Demonstration of event position reconstruction based on diffusion in the NEXT-white detector.

Noble element time projection chambers are a leading technology for rare event detection in physics, such as for dark matter and neutrinoless double beta decay searches. Time projection chambers typically assign event position in the drift direction using the relative timing of prompt scintillation and delayed charge collection signals, allowing for reconstruction of an absolute position in the drift direction. In this paper, alternate methods for assigning event drift distance via quantification of electron diffusion in a pure high pressure xenon gas time projection chamber are explored. Data from the NEXT-White detector demonstrate the ability to achieve good position assignment accuracy for both high- and low-energy events. Using point-like energy deposits from 83mKr calibration electron captures (E∼45 keV), the position of origin of low-energy events is determined to 2 cm precision with bias <1mm. A convolutional neural network approach is then used to quantify diffusion for longer tracks (E≥1.5 MeV), from radiogenic electrons, yielding a precision of 3 cm on the event barycenter. The precision achieved with these methods indicates the feasibility energy calibrations of better than 1% FWHM at Qßß in pure xenon, as well as the potential for event fiducialization in large future detectors using an alternate method that does not rely on primary scintillation.

[Patient advanced directives from the perspective of surgery patients-new aspects and aims : Living wills of patients before planned surgery]. / Patientenverfügungen aus Sicht des chirurgischen Patienten ­ neue Aspekte und Ziele : Einstellungen und Verbreitungsgrad vorsorglicher Willensbekundungen von Patienten vor geplanten Operationen.

BACKGROUND: Patient advance directives and other forms of precautionary medical provisions have arisen from patients' determination to influence and decide about medical treatment even in extreme situations. Although this topic is very present in the media, clinical experience indicates that the majority of patients are not yet aware of this subject. This current investigation aimed to collect data about the familiarity and degree of distribution of patient medical advance directives. Furthermore, it was examined how a routine question concerning patient's provisions in a preoperative setting is perceived by the patients and from which source information about this topic should be provided. METHODS: Between April 2017 and October 2017 a total of 200 patients were randomly selected prior to planned surgery and interviewed anonymously using a standardized questionnaire. RESULTS: Of the patients surveyed 78.8% stated that they knew about the possibility of patient advance directives. Of the patients interviewed 26.3% stated they had drawn up an advance directive, 20.7% had a precautionary power of attorney and 12.3% had signed a care directive. Among the influencing factors in drawing up an advance directive, age, as well as familial and disease-related causes, were identified as significant factors. The overwhelming majority of respondents (77.6%) wished to be approached on the subject of precautionary medical provisions before a planned operation. CONCLUSION: Despite an increasing proportion of patients who have drawn up an advance directive, there is still a great need for information on the subject. Doctors should address patients on the topic before planned interventions.

¿Constituyen los cannabinoides una alternativa terapéutica para insomnio? / Do cannabinoids constitute a therapeutic alternative for insomnia?

INTRODUCCIÓN: Se ha planteado que la estimulación del sueño con cannabinoides podría constituir una alternativa terapéutica en pacientes con insomnio. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen tres estudios primarios, de los cuales dos corresponden a ensayos aleatorizados. Concluimos que no está claro si los cannabinoides tienen un efecto en la severidad del insomnio o en la calidad del sueño; que podrían no tener efecto en la conciliación del sueño, despertar del sueño ni comportamiento durante vigilia, y probablemente se asocian a efectos adversos frecuentes.

INTRODUCTION: It has been suggested that cannabinoids would constitute a therapeutic alternative for patients with insomnia. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including three studies overall, of which two were randomized trials. We concluded it is not clear whether cannabinoids have an effect on insomnia severity or on sleep quality; that they might have no effect on sleep conciliation, sleep awakening or behavior during wakefulness, and are probably associated with frequent adverse effects.

Growth Modeling of Aspergillus niger Strains Isolated from Citrus Fruit as a Function of Temperature on a Synthetic Medium from Lime (Citrus latifolia T.) Pericarp.

