Cartilage oligomeric matrix protein (COMP) is modified by intra-articular liposomal clodronate in an experimental model of arthritis.

OBJECTIVE: High-dose liposomal bisphosphonates exert apoptotic effects. This work studies the chondroprotective and anti-inflammatory properties of intra-articularly administered low-dose, non-cytotoxic liposomal clodronate. METHODS: Antigen induced arthritis in rabbits was treated with intra-articular injections of liposomal clodronate. Drug effects on cartilage oligomeric matrix protein COMP was assessed using immunohistochemistry and morphometry of synovial membrane and hyaline articular cartilage. RESULTS: COMP remained close to normal in liposomal clodronate treated superficial articular cartilage compared to a significant loss of COMP in arthritis controls treated with empty liposomes. The middle and deep layers of the hyaline articular cartilage were characterized by highly increased COMP expression in liposomal clodronate treated AIA joints compared to controls. In contrast to cartilage, synovial COMP expression was slightly decreased as a result of liposomal clodronate treatment. CONCLUSION: Low-dose, non-cytotoxic liposomal clodronate exerts a dichotomous effect on synovial membrane and articular cartilage COMP in the AIA model. COMP is a useful inflammation marker in the synovial tissue, but it also contributes to the structural integrity of the hyaline articular cartilage forming bridges between type II and IX collagens. Enhancement of COMP in clodronate treated AIA cartilage suggests a chondroprotective and anti-inflammatory effect in the inflammatorily damaged and mechanically strained cartilage.

Actitud hacia la prevención de lesiones por presión en estudiantes de enfermería: cuestionario APuP / Attitude towards pressure injury prevention in nursing students: the APuP questionnaire

OBJETIVOS: Conocer la actitud hacia la prevención de las lesiones por presión que tienen los estudiantes y las estudiantes del Grado en Enfermería. Objetivos secundarios: a) realizar la valoración psicométrica de la versión española del cuestionario Attitudes towards Pressure ulcer Prevention (APuP) (Actitudes hacia la prevención de las UPP) en población de estudiantes y b) identificar los factores formativos asociados con la actitud. MÉTODOS: Estudio observacional transversal, llevado a cabo en la Universidad de Jaén mediante un cuestionario online en estudiantes de los 4 cursos del Grado en Enfermería. Se utilizó el análisis de Rasch para establecer las propiedades psicométricas del cuestionario. Se calculó la puntuación de actitud y su asociación con variables formativas. Para estimar el tamaño del efecto se usó la diferencia estandarizada de medias (d de Cohen). RESULTADOS: Se analizaron un total de 188 cuestionarios válidos. La puntuación media obtenida en el cuestionario APuP fue 22,60 (44,23% del máximo). El cuestionario presenta una buena consistencia global (α = 0,74) y los índices de ajuste de los ítems fueron buenos. Se encontró una actitud menos positiva en estudiantes que habían realizado prácticas clínicas (p < 0,0001) y los de los cursos superiores (p < 0,0001). Existe una correlación inversa entre la puntuación de actitud y la puntuación de conocimientos (r = -0,46). CONCLUSIONES: El cuestionario APuP (versión española) es un instrumento válido y fiable para su uso en estudiantes de enfermería. La actitud hacia la prevención no es positiva en estos estudiantes y se evidencia un posible efecto de la realización de prácticas clínicas y el aumento de conocimientos en una actitud menos favorable

