martes, 11 de enero de 2011

60 First Graders, 4 Teachers, One Loud New Way to Learn

60 First Graders, 4 Teachers, One Loud New Way to Learn


Michael Nagle for The New York Times
The New American Academy features large classes with several teachers each. More Photos »



Sixty children in a first-grade class can get loud — sometimes too loud for a teacher to explain a lesson.
Michael Nagle for The New York Times
Andrea Nolet is a teacher at the New American Academy. More Photos »


So while waiting for her teacher to come by, one little girl arranged the pennies she had been given to practice subtraction into a smiley face. Another shook her pennies in a plastic bag. A high-pitched argument broke out over someone’s missing quarter.
“We don’t know what we are supposed to be doing, but we are learning about math,” Thea Burnett, 6, said.
Across the room, a second teacher, Jennifer McSorley, successfully led the class’s weakest students in a counting rhyme. But when she leaned forward out of her chair to write a word on an easel, a 6-year-old boy moved it, and she fell when she tried to sit back down.
“Jahmeer, sit down,” Ms. McSorley demanded, unharmed but flustered. “I could have hurt myself very badly.” Then another boy ran off to hide under an easel. Someone grabbed someone else’s pennies. The noise snowballed.
All this was the early stages of an audacious public education experiment taking place in Crown Heights, Brooklyn, one that its founder hopes will revolutionize both how students learn and how teachers are trained. Instead of assigning one teacher to roughly 25 children, the New American Academy began the school year with four teachers in large, open classrooms of 60 students. The school stresses student independence over teacher-led lessons, scientific inquiry over rote memorization and freedom and self-expression over strict structure and discipline. The founder, Shimon Waronker, developed the idea with several other graduate students at Harvard. It draws its inspiration, he said, from Phillips Exeter Academy, an elite boarding high school in New Hampshire where students in small classes work collaboratively and hold discussions around tables.
But Mr. Waronker decided to try out the model in one of the nation’s toughest learning environments, a high poverty elementary school in which 20 percent of the children have been found to have emotional, physical or learning disabilities. The idea, he said, was to prove that his method could help any child, and should be widely used elsewhere. “I didn’t want to create an environment that wasn’t real for everyone else and then say, look at my success,” he said.
The challenges have been considerable. Faced with out-of-control classroom situations, Mr. Waronker, 42, had to rethink his idea that his model could work for even the most disturbed children. By January, three children who were violent had been moved to more-structured environments; seven other first graders moved away or withdrew, reducing the class size to 50.
The school was founded with the strong backing of Joel I. Klein, the former schools chancellor, who frequently lauded Mr. Waronker for his efforts as the principal of a tough middle school in the South Bronx. They found a space in an elementary school three blocks from Mr. Waronker’s home in Crown Heights, and in a special deal with the teachers’ union, he won the right to pay teachers on a scale that considered performance.
While the model flies against efforts to keep class sizes low, Mr. Waronker notes that the teacher-student ratio is lower than in most schools. At its heart is the idea that the teachers, not to mention the students, will collaborate and learn from one another, rather than being isolated in separate classrooms. He hired one $120,000-per-year master teacher per class. Most of the others are novice early childhood teachers, which recreates the staff composition in typical high-poverty schools.
New American Academy opened with 126 kindergartners and first graders and at least eight adults per classroom, including intern principals and paraprofessionals assigned to disabled children. It will expand by one grade per year until it reaches the fifth grade, and the teachers will stay with the same children every year, to build accountability for their learning. There is no assistant principal, dean or art teacher, saving money for classroom salaries.
Lessons are a series of complex choreographies. In the 2,000-square-foot kindergarten, for example, each child is assigned a “university”— a grouping by skill level — and another group by color: blue, red or green. Every 40 minutes or so, the children regroup in a different part of the room. During a visit in November, an observer noticed that each move led to the children’s standing up, running, talking, and then having to quiet down again.

“This is the hardest moment of the day,” said Lorraine Scorsone, the master teacher in the kindergarten, as eight adults tried to wrangle the children into a semicircle for group reading time. “In early childhood, disengaging is very difficult, and moving to another activity is very difficult.”




