El tabaquismo duplica la posibilidad de muerte en los niños al nacer o durante el primer año de vida, según un estudio elaborado por la doctora Marta Maya y coordinado por el doctor Francisco Carrión, del Hospital Clínico de Valencia. Según informó la Generalitat, el hospital Clínico de Valencia ha realizado un estudio sobre los riesgos del tabaquismo durante el embarazo, que indica que esta adicción duplica la posibilidad de que los niños mueran al nacer o durante el primer año de vida.
Según el citado estudio, con el tabaquismo hay más posibilidad de que aparezcan enfermedades como el síndrome de muerte súbita del lactante. Sin embargo, los autores del estudio han comprobado que si la mujer deja de fumar al principio de su embarazo el exceso de riesgo desaparece.
Para el doctor Carrión, "el tabaquismo, especialmente en mujeres embarazadas, es un problema de primera magnitud porque duplica la probabilidad de que los niños puedan nacer muertos o morir durante el primer año de vida". Según el estudio, el tabaquismo durante la gestación es responsable de, al menos, 750 muertes en España entre muertes fetales tardías y muertes en el primer año de vida. En el caso de la Comunidad Valenciana, se producen 75 muertes al año por estas causas.
**AGENCIAS
05 December 2011
Probiotics reduce infections for patients in intensive care
Traumatic brain injury is associated with a profound suppression of the patient's ability to fight infection. At the same time the patient also often suffers hyper-inflammation, due to the brain releasing glucocorticoids in response to the injury. New research published in BioMed Central's open access journal Critical Care shows that including probiotics with nutrients, supplied via the patient's feeding tube, increased interferon levels, reduced the number of infections, and even reduced the amount of time patients spent in intensive care. In a small scale trial, based at North Sichuan Medical College and Hospital in China, 52 patients who had suffered traumatic brain injuries, and who were being treated in the intensive care unit (ICU), were either treated as usual or had their nutrition supplemented with probiotics.
Suppression of the immune system can be measured by an alteration of helper T-cells (Th) from Th1, which stimulate the action of macrophages to fight infection, to Th2. Th2 cells recruit B-cells which in turn are involved in antibody production. This switch from Th1 to Th2 leaves patients vulnerable to infections including ventilator-associated pneumonia and sepsis. Researchers involved in this trial monitored the TH1/Th2 switch by measuring levels of the Th1-associated signaling molecules (cytokines) IL-12 and interferon gamma (IFNy).
No differences were found between the groups of patients when they began the trial, and throughout the study all the patients had lower levels of IL-12 and IFN? than uninjured healthy controls. However by day 15 the patients who received the probiotics had significantly higher levels of both IL-12 and IFNy than the control patients. They also showed a decrease in the Th2-associated factors IL-4 and IL-10.
Prof Jing-Ci Zhu, the supervisor of this study from the Third Military Medical University School of Nursing in China, explained, "Probiotic treatment appeared to swing the Th1/Th2 balance back towards normality and, in our study, had beneficial effects. Possibly due to the small size of our study there was no significant difference in the number of infections between the groups (9 for the probiotic group, 16 for the control patients). However probiotic therapy reduced the number of infections occurring after seven days, reduced the number of different antibiotics needed to treat infections, and shortened the length of time the patients were required to stay in ICU."
*Source: BioMed Central
Suppression of the immune system can be measured by an alteration of helper T-cells (Th) from Th1, which stimulate the action of macrophages to fight infection, to Th2. Th2 cells recruit B-cells which in turn are involved in antibody production. This switch from Th1 to Th2 leaves patients vulnerable to infections including ventilator-associated pneumonia and sepsis. Researchers involved in this trial monitored the TH1/Th2 switch by measuring levels of the Th1-associated signaling molecules (cytokines) IL-12 and interferon gamma (IFNy).
No differences were found between the groups of patients when they began the trial, and throughout the study all the patients had lower levels of IL-12 and IFN? than uninjured healthy controls. However by day 15 the patients who received the probiotics had significantly higher levels of both IL-12 and IFNy than the control patients. They also showed a decrease in the Th2-associated factors IL-4 and IL-10.
Prof Jing-Ci Zhu, the supervisor of this study from the Third Military Medical University School of Nursing in China, explained, "Probiotic treatment appeared to swing the Th1/Th2 balance back towards normality and, in our study, had beneficial effects. Possibly due to the small size of our study there was no significant difference in the number of infections between the groups (9 for the probiotic group, 16 for the control patients). However probiotic therapy reduced the number of infections occurring after seven days, reduced the number of different antibiotics needed to treat infections, and shortened the length of time the patients were required to stay in ICU."
*Source: BioMed Central
Más de 1.400 personas mayores de 65 años mueren anualmente por caídas
Con el paso de los años disminuyen los reflejos en las personas. Se empieza a mover más lentamente y a medida que envejece tiene más posibilidades de sufrir Parkinson, demencia, artrosis o problemas visuales o auditivos, entre otros trastornos, que aumentan el riesgo de perder el equilibrio. Pero además de estos problemas físicos, los ancianos deben superar muchas barreras arquitectónicas. Tantas complicaciones hacen que la cifra de personas mayores de 65 años que mueren anualmente por caídas sea de más de 1.400.
Según la encuesta de discapacidad de 2008, el número de personas con alguna discapacidad o limitación por encima de los 65 años es de 4.454.200, de los cuales 2.415.900 tienen problemas de movilidad. Actualmente, el 25,51% de los mayores de 65 es dependiente.