OBJECTIVES: To explore the attitude towards pressure injury prevention of nursing students. Secondary objectives: a) To establish the psychometric properties of the questionnaire of Attitudes towards the prevention of pressure ulcer (APuP) -Spanish version- in student population, and b) To identify the educational factors associated with the attitude. METHODS: A cross-sectional observational and validation study was carried out with students of the four years of the Bachelor in Nursing in the University of Jaén (Spain) using an online survey. Rasch analysis was used to establish the psychometric properties of the questionnaire. Also, the score of attitude and its association with educational variables were analysed. The standardised median difference (Cohen's d) was used to estimate the effect size. RESULTS: A total of 188 valid questionnaires were analysed. The average score obtained in the APuP questionnaire was 22.60 (44.23% of the maximum). The questionnaire has a good overall internal consistency (α=0.74) and the item fit indices were good. It was found a less positive attitude in students who had done clinical placements (p < 0.0001) and those in higher years (p < 0.0001). There is an inverse correlation between the attitude score and the knowledge score (r= -0.46). CONCLUSIONS: The questionnaire of attitudes towards prevention of pressure ulcers (APuP) Spanish version is a valid and reliable instrument to use in nursing students. The attitude towards prevention is not positive in these students and there is some evidence for a possible effect of clinical placements and increased knowledge over a less favourable attitude

[Percutaneous tracheostomy under endoscopic guidance in adolescents]. / Traqueostomía percutánea bajo control endoscópico en adolescentes.

Percutaneous tracheostomy (PT) is a well-established procedure in adult patients who require long-term airway control. Because experience with this procedure is scarce in pediatrics, we report the results of PT by means of a progressive dilatational method with endoscopic guidance in three critically-ill adolescents with severe head injury. PT was performed by means of the Ciaglia Blue Rhino method at the bedside, guided by fiberoptic bronchoscopy by the pediatric intensive care unit staff. No hemodynamic or respiratory compromise was observed during the procedure. No complications were attributable to PT. Two patients were decannulated without incidents. The reported cases indicate that PT can be performed safely, at least in adolescents.

[Burnout syndrome among health workers in pediatrics]. / Síndrome de desgaste profesional en el personal asistencial pediátrico.

BACKGROUND: Burnout syndrome (BS) is a chronic adaptation disorder that provokes serious problems in occupational behavior. OBJECTIVE: In the present study we assessed the prevalence of burnout syndrome in pediatric healthcare workers. DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHODS: In November 2002, the Maslach Burnout Inventory was given to 127 staff members (doctors, nurses and nurse assistants) working in a pediatrics department. The questionnaire includes 22 items that explore three aspects of BS: a) emotional exhaustion; b) depersonalization, and c) personal achievement. RESULTS: The questionnaire was completed by 93 staff members (73.2 % of the whole sample; 83 % women and 17 % men). The mean age was 38.6 +/- 10.2 years and the median number of years worked was 10 (range: 1-37 years). Twenty-nine percent were pediatricians, 50.5 % were nurses and 20.5 % were nurse assistants. A total of 20.8 % had a high level of BS, 19.8 % had a moderate level and 59.4 % showed a low level. When sub-scales were applied, the results showed that 67.7 % of respondents presented a low level of personal achievement, 14.5 % had high scores of emotional exhaustion and 23.9 % obtained high scores in the depersonalization scale. CONCLUSIONS: BS is present in a significant percentage of hospital workers attending pediatric patients. In our sample, the most notable component of BS was the lack of personal achievement. This finding alerted us to the eventual presence of negative attitudes toward self and professional activity, as well as to the loss of interest in pediatric care, low productivity and diminished self-esteem. We believe that specific strategies should be implemented to attenuate the factors influencing the development of BS in pediatric health staff.

Coronavirus COVID-19 / No disponible

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Colaboración entre las revistas de salud pública en España / Collaboration between public health journals in Spain

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Día Internacional para la Prevención del Suicidio (10 de septiembre de 2019). Trabajando juntos por su prevención / No disponible

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Semana Europea de la Vacunación (del 22 al 28 de abril de 2019) / No disponible

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Día Mundial sin Tabaco (31 de mayo de 2019) / No disponible

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Evaluation of a minimally aggressive method of patellofemoral osteoarthritis treatment at 10 years minimum follow-up.

