Experiences of caregiving and quality of healthcare among caregivers of patients with complex chronic processes: A qualitative study.

Aim To explore the perceptions of main caregivers regarding caring for chronic complex patients in two different regions of Spain. BACKGROUND: Spain is a country with an ageing population and a high number of people with chronic diseases. It is well known that the role of the caregiver is important to ensure quality of life and appropriate care. METHODS: Qualitative design using focus groups. Five focus groups, from two different regions, were conducted with 22 caregivers of people with chronic complex diseases to explore their personal experience, examine the quality of care received by the patient and their family and to develop strategies for the improvement of the quality of health care. The focus groups were audio and video recorded. The transcriptions of the focus group sessions were exported to qualitative software analysis MAXQDA 2018.2. The qualitative content analysis was based on different analytical cycles. RESULTS: In general terms, caregivers would refer to accepting the care of their family members, but they highlight many negative aspects such as tiredness, lack of help and overload of care. They indicated general satisfaction with the health system but indicated that help was insufficient and that strategies to better address the situations of the complex chronic patient should be improved. The main categories observed were: Conclusions. Complex chronic illnesses are increasingly common at present, generating important consequences on the lives of patients and that of their caregivers. The design of any health strategy for facing the dilemma of chronic illnesses, must necessarily include the vision of the caregivers.

Short wavelength infrared frequency conversion in ultra-compact fiber device.

Linear and nonlinear characteristics of devices using millimeter-scale spools of highly nonlinear fiber are experimentally investigated within 2000-2400nm spectral range. Coils with radius larger than 3.5 mm indicate that macro-bending induced radiation loss is negligible up to 2400nm. Devices with smaller diameter coiling resulted in macro-bending losses that dominate over micro-bending losses beyond 2200nm. A tunable short-wave infrared source was constructed using a coin-sized fiber module to demonstrate an efficient nonlinear conversion from 1.26 to 2.2 microm.

Evidence of subtle departures from Mendelian segregation in a wild lesser kestrel (Falco naumanni) population.

Some alleles are inherited more frequently than expected from Mendel's rule. This phenomenon, known as transmission ratio distortion (TRD), is found in a broad variety of taxa, but it is thought to be unusual and occurs at a low frequency in any particular population. Here, we used seven microsatellite markers to search for possible TRD in a wild lesser kestrel (Falco naumanni) population. Among the nine alleles analysed with at least 200 known meioses for each sex, we found that two of them (156-AG5 in males and 362-FN1.11 in females) presented subtle (k=0.6) but significant departures from Mendelian segregation. Moreover, in a sample of 53 alleles with at least 15 known meioses, we found a positive correlation between their transmission rates and their frequencies in the population. To estimate the transmission scores for the loci and individuals, we developed a method that allowed us to discover that another locus, FP-46, showed significant TRD, despite the lack of a significant deviation from parity for the alleles considered individually. Finally, we found a consistent transmission bias both within loci and within individuals across loci. Inter-individual differences in TRD support the idea that distorters act over several loci that are evenly distributed across the whole genome, particularly in individuals bearing the distorter alleles. Overall, these findings suggest that TRD might be a more widespread phenomenon than previously revealed by analyses at the allele level.

Auditory discrimination training for tinnitus treatment: the effect of different paradigms.

Acoustic deprivation, i.e. hearing loss, is responsible for a cascade of processes resulting in reorganisation of the cortex. Tinnitus mechanisms are explained by synchronization of the neural spontaneous activity and might be related to cortical re-mapping. Auditory discrimination training (ADT) has demonstrated in both animals and humans to induce tonotopical changes in the auditory pathways through neural plasticity. We hypothesize that ADT could have some effect on tinnitus perception. The objective of this study is to compare the effect on tinnitus following two paradigms of ADT. Only patients from 20 to 60 years of age were recruited. Inclusion criteria were pure tone tinnitus of mild or moderate handicap according to the Tinnitus Handicap Inventory score (<56). ADT patients were randomized in two groups: SAME (ADT in the same frequency of tinnitus pitch, 20 patients) and NONSAME (ADT in the frequency one-octave below tinnitus pitch, 21 patients). Groups of pair of tones (70% standard tones ST, 30% deviant tones ST + 0.1-0.5 kHz) were randomly mixed for 20 min/day during 1 month. Patient had to mark when the two sounds of the pair were similar or different. Control group included 26 patients from the waiting list (WLG). Patients were also divided according to the trained frequency and the deepest hearing-impaired frequency. Outcome parameters were set up according to the answer to the question "is your tinnitus better, same, or worse with the treatment?" (RESP), the tinnitus handicap inventory (THI) and the visual analogue scale from 1 to 10 on tinnitus intensity (VAS). Tinnitus improved in 42.2% of the patients (RESP). VAS and THI scores were reduced but only THI differences were statistically significant (P = 0.003). ADT patients improved significantly compared with WLG in RESP and THI scores (P < 0.01). Training frequencies one-octave below the tinnitus pitch (NONSAME) decreased significantly THI scores compared with patients trained frequencies similar to tinnitus pitch (SAME, P = 0.035). RESP and VAS scores decreased more in NONSAME group though differences were not significant. We did not find any differences when comparing the group training the deepest hearing-impaired frequency and the group who trained other frequencies. Auditory discrimination training significantly improved tinnitus handicap compared to a waiting list group. Those patients who trained frequencies one octave below the tinnitus pitch had better outcome than those who performed the ADT with frequencies similar to the tinnitus pitch (P = 0.035).

