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El paciente crítico tiene una pérdida de masa muscular significativa, observando frecuentemente sarcopenia en estos pacientes. Su presencia aumenta los desenlaces adversos, estancias hospitalarias, mayor riesgo de infecciones, aumento del tiempo de asistencia ventilatoria mecánica, mayor discapacidad al alta hospitalaria, menor posibilidad del retorno normal a la vida habitual de los pacientes, incremento en gastos en salud y mayor mortalidad. Objetivo: Indicar el uso oportuno y adecuado de la proteína en el paciente crítico. Métodos: la Asociación Colombiana De Nutrición Clínica (ACNC) y la Asociación Colombiana de Medicina Critica y Cuidados Intensivos (AMCI) mediante metodología de consenso realizaron unas recomendaciones con un grupo de expertos. Resultados: 46 recomendaciones fueron aprobadas con consenso superior al 80%. Conclusiones: La intervención óptima proteica temprana y progresiva en el paciente crítico, es importante para obtener los mejores desenlaces clínicos, disminuir complicaciones e impactar en costos de atención hospitalaria.

A proper understanding of thyroid physiology and its changes through pregnancy is critical to suspect diseases affecting the functioning of the hypothalamic-pituitary-thyroid axis, and to make a proper interpretation of the tests that measure its function. Alterations in thyroid function tests are common during pregnancy, and it may be difficult to distinguish them from those due to disease. Clinical hypothyroidism and hyperthyroidism are rare during pregnancy (0.2% to 0.36%), but subclinical forms are more frequent (around 2%). Iodine is essential as substrate for thyroid hormone synthesis, and the requirements vary according to the population and the moment of pregnancy. Infertile couples have five to ten times more thyroid disorders; for that reason they should be studied as to thyroid function when searching for the cause of the infertility. Autoimmunity has been associated with maternal and perinatal complications such as abortion, preterm delivery and postpartum thyroiditis; some studies have shown that their incidence decreases with levothyroxine. This review includes the following aspects: thyroid physiology during pregnancy, thyroid function and fertility, iodine and pregnancy, anti-thyroid antibodies and pregnancy, thyroid function tests during pregnancy, and screening for thyroid disorders in pregnant women.

Thyroid disorders are frequent in women of reproductive age. However, they are often overlooked because their manifestations may be confused with those of the hypermetabolic state that is characteristic of pregnancy. To the physiological changes that occur during pregnancy –cardiovascular, pulmonary, hematological, immunological, etc., it is necessary to add modifications in the thyroid axis that presents different situations during pregnancy; those variations make it difficult to correctly diagnose and treat pathological situations. Disorders of thyroid axis have negative consequences on both mother and fetus, among them: preeclampsia, abortion, premature delivery and disorders of the fetal central nervous system. Treatment must be oriented to counteract the effects of either increased or diminished thyroid function; for that purpose, differences concerning requirements and safety of medicines must be taken into account. Presently there is controversy concerning routine screening of pregnant women for thyroid disorders; so far, the available tests are usually performed only in high-risk women.