Los registros que maneja la Sociedad Española de Geriatría y Gerontología (SEGG), correspondientes al año 2009, reflejan que 1.438 personas de más de 65 años fallecieron por una caída, lo que supone el 25% del total de muertes accidentales anuales en ese rango de edad.
"Nos encontramos con que los ancianos son los más proclives a tener una discapacidad", explica el doctor Alfonso González, coordinador del Grupo de Osteoporosis, Caídas y Fracturas de la SEGG. "La discapacidad física les hace más vulnerables a las caídas", advierte.
Los estudios epidemiológicos indican que uno de cada tres ancianos se cae al menos una vez al año. El estigma personal y social que para una persona mayor supone una caída provoca que, en ausencia de lesiones severas, el afectado no solicite ayuda y dichas caídas menores queden sin registrar. Para un anciano reconocer que se ha caído conlleva admitir, en cierto modo, que ha perdido autonomía personal, un aspecto muy valorado a estas edades.
"Lo dramático de esta situación es que las cifras oficiales son muy inferiores a la magnitud real del problema. El anciano que se cae, si puede, lo oculta por lo que muchas veces desde la Geriatría no podemos poner en marcha la medidas de prevención adecuadas. Hay que concienciar a la población mayor que las caídas son un importante problema de salud y que existen especialistas dedicados a prevenirlas y tratarlas", explica el doctro González. Y añade que "lamentablemente son las consecuencias médicas mayores las que ponen de manifiesto el problema, y éstas son con frecuencia el inicio de la etapa de discapacidad. Así, una de cada diez caídas genera lesiones severas, entre las que podemos citar la fractura de cadera, el hematoma subdural y contusiones y heridas, entre otras", explica el doctor González.
-Cómo evitar las caídas
Ante este problema de gran magnitud, la Sociedad Española de Geriatría y Gerontología, recomienda llevar a cabo las siguientes acciones tanto dentro como fuera del hogar.
En el hogar: Los muebles nunca deben ser un obstáculo; no dejar nada en el suelo -ni alfombras, mantas, cajas, cables u otros objetos- para evitar tropezar con ellos; la iluminación de los espacios es muy importante -utilizar bombillas de al menos 60 vatios de potencia-; a la hora de subir escaleras, asegurar que la barandilla está firmemente agarrada; colocar los utensilios de uso habitual al alcance de la mano; usar zapatos de suela antideslizante y tacón bajo; si el suelo de la ducha o del baño es resbaladizo, colocar esterillas de caucho antideslizantes; hacer ejercicio regularmente.
En la calle: Es imprescindible que se cumpla el Real Decreto 505/2007, de 20 de abril, donde se indican las condiciones básicas de accesibilidad y no discriminación de las personas con discapacidad para el acceso y la utilización de los espacios públicos urbanizados y de las edificaciones. En el artículo 17 de dicho Real Decreto, también se regula la obligación de garantizar accesibilidad y seguridad del peatón, con un paso continuo y sin resaltes, en caso de obras, así como "una señalización adecuada y rigurosa de delimitación, advertencia y peligro, que debe ser perceptible por personas con cualquier tipo de discapacidad".
Según las Organización Mundial de la Salud (OMS), alrededor de un 15% de la población mundial, es decir, mil millones de personas, viven con algún tipo de discapacidad.
**Publicado en "EL MUNDO"
Según la encuesta de discapacidad de 2008, el número de personas con alguna discapacidad o limitación por encima de los 65 años es de 4.454.200, de los cuales 2.415.900 tienen problemas de movilidad. Actualmente, el 25,51% de los mayores de 65 es dependiente.
Los registros que maneja la Sociedad Española de Geriatría y Gerontología (SEGG), correspondientes al año 2009, reflejan que 1.438 personas de más de 65 años fallecieron por una caída, lo que supone el 25% del total de muertes accidentales anuales en ese rango de edad.
"Nos encontramos con que los ancianos son los más proclives a tener una discapacidad", explica el doctor Alfonso González, coordinador del Grupo de Osteoporosis, Caídas y Fracturas de la SEGG. "La discapacidad física les hace más vulnerables a las caídas", advierte.
Los estudios epidemiológicos indican que uno de cada tres ancianos se cae al menos una vez al año. El estigma personal y social que para una persona mayor supone una caída provoca que, en ausencia de lesiones severas, el afectado no solicite ayuda y dichas caídas menores queden sin registrar. Para un anciano reconocer que se ha caído conlleva admitir, en cierto modo, que ha perdido autonomía personal, un aspecto muy valorado a estas edades.
"Lo dramático de esta situación es que las cifras oficiales son muy inferiores a la magnitud real del problema. El anciano que se cae, si puede, lo oculta por lo que muchas veces desde la Geriatría no podemos poner en marcha la medidas de prevención adecuadas. Hay que concienciar a la población mayor que las caídas son un importante problema de salud y que existen especialistas dedicados a prevenirlas y tratarlas", explica el doctro González. Y añade que "lamentablemente son las consecuencias médicas mayores las que ponen de manifiesto el problema, y éstas son con frecuencia el inicio de la etapa de discapacidad. Así, una de cada diez caídas genera lesiones severas, entre las que podemos citar la fractura de cadera, el hematoma subdural y contusiones y heridas, entre otras", explica el doctor González.
-Cómo evitar las caídas
Ante este problema de gran magnitud, la Sociedad Española de Geriatría y Gerontología, recomienda llevar a cabo las siguientes acciones tanto dentro como fuera del hogar.