Temporal variation of heterozygosity-based assortative mating and related benefits in a lesser kestrel population.

Heterozygosity as a target of mate choice has received much attention in recent years and there is growing evidence supporting its role in the evolution of mate preferences. In this study we analyse mating patterns in relation to heterozygosity in a lesser kestrel (Falco naumanni) population intensively monitored over six study years (2002-2007). The magnitude of heterozygosity-based assortative mating varied over time, being particularly patent in the last study years (2006, 2007). We have found evidence that this mating pattern entails both direct and indirect-genetic benefits. Clutch size increased with female heterozygosity and more heterozygous males raised a higher number of fledglings particularly in those years when the strength of the heterozygosity-based assortative mating was markedly higher. In the last study year, parent-offspring correlation of heterozygosity was stronger and higher than the expected if individuals would have randomly mated with respect to heterozygosity. Overall, our results offer empirical support to the heterozygous mate hypothesis of sexual selection but suggest that genetic diversity may act as a temporally variable target for mate choice.

Cortical reorganisation and tinnitus: principles of auditory discrimination training for tinnitus management.

Scientific evidence has proved reorganisation processes in the auditory cortex after sensorineural hearing loss and overstimulation of certain tonotopic cortical areas, as we see in auditory conditioning techniques. Acoustic rehabilitation reduces the impact of these reorganisation changes. Recent theories explain tinnitus mechanisms as a negative consequence of neural plasticity in the central nervous system after a peripheral aggression. Auditory discrimination training (ADT) could partially reverse the wrong changes in tonotopic representation and improve tinnitus. We discuss different studies and their efficacy on tinnitus perception and annoyance. Indications, method, dose and sound strategy need to be implemented.

Molecular basis of argininemia. Identification of two discrete frame-shift deletions in the liver-type arginase gene.

Argininemia results from a deficiency of arginase (EC 3.5.3.1), the last enzyme of the urea cycle in the liver. We examined the molecular basis for argininemia by constructing a genomic library followed by cloning and DNA sequencing. Discrete mutations were found on two alleles from the patient, a product of a nonconsanguineous marriage. There was a four-base deletion at protein-coding region 262-265 or 263-266 in exon 3 that would lead to a reading-frame shift after amino acid residue 87 and make a new stop codon at residue 132. The other was a one-base deletion at 77 or 78 in exon 2 that would lead to a reading-frame shift after residue 26 and make a stop codon at residue 31. For confirmation, genomic DNAs from the patient and from her parents were amplified by the polymerase chain reaction method. The patient was shown to be a compound heterozygote, inheriting an allele with the four-base deletion from the father and the other allele with the one-base deletion from the mother. These data seem to be the first evidence of a case of argininemia caused by two different deletion mutations.

[Mechanisms and management of hyperacusis (decreased sound tolerance)]. / Fisiopatología y tratamiento de la hiperacusia (hipersensibilidad al sonido).