Molds are responsible for postharvest spoilage of citrus fruits. The objective of this study was to evaluate the effect of temperature on growth rate and the time to visible growth of Aspergillus niger strains isolated from citrus fruits. The growth of these strains was studied on agar lime medium (AL) at different temperatures, and growth rate was estimated using the Baranyi and Roberts model (Int. J. Food Microbiol. 23:277-294, 1994). The Rosso et al. cardinal model with inflexion (L. Rosso, J. R. Lobry, S. Bajard, and J. P. Flandrois, J. Theor. Biol. 162:447-463, 1993) was used as a secondary model to describe the effect of temperature on growth rate and the lag phase. We hypothesized that the same model could be used to calculate the time for the mycelium to become visible (tv) by substituting the lag phase (1/λ and 1/λopt) with the time to visible colony (1/tv-opt and 1/tv), respectively, in the Rosso et al. MODEL: High variability was observed at suboptimal conditions. Extremes of temperature of growth for A. niger seem to have a normal variability. For the growth rate and time tv, the model was satisfactorily compared with results of previous studies. An external validation was performed in lime fruits; the bias and accuracy factors were 1.3 and 1.5, respectively, for growth rate and 0.24 and 3.72, respectively, for the appearance time. The discrepancy may be due to the influence of external factors. A. niger grows significantly more slowly on lime fruit than in culture medium, probably because the nutrients are more easily available in medium than in fruits, where the peel consistency may be a physical barrier. These findings will help researchers understand the postharvest behavior of mold on lime fruits, host-pathogen interactions, and environmental conditions infecting fruit and also help them develop guidelines for future work in the field of predictive mycology to improve models for control of postharvest fungi.

Linfoma No-Hodgkin y pancreatitis aguda en gestante: reporte de caso / Non-Hodgkin's lymphoma and acute pancreatitis in pregnant women: case report

ANTECEDENTES: El linfoma no Hodgkin durante el embarazo es una entidad rara, el tipo difuso de células grandes es aún menos frecuente y se caracteriza por una alta tasa de progresión tumoral con poca expresión clínica. Su diagnóstico y tratamiento representan un reto clínico debido a la baja incidencia de la enfermedad y a las posibles repercusiones fetales a causa del tratamiento. CASO CLÍNICO: Gestante secundípara de 31 años que ingresa por cuadro de dolor abdominal y cifras elevadas de lactato deshidrogenasa. Durante la gestación precisa varios ingresos por pancreatitis aguda de repetición y cuadro de colestasis intrahepática. Tras el parto evoluciona tórpidamente con aparición de edema en esclavina en cuello y miembros superiores, siendo diagnosticada de gran masa torácica cuya biopsia es informada como Linfoma No Hodgkin tipo B difuso de células grandes primario mediastinal. Se administran dos ciclos de tratamiento quimioterápico tras lo cual remite completamente la enfermedad. Se induce el parto con prostaglandinas intravaginal, con recién nacido de 3350 gramos y APGAR 8/10. Tras un año la paciente permanece en remisión completa.

BACKGROUND: During pregnancy, Non-Hodgkin's lymphoma is a rare entity; the diffuse large cell lymphoma is still less common, and it has a high rate of tumor progression with a little clinical expression. Diagnosis and treatment is a huge challenge due to the low incidence of the condition and to the possible fetal effects because of the treatment. CLINICAL CASE: A 31-year-old woman -in her second delivery- was admitted with abdominal pain and elevated lactate dehydrogenase levels. During pregnancy, she was required several admissions reporting repeated acute pancreatitis and intrahepatic cholestasis. After delivery, it evolves into facial and upper extremity oedema, diagnosed with a large chest mass, resulting in the diagnosis of primary mediastinal large B-cell lymphoma through the biopsy. The disease goes into remission completely after two cycles of chemotherapy treatments are given. Labor is induced with intravaginal prostaglandins, with a newborn of 3350 g and Apgar 8/10. After a year, the patient remains in complete remission.

Prácticas de liderazgo y su relación con la cultura en un grupo de países latinoamericanos / Leadership practices and its relationship with the culture in a group of latin american countries

El propósito de este estudio fue analizar, a través del MLQ 5X, los perfiles de liderazgo de 167 directivos de cuatro países latinoamericanos (Perú, Venezuela, Ecuador y Colombia), para observar si a pesar de la similitud cultural se presentan diferencias en los patrones de liderazgo. Se compararon estos perfiles con los obtenidos por otros autores en regiones culturalmente distintas, para finalmente confrontar los resultados con los de otra muestra colombiana. Se evidenciaron diferencias significativas en liderazgo, tanto entre países culturalmente distintos, como entre los mismos países latinoamericanos, a pesar de su similitud cultural. Finalmente, la muestra de directivos de este estudio difiere significativamente de la otra muestra colombiana, respecto a algunas variables del MLQ. Se discuten esos hallazgos.