Ms. Scorsone, with 23 years of experience, had what appeared to be a magical touch, and the children listened raptly one day in November as she explained how a banana travels from foreign lands to local stores. But the other teachers, who do the bulk of the teaching, had more trouble gaining the attention of the children, who lay on carpets looking at the ceiling or fiddled with belts and shoelaces on the outskirts of lessons.
“Ewww,” squealed a boy named Ethan when he was told that the class would plant a banana tree later that day. Other children began mimicking the sound, which they had been making earlier. “Ethan, stop it,” said his teacher, Pepe Gutierrez. “I don’t know why you are screaming.”
The first grade was tougher, with less-experienced teachers and more children who were violent. In the first two months of school, a student pulled a chunk of an adult’s hair out, and an ambulance crew was called twice to calm a child. Eight weeks into the year, the only student work visible on the blue-painted walls was a poster with finger-painted hand prints and the words “Hands Are Not for Hitting.”
“Many of the children have already had a year in what I would call a state of nature, when Rousseau spoke about people who live under no civilization,” Mr. Waronker said, referring to the children’s experience in a regular public school kindergarten. Fifteen children still could not recognize letters, and only one-third were at grade level. “This is messy work — this is the front lines.”
In the front of the room, Kathleen Kearns, a first-year teacher, strained to get her 20 students to understand how to use a chart to classify similarities and differences between two characters in a book. About half a dozen students refused to sit in their places.
“I need you here; your job is here,” she said to one, trying to be heard. After class, she said, “I am exhausted at the end of the day.”
It is the same struggle that first-year teachers across the city face, but the difference, Mr. Waronker said, is that in his school, it is out in the open. Other teachers can offer advice and pitch in, and they have 90 minutes of joint planning time each morning. The intensive collaboration, he believes, is what will cause his model, while admittedly still in a “trial-and-error” phase, to ultimately surpass others.
Indeed, by this month, there were significant improvements. Children appeared more focused during lessons. Jahmeer decided to play with pencils rather than do his counting work sheet, but he stayed in his seat, and another child asked if he needed help. One boy started crying, but not because someone pushed him; he wanted to have a turn writing his answer on the board.
“It’s tough on them, it’s tough on all of us,” Keema Flourney, the first-grade master teacher, said of her teachers, “but they are pulling through.”
Next year, Mr. Waronker said, he will hire more-experienced teachers, because expecting that novices could learn quickly enough from the master teachers was wrong. “I put added stressors that shouldn’t have been there,” he said.
Most of the teachers said they felt the school’s model would show good results over time. Several parents praised the school’s inclusiveness and its effort to offer something different. But one father, who withdrew his daughter, said the school was not for her because of her behavior problems.
The first-year teacher who had been leading the penny lesson in November for Thea and 19 other children, Daniella Schonbuch, while the master teacher was away, said she calmed herself after tough days by remembering that she would have years to build progress with her students. By January, she was leading a regular morning French lesson.
“It’s small moments, it really is,” said Ms. McSorley, the first-grade teacher whose chair had been pulled out from under her. “We are still in the process of figuring out what works for the kids, and what works today does not always work tomorrow.”

El pretratamiento con atorvastatina disminuye los niveles de marcadores tempranos de isquemia miocárdica después de cirugía coronaria. Estudio observacional

El pretratamiento con atorvastatina disminuye los niveles de marcadores tempranos de isquemia miocárdica después de cirugía coronaria. Estudio observacional
Atorvastatin pretreatment diminishes the levels of myocardial ischemia markers early after CABG operation: an observational study.
Ege E, Dereli Y, Kurban S, Sarigül A.
Selçuk University, Meram Medical School, Department of Cardiovascular Surgery, Konya, Turkey.
J Cardiothorac Surg. 2010 Aug 13;5:60.
 

