Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery.

OBJECTIVES: (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. METHOD: The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression "Do you feel depressed?" (DEPQ). RESULTS: The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. CONCLUSIONS: A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.

Comprensiones alrededor del concepto de tránsito a la vida adulta y su relación con la autonomía desde el paradigma sistémico / Understandings Around the Concept of Transition to Adulthood and its Relationship with Autonomy From the Systemic Paradigm

Resumen El presente artículo parte de la importancia que el tránsito a la vida adulta ha adquirido a lo largo del tiempo, por ser un tema de reflexión y de múltiples estudios para conocer cómo las condiciones de hoy en día permiten este proceso en los jóvenes. Este artículo es un estudio cualitativo de revisión sistemática y tuvo como objetivo describir el tránsito a la adultez desde dos perspectivas. La primera, una construcción por medio de investigaciones realizadas por varios autores, los cuales encontraron que la transición a la adultez está mediada por aspectos como la autonomía, los nuevos roles, las expectativas individuales, las demandas, entre otras. Y la segunda, una visión anclada a paradigmas emergentes y el enfoque sistémico, que plantean que el tránsito a la vida adulta se ve permeado por elementos como la desvinculación, la individuación y las dinámicas familiares. La revisión permitió concluir que las condiciones familiares y sociales en las que se desarrolla el individuo son determinantes en su tránsito a la vida adulta, favoreciendo o dificultando este proceso.

Abstract This article is based on the importance that the transition to adulthood has had over time, as it is a subject of reflection and multiple studies that aim to understand how the current conditions allow this process in young people. This is a qualitative study of systematic review and its objective is to describe the transition to adulthood from two perspectives. The first, a construction through research conducted by different authors, who found that the transition to adulthood is mediated by aspects such as autonomy, new roles, individual expectations, and demands, among others. The second one, a vision anchored to emerging paradigms and the systemic approach, which suggests that the transition to adulthood is influenced by elements such as decoupling, individuation, and family dynamics. The review made it possible to conclude that the social and family conditions in which the individual develops are determining factors in his/her transition to adulthood, either favoring or hindering this process.

Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery.

OBJECTIVES: (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. METHOD: The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression "Do you feel depressed?" (DEPQ). RESULTS: The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. CONCLUSIONS: A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.

Implementing a distress screening program in a thoracic surgery service. / Implementación de un programa de cribado del malestar emocional en un servicio de cirugía torácica.

INTRODUCTION: The aim of the present study was to examine the diagnostic accuracy of screening tests in detecting cases requiring psychological intervention among patients referred for thoracic surgery. METHODS: Emotional distress was evaluated in 105 patients referred for thoracic surgery by means of a diagnostic psychological interview (criterion variable). The screening ability of the following methods was analyzed: the physician's opinion (Yes/No), Hospital Anxiety and Depression Scale (HADS), single-item interview: «Are you depressed?¼ (Depression Question, ADEP) (1-5) and the single-item interview: «Are you anxious?¼ (Anxiety Question, ANXQ) (1-5). RESULTS: According to the clinical interview, 34% of the patients were clinical cases requiring psychological intervention. The total HADS (cut-off point of 10) showed a sensitivity=0.89, specificity=0.75 and AUC=0.883; the ADEP scale (>1) showed a sensitivity=0.79, specificity=0.74 and AUC=0.795; the ANXQ scale (>1) showed a sensitivity=0.78, specificity=0.41 and AUC=0.690; and the physician's opinion showed a sensitivity=0.47 and specificity=0.86. CONCLUSIONS: A high percentage of patients referred for thoracic surgery required psychological intervention. The best instrument to identify those patients requiring psychological care, taking a psychological interview as the criterion variable, was the total HADS score. This test is brief, simple and well accepted by patients; it is easy to implement within a thoracic surgery service and has a good diagnostic accuracy.

Effect of incretin therapies compared to pioglitazone and gliclazide in non-alcoholic fatty liver disease in diabetic patients not controlled on metformin alone: An observational, pilot study. / Efecto de las terapias incretínicas comparadas con pioglitazona y gliclazida en la esteatosis hepática no alcohólica de los pacientes diabéticos no controlados solo con metformina: estudio observacional piloto.