The aim of this study was to analyze, by using the MLQ5X, the leadership profiles of 167 managers from four Latin American countries (Peru, Venezuela, Ecuador and Colombia), to see if there are different patterns of leadership despite cultural similarities. Likewise, these profiles were compared with results obtained by other authors from different regions. Finally, these results were compared with another Colombian sample. Significant differences in leadership were found, both in culturally different countries and in Latin American countries, despite their cultural similarities. Finally, the sample of managers in this study differs significantly from the other Colombian sample, in some variables of the MLQ. These findings are discussed.

La silicosis: ¿un problema de salud pública prioritario para Chile? / Silicosis: a relevant public health issue in Chile?

Work related diseases and common diseases are covered by separated health systems in Chile. Chilean Ministry of Health focuses on common diseases, making work related diseases almost absent from public health policies. In this article current national and international information about the magnitude and impact of silicosis is reviewed. Although the quality of the national information is suboptimal, it is possible to estimate in several hundreds of thousands the number of workers exposed to silica dust, tens of thousands those under medical surveillance and thousands those currently affected by the disease. Albeit, additional efforts need to be made to estimate the burden of this disease on the Chilean population, information gathered in this article suggests that it is a relevant public health issue, deserving more importance among public policies in our country.

Las enfermedades comunes y laborales son atendidas en distintos sistemas de aseguramiento de la salud en Chile. Las políticas públicas emanadas del Ministerio de Salud se enfocan en las enfermedades comunes, relegando a un rol secundario a aquellas ocasionadas por la actividad laboral de las personas. En este artículo, los autores revisan información actualizada tanto nacional como internacional con el fin de determinar si la silicosis constituye un problema de salud relevante. Aunque la calidad de la información nacional no es óptima, su revisión permite estimar que son cientos de miles los trabajadores expuestos a sílice cristalina, que hay varias decenas de miles bajo vigilancia médica y que son más de mil los portadores de la enfermedad. Si bien es necesario hacer mayores esfuerzos para estimar la carga que esta patología representa para la sociedad chilena, la información recopilada indica que constituye un problema de salud pública relevante que debiera tener mayor protagonismo en las políticas públicas de nuestro país.

Effect of root planing on surface topography: an in-vivo randomized experimental trial.

BACKGROUND AND OBJECTIVE: The root surface topography exerts a major influence on clinical attachment and bacterial recolonization after root planing. In-vitro topographic studies have yielded variable results, and clinical studies are necessary to compare root surface topography after planing with current ultrasonic devices and with traditional manual instrumentation. The aim of this study was to compare the topography of untreated single-rooted teeth planed in vivo with a curette, a piezoelectric ultrasonic (PU) scraper or a vertically oscillating ultrasonic (VOU) scraper. MATERIAL AND METHODS: In a randomized experimental trial of 19 patients, 44 single-rooted teeth were randomly assigned to one of four groups for: no treatment; manual root planing with a curette; root planing with a PU scraper; or root planing with a VOU scraper. Post-treatment, the teeth were extracted and their topography was analyzed in 124 observations with white-light confocal microscopy, measuring the roughness parameters arithmetic average height, root-mean-square roughness, maximum height of peaks, maximum depth of valleys, absolute height, skewness and kurtosis. RESULTS: The roughness values arithmetic average height and root-mean-square roughness were similar after each treatment and lower than after no treatment ( p < 0.05). Absolute height was lower in the VOU group than in the untreated ( p = 0.0026) and PU (p = 0.045) groups. Surface morphology was similar after the three treatments and was less irregular than in the untreated group. Values for the remaining roughness parameters were similar among all treatment groups ( p > 0.05). CONCLUSION: Both ultrasonic devices reduce the roughness, producing a similar topography to that observed after manual instrumentation with a curette, to which they appear to represent a valid alternative.