Abstract
BACKGROUND: Statin pretreatment has been associated with a decrease in myocardial ischemia markers after various procedures and cardiovascular events. This study examined the potential beneficial effects of preoperative atorvastatin treatment among patients undergoing on-pump CABG operation. METHODS: Twenty patients that had received atorvastatin treatment for at least 15 days prior to the operation and 20 patients who had not received any antihyperlipidemic agent prior to surgery were included in this study. CK-MB and troponin I levels were measured at baseline and 24 hours after the operation. Perioperative variables were also recorded. RESULTS: Twenty-four hours after the operation, troponin I and CK-MB levels were significantly lower in the atorvastatin group: for CK-MB levels, 12.9 +/- 4.3 versus 18.7 +/- 7.4 ng/ml, p = 0.004; for troponin I levels, 1.7 +/- 0.3 versus 2.7 +/- 0.7 ng/ml, p < 0.001. In addition, atorvastatin use was associated with a decrease in the duration of ICU stay. CONCLUSIONS: Preoperative atorvastatin treatment results in significant reductions in the levels of myocardial injury markers early after on-pump CABG operation, suggesting a reduction in perioperative ischemia in this group of patients. Further studies are needed to elucidate the mechanisms of these potential benefits of statin pretreatment

 
Impacto de la terapia preoperatoria con estatinas sobre la evolución postoperatoria adversa en pacientes con cirugía vascular
Impact of Preoperative Statin Therapy on Adverse Postoperative Outcomes in Patients Undergoing Vascular Surgery
Le Manach, Yannick M.D; Ibanez Esteves, Cristina M.D.; Bertrand, Michelle M.D.; Goarin, Jean Pierre M.D.; Fléron, Marie-Hélène M.D.; Coriat, Pierre M.D.; Koskas, Fabien M.D., Ph.D.; Riou, Bruno M.D., Ph.D.; Landais, Paul M.D., Ph.D.
Anesthesiology January 2011,14 - Issue 1 - pp 98-104. doi:10.1097/ALN.0b013e31820254a6

Abstract
Background: Chronic statin therapy is associated with reduced postoperative mortality. Renal and cardiovascular benefits have been described, but the effect of chronic statin therapy on postoperative adverse events has not yet been explored. Methods: In this observational study involving 1,674 patients undergoing aortic reconstruction, we prospectively assessed chronic statin therapy compared with no statin therapy, with regard to serious outcomes, by propensity score and multivariable methods. Results: In propensity-adjusted multivariable logistic regression (c-index: 0.83), statins were associated with an almost threefold reduction in the risk of death in patients undergoing major vascular surgery (odds ratio: 0.40; 95% CI: 0.28-0.59) and an almost twofold reduction in the risk of postoperative myocardial infarction (odds ratio: 0.52; 95% CI: 0.38-0.71). Likewise, the use of chronic statin therapy was associated with a reduced risk of postoperative stroke and renal failure. Statins did not significantly reduce the risk of pneumonia, multiple organ dysfunction syndrome, and surgical complications; however, in the case of postoperative multiple organ dysfunction syndrome (odds ratio: 0.34; 95% CI: 0.12-0.94) and surgical complications (odds ratio: 0.39; 95% CI: 0.17-0.86), reduced mortality was observed. Conclusions: Chronic statin therapy was associated with a reduction in all cardiac and vascular outcomes after major vascular surgery. Furthermore, in major adverse events, such as multiple organ dysfunction syndrome and surgical complications, statins were also associated with decreased mortality.
Enlace para leer el artículo completo;


Impacto de la terapia preoperatoria con estatinas sobre la evoluión postoperatoria de pacientes con cirugía cardiaca: meta análisis de más de 30,000 pacientes
Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients.
Liakopoulos OJ, Choi YH, Haldenwang PL, Strauch J, Wittwer T, Dörge H, Stamm C, Wassmer G, Wahlers T.
Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany.
Eur Heart J. 2008 Jun;29(12):1548-59. Epub 2008 May 27
 
