Elena Guardiola

A bibliometric analysis of the scientific literature on Internet, video games, and cell phone addiction.

OBJECTIVES The aim of this study was to locate the scientific literature dealing with addiction to the Internet, video games, and cell phones and to characterize the pattern of publications in these areas. METHODS One hundred seventy-nine valid articles were retrieved from PubMed and PsycINFO between 1996 and 2005 related to pathological Internet, cell phone, or video game use. RESULTS The years with the highest numbers of articles published were 2004 (n = 42) and 2005 (n = 40). The most productive countries, in terms of number of articles published, were the United States (n = 52), China (n = 23), the United Kingdom (n = 17), Taiwan (n = 13), and South Korea (n = 9). The most commonly used language was English (65.4%), followed by Chinese (12.8%) and Spanish (4.5%). Articles were published in 96 different journals, of which 22 published 2 or more articles. The journal that published the most articles was Cyberpsychology & Behavior (n = 41). Addiction to the Internet was the most intensely studied (85.3%), followed by addiction to video games (13.6%) and cell phones (2.1%). CONCLUSIONS The number of publications in this area is growing, but it is difficult to conduct precise searches due to a lack of clear terminology. To facilitate retrieval, bibliographic databases should include descriptor terms referring specifically to Internet, video games, and cell phone addiction as well as to more general addictions involving communications and information technologies and other behavioral addictions.

EFFICACY AND TOLERABILITY OF MIGLITOL IN THE TREATMENT OF PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES MELLITUS

Abstract The efficacy of miglitol in improving postprandial glucose levels and its relationship to carbohydrate metabolism and absorption has been shown in several in vivo and in vitro studies. A multicenter (10 centers), randomized, double-blind, parallel-group study was designed to evaluate long-term efficacy and tolerability of miglitol versus placebo in patients with non—insulin-dependent diabetes mellitus (NIDDM). A total of 102 patients were recruited and randomized (89 assessable patients); after a run-in placebo period of 4 weeks, patients received miglitol or placebo 100 mg thrice daily for 18 weeks. Fasting blood glucose, cholesterol, and triglyceride levels were determined every 6 weeks; glycosylated hemoglobin HbA 1c levels were determined at the beginning and at the end of the study. No significant differences appeared in baseline values of efficacy variables. The primary efficacy analysis showed that miglitol was significantly more effective in reducing HbA 1c levels that placebo ( P = 0.0158). Miglitol was also significantly more effective in reducing fasting blood glucose levels ( P = 0.0012). No statistically significant differences were found in cholesterol or triglyceride levels. Meteorism, diarrhea, and flatulence were the most common adverse events and occurred more frequently in the miglitol group (49.0% of miglitol patients vs 36.7% of placebo patients). Hypoglycemic episodes occurred in 7 patients (2 in the miglitol group and 5 in the placebo group). Miglitol appears to be useful in the treatment of patients with NIDDM as it significantly reduces HbA 1c and fasting blood glucose levels.

Evaluación económica del tratamiento con ácido acetilsalicílico en dosis bajas en la prevención primaria de enfermedades cardiovasculares

Introduccion y objetivos El acido acetilsalicilico (AAS) en dosis bajas es un tratamiento estandar en pacientes con antecedentes de enfermedades cardiovasculares (ECV); se discute su empleo en prevencion primaria. Recientes estudios apoyan su uso en personas de alto riesgo y sin antecedentes de ECV. Se evaluo la repercusion economica del uso de AAS en la prevencion primaria de ECV en Espana. Metodos Se desarrollo un modelo para estimar la relacion coste/efectividad del tratamiento con AAS a dosis bajas en la prevencion primaria de ECV a los 10 anos. Se estudiaron los costes directos desde la perspectiva del Sistema Nacional de Salud (SNS) espanol. Los resultados se expresaron como coste por anos de vida ganados y por anos de vida ajustados por calidad. Resultados La administracion de AAS en dosis bajas a personas con riesgo de enfermedad coronaria (EC) ≥ 15% a los 10 anos produce un ahorro neto medio de 797 euros (intervalo de confianza [IC] del 95%, 263-1.331 euros), que empieza el primer ano. A partir de un riesgo annual ≥ 0,24%, este tratamiento ahorra costes al SNS. El tratamiento con AAS a toda la poblacion espanola con riesgo produciria un ahorro de 26,5 millones de euros en servicios sanitarios desde el primer ano. Conclusiones El tratamiento con AAS en dosis bajas de individuos con riesgo de EC ≥ 15% a los 10 anos produciria un ahorro de costes significativo al SNS. Los analisis de sensibilidad prueban la robustez de los resultados.