[New spirometric reference equations for healthy Chilean adults]. / Proposición de nuevas ecuaciones para calcular valores espirométricos de referencia en población chilena adulta: Sociedad Chilena de Enfermedades Respiratorias (SER).

BACKGROUND: To correctly interpret spirometric results, reference values should come from the same population. Current spirometric reference equations have been under scrutiny due to deficiencies to fit adequately for Chilean population, specially, for those aged over 65 years old. AIM: To develop new spirometric reference values for Chilean adults, based on national studies in which spirometries were performed in healthy non-smoker adults. MATERIAL AND METHODS: A standardized database of spirometric values was developed combining spirometric data collected from five population-based studies, in which healthy nonsmoker adults participated. Spirometries from 448 males aged 19 to 84 years and from 726 females aged 19 to 94 years, obtained according to guidelines from the American Thoracic and European Respiratory Societies, were analyzed. Using multiple regression models, which included height, gender, and age, the theoretical value and inferior limits of normality were calculated for 1st second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced mid-expiratory flow rate (FEF25-75). RESULTS: Reference values and lower limits of normality (LLN) were constructed for Chilean adults of both genders. The new proposed set of equations had a better fit, when compared with the current reference values used in Chile. CONCLUSIONS: The new spirometric references values derived from this study, fit better than currently used ones. Therefore, they should be used as new references values for Chilean adults.

Recognizing odd smells and ejection of brood parasitic eggs. An experimental test in magpies of a novel defensive trait against brood parasitism.

One of the most important defensive host traits against brood parasitism is the detection and ejection of parasitic eggs from their nests. Here, we explore the possible role of olfaction in this defensive behaviour. We performed egg-recognition tests in magpie Pica pica nests with model eggs resembling those of parasitic great spotted cuckoos Clamator glandarius. In one of the experiment, experimental model eggs were exposed to strong or moderate smell of tobacco smoke, whereas those of a third group (control) were cleaned with disinfecting wipes and kept in boxes containing odourless cotton. Results showed that model eggs with strong tobacco scent were more frequently ejected compared with control ones. In another experiment, models were smeared with scents from cloacal wash from magpies (control), cloacal wash or uropygial secretions from cuckoos, or human scents. This experiment resulted in a statistically significant effect of treatment in unparasitized magpie nests in which control model eggs handled by humans were more often rejected. These results provide the first evidence that hosts of brood parasites use their olfactory ability to detect and eject foreign eggs from their nests. These findings may have important consequences for handling procedures of experimental eggs used in egg-recognition tests, in addition to our understanding of interactions between brood parasites and their hosts.

Enfermedades respiratorias laborales en Chile: Ley 16.744 / Work related respiratory diseases in Chile – Law 16.744

Since 1968 Chile has two separate systems to manage the health problems of Chileans. One is devoted to prevent and care for all kind of diseases, from gestation to death, and the other one is devoted exclusively to work-related diseases and accidents. The last one has been very successful in lowering the work related accidents below 5 percent, rate that is similar to those of developed countries. The system has been replicated in other Latin-American countries. Occupational diseases, on the other hand, had been neglected by the system (although not in its design). The current article visit the most relevant aspects of the system and focus on the role of respiratory diseases specialists in the diagnosis and management of work related respiratory diseases.

Desde 1968 Chile cuenta con dos sistemas paralelos para manejar los problemas de salud de la población. Uno está orientado a prevenir y curar todo tipo de enfermedades, desde la gestación hasta la muerte; el otro está diseñado para preocuparse de las enfermedades y accidentes relacionados con la actividad laboral. Este último sistema ha sido muy exitoso en disminuir la accidentabilidad laboral, la que se ubica actualmente bajo el 5 por ciento, frecuencia similar a la observada en países desarrollados. Este sistema ha sido copiado en otros países de Latinoamérica. Las enfermedades ocupacionales han sido descuidadas por el sistema, aun cuando fueron adecuadamente consideradas en el cuerpo legal. El presente artículo presenta los aspectos más relevantes de este sistema y destaca el papel de los especialistas en enfermedades respiratorias en el diagnóstico y manejo de las enfermedades respiratorias ocupacionales.