En el hogar: Los muebles nunca deben ser un obstáculo; no dejar nada en el suelo -ni alfombras, mantas, cajas, cables u otros objetos- para evitar tropezar con ellos; la iluminación de los espacios es muy importante -utilizar bombillas de al menos 60 vatios de potencia-; a la hora de subir escaleras, asegurar que la barandilla está firmemente agarrada; colocar los utensilios de uso habitual al alcance de la mano; usar zapatos de suela antideslizante y tacón bajo; si el suelo de la ducha o del baño es resbaladizo, colocar esterillas de caucho antideslizantes; hacer ejercicio regularmente.
En la calle: Es imprescindible que se cumpla el Real Decreto 505/2007, de 20 de abril, donde se indican las condiciones básicas de accesibilidad y no discriminación de las personas con discapacidad para el acceso y la utilización de los espacios públicos urbanizados y de las edificaciones. En el artículo 17 de dicho Real Decreto, también se regula la obligación de garantizar accesibilidad y seguridad del peatón, con un paso continuo y sin resaltes, en caso de obras, así como "una señalización adecuada y rigurosa de delimitación, advertencia y peligro, que debe ser perceptible por personas con cualquier tipo de discapacidad".
Según las Organización Mundial de la Salud (OMS), alrededor de un 15% de la población mundial, es decir, mil millones de personas, viven con algún tipo de discapacidad.
**Publicado en "EL MUNDO"
Study shows many older Floridians have no backup plan after hanging up their keys
Florida is home to one of the highest percentages of residents ages 65 and older in the United States, but very few of them have thought ahead to a time when they will no longer be able to drive a vehicle safely or considered how they will get around without a car, according to a new survey developed by Florida State University and the Florida Department of Transportation. In fact, 13 percent of survey respondents indicated they would not stop driving at all, with 3 percent expressing the opinion that they would die before they would stop driving.
The findings reflect a serious issue in Florida -- and across the nation -- that older drivers are at a disproportionate risk for being involved in a fatal vehicular crash, according to John Reynolds, the Eagles Professor of Sociology at Florida State and director of the university's Pepper Institute on Aging and Public Policy.
John Reynolds
To address the problem, the Florida Department of Transportation (FDOT) has awarded the Pepper Institute grants totaling $475,000 to assist it in establishing and implementing a statewide coalition to create a statewide Aging Road User Strategic Safety Plan.
"The bottom-line measure of success for the grant from the DOT is that we reduce the number of fatalities, injuries and crashes that involve older adults in Florida," Reynolds said. "However, in doing so we'll be making the roads safer for all Floridians and hopefully serving as a national model for other states."
In establishing a baseline for the development of the coalition and the safety plan, Reynolds analyzed the responses of more than 900 Floridians who participated in the 2011 Florida Aging Road User Survey, which was conducted this past spring and summer. Of those survey participants, half ranged in age from 50 to 64 years old, while the other half were 65 and older. Their responses provide some insights into the perceptions of older drivers regarding the mobility and safety challenges that they may one day face.
Among the findings:
Most older drivers don't plan for a future day when they may be unable to drive safely. Eighty-three percent of survey respondents ages 65 and older, and 92 percent of 50- to 64-year-olds, reported that they have no "transportation retirement plan." When asked to describe how they might transition from driving in the future, many indicated they would rely on family, friends or neighbors (23 percent), but many more replied that they did not know or had not ever thought about it (36 percent). About 13 percent said they would not stop driving at all, with some of those (3 percent overall) expressing an opinion that they would die before they needed to stop driving. Very few -- slightly under 4 percent -- of respondents stated that they planned to use a community driver program or paratransit service such as Dial-A-Ride.
Many aging road users see no alternatives to driving in their communities. When asked about ways they get around besides driving a car, 40 percent of respondents ages 65 and older replied that they ride with family or friends, 26 percent said they walk, and 15 percent said there was no other way to get around other than driving. (For 50- to 64-year-olds, the percentages were 38 percent, 29 percent and 16 percent, respectively.)
The findings reflect a serious issue in Florida -- and across the nation -- that older drivers are at a disproportionate risk for being involved in a fatal vehicular crash, according to John Reynolds, the Eagles Professor of Sociology at Florida State and director of the university's Pepper Institute on Aging and Public Policy.
John Reynolds
To address the problem, the Florida Department of Transportation (FDOT) has awarded the Pepper Institute grants totaling $475,000 to assist it in establishing and implementing a statewide coalition to create a statewide Aging Road User Strategic Safety Plan.
"The bottom-line measure of success for the grant from the DOT is that we reduce the number of fatalities, injuries and crashes that involve older adults in Florida," Reynolds said. "However, in doing so we'll be making the roads safer for all Floridians and hopefully serving as a national model for other states."
In establishing a baseline for the development of the coalition and the safety plan, Reynolds analyzed the responses of more than 900 Floridians who participated in the 2011 Florida Aging Road User Survey, which was conducted this past spring and summer. Of those survey participants, half ranged in age from 50 to 64 years old, while the other half were 65 and older. Their responses provide some insights into the perceptions of older drivers regarding the mobility and safety challenges that they may one day face.
Among the findings:
Most older drivers don't plan for a future day when they may be unable to drive safely. Eighty-three percent of survey respondents ages 65 and older, and 92 percent of 50- to 64-year-olds, reported that they have no "transportation retirement plan." When asked to describe how they might transition from driving in the future, many indicated they would rely on family, friends or neighbors (23 percent), but many more replied that they did not know or had not ever thought about it (36 percent). About 13 percent said they would not stop driving at all, with some of those (3 percent overall) expressing an opinion that they would die before they needed to stop driving. Very few -- slightly under 4 percent -- of respondents stated that they planned to use a community driver program or paratransit service such as Dial-A-Ride.