BACKGROUND: Knee osteoarthritis mainly affecting the lateral facet of the patella, especially in young patients, is a definite challenge to the surgeon. Our purpose was to investigate the long-term outcome of a simple operation such as the partial lateral facetectomy on middle-aged to elderly patients with predominant lateral patellofemoral osteoarthritis. METHODS: A retrospective, long-term study of 39 knees (28 females, mean aged at surgery 61yearsold) with a minimum follow-up of 10years was performed. Evaluations included preoperative and postoperative questionnaires, physical examinations, and radiographs. RESULTS: The main outcomes included the initial anterior pain relief, with higher scores using the Knee Society Score (that improved in 84% of the knees), and the eventual failure of the technique, including percentage of patients that required secondary total knee replacement (30% of the knees). CONCLUSION: Partial lateral facetectomy aiming to decrease the high pressure in the lateral facet of the patella confirmed frequent pain relief. This surgical procedure being minimally invasive, relatively simple, and effective in selected patients, is a valid early alternative to more complex operations and does not preclude further reconstructive surgery in case of disease progression.

Eficacia del aceite de oliva virgen extra frente a los ácidos grasos hiperoxigenados en la prevención de las úlceras por presión: revisión sistemática con metaanálisis / Efficacy of extra-virgin olive oil versus hyperoxygenated fatty acids for pressure ulcers prevention: a systematic review with meta-analysis

Objetivo: Conocer la eficacia del aceite de oliva frente a los ácidos grasos hiperoxigenados en la prevención de las úlceras por presión. Metodología: Revisión sistemática de la literatura con metaanálisis sobre la eficacia del aceite de oliva virgen extra (AOVE) frente a los ácidos grasos hiperoxigenados (AGHO) en la prevención de las úlceras por presión (UPP). Búsqueda de estudios en bases de datos bibliográficas sin límite de fechas ni de idiomas. Se incluyeron ensayos clínicos aleatorizados (ECA) que comparasen el uso de AOVE y de AGHO en la prevención de las UPP. Cada artículo fue revisado utilizando la guía de valoración crítica de ensayos clínicos del CASP y también se valoró la calidad de la evidencia mediante el sistema GRADE. Se realizó el metaanálisis (efectos fijos) calculando la diferencia de riesgo con su intervalo de confianza del 95%. También se midió la heterogeneidad del mismo mediante la Q de Cochran y la I2 . Resultados: Se identificaron inicialmente 16 artículos, de los cuales se excluyeron 13 a partir de título y resumen por tratarse de artículos sobre el uso del aceite de oliva en otras patologías. Se incluyeron 2 ECA con una puntuación CASP > 5 y buena calidad de evidencia. En los estudios incluidos, ambos productos mostraron igual eficacia preventiva. La diferencia de riesgo estimada en el metaanálisis incluye el valor 0 en su intervalo de confianza, lo que indica que no hay diferencias entre los grupos de comparación. Conclusión: El AOVE es al menos igual de eficaz que los AGHO en la prevención de UPP

Aim: To determine the efficacy of olive oil against hyperoxygenated fatty acids in preventing pressure ulcers. Methodology: Systematic review of the clinical literature with meta-analysis about the effectiveness of extra virgin olive oil in relation to hyperoxygenated fatty acids in preventing pressure ulcers (PU). A literature search was conducted in bibliographic databases. Randomized clinical trials which comparing the use of extra virgin olive oil and HOFA in preventing pressure ulcers were included. The methodological quality and evidence of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program (CASP) and de GRADE system respectively. A meta-analysis (fixed effects model) was carried out using risk difference with a 95% confidence interval. Also heterogeneity was measured by Q Cochran and I2 . Results: 16 articles were initially identified. 13 articles were excluded from title and summary for being articles related to olive oil in other pathologies. Finally, 2 randomized controlled trials were including after overcoming the CASP> 5 score and obtain adequate quality of evidence. In the included studies, both products showed the same preventive efficacy. The risk difference estimated in the metaanalysis includes the value 0 in the IC, which indicates there are no differences between the comparison groups. Conclusions: Extra virgin olive oil is at least as effective as the HOFA in preventing pressure ulcers

Prevención del consumo de alcohol: límites de consumo de bajo riesgo y otras actuaciones / No disponible

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Strategy to control methicillin-resistant Staphylococcus aureus post-operative infection in orthopaedic surgery.