Abstract
AIMS: To determine the strength of evidence for preoperative statin use for prevention of adverse postoperative outcomes in patients undergoing cardiac surgery. METHODS AND RESULTS: After literature search in major databases, 19 studies were identified [three RCT (randomized prospective clinical trials), 16 observational] that reported outcomes of 31 725 cardiac surgery patients with (n = 17 201; 54%) or without (n = 14 524; 46%) preoperative statin therapy. Outcomes that were analysed included early all-cause mortality (30-day mortality), myocardial infarction (MI), atrial fibrillation (AF), stroke and renal failure. Odds ratio (OR) with 95% confidence intervals (95%CI) were reported using fixed or random effect models and publication bias was assessed. Preoperative statin therapy resulted in a 1.5% absolute risk reduction (2.2 vs. 3.7%; P < 0.0001) and 43% odds reduction for early all-cause mortality (OR 0.57; 95%CI: 0.49-0.67). A significant reduction (P < 0.01) in statin pretreated patients was also observed for AF (24.9 vs. 29.3%; OR 0.67, 95%CI: 0.51-0.88), stroke (2.1 vs. 2.9%, OR 0.74, 95%CI: 0.60-0.91), but not for MI (OR 1.11; 95%CI: 0.93-1.33) or renal failure (OR 0.78, 95%CI: 0.46-1.31). Funnel plot and Egger's regression analysis (P = 0.60) excluded relevant publication bias. CONCLUSION: Our meta-analysis provides evidence that preoperative statin therapy exerts substantial clinical benefit on early postoperative adverse outcomes in cardiac surgery patients, but underscores the need for RCT trials.
Enlace para leer el artículo completo:
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor

Arboles de navidad en la basura...

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Devastating Australian Floodwaters Reach City of Brisbane

Devastating Australian Floodwaters Reach City of Brisbane

Eddie Safarik/Agence France-Presse — Getty Images
Alan Attard, front left, helped transfer his parents’ possessions to higher ground from their flooded home in Ipswich, Australia.
SYDNEY, Australia — Muddy floodwaters began swamping thousands of homes and businesses in Brisbane, Australia’s third-largest city, and nearby townships on Wednesday as residents braced for further inundations in what has become one of Australia’s most devastating natural disasters.
At least 12 people have been killed this week, bringing to 22 the death toll from tropical flooding that has plagued the northeastern state of Queensland since November. Five children were among the latest casualties, caught up in a freak flood that late Monday tore through the highland city of Toowoomba, just 80 miles west of Brisbane, and other parts of the Lockyer Valley.
The so-called inland tsunami has been rushing toward Brisbane, a city of 2 million people, and other heavily populated coastal areas, gathering momentum in converging with the major Brisbane and Bremer Rivers. After weeks of torrential rain, officials say the region’s soil has lost its ability to absorb more water; worsening the situation, the region’s reservoirs are beginning to overflow.
Emergency management officials have predicted that up to 20,000 homes and businesses could be entirely or partially flooded in Brisbane, Queensland’s coastal capital, by the time the Brisbane River reaches its expected peak of around 20 feet above normal in the early hours of Thursday.
Officials expect that around 6,500 Brisbane homes could be completely underwater, along with some 2,100 streets. before the river begins to subside, possibly on Saturday, the city’s mayor, Campbell Newman said Wednesday.
Thousands of residents began fleeing on Tuesday, gathering whatever belongings they could carry in trailers, trucks and cars. Shoppers emptied the shelves of several supermarkets, and vehicles jammed the city’s streets late Tuesday as emergency officials urged residents not to wait until the last minute to find higher ground.
Emergency evacuation centers have been set up to accommodate nearly 10,000 people at community centers, showgrounds and stadiums in both Brisbane and in Ipswich, along the Bremer River to the west.
Aerial footage taken around midday Wednesday showed the slow-moving brown tide engulfing entire blocks of riverside Brisbane neighborhoods. Murky water lapped at the rooftops of businesses along the main street of Ipswich, where some 3,000 homes and businesses were reportedly already underwater, according to television reports.
Meanwhile, search and rescue crews began entering areas of the devastated Lockyer Valley that had been cut off by the raging torrent since late Monday. The police have repeatedly revised the number of those unaccounted for in the chaos of the past two days; on Wednesday, they put it at 60.
The Queensland State premier, Anna Bligh, said the death toll was likely to rise as emergency crews began reaching isolated communities and sifting through the debris.
“I think it’s going to be a tough and emotional day in the Lockyer Valley, as the search and rescue teams get in there for the first time,” Ms. Bligh told the Australian Broadcasting Corporation. “Families who are still holding out hope, some of them are likely to have their hopes tragically crushed.”
After enduring a decade of one of the worst droughts in Australian history, Queensland residents are now facing billions of dollars in flood damage. One member of Australia’s Reserve Bank warned Wednesday that the disaster in Queensland could shave up to 1 percent off Australia’s gross domestic product.
The floods have virtually paralyzed the state’s lucrative coal and agricultural industries. Queensland produces roughly one-third of the world’s supply of coking coal, used in the production of steel. Industry analysts say global prices of coking coal and thermal coal, used to supply power plants, are sure to rise because of the flooding in Queensland.