Hyperacusis is a decreased sound tolerance. Prevalence of the disease is described in 9-15% of the population, but this percentage increases among the tinnitus patients. Pathophysiological mechanisms involve some disruptions in the amplification and regulation processes of the external hair cells or affect the central sound processing at the subcortical level. The role of the serotonin, also involved in other diseases related with hyperacusis (migraine, depression), can be crucial in this disorder. Other theories confirm the effect of the endorphins that activate the excitatory function of the glutamate, the auditory neurotransmitter, increasing its toxicity. The activation of the limbic and autonomic nervous systems produces the emotional reaction of the hyperacusis (anxiety, fear and depression). Proposed treatments are based on acoustic stimulation by a progressive introduction of sound (tinnitus retraining therapy TRT). Noise generators and hearing aids can be fitted in severe cases. The role of some drugs involved in the metabolism of the serotonin open new approaches for the management of hyperacusis.

[Assessment of hyperacusis: the self-rating questionnaire on hypersensitivity to sound]. / Evaluación de la hiperacusia: test de hipersensibilidad al sonido.

BACKGROUND: Hyperacusis is a decreased sound tolerance. The audiological examination includes the loudness discomfort level measurement and the handicap evaluation, so we introduce the Spanish validation of the german sound intolerance questionnaire. OBJECTIVES: To update the concept of hyperacusis and to evaluate its handicap through a Spanish validation of the Geräuschüberempfindlichkeit (GUF). PATIENTS: Forty patients referred to our Tinnitus and Hyperacusis Clinic in the University Hospital, between October 2004 and February 2005. OUTCOME MEASURES: The Spanish version of the GUF was performed after transla-tion and retro-translation. Internal consistency and reliability were established. RESULTS: Spanish adaptation of the GUF and its subscales (cognitive, somatic behaviour and emotional reaction) showed a high reliability and internal consistency (Cronbach's alfa: 0.9007). Higher GUF scores were statistically demonstrated in hyperacusis patients with hearing loss (p < 0.05) or tinnitus (p < 0.05). CONCLUSIONS: Spanish adaptation of the GUF is valid, reliable and can be used in a clinical setting to quantify the impact of hyperacusis on patient's quality of life.

[The use of Quality of Life Questionnaire in patients with nasal polyposis]. / Utilidad del cuestionario RSDI para la valoración de la calidad de vida en pacientes con poliposis nasal.

OBJECTIVES: Polyposis handicap evaluation through Spanish validation of the Rhinosinusitis Disability Index. MATERIAL AND METHODS: Spanish validation of the Polyposis Disability Index (PDI). One hundred and fifty one patients referred to our Nose Unit in Fundación Hospital Alcorcón. The Spanish version of the PDI was administered after translation and retrotranslation. Internal consistency and reliability were established. RESULTS: Spanish adaptation of the PDI and ists subscales (functional, emotional and physical) showed a high reliability and internal consistency (Cronbach's alfa: 0,90). CONCLUSIONS: Spanish adaptation of the PDI is valid, reliable and can be used in a clinical setting to quantify the impact of polyposis on patient's quality of life.

The effects of the minimum threshold condition for breeding on offspring sex-ratio adjustment in the lesser kestrel.

We propose a model for sex-ratio adjustment complementary to that of Trivers and Willard. In addition to the three basic assumptions of the Trivers-Willard model, our model assumes that the sex with more variable reproductive success (normally male) is also the sex less constrained for reproduction. This assumption seems realistic, because several studies have demonstrated that poor-condition males may adopt alternative mating strategies and sire some offspring, whereas females have physiological constraints for gestation or egg production that cannot be avoided. Thus, under these circumstances, sons of both poor and good condition would be more valuable for parents than daughters, whereas daughters would be relatively more valuable than sons at intermediate condition. This model predicts, therefore, a U-shaped relationship between parental condition and offspring sex ratio. We present a case study for the monogamous lesser kestrel (Falco naumanni) that fulfills the assumptions and predictions of the model. The minimum body condition for breeding, measured as pectoral thickness, was lower for sons than for daughters. Below this minimum, males had a higher chance of breeding than females. Above this minimum, however, the lifetime reproductive success was condition dependent in males but not in females. Thus, males in better body condition attain, on average, higher reproductive success than females. Offspring sex ratio varied with the size of the father's ornaments and mother condition according to the U-shaped pattern predicted by the model.

Non-HLA genetic factors and insulin dependent diabetes mellitus in the Japanese: TCRA, TCRB and TCRG, INS, THY1, CD3D and ETS1.

