Abstract: The precast decorative elements found in Built Heritage have a great aesthetic importance, especially in the late nineteenth and early twentieth centuries. At the moment, many of these buildings are in need of a full rehabilitation intervention, as well as its decorative elements. As part of the recovery and enhancement project of the Punta Begoña galleries (Getxo, Spain), outcome of the collaboration between Getxo City Council and the University of the Basque Country UPV / EHU, new methodologies are being developed, based on existing molding systems, to improve restoration interventions carried out in this area, and thus ease the work and provide the maximum respect to the conserved original elements. Currently, work is being executed with three variations of the laminated elastic molds, which allows them to be applied without direct contact with the artistic element and reintegrating missing parts of original fragments inside the mold.

Resumen: Los elementos decorativos prefabricados en Patrimonio Construido tienen una gran importancia estética, sobre todo en las edificaciones de finales del s. XIX y principios del s. XX. Actualmente, muchos de estos edificios requieren de una intervención de rehabilitación integral, así como también sus elementos decorativos. Es el caso del proyecto de recuperación y puesta en valor de las galerías Punta Begoña (Getxo, España), fruto de la colaboración de Ayuntamiento de Getxo y la Universidad del País Vasco UPV/EHU, se están desarrollando nuevas metodologías, a partir de los sistemas de moldeo existentes, para mejorar las intervenciones de restauración que se realizan en este campo, así facilitar el citado trabajo y con ello permitir el respeto al máximo de los elementos originales conservados. Actualmente se están efectuando trabajos con tres variaciones sobre los moldes elásticos laminados, lo que permite realizarlos sin contacto directo con la obra e intentando reintegrar fragmentos originales en su interior.

Abstract: Krabbe disease is a type of autosomal recessive lysosomal leukodystrophy caused by deficiency of the enzyme galactosylceramidase. The results of the neuropsychological evaluation in a three-year-old boy with apperceptive visual agnosia and prosopagnosia are presented.

Resumen: La enfermedad de Krabbe es un tipo de leucodistrofia lisosomal autosómica recesiva provocada por la deficiencia de la enzima galactosilceramidasa. Se presentan los resultados de la evaluación neuropsicológica en un niño de tres años, que presenta agnosia visual aperceptiva y prosopagnosia.

ABSTRACT The saturated hydraulic conductivity (Ks) determines the movement of subsurface water in the soil under conditions of saturation, is important in the relation water - soil - plant, and also to reveal the alterations in the ecosystems product of change of coverage. We evaluated the incidence of the vegetation in the Ks for the coverage of forest-natural (BN) dominated by “Weinmannia tomentosa” L. f., plantations of “Hesperocyparis lusitanica” and “Eucalyptus globulus”, of the basin of the river San Cristóbal (Bogotá-Colombia). Quantified variables density and coverage of vegetation of trees and understory, in addition to soil physical characteristics. The coverages presented different infiltration rates (mm/h): 4,21 to 0,89; 8,06 1,50 and 1,84 to 0,72 respectively. There are no significant differences in the trees in the Ks, but if the understory

RESUMEN La conductividad hidráulica saturada (Ks) determina el movimiento subsuperficial del agua en el suelo en condiciones de saturación, resulta importante en la relación agua - suelo - planta, además permite evidenciar las alteraciones en los ecosistemas producto de cambio de coberturas. Se evaluó la incidencia de la vegetación en la Ks para las coberturas de bosque-natural (BN) dominado por “Weinmannia tomentosa” L.f., plantaciones de “Hesperocyparis lusitánica” y “Eucalyptus globulus”, de la cuenca del río San Cristóbal (Bogotá-Colombia). Se cuantificaron las variables densidad y cobertura de la vegetación arbórea y sotobosque, además de características físicas del suelo. Las coberturas presentaron diferentes tasas de infiltración (mm/h): 4,21 a 0,89; 8,06 a 1,50 y 1,84 a 0,72 respectivamente. No hay diferencias significativas de la vegetación arbórea que incida en la Ks, pero si el sotobosque.