"El 80% de los ciudadanos con hipercolesterolemia familiar están sin diagnosticar"

Pedro Mata, presidente de la Fundación de Hipercolesterolemia Familiar"El 80% de los ciudadanos con hipercolesterolemia familiar están sin diagnosticar"

Twittéalo
Los niveles de colesterol pueden ser elevados desde la infancia si se padece una enfermedad denominada hipercolesterolemia familiar. Las personas que la sufren y no se tratan tienen una esperanza de vida entre 20 y 30 años menor que la población general. Un dato escalofriante es que, en España, hasta el 80% de los afectados están sin diagnosticar y, por lo tanto, sin tratarse. Ante esta situación, se trabaja para impulsar un Plan Nacional para su detección precoz, según explica Pedro Mata, presidente de la Fundación de Hipercolesterolemia Familiar (FHF) y médico internista de la Fundación Jiménez Díaz, de Madrid.
  • Por CLARA BASSI
  • 4 de enero de 2011
¿Qué es la hipercolesterolemia familiar?
Es un trastorno genético que provoca elevadas concentraciones de colesterol. Se manifiesta desde la infancia y quien lo sufre puede transmitirlo a la mitad de su descendencia. Por este motivo, se considera que afecta a la mitad de los miembros de una familia, tanto mujeres como hombres.
¿Se manejan datos sobre el grado de afección en la población española?
Afecta a 1 de cada 400 personas, por lo que en España habría 100.000 personas afectadas.
¿Esta cifra se mantiene estable o ha variado en el tiempo?
"Como ocurre con otras enfermedades hereditarias, la hipercolesterolemia familiar pasa desapercibida y puede afectar a cualquier estrato de la población"
Se mantiene estable, aunque puede haber áreas de determinadas zonas geográficas del mundo con cifras mayores, al estar más aisladas y haberse registrado una mayor más consanguinidad (muchos primos segundos casados entre sí). En estos casos, puede ser más frecuente.
¿Desde qué momento de la infancia se manifiesta?
Desde el nacimiento, cuando las cifras de colesterol pueden ser el doble que en la población general. Sus manifestaciones más graves ocurren antes de la edad adulta y desarrollan enfermedad cardiovascular o coronaria a edades más jóvenes. Por este motivo, si no se diagnostica ni se trata, estas personas tienen una esperanza de vida 20 o 30 años inferior a la de la población general. Pueden sufrir un infarto agudo de miocardio (IAM) a los 40 o 50 años.
Es decir, mucho antes que los ciudadanos en general.
"Los adolescentes afectados tienen un mayor engrosamiento de las paredes arteriales, que favorece la formación de placas"
Sí. Además, como ocurre con otras enfermedades hereditarias, la hipercolesterolemia familiar pasa desapercibida y puede afectar a cualquier estrato de la población. De ahí la importancia del diagnóstico precoz, de modificar los hábitos de vida y de un tratamiento que reduzca las cifras de colesterol con fármacos, como las estatinas. De esta forma, los pacientes pueden llevar una vida normal y tienen la misma esperanza de vida que el resto de la población.
¿Hay muchas familias que desconocen su afección?
Así es, pero no solo en España, sino en otros muchos países. Se calcula que solo están diagnosticados entre el 20% y el 25% de los casos, que significa que casi el 80% de los individuos afectados lo desconoce. El problema es que sin diagnóstico ni tratamiento tiene importantes consecuencias a largo plazo.
¿Es difícil la detección de este trastorno?
"Al ser una enfermedad hereditaria, las arterias están expuestas desde la infancia al colesterol"
La detección es fácil, no ya de niño, sino de adulto, cuando las cifras de colesterol superan los 290-300 mg/dl de colesterol total y se tienen antecedentes con familiares de primer grado en la misma situación (un padre, una madre, un hermano o un hijo). Como la transmisión de la enfermedad es vertical, en estos casos todo apunta a que una persona padece hipercolesterolemia familiar, más si en la familia ha habido algún miembro que haya sufrido un IAM u otra enfermedad coronaria en la cuarta o quinta década de la vida. Por lo tanto, es fácil sospecharlo, el diagnóstico de certeza se confirmaría con un test genético.
Si el diagnóstico es fácil, sorprende que el 80% de los afectados desconozca su estado.