AIM: To compare the effect of different hypoglycemic drugs on laboratory and ultrasonographic markers of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes not controlled on metformin alone. METHODS: Prospective study of diabetic patients treated with metformin in combination with gliclazide, pioglitazone, sitagliptin, exenatide, or liraglutide. NAFLD was assessed by abdominal ultrasound and NAFLD fibrosis score was calculated at baseline and 6 months. RESULTS: Fifty-eight patients completed 6 months of follow-up: 15 received gliclazide, 13 pioglitazone, 15 sitagliptin, 7 exenatide, and 8 liraglutide. NAFLD affected 57.8% of patients at baseline, and its ultrasonographic course varied depending on changes in weight (P=.009) and waist circumference (P=.012). The proportions of patients who experienced ultrasonographic improvement in the different treatment groups were: 33.3% with gliclazide, 37.5% with pioglitazone, 45.5% with sitagliptin, 80% with exenatide, and 33% with liraglutide (P=.28). CONCLUSIONS: Qualitative ultrasonographic NAFLD improvement in diabetic patients treated with metformin in combination with other hypoglycemic drugs is associated to change over time in weight and waist circumference. Long-term clinical trials are needed to assess whether incretin therapies result in better liver outcomes than other hypoglycemic therapies.

Longitudinal analysis of participants in the KEEP Mexico's chronic kidney disease screening program.

BACKGROUND AND AIMS: The Kidney Early Evaluation Program (KEEP) is a free screening and educational program aimed at detecting chronic kidney disease (CKD) among adult individuals who are at high-risk (those with diabetes, hypertension, or family history of these conditions or CKD). Confirmation of CKD diagnosis requires persistence of albuminuria or estimated GFR <60 mL/min for at least 3 months. We undertook this study to determine in a follow-up KEEP done at least 1 year after a baseline KEEP the following: 1) CKD incidence among individuals who initially tested negative for CKD, 2) transitions between CKD stages among individuals who initially tested positive for CKD. METHODS: A random sample of KEEP participants was invited to participate in a follow-up KEEP between 2008 and 2010. Paired analyses were conducted to compare CKD stages between baseline and follow-up KEEP. RESULTS: A total of 434 individuals with a mean age of 49 years and 77% females participated in the study. Overall CKD prevalence in the baseline KEEP was 24%, and most patients were unaware of the diagnosis. In the follow-up KEEP, CKD incidence was 14%. The percentage of patients who tested positive for CKD in the baseline KEEP and who remained positive regardless of stage in the follow-up KEEP was 40% for those with stage 1 at baseline, 52% for those with stage 2, 65% for those with stage 3, and 100% for those with stages 4 or 5. CONCLUSIONS: Screening for CKD among high-risk individuals is uncommon. KEEP is an effective program for detecting CKD.

N-oleoyldopamine enhances glucose homeostasis through the activation of GPR119.

G protein-coupled receptor 119 (GPR119) is largely restricted to pancreatic insulin-producing beta-cells and intestinal glucagon-like peptide-1-producing L-cells. Synthetic agonists of this receptor elicit glucose-dependent release of these endocrine factors, thereby enhancing glycemic control. Oleoylethanolamide also activates GPR119, but it remains unclear whether endogenous production of this lipid modulates GPR119 activity under normal or dysglycemic conditions. We show here that a relatively diverse set of lipid amides activate GPR119. Among these, the endovallinoid N-oleoyldopamine (OLDA) stimulated cAMP accumulation in GPR119-transfected cells as effectively as oleoylethanolamide and the previously described synthetic agonist AR231453. None of these lipid amides increased cAMP in control-transfected cells or in cells transfected with a number of other G protein-coupled receptors. OLDA stimulated both cAMP accumulation and insulin release in HIT-T15 cells, which express GPR119 endogenously, and in GPR119-transfected RIN-5F cells. Oral administration of OLDA to C57bl/6 mice elicited significant improvement in glucose tolerance, whereas GPR119-deficient mice were essentially unresponsive. OLDA also acutely elevated plasma gastric inhibitory peptide levels, a known hallmark of GPR119 activation. OLDA represents a possible paracrine modulator of GPR119 in pancreatic islets, where markers of dopamine synthesis correlated well with GPR119 expression. However, no such correlation was seen in the colon. Collectively, these studies indicate that multiple, distinct classes of lipid amides, acting via GPR119, may be important modulators of glucose homeostasis.

