La integración laboral de las personas con trastorno mental grave. Una cuestion pendiente / Work integration of people with severe mental disorder: a pending question

El empleo en la mayoría de las personas genera amplios beneficios psicológicos. Los avances científicos en el descubrimiento de la regeneración y estimulación del cerebro, la nueva visión integradora de la discapacidad y una sociedad que camina hacia el pleno empleo, hacen que se presente en el siglo CCI un escenario de nuevas oportunidades para todos, entre ellas, para las personas con trastorno mental grave. La eliminación de las barreras culturales, muy vinculadas a la discriminación y al estigma, será determinante para hacer realidad el deseo de un amplio número de estas personas. Sabemos que un 30-40 por ciento de estas personas con apoyo se mantienen en el empleo. A la luz de la revisión realizada los profesionales y las familias no deberíamos fijarnos tanto en las características de la persona, sino en la forma en que intentamos apoyarla para conseguir y mantener un empleo. Existe legislación referida a la integración laboral de este colectivo que plantea medidasa promover la misma; sin embargo, el altísimo incumplimiento que se da por nuestra parte hacen que se tornen en ineficaces. Debemos emplear técnicas que hayan demostrado su eficacia de forma científica. Múltiples expertos de distintos países, reconocen la validez de los contextos normalizados como el terreno propio de la integración social en su más amplio sentido (AU)

Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS).

The aim of this analysis was to determine the influence of lifestyle, anthropometric and reproductive factors on the subsequent risk of incident vertebral fracture in men and women aged 50-79 years. Subjects were recruited from population registers from 28 centers across Europe. At baseline, they completed an interviewer-administered questionnaire and had lateral thoraco-lumbar spine radiographs performed. Repeat spinal radiographs were performed a mean of 3.8 years later. Incident vertebral fractures were defined morphometrically and also qualitatively by an experienced radiologist. Poisson regression was used to determine the influence of the baseline risk factor variables on the occurrence of incident vertebral fracture. A total of 3173 men (mean age 63.1 years) and 3402 women (mean age 62.2 years) contributed data to the analysis. In total there were 193 incident morphometric and 224 qualitative fractures. In women, an age at menarche 16 years or older was associated with an increased risk of vertebral fracture (RR = 1.80; 95%CI 1.24, 2.63), whilst use of hormonal replacement was protective (RR = 0.58; 95%CI 0.34, 0.99). None of the lifestyle factors studied including smoking, alcohol intake, physical activity or milk consumption showed any consistent associations with incident vertebral fracture. In men and women, increasing body weight and body mass index were associated with a reduced risk of vertebral fracture though, apart from body mass index in men, the confidence intervals embraced unity. For most variables the strengths of the associations observed were similar using the qualitative and morphometric approaches to fracture definition. In conclusion our data suggest that modification of other lifestyle risk factors is unlikely to have a major impact on the population occurrence of vertebral fractures. The important biological mechanisms underlying vertebral fracture risk need to be explored using new investigational strategies.

Antioxidants and atherosclerotic heart disease.

Epidemiologic studies have provided evidence of an inverse relation between coronary artery disease and antioxidant intake, and vitamin E supplementation in particular. The oxidative-modification hypothesis implies that reduced atherosclerosis is a result of the production of LDL that is resistant to oxidation, but linking the reduced oxidation of LDL to a reduction in atherosclerosis has been problematic. Several important additional mechanisms may underlie the role of antioxidants in preventing the clinical manifestations of coronary artery disease (Fig. 2). Specifically, there is evidence that plaque stability, vasomotor function, and the tendency to thrombosis are subject to modification by specific antioxidants. For example, cellular antioxidants inhibit monocyte adhesion, protect against the cytotoxic effects of oxidized LDL, and inhibit platelet activation. Furthermore, cellular antioxidants protect against the endothelial dysfunction associated with atherosclerosis by preserving endothelium-derived nitric oxide activity. We speculate that these mechanisms have an important role in the benefits of antioxidants.

The influence of family history of hip fracture on the risk of vertebral deformity in men and women: the European Vertebral Osteoporosis Study.

There are few data exploring clustering of osteoporotic fractures within families. The aim of this study was to determine the influence of maternal and paternal history of hip fracture on the risk of vertebral deformity. 12,816 men and women aged 50 to 75 years were recruited from population based sampling frames across Europe. Subjects were invited to attend by letter of invitation for an interviewer administered questionnaire and lateral spinal radiographs. Vertebral deformity was defined morphometrically using the McCloskey-Kanis method. 6.4% of men and 7.1% of women reported that their mother had suffered a hip fracture, while 1.7% of both men and women reported that their father had suffered a hip fracture. A maternal history of hip fracture was associated with a modest increased risk of vertebral deformity in men [odds ratio (OR) 1.3, 95% confidence interval (CI) 1.0-1.8], the risk being greater among those aged 65 years and over (OR = 1.5; 95% CI 1.0-2.4) and in those from low prevalence areas. There was no increased risk in women. Paternal history of hip fracture was not associated with vertebral deformity in either sex. In conclusion, maternal history of hip fracture appears to be a risk factor for vertebral deformity, particularly in men.