Los médicos prefieren que les atiendan en el hospital Clínic de Barcelona según una encuesta de la OCU

A falta de datos públicos, que sean las opiniones de los expertos. Y, entre ellos, los mejores son los propios médicos, que son los que más información tienen. A 281 de ellos se ha dirigido la Organización de Consumidores y Usuarios (OCU) para preguntarles dónde les gustaría ser tratados si tuvieran una afección grave en 13 especialidades. El resultado es un predominio de centros de Barcelona y Madrid, y casi todos, públicos.
El preferido de una manera general sería el Clínic de Barcelona, que ocupa el primer puesto de esta clasificación. El grupo de los 10 primeros lo completan el Vall d'Hebron (Barcelona), La Paz (Madrid), 12 de Octubre (Madrid), La Fe (Valencia), Ramón y Cajal (Madrid), Gregorio Marañón (Madrid), Universidad de Navarra (el único 100% privado), Bellvitge (Barcelona ) y Santa Creu i Sant Pau (Barcelona).
Entre las 13 especialidades salen mencionados en los primeros puestos 32 centros diferentes, pero eso no quiere decir, subraya la OCU, que los otros sean malos, sino que no son “los mejores” según los entrevistados. Solo dos están entre los 10 primeros en las 13 áreas sobre las que se consultó: La Paz y Vall d'Hebron.
De ellos, solo 16 repite, lo que da idea de una especialización en muchos de ellos, como los casos de urología u oftalmología.
El Clínic es el preferido para aparato digestivo, diabetes, ginecología, nefrología, neurología y neumología. El Vall d'Hebrón lo es en cardiología y oncología. El resto de los primeros son la Fundación Puigvert (Barcelona) en urología, La Universitaria de Navarra en Otorrinolaringología, La Paz en pediatría, el Instituto de Microcirugía Ocular (Barcelona) en oftalmología y Bellvitge en cirugía ortopédica y traumatología.
Con el trabajo la OCU quiere informar a los pacientes en un momento en que el Ministerio de Sanidad aboga por la libre elección de centro, ya que sin información -y las comunidades no la dan- la elección se convierte en un ejercicio de adivinación por parte de los usuarios.

**Publicado en "EL PAIS"

Diabetes drug can prevent heart disease

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The widely used diabetes medicine metformin can have protective effects on the heart, reveals a new study conducted at the Sahlgrenska Academy, at the University of Gothenburg, Sweden. Researchers at the University of Gothenburg's Sahlgrenska Academy have shown in a preliminary study in rats that one of the most common diabetes drugs, metformin, also has a protective effect on the heart.
The study, carried out in collaboration with a research group from Naples and published in the journal Diabetes, reveals that metformin helps increase pumping capacity, improve energy balance, reduce the accumulation of fat, and limit the loss of heart cells through programmed cell death.
Long term effect
The results were compared with animals treated with another diabetes drug, which proved to have no positive effects on the heart.
“The animals in our study were treated with metformin for a whole year, so the effect seems to persist,” says Jörgen Isgaard, the researcher at the Sahlgrenska Academy who led the Swedish research group involved in the study.
New study on patients
Diabetes drugs have proved to have a number of serious side-effects for people with heart disease. Rosiglitazone, for example, was recently withdrawn due to its cardiac side-effects. Metformin too can occasionally have side-effects, primarily in patients with kidney failure.
“Our results nevertheless strengthen the indication for metformin as a diabetes medicine, and we hope that they are now followed up with studies on actual patients,” says Isgaard.
The article Metformin Prevents the Development of Chronic Heart Failure in the SHHF Rat Model was published in Diabetes on 22 February.

