Model of psychosocial determinants of health in processes of social exclusion.

The substantial increase in the number of families facing social exclusion in Europe and its direct relationship with health inequities is a challenge for studies approaching the social determinants of health and policies dealing with welfare and social inclusion. We start from the premise that reducing inequality (SDG10), has a value and contributes on other goals such as improving health and well-being (SDG3), ensuring quality education (SDG4), promoting gender equality (SDG5) and decent work (SDG8). In this study, we identify disruptive risk factors and psychological and social well-being factors that influence self-perceived health in trajectories of social exclusion. The research materials used a checklist of exclusion patterns, life cycles and disruptive risk factors, Goldberg's General Health Questionnaire (GHQ-12), Ryff's Psychological Well-being (PWB) Scale and Keyes' Social Well-being Scale. The sample consists of 210 people (aged between 16 and 64 years): 107 people in a situation of social inclusion and 103 people in a situation of social exclusion. The data treatment involved statistical analysis, including correlation study and multiple regression analysis, aimed at developing a model of psychosocial factors that may act as health modulators, considering social factors as predictors in the regression model. The results showed that individuals in the sample, in a situation of social exclusion, have a greater accumulation of disruptive risk factors, and these are related to having fewer psychosocial and cognitive resources to cope with stressful situations: less self-acceptance, less mastery of the environment, less purpose in life, less level of social integration and social acceptance. Finally, analysis showed that in the absence of social integration and purpose in life, self-perceived health statuses decline. This work allows us to use the model obtained as a basis for confirming that there are dimensions of psychological and social well-being that should be considered stress-buffering factors in trajectories of social exclusion. These findings can help design psychoeducational programs for prevention and intervention with the aim of improving psychological adjustment and health states, as well as to promote proactive and reactive policies to reduce health inequalities.

Spanish Adaptation of the Family Involvement Questionnaire - High School: Version for Parents / La adaptación española del Cuestionario de Implicación Familiar - bachillerato: versión para padres

Many studies highlight the importance of parental involvement in the academic performance of children and adolescents across subject areas. In view of the lack of instruments in Spain to assess family involvement of parents of adolescents, we undertook this study to develop the Spanish adaptation of the Family Involvement Questionnaire - High School version (FIQ-HS). The sample consisted of 928 parents (85.7 % females) with adolescent sons and daughters. Exploratory and confirmatory factor analyses substantiated the expected three-factor structure (home-school communication, school-based activities, and home-based activities), though seven poorly functioning items were removed. The results show that this instrument has adequate psychometric properties, good reliability, and convergence with another measure of family adaptability and cohesion. Therefore, the FIQ-HS is adequate for the assessment of family involvement in Spanish parents. (AU)

Muchos estudios subrayan la importancia de la implicación familiar en el rendimiento académico de niños y adolescentes en diferentes materias. Teniendo en cuenta la falta de instrumentos en España para evaluar la implicación familiar de los padres de adolescentes, se ha llevado a cabo este estudio para desarrollar una adaptación española del instrumento Family Involvement Questionnaire - High School version (FIQ-HS). La muestra constó de 928 padres (85.7% mujeres) con hijos e hijas adolescentes. Los análisis factoriales exploratorio y confirmatorio confirmaron la estructura esperada de tres factores (comunicación hogar-escuela, actividades basadas en la escuela y actividades basadas en el hogar), aunque se eliminaron siete ítems que presentaban mal funcionamiento. Los resultados muestran que este instrumento presenta unas adecuadas propiedades psicométricas, buena fiabilidad y convergencia con otra medida de adaptabilidad familiar y cohesión. Por lo tanto, el FIQ-HS es adecuado para evaluar la implicación familiar de los padres españoles. (AU)

Personal and Social Responsibility Programme Effects, Prosocial Behaviours, and Physical Activity Levels in Adolescents and Their Families.

The aim of this study was to analyse a personal and social responsibility programme in students and their family's perceptions relative to responsibility, prosocial behaviours, empathy, violence perception and physical activity levels. A sample consisting of 57 physical education students between 11 and 14 years old (mean (M) = 11.93; standard deviation (SD) = 0.73) that included 32 of their parents (M = 49.31; SD = 6.39) was distributed into experimental and control groups. The main results indicate that there were initial significant differences in favour of the control group for personal and social responsibility compared to the experimental group and they disappeared at the end of the treatment. There was an increase in antisocial behaviours for the control group at the end of the treatment. The experimental group also enhanced the values in violence perception for both students and families as compared to the control group. These results seem contradictory, which may be due in part to a short-time intervention programme and a low number of participants in the sample. More studies will clarify the improvements this kind of programme can bring to the variables studied.

