RESUMEN
Tuberculosis (TB) is an infectious disease that causes a great number of deaths in the world (1.5 million people per year). This disease is currently treated by administering high doses of various oral anti-TB drugs for prolonged periods (up to 2 years). While this regimen is normally effective when taken as prescribed, many people with TB experience difficulties in complying with their medication schedule. Furthermore, the oral administration of standard anti-TB drugs causes severe side effects and widespread resistances. Recently, we proposed an original platform for pulmonary TB treatment consisting of mannitol microspheres (Ma MS) containing iron (III) trimesate metal-organic framework (MOF) MIL-100 nanoparticles (NPs). In the present work, we loaded this system with the first-line anti-TB drug isoniazid (INH) and evaluated both the viability and safety of the drug vehicle components, as well as the cell internalization of the formulation in alveolar A549 cells. Results show that INH-loaded MOF (INH@MIL-100) NPs were efficiently microencapsulated in Ma MS, which displayed suitable aerodynamic characteristics for pulmonary administration and non-toxicity. MIL-100 and INH@MIL-100 NPs were efficiently internalized by A549 cells, mainly localized in the cytoplasm. In conclusion, the proposed micro-nanosystem is a good candidate for the pulmonary administration of anti-TB drugs.
Asunto(s)
Antituberculosos/farmacología , Isoniazida/farmacología , Estructuras Metalorgánicas/farmacología , Tuberculosis Pulmonar/tratamiento farmacológico , Células A549 , Administración por Inhalación , Antituberculosos/administración & dosificación , Antituberculosos/química , Cápsulas/administración & dosificación , Cápsulas/química , Cápsulas/farmacología , Supervivencia Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Humanos , Isoniazida/administración & dosificación , Isoniazida/química , Estructuras Metalorgánicas/administración & dosificación , Estructuras Metalorgánicas/química , Tamaño de la PartículaRESUMEN
PURPOSE: To assess changes in the self-reported performance of smoking cessation interventions according to the 5A's model (Ask; Advise; Assess; Assist; and Arrange follow-up) among clinicians; and to identify the main barriers and facilitators in smoking cessation implementation before and after an online smoking cessation training program. DESIGN: Pre-post evaluation. METHODS: We assessed self-reported smoking cessation interventions in the implementation of the 5A's model among clinicians working in Catalan hospitals (Spain). In addition, we assessed individual-, behavioral-, and organizational-level factors that act as barriers and facilitators in the implementation of the 5A's model. We used a questionnaire of 63 items reflecting each of the 5A's performance (scored from 0 = none to 10 = most possible). The questionnaire was completed both immediately before and 6 months after the training. We analyzed the data of those participants who had a clinical role and answered pre- and post-questionnaires. We used the nonparametric test for paired data (Wilcoxon) to examine changes in scores. FINDINGS: A total of 127 clinicians completed the pre-post questionnaire; 63.0% were registered nurses, 17.3% were nursing assistants, 7.9% were physicians, and 11.8% were other professionals (p < .001). Overall, there were significant increases in the implementation of the assist component (from a score of 4.5 to 5.2; p < .003) and arrange a follow-up component (from 3.6 to 4.5; p < .001) of the intervention. Scores in the perception of the level of overall preparation, preparedness in using smoking cessation drugs, level of competence, and organizational recognition improved (p < .001) at the follow-up; however, the score in the perception that implementing smoking cessation is part of their job decreased (from 6.3 to 4.4; p < .001). CONCLUSIONS: The online training had a positive impact on the implementation of assist and arrange follow-up components. Although self-preparedness in the management of smokers increased, the motivation and involvement of key professionals decreased. Organizational factors related to the incorporation of resources (such as protocols, records, etc.) should be improved for the correct progression of smoking cessation interventions within the institutions. CLINICAL RELEVANCE: Smoking cessation training programs should incorporate some motivational content to increase the engagement of health professionals in smoking cessation interventions in their clinical practice.
Asunto(s)
Personal de Salud/educación , Hospitales/estadística & datos numéricos , Cese del Hábito de Fumar/métodos , Adulto , Femenino , Humanos , Masculino , Autoinforme , España , Encuestas y CuestionariosRESUMEN
BACKGROUND: Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws. METHODS: Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law). RESULTS: Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project. CONCLUSIONS: A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.