In the year 2000 the rate of infection after arthroplasty in our hospital was 9.75% and methicillin-resistant Staphylococcus aureus (MRSA) was the organism in 33% of the infected joints. In an attempt to overcome this unacceptable situation, we changed our prophylaxis regime over a period of 6 months. This involved modifying the precautionary measures for preventing surgical infections, active prophylaxis against any nasal reservoir of infection in joint implant patients, the control of health care personnel, the strict application of standard and contact precautions in all patients with MRSA, and the use of teicoplanin as prophylaxis during this 6-month period. This resulted in a definite decrease in the incidence of orthopaedic wound infections by MRSA, while the level of MRSA infection elsewhere in the hospital remained constant. Only one infection was detected during this 6-month trial, and this beneficial effect was maintained during the following 6 months. Since then, only sporadic new infections have been detected. Patients with arthroplasties performed during the study were followed for 12 months, and no new cases of MRSA infection were detected.

Early point of significantly higher lesions in insufficient anterior cruciate ligament knees

An experimental study was designed to determine the impact of the instability in the rabbit knee.Ten mature white New Zealand male rabbits were studied. Anterior cruciate ligament-transection of the right knee joint was performed. Animals were sacrificed at 4 weeks (group 1: five animals) and 12 weeks (group 2: five animals) after the surgery. Left knee joints were used as controls. Gross injuries in articular cartilage and in menisci were scored. Forty percent of the knees from the group 1 showed fibrillation. In the group 2, all the knees were damaged and 2/5 showed full-thickness erosion. Tears were observed in 2 internal menisci from the group 1 and in 2 external menisci and 5/5 internal menisci from the group 2. The earliest point of significantly higher incidence of knee damage was 3 months post injury. Therefore, when an anterior cruciate ligament reconstruction is indicated it should carry out as soon as possible (AU)

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Errores frecuentes en la comparación de resultados de estudios sobre burn-out o desgaste profesional. Réplica / Frequent errors in the comparison of results of studies on burn-out. Response

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Traqueostomía percutánea bajo control endoscópico en adolescentes / Percutaneous tracheostomy under endoscopic guidance in adolescents

La traqueostomía percutánea es una técnica bien establecida en pacientes adultos que precisan control a largo plazo de la vía aérea. La experiencia con este procedimiento en Pediatría es muy escasa; por ello comunicamos los resultados de la realización de traqueostomía percutánea mediante un método de dilatación progresiva y visualización endoscópica en tres adolescentes que presentaban traumatismos craneales graves. La traqueostomía se realizó con la técnica Ciaglia Blue Rhino guiada por fibrobroncoscopia, por parte del personal asistencial de la unidad de cuidados intensivos pediátricos (UCIP), a la cabecera de los pacientes. No se observaron datos de compromiso respiratorio o hemodinámico durante el procedimiento ni se detectaron complicaciones relacionadas con la técnica. Posteriormente, a dos de los pacientes se les pudo retirar la cánula de traqueotomía, sin incidencias. Los casos presentados indican que la traqueostomía percutánea puede ser realizada de forma segura, al menos en pacientes adolescentes

Percutaneous tracheostomy (PT) is a well-established procedure in adult patients who require long-term airway control. Because experience with this procedure is scarce in pediatrics, we report the results of PT by means of a progressive dilatational method with endoscopic guidance in three critically-ill adolescents with severe head injury. PT was performed by means of the Ciaglia Blue Rhino method at the bedside, guided by fiberoptic bronchoscopy by the pediatric intensive care unit staff. No hemodynamic or respiratory compromise was observed during the procedure. No complications were attributable to PT. Two patients were decannulated without incidents. The reported cases indicate that PT can be performed safely, at least in adolescents