Resumen Los alumnos de ciencias, tecnología e ingeniería, en el ámbito del Espacio Europeo de Educación Superior, suelen abordar sus asignaturas como parcelas de conocimiento debido a la propia construcción de los planes docentes y la estructura interdepartamental de las universidades. es decir, sin que se profundice en la interrelación entre esas parcelas y la futura realidad laboral que el estudiante tendrá que vivir. Durante esta investigación se diseñó un juego de mesa, desde el marco de referencia de educación STEAM, con la finalidad de establecer dinámicas propias de las actividades lúdicas para generar un entorno de aprendizaje ludificado. Mediante un proceso de investigación planificado, organizado, dirigido y sistemático se valoró el efecto que tiene la utilización del juego de mesa sobre las calificaciones académicas del alumnado de ingeniería, partiendo de la hipótesis de que la utilización de este juego permite adquirir no solo conocimientos, sino también la capacidad de integrar los conocimientos de las asignaturas directamente vinculadas al entorno STEAM. El análisis de los resultados verificó la hipótesis de partida de esta investigación, confirmando el efecto positivo que tiene el uso de elementos de ludificación en entornos STEAM.

Abstract Science, technology and engineering students, within the scope of the European Higher Education Area, often approach their subjects as chunks of knowledge due to the very construction of the teaching plans and the interdepartmental structure of the universities, that is, without deepening the interrelationship between these chunks and the future working reality that the student will have to live. During this research, a board game was designed, within the framework of STEAM education, in order to establish the dynamics of playful activities to generate a gamified learning environment. Through a planned, organized, directed and systematic research process, the effect of the use of the board game on the academic grades of engineering students was assessed, based on the hypothesis that the use of this game allows the acquisition not only of knowledge, but also of the ability to integrate the knowledge of subjects directly linked to the STEAM environment. The analysis of the results verified the initial hypothesis of this research, confirming the positive effect that the use of gamified elements has in STEAM environments.

Abstract Among the distinctions in the field of collective memory studies, there is one that refers to the source of the memories, and is growing in force and importance: that is, the distinction between communicative and cultural memories. Another important distinction refers to the type of memories that constitute collective memories, and is the one between Lived Semantic Collective Memory and Distant Semantic Collective Memory. Another two important factors are the ideology of the rememberer and how was the rememberer affected by the crisis. The present study aims to investigate how the last three factors (type of memory, being affected or not, and ideology) influenced the content of collective recall of the 2001 crisis, considering themes/main ideas as dependent variables. As national memories allow us to study collective memory, the present study is focused on the memories Argentinians have of the economic, political and social crisis of 2001. This is considered the most profound economic and financial crisis in Argentina´s recent history. After years of economic recession, the crisis was triggered by an economic measure called “corralito,” which almost completely froze bank accounts and thereby prevented people from withdrawing their money. Demonstrations and protests followed, which contributed to the resignation of President Fernando de la Rúa after he declared a state of siege. Police action resulted in more than 30 deaths. Institutional and political chaos and a succession of five Presidents in one week followed De la Rúa’s resignation. Despite its magnitude, there is not a cultural memory constituted around this event. For example, there are only a few books, films, memorials or monuments on this event, it has received little attention in High School history curricula, and there is not a national commemorative day. That is why it is considered an event around which people have predominantly a communicative memory. Conversely, the 1976 coup d´état and the military dictatorship that followed has led to the development of a cultural memory (for example, there are many books, movies, monuments or memorials, and a national commemorative day). In the present study, participants´ memories about the 2001 crisis are considered. Eighty participants responded to a free-recall task about the crisis. Two groups of forty participants were conformed, one with Lived Semantic Collective Memory and the other with Distant Semantic Collective Memory. At the same time, half of the members of each of these groups were directly affected by the crisis, and the other half was indirectly affected. The political ideology of the participants in terms of right and left is also considered. The dependent variables were the themes or main ideas that constitute the participants recall of the 2001 crisis. Multiple Anova´s were performed. Results showed that participants with Lived Semantic Collective Memories and indirectly affected remembered themes/main ideas which offered information regarding the social and emotional climate of that period or, in the case of those with Lived Semantic Collective Memories, a themes/main idea that assigned responsibilities for the crisis. We found no differences as a function of ideology. But most importantly, results show a predominant lack of differences in the themes/main ideas remembered by different groups. Overall, the recall is mostly composed of themes/main ideas that are mostly descriptive of the different facts that took place during the 2001 crisis. There are no differences for themes/main ideas that offered a more contextualized recall. In general, results are explained in terms of the kind of memories promoted by communicative memories, which are less elaborated, more emotional and composed mostly of facts. In contrast, cultural memories seem to offer a more contextualized version, with causes and consequences that explain the facts.