Many aging road users see no alternatives to driving in their communities. When asked about ways they get around besides driving a car, 40 percent of respondents ages 65 and older replied that they ride with family or friends, 26 percent said they walk, and 15 percent said there was no other way to get around other than driving. (For 50- to 64-year-olds, the percentages were 38 percent, 29 percent and 16 percent, respectively.)
**Source: Florida State University
La Jolla Institute researchers provide world's first view of Type 1 diabetes as it unfolds
A war is being waged in the pancreases of millions of people throughout the world. The siege leads to the development of type 1 diabetes and has been a battlefield largely hidden from view -- until now. Researchers at the La Jolla Institute for Allergy & Immunology have created the first cellular movies showing the destruction underlying type 1 diabetes in real-time in mouse models. This detailed, dynamic view will provide the worldwide scientific community insights into this disease process as never before possible and may profoundly affect future directions in type 1 diabetes research. "We are presenting the first images at cellular resolution of type 1 diabetes as-it-unfolds," said Matthias von Herrath, M.D. one of the world's top type 1 diabetes researchers and director of the Diabetes Research Center at the La Jolla Institute for Allergy & Immunology. "Being able to view these insulin-producing cells while they interact in the pancreas, rather than in a static state under the microscope, will greatly enhance our ability -- and that of the broader scientific community -- to find interventions for type 1 diabetes."
A paper on the team's scientific findings, along with the cellular movies taken by the researchers, were published online December 1 in the Journal of Clinical Investigation. The movies are freely available and can be seen at: http://www.jci.org/articles/view/59285 (movie links at end of paper). Ken Coppieters, Ph.D., formerly of the La Jolla Institute and now at Ghent University, Belgium, is first author on the study. Dr. von Herrath is senior author.
"This live imaging of the white blood cells that cause diabetes is quite remarkable," said George Eisenbarth, M.D., Ph.D., a prominent type 1 diabetes researcher and executive director of the Barbara Davis Center for Childhood Diabetes in Colorado. "These images provide critical information about the disease process, in particular showing us the reasons why the beta cell destruction (underlying type 1 diabetes) occurs very slowly over time. Such information may enable new approaches to stop the destruction process, with the ultimate goal being prevention."
The studies are illuminating cell processes that previously had to be extrapolated from photos, computer modeling or lab experiments. Bart Roep, M.D., Ph.D., a diabetes expert and professor at Leiden University Medical Center in the Netherlands, called the work a technological breakthrough. "I thought this was unfeasible (in vivo imaging of type 1 diabetes). But thankfully, they proved me wrong," he said. "These videos show the cellular interactions in incredible detail, things are moving. The information they have found thus far is amazing and this is just the beginning of the knowledge that can be gained through this technology."
Dr. Coppieters said the movies have provided a number of surprising insights. "We have drawn several scientific conclusions from these studies in mice that we believe will influence future therapeutic directions," he said. "We are continuing our studies and hope that other researchers will also find these movies valuable in enhancing their research efforts."
In the movies, objects resembling ants can be seen furiously scampering about looking for their prey. The "ants" are actually immune system T cells, the body's cellular soldiers. The "prey" is insulin-producing beta cells, which the T cells mistakenly attack and destroy, eventually leading to type 1 diabetes.
The groundbreaking studies were enabled through the use of a two-photon microscope and a new procedure developed by Dr. von Herrath that allowed the microscope's use in the pancreas. The pancreas is a small, soft and difficult to access organ that has long presented special challenges for researchers. Up to this point, the scientific community has used the two-photon to study lymph nodes, the liver and other organs in vivo, but never the pancreas.
"The two-photon microscope enables researchers to "see" into living tissues at a much greater depth than conventional imaging methods," said Dr. von Herrath. "It uses intense pulses of light that enable us to monitor interactions of cells without destroying them."
The Brehm Coalition, a unique type 1 diabetes research collaboration, provided major funding for the two-photon microscope. The Juvenile Diabetes Research Foundation (JDRF) was a significant contributor to the research studies. "Dr. von Herrath was one of a very limited, select group of scientists chosen to receive funding through the JDRF Scholar Award program," said Richard Insel, M.D., the JDRF's chief scientific officer, noting the award targets high-risk, high-reward endeavors. "We are thrilled that Dr. von Herrath's research has provided new insights into the pathogenesis of type 1 diabetes that could lead to novel therapeutic approaches. This is just the kind of pioneering research that the Scholar Award was designed to encourage."
Dr. Coppieters said the as-it-happens movies reveal the specific behaviors of various cells. "We're able to see how the beta cells eventually die and how the immune T cells access the pancreas from the blood stream," he said. Among the many insights gained, the researchers were able to identify the specific blood vessels where the T cells (normally none of these reside in the pancreas) enter the pancreas, how the T cells launch an attack and the time sequence of events.
The movies also illuminated particularly interesting information regarding the beta cell destruction process. "The T cells move randomly throughout the pancreas until they encounter the beta cells, where they slow down and release toxic substances that eventually kill the beta cells. What was most surprising is that this 'kiss of death' takes quite a while, elaborate calculations indicated a timeline in the order of hours (to kill a few beta cells)," said Dr. Coppieters.
The scientists also found remarkable the large numbers of T cells needed in the mice -- tens of millions -- to produce massive beta cell destruction. "These factors may help to explain the long pre-clinical stage in type 1 diabetes," said Dr. von Herrath, since T cell numbers in the human pancreas are thought to be significantly lower than in mice.