Lista de comprobación (checklist) abreviada para la evaluación de artículos de investigación biomédica básica

El proceso de revision y evaluacion de manuscritos, conocido como arbitraje cientifico o revision por expertos (peer review), supone actualmente un paso que se considera necesario para la divulgacion de los avances cientificos de una determinada disciplina. Cuando una revista recibe un articulo, sus editores suelen recurrir a revisores del propio comite de expertos o, en muchas ocasiones, a revisores externos (peer reviewer, referee) que, despues de la lectura detenida del manuscrito, evaluan la idoneidad de su publicacion atendiendo, entre otros aspectos, al cumplimiento de determinados requisitos de calidad, la coherencia de los resultados y las conclusiones que se presentan. De ahi puede deducirse el incuestionable papel que los revisores tienen en la calidad de las revistas cientificas 1 . Sin embargo, este proceso de revision, en su conjunto, no esta exento de criticas y, por este motivo, se ha reclamado un cambio de mentalidad a fin de mejorarlo de forma sustancial 2,3 . En el cuarto congreso internacional sobre revision por expertos en revistas biomedicas (Peer Review in Biomedical Publications, Barcelona 2001) se discutieron algunos problemas del proceso de revision y se propusieron determinadas alternativas de mejora 4

Trends in Scientific Literature on Addiction to the Internet, Video Games, and Cell Phones from 2006 to 2010

Background: The goals of the present work were to retrieve the scientific articles published on addiction to the Internet, video games, and cell phones and to analyze the pattern of publications in this area (who is doing the research, when and where it is taking place, and in which journals it is being published), to determine the research being conducted as well as to document geographical trends in publication over time in three types of technological addictions: Internet, cell phones, and video games. Methods: Articles indexed in PubMed and PsycINFO between 2006 and 2010 related to the pathological use of Internet, cell phones, and video games were retrieved. Search results were reviewed to eliminate articles that were not relevant or were duplicates. Results: Three hundred and thirty valid articles were retrieved from PubMed and PsycINFO from 2006 to 2010. Results were compared with those of 1996–2005. The year with the highest number of articles published was 2008 (n = 96). The most productive countries, in terms of number of articles published, were China (n = 67), the United States (n = 56), the United Kingdom (n = 47), and Taiwan (n = 33). The most commonly used language was English (70.3%), followed by Chinese (15.4%). Articles were published in 153 different journals. The journal that published the most articles was Cyberpsychology and Behavior (n = 73), followed by Chinese Journal of Clinical Psychology (n = 27) and International Journal of Mental Health and Addiction (n = 16). Internet was the area most frequently studied, with an increasing interest in other areas such as online video games and cell phones. Conclusions: The number of publications on technological addictions reached a peak in 2008. The scientific contributions of China, Taiwan, and Korea are overrepresented compared to other scientific fields such as drug addiction. The inclusion of Internet Gaming Disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition could change the publication trends in the technological addiction area and underline the relevance of this upcoming disorder in dissatisfaction with life in general.

[Health economic evaluation of low-dose acetylsalicylic acid in the primary prevention of cardiovascular disease].

INTRODUCTION AND OBJECTIVES Low-dose aspirin is standard treatment for patients with a history of cardiovascular disease. Its use in primary prevention is more controversial. However, recent studies also support the use of aspirin in high-risk individuals with no history of cardiovascular disease. This study investigated the health economic implications of using low-dose aspirin in the primary prevention of cardiovascular disease in Spain. METHODS A model was developed to predict the cost-effectiveness of low-dose aspirin in the primary prevention of cardiovascular disease over a period of 10 years. The direct costs used were those of the Spanish National Health Service (NHS). Results were expressed as cost per life-year gained and per quality-adjusted life-year gained. RESULTS Administering low-dose aspirin to an individual with a 10-year risk of coronary heart disease > or =15% resulted in an average net saving of e 797 (95% CI, e 263-1331) over the 10-year period, with savings starting in the first year. For an annual risk > or =0.24%, this form of treatment would reduce NHS costs. Treating all at-risk individuals in the Spanish population with aspirin would save e 26.5 million from the healthcare budget, starting in the first year. CONCLUSIONS Administering low-dose aspirin to individuals with a 10-year risk of coronary heart disease > or =15% would result in significant cost savings for the Spanish NHS. Sensitivity analysis confirmed the robustness of these findings.

Dalí and the double helix.

Science fascinated the great surrealist, who combined it with angels and allegories.

Utilidad de los textos literarios en la docencia de ciencias de la salud: ejemplos en cardiología