Resumen El desarrollo de estudios en torno a la memoria colectiva da lugar a la consideración de nuevas elaboraciones y distinciones en su composición. De estas últimas, hay dos que son relevantes al presente estudio. La primera, en relación a la fuente del recuerdo, distingue entre una memoria comunicativa y una memoria cultural. La segunda, en relación al tipo de recuerdo, distingue entre la memoria colectiva semántica vivida (MCSV) y la memoria colectiva semántica distante (MCSD). También se considera la forma de afectación que han tenido los hechos sobre los participantes y la autocategorización ideológica/política de los participantes. El presente estudio aborda cómo los factores tipo de recuerdo, afectación e ideología influyeron en el contenido del recuerdo colectivo de la crisis de 2001, considerando a los temas/ideas principales. 80 participantes respondieron a una tarea de recuerdo libre. Se llevaron a cabo múltiples Análisis de la Varianza (ANOVAs). Los resultados muestran que los distintos grupos (MCSV y MCSD; Afectados Directamente e Indirectamente; Derecha e Izquierda) comparten los mismos contenidos, caracterizados por una descripción de hechos y por una ausencia de contextualización de los mismos. Las pocas diferencias tienden a mostrar un clima emocional y social de la época, ofrecido por aquellos participantes con recuerdos vividos y afectados indirectamente. No se encontraron diferencias en función de la autocategorización ideológica/política. Esta falta de diferencias se explicaría por las características propias de una memoria a predominio comunicativo, como la de la crisis de 2001, que no promovería la elaboración de contextos en la memoria colectiva.

ABSTRACT Objective To assess the amount of employment generated from the effective development of the Dependency Act in 2012, by evaluating the number of jobs depending on whether in-kind services or cash benefits were applied. Methods The level and total costs of dependency were obtained by using the Survey on Disability, Personal Autonomy and Dependency Situations of 2008. The consumption of dependent households was collected from the Household Budget Survey of 2012 carried out by the Spanish Statistics Institute. The impact on employment was estimated using an extended Input-Output model based on Symmetric Input-Output Tables and labour data from the Spanish National Accounts Base. Results The total estimated costs of dependency in 2012 were 4,545 million Euros for in-kind services and 2,662 for cash benefits. One hundred and ninety-five thousand, six hundred and sixty-eight jobs were generated in 2012 from dependency costs, and132,997 were linked to in-kind services and 62,671 to cash benefits. Every million Euros allocated for dependency by the Government returned 53.33 jobs linked to in-kind services and 46.21 to cash benefits. Furthermore, 341,505 jobs would have been created if dependency benefits had been exclusively offered via in-kind services. Conclusions Dependency benefits were equally distributed between in-kind services and cash benefits in 2012. Given that two out of three job positions generated from dependency benefits are linked to in-kind services, while the remaining third is generated by cash benefits, we conclude that around 146 thousand more jobs would have been generated if benefits had been offered as in-kind services instead of overusing cash benefits.

RESUMEN Objetivo Estimar la creación de empleo generada por la implantación de la Ley de Dependencia en 2012, evaluando el número de puestos de trabajo vinculados a servicios y a prestaciones económicas. Métodos Los grados y los costes totales de la dependencia se han obtenido de la Encuesta sobre Discapacidades, Autonomía Personal y Situaciones de Dependencia de 2008. El consumo de los hogares dependientes proviene de la Encuesta de Presupuestos Familiares realizada por el Instituto Nacional de Estadística en 2012. La creación de empleo se ha estimado con un modelo ampliado input-output basado en las tablas simétricas input-output y en datos de empleo de la Contabilidad Nacional de España. Resultados Los costes totales de dependencia estimados en 2012 fueron de 4545 millones de euros en servicios y 2662 millones de euros en prestaciones económicas. Se generaron 195.668 empleos vinculados a prestaciones de dependencia en 2012, 132.997 asociados a servicios y 62.671 a prestaciones económicas. Cada millón de euros asignados a prestaciones de dependencia por la Administración generó 53,33 empleos vinculados a servicios y 46,21 a prestaciones económicas. Además, se habrían creado 341.505 empleos si las prestaciones de dependencia hubieran sido asignadas únicamente como servicios. Conclusiones Los costes de dependencia se distribuyeron por igual entre servicios y prestaciones económicas en 2012. Dado que dos de cada tres empleos generados por las prestaciones de dependencia están vinculados a servicios, mientras que el tercio restante a prestaciones económicas, se habrían generado 146.000 empleos más si todas las prestaciones hubieran sido asignadas como servicios en lugar de la masiva utilización de prestaciones económicas.