Propuesta de validación de indicadores y estándares para el manejo del dolor en el paciente / Proposal for validation of indicators and standards for pain management in the patient / Proposta de validação estandares e indicadores para o manuseio do dor em paciente

El dolor es una experiencia sensorial y emocional desagradable relacionada con daño a los tejidos. El objetivo fue validar los estándares e indicadores para el manejo del dolor. Es un estudio transversal y descriptivo. Se utilizó el modelo de estándares de A. Donavedis. El universo fueron 150 enfermeras y la muestra 109. El proceso de validación se realizó en tres etapas: En laprimera se utilizó la técnica delphi en 24 enfermeras expertas con dos rondas. En la segunda una prueba piloto en el 10% de la muestra, en donde se validó la consistencia con el alfa de Cronbach con índices de validación de exactitud mayores a 0,711. En la tercera, se midió la precisión utilizando el Modelo de Capacidad de Procesos (Icp). En conclusión el instrumento se validó contres estándares: 7 de estructura, 13 de proceso y 4 de resultado todos con un Icp máximo mayores a uno.

Rehabilitation of atrophic maxilla: a review of 101 zygomatic implants.

INTRODUCTION: Zygomatic implants are a good rehabilitation alternative for upper maxilla with severe bone reabsorption. These implants reduce the need for onlay-type bone grafting in the posterior sectors and for maxillary sinus lift procedures - limiting the use of bone grafts to the anterior zone of the upper jaw in those cases where grafting is considered necessary. OBJECTIVE: To evaluate the survival of 101 zygomatic implants placed in upper maxilla presenting important bone reabsorption, with a follow-up of 1-72 months. PATIENTS AND METHODS: A retrospective study was made of 101 Zygoma(R) implants (Nobel Biocare, Göteborg, Sweden) placed in 54 patients with totally edentulous and atrophic upper maxilla, in the period between 1998-2004. There were 35 women and 19 men, subjected to rehabilitation in the form of fixed prostheses and overdentures using 1-2 zygomatic implants and 2-7 implants in the anterior maxillary zone. The principal study variables were smoking, a history of sinusitis, the degree of bone reabsorption, and peri-implant bone loss, among others. RESULTS: The descriptive analysis of the 101 zygomatic implants placed in 54 patients with a mean age of 56 years (range 38-75) yielded a percentage survival of 96.04%, with four failed implants that were removed (two before and two after prosthetic loading). Nine patients were smokers, and none of the 54 subjects reported a history of sinus disorders. DISCUSSION AND CONCLUSIONS: Zygomatic implants are designed for use in compromised upper maxilla. They allow the clinician to shorten the treatment time, affording an interesting alternative for fixed prosthetic rehabilitation. This study confirms that zygomatic bone offers predictable anchorage and acceptable support function for prostheses in atrophic jaws. However, these implants are not without complications. Longer-term evaluations are needed of zygomatic implant survival in order to establish a correct clinical prognosis.

A role for intestinal endocrine cell-expressed g protein-coupled receptor 119 in glycemic control by enhancing glucagon-like Peptide-1 and glucose-dependent insulinotropic Peptide release.

