Cervical Cancer Screening in Women With Severe Mental Disorders: An Approach to the Spanish Context.

BACKGROUND: The incidence of invasive cervical cancer and its mortality have been reduced through primary and secondary prevention. Screening rates tend to be lower in vulnerable groups, such as people with severe mental disorders, who have a later detection of cancer and a higher mortality. The access of these women to cervical cancer screening is uncertain in our context. OBJECTIVE: The aim of this study was to determine the cervical cancer screening rates in women with severe mental disorders. METHODS: This was a descriptive cross-sectional study. Women 25 to 65 years old who were admitted during 2016 to the psychiatric unit of a public hospital in Spain were included in the study, and it was determined if they had had cervical cancer screening. RESULTS: A total of 103 eligible women, with a mean age of 45.6 years, were enrolled. Only 28 of the participants (27.2%) had had a cervical cancer screening done in the last 5 years. By age groups, statistically significant differences were found, with women between 35 and 44 years of age having higher rates of cervical cancer screening (41.9%) and the oldest, between 55 and 65 years of age, having the lowest (5%). CONCLUSIONS: Women with severe mental health disorders who were admitted to acute psychiatric care units had much lower cervical cancer screening rates compared with the general population. IMPLICATIONS FOR PRACTICE: Mental health nurses could be the optimum professionals to promote cancer primary and secondary prevention in women with mental disorders.

Topografía aterosclerótica obtenida por coronariografía prequirúrgica en pacientes intervenidos de revascularización coronaria / Atherosclerotic topography obtained by presurgical coronariography in patients undergoing coronary revascularization

El síndrome coronario es un desbalance entre demanda miocárdica y entrega coronaria usualmente causado por estenosis ateroscleróticas, la mayoría de las lesiones de ubican en la coronaria izquierda, especialmente en la descendente anterior . Los factores de riesgo cardiovascular clásicos son útiles como predictores del cuadro pero no explican la selectividad vascular izquierda sin recurrir a comprender la hemodinamia local coronaria. En este sentido, se debe tener en cuenta lo siguiente: 1) En la coronaria derecha el flujo tiende a ser constante en todo el ciclo cardiaco, en la izquierda es bifásico y el 80% se produce en diástole, el endotelio está expuesto a mayor estrés. 2) En las ramas de la coronaria izquierda, el miocardio en sístole comprime el sistema subendocárdico y provoca flujo retrógrado, los vasos epicárdicos son reservorio del flujo que asciende y aumentan su diámetro estresando su pared, en la coronaria derecha no se produce este fenómeno. 3) La vasculatura coronaria acompaña al miocardio en cada contracción por lo que es torsionada, estirada y aplanada, las ramas de la coronaria izquierda están expuestas a mayor deformación geométrica. 4) La coronaria izquierda tiene más ramifcaciones que la derecha lo que induce más turbulencia. La presentación clínica, consideraciones terapéuticas, complicaciones y pronóstico dependen de varios aspectos, entre ellos, el vaso afectado. La valoración de los factores de riesgo cardiovascular predice el desarrollo del cuadro, pero no el vaso que podría lesionarse. En nuestro medio no existe una descripción estadística amplia que haya reportado la predominancia izquierda y que permita añadir los factores hemodiná- micos estresantes de la pared coronaria al riesgo cardiovascular.

Coronary syndrome is an imbalance between myocardial demand and coronary delivery usually caused by atherosclerotic stenosis, the majority of lesions are located in the left coronary artery, especially in the anterior descending. Classic cardiovascular risk factors are useful as predictors of the picture but do not explain the left vascular selectivity without resort to understanding local coronary hemodynamics. In this sense, the following should be taken into account: 1) In the right coronary the flow tends to be constant throughout the cardiac cycle, on the left It is biphasic and 80% is produced in diastole, the endothelium is exposed to increased stress 2) In the branches of the left coronary, the myocardium in systole compresses the subendocardial system and causes retrograde flow, the epicardial vessels are reservoirs of the ascending fl ow its diameter stressing its wall, in the right coronary does not occur this phenomenon. 3) The coronary vasculature accompanies the myocardium in each contraction so it is twisted, stretched and flattened, the branches of the left coronary are exposed to greater deformation geometric 4) The left coronary has more ramifications than the right which induces more turbulence . The clinical presentation, therapeutic considerations, complications and prognosis depend on several aspects, including the affected vessel. The assessment of cardiovascular risk factors predicts the development of the condition, but not the vessel that could be injured. In our there is no broad statistical description that has reported the left predominance and that allows adding hemodynamic factors stressful mycoses of the coronary wall to cardiovascular risk