"This means that the autoimmune attack is already ongoing for years before the number of beta cells drops below a critical threshold, resulting in clinical diagnosis," he said, noting that 90 percent of beta cells are destroyed in humans before the disease is usually recognized. "From a therapeutic perspective, these studies suggest that we may need to find a way to prevent the T cells from accessing the pancreas in the first place, since once they do, they have the ability to destroy several beta cells at a time."
*Source: La Jolla Institute for Allergy and Immunology
A paper on the team's scientific findings, along with the cellular movies taken by the researchers, were published online December 1 in the Journal of Clinical Investigation. The movies are freely available and can be seen at: http://www.jci.org/articles/view/59285 (movie links at end of paper). Ken Coppieters, Ph.D., formerly of the La Jolla Institute and now at Ghent University, Belgium, is first author on the study. Dr. von Herrath is senior author.
"This live imaging of the white blood cells that cause diabetes is quite remarkable," said George Eisenbarth, M.D., Ph.D., a prominent type 1 diabetes researcher and executive director of the Barbara Davis Center for Childhood Diabetes in Colorado. "These images provide critical information about the disease process, in particular showing us the reasons why the beta cell destruction (underlying type 1 diabetes) occurs very slowly over time. Such information may enable new approaches to stop the destruction process, with the ultimate goal being prevention."
The studies are illuminating cell processes that previously had to be extrapolated from photos, computer modeling or lab experiments. Bart Roep, M.D., Ph.D., a diabetes expert and professor at Leiden University Medical Center in the Netherlands, called the work a technological breakthrough. "I thought this was unfeasible (in vivo imaging of type 1 diabetes). But thankfully, they proved me wrong," he said. "These videos show the cellular interactions in incredible detail, things are moving. The information they have found thus far is amazing and this is just the beginning of the knowledge that can be gained through this technology."
Dr. Coppieters said the movies have provided a number of surprising insights. "We have drawn several scientific conclusions from these studies in mice that we believe will influence future therapeutic directions," he said. "We are continuing our studies and hope that other researchers will also find these movies valuable in enhancing their research efforts."
In the movies, objects resembling ants can be seen furiously scampering about looking for their prey. The "ants" are actually immune system T cells, the body's cellular soldiers. The "prey" is insulin-producing beta cells, which the T cells mistakenly attack and destroy, eventually leading to type 1 diabetes.
The groundbreaking studies were enabled through the use of a two-photon microscope and a new procedure developed by Dr. von Herrath that allowed the microscope's use in the pancreas. The pancreas is a small, soft and difficult to access organ that has long presented special challenges for researchers. Up to this point, the scientific community has used the two-photon to study lymph nodes, the liver and other organs in vivo, but never the pancreas.
"The two-photon microscope enables researchers to "see" into living tissues at a much greater depth than conventional imaging methods," said Dr. von Herrath. "It uses intense pulses of light that enable us to monitor interactions of cells without destroying them."
The Brehm Coalition, a unique type 1 diabetes research collaboration, provided major funding for the two-photon microscope. The Juvenile Diabetes Research Foundation (JDRF) was a significant contributor to the research studies. "Dr. von Herrath was one of a very limited, select group of scientists chosen to receive funding through the JDRF Scholar Award program," said Richard Insel, M.D., the JDRF's chief scientific officer, noting the award targets high-risk, high-reward endeavors. "We are thrilled that Dr. von Herrath's research has provided new insights into the pathogenesis of type 1 diabetes that could lead to novel therapeutic approaches. This is just the kind of pioneering research that the Scholar Award was designed to encourage."
Dr. Coppieters said the as-it-happens movies reveal the specific behaviors of various cells. "We're able to see how the beta cells eventually die and how the immune T cells access the pancreas from the blood stream," he said. Among the many insights gained, the researchers were able to identify the specific blood vessels where the T cells (normally none of these reside in the pancreas) enter the pancreas, how the T cells launch an attack and the time sequence of events.
The movies also illuminated particularly interesting information regarding the beta cell destruction process. "The T cells move randomly throughout the pancreas until they encounter the beta cells, where they slow down and release toxic substances that eventually kill the beta cells. What was most surprising is that this 'kiss of death' takes quite a while, elaborate calculations indicated a timeline in the order of hours (to kill a few beta cells)," said Dr. Coppieters.
The scientists also found remarkable the large numbers of T cells needed in the mice -- tens of millions -- to produce massive beta cell destruction. "These factors may help to explain the long pre-clinical stage in type 1 diabetes," said Dr. von Herrath, since T cell numbers in the human pancreas are thought to be significantly lower than in mice.
"This means that the autoimmune attack is already ongoing for years before the number of beta cells drops below a critical threshold, resulting in clinical diagnosis," he said, noting that 90 percent of beta cells are destroyed in humans before the disease is usually recognized. "From a therapeutic perspective, these studies suggest that we may need to find a way to prevent the T cells from accessing the pancreas in the first place, since once they do, they have the ability to destroy several beta cells at a time."
*Source: La Jolla Institute for Allergy and Immunology
Vegetables, fruits, grains reduce stroke risk in women
Swedish women who ate an antioxidant-rich diet had fewer strokes regardless of whether they had a previous history of cardiovascular disease, in a study reported in Stroke: Journal of the American Heart Association. "Eating antioxidant-rich foods may reduce your risk of stroke by inhibiting oxidative stress and inflammation," said Susanne Rautiainen, M.Sc., the study's first author and Ph.D. student at the Karolinska Institutet in Sweden. "This means people should eat more foods such as fruits and vegetables that contribute to total antioxidant capacity."
Oxidative stress is an imbalance between the production of cell-damaging free radicals and the body's ability to neutralize them. It leads to inflammation, blood vessel damage and stiffening.