Asunto(s)
Hospitales , Personal de Hospital , Política para Fumadores/legislación & jurisprudencia , Cese del Hábito de Fumar , Fumar/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Fumar/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos , Prevención del Hábito de Fumar , España/epidemiología , Encuestas y Cuestionarios , Nicotiana , Contaminación por Humo de Tabaco/prevención & control , Tabaquismo/epidemiología , Adulto JovenRESUMEN
Anti glomerular basement membrane disease (AGBM) is an autoinmune disorder characterised by the presence of anti-glomerular basement membrane (Anti-GBM) antibodies, alveolar hemorrhage, necrotizing glomerulonephritis, and linear deposition of immunoglobulins through direct inmunofluorescence. Genetic predisposition, among other factors, plays an important role in the development of the disease. Previous studies have shown that HLA-DR15 and HLA-DR4 increase the risk of presenting it, while HLA-DR1 and HLA-DR7 protect against its development. We describe the first case of two non-twin siblings with AGBM and identical HLA, with HLA-DR4 as risk factor and HLA-DR7 as protection factor. We propose the importance of analysing HLA in siblings of patients with AGBM, to determine the degree of genetic susceptibility and to carry out a close follow-up on them, with the aim of achieving an early diagnosis and treatment in case of presenting the disease.
Asunto(s)
Enfermedad por Anticuerpos Antimembrana Basal Glomerular , Glomerulonefritis , Humanos , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , Antígeno HLA-DR7 , Antígeno HLA-DR4 , HermanosRESUMEN
In this work, we propose chitosan (CS)-based nanocapsules (NCs) for pulmonary gene delivery. Hyaluronic acid (HA) was incorporated in the NCs composition (HA/CS NCs) aiming to promote gene transfection in the lung epithelium. NCs were loaded with a model plasmid (pCMV-ßGal) to easily evaluate their transfection capacity. The plasmid encapsulation efficiencies were of approx. 90%. To facilitate their administration to the lungs, the plasmid-loaded NCs were microencapsulated in mannitol (Ma) microspheres (MS) using a simple spray-drying technique, obtaining dry powders of adequate properties. In vivo, the MS reached the deep lung, where the plasmid-loaded CS-based NCs were released and transfected the alveolar cells more homogeneously than the control formulation of plasmid directly microencapsulated in Ma MS. The HA-containing formulation achieved the highest transfection efficiency, in a more extended area and more homogeneously distributed than the rest of tested formulations. The new micro-nanostructured platform proposed in this work represents an efficient strategy for the delivery of genetic material to the lung, with great potential for the treatment of genetic lung diseases.
RESUMEN
Grafting typically offers a shortcut to breed tree orchards throughout a multidimensional space of traits. Despite an overwhelming spectrum of rootstock-mediated effects on scion traits observed across several species, the exact nature and mechanisms underlying the rootstock-mediated effects on scion traits in cacao (Theobroma cacao L.) plants often remain overlooked. Therefore, we aimed to explicitly quantify rootstock-mediated genetic contributions in recombinant juvenile cacao plants across target traits, specifically cadmium (Cd) uptake, and its correlation with growth and physiological traits. Content of chloroplast pigments, fluorescence of chlorophyll a, leaf gas exchange, nutrient uptake, and plant biomass were examined across ungrafted saplings and target rootstock × scion combinations in soils with contrasting levels of Cd. This panel considered a total of 320 progenies from open-pollinated half-sib families and reciprocal full-sib progenies (derived from controlled crosses between the reference genotypes IMC67 and PA121). Both family types were used as rootstocks in grafts with two commercial clones (ICS95 and CCN51) commonly grown in Colombia. A pedigree-based best linear unbiased prediction (A-BLUP) mixed model was implemented to quantify rootstock-mediated narrow-sense heritability (h 2) for target traits. A Cd effect measured on rootstocks before grafting was observed in plant biomass, nutrient uptake, and content of chloroplast pigments. After grafting, damage to the Photosystem II (PSII) was also evident in some rootstock × scion combinations. Differences in the specific combining ability for Cd uptake were mostly detected in ungrafted rootstocks, or 2 months after grafting with the clonal CCN51 scion. Moderate rootstock effects (h 2> 0.1) were detected before grafting for five growth traits, four nutrient uptake properties, and chlorophylls and carotenoids content (h 2 = 0.19, 95% CI 0.05-0.61, r = 0.7). Such rootstock effects faded (h 2< 0.1) when rootstock genotypes were examined in soils without Cd, or 4 months after grafting. These results suggest a pervasive genetic conflict between the rootstock and the scion genotypes, involving the triple rootstock × scion × soil interaction when it refers to Cd and nutrient uptake, early growth, and photosynthetic process in juvenile cacao plants. Overall, deepening on these findings will harness early breeding schemes of cacao rootstock genotypes compatible with commercial clonal scions and adapted to soils enriched with toxic levels of Cd.