Proposición de nuevas ecuaciones para calcular valores espirométricos de referencia en población chilena adulta: Sociedad Chilena de Enfermedades Respiratorias (SER) / New spirometric reference equations for healthy Chilean adults

Background: To correctly interpret spirometric results, reference values should come from the same population. Current spirometric reference equations have been under scrutiny due to deficiencies to fit adequately for Chilean population, specially, for those aged over 65 years old. Aim: To develop new spirometric reference values for Chilean adults, based on national studies in which spirometries were performed in healthy non-smoker adults. Material and Methods: A standardized database of spirometric values was developed combining spirometric data collected from five population-based studies, in which healthy nonsmoker adults participated. Spirometries from 448 males aged 19 to 84 years and from 726 females aged 19 to 94 years, obtained according to guidelines from the American Thoracic and European Respiratory Societies, were analyzed. Using multiple regression models, which included height, gender, and age, the theoretical value and inferior limits of normality were calculated for 1st second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced mid-expiratory flow rate (FEF25-75). Results: Reference values and lower limits of normality (LLN) were constructed for Chilean adults of both genders. The new proposed set of equations had a better fit, when compared with the current reference values used in Chile. Conclusions: The new spirometric references values derived from this study, fit better than currently used ones. Therefore, they should be used as new references values for Chilean adults.

[Validity and reliability of the personalised nursing care index in a hospital medical unit]. / Validez y fiabilidad del índice de personalización de cuidados en una unidad médica hospitalaria.

OBJECTIVES: To determine the validity and reliability of the personalised nursing care index (PNCI). METHODS: A descriptive study was carried out in the Puerta del Mar Hospital (Cádiz) of the Andalusian Health Service, which included all patients admitted to an Internal Medicine ward from May 2007 to July 2008. A descriptive analysis was performed on the population included in the study. Furthermore, reliability was analysed with the 20-Kuder-Richardson coefficient and a correlation matrix between PNCI items; and validity via a maximum likelihood factorial analysis, and a ROC curve to determine sensitivity and specificity. RESULTS: A total of 219 people were included in the survey, of whom 74.4% were patients and 26.6% caregivers. The percentages of males and females were similar with a mean age of 62.5 years and 48.4% finished basic school education. The 20-Kuder-Richarson value was 0.835; and a positive correlation between items, which corresponded to 3 groups of items (factors). The maximum likelihood factorial analysis confirmed the 3 items-factor groups with a Promax rotation due to the high correlation between them. The maximum explained variance was 91.42%. The ROC curve area was 90.1% with a cut-off point of 8, for a sensitivity of 79.9% and a specificity of 90.6%. CONCLUSIONS: The PCNI is reliable, with the internal consistency coefficient value in between an optimum range. Furthermore, factors obtained from the matrix correlation inter-items were confirmed with a factorial analysis, resulting in a high explained variance. The curve ROC area is excellent compared to the gold standard, considered as the perception of confidence relationship.

Validez y fiabilidad del índice de personalización de cuidados en una unidad médica hospitalaria / Validity and reliability of the personalised nursing care index in a hospital medical unit

Objetivo. Determinar la validez y la fiabilidad del índice de personalización de cuidados (IPC). Método. Estudio transversal realizado en el Hospital Puerta del Mar (Cádiz) del Servicio Andaluz de Salud, que incluyó a todos los pacientes ingresados en la unidad de Medicina Interna, 1.a sección, desde mayo 2007 a julio 2008. Se hizo un análisis descriptivo de la población estudiada y se calculó la fiabilidad, mediante el coeficiente 20 de Kuder-Richardson y una matriz de correlación de los ítems del IPC, y la validez, con un análisis factorial de máxima verosimilitud y una curva ROC para determinar la sensibilidad y la especificidad. Resultados. Se incluyó a 219 sujetos; el 74,4% de los encuestados eran pacientes y el 25,6%, cuidadores familiares. El 50,7% son mujeres, con una media de edad de 62,5 años y el 48,4% tiene nivel de estudios básico. Se obtuvo un valor de coeficiente 20 de Kuder-Richardson para el IPC de 0,835 y una correlación de ítems positiva, que se corresponden con tres grupos de ítems (factores). El análisis factorial de máxima verosimilitud confirmó los tres grupos mediante una rotación promax por la alta correlación entre ellos, y con una variancia máxima explicada del 91,42%. El área bajo la curva ROC es del 90,1%, con un punto de corte situado en 8 para una sensibilidad del 79,9% y una especificidad del 90,6%. Conclusiones. La fiabilidad del IPC, medida con la consistencia interna, está dentro del rango óptimo. Además, los factores de la matriz de correlaciones entre ítems se confirman mediante el análisis factorial, obteniendo una elevadísima variancia total explicada. El área bajo la curva ROC obtiene un excelente resultado frente al patrón de referencia considerado, la percepción de la relación de confianza(AU)