Un porcentaje importante se realiza análisis de sangre de manera sistemática, cuyos resultados muestran cifras de colesterol alto. En ocasiones, a estas personas se les prescribe un fármaco para reducirlo, pero no se les informa de que padecen hipercolesterolemia familiar. En estos casos, se registra un fallo de continuidad porque, cuando el fármaco hace su efecto, lo dejan, pese a que deberían tomarlo toda la vida. Además, se les debería realizar un estudio y seguimiento familiar para detectar este trastorno crónico, así como un test genético.
Y este desconocimiento implica consecuencias negativas.
"Algunos afectados precisan de LDL-aféresis para evitar un infarto agudo de miocardio antes de los 15 años"
Al ser un trastorno hereditario, los afectados pueden adoptar hábitos de vida saludables lo antes posible, tener una mejor adherencia al tratamiento. Como su riesgo cardiovascular está aumentado, pueden estar más atentos a las señales de alteraciones en las arterias que han estado expuestas desde la infancia a cifras de colesterol altas, que las obstruye de forma progresiva y provoca episodios coronarios. Además, el diagnóstico también sirve para hacer una determinación genética, ya que si una pareja decide tener hijos puede transmitir el trastorno a la mitad de su descendencia y otro 25% de los hijos podrían tener cifras de 1.000 mg/dl de colesterol al nacer, una situación tan seria que necesitan, junto con el tratamiento farmacológico, LDL-aféresis.
¿En qué consiste la LDL-aféresis?
Se asemeja a una diálisis renal, pero se realiza dos veces al mes. Se pasa la sangre del paciente a través de unos filtros donde se queda depositado el colesterol y se le devuelve "limpia". Sin esta técnica, estos niños podrían sufrir un infarto antes de los 15 años. Afortunadamente, sucede en pocos casos. Pero, por este motivo, es muy importante el consejo genético.
¿Cuál es la diferencia entre una tasa alta de colesterol e hipercolesterolemia familiar?
"Cuando la enfermedad está diagnosticada, se trata con fármacos y se adopta un estilo de vida apropiado, el riesgo cardiovascular se normaliza"
Al ser una enfermedad hereditaria, las arterias están expuestas desde la infancia, durante más años, al colesterol. Los adolescentes con hipercolesterolemia familiar también padecen un mayor engrosamiento de las paredes arteriales, que favorece la formación de placas. Esto no sucede en la población que tiene elcolesterol elevado por otras causas, que es muy frecuente (cerca del 18% de los adultos), por encima de los 250 mg/dl. En estos casos, aunque también puede haber cierta susceptibilidad familiar, se debe a hábitos dietéticos inadecuados -dieta con alto contenido calórico y grasa-, sobrepeso y falta de ejercicio físico.
¿En qué consiste el plan que quieren impulsar para mejorar la detección de la hipercolesterolemia familiar?
En identificar más casos, a partir de una persona que acude a la consulta y tiene el colesterol igual o superior a 300 mg/dl. Es importante preguntar siempre sobre los datos de otros familiares y realizar una detección genética en la consulta. Si el análisis del gen es positivo, se sigue la localización en cascada a los familiares de primer grado. Es una detección selectiva, a partir de un caso índice, no a la población general. La clave no es identificar a una sola persona, sino al resto de afectados de una familia.
¿Hay otras formas de hipercolesterolemia?
Las hay y, aunque el plan se refiere a la hipercolesterolemia familiar porque están bien identificadas las mutaciones que la provocan y podemos diagnosticarla con el test genético, también destaca la hiperlipidemiafamiliar combinada. Ésta, en general, afecta a la mitad de los miembros de la familia que tienen elevada la tasa de colesterol y de triglicéridos, otro tipo de grasa. Afecta a casi un 2% de la población, por lo que en España se estima que hay unas 700.000 personas afectadas. En este caso, todavía no disponemos de la caracterización molecular necesaria para aplicar un test genético y detectarla.
¿Qué mensaje final destacaría sobre esta enfermedad?
"El Plan Nacional no solo va a permitir salvar la vida de personas en edades jóvenes, sino un ahorro importante en costes del sistema de salud"
La población debe saber que los afectados sufren infartos precoces y tienen una esperanza de vida menor. Sin embargo, una vez que se diagnostica y se trata de manera adecuada, si se evita el tabaco y se adoptan unos hábitos de vida apropiados, estas personas están controladas por completo, no tienen un riesgo cardiovascular aumentado y su esperanza de vida se iguala a la de la población general. Éste es un mensaje importante, puesto que es una enfermedad hereditaria, pero se controla muy bien con un diagnóstico precoz.