**Source: University of Gothenburg

El riesgo de pasar más de ocho horas al día sentado

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Si usted es de los que tienen un trabajo en una oficina, en la ventanilla de un banco, en la recepción de un hotel o en cualquier otro lugar que le 'obligue' a mantenerse sentado más de cuatro horas al día, siga leyendo, seguro que le interesa. Según un estudio que ha evaluado los datos de 222.000 personas, el sedentarismo es responsable del 6,9% de las muertes ocurridas por cualquier causa. En otras palabras, caminar 30 minutos al día es tan beneficioso como perjudicial es permanecer sentado 10 horas al día.
La Organización Mundial de la Salud (OMS) recomienda al menos 150 minutos de actividad moderada o intensa a la semana pero, ¿qué ocurre con los otros 6.500 minutos que quedan restando aquellos que dedicamos a dormir? ¿Si cumplimos con los consejos de la OMS nuestra salud está a salvo?
Para dar respuesta a estas preguntas, investigadores de la Escuela de Salud Pública de la Universidad de Sidney (Australia) han llevado a cabo un estudio, cuyos datos publica la revista 'Archives of Internal Medicine', en el que han analizado las respuestas a cuestionarios sobre la salud y la actividad física de 222.497 personas de 45 o más años de edad y los datos del registro de nacimientos, muertes y matrimonios de Nueva Gales del Sur (Australia), desde febrero de 2006 hasta diciembre de 2010. En el periodo de tiempo analizado, se produjeron 5.405 muertes.
"Los resultados muestran que el sedentarismo prolongado está significativamente asociado con un mayor riesgo de muerte por cualquier causa independientemente de la actividad física que se realice. Permanecer inactivo fue responsable de un 6,9% de todas las muertes", sentencian los autores de la investigación. Además, el trabajo mostró que la relación entre inactividad y mortalidad es dosis-dependiente, es decir, que a mayor tiempo de reposo mayor probabilidad de muerte, y ese riesgo aumenta a partir de las cuatro horas al día que se permanezca sentado, y sobre todo si el tiempo sin actividad supera las ocho horas.
No obstante, quienes mayor probabilidad de muerte tienen son aquellas personas con alguna patología, como las que tienen una enfermedad cardiovascular, diabetes, sobrepeso u obesidad, y que además pasan más tiempo sentadas, según recoge el estudio.
"Nuestros resultados ayudan a acumular evidencia sobre la relación entre conductas sedentarias y salud [...] Se ha comprobado que permanecer mucho tiempo sentado altera la función metabólica, resultando en un incremento del nivel de triglicéridos en sangre, una reducción de las cifras de colesterol de alta densidad (el bueno) y una disminución de la sensibilidad a la insulina. También se ha sugerido que afecta al metabolismo de los carbohidratos mediante cambios en las proteínas transportadoras de la glucosa muscular", explican los autores.
Tal y como explican en un editorial, publicado en la revista mencionada, David Dunstan y Neville Owen, doctores del Instituto Baker IDI del Corazón y Diabetes en Melbourne (Australia), "junto con una disminución del metabolismo energético, el sedentarismo también puede ser peligroso por la ausencia prolongada de actividad contráctil en los músculos de las piernas [...] Con este estudio, la evidencia es tan suficientemente fuerte que los médicos deberían pedirles a los pacientes que reduzcan el tiempo que pasan sentados".
La recomendación tiene cada vez más sentido. Según los datos de una encuesta realizada por el Instituto Estadounidense de Salud y Nutrición, la gran mayoría del tiempo que pasamos sin dormir se gasta en acciones sedentarias (58%) o en una actividad de ligera intensidad (como lavar los platos o cuidar el jardín, un 39%) y sólo el 3% del tiempo se dedica a una actividad que mejora la salud física.
Finalmente, los editorialistas señalan que "los esfuerzos para reducir comportamientos sedentarios requerirán poner atención en la normativa del lugar del trabajo, en la salud laboral y ocupacional, en la planificación del transporte y en innovaciones en el diseño de tecnologías de la comunicación, al igual que en campañas de educación pública".