Antioxidants such as vitamins C and E, carotenoids and flavonoids can inhibit oxidative stress and inflammation by scavenging the free radicals. Antioxidants, especially flavonoids, may also help improve endothelial function and reduce blood clotting, blood pressure and inflammation.
"In this study, we took into account all the antioxidants present in the diet, including thousands of compounds, in doses obtained from a usual diet," Rautiainen said.
Researchers collected dietary data through a food-frequency questionnaire. They used a standard database to determine participants' total antioxidant capacity (TAC), which measures the free radical reducing capacity of all antioxidants in the diet and considers synergistic effects between substances.
Researchers categorized the women according to their TAC levels -- five groups without a history of cardiovascular disease and four with previous cardiovascular disease.
For women with no history of cardiovascular disease who had the highest TAC, fruits and vegetables contributed about 50 percent of TAC.
Other contributors were whole grains (18 percent), tea (16 percent) and chocolate (5 percent).
The study found:
Higher TAC was related to lower stroke rates in women without cardiovascular disease.
Women without cardiovascular disease with the highest levels of dietary TAC had a statistically significant 17 percent lower risk of total stroke compared to those in the lowest quintile.
Women with history of cardiovascular disease in the highest three quartiles of dietary TAC had a statistically significant 46 percent to 57 percent lower risk of hemorrhagic stroke compared with those in the lowest quartile.
"Women with a high antioxidant intake may be more health conscious and have the sort of healthy behaviors that may have influenced our results," Rautiainen said. "However, the observed inverse association between dietary TAC and stroke persisted after adjustments for potential confounders related to healthy behavior such as smoking, physical activity and education."
For the study, researchers used the Swedish Mammography Cohort to identify 31,035 heart disease-free women and 5,680 women with a history of heart disease in two counties. The women were 49-83 years old.
Researchers tracked the cardiovascular disease-free women an average 11.5 years and the women with cardiovascular disease 9.6 years, from September 1997 through the date of first stroke, death or Dec. 31, 2009, whichever came first.
Researchers identified 1,322 strokes among cardiovascular disease-free women and 1,007 strokes among women with a history of cardiovascular disease from the Swedish Hospital Discharge Registry.
"To the best of our knowledge, no study has assessed the relation between dietary TAC and stroke risk in participants with a previous history of cardiovascular disease," Rautiainen said. "Further studies are needed to assess the link between dietary TAC and stroke risk in men and in people in other countries, but we think our results are applicable."
Co-authors are Susanna Larsson, Ph.D.; Jarmo Virtamo, M.D.; and Alicja Wolk, Dr.Med.Sci. Authors' disclosures are on the manuscript.
The Swedish Research Council for Infrastructure and the Swedish Council for Working Life and Social Research funded the study.
**Source: American Heart Association
Oxidative stress is an imbalance between the production of cell-damaging free radicals and the body's ability to neutralize them. It leads to inflammation, blood vessel damage and stiffening.
Antioxidants such as vitamins C and E, carotenoids and flavonoids can inhibit oxidative stress and inflammation by scavenging the free radicals. Antioxidants, especially flavonoids, may also help improve endothelial function and reduce blood clotting, blood pressure and inflammation.
"In this study, we took into account all the antioxidants present in the diet, including thousands of compounds, in doses obtained from a usual diet," Rautiainen said.
Researchers collected dietary data through a food-frequency questionnaire. They used a standard database to determine participants' total antioxidant capacity (TAC), which measures the free radical reducing capacity of all antioxidants in the diet and considers synergistic effects between substances.
Researchers categorized the women according to their TAC levels -- five groups without a history of cardiovascular disease and four with previous cardiovascular disease.
For women with no history of cardiovascular disease who had the highest TAC, fruits and vegetables contributed about 50 percent of TAC.
Other contributors were whole grains (18 percent), tea (16 percent) and chocolate (5 percent).
The study found:
Higher TAC was related to lower stroke rates in women without cardiovascular disease.
Women without cardiovascular disease with the highest levels of dietary TAC had a statistically significant 17 percent lower risk of total stroke compared to those in the lowest quintile.
Women with history of cardiovascular disease in the highest three quartiles of dietary TAC had a statistically significant 46 percent to 57 percent lower risk of hemorrhagic stroke compared with those in the lowest quartile.
"Women with a high antioxidant intake may be more health conscious and have the sort of healthy behaviors that may have influenced our results," Rautiainen said. "However, the observed inverse association between dietary TAC and stroke persisted after adjustments for potential confounders related to healthy behavior such as smoking, physical activity and education."
For the study, researchers used the Swedish Mammography Cohort to identify 31,035 heart disease-free women and 5,680 women with a history of heart disease in two counties. The women were 49-83 years old.
Researchers tracked the cardiovascular disease-free women an average 11.5 years and the women with cardiovascular disease 9.6 years, from September 1997 through the date of first stroke, death or Dec. 31, 2009, whichever came first.
Researchers identified 1,322 strokes among cardiovascular disease-free women and 1,007 strokes among women with a history of cardiovascular disease from the Swedish Hospital Discharge Registry.
"To the best of our knowledge, no study has assessed the relation between dietary TAC and stroke risk in participants with a previous history of cardiovascular disease," Rautiainen said. "Further studies are needed to assess the link between dietary TAC and stroke risk in men and in people in other countries, but we think our results are applicable."
Co-authors are Susanna Larsson, Ph.D.; Jarmo Virtamo, M.D.; and Alicja Wolk, Dr.Med.Sci. Authors' disclosures are on the manuscript.
The Swedish Research Council for Infrastructure and the Swedish Council for Working Life and Social Research funded the study.