ABSTRACT Objective To assess the amount of employment generated from the effective development of the Dependency Act in 2012, by evaluating the number of jobs depending on whether in-kind services or cash benefits were applied. Methods The level and total costs of dependency were obtained by using the Survey on Disability, Personal Autonomy and Dependency Situations of 2008. The consumption of dependent households was collected from the Household Budget Survey of 2012 carried out by the Spanish Statistics Institute. The impact on employment was estimated using an extended Input-Output model based on Symmetric Input-Output Tables and labour data from the Spanish National Accounts Base. Results The total estimated costs of dependency in 2012 were 4,545 million Euros for in-kind services and 2,662 for cash benefits. One hundred and ninety-five thousand, six hundred and sixty-eight jobs were generated in 2012 from dependency costs, and132,997 were linked to in-kind services and 62,671 to cash benefits. Every million Euros allocated for dependency by the Government returned 53.33 jobs linked to in-kind services and 46.21 to cash benefits. Furthermore, 341,505 jobs would have been created if dependency benefits had been exclusively offered via in-kind services. Conclusions Dependency benefits were equally distributed between in-kind services and cash benefits in 2012. Given that two out of three job positions generated from dependency benefits are linked to in-kind services, while the remaining third is generated by cash benefits, we conclude that around 146 thousand more jobs would have been generated if benefits had been offered as in-kind services instead of overusing cash benefits.

RESUMEN Objetivo Estimar la creación de empleo generada por la implantación de la Ley de Dependencia en 2012, evaluando el número de puestos de trabajo vinculados a servicios y a prestaciones económicas. Métodos Los grados y los costes totales de la dependencia se han obtenido de la Encuesta sobre Discapacidades, Autonomía Personal y Situaciones de Dependencia de 2008. El consumo de los hogares dependientes proviene de la Encuesta de Presupuestos Familiares realizada por el Instituto Nacional de Estadística en 2012. La creación de empleo se ha estimado con un modelo ampliado input-output basado en las tablas simétricas input-output y en datos de empleo de la Contabilidad Nacional de España. Resultados Los costes totales de dependencia estimados en 2012 fueron de 4545 millones de euros en servicios y 2662 millones de euros en prestaciones económicas. Se generaron 195.668 empleos vinculados a prestaciones de dependencia en 2012, 132.997 asociados a servicios y 62.671 a prestaciones económicas. Cada millón de euros asignados a prestaciones de dependencia por la Administración generó 53,33 empleos vinculados a servicios y 46,21 a prestaciones económicas. Además, se habrían creado 341.505 empleos si las prestaciones de dependencia hubieran sido asignadas únicamente como servicios. Conclusiones Los costes de dependencia se distribuyeron por igual entre servicios y prestaciones económicas en 2012. Dado que dos de cada tres empleos generados por las prestaciones de dependencia están vinculados a servicios, mientras que el tercio restante a prestaciones económicas, se habrían generado 146.000 empleos más si todas las prestaciones hubieran sido asignadas como servicios en lugar de la masiva utilización de prestaciones económicas.

ABSTRACT Background: constipation-predominant irritable bowel syndrome (C-IBS) is a prevalent, complex and multifactorial disorder that represents a challenge in terms of diagnosis and therapeutic management. Objective: to evaluate the effectiveness, safety and treatment satisfaction of linaclotide in C-IBS patients. Methods: prospective, single-center and observational study conducted in patients diagnosed with C-IBS. The patients were treated with linaclotide (Constella(r), Allergan Inc., Irvine, CA), once-daily via an oral capsule of 290-µg, 30 minutes before breakfast. The primary effectiveness endpoint was the number of bowel movements per week. The secondary endpoints included treatment satisfaction and changes from baseline in frequency and severity of symptoms (abdominal pain and bloating). This was assessed via an 11-point visual analog scale (VAS) reported by the patients in a daily register. Results: thirty female patients were consecutively included. The median follow-up time was 18 months. The mean (standard deviation [SD]) number of weekly bowel movements significantly increased from 0.9 (0.6) at baseline to 4.7 (3.9) at the end of follow-up, p < 0.0001. Abdominal pain significantly decreased from 5.7 (2.3) at baseline to 3.1 (2.8) at the end of the follow-up period, p < 0.0001. Similarly, bloating significantly decreased from 6.8 (1.6) to 2.9 (2.5) at the beginning and end of the treatment period, respectively, p < 0.0001. The mean (SD) degree of satisfaction at the end of the study was 6.7 (3.0). Conclusions: long-term linaclotide treatment in patients with C-IBS is effective and safe in the clinical setting.

