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Objective. Evaluate the efficacy of acupuncture associated with physiotherapy for patients with painful shoulder. Methods. In a multicentre controlled randomized study, participants were recruited with a clinical diagnosis of unilateral subacromial syndrome from six rehabilitation medicine departments belonging to the Public Health System in two Spanish regions. All participants received 15 sessions of physiotherapy during the 3 weeks that the treatment lasted and were randomized to additionally receive, once a week, acupuncture or mock TENS (transcutaneous electrical nerve stimulation). The primary outcome measure was the change in the Constant–Murley Score (CMS) for functional assessment of the shoulder, at 4 weeks after randomization. This study is registered as an International Standard Randomized Controlled Trial, number ISRCTN28687220. Results. A total of 425 patients were recruited. The mean score (s.d.) on the CMS had increased by 16.6 (15.6) points among the acupuncture group, compared with 10.6 (13.5) points in the control group, and the mean difference between the two groups was statistically significant (6.0 points; 95% CI 3.2, 8.8 points; P < 0.001). By the end of the treatment, 53% of the patients in the acupuncture group had decreased their consumption of analgesics, compared with a corresponding 30% among the control group (P < 0.001). Conclusions. Single-point acupuncture in association with physiotherapy improves shoulder function and alleviates pain, compared with physiotherapy as the sole treatment. This improvement is accompanied by a reduction in the consumption of analgesic medicaments. [ABSTRACT FROM AUTHOR]

Background: Primary congenital glaucoma (PCG) is a rare disease. In around a third of Spanish patients, the disease is attributed to mutations in the CYP1B1 gene inherited in an autosomal recessive manner. Such mutations are the main known genetic cause of PCG., Case Report: We describe the case of a family with 3 of 7 siblings diagnosed with PCG. In a genetic study of the CYP1B1 gene, 2 null mutations were identified in the affected siblings (R355fsX69/T404fsX38). Two of the 4 healthy siblings were heterozygous for mutation R355fsX69 and the remaining 2 had no mutations. The healthy parents were found to be heterozygous for mutations T404fsX38 (mother) and R355fsX69 (father). High variation in the expression of PCG was observed, especially in terms of disease onset and severity: Patient 1 in the eldest affected sibling, PCG was diagnosed at 8 years of age and is presently stable after 60 months of medical treatment; patient 2 the second affected child underwent surgery at 7 days of age. Today, at 104 months, she has undergone 2 operations on the right eye and 3 on the left eye; patient 3 the youngest sibling, the disease also manifested at birth and the boy underwent surgery at 4 days. Currently he is 84 months old, he has required 7 operations for glaucoma, 3 in the right eye and 4 in the left., Conclusions: This clinical case reveals the etiological relationship between CYP1B1 mutations and PCG. In addition, it indicates a highly variable clinical picture associated with a single disease genotype mainly affecting disease onset and progression.

Background: This study assesses the lifetime and active prevalence of epilepsy in Spain in people older than 18 years., Methods: EPIBERIA is a population-based epidemiological study of epilepsy prevalence using data from three representative Spanish regions (health districts in Zaragoza, Almería, and Seville) between 2012 and 2013. The study consisted of two phases: screening and confirmation. Participants completed a previously validated questionnaire (EPIBERIA questionnaire) over the telephone., Results: A total of 1741 valid questionnaires were obtained, including 261 (14.99%) raising a suspicion of epilepsy. Of these suspected cases, 216 (82.75%) agreed to participate in phase 2. Of the phase 2 participants, 22 met the International League Against Epilepsy's diagnostic criteria for epilepsy. The estimated lifetime prevalence, adjusted by age and sex per 1,000 people, was 14.87 (95% CI: 9.8-21.9). Active prevalence was 5.79 (95% CI: 2.8-10.6). No significant age, sex, or regional differences in prevalence were detected., Conclusions: EPIBERIA provides the most accurate estimate of epilepsy prevalence in the Mediterranean region based on its original methodology and its adherence to ILAE recommendations. We highlight that the lifetime prevalence and inactive epilepsy prevalence figures observed here were compared to other epidemiological studies.