We recently showed that activation of G protein-coupled receptor 119 (GPR119) (also termed glucose dependent insulinotropic receptor) improves glucose homeostasis via direct cAMP-mediated enhancement of glucose-dependent insulin release in pancreatic beta-cells. Here we show that GPR119 also stimulates incretin hormone release and thus may regulate glucose homeostasis by this additional mechanism. GPR119 mRNA was found to be expressed at significant levels in intestinal subregions that produce glucose-dependent insulinotropic peptide and glucagon-like peptide (GLP)-1. Furthermore, in situ hybridization studies indicated that most GLP-1-producing cells coexpress GPR119 mRNA. In GLUTag cells, a well-established model of intestinal L-cell function, the potent GPR119 agonist AR231453 stimulated cAMP accumulation and GLP-1 release. When administered in mice, AR231453 increased active GLP-1 levels within 2 min after oral glucose delivery and substantially enhanced total glucose-dependent insulinotropic peptide levels. Blockade of GLP-1 receptor signaling with exendin(9-39) reduced the ability of AR231453 to improve glucose tolerance in mice. Conversely, combined administration of AR231453 and the DPP-4 inhibitor sitagliptin to wild-type mice significantly amplified both plasma GLP-1 levels and oral glucose tolerance, relative to either agent alone. In mice lacking GPR119, no such enhancement was seen. Thus, GPR119 regulates glucose tolerance by acting on intestinal endocrine cells as well as pancreatic beta-cells. These data also suggest that combined stimulation of incretin hormone release and protection against incretin hormone degradation may be an effective antidiabetic strategy.

Factores asociados a las tentativas suicidas por intoxicación en adolescentes y atención hospitalaria (Hospital Viedma Enero-Octubre 2007) / Factors associated to the suicidal attempts by poisoning in adolescents and hospitable attention (Hospital Viedma January-October 2007)

El suicidio es un fenómeno complejo que afecta a toda la sociedad, siendo un problema grave de salud pública, por lo que requiere la máxima atención. Su prevención y control no son tarea fácil. Con estas consideraciones se realizó un estudio con el objetivo de, conocer los factores asociados a las tentativas suicidas por intoxicación en adolescentes y atención hospitalaria.Se tomó a todos los pacientes que ingresaron al hospital con el diagnóstico de intento de suicidio por intoxicación; el primer semestre de 2007, de enero a junio; a la vez, a todos los pacientes que ingresaron el mes de noviembre del mismo año.El enfoque y tipo de investigación realizado es cuantitativo, descriptivo y transversal. La información fue obtenida de las historias clínicas de pacientes adolescentes que fueron internados, y a la vez se realizó entrevistas personales, utilizando como instrumento una guía de entrevista. Los resultados más significativos muestran que las mujeres adolescentes fueron las que más realizaron intentos suicidas (77%), a diferencia de los varones que fue de un 23%. Las edades con mayor prevalencia fue de 19 a 21 años (52%), se da más en adolescentes solteros en un 86%, adolescentes que estudian, 54%; que se encuentran cursando el nivel secundario un 61%. Son adolescentes que viven en el área urbana (77%).Así mismo son adolescentes que provienen de familias disfuncionales (97%) e incompletas con (56%); la causa más común para los intentos suicidas fueron el motivo pasional (41%) y problemas familiares (36%). El tóxico más utilizado (70%) fue el carbamato.Palabras clave: Suicidio, tóxico, familia, adolescente, violencia, droga, bebida, sociedad, inestabilidad, personalidad.

Characterization of partial Hox gene sequences in annual fish of the subfamily Cynolebiatinae (Cyprinodontiformes, Rivulidae)

Hox genes encode a family of transcription factors implicated in conferring regional identity along the anteroposterior axis in developing animal embryos. These genes are organized in genomic clusters, expressed collinearly and highly conserved in vertebrates. Among teleost, South American annual killifishes of the Cynolebiatinae subfamily represent an excellent model in development studies because their embryos are capable of undergoing reversible developmental arrest (diapause) at three well-defined morphological stages. They are also an excellent model for evolutionary studies due to the high rates of mutation of their mitochondrial genome, their karyotypic divergence and their morphological variability. In this study, three partial homeobox sequences were isolated from different species of the Cynolebiatinae subfamily. Phylogenetic analyses and sequence comparisons revealed that they belong to the anterior Hox complex group, specifically to paralogue groups 1 and 3. This is the first time that partial Hox genes have been described in species of the Cynolebiatinae subfamily.