RESUMEN Antecedentes: el síndrome de intestino irritable tipo estreñimiento (SII-E) es una patología prevalente, compleja y multifactorial que representa un desafío tanto desde el punto de vista diagnóstico como terapéutico. Objetivo: evaluar la efectividad, seguridad y satisfacción de linaclotida en pacientes con SII-E. Métodos: estudio prospectivo, unicéntrico y observacional realizado en pacientes con diagnóstico de SII-E. Los pacientes recibieron tratamiento con linaclotida (Constella(r), Allergan Inc., Irvine, CA), 290 microgramos/24 horas, una cápsula 30 minutos antes del desayuno. La variable primaria de efectividad fue el número de deposiciones por semana. Las variables secundarias incluían el grado de satisfacción y el registro de la frecuencia e intensidad de los síntomas (dolor e hinchazón), medidos mediante una escala visual analógica (EVA) de once niveles (0-10), y recogidas mediante un diario que se entregó al paciente. Resultados: treinta pacientes, todas mujeres, fueron incluidas consecutivamente. La mediana del tiempo de seguimiento fue de 18 meses. La media (deviación estándar [DE]) de deposiciones por semana aumentó desde 0,9 (0,6) al inicio del estudio hasta 4,7 (3,7) al final del mismo (p < 0,0001). Resultados similares fueron observados con el dolor (5,7 [2,3] frente a 3,1 [2,8] al inicio y al final del estudio, respectivamente, p < 0,0001) y con la hinchazón (6,8 [1,6] frente a 2,9 [2,5] al inicio y final del estudio, respectivamente, p < 0,0001). El grado medio (DE) de satisfacción al final del estudio fue 6,7 (3,0). Conclusiones: el tratamiento con linaclotida en pacientes con SII-E en el entorno de la práctica clínica se ha mostrado eficaz y seguro a largo plazo.

Introduction: Patients with inflammatory bowel disease can experience extra-intestinal manifestations that may cause significant morbidity. Aims: To describe the prevalence, characteristics, treatment and evolution of extra-intestinal manifestations in inflammatory bowel disease patients treated in our hospital and to identify associated risk factors. Methods: This was a retrospective, observational, case-control study. All inflammatory bowel disease patients with extra-intestinal manifestations were considered as cases and inflammatory bowel disease patients without extra-intestinal manifestations were considered as controls. Results: Six hundred and nineteen patients with inflammatory bowel disease (327 Crohn's disease, 265 ulcerative colitis, 27 indeterminate colitis) were included in the study; 16.5% experienced at least one extra-intestinal manifestation (CI 95% 13.5-19.5; n = 102). The most frequent extra-intestinal manifestations observed were musculoskeletal (n = 50; 40%) and cutaneous manifestations (n = 50; 40%). With regard to treatment, arthropathies were treated with non-steroidal anti-inflammatory drugs (31%) and corticosteroids (19%, oral or intra-articular), and the majority of the cutaneous manifestations were managed with corticosteroids. Overall, the efficacy of extra-intestinal manifestation treatment was 90% and only 13% of patients had a recurrence of extra-intestinal manifestations. The multivariate analysis showed that female gender (p = 0.012; OR = 1.61; 95% CI 1.11-2.34) and the severity of inflammatory bowel disease (p = 0.009; OR = 1.65; 95% CI 1.13-2.4 if immunosuppressant therapy alone, or p = 0.029; OR = 2.28; 95% CI 1.09-4.78 if in combination with adalimumab) were associated with an increased risk of developing extra-intestinal manifestations. Conclusions: The most frequent extra-intestinal manifestations in our environment were musculoskeletal and cutaneous manifestations. Female gender and a more severe disease were associated with a higher risk of developing extra-intestinal manifestations. Individualized treatment of extra-intestinal manifestations is effective and the risk is low in our series.