Background: The place of death is an important consideration in the end-of-life care of patients with chronic obstructive pulmonary disease (COPD)., Objective: This study aimed to describe the place of death for patients with COPD in Andalusia (Spain) and the determinants of death at home compared to death outside of home., Design: This observational study analyzed place of death from death certificates for the years 2010 and 2011 in Andalusia, Spain (over 8 million inhabitants, 17.8% of the Spanish population)., Measurements: Death certificates obtained from the Institute of Statistics and Cartography of Andalusia were used to describe where patients with COPD died. All deaths with ICD-10 codes J40 to J44 or J47 (International Classification of Diseases, Tenth Revision) were included for the years 2010 and 2011. Upon review of the death certificates, the following data were recorded: age, sex, marital status, rural areas, and place of death., Results: Out of a total of 119,589 decedents, the research team retrieved the place of death for 4983 subjects. The chance of dying at home was higher for COPD patients aged ≥ 89 years and for females. Married and widowed persons had a greater likelihood of dying at home than singles. Moreover, the likelihood of death at home was higher for individuals residing in rural areas., Conclusions: Age, sex, marital status, and rural areas of residence determine where COPD patients will end their life in Andalusia. Knowledge about place of death and its determinants will facilitate the planning of health care palliative services.

Background: The World Health Organization reported in 2007 that inclusion of PCV7 in national immunization programs should be seen as a priority, also encouraging countries to conduct appropriate surveillances for monitoring the impact of vaccination. These analyses should be conducted in specific geographical areas and should be aimed to evolution of invasive pneumococcal disease (IPD), by age groups, clinical presentation, and vaccine serotypes (and non-vaccine serotypes to detect possible replacement). This study aimed to monitor the evolution of IPD incidence in children <15 years requiring hospitalization in the Island of Majorca., Methods: A prospective clinical surveillance of all culture and/or PCR-confirmed IPD in children <15 years was performed in all hospitals in the Island of Majorca (approximately 900,000 inhabitants) from January 2008 to December 2010. Incidence rate (IR) was calculated as cases/100,000 inhabitants using children population data., Results: 66 IPDs were identified: 39 (59.1%) parapneumonic pneumococcal empyema (PPE), 16 (24.2%) bacteremic pneumonia (BP), 7 (10.6%) primary bacteremia, 3 (4.5%) meningitis, and 1 (1.5%) osteomyelitis. IRs in the three-year study period were: 64.22 for children 12- < 24 months, 37.21 for those 24-59 months, 22.62 for those <12 months, and 3.98 for children >59 months. By study year, IRs were 21.25 in 2008, 19.89 in 2009 and 9.80 in 2010. The reduction found in 2010 was significant and due to significant reductions in IRs of IPDs caused by serotypes included in PCV10 and PCV13. Overall, estimated serotype coverage by conjugate vaccines was 12.1% for PCV7, 37.9% for PCV10 and 65.2% for PCV13. Of the 66 hospitalized children with IPD, 20 had received at least one dose of PCV7 (13 cases with identified serotype). None of these 13 cases was caused by PCV7 serotypes, all were caused by PCV13 serotypes and only 53.8% by PCV10 serotypes., Conclusions: The results of the present study evidence the importance of expanding the number of serotypes covered by PCV, and the added value of PCV13 with respect to PCV10 and PCV7, even in an area of low prevalence of 19A as the Island of Majorca.

Objectives: The aim of the study was to analyse the evolution of antibiotic non-susceptibility in Spanish invasive Streptococcus pneumoniae after licensure of respiratory-quinolones for adults and 7-valent pneumococcal conjugate vaccine (PCV-7) for immunization of children., Methods: All invasive pneumococci received in the Reference Laboratory (January 2000-August 2007; n = 12 957 isolates) were serotyped, and susceptibility to penicillin/erythromycin/levofloxacin was determined. Antibiotic consumption and PCV-7 doses/year were provided by IMS and the manufacturer, respectively., Results: In 2000-07, PCV-7 distribution (doses/1000 inhabitants

All patients < or =14 years old with a diagnosis of pneumococcal meningitis (n = 160) were included (2001, 2004-2006). Incidence per 100,000 child <5 years old varied from 6.14 in 2001 to 2.83 in 2006 (54% of reduction, P < 0.01). There was a significant correlation (R2 = 0.9506) with PCV7 distribution increase. No significant changes in the incidence by nonvaccine serotypes were found when comparing 2001 and 2006. The case fatality rate was 7.5%.