**Source: American Heart Association
Ana Pastor, Rafael Matesanz y la ONT, medallas de oro de la OMC
La OMC ha decidido otorgar la máxima condecoración que concede esta Corporación a la Dra Ana Pastor Julián por su contribución al sistema nacional de salud. Ana Pastor, médico y coordinadora de Participación Social del Partido Popular, ha mostrado siempre su defensa y compromiso con la colegiación universal, y ha sido impulsora de las iniciativas que ha llevado a cabo el PP en este sentido.
Con la distinción concedida por la OMC al doctor Rafael Matesanz a título individual se ha pretendido reconocer su trabajo en trasplantes de órganos, y a la ONT, en representación de todos los profesionales sanitarios que trabajan en ella, por haber logrado que el modelo español de trasplantes se haya convertido en un referente internacional y proporcione al paciente trasplantado antes, durante y tras la intervención, así como durante el resto de su vida los mejores cuidados, independientemente, de su posición y condición social o económica.
Asimismo, se ha reconocido el trabajo de los coordinadores autonómicos, Dr. Antonio Álvarez, Dr. Juan Bautista Araujo, Dr. Manuel Avellanas, Dra. Mariana Badia, Dra. Ana Carolina Caballero, Dr. José Manuel Domínguez, Dra. Gema Guerrero, Dr. José Manuel Jiménez , Dr. Eduardo Quiros, Dr. Juan Carlos Robles, Dr. Jacinto Sánchez, Dr. José Ignacio Sánchez, Dr. Juan José Unzue, Dra. Concepción Valdovinos y Dr. Julio Viseda.
Ana Pastor agradeció el premio y dijo que “el que te premien los tuyos, tus compañeros, los profesionales, es una gran satisfacción por eso nunca olvidaré este detalle que habéis tenido conmigo y este agradecimiento lo llevaré siempre”.
“Hemos trabajado – afirmó - para decirle a la sociedad que un sistema sanitario equitativo, universal, de cualidad y cohesionado solo es posible teniendo a los profesionales como piedra angular del SNS porque son los profesionales sanitarios quienes procuran dar solución a los problemas de la gente, son los que, con los recursos disponibles y bastante escasos, le toman el pulso cada mañana y cada noche a esto tan importante que es la salud de las personas”.
La coordinadora de Participación Social del Partido Popular manifestó que “tenemos que seguir jugando este papel, este papel protagonista en el SNS y que estamos ahora ante una nueva etapa, un nuevo periodo, como está pasando en muchos países del mundo, un nuevo periodo que requiere nuevas ideas, optimizar recursos, que requiere mayor flexibilidad, mayor autonomía de gestión de los profesionales y que requiere también un desarrollo profesional homologado para todos los sanitarios, que requiere el profesionalismo que es consustancial a la práctica clínica y la confianza mutua entre el médico y sus pacientes, que es lo que queremos lograr entre todos. Y por eso como sabéis, he defendido siempre la colegiación universal que no es ni más ni menos que la sociedad civil organizada, un ente de derecho público sea el que trasmita a la sociedad la certidumbre de que están los mejores, de que están capacitados, motivados y que tienen un desarrollo profesional aceptable.”
“Por eso –dijo- el futuro se tiene que escribir con varias letras: con la letra de sistema retributivo que recompense el talento, el mérito, el esfuerzo y el desempeño; se tiene que escribir con la palabra formación continuada; se tiene que escribir con la palabra planificación y se tiene que escribir con un nuevo modelo de atención primaria y especializada, y se tiene que seguir escribiendo con una buena práctica clínica, con un código deontológico que haga que los profesionales, todos, estemos inspirando nuestras actuaciones en la mejor práctica clínica”
Se refirió a los colegios y la colegiación universal como “elementos clave para impulsar el profesionalismo, esto no es una idea anticuada como piensan algunos. Hoy, los países más modernos, los países más avanzados defienden la colegiación universal, defienden impulsar el profesionalismo y defienden la toma de decisiones con autonomía y con responsabilidad, y sobre todo con un compromiso firme de servicio a la sociedad y este servicio es para dar a todos los ciudadanos una asistencia sanitaria equitativa, excelente e integral, por eso es tan importante que en esta nueva etapa que tenemos que afrontar entre todos, lo hagamos con realismo, pero también con optimismo porque en este momento hay oportunidades más que nunca; hay oportunidades para impulsar una vez más el papel que juegan los profesionales sanitarios, - queremos aprovechar esta oportunidad - y también que hay estímulos, que debe haberlos para una mayor responsabilidad pero también para una mayor participación.
“Yo confío – añadió- en la vocación, en nuestro sentido profesional , que creo que lo tenemos y lo hemos demostrado, en nuestra generosidad, en la de todos los sanitarios que hemos conseguido que la sanidad, - ahora parece que no que es uno de los problemas que tienen los españoles - sea siempre uno de los servicios más valorados de los ciudadanos. Creo que existe un consenso de cómo debe ser el sistema sanitario, que tiene que ser un sistema para todos, universal, con una calidad de excelencia que además tenga unos servicios que sean iguales para todos los españoles. Solo con vocación, profesionalidad y sentido del deber, seremos capaces de afrontar los cambios que se avecinan.”
Finalmente la Dra. Pastor expresó su confianza en que “a través de esos valores de la vocación, de la disciplina, de la competencia y del compromiso, haga posible que en esta nueva etapa el futuro del SNS sea el mejor y recuperemos de nuevo ese lugar que hemos ocupado durante muchos años en el mundo.”