RESUMEN
Anti-glomerular basement membrane disease (AGBM) is an autoinmune disorder characterized by the presence of anti-glomerular basement membrane (anti-GBM) antibodies, alveolar hemorrhage, necrotizing glomerulonephritis, and linear deposition of immunoglobulins through direct inmunofluorescence. Genetic predisposition, among other factors, plays an important role in the development of the disease. Previous studies have shown that HLA-DR15 and HLA-DR4 increase the risk of presenting it, while HLA-DR1 and HLA-DR7 protect against its development. We describe the first case of two non-twin siblings with AGBM and identical HLA, with HLA-DR4 as risk factor and HLA-DR7 as protection factor. We propose the importance of analyzing HLA in siblings of patients with AGBM, to determine the degree of genetic susceptibility and to carry out a close follow-up on them, with the aim of achieving an early diagnosis and treatment in case of presenting the disease.
RESUMEN
Playing-related musculoskeletal disorders represent a commitment to the health and competence of musicians. This review aimed to analyse how musician's posture influences instrumental practice and the appearance of musculoskeletal disorders related to musical performance. To do this, a literature search was carried out in the Medline, CINAHL and Web of Science, and Pubmed databases, obtaining 14 valid articles after application of the inclusion and exclusion criteria. Several authors analysed posture during instrumental practice, posture and interpretive quality, and the appearance of musculoskeletal disorders related to musical performance and postural quality, based on distinct variables such as the instrument and interpretive anxiety. Posture seems to be one of the most important risk factors, influencing both musculoskeletal and interpretive levels. Physiotherapy could be effective for prevention and treatment.
Asunto(s)
Enfermedades Musculoesqueléticas/etiología , Música , Enfermedades Profesionales/etiología , Postura/fisiología , Terapia por Ejercicio , Humanos , Enfermedades Musculoesqueléticas/prevención & control , Enfermedades Musculoesqueléticas/terapia , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/terapiaRESUMEN
BACKGROUND AND AIMS: Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self-reported receipt of the 5As (ask, advise, assess, assist and arrange). DESIGN: Multi-center cross-sectional study. SETTING AND PARTICIPANTS: Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014-2015. MEASUREMENTS: We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0 : no intervention; A1 : ask; A2 : ask and advise; A3 : A2 and assess; A4 : A3 and assist; and A5 : A4 and arrange a follow-up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi-level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. FINDINGS: A total of 60.4% (n = 624) of patients had been asked (A1 ) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2 ), 26.6% (n = 48) assessed (A3 ) and 4.6% (n = 10) received all the components of the 5As (A5 ). Middle-aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69-7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11-4.34) were most likely to have been asked, advised and assessed (A3 ). The cessation intervention was most frequently performed by physicians. CONCLUSIONS: In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation.
Asunto(s)
Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Cese del Hábito de Fumar/estadística & datos numéricos , Adulto , Estudios Transversales , Atención a la Salud , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Fumadores/estadística & datos numéricos , España , Encuestas y Cuestionarios , Tabaquismo/terapiaRESUMEN
Although nanoscaled metal-organic frameworks (nanoMOFs) are promising drug carriers, their appropriate formulation remains almost unexplored and basically restricted to intravenous routes. Lungs, beneficiating from a large absorption surface and low enzymatic presence, are a very attractive target for both local and systemic delivery. However, pulmonary nanoMOF formulation is a pending and defying task. Thus, we propose a pioneer nanoMOF-based microsphere system as a potential platform for pulmonary administration. A biocompatible nanoMOF was successfully encapsulated in mannitol by a simple and continuous spray-drying technique. Upon intratracheal administration to rats, the resulting formulation, exhibiting optimal properties (i.e., homogeneity, size, density, and spray-drying process yield), was able to release the intact nanoMOF carrier uniformly along the lungs, reaching the bronchioles and alveoli.
