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Objective: To assess whether the combination of fixed-dose Oral Antidiabetic drugs (OA) in a single tablet compared to OA separated into 2 or more tablets is an effective strategy to improve adherence in insulin-dependent patients with Type 2 Diabetes Mellitus (DM2). Methods: This was a prospective, longitudinal, multi-center study, carried out in 3 primary care centers in Spain. One hundred and twenty patients treated with OA and insulin prescribed for insulin-dependent DM2 were included. A cluster randomization was performed based on two groups: (1) Control Group (CG): Sixty patients treated with two OA prescribed separately in different tablets, and (2) an Intervention Group (IG): Sixty patients treated with OA were with 2 drugs in combination at a fixed dose, in a single tablet. Three visits took place. AO Adherence was measured by using electronic monitors (MEMS). Average adherence percentage (%; Average AP) and daily compliance (%; Daily AP) was calculated. A patient was considered adherent when AP was 80–100%. Insulin adherence was measured by counting. Results: One hundred and ten patients completed the study (79 in the IG and 31 in the CG). Global adherence was 92,59% and 79,62% in IG and 82,85% and 48,21% in CG at 6 and 12 months, respectively (p

ResumenObjetivosOfrecer una estimación de las personas dependientes por grado y nivel para el periodo 2007-2045 y del coste asociado a su atención en el Sistema para la Autonomía y Atención a la Dependencia (SAAD).MétodosA partir de la Encuesta de Discapacidad, Autonomía personal y situaciones de Dependencia (2008), y del baremo de valoración de los grados y niveles de dependencia, aplicamos un procedimiento de estimación bietápico para las proyecciones de personas dependientes. En la primera etapa se calcula la probabilidad de que una persona sea o no dependiente con derecho a prestación mediante un modelo logit, mientras que en la segunda etapa se calcula (mediante un modelo logit ordenado) la probabilidad de que una persona, siendo dependiente con derecho a prestación, presente un determinado nivel y grado de dependencia. A continuación se ofrecen proyecciones de gasto en dependencia a partir de costes medios por punto de baremo según grado y nivel.ResultadosSe obtiene una mayor incidencia de las situaciones de dependencia en las beneficiarias mujeres que en los hombres, con tasas de crecimiento entre 2007 y 2045 más altas para casi todas las categorías de grado y nivel. Para 2045 estimamos que habrá 1.592.798 beneficiarios del SAAD (596.332 hombres y 996.466 mujeres). Asimismo, entre 2007 y 2045 el coste de atención a los beneficiarios hombres se multiplicaría por 2,64 y el de las mujeres dependientes por 2,89, ascendiendo en 2045 a 41.926 millones de euros.ConclusionesLa atención a las personas en situación de dependencia supone un importante reto para la sociedad española, por la cuantía de personas a cubrir y por el creciente esfuerzo económico que conlleva, lo cual debería abrir el debate sobre la manera más adecuada de financiar los servicios y prestaciones del SAAD y asegurar su sostenibilidad.AbstractObjectiveTo provide estimates of the number of dependent individuals per grade and level for the period 2007-2045 and the cost associated with the care of these individuals for the System for Promoting the Autonomy and Care of Dependent Persons [Sistema para la Autonomía y Atención a la Dependencia (SAAD)].MethodsBased on the Disabilities, Independence and Dependency Situations Survey (2008) and the scale for the assessment of grades and levels of dependency, we applied a two-stage estimation procedure to project the number of dependent individuals. In the first stage, we calculated the probability of a person being dependent and entitled to benefits by using a logit model. In the second stage, using an ordered logit model, we calculated the probability of distinct grades and levels of dependency in dependent persons entitled to benefits. Subsequently, we calculated expenditure projections based on average cost per point scale by grade and level of dependency.ResultsOur results suggest a higher incidence of situations of dependency in female beneficiaries than in male beneficiaries, with higher growth rates for almost all categories of grade and level between 2007 and 2045. We estimated that in 2045 there will be 1,592,798 beneficiaries of the SAAD (596,332 men and 996,466 women). Moreover, between 2007 and 2045 the cost of care for dependent people will be multiplied by 2.64 for male beneficiaries and by 2.89 for female beneficiaries, amounting to 41,926 million euros in 2045.ConclusionsThe care of dependent persons is a major challenge for Spanish society both because of the number of persons that will require care and because of the greater economic cost involved. These findings should prompt a debate on how to fund services and benefits and how to ensure the sustainability of the system.

Introduccion. Las hemicraneas son cefaleas raras caracterizadas por dolor estrictamente unilateral, bien como una cefalea continua, aunque fluctuante, en la hemicranea continua (HC), o en forma de ataques recurrentes en la hemicranea paroxistica (HP). En ambos tipos de cefalea se describe una respuesta absoluta a la indometacina. Objetivo. Analizar el cumplimiento de los criterios diagnosticos actuales para HC y HP, y la reciente introduccion de la HC en el grupo de las cefaleas trigeminoautonomicas. Pacientes y metodos. Evaluamos retrospectivamente las caracteristicas clinicas y terapeuticas de pacientes diagnosticados de HC o HP. Incluimos informacion demografica, sintomatologia, escala analogica de dolor y respuesta a la indometacina. Resultados. Evaluamos una muestra de 12 pacientes con HC (cuatro hombres y ocho mujeres) de un total de 520 casos (2,3%). Edad media de inicio: 47,1 ± 16,4 anos. Intensidad de dolor basal: 3,3 ± 1,9. Exacerbaciones: 9,2 ± 1,1. Ocho casos (66,7%) presentaban sintomas autonomicos, cuatro (33,3%) tenian patron horario y dos (16,7%) no respondieron a la indometacina. Evaluamos una muestra de 11 pacientes con HP (100% mujeres) de 520 casos (2,1%). Edad media de inicio: 37,0 ± 13,9 anos. Intensidad de dolor: 8,7 ± 2,7. Nueve casos (81,8%) presentaban sintomas autonomicos, tres (27,3%) tenian patron horario y uno (9,1%) no respondio a la indometacina. Conclusiones. Las hemicraneas son diagnosticos infrecuentes en consultas de cefalea. Su diagnostico requiere el cumplimiento de unos criterios que a veces no se cumplen en su totalidad. Pensamos que se precisa una revision de los criterios y apoyamos que la HC se haya introducido recientemente en el grupo de las cefaleas trigeminoautonomicas.

Evidence has suggested a genetic link between the HLA-DR4 phenotype and rheumatoid arthritis (RA), particularly in its seropositive form. Such an association varies among different ethnic groups and remains controversial for seronegative patients. Data obtained for a group of 64 Chilean patients with RA (46 seropositive, 18 seronegative), as defined by the 1987 criteria of the American Rheumatism Association, and for 76 controls are reported here. The prevalence of HLA-DR4 and DR9 was significantly increased in the group of patients considered as a whole. The prevalence of HLA-DR4 was not significantly higher, however, when seronegative and seropositive patients were separately compared with controls. Also, it did not correlate with the severity of the disease within each subgroup of patients. On the other hand, HLA-DR9 showed a highly significant difference, not previously described, only for the seropositive patients in comparison with controls. The prevalence of DQ specificities showed no relevant differences among the groups. The HLA-DR4 serotype, therefore, is a weak marker for RA and does not differentiate any subgroup of patients in the Chilean group studied. This new finding, indicating an association between RA and the DR9 antigen, may be explained by the suggestion that susceptibility epitopes are shared among different DR molecules. This hypothesis might also account for the variation in the association of DR4 with RA.