Producing human proteins in lower organisms' cells using recombinant technology represents a very promising approach for treating many diseases produced by a particular protein deficiency, including close to 40 lysosomal storage diseases. Although E. coli has been the first host successfully employed in expressing human recombinant proteins, it has some limitations owing to its inability to perform some post-traductional steps such as glycosylation. The yeast Saccharomyces cerevisiae (S. cerevisiae) has thusbeen initially considered and used. However, S. cerevisiae glycosylates proteins in a very different way to human cells producing highly antigenic proteins and thus some other non-conventional yeasts such as Pichia pastoris have been used recently. Human protein expression is not assodated with growth in this system; growth may occur at high cell concentrations, increasing heterologous protein productivity and yield. The system employs a very efficient, methanol-induced promoter which may be used as sole carbon and energy source. Post-traductional modifications seem more similar to human cells than those produced by other non-mammalian systems used in producing human glycoproteins; they do not secrete large amounts of endogenous proteins, simplifying expressed protein purification. This review presents some strategies for producing heterologous proteins in high density cultures using P. pastoris as an expression system.La producción de proteínas humanas en células de organismos inferiores, mediante tecnología recombinante es una muy prometedora aproximación al tratamiento de muchas enfermedades producidas por la deficiencia de una proteína en particular, entre ellas cerca de 40 enfermedades de almacenamiento lisosomal. Aunque Escherichia coli (E. coli) fue el primer hospedero empleado con éxito para expresar proteínas humanas recombinantes, tiene algunas limitaciones, causadas principalmente por su inhabilidad para hacer algunas modificaciones postraduccionales, como la glicosilación. Debido a esto, la levadura Saccharomyces cerevisiae (S. cerevisiae) fue consi­derada y usada al comienzo para tales propósitos. Sin embargo, S. cerevisiae glicosila proteínas de manera muy diferente a las células humanas y produce proteínas bastante antigénicas; por este motivo algunas otras levaduras no-convencionales, como Pichia pastoris (P. pastoris), han sido usadas recientemente. En este sistema, la expresión de proteínas humanas no está asociada al crecimiento; puede crecer a altas densidades celulares, aumentando la productividad y el rendimiento de la proteína heteróloga; tiene un promotor muy eficiente, inducible por adición de metanol, el cual puede ser usado como única fuente de carbono y energía. Las modificaciones postraduccionales, parecen más semejantes a las células humanas que a las de otros sistemas no mamíferos usados para la producción de glicoproteínas humanas y no secretan considerables cantidades de proteínas endógenas, lo cual simplifica la purificación de la proteína expresada. En esta revisión se presentan estrategias para la producción de proteínas heterólogas en cultivos de alta densidad, empleando P. pastoris como sistema de expresión. Palabras clave: estrategias de fermentación; glicoproteínas humanas; P. pastoris; proteínas recombinantes; fermentation strategies; human glycoprotein; P. pastoris; recombinant protein

Objetivos. Establecer la presencia y prevalencia de parásitos nematodos Strongylida en Achatina fulica en el Valle del Cauca, especialmente los nematodos que son potencialmente patogénicos para los humanos. Materiales y métodos. Individuos de A. fulica fueron colectados en nueve ciudades del Valle del Cauca, Colombia. Los nematodos fueron identificados mediante inspección directa de los individuos, estos se separaron de los tejidos y el mucus, luego, los nematodos se lavaron en solución salina, y fijaron en solución AFA caliente. Se montaron placas en glicerina para observar al microscopio. Resultados. La prevalencia general de parásitos nematodos fue 35% en 2013. La ciudad con mayor prevalencia durante 2013 fue Cartago (60%), seguido de Buenaventura (42.9%) y Cali (33%), mientras que en 2014 fue Cali (30%) y Buenaventura (30%). Los nematodos Strongylida registrados fueron clasificados en tres géneros: Angiostrongylus (prevalencia 14.7%), Aelurostrongylus (2.6%), y Strongyluris (2.6%). La ciudad con la mayor cantidad de positivos para Angiostrongylus fue Cali durante 2014 y Buenaventura con Aelurostorngylus para el 2013. El género Strongyluris solo se reportó en Cali durante 2013, con una prevalencia del 11%. En cinco de las nueves ciudades evaluadas se registró la presencia de Angiostrongylus. Conclusiones. Tres géneros de nematodos Strongylida se reportaron en individuos de A. fulica en el Valle del Cauca durante 2013 y 2014. Por lo tanto, no debe subestimarse el papel de A. fulica y las especies de moluscos nativas en el ciclo de vida de estos parásitos.

Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC)., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Alcohol is associated with all-cause mortality increase. However, when this increase takes place has not been clearly established. The objective of this study was to establish the levels of alcohol consumption that can be considered low risk for overall mortality., Methods: Systematic review of cohort studies published since 2014 that established a relationship between general mortality and alcohol consumption in the general population. Those studies not conducted in countries with Spain socio-cultural environment and those that present conflicts of interest were excluded., Results: The median of alcohol consumption (in grams) from which mortality increased was 23-25 g/day. Differentiating by sex, these values were 20 g/day in women and 24 g/day in men. The minimum value of the median from which an increase in mortality was observed was 17-21 g/day of alcohol; 12 g/day in women and 20 g/day in men., Conclusions: If we take into account caution principle, taking more conservative levels of average alcohol consumption from which an increase in mortality was observed, low-risk consumption should be 20 g/day in men and 10 g/day in women, assuming that there is no safe level of alcohol consumption.

