and clinical factors such as the severity of the cardiac event.
“Thirdly, fear of dying and inflammatory responses in turn predicted biological changes in the weeks following an acute cardiac event, namely reduced heart rate variability and alterations in the output of the hormone cortisol. These processes may contribute to poor outcomes in the longer term.”
The level of distress was unrelated to any previous experience of having a heart attack, but the research suggested that intense distress might be stimulated by worse or more painful symptoms during ACS, and then accentuated in patients who are more socially isolated and economically deprived.
Prof Steptoe and his co-authors say that processes underlying the association between the intense emotional responses and higher levels of TNF alpha are not fully understood. However, they may be connected as manifestations of an integrated biological and emotional response to severe injury to the heart.
The findings could suggest new avenues of research to improve the management of ACS patients. “This is an observational study, so we do not know whether helping people overcome their fears would improve the clinical outlook, or whether reducing the levels of acute inflammation would have beneficial emotional effects, but these are possibilities,” said Prof Steptoe. “At the immediate clinical level, we would recommend that doctors talk to patients more about their emotional experience when having a heart attack, rather than just concentrating on the physical outcomes. The two are closely linked, and better information and reassurance could be of great benefit.
“Care for patients with acute heart disease has improved greatly over recent decades, but we are still concerned about people who recover in the short-term, but remain at risk for repeat heart attacks or other cardiovascular problems. This research is an illustration of how closely emotional, behavioural and biological responses are integrated. Patients' emotional responses are relevant to how they react biologically, and vice versa.”
In an accompanying editorial, Susanne Pedersen, Professor of Cardiac Psychology at the University of Tilburg (Tilburg, The Netherlands), and colleagues describe Prof Steptoe’s findings as “seminal” and write that they “point towards an avenue worthwhile pursuing for the fields of translational cardiovascular medicine and behavioural cardiology”.
They conclude: “In order to optimize the management and care of CHD [coronary heart disease] patients, we need to acknowledge that emotions carry independent additional risk, with particular subsets of patients dying prematurely due to their psychological vulnerability. Physiological mechanisms may provide part of the answer to the vicious cycle linking emotions
to incident CHD and its progression. Behavioural mechanisms should not be forgotten, as there is an urgent need for more effective lifestyle management in these patients, due to increases in the prevalence of obesity and diabetes, and no change in the proportion of patients who smoke, despite an increase in the prescription of cardioprotective drugs. The issue of inadequate lifestyle management is unlikely to be resolved without attending to the emotions of our patients, as emotions such as depression play a pivotal role in compliance and adherence. This suggests that the ‘one size fits all approach’ to intervention in CHD patients is unlikely to work and that a personalized medicine approach is warranted.”
Acute coronary syndrome (ACS) is a medical emergency arising from blockage of the coronary arteries, resulting either in a myocardial infarction (heart attack) or unstable angina. The symptoms are varied, but often include pain in the chest, shortness of breath, sweating, nausea and vomiting. ACS patients are at risk of further heart problems and a worse quality of life in the future.
Researchers in London (UK) set out to discover whether there was an association between the intense emotional responses of patients suffering ACS and levels of a cell-signalling molecule – tumour necrosis factor alpha (TNF alpha) – that is involved in inducing systemic inflammation. They also wanted to see whether the emotional response and TNF alpha correlated with indicators of worse biological function (and, therefore, worse prognosis) three weeks later.
A total of 208 patients admitted to St George’s Hospital (London, UK) between June 2007 and October 2008, with a diagnosis of ACS were included in the study. The researchers assessed the patients’ level of distress and fear of dying and measured levels of TNF alpha within two to three days of hospital admission. Around three to four weeks after the hospital admission researchers made a home visit to record heart rate variability (HRV) and the stress hormone cortisol. Low levels of cortisol may lead to a failure to control inflammation, while low HRV indicates that the heart is functioning poorly and is a predictor of future cardiac problems.
Professor Andrew Steptoe, Head of the Department of Epidemiology and Public Health and British Heart Foundation Professor of Psychology at University College London (UK), said: “We found that, first of all, fear of dying is quite common among patients suffering a heart attack; it was experienced by one in five patients. Although survival rates have improved tremendously over the last few decades, many patients remain quite frightened during the experience.