Asunto(s)
Sistemas de Liberación de Medicamentos/métodos , Excipientes/química , Estructuras Metalorgánicas/química , Microesferas , Administración por Inhalación , Animales , Dextranos/química , Manitol/química , Estructuras Metalorgánicas/administración & dosificación , Prueba de Estudio Conceptual , Ratas Wistar , alfa-Ciclodextrinas/químicaRESUMEN
OBJECTIVE: To examine patient perceptions of the role of health care providers in tobacco control and tobacco-related services they should provide after the introduction of national smoke-free hospital grounds legislation in Spain. DESIGN: Multi-center cross-sectional study. SETTING: Thirteen hospitals in Barcelona province in 2014-2015. PARTICIPANTS: A total of 1,047 adult hospital patients, with a stay ≥ 24 h were randomly selected. METHOD: We explored participants' perceptions of the role of health professionals and hospitals in tobacco control by asking about their agreement with several statements after the introduction of national legislation on smoke-free hospital grounds: (i) health professionals "should set an example and not smoke" and "should provide smoking cessation support"; (ii) hospitals "should provide smoking cessation treatments" and are "role model organizations in compliance with the smoke-free legislation", and (iii) "hospitalization is a perfect moment to quit smoking". Responses were described overall and according to participant and hospital characteristics: patient sex and age, type of hospital unit, number of beds, and smoking prevalence among hospital staff. RESULTS: The majority of participants considered that health professionals should be role models in tobacco cessation (75.3%), should provide smoking cessation support to patients (83.0%), and that hospitalization is a good opportunity for initiating an attempt to quit (71.5%). Inpatients admitted to general hospitals where smoking cessation was not given as part of their portfolio, with a low level of implementation in tobacco control, and who stayed in surgical units had higher expectations of receiving smoking cessation interventions. CONCLUSIONS: Inpatients strongly support the role of hospitals and health professionals in tobacco control and expect to receive smoking cessation interventions during their hospital stay. Systematically providing smoking cessation services in hospitals may have a relevant impact on health outcomes among smokers and on health care system expenditures.
Asunto(s)
Pacientes Internos/psicología , Legislación Hospitalaria , Percepción , Contaminación por Humo de Tabaco/prevención & control , Fumar Tabaco/legislación & jurisprudencia , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cese del Hábito de Fumar , EspañaRESUMEN
This article presents analyses of soil and environmental information for the Darro River basin (Granada-Spain) preliminary to its hydrological and forestry restoration. These analyses were carried out using a geographical information system (GIS) and employing a new procedure that adapts hydrological forest-restoration methods. The complete analysis encompasses morphological conditions, soil and climate characteristics as well as vegetation and land use. The study investigates soil erosion in the basin by using Universal Soil Loss Equation (USLE) and by mapping erosion fragility units. The results are presented in a set of maps and their analysis, providing the starting point for river basin management and the hydrological and forestry-restoration project that was approved at the end of 2015. The presence of soft substrates (e.g. gravel and sand) indicates that the area is susceptible to erosion, particularly the areas that are dominated by human activity and have little soil protection. Finally, land use and vegetation cover were identified as key factors in the soil erosion in the basin. According to the results, river authorities have included several measures in the restoration project aimed at reducing the erosion and helping to recover the environmental value of this river basin and to include it in recreation possibilities for the community of Granada. The presented analytical approach, designed by the authors, would be useful as a tool for environmental restoration in other small Mediterranean river basins.
RESUMEN
INTRODUCTION: A comprehensive smoking ban was recently enacted for acute-care hospital campuses in Spain. The aim of this study was to assess the prevalence and patterns of smoking among inpatients before and during hospitalization. METHODS: Multi-center cross-sectional study was conducted in 13 hospitals in the province of Barcelona, Spain from May 2014 to May 2015. Participants were adults who provided informed consent. The sample size was calculated to be representative of each hospital (prevalence 29.4%, precision ± 5%, error 5%). We approached 1228 subjects, 888 accepted to participate and 170 were replaced (were not available or declined to participate). Final sample comprised 1047 subjects. We used a computer-assisted personal interview system to collect data, including sociodemographic variables and use of tobacco before and during hospitalization. Smoking status was validated with exhaled carbon monoxide. We calculated overall tobacco prevalence and investigated associations with participant and center characteristics. We performed multiple polytomous and multilevel logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustments for potential confounders. RESULTS: In all, 20.5% (95% CI: 18.1-23.0) of hospitalized patients were smokers. Smoking was most common among men (aOR=7.47; 95% CI: 4.88-11.43), young age groups (18-64 years), and individuals with primary or less than primary education (aOR=2.76; 95% CI: 1.44-5.28). Of the smokers, 97.2% were daily consumers of whom 44.9% had medium nicotine dependence. Of all smokers, three-quarters expressed a wish to quit, and one-quarter admitted to consuming tobacco during hospitalization. CONCLUSIONS: Our findings indicate the need to offer smoking cessation interventions among hospitalized patients in all units and service areas, to avoid infringements and increase patient safety, hospital efficiency, and improve clinical outcomes. Hospitalization represents a promising window for initiating smoking interventions addressed to all patients admitted to smoke-free hospitals, specially after applying a smoke-free campus ban.