**Publicado en "EL MUNDO"

Snacking on raisins may offer a heart-healthy way to lower blood pressure

If you have slightly higher than normal blood pressure -- known as prehypertension -- consider eating a handful of raisins. New data suggest that, among individuals with mild increases in blood pressure, the routine consumption of raisins (three times a day) may significantly lower blood pressure, especially when compared to eating other common snacks, according to research presented today at the American College of Cardiology's 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field. Even though raisins are popularly cited to lower blood pressure on various websites and are known to have intrinsic properties that could benefit heart and vascular health, researchers believe this is the first controlled study to scientifically support raisins' blood pressure-lowering effects compared to alternative snacks.
"It is often stated as a known fact that raisins lower blood pressure. But we could not find much objective evidence in the medical literature to support such a claim," said Harold Bays, MD, medical director and president of Louisville Metabolic and Atherosclerosis Research Center (L-MARC) and the study's lead investigator. "However, our study suggests if you have a choice between eating raisins or other snacks like crackers and chocolate chip cookies, you may be better off snacking on raisins at least with respect to blood pressure."
In this investigation, Dr. Bays and his team conducted a randomized controlled clinical trial to compare the blood pressure effect of eating raisins versus other snacks in 46 men and women with prehypertension. Participants were randomly assigned to snack on raisins or prepackaged commercial snacks that did not contain raisins, other fruits or vegetables but had the same number of calories per serving three times a day for 12 weeks. The study controlled for individual differences in nutrition and physical activity.
Data analyses found that compared to other snacks, raisins significantly reduced systolic blood pressure at weeks 4, 8, and 12, ranging from -4.8 to -7.2% or -6.0 to -10.2 mmHg (p values <0.05). Within group analysis demonstrated that raisins significantly reduced mean diastolic blood pressure at all study visits, with changes ranging from -2.4 to -- 5.2 mmHg (p values < 0.05). Pre-packaged snacks (including crackers and cookies) did not significantly reduce systolic or diastolic blood pressure at any study visit.
"Overall, these findings support what many people intrinsically believe: that natural foods often have greater health benefits than processed foods," Dr. Bays said.
The study did not identify how raisins lower blood pressure. However, raisins are high in potassium, and have fiber, polyphenols, phenolic acid, tannins and antioxidants.
"Raisins are packed with potassium, which is known to lower blood pressure," Dr. Bays said. "They are also a good source of antioxidant dietary fiber that may favorably alter the biochemistry of blood vessels, causing them to be less stiff, which in turn, may reduce blood pressure."
Although this study was not designed or powered to evaluate for outcomes benefits, other studies support that in patients with prehypertension, mild lowering of blood pressure with medications may have clinical benefits in reducing cardiovascular events.
According to the Centers for Disease Control and Prevention, nearly one in three (28 percent) American adults have prehypertension -- defined as a systolic pressure from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure from 80 to 89 mm Hg. This study's findings help validate some current nutritional recommendations. For example, 60 raisins -- about a handful -- contain 1 gram of fiber and 212 milligrams of potassium, which are both recommended in the Dietary Approaches to Stop Hypertension (DASH) diet.
Dr. Bays cautions that this was a single site study; larger trials are needed to confirm the blood pressure-regulating effect of raisins. Nonetheless, he says work in this area is particularly exciting because applying similar scientific methods to natural products, as required for drug development, provides consumers with objective data about which foods may or may not benefit heart health.
This study was funded by the California Raisin Marketing Board through a grant to L-MARC Research Center.

**Source: American College of Cardiology

En un estudio asocian el tabaco con la esquizofrenia

Fumar afecta negativamente a nuestra salud; provoca cáncer, enfermedades cardiovasculares, respiratorias, etc. Ahora, un estudio que se publica en The Proceedings of the National Academy of Sciences (PNAS), sugiere que, en personas sanas que poseen determinantes variantes genéticas que aumentan el riesgo de la esquizofrenia, los fumadores tienen un marcador neurobiológico de la esquizofrenia más elevado que los no fumadores.

Los científicos han pensado durante mucho tiempo que la esquizofrenia era hereditaria. Sin embargo, como un crisol de trastornos con diferentes causas genéticas se oculta tras las manifestaciones de esquizofrenia, los investigadores aún no han sido capaces de identificar el principal gen responsable. Ahora, el equipo de Boris Quednow, del Hospital Universitario de Zurich (Suiza), ha analizado la relación entre las variaciones genéticas en TCF4, que se sabe que aumentan el riesgo de esquizofrenia, y un déficit en el procesamiento de la información asociada con el trastorno.

Los autores analizaron 1821 voluntarios sanos, seleccionados al azar, con 21 variaciones en el gen TCF4, y evaluaron sus hábitos de fumar. Las personas con esquizofrenia tienen un alto índice de consumo de tabaco.

A través de un electroencefalograma, los investigadores vieron que los portadores de cuatro variantes distintas del gen TCF4 tenían alterado el procesamiento de la información auditiva. Cuando los autores ajustaron los resultados de acuerdo al hábito de fumar, encontraron que, entre los portadores de las variantes del gen TCF4, los fumadores muestran mayores déficits en el procesamiento de la información que los no fumadores.

Los autores concluyen que fumar puede interactuar con las mutaciones en TCF4 y jugar un papel importante en el desarrollo del déficit en el procesamiento de la información asociada con la esquizofrenia. A pesar de que aún queda por determinar si el hecho de fumar modula el riesgo de esquizofrenia en sí, los resultados puede facilitar nuevas pistas sobre factores de riesgo genético para la esquizofrenia.