Objectives. To determine the validity and reliability of the personalised nursing care index (PNCI). Methods. A descriptive study was carried out in the Puerta del Mar Hospital (Cádiz) of the Andalusian Health Service, which included all patients admitted to an Internal Medicine ward from May 2007 to July 2008. A descriptive analysis was performed on the population included in the study. Furthermore, reliability was analysed with the 20-Kuder-Richardson coefficient and a correlation matrix between PNCI items; and validity via a maximum likelihood factorial analysis, and a ROC curve to determine sensitivity and specificity. Results. A total of 219 people were included in the survey, of whom 74.4% were patients and 26.6% caregivers. The percentages of males and females were similar with a mean age of 62.5 years and 48.4% finished basic school education. The 20-Kuder-Richarson value was 0.835; and a positive correlation between items, which corresponded to 3 groups of items (factors). The maximum likelihood factorial analysis confirmed the 3 items-factor groups with a Promax rotation due to the high correlation between them. The maximum explained variance was 91.42%. The ROC curve area was 90.1% with a cut-off point of 8, for a sensitivity of 79.9% and a specificity of 90.6%. Conclusions. The PCNI is reliable, with the internal consistency coefficient value in between an optimum range. Furthermore, factors obtained from the matrix correlation inter-items were confirmed with a factorial analysis, resulting in a high explained variance. The curve ROC area is excellent compared to the gold standard, considered as the perception of confidence relationship(AU)

Nomogramas de ecuaciones de referencia espirométrica SER 2009 / Spirometric nomograms for Chilean normal adults

As a result of the availability of programmes to detect and treat respiratory disease in Chile there has been a greater use of spirometry in diagnosis. To be able to correctly interpret spirometry results there must be reference patterns which, ideally come from the same population in which they will be used. In order to facilitate the use and application of new spirometric reference equations recently calculated for the adult population, there follows a series of nomograms. These nomograms have been designed for each of the following parameters: gender, age, and size of subjects between 19 and 50 years old and also for subjects over 51 years old. These equations are taken from 5 national studies. These studies included a population which complied with universal criteria to determine reference values ( 1.174 subjects, between 19 and 94 years old), spirometries were carried out on this population following international recommendations (ATS).

La actual disponibilidad de programas de detección y tratamiento de enfermedades respiratorias en Chile ha determinado una mayor utilización de la espirometría en el diagnóstico de dichas enfermedades. La adecuada interpretación de los resultados de la espirometría requiere disponer de patrones de referencia idealmente originados en la misma población en la cual se utilizarón. Para facilitar el uso y aplicación de nuevas ecuaciones de referencia espirométricas recientemente modeladas en población adulta chilena, se presentan nomogramas diseñados para cada uno de los parámetros en base al género, edad y talla para sujetos entre 19 y 50 años y en mayores de 51 años. Estas ecuaciones derivan de 5 estudios nacionales que incluyeron población que cumplió criterios universales para determinar valores de referencia, (1.174 sujetos, 19 a 94 años), que efectuaron espirometrías siguiendo recomendaciones internacionales (ATS).

[Advance health care directives as seen by surgical patients]. / Patientenverfügung aus der Sicht des chirurgischen Patienten.