Introducción: los pacientes con enfermedad inflamatoria intestinal pueden presentar manifestaciones extraintestinales que en ocasiones asocian gran morbilidad. Objetivos: evaluar la prevalencia, las características, los tratamientos y la evolución de las manifestaciones extraintestinales en pacientes con enfermedad inflamatoria intestinal en nuestro centro e identificar los posibles factores de riesgo asociados. Métodos: estudio retrospectivo, observacional, tipo casos y controles. Los pacientes con enfermedad inflamatoria intestinal con manifestaciones extraintestinales fueron considerados casos y los que no las presentaban, controles. Resultados: fueron incluidos 619 pacientes con enfermedad inflamatoria intestinal (327 enfermedad de Crohn, 265 colitis ulcerosa, 27 colitis no clasificada). El 16,5% mostró al menos una manifestación extraintestinal (IC 95% 13,5-19,5; n = 102), siendo las más frecuentes las musculoesqueléticas (n = 50, 40%) y las cutáneas (n = 50, 40%). Respecto al tratamiento, en las artropatías predominó el uso de antiinflamatorios no esteroideos (31%) y corticoides (19%, orales o intraarticulares) y para las alteraciones cutáneas se recurrió mayoritariamente a los corticoides (83%). Globalmente, la eficacia del tratamiento fue del 90%. En el 13% se produjo recidiva de la manifestación extraintestinal. El análisis multivariante identificó el sexo femenino (p = 0,012; OR = 1,61; IC 95% 1,11-2,34) y la gravedad de la enfermedad inflamatoria intestinal (p = 0,009, OR = 1,65, 1,13-2,4, si precisaron terapia inmunosupresora; p = 0,029, OR = 2,28, 1,09-4,78, si requirieron terapia combinada con inmunosupresor y adalimumab) como factores de riesgo asociados al desarrollo de manifestaciones extraintestinales. Conclusiones: las manifestaciones extraintestinales más frecuentes en nuestro medio son las musculoesqueléticas y las cutáneas. El sexo femenino y la gravedad de la enfermedad inflamatoria intestinal asocian un mayor riesgo de desarrollar manifestaciones extraintestinales. El tratamiento individualizado de las mismas es eficaz y el porcentaje de recidiva es bajo.

Objective: To describe how mesalazine (MSZ) is used in our practice in ulcerative colitis (UC), at what dose, and the success rate (regarding adherence to therapy). Methods: Observational, transversal study, including all patients with UC and with MSZ maintenance therapy seen from September 2014 to February 2015 at two IBD units in Spain. Treatment adherence was measured by the Morisky-Green scale. Results: We included 203 patients (mean MSZ dose: 2.6 ± 1.0 g/d; median of treatment: 19.5 months [IQR: 8-48]). Doses < 2 g/d were used in 15.3% of cases, 2-2.9 g/d doses in 35.0%, 3-3.9 doses in 29.5%, and ≥ 4 g/d doses in the remaining 20.2%. A single daily dose was preferred in 51.2% of cases, two doses in 33.0% and three doses in 15.8%. A different MSZ brand had been previously used in 36.6% of patients. In 134 cases (66%), the maintenance dose had been increased during a flare-up, and in 49 (36.6% of cases) this higher dose had been kept for maintenance (dose ≥ 4 g/d in 36 patients). During the MSZ therapy, 14 patients (6.9%) suffered mild side effects (21.4% altered liver function tests). Therapy adherence was good in 81.8% of cases. Conclusions: Half of our UC patients take high MSZ doses (≥ 3 g/d) as maintenance therapy, with acceptable safety and good adherence. Half of all patients take a single daily dose, and one third needed a different commercial brand during therapy. Opting for a higher MSZ maintenance dose is a possible strategy for a satisfactory maintenance therapy.