Objective: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations., Method: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories., Results: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation., Conclusions: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Estimate tobacco use in adults in 2015 and observance of the provisions of the General Law for the Control of Tobacco and its Harmful Effects on Health and its regulations., Methods: A cross-sectional study was conducted using the Global Adult Tobacco Survey (GATS) in homes, with national representation based on a three-stage probabilistic sample by sex and area of residence., Results: Visits were made to 9 632 homes where 8 607 individual interviews were conducted; the response rate was 89%. Current smokers were 8.9% (95% CI: 8.1-9.8). Prevalence in men was 13.4% (12.0-15.0), and in women, 4.4% (3.7-5.2); in urban areas, 9.6% (8.5-10.7), in rural areas, 7.1% (6.2-8.2); and mean age of smoking initiation and mean number of cigarettes smoked per day, 16.1 years (15.6-16.6) and 13.4 (12.2-14.7), respectively. Prevalence was highest in the group aged 45 to 64 years: 10.4% (9.0-12.0); 47.5% of interviewees had never heard of electronic cigarettes; and 6.3% had been exposed to tobacco smoke in the workplace and 7.9% in restaurants., Conclusions: This survey yielded policy and health information relevant to surveillance, health care, and enforcement of Costa Rica's antismoking legislation. Greater effort is needed to ensure that all obligations under Law 9028 are met, and that the results will remain in place until the second GATS in 2020., Competing Interests: Conflictos de interés. Los autores declaran que no tienen conflictos de interés.

Early insulinization therapy is regarded as an efficient aid to improve long term control and quality of life in patients with diabetes mellitus type 2 (DM2). Nevertheless, both patients and medical staff confront barriers in using this therapeutic tool. This study employs a qualitative approach to explore the barriers to early insulinization among medical staff from the public sector in the city of Xalapa, Veracruz, México. Between 2015 and 2016, in-depth interviews were conducted with general and specialist physicians offering primary health care to patients with DM2. The transcribed interviews were analyzed to extract and organize categories and subcategories of barriers among medical staff. These barriers were then grouped into three categories and exemplified with interview excerpts: barriers coming from the medical staff itself, barriers emerging from the doctor-patient interaction, and institutional barriers. Uses for the classification obtained are discussed, as are some of the solutions proposed by study participants.

Healthy eating habits promote wellness and prevent disease, however, despite the intention to change a bad habit, people often fail in theirattempts. This is due, since the performance of a change requires self-regulation skills that allow to observe, to evaluate and to take an action, in a constant motivation during the all the process; not only theknowledge about proper nutrition. The objective of this study was to design and validate an instrument to evaluate the level of self-regulation for eating habits in college students.62 items were written and evaluated by four expert judges. Two applications of the instrument were performed to 487 subjects. An unweighted least squares factor analysis whit direct Oblimin rotation was performed. The items saturated in more than one factor were discarded, as well as those who had a loading factor less than 0.40 or commonality less than 0.30. It was obtained an instrument integrated by 14 items grouped into three factors, which explained the 46.9% of the variance: self-reaction, self-observation and self-evaluation. Cronbach's alpha yielded a high reliability coefficient (α = 0.874).The results show that the scale is a valid and reliable tool to measure of self-regulation of eating habits in college students. Its applications include the diagnostic of a population and the evaluation of interventions aimed to improving nutrition based on the assumption that the processes of change require sustained self-regulation skills in people protective effect against increases in both systolic and diastolic blood pressure.