BACKGROUND: Progressive health care implies progress also in physician/patient interaction, especially with regard to moribund patients and their relatives. Advance health care directives emerged from the desire to influence medical treatment even in borderline situations. In spite of the present political and public discussions in Germany, advance directives are rarely of much importance in everyday surgical practice. By means of questionnaires, this study aimed at the frequency of advance directives among the patients of a surgical hospital and at related influencing factors. METHODS: Between August 2007 and January 2008, 450 patients at our hospital were interviewed, prior to scheduled surgery, on the topic of advance health care directives by means of anonymous questionnaires. In addition to questions about the existence of or the intention to draw up advance directives, the study focussed particularly on the relationship between patient and attending physician. Patient-specific and sociodemographic data were collected as well. RESULTS: Of the patients interviewed, 16.7% stated they had drawn up advance directives, while 21.3% did not know about the possibility of drawing up such a document. A mere 9.7% of the patients interviewed saw no need for such directives, whereas the majority (65.3%) considered it an option. Among the factors influencing the drawing up of advance directives, age and prior experience with severe disease figured significantly. Of the patients interviewed, 64.8% wished for more information on the topic of advance health care directives and health care proxies. The wish was expressed by 80.1% of patients that the attending surgeon mention the topic prior to surgery. CONCLUSIONS: Although the proportion of patients that draw up advance health care directives continues to be less than one fifth, surgical patients have a great need for information regarding the topic. Surgical hospital personnel should also set themselves to this task.

Influencia del Burnout, la calidad de vida y los factores socioeconómicos en las estrategias de afrontamiento utilizadas por los profesionales y auxiliares de enfermería / The influence of Burnout, the quality of life, socioeconomic factors and coping strategies used by health-care professionals and nursing aids

El propósito de este estudio fue evaluar la influencia del síndrome de Burnout y la calidad de vida, así como las variables socioeconómicas, en los estilos de afrontamiento utilizados por 71 trabajadores de la salud (52,1 por ciento enfermeros y 47,9 por ciento auxiliares de enfermería). Se aplicó el cuestionario de salud (SF-36), el cuestionario de afrontamiento al estrés (CAE) y el Maslach Burnout Inventory (MBI). De acuerdo con los resultados, la presencia de Burnout fue baja (77,5 por ciento sin Burnout), la calidad vida estuvo reducida en las dimensiones de vitalidad, dolor corporal y salud general, y las estrategias más utilizadas fueron la focalización en la solución de problemas y la reevalución positiva. El incremento en la calidad de vida, la reducción en la severidad de los síntomas de Burnout, pertenecer al género femenino, tener menor edad y ser enfermera son predictores significativos (regresión cúbica) del incremento en el uso de todas las estrategias de afrontamiento, especialmente la focalización en la solución de problemas y la reevaluación positiva.

The aim of this study was to evaluate the influence of the Burnout syndrome and quality of life, as well as the socioeconomic variables in the coping styles used by 71 health workers (52.1 percent nurses and 47.9 percent nursing aids). The health questionnaire (SF36), the stress coping questionnaire (CAE) and the Maslach Burnout Inventory (MBI) were applied. According to the results, the presence of Burnout was low (77.5 percent without Burnout), the quality of life was reduced in the areas of vitality, corporal pain and general health, and the most used strategies were those of focusing on the solution of problems and positive reappraisal. The increase in the quality of life, the reduction in the severity of Burnout symptoms, being female, young and working as a nurse, are all significant predictors (cubic regression) of the increase in the use of all the coping strategies, especially those focusing on the solution of problems and positive reappraisal.

O propósito deste estudo foi avaliar a influência da síndrome de Burnout e a qualidade de vida, assim como os fatores socioeconômicos, nos estilos de enfrentamento utilizados por 71 trabalhadores da saúde (52,1 por cento enfermeiros e 47,9 por cento auxiliares de enfermaria). Se aplicou o questionário de saúde (SF-36), o questionário de enfrentamento ao stress (CAE) e o Maslach Burnout Inventory (MBI). De acordo com os resultados, a presença de Burnout foi baixa (77,5 por cento sem Burnout), a qualidade vida esteve reduzida nas dimensões de vitalidade, dor corporal e saúde geral, e as estratégias mais utilizadas foram a focagem na solução de problemas e a reevalución positiva. O aumento na qualidade de vida, a redução na severidade dos sintomas de Burnout, pertencer ao gênero feminino, ter menor idade e ser enfermeira, são predictores significativos (regressão cúbica) do aumento no uso de todas as estratégias de enfrentamento, especialmente a focagem na solução de problemas e a reavaliação. positiva.