Polymorphism of the genes encoding the alpha, beta, and gamma chains of the human T-cell receptor (TCRA, TCRB, and TCRG), insulin gene (INS), and three closely linked polymorphic genes on chromosome 11q23, Thy-1 (THY1), T3-D (CD3D), and c-ets proto oncogene (ETS1) were investigated among 56 unrelated patients with insulin-dependent diabetes mellitus (IDDM) and 48 healthy controls. Only eight of the 17 enzymes examined revealed restriction fragment length polymorphism (RFLP), with the use of TCRA, TCRB, and TCRG. No significant association was observed. Polymorphism after BglI, SstI, and TaqI digestion was observed for the INS gene. In consideration of the three classes within the insulin-gene-linked DNA polymorphism alleles, A1 and more rarely A2 alleles were found, but with no significant frequencies. THY1 and CD3D genes were polymorphic after MspI digestion but no significant association was observed. Conversely, the ETS1 gene showed polymorphism after TaqI, SstI, and AvaII were used. Only a significant AvaII-polymorphic fragment (p less than 0.03) was found. However, this significant association disappeared when the correct p value was applied. These results were compared to findings in Caucasians and some differences were noted. The polymorphism observed in this study may be useful in genetic studies on immunologically affected populations.

[Low grade disseminated astrocytoma in childhood]. / Astrocitomas de bajo grado diseminados en la infancia.

INTRODUCTION: Leptomeningeal dissemination is a common event in some kinds of cerebral tumours, but in low-grade astrocytomas who classically have been conferred a benign course. However, multifocal affectation is described each time more frequently in these group of tumours. CLINIC CASES: We present three patients aged respectively 8 and 10 months and 10 years, who were diagnosed of low-grade astrocytoma with multicentric spread. They were treated with systemic chemotherapy and controlled with MRI. At the end of the treatment an important reduction in tumours' size was observed in the three cases. DISCUSSION: Biological behaviour of low-grade astrocytoma as been reviewed in last years. By one side, it has been seen that certain histological characteristics are associated with an aggressive behaviour: on the other hand, long-term evolution of these tumours can be complicated with tumoral recurrence, malignization and leptomeningeal dissemination. This last one is observed each time more frequently since the use of MRI in the diagnose of cerebral tumours has become routine. From the therapeutic point of view, chemotherapy represents an effective choice for these patients' management, when surgery is not possible and radiotherapy not advisable, allowing in many cases to stop tumoral growth and sometimes to reduce it's size strongly.

[Diagnostic efficiency of biological markers of alcohol consumption for the detection of excessive drinkers]. / Eficacia diagnóstica de los marcadores biológicos de consumo alcohólico en la detección de bebedores excesivos.

The objective of our study was to test the usefulness of some biological markers of alcoholism to detect heavy drinkers, using a structured interview with a 7-day memory as this is currently considered the most reliable technique for determining alcohol consumption. A transversal, observational study was designed with a sample representative of the working population of the province of Alicante seen by the Ibermutua medical service. Participants were selected randomly and classified according to region and sex. The total sample include 1,033 subjects (644 men and 389 women, mean age 36 +/- 11.7 years). Of these 13.5 were heavy drinkers (> 40 g. of alcohol per day), 23.3 moderates drinkers (20-40 g. alcohol per day). Average consumption of alcohol was from 26 g/day + 29.9 grams. In order to quantify the random error, the confidence interval was set at 95. The methods used to test the biological markers were 2 x 2 tables and the calculation of indicators of sensitivity (S). specificity (E), positive predictive value (Vp+), negative predictive value (Vp-) and effectiveness. The highest S was obtained by associating various markers (65.5%), followed by GGT with 53.9%. The GGT/ALP quotient obtained an E of 95.9% and an AST of 92.2%. The GGT/ALP quotient achieved the best effectiveness (85%) and Vp+ (36.2%) and the association of markers the best Vp-at 92.9%, followed by GGT at 91.3%. In spite of the fact that the markers studied do not meet the conditions required to be considered acceptable as screening (S and E > 80%), their use seems appropriate if their limitations are kept in mind (many false negatives). As the GGT/ALP quotient has the highest E, there are few false positives. In order to decrease the number of false negatives, an evaluation of GGT or marker association can be done for those with negative values. In order to resolve the disadvantages of Vp+, the best solution is to order tests for groups of markers that are most prevalent in heavy drinkers.

[Usefulness of the new classification for regional extension on CT of head and neck cancer]. / Utilidad de la nueva clasificación de la extensión regional en TC del cáncer de cabeza y cuello.