Objectives: To evaluate total serum calcium (TC) and albumin-corrected calcium (ACC) as prognostic severity factors in acute pancreatitis (AP)., Methods: Ninety-six patients were included in the study. They were diagnosed with AP and admitted to the Hospital Regional de Veracruz within the time frame of January 2010 to December 2012. AP severity was determined through the updated Atlanta Classification (2013). TC and ACC values were measured in the first 24hours of admittance and the percentages of sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated through ROC curves and contingency tables., Results: In accordance with the updated Atlanta Classification, 70 patients presented with mild AP, 17 with moderately severe AP, and 9 with severe AP. Of the patient total, 61.5% were women, and 69.8% presented with biliary etiology. The maximum TC cut-off point was 7.5mg/dL, with values of S, 67%; Sp, 82%; PPV, 27%, and NPV, 96%. The maximum ACC cut-off point was 7.5mg/dL, with values of S, 67%; Sp, 90%; PPV, 40%; NPV, 96%. Both had values similar to those of the Ranson and APACHE II prognostic scales., Conclusions: TC and ACC, measured within the first 24hours, are useful severity predictors in acute pancreatitis, with sensitivity and predictive values comparable or superior to those of the conventional prognostic scales., (Copyright © 2013 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Objective: To evaluate pollution by second-hand smoke in a sample of hospitality venues before and after the implementation of smoke-free legislation., Methods: A cross sectional, before-after study was conducted in 2008 and 2011 after the total ban. A SidePack Aerosol monitor was used both inside and outside the hospitality venues to measure fine breathable particles (PM2.5). A total of 43 places with pre- and post-legislation measurements were included., Results: The median indoor pollution in hospitality venues was 204.2μg/m(3) in 2008 and 18.82μg/m(3) in 2011; the average outdoor PM2.5 concentration was 47.04μg/m(3) in 2008 and 18.82μg/m(3) in 2011. Pollution was higher in bars and cafeterias, followed by pubs and discos. Before the law was implemented, pollution was 4.34 times higher indoors than outdoors; in 2011 the average indoor PM2.5 concentration decreased by 90.88%., Conclusions: Only a complete ban is able to protect workers and customers against the health risks of second-hand smoke exposure., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Extended-release (ER) paliperidone is an innovative atypical antipsychotic that allows minimal peak-to-through fluctuations with once-daily dosing., Objective: To evaluate effectiveness, safety and tolerability of flexible, once-daily doses of paliperidone ER (3-12 mg/day) in patients with schizophrenia from Argentina and Colombia who had previously failed treatment with other antipsychotic agents., Methods: The authors conducted a 6-month, open-label, prospective and multicentric study. Effectiveness was assessed with Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance scale (PSP). Other measures of effectiveness, safety and tolerability, were also conducted., Results: Paliperidone ER 3-12 mg/day improved Positive and Negative Syndrome Scale (PANSS) total scores (primary endpoint) from baseline to study end (p < 0,001). In the PANSS total score, the mean change from baseline (83, 9 units) to end point (53,7 units) was significant (p < 0,001). Flexible doses of paliperidone ER demonstrated a ≥20% reduction in the PANSS total score (p<0.001) in almost two-thirds of patients. PSP mean change from baseline (52 units) to end point (85 units) was significant (p < 0,001). Secondary effectiveness assessments, as well as safety and tolerability measures, demonstrated favourable results throughout the study., Conclusions: Flexible doses of paliperidone ER over 6 months were effective, safe and well tolerated in patients with schizophrenia from Argentina and Colombia., (Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

Objective: This study assessed the treatment preferences among Latin-American psychiatrists for their bipolar disorder patients and if these preferences reflect the current guidelines., Methods: We designed a survey comprised of fourteen questions. All the questions were aimed at the treatment of bipolar I patients only. We distributed the survey by hand or e-mail to psychiatrists in eight different countries: Argentina, Brasil, Colombia, Costa Rica, Ecuador, México, Perú and Venezuela. Between May 2008 and June 2009, we were able to gather 1143 surveys., Results: As the initial choice of treatment for a bipolar patient who debuts with mania, 61.3% choose a combination of an atypical antipsychotic and a mood stabilizer. Lithium Carbonate (50%) was the first choice for a mood stabilizer in a manic episode. Olanzapine (55.4%) was the initial antipsychotic of choice for the treatment of acute mania. For the treatment of acute bipolar depression, 27% choose Lamotrigineas their first choice. Most of the psychiatrists (74.8%) prescribe antidepressants for the treatment of bipolar depression. For maintenance treatment of bipolar depression most psychiatrists first choice would be Lamotrigine (50.3%). Most of the psychiatrists (89.1%) prescribed two or more psychotropic drugs for the maintenance treatment of their bipolar patients., Conclusions: There were some similarities with the studies previously done in the US. It seems that for the most part the Latin-American psychiatrists don't strictly follow the literature guidelines that are published, but rather adapt the treatment to the specific case. More longitudinal studies of prescribing patterns in bipolar disorder are needed to corroborate these findings., (Copyright © 2011 SEP y SEPB. Published by Elsevier Espana. All rights reserved.)