PLAN PARA MEJORAR LA DETECCIÓN

El Plan Nacional para mejorar la detección de la hipercolesterolemia familiar es un deseo en ciernes de los expertos en esta enfermedad, que se ha impulsado en nueve comunidades autónomas: Cataluña, Navarra, La Rioja, Aragón, País Vasco, Asturias, Castilla y León, Extremadura y Madrid. Se prevé que se extienda al resto, ya que hay familias de afectados amplias, cuyos miembros viven en distintas autonomías, por lo que no sería lógico que solo unas se beneficiaran del plan, informa Pedro Mata.
Una singularidad, en el caso de Castilla y León, es que por primera vez el médico de atención primaria puede solicitar el test genético, lo que constituye una revolución en medicina, porque antes solo se podía solicitar desde la atención hospitalaria. Puesto que los afectados son personas sanas, pocas veces acuden al médico y, por ello, es más fácil de detectar desde la atención primaria, según Mata.
El test genético, que se aplica en los casos de sospecha, se realiza en saliva. Sus resultados están listos en un máximo de dos semanas, un periodo de tiempo que se considera muy rápido para detectar un problema genético. El test se efectúa a partir de un biochip donde figuran las 300 mutaciones genéticas más frecuentes que se han detectado en España de esta enfermedad y con las que está representada casi toda la población. En ocasiones, se da el caso de familias con una mutación no identificada y que no se haya introducido en el biochip. Entonces, se secuenciaría el gen completo, lo que tardaría más tiempo.
En cuanto a la consecución de un plan nacional que incluya la realización de este test para la detección precoz de la hipercolesterolemia familiar, Mata destaca que "es muy coste-eficaz (es muy eficaz y cuesta poco) y una de las investigaciones en salud más rentables, porque no solo va a permitir salvar la vida de personas en edades jóvenes, sino un ahorro importante en costes del sistema de salud", desde la atención al infarto o unaenfermedad coronaria a los fármacos que necesitan los enfermos, los ingresos hospitalarios, la revascularización coronaria y la colocación de stents en las arterias, "todo con unos costes altísimos". Se estima que este programa generará un ahorro personal, social y sanitario y, por lo tanto, concluye Mata, "merece la pena".