Background: Data about use and effectiveness of mercaptopurine in inflammatory bowel disease are relatively limited. Aims: To assess the possible therapeutic indications, efficacy and safety of mercaptopurine as an alternative to azathioprine in inflammatory bowel disease. Methods: Retrospective observational study in patients treated with mercaptopurine in a total cohort of 1,574 patients with inflammatory bowel disease. Results: One hundred and fifty-two patients received mercaptopurine, 15.7% of these patients as an initial thiopurine, 5.3% after azathioprine failure, and 79% after azathioprine intolerance. In 52.6% of patients (n = 80), adverse effects of mercaptopurine occurred, resulting in withdrawal in 49 of them. Mercaptopurine was effective in 39% of cases (95% CI 31-48%). In the remaining patients, failure was due mainly to withdrawal due to side effects (55.1%) and therapeutic step-up (33.7%). The average total time of mercaptopurine exposure was 36 months (IQR: 2-60). Myelotoxicity with mercaptopurine was more common in patients with intermediate TPMT activity than in those with normal activity (p = 0.046). Conclusions: In our setting, mercaptopurine is primarily used as a rescue therapy in patients with azathioprine adverse effects. This could explain its modest efficacy and the high rate of adverse effects. However, this drug is still an alternative in this group of patients, before a therapeutic step-up to biologics is considered.

Objective: Patient compliance in chronic inflammatory diseases is essential to achieve treatment effectiveness. The study objective is to develop a recommendations document for healthcare professionals to encourage treatment compliance. Methods: A sequential methodology was followed: 1. Systematic review of EBM Reviews, Embase and MedLine without time restriction of interventions on compliance in chronic inflammatory diseases. Studies were selected according to previously defined criteria (confirmed diagnosis of chronic inflammatory disease of patients included, assessment of adherence interventions and experimental study design). 2. Three expert workshops (hospital pharmacy, nursing and medical specialties) to elaborate recommendations. 3. Expert online voting about the degree of agreement with recommendations. 4. Final face to face consensus workshop. Results: A total of 1 115 papers were identified, 84 were fully reviewed and 30 were selected according to criteria. A preliminary list of 8 recommendations based on evidence was developed and discussed in the expert workshops. As a result, a new version of 14 recommendations was created. Later, online voting showed a high degree of agreement among experts: 7 out of 14 recommendations obtained unanimous approval; in the other 7, 1 to 3 experts were partially in disagreement. Recommendations without unanimous agreement were further reviewed and modified in the face to face meeting and final recommendations were approved unanimously. Conclusions: This consensus statement gathers all relevant aspects to be interdisciplinary considered to detect, monitor and assess medication adherence, involving the patient in the process. Further studies are needed to assess the impact of interventions to improve compliance in patients with chronic inflammatory diseases both in terms of adherence and in health outcomes.

Objetivo: La adherencia terapéutica en los pacientes con enfermedades inflamatorias crónicas es fundamental para alcanzar la efectividad del tratamiento. El objetivo de este trabajo es crear un documento de recomendaciones para los profesionales de la salud que promueva la adherencia al tratamiento. Métodos: Se siguió una metodología secuencial: 1. Revisión sistemática en Evidence Based Medicine Reviews (EBMR), Embase y MedLine de intervenciones en adherencia en enfermedades inflamatorias crónicas sin restriciones temporales. Los estudios se seleccionaron según criterios previamente definidos (pacientes diagnosticados de enfermedad inflamatoria crónica, evaluación de intervenciones para la mejora de la adherencia y diseño experimental de estudio). 2. Reunión con tres grupos de expertos (farmacia hospitalaria, enfermería y especialidades médicas) para generar recomendaciones. 3. Votación electrónica de los expertos sobre el grado de acuerdo con las recomendaciones. 4. Reunión presencial final de las recomendaciones. Resultados: Se identificaron 1.115 citas, se revisaron 84 y se seleccionaron 30 de acuerdo a los criterios de elegibilidad. Se redactó un listado inicial de 8 recomendaciones basadas en la evidencia, que se discutió en las reuniones de expertos y dio lugar a una nueva versión de 14 recomendaciones. La posterior votación electrónica de esta versión evidenció un elevado grado de acuerdo entre los expertos: en 7 recomendaciones, acuerdo unánime; en las 7 restantes, entre 1 y 3 expertos parcialmente en desacuerdo. En la reunión presencial se volvieron a revisar y modificar las recomendaciones, sin acuerdo unánime, que finalmente se aprobaron por unanimidad. Conclusiones: Estas recomendaciones recogen los aspectos relevantes para detectar, monitorizar y evaluar la adherencia terapéutica de forma multidisciplinar, implicando de forma activa al paciente. Son necesarios nuevos estudios para evaluar el impacto de las intervenciones para mejorar la adherencia en los pacientes con enfermedades inflamatorias crónicas y su influencia tanto en los aspectos relativos al cumplimiento como en los resultados en salud.