OBJECTIVE: To present the usefulness of the new classification of neck nodes based in commuted tomography (CT). MATERIAL AND METHODS: We present several illustrative images showing neck nodes in each of the new levels (Ia, Ib, IIa, IIb, III, IV, Va, Vb, and VI) as an adjunct to nodal classifications. RESULTS AND CONCLUSION: An imaging-based classification for the cervical nodes allows to know much better their distribution along the neck, helping to find correlation between clinical, radiological and surgical findings.

[Basilar artery aneurysm: report of a case]. / Aneurisma de arteria basilar: a propósito de un caso.

We present a case of a patient with vertigo, disequilibrium and facial palsy. Nistagmus features pointed to a diagnosis of central vertigo. MRI showed a basilar aneurysm that compressed the brain stem and caused a stroke. We review the diagnosis.

[Magnetic resonance: first choice test in the screening of internal auditory canal and cerebellopontine angle tumors]. / Resonancia magnética: prueba de elección en el despistaje de tumores del conducto auditivo interno y ángulo pontocerebeloso.

Although internal auditory canal (IAC) and cerebellopontine angle (CPA) tumors are rare, their clinical suspicion is quite common in the otolaryngology office. MRI is the imaging modality of choice in diagnosing these tumors. Perceived high costs may prevent clinicians from using it as a screening tool. A protocol designed to improve cost-effectiveness in such diagnosis results in a more rationale clinical practice. Our aim was to evaluate the usefulness of MRI as screening tool in diagnosis of IAC and CPA tumors in our population. Between March 1998 and March 2000, a prospective series of 200 cases had a MRI screening requested. MRI were performed following Fast Spin Echo technique, providing T2-weighted images. Gadolinium enhanced MRI was reserved for selected cases. We report on 190 MRI done. We found 7 neuromas (3.5%), one CPA metastasis, one epidermoid cyst and 9 IAC vascular anomalies. Only 138 cases (69%) had normal MRI images. When used following a designed protocol, MRI is our procedure of choice while screening IAC and CPA tumors because it is a cost-effective tool.

[The Connecticut Chemosensorial Clinical Research Center olfaction test: values in healthy volunteers]. / Test de olfato de Connecticut (CCCRC): valores en voluntarios sanos.

OBJECTIVE: To know the values of the olfactory test (CCCRC) performed in healthy people. To analyse how the age and sex affect the test. MATERIAL AND METHODS: Descriptive study in 100 volunteers with no olfactory disorders. We used CCCRC olfactory test, which it has an odor threshold component, an odor identification component and a composite score. We analysed how age and sex variables affect olfactory test data, listing a t-Student test. The size sample is calculated to 0.05 alfa error. RESULTS: Threshold test data mean was 5.8. Identification test data mean was 7.5. Composite score mean was 6.7. CONCLUSION: Age is a significant factor in our study but not sex. Sample size is sufficient to analyze normal values. Our results are similar to other authors.

HLA and non-HLA genetic factors in Japanese IDDM.

The HLA of 56 unrelated Japanese with insulin-dependent diabetes mellitus (IDDM) was investigated and reconfirmed their role in the pathogenesis by restriction fragment length polymorphism (RFLP). DQw4 showed the highest correlation to IDDM not only within the DQ system but among all the antigens, suggesting that HLA-DQ might play the most important role in the development of IDDM similar as in Caucasians. When the amino acid sequences of DQA1 and DQB1 alleles were analyzed to find susceptibility to IDDM, common features were observed. That is, in any ethnic group, DQA1 alleles of non-Leu at 76th residue combined with DQB1 alleles of non-Asp at 57th residue show association with IDDM, whereas other combinations give rise to negative association. However, two exceptions were observed in case of Japanese IDDM patients with DQw4 and DQw9. Since DQw4 and DQw9 are in strong linkage disequilibrium with DRB1 containing non-Asp-57th, mixed isotype molecules of DQA1 and DRB1 might be responsible to determine IDDM susceptibility. Furthermore, several non-HLA genes, the polymorphism in the genes encoding the alpha (A), beta (B) and gamma (G) chains of the T-cell receptor (TCRA, TCRB and TCRG), insulin gene (INS) and three closely linked polymorphic genes on chromosome 11q23; Thy-1 (THY1), T3-D (CD3D) and c-ets proto oncogene (ETS1) were analyzed. Only the EST1 gene showed a significant association with IDDM by AvaII-polymorphic fragment (P less than 0.03). These results were discordant with some of the strongly associated genes observed in Caucasians. The discrepancy of the HLA and non-HLA results between both ethnic groups is discussed.