Congestive heart failure (CHF) would be associated with mitochondrial abnormalities and increased of reactive species of oxygen (ROS). To clarify these issues we studied the structure, function of the mitochondrial enzyme nitro oxide synthase inducible (iNOS) and lipoperoxidation of membranes, one of their products through the peroxide nitrite ion (ONOO-), in the heart muscle of patients with heart failure congestive (ICC) grade III and IV (according to New York Heart Association). We included 25 patients who underwent cardiovascular surgery to biopsies of the heart muscle. They were stratified into a group with CHF (n = 18) and control group (n = 7). In di-chas biopsies analyzed the enzymatic activity of mitochondrial complex III spectrophotometrically, which was measured in mM.ubiquinona-1.mg prot, while the mitochondrial morphology was analyzed by the Zeiss electron microscope, the areas were quantified with program Axionvision 4.6. Lipoperoxidation of membranes was measured by the presence of ONOO-by immunohistochemistry against primary antibody against 3-nitrotyrosine was used lab kit system biogenic steptobidin biotin peroxidase (SBA) and coloring triamiobencidina (TAB), it is made with semicuantificacion intensity SCORE test. The statistical test used was ANOVA. The heart muscle of patients with CHF showed that the mitochondrial area was reduced by 78% compared with the control (160.37 μm2 ± 9.87) (936.81 μm2 ± 78.48) p 0.0001. There was also a 70% reduction in complex III activity compared to control (1.9 10-2 mM ubiq.mim-prot 1.mg ± 12.6) (5.79 10-2mM ubiq.mim prot-1.mg ± 36.6) p . The presence of ONOO-was significantly increased in patients with CHF. Alterations ultraestructutural and functional mitochondria found in patients with CHF and increased ROS are involved in the measures of physiopathology CCI and whites should be taken into account for future therapies of this condition.

The smoking control policies recommended by the World Health Organisation have achieved a slight decrease in smoking prevalence in the developed countries, although associated mortality is still very high. The use of tobacco products other than cigarettes and even medicinal nicotine (known as nicotine replacement therapy (NRT)) has been proposed as a risk reduction strategy. Among the tobacco products with less individual risk than cigarettes would be any type of tobacco without smoke (smokeless) with a low content in nitrosamines and modified cigarettes; both forms included under the PREP (Potentially Reduced Exposure Products) concept. The idea would be to promote these products among those who cannot quit smoking or wish to reduce their risk without giving up nicotine intake. The possible effects of risk reduction strategies, including PREP, on the decreased prevalence and morbidity and mortality are reviewed, and the possible implications that this measure could have in our country are analysed. Tobacco control measures in Spain are recent and still insufficient. Therefore, the current priority in Spain is the development of policies of control that have shown to more than effective. The marketing and advertising of new tobacco products, even with reduced potential risk, seems more a serious threat than an opportunity for the development of smoking control policies.

Objectives: The primary objective is to describe the profile of the psychiatric members of a national psychiatry association in 19 Latin American countries (Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Chile, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru, Panama, Paraguay, Uruguay, and Venezuela). Secondary objectives are to evaluate job satisfaction and examine the factors related with job satisfaction., Methods and Materials: A total of 8,028 psychiatrists, members of a national psychiatry association in Latin America, were identified. A probabilistic stratified sample of 2465 psychiatrists was designed and they were asked to fill out an anonymous electronic survey., Results: A sample of 1,292 Latin American psychiatrists was obtained between April 2005 and July 2006 (52.4% of the designed sample). Response rates were superior to 70% in 11 countries. Mean age was 48.2 years, mean experience was 18.2 years; 63.8% were male and 99.9% of the surveyed psychiatrists were working as psychiatrists. Most of the respondents declared being satisfied with their quality of life (70.8%), a slightly larger percentage reported they were satisfied with their work (86.4%). However, 35.3% of the psychiatrists reported being unsatisfied with the income perceived for their economic activity as psychiatrists. Factors associated with job dissatisfaction are described., Conclusions: In Latin America, there is lower satisfaction with the incomes obtained from psychiatric practice and with the quality of life level. Nonetheless, the level of commitment with the profession in itself and job satisfaction remain similar to those reported in developed countries.

Objectives: To report trends in mortality from suicide in Colombia from 1985 to 2002 by sex, age group, and method, and determine the number of Years of Potential Life Lost (YPLL) to suicide during this period., Methods: Age- and sex-specific and age-adjusted crude mortality rates were calculated based on mortality and population information available from the official database of the Department of National Statistics Administration, Colombia. YPLL were estimated and adjusted for societal impact, age, and poor quality of mortality records. The results were tabulated according to codes X600-X849 and Y870 from the International Statistical Classification of Disease and Related Health Problems, 10th revision (ICD-10), and codes E950-E959 from the 9th revision (ICD-9)., Results: Suicide rates have been climbing in Colombia since 1998, particularly among young adults and males. The highest rates among males were in the age groups 20-29 years of age and over 70 years of age, and rates increased over time. Among females, the highest rates were recorded for the group 10-19 years of age. The YPLL rose in proportion with the increase in suicides, from 0.81% in 1981 to 2.20% in 2002. Among males, the most common methods used were firearms and explosives, hanging, and poison, with a relative increase in hanging; whereas among females, poison was most common., Conclusions: A rising trend in suicide rates in Colombia was confirmed, especially among the productive segment of the population, which has resulted in a marked increase in YPLL.