Síndrome de desgaste profesional en el personal asistencial pediátrico / Burnout syndrome among health workers in pediatrics

Antecedentes: El síndrome de desgaste profesional es un trastorno adaptativo crónico que condiciona alteraciones importantes de la conducta laboral. Objetivo: En este trabajo se ha pretendido conocer su prevalencia entre el personal asistencial pediátrico, para la cual se diseñó un estudio transversal y descriptivo. Material y métodos En noviembre de 2002 se presentó el cuestionario Maslach Burnout Inventory (MBI) a 127 personas (médicos, enfermeras y auxiliares) que trabajan en un Departamento de Pediatría. El cuestionario consta de 22 ítems que exploran tres aspectos del síndrome de desgaste profesional: a) cansancio emocional; b) despersonalización, y c) realización personal. Resultados: El cuestionario fue contestado por 93 personas (tasa de respuesta: 73,2 %). El 83 % de las encuestas fueron cumplimentadas por mujeres y el 17 % por varones. La media de edad fue de 38,6 ± 10,2 años y la mediana de antigüedad en el puesto de trabajo de 10 años (límites, 1-37 años). El 29,0 % eran pediatras, el 50,5 %, personal de enfermería, y el 20,5 %, auxiliares de enfermería. Según la escala utilizada, el 20,8 % de los entrevistados presentaban un alto grado de síndrome de desgaste profesional, el 19,8 % un nivel moderado y el 59,4 % un nivel bajo de síndrome de desgaste profesional. En relación con las subescalas del cuestionario, el 67,7 % de los encuestados presenta un bajo grado de realización personal, el 14,5 % obtiene puntuaciones altas de cansancio emocional y el 23,9% tiene valores altos en la escala de despersonalización. Conclusiones: El síndrome de desgaste profesional es un trastorno presente en un porcentaje considerable de las personas que atienden a pacientes pediátricos a nivel hospitalario. En la muestra estudiada, la falta de realización personal se destaca sobre los demás componentes del síndrome, lo que alerta sobre la posible existencia de actitudes negativas hacia uno mismo y la actividad laboral, pérdida de interés por la atención a los niños, baja productividad y disminución de la autoestima. Por lo tanto, deberían tomarse medidas para atenuar los factores que influyen en el desarrollo del síndrome de desgaste profesional entre el personal asistencial pediátrico

Background: Burnout syndrome (BS) is a chronic adaptation disorder that provokes serious problems in occupational behavior. Objective: In the present study we assessed the prevalence of burnout syndrome in pediatric healthcare workers. Design: Cross-sectional, descriptive study. Material and methods In November 2002, the Maslach Burnout Inventory was given to 127 staff members (doctors, nurses and nurse assistants) working in a pediatrics department. The questionnaire includes 22 items that explore three aspects of BS: a) emotional exhaustion; b) depersonalization, and c) personal achievement. Results: The questionnaire was completed by 93 staff members (73.2 % of the whole sample; 83% women and 17% men). The mean age was 38.6 +/- 10.2 years and the median number of years worked was 10 (range: 1-37 years). Twenty-nine percent were pediatricians, 50.5% were nurses and 20.5% were nurse assistants. A total of 20.8 % had a high level of BS, 19.8 % had a moderate level and 59.4 % showed a low level. When sub-scales were applied, the results showed that 67.7 % of respondents presented a low level of personal achievement, 14.5 % had high scores of emotional exhaustion and 23.9 % obtained high scores in the depersonalization scale. Conclusions: BS is present in a significant percentage of hospital workers attending pediatric patients. In our sample, the most notable component of BS was the lack of personal achievement. This finding alerted us to the eventual presence of negative attitudes toward self and professional activity, as well as to the loss of interest in pediatric care, low productivity and diminished self-esteem. We believe that specific strategies should be implemented to attenuate the factors influencing the development of BS in pediatric health staff

Artritis meningocócica como presentación de enfermedad invasiva insospechada / Meningococcal arthritis as the form of presentation of unsuspected invasive disease

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