RESUMEN
This study's purpose was to analyse basic reading processes in different age groups of Spanish-speaking children using confirmatory factor analysis (CFA) and regression analysis. Two hundred forty-five children (aged 4 years and 9 months, to 9 years and 7 months; 120 boys, 125 girls), native Spanish-speakers, were selected from schools in Madrid. All participants were in either their last year of preschool or the first three years of elementary school, depending on their age. Nine classic reading tasks were created and administered to measure three reading skills: word recognition, phonological awareness, and reading comprehension. The results of the CFA show that data fit to proposed model with a general reading factor based on these three reading skills χ2(27) = 29.03, p = .36, RMSEA = .02, 90% CIs [.0, .05], CFI = 1.0. The word recognition skills were the best at describing reading performance in preschool children (R 2 = .51 for word identification task); phonological awareness, especially rhyme identification task, discriminated well until second grade (R 2 = .60); and finally, reading comprehension, basically phrase completion task, were the best measure of reading performance in third grade (R 2 = .45).
Asunto(s)
Desarrollo Infantil/fisiología , Comprensión/fisiología , Lenguaje , Reconocimiento Visual de Modelos/fisiología , Lectura , Niño , Preescolar , Femenino , Humanos , Pruebas del Lenguaje , Masculino , EspañaRESUMEN
RESUMEN El síndrome de Blue Rubber Bled Nevus se caracteriza por múltiples malformaciones cutáneas, asociadas con malformaciones menores en órganos internos, (comúnmente afectan los órganos del sistema digestivo y el sistema nervioso central). A nivel mundial, se afirma que hay cerca de 1 a 2 millones de individuos afectados por este síndrome, y se cree que incide en 1 de cada 6000. En recién nacidos la incidencia se ha calculado en menos de 1 caso por 100 000 persona/año. Se presentó un caso de una paciente femenina de 8 años de edad, con antecedentes de hemangiomas múltiples de color azul violáceo, distribuidos por toda la superficie corporal, de diferentes diámetros. Algunos protruyen y depresibles al tacto. Presentaba ptosis palpebral y movimientos torpes de los cuatro miembros, epilepsia y afectaciones del neurodesarrollo el cual corresponde con una edad cronológica de 11 meses. Mostraba una disminución importante de la visión. Presencia de pie valgo a predominio derecho. Apareció anemia leve por déficit de hierro, inmunoglobulina C3 y C4, la química sanguínea al límite de lo normal. La resonancia magnética nuclear mostró importantes signos de atrofia cortical, más acentuados en región temporal derecha. Son entidades de muy escasa presentación y en la provincia de Matanzas es el único caso con este diagnóstico, por lo que constituyó el motivo para la presentación del caso.
ABSTRACT The syndrome of Blue Rubber Bled Nevus is characterized by multiple skin malformations, associated to minor malformations in internal organs (it commonly affects the organs of the digestive system and the central nervous system). It is affirmed that around 1 to 2 millions of individuals are affected by this syndrome worldwide, and it is believed that it has incidence on 1 of each 6000 persons. In newborns the incidence has been calculated in less than 1 case per 100 000 persons/year. The authors presented the case of a female patient, aged 8 years, with antecedents of purplish-blue multiple hemangiomas of different diameters, distributed all over the surface if the body. Several of them are protruding and depressible to the touch. She presented eyelid ptosis and slow movements of the four limbs, epilepsy, and neurodevelopment affectations corresponding to a chronological age of 11 months. She showed an important decrease of the vision. The study showed a slight iron-deficiency anemia, immunoglobulin C3 and C4, blood chemistry at the normal limit. The magnetic resonance imaging showed important signs of cortical atrophy, stronger in the right temporal region. These are entities of scarce presentation and it is the only case with this diagnosis found in the province of Matanzas; that motivated this case presentation.