ABSTRACT Background: The objective was to evaluate the efficiency (relation between the cost and the results in health) of the treatments in psoriasis, seeking a higher quality of economic evaluations, consistency and transparency in these studies. Methods: We developed a model of economic evaluation in psoriasis collecting all the many direct and indirect costs of each treatment. The effectiveness indicator used was Psoriasis Area Severity Index [PASI 75] which is generally acceptable in studies of psoriasis. The effectiveness indicator was a PASI 75. Subsequently we calculated the Incremental Cost-Effectiveness Ratio (ICER) for the period of 12 weeks and PASI 75, ordering treatments by level of effectiveness at the expense of treatment costs. Results: The most cost effective treatment was methotrexate (ICER -7.5) followed by acitretin (ICER 29.5). The least cost has proved effective PUVA (ICER 4,651), followed by UVB narrow band (2,886.1). Conclusions: When taking into account both direct and indirect costs together with efficiency, methotrexate is the most cost effective treatment.

RESUMEN Fundamentos: Los nuevos tratamientos biológicos, si bien mejoran la calidad de vida del paciente, incrementan los costes exponencialmente en relación al resto de tratamientos. El objetivo fue calcular el tratamiento más coste efectivo de los existentes para la psoriasis. Métodos: Se desarrolló un modelo de evaluación económica en psoriasis recogiendo todos los costes directos e indirectos de cada tratamiento. El indicador de efectividad que se utilizó fue Psoriasis Area Severity Index (PASI 75), que es el aceptable de manera general en estudios de psoriasis. Posteriormente se realizó un análisis de incremento coste efectividad (ICER) para el periodo de 12 semanas y PASI 75, ordenando los tratamientos por nivel de efectividad en detrimento de los costes de los tratamientos. Resultados: El tratamiento más coste efectivo fue el metotrexato (ICER -7,5) seguido de acitretina (ICER 29,5). El menos coste efectivo resultó ser PUVA (ICER 4.651) seguido de UVB de banda estrecha (2.886,1). Conclusiones: Aunque el tratamiento más económico teniendo en cuenta solo los costes directos sería el UVBbe, al incluir los costes indirectos y ajustarlos por la efectividad el tratamiento más coste efectivo es el metotexato.

ABSTRACT Background: The objective was to evaluate the efficiency (relation between the cost and the results in health) of the treatments in psoriasis, seeking a higher quality of economic evaluations, consistency and transparency in these studies. Methods: We developed a model of economic evaluation in psoriasis collecting all the many direct and indirect costs of each treatment. The effectiveness indicator used was Psoriasis Area Severity Index [PASI 75] which is generally acceptable in studies of psoriasis. The effectiveness indicator was a PASI 75. Subsequently we calculated the Incremental Cost-Effectiveness Ratio (ICER) for the period of 12 weeks and PASI 75, ordering treatments by level of effectiveness at the expense of treatment costs. Results: The most cost effective treatment was methotrexate (ICER -7.5) followed by acitretin (ICER 29.5). The least cost has proved effective PUVA (ICER 4,651), followed by UVB narrow band (2,886.1). Conclusions: When taking into account both direct and indirect costs together with efficiency, methotrexate is the most cost effective treatment.

RESUMEN Fundamentos: Los nuevos tratamientos biológicos, si bien mejoran la calidad de vida del paciente, incrementan los costes exponencialmente en relación al resto de tratamientos. El objetivo fue calcular el tratamiento más coste efectivo de los existentes para la psoriasis. Métodos: Se desarrolló un modelo de evaluación económica en psoriasis recogiendo todos los costes directos e indirectos de cada tratamiento. El indicador de efectividad que se utilizó fue Psoriasis Area Severity Index (PASI 75), que es el aceptable de manera general en estudios de psoriasis. Posteriormente se realizó un análisis de incremento coste efectividad (ICER) para el periodo de 12 semanas y PASI 75, ordenando los tratamientos por nivel de efectividad en detrimento de los costes de los tratamientos. Resultados: El tratamiento más coste efectivo fue el metotrexato (ICER -7,5) seguido de acitretina (ICER 29,5). El menos coste efectivo resultó ser PUVA (ICER 4.651) seguido de UVB de banda estrecha (2.886,1). Conclusiones: Aunque el tratamiento más económico teniendo en cuenta solo los costes directos sería el UVBbe, al incluir los costes indirectos y ajustarlos por la efectividad el tratamiento más coste efectivo es el metotexato.