“Secondly, fear of dying is not just an emotional response, but is linked into the biological changes that go on during acute cardiac events. Large inflammatory responses are known to be damaging to the heart, and to increase the risk of longer-term cardiac problems such as having another heart attack. We found that, when compared with a low fear of dying, intense
fear was associated with a four-fold increased risk of showing large inflammatory responses, measured by raised levels of TNF alpha. Interestingly, this was independent of demographic and clinical factors such as the severity of the cardiac event.
“Thirdly, fear of dying and inflammatory responses in turn predicted biological changes in the weeks following an acute cardiac event, namely reduced heart rate variability and alterations in the output of the hormone cortisol. These processes may contribute to poor outcomes in the longer term.”
The level of distress was unrelated to any previous experience of having a heart attack, but the research suggested that intense distress might be stimulated by worse or more painful symptoms during ACS, and then accentuated in patients who are more socially isolated and economically deprived.
Prof Steptoe and his co-authors say that processes underlying the association between the intense emotional responses and higher levels of TNF alpha are not fully understood. However, they may be connected as manifestations of an integrated biological and emotional response to severe injury to the heart.
The findings could suggest new avenues of research to improve the management of ACS patients. “This is an observational study, so we do not know whether helping people overcome their fears would improve the clinical outlook, or whether reducing the levels of acute inflammation would have beneficial emotional effects, but these are possibilities,” said Prof Steptoe. “At the immediate clinical level, we would recommend that doctors talk to patients more about their emotional experience when having a heart attack, rather than just concentrating on the physical outcomes. The two are closely linked, and better information and reassurance could be of great benefit.
“Care for patients with acute heart disease has improved greatly over recent decades, but we are still concerned about people who recover in the short-term, but remain at risk for repeat heart attacks or other cardiovascular problems. This research is an illustration of how closely emotional, behavioural and biological responses are integrated. Patients' emotional responses are relevant to how they react biologically, and vice versa.”
In an accompanying editorial, Susanne Pedersen, Professor of Cardiac Psychology at the University of Tilburg (Tilburg, The Netherlands), and colleagues describe Prof Steptoe’s findings as “seminal” and write that they “point towards an avenue worthwhile pursuing for the fields of translational cardiovascular medicine and behavioural cardiology”.
They conclude: “In order to optimize the management and care of CHD [coronary heart disease] patients, we need to acknowledge that emotions carry independent additional risk, with particular subsets of patients dying prematurely due to their psychological vulnerability. Physiological mechanisms may provide part of the answer to the vicious cycle linking emotions
to incident CHD and its progression. Behavioural mechanisms should not be forgotten, as there is an urgent need for more effective lifestyle management in these patients, due to increases in the prevalence of obesity and diabetes, and no change in the proportion of patients who smoke, despite an increase in the prescription of cardioprotective drugs. The issue of inadequate lifestyle management is unlikely to be resolved without attending to the emotions of our patients, as emotions such as depression play a pivotal role in compliance and adherence. This suggests that the ‘one size fits all approach’ to intervention in CHD patients is unlikely to work and that a personalized medicine approach is warranted.”
HEFAME, PREMIADA POR SU CALIDAD EN EL EMPLEO Y RESPONSABILIDAD EMPRESARIAL
El Presidente de Grupo Hermandad Farmacéutica del Mediterráneo (HEFAME), Antonio Abril, ha recibido el premio Institucional de Calidad en el Empleo y Responsabilidad Social Empresarial de la Comunidad Autónoma de Murcia.El Consejero de Educación, Formación y Empleo de la región de Murcia, Constantino Sotoca, fue el encargado de hacer entrega del premio que celebra este año su III edición. Este galardón de buenas prácticas corporativas fue otorgado a la empresa distinguida por la optimización de sus recursos humanos y su flexibilidad en el empleo que se traducen en una mayor rentabilidad.