Asunto(s)
Humanos , Femenino , Niño , Trastornos Psicomotores/diagnóstico , Síndrome , Nevo Azul/diagnóstico , Nevo Azul/microbiología , Nevo Azul/diagnóstico por imagen , Hemangioma/diagnóstico , Hemangioma/microbiología , Hemangioma/diagnóstico por imagen , Nevo Azul/rehabilitación , Epilepsia/diagnósticoRESUMEN
On 2nd of June 2011 the Institut Català d' Oncologia l'Hospitalet--Hospital Duran i Reynals hosted the first Meeting of Multidisciplinary Work in Oncogeriatrics. The reason for the meeting, which follows on from an initiative of the Medical Societies of Radiotherapy, Oncology, Geriatrics and Gerontology and Palliative Care and Medical Oncology, was to initiate a joint line of work among the different specialties that generally take part in the handling of the elderly patient suffering from oncologic pathologies. This document summarises the different subjects covered during the Meeting.
Asunto(s)
Geriatría , Oncología Médica , Neoplasias , Anciano , Humanos , Neoplasias/diagnóstico , Neoplasias/terapia , Guías de Práctica Clínica como AsuntoRESUMEN
Introducción: la ataxia cerebelosa constituye uno de los trastornos motores más complejos asociada a enfermedades neurológicas. Objetivo: destacar la efectividad de la neurorrehabilitación en la reducción del deterioro de las funciones motoras en pacientes atáxicos. Fuente de datos: revisión de la literatura publicada sin límite de fecha y hasta septiembre del 2012, en las bases de datos MedLine, Embase, Hinari, Lilacs y SciELO; estrategia de búsqueda con vocabulario controlado y la inclusión de las siguientes palabras clave: ataxia, neurorrehabilitación, recuperación motora. Se tomaron los criterios de especialistas en neurorrehabilitación del Centro internacional de Restauración Neurológica. Resultados: la terapia física es el factor esencial del proceso de rehabilitación en los pacientes con ataxia, incluye adiestramiento, ejercicios y manipulación física del cuerpo del paciente con la intención de restaurar el movimiento, el equilibrio y la coordinación. Las estrategias terapéuticas en los pacientes con ataxia cerebelosa requieren un enfoque intensivo e interdisciplinario. La recuperación motora en ellos está muy relacionada con el incremento de la capacidad de fuerza después de la aplicación de programas de rehabilitación. En la medida en que aumentan los niveles de fuerza, comienzan a aparecer signos de recuperación en el comportamiento motor, desde actividades tan simples como realizar transferencias de una posición a otra, hasta las más complejas, como es caminar. Conclusiones: el comportamiento motor de los pacientes con ataxia cerebelosa se modifica significativamente con el empleo de la neurorrehabilitación, con registro de mejorías notables en los trastornos de la postura y la marcha, el movimiento y la fuerza
Introduction: cerebellar ataxia is one of the most complex motor impairments derived from neurological diseases. Objective: to highlight the effectiveness of neurorehabilitation of the motor functions in patients with cerebellar ataxia. Data source: systematic literature review of documents published up to September 2012 in MEDLINE, EMBASE, HINARI LILACS and SciELO, search strategy using controlled vocabulary and the keywords ataxia, neurorehabilitation and motor recovery. Several criteria from specialists in neurorehabilitation in the International Center of Neurological Restoration were consulted in and taken into consideration. Results: the physical therapy is the essential factor of the rehabilitation process for ataxic patients and includes training, exercising and physical handling of the patient's body aimed at recovering movement, balance and coordination. The therapeutic strategies for patients with cerebellar ataxia require an intensive and interdisciplinary approach. Motor function recovery was very much related to significant strength increase after implementation of the rehab program. As the strength levels rise, there begins to appear signs of recovery in the patient's motor behavior that covers moving from one position to another including turning up to the most complex ones like walking. Conclusions: the motor behavior of patients suffering cerebellar ataxia can be significantly modified with neurorehabilitation, leading to significant reduction on posture, gait, movement and strength impairments