Para el Dr. Rafael Matesanz “siempre es un placer y da mucho gusto recibir un reconocimiento, pero cuando este reconocimiento viene de tus propios compañeros pues la verdad es que sabe mucho mejor. Y claro para un médico como yo que ha dedicado la mitad de su vida activa a la gestión, pues resulta mucho más sorprendente porque los gestores como yo no tenemos muy buena prensa entre los médicos, entonces se agradece doblemente. Me llevo esta medalla en el corazón”.
Afirmó que “la ONT ha sido un perfecto ejemplo de gobierno clínico de todos los profesionales de la sanidad. La ONT probablemente sea la marca sanitaria española más conocida en los cinco continentes, es impresionante ver el respeto que merece la marca España en este campo” y señaló que “la semana pasada se produjo durante un período de 72 horas, el mayor récord de trasplantes, de donaciones y trasplantes que se ha producido en España en toda la vida, alrededor de unos 40 donantes, alrededor de unos 100 trasplantes de todo tipo, 14 comunidades autónomas involucradas en el tema, más de 1000 personas trabajando, y no son personas solo de la red de coordinación, son personas de nuestro sistema, eso significa que nuestro sistema está ahí, que es tremendamente sólido. El SNS sobre el que recae realmente toda la coordinación está ahí y efectivamente está funcionando. Lo que habrá que hacer ahora es gestionar la escasez con inteligencia y no perder lo que se ha conseguido por parte de nuestra sociedad.”
El director de la ONT manifestó que “uno de los retos más grandes que tiene hoy en día el sistema es su sostenibilidad. Yo quiere hacer una constatación de la solidez de nuestro sistema sanitario y de la necesidad de eliminar lo superfluo pero manteniendo lo fundamental.”
El Dr. Matesanz expresó también su satisfacción e ilusión por “ver cómo las personas de la coordinación autonómica clínica y hospitalaria recibían el reconocimiento, porque desde luego son la infantería, son los que consiguen verdaderamente los donantes todos los días y los que hacen posible todos estos milagros.”
Por su parte, el Dr. Carlos Fernández Renedo, coordinador de trasplantes de la Comunidad Autónoma de Castilla y León, que recogió el Emblema de Oro a la ONT recordó “a los otros protagonistas, los cientos de donantes y sus familias. Estas familias que en los momentos más difíciles de su vida han dicho sí a la donación, sin las cuales nada de esto habría sucedido”
Se refirió a los coordinadores autonómicos de trasplantes, “que se ocupan de impulsar nuevos programas de trasplante, de investigación, de formación continuada, programas de calidad, unificación de protocolos, recogida y análisis de datos y otra serie de funciones que ayudan a que en los hospitales se desarrollen las actividades de donación y trasplante de la manera más eficaz. Su colaboración dentro del sistema resulta imprescindible”
El Dr. Fernández Renedo valoró el trabajo y la entrega de los coordinadores hospitalarios que “son los soldados de infantería que durante 24 horas, los 365 días del año realizan una labor no siempre valorada como se merece, compatibilizándola con su trabajo habitual, y sin cuyo esfuerzo, el modelo español no sería el referente mundial”.
El Presidente de la OMC, el Dr. Rodríguez Sendín, que cerró el acto, se refirió a los premiados como “claros exponentes del buen ejercicio médico y de la calidad del SNS, porque saben combinar cuatro pilares fundamentales que se entrecruzan y que cada cual condiciona al otro y a todos entre sí. Me refiero a la Medicina como ciencia que actúa en función de valores vivos y que tiene en cuenta la economía y la política.”
El doctor Rodríguez Sendín dijo del Dr Matesanz que “ es un gran profesional, que ha sabido mover conciencias, responsabilidad y recursos hacia un fin solidario.” Y de Ana Pastor, alabó su “defensa de la profesión médica y de las Corporaciones Colegiales como garantía de calidad y seguridad en la atención a los pacientes” y resaltó que “sus posicionamientos casi siempre han estado alineados con los posicionamientos institucionales de la Corporación Colegial Médica y que hemos explicitado en numerosos actos y actuaciones en los últimos años y en muy diversos foros, especialmente en defensa de una Colegiación Médica universal para el ejercicio profesional, en defensa de las garantías que todo ciudadano ha de tener como derecho ante un bien de interés público como es la Sanidad y el cuidado de la salud.”
El Presidente de la OMC se refirió al SNS como “herramienta imprescindible para que los médicos podamos responder a nuestros compromisos con todos y cada uno de los pacientes”. Y afirmó que “es precisamente en estos tiempos que corren lo que permite que las expectativas de los españoles ante la vida, la muerte, el dolor y la enfermedad, independientemente de nivel social o procedencia, sean muy similares. De esos compromisos surge la obligación ética de preservar la calidad del sistema sanitario y sus atributos básicos. Sin embargo, hoy su sostenibilidad está en peligro por la insuficiente financiación, por algunas irresponsabilidades y por la falta de un gran acuerdo político.”
El acto fue presidido por todos los miembros de la Comisión Permanente, los doctores Rodríguez Sendín, Ricard Gutiérrez, Serafín Romero, Jerónimo Fernández Torrente y José María Rodríguez Vicente. Asistieron los máximos representantes de los 52 Colegios de Médicos de España, así como los consejeros de Sanidad de Madrid y Extremadura, Javier Fernández-Lasquetty, y Mª Jerónima Sayagués, y los presidentes de los Consejos Generales de Enfermería y Odontología, Máximo González Jurado y Manuel A. Villa Vigil, respectivamente, y relevantes personalidades del sector sanitario.
**Publicado en "MEDICOS Y PACIENTES"
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