**Publicado en "ABC SALUD"

Researchers identify drugs with fewest side-effects for treating irritable bowel syndrome

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Cedars-Sinai researchers have determined that two prevalent drug therapies -- rifaximin and lubiprostone -- offer some of the best options for treating irritable bowel syndrome, a widespread disorder that affects up to one in five Americans. The findings, based on an analysis of more than two dozen large-scale clinical trials, are contained in a peer-reviewed study published online by The American Journal of Medicine and set to appear in the publication's April print edition. Patients with irritable bowel syndrome often experience abdominal pain or cramps, excess gas or bloating and visible abdominal distension. Many drug therapies cause troubling side effects of their own, including nausea, insomnia, palpitations and decreased appetite.
"For the millions of patients who suffer from IBS, effective treatment options have been very scarce," said Dr. Mark Pimentel, a lead author of the study and director of Cedars-Sinai's Gastrointestinal Motility Program.
Pimentel and the other researchers analyzed common treatments for IBS.
For diarrhea forms of the condition, they evaluated tricyclic antidepressants; alosetron, a drug that slows movement of stool in the gut; and rifaximin, an antibiotic that stays in the gut and is currently FDA-approved to treat traveler's diarrhea and hepatic encephalopathy.
For constipation forms of IBS, the researchers examined antidepressants known as serotonin reuptake inhibitors and lubiprostone, a drug that promotes gut secretion.
The research found striking differences:
• For every 2.3 patients who benefited from tricyclic antidepressants, one suffered harmful side effects and had to stop taking the medication.
• For every 2.6 patients helped by alosetron, one had to halt the drug.
• By contrast, for every 846 patients aided by rifaximin, one had to discontinue the medication.
• Lubiprostone and serotonin reuptake inhibitors demonstrated a complete lack of "harm" to IBS patients with constipation, as defined by the study.
"We found that rifaximin and lubiprostone have the lowest level of harmful side effects of all the well-studied drug therapies for IBS," Pimentel said.
"This underscores the need for us to continue to monitor new therapies for this disease," Pimentel added. "While it is important to see benefit with drugs, harm is something we do not often assess well."
Besides Cedars-Sinai, other centers participating in the research included the School of Medicine at Texas Tech University's Health Sciences Center; the UCLA Department of Medicine; Beth Israel Deaconess Medical Center; and Harvard Medical School.
Funding for the study was provided by the Beatrice and Samuel A. Seaver Foundation.
Pimentel discovered the use of rifaximin for IBS. Cedars-Sinai holds patent rights to the discovery and has a licensing agreement with Salix Pharmaceuticals Inc., which markets the drug. Pimentel is a consultant to Salix and serves on its scientific advisory board. None of the authors is affiliated with lubiprostone maker Takeda Pharmaceuticals or other drugs that were evaluated.

**Source: Cedars-Sinai Medical Center

Incontinence 20 years after child birth 3 times more common after vaginal delivery

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Women are nearly three times more likely to experience urinary incontinence for more than 10 years following a vaginal delivery rather than a caesarean section, finds new research at the Sahlgrenska Academy at the University of Gothenburg, Sweden. Urinary incontinence (UI) is a common condition affecting adult women of all ages and can have a negative influence on quality of life.
This new study from the University of Gothenburg in Sweden looked at the prevalence and risk factors for UI 20 years after vaginal delivery (VD) or caesarean section (CS). The study included women who had only one child and assessed their prevalence of UI for less than five years, between 5-10 years and for more than 10 years.
Over six thousand women involved
The SWEPOP (Swedish pregnancy, obesity and pelvic floor) study was conducted in 2008 and data were obtained from the Medical Birth Register (MBR) for deliveries between 1985 and 1988. A questionnaire was sent to women and 6, 148 completed it answering questions on height, weight, urinary or anal incontinence, genital prolapse, menstrual status, hysterectomy, the menopause and hormone treatment.
Prevalence of incontinence tripled
Overall, the prevalence of UI was considerably higher after a vaginal delivery (40.3%) compared to women who delivered by caesarean section (28.8%).
The study also found that the prevalence of UI for more than 10 years almost tripled after VD (10.1%) compared to women who had a CS (3.9%).
Overweight also a risk factor
In addition, the paper looks at the impact of BMI on UI. The risk increase of UI in obese women more than doubled in comparison to women with a normal BMI after VD and more than tripled after CS.
Many risk factors
Maria Gyhagen, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Sweden and co-author of the paper said:
"In conclusion, the risk of developing urinary incontinence was higher 20 years after a vaginal delivery compared to a caesarean section.
"There are many factors affecting urinary incontinence but obesity and aging as well as obstetric trauma during childbirth are known to be three of the most important risk factors."
Affects daily life
BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added: "Urinary incontinence affects many women and can have a big impact on day to day life.
"However, women need to look at all the information when deciding on mode of delivery as despite vaginal delivery and BMI being linked to urinary incontinence, caesarean section involves its own risks."

**Source: University of Gothenburg