Para Antonio Abril, "es una profunda satisfacción esta distinción que como reconocimiento a las políticas de recursos humanos, porque estamos convencidos de que hay elementos claves para que el trabajador se identifique plenamente con su empresa: estabilidad en el empleo, seguridad en el mismo, y por último, flexibilidad en la organización". El Grupo HEFAME recibió varios premios durante los últimos meses de buenas prácticas empresariales en los que la óptima gestión de la parte social de la empresa coadyuva a la mejora de los resultados empresariales por la eficacia que traslada a través de su estructura orgánica. Entre los galardones recibidos destacan el premio nacional y regional de "Empresa Flexible" y el premio "8 de Marzo".
A juicio del Presidente de Grupo HEFAME, "un trabajador es más productivo, cuando sabe que el criterio rector de la organización es el mantenimiento de todos sus puestos de trabajo hasta sus últimas consecuencias. Se identifica más con su empresa y está más motivado. Otros aspectos que le incentivan en labor diaria hacen referencia a la prevención de riesgos laborales y la adopción de medidas que mejoren las condiciones de seguridad y salud".
Fruto de la aplicación de dichas actuaciones, en HEFAME se consiguió reducir el nivel de absentismo en cuatro años, de un 16 a tan solo un 2 por ciento. Estas son cifras tan significativas por sí mismas que demuestran la implicación de los trabajadores en la buena marcha empresarial. Pero además, Antonio Abril, remarcó durante el acto de entrega del galardón que se sigue trabajando en la vía de mejorar las condiciones laborales que mejoran la implicación de los trabajadores en el proceso productivo y por ello, "no es menos importante, el reconocimiento de las medidas de conciliación y flexibilidad de la vida familiar y laboral, para conseguir en definitiva una alta productividad".
El análisis de las células tumorales circulantes en la sangre predice la respuesta al tratamiento del cáncer de colon
“El estudio de las células tumorales circulantes en pacientes con cáncer colorrectal representa un marcador predictivo de primer orden en la evolución de la enfermedad. Por lo tanto nos ayuda a identificar cuál es el tratamiento más eficaz para los afectados”. Así lo ha señalado el profesor Eduardo Díaz-Rubio, jefe del Servicio de Oncología Médica del Hospital Clínico San Carlos de Madrid, durante la conferencia ‘Células tumorales circulantes y cáncer colorrectal avanzado: un nuevo marcador de eficacia’ que ha tenido lugar recientemente en la de la Real Academia Nacional de Medicina (RANM). Ésta es la principal conclusión de un estudio coordinado por el Hospital Clínico San Carlos de Madrid, en el que han participado oncólogos de toda España, y cuyo objetivo ha sido estudiar el comportamiento biológico del tumor colorrectal y su capacidad de respuesta a través del estudio de células tumorales circulantes (CTC) en sangre periférica.
“Extrayendo una pequeña muestra de sangre a los pacientes podemos analizar en apenas 72 horas la cantidad de marcadores tumorales existentes. Estas CTC se relacionan con la respuesta que los pacientes tienen a la quimioterapia y, por tanto, suponen un factor pronóstico y predictivo de la evolución de la enfermedad”. Según explica Díaz-Rubio, “esta prueba es muy útil como factor pronóstico en estos grupos tumorales, ya que los pacientes que tienen mayor número de células tumorales en sangre periférica también presentan peor pronóstico, por lo que en cierta medida determina la actitud terapéutica"
**Publicado en "EL MEDICO INTERACTIVO"
“Extrayendo una pequeña muestra de sangre a los pacientes podemos analizar en apenas 72 horas la cantidad de marcadores tumorales existentes. Estas CTC se relacionan con la respuesta que los pacientes tienen a la quimioterapia y, por tanto, suponen un factor pronóstico y predictivo de la evolución de la enfermedad”. Según explica Díaz-Rubio, “esta prueba es muy útil como factor pronóstico en estos grupos tumorales, ya que los pacientes que tienen mayor número de células tumorales en sangre periférica también presentan peor pronóstico, por lo que en cierta medida determina la actitud terapéutica"
**Publicado en "EL MEDICO INTERACTIVO"
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