espanolLa importancia de las humanidades en la educacion medica es un hecho generalmente aceptado y se ha sugerido su introduccion en los planes de estudio de cursos como los basados en literatura y medicina. A pesar de su viabilidad, existen dificultades en incluir asignaturas especificas en curriculos ya apretados. Se ha planteado la posibilidad de utilizar textos literarios como elementos docentes en las asignaturas tradicionales. Sin embargo, existen pocas publicaciones que analicen la utilidad potencial de algunos de ellos. En el presente articulo se presentan tres obras que podrian emplearse para ilustrar la experiencia de la enfermedad en el caso de las cardiopatias. Se escogieron dos textos autobiograficos, Un infart de miocardi, de Josep Pla, y Monte Sinai, de Jose Luis Sampedro, y uno de ficcion, Memoires d’Hadrien, de Marguerite Yourcenar. Se revisaron para constatar que podian contribuir a comprender la vivencia de la enfermedad por los pacientes y alcanzar los objetivos educativos establecidos. Se presentan los fragmentos escogidos para ilustrar las repercusiones de la enfermedad y se debate la utilidad para la comprension de los aspectos emocionales de la enfermedad y de la relacion medico-paciente. EnglishThe importance of humanities in the medical training is commonly recognized and it has been suggested that its implementation in the medical curricula as literature and medicine courses. In spite of its viability, there is often difficult to include specific subjects in the already crowded medical curricula. Therefore, it has been suggested the use of literary texts as a teaching tool in traditional subjects. However, there are few publications that analyse the potential usefulness of them. In the present paper three literary works that might be used to illustrate the experience of disease in cardiology are discussed. Two autobiographical texts, Un infart de miocardi of Josep Pla and Monte Sinai of Jose Luis Sampedro, and a fiction work, Memoires d’Hadrien of Marguerite Yourcenar, were chosen. They were reviewed to establish their usefulness to understand the patient’s experience of disease and to reach educative objectives. The paper shows the chosen fragments to illustrate the disease consequences and its usefulness to understand emotional aspects of sickness and the patient-physician relationship is discussed.

La utilización del Mini Clinical Evaluation Exercise (mini-CEX) en estudiantes de medicina

espanolEn los ultimos anos se recomienda el uso de instrumentos que evaluen la adquisicion de habilidades clinicas en el contexto de la practica clinica. Entre los instrumentos mas recomendados se encuentra el Mini Clinical Evaluation Exercise (mini-CEX), desarrollado inicialmente para la evaluacion de medicos residentes, y que ha demostrado una buena fiabilidad y validez. Aunque se ha utilizado en estudiantes de medicina, no se dispone de un analisis completo de la experiencia acumulada. Para la presente revision se realizo en septiembre de 2014 la busqueda de los articulos indizados en Medline, Embase, Biosis Previews y Current Contents. Se seleccionaron aquellos articulos que incluian los terminos ‘mini clinical evaluation exercise’, ‘mini-CEX’ o ‘mcex’. Tras la eliminacion de los duplicados se obtuvo un total de 168 articulos. Se revisaron los que se referian al uso del mini-CEX en estudiantes de medicina (n = 34) y se analizaron a fondo aquellos que contenian datos empiricos (n = 21). Los estudios llevados a cabo en estudiantes de medicina confi rman que el mini-CEX es un instrumento util y factible para evaluar las habilidades clinicas de los estudiantes de medicina y que posee propiedades psicometricas adecuadas en terminos de validez y fi abilidad. Asimismo, es bien aceptado por estudiantes y tutores y puede ser usado tanto con fi nalidades formativas como sumativas. La importancia de dar un feedback adecuado y la concordancia de las puntuaciones de los tutores son los puntos mas criticos en la implementacion del mini-CEX en estudiantes de grado. EnglishIn recent years the use of work-based assessments has been increasingly recommended to evaluate clinical skills, as they allow for the evaluation of performance in the context of clinical practice. Among these tools, one of the most recommended is the Mini Clinical Evaluation Exercise (mini-CEX). This method was developed to be used in physicians-in-training and has good reliability and validity properties. Even when mini-CEX has also been used in medical students, a review of its value in undergraduates is lacking. This review is mainly based on a search of the articles indexed in Medline, Embase, Biosis Previews or Current Contents databases in September 2014. References were selected for articles which included the following terms: ‘mini clinical evaluation exercise’, ‘mini-CEX’ or ‘mcex’. Duplicates between databases were eliminated; as a result, a total of 168 articles were retrieved. Articles that dealt with the use of mini-CEX in medical students were reviewed (n = 34) and those that included empirical data were further analysed (n = 21). These studies confirm that this tool is useful and feasible to assess medical students and has adequate psychometric properties in different domains of validity and reliability. It is also well-accepted by students and tutors and may be used both in formative and summative evaluations. The present review shows that mini-CEX is also a good tool to assess clinical skills of medical students. The importance of giving adequate feedback and the alignment in the scores of tutors are the most critical points to be considered in the implementation of mini-CEX in undergraduate students.

EFFICACY AND SAFETY OF NITRENDIPINE IN THE OUTPATIENT TREATMENT OF MILD-TO-MODERATE HYPERTENSION

Abstract A study was undertaken to evaluate the safety and efficacy of nitrendipine in the outpatient treatment of patients with mild-to-moderate hypertension. Nine hundred primary care physicians throughout Spain participated in this study. The physicians enrolled a total of 3291 patients, of whom 90.6% had essential hypertension. The mean age of the patients was 61 ± 11 years. Patients were evaluated after 30 and 60 days of nitrendipine therapy. Blood pressure decreased from a mean of 172/101 mm Hg at the start of the study to 155/90 mm Hg at day 30 and 148/85 mm Hg at day 60. The most frequently used dose was 20 mg/d. Only 6% of patients reported adverse events, mainly caused by the vasodilating action of the drug. The results of this study globally agree with those of previously published studies and confirm the efficacy and safety of nitrendipine for the outpatient treatment of patients with mild-to-moderate hypertension.