The prevention movement has been the key agent involved in smoking control policies. This study describes the context and the process in which Law 28/2005 was passed in Spain with a synthesis of its substance. It provides the background of the events leading up to Spain's current smoking control law in addition to an analysis of the role played by the different social actors in the process and the arguments and strategies employed in opposition by the tobacco industry. A review is also provided of the political agents, highlighting that decentralized countries have further problems in enforcing regulations. This case offers lessons for the future.

The growing involvement in Spain by civil society in the demand for tobacco control policies has been notable. The basis for the creation of the National Committee for Tobacco Prevention was established in 2004. At the end of that year, an intensive intervention was aimed at specifying, in law, the regulatory actions in the National Plan for Tobacco Prevention. This would facilitate a qualitative leap, taking advantage of the legal transposition of the European directive on advertising. With broad political consensus, the Law 28/2005 was established regarding sanitary measures for tobacco and the regulation of the sale, supply and consumption of tobacco products. The objective stated in this law is to prevent the initiation of tobacco consumption, especially among youth, guarantee the right of non-smokers to breathe air free from tobacco smoke and make quitting this habit easier for people who wish to do so. The main issues included are the prohibition of tobacco advertising and the limitation of tobacco consumption in common work areas and enclosed public spaces. The new law has replaced the previous rules in Spain, which were some of the most permissive in the European Union in terms of tobacco sales, advertising limitations and restrictions on smoking locations. It is clear that there is still much to be done. At this time, more social support needs to be generated in favor of the new regulations, and an important effort needs to be made to educate the public.

Objective: To evaluate a self-measuring blood pressure (BP) monitor, the OMRON-HM 722C., Design: Based on the protocol of the British Hypertension Society (BHS)., Setting: Urban health centre., Participants: A sample of 120 people (69 women) excluded those with a brachial perimeter under 24 centimetres or over 32., Measurements and Main Results: Each subject had four BP measurements in succession, separated by a minute: a) Manually, with a mercury sphygmomanometer (MSM); b) with self-measurement monitor; c) with self-measurement monitor; d) with MSM. Means and SD of systolic and diastolic pressures, means and SD of the differences and a graphic representation of these by the Bland and Altman method, were calculated. The cumulative percentages of differences the same as or below 5, 10 and 15 mm Hg were calculated. 89.1% of systolic BPs, and 92.5% of diastolic BPs, showed mean differences between monitor and observer equal to or below 5 mm Hg. The size of the differences was grade A in both cases, according to the BHS criteria., Conclusion: The OMRON-HM 722C self-measuring monitor could be useful for self-measurement of BP at home by primary care patients.

Background: The aim of this study was to analyse and to verify the efficacy of systematic advice for alcoholism prevention, assessing the reduction of the number in risk drinkers., Patients and Methods: A multicenter randomized controlled clinical trial was designed, to perform in general practitioner setting, on a sample of risk drinkers (alcohol intake > 280 g weekly, without dependence) sent by random in intervention group (systematic brief advice with support material and a five visit program during a year) and control group (once brief advice and a control in 1 year). The procedure to incorporate in both groups included physical exam, a blood test and the MALT questionnaire. A descriptive and analytic study on included variables was realised, assessing the percentage of drinkers who reduced alcohol intake below risk limit at the end of a year follow up, as well as the reduction intake in each group., Results: Of the 139 included males, 75 were in the intervention group and 64 in the control group. The percentage of patients not excluded by MALT > 10, and/or liver disease, that finished the 1 year follow up, was 46%, being the sample average age of 43 +/- 11.8. Patients included in both groups were initially comparable. At the end of a year follow up there were statistically significant differences in: percentage of risk drinkers who decreased alcohol intake below 280 g weekly (82% intervention group; 47% control group); percentage of reduction in GPT, GGT, triglycerides, systolic blood pressure and the MALT questionnaire., Conclusions: The efficacy of isolated advice of general practitioner was proved to achieve the alcohol intake reduction below the risk limit accepted in male risk drinkers without alcohol dependence. The systematic follow up during a year significantly improves the results achieved with the isolated advice.