Curva de aprendizaje de la punción aspiración con aguja fina de tiroides / Learning curve of thyroid fine-needle aspiration biopsy

Introducción: La punción-aspiración con aguja fina (PAAF) es la técnica de referencia en la evaluación de los pacientes con nódulos tiroideos. Su mayor limitación son las muestras inadecuadas, que deberían ser menos del 20% de los casos. Objetivo: Analizar la curva de aprendizaje de dicha técnica de un endocrinólogo sin experiencia (endocrinólogo 2), comparando sus resultados con los obtenidos en los mismos nódulos por un colega experimentado (endocrinólogo 1). Material y métodos: Se realizaron 60 PAAF entre los meses de febrero y junio de 2016. Cada endocrinólogo realizó 2punciones de cada nódulo en un orden establecido aleatorizadamente. El orden de las punciones y el endocrinólogo que las realizaba eran datos desconocidos para la patóloga que analizó las muestras. Resultados: En el total de las PAAF, el endocrinólogo 1 tuvo un porcentaje de diagnósticos significativamente superior al endocrinólogo 2 (82 vs. 72%; p=0,015). En las primeras 20 PAAF la diferencia entre ambos fue notable y estadísticamente significativa (80 vs. 50%; p=0,047). En las siguientes 20 PAAF la diferencia se redujo y ya no tenía significación estadística (90 vs. 65%; p=0,058). Y en las últimas 20 la diferencia fue mínima y sin significación estadística (75 vs. 70%; p=0,723). Conclusiones: La curva de aprendizaje de la eco-PAAF puede completarse en un entorno adecuado haciéndola un mínimo de 60 veces. Aunque las guías recomiendan al menos 3punciones por nódulo, 2son suficientes para conseguir un porcentaje adecuado de diagnósticos (AU)

Background: Fine-needle aspiration biopsy (FNAB) is the reference procedure for thyroid nodule evaluation. Its main limitation are inadequate samples, which should be less than 20%. Objective: To analyze the learning curve of the procedure by comparing the results of a non-experienced endocrinologist (endocrinologist 2) to those of an experienced one (endocrinologist 1). Material and methods: Sixty FNABs were analyzed from February to June 2016. Each endocrinologist made 2punctures of every nodule in a random order. This order and the professional making every puncture were unknown to the pathologist who examined the samples. Results: Endocrinologist 1 had a higher percentage of diagnoses than endocrinologist 2 (82% vs. 72%, P=.015). In the first 20 FNABs, the difference between both physicians was remarkable and statistically significant (80% vs. 50%, P=.047). In the following 20 FNABs, the difference narrowed and was not statistically significant (90% vs. 65%, P=.058). In the final 20 FNABs, the difference was minimal and not statistically significant (75% vs. 70%, P=.723). Conclusions: The learning curve of ultrasound-guided FNAB may be completed in a suitable environment by performing it at least 60 times. Although the guidelines recommend at least 3punctures per nodule, 2are enough to achieve an accurate percentage of diagnoses (AU)

Learning curve of thyroid fine-needle aspiration biopsy. / Curva de aprendizaje de la punción aspiración con aguja fina de tiroides.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) is the reference procedure for thyroid nodule evaluation. Its main limitation are inadequate samples, which should be less than 20%. OBJECTIVE: To analyze the learning curve of the procedure by comparing the results of a non-experienced endocrinologist (endocrinologist 2) to those of an experienced one (endocrinologist 1). MATERIAL AND METHODS: Sixty FNABs were analyzed from February to June 2016. Each endocrinologist made 2punctures of every nodule in a random order. This order and the professional making every puncture were unknown to the pathologist who examined the samples. RESULTS: Endocrinologist 1 had a higher percentage of diagnoses than endocrinologist 2 (82% vs. 72%, P=.015). In the first 20 FNABs, the difference between both physicians was remarkable and statistically significant (80% vs. 50%, P=.047). In the following 20 FNABs, the difference narrowed and was not statistically significant (90% vs. 65%, P=.058). In the final 20 FNABs, the difference was minimal and not statistically significant (75% vs. 70%, P=.723). CONCLUSIONS: The learning curve of ultrasound-guided FNAB may be completed in a suitable environment by performing it at least 60 times. Although the guidelines recommend at least 3punctures per nodule, 2are enough to achieve an accurate percentage of diagnoses.

Características del uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada / Characteristics of potentially inappropriate prescribing of drugs in elderly polypathological patients

Objetivo: Analizar el uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. Método: Estudio multicéntrico, observacional y prospectivo. Se reclutaron 672 pacientes mayores de 75 años hospitalizados en Medicina Interna entre abril de 2011 y marzo de 2012. Se utilizaron los criterios Beers, STOPP-START y ACOVE para detectar el uso inadecuado de medicamentos, y los resultados se compararon entre pacientes pluripatológicos y no pluripatológicos. Resultados: De 672 pacientes incluidos, 419 (62%) eran pluripatológicos y el 89,3% de ellos presentaban un uso inadecuado de medicamentos, frente al 79,4% de los no pluripatológicos (p <0,01). El 40,3% de los pacientes pluripatológicos cumplía criterios de Beers, el 62,8% criterios STOPP, el 62,3% criterios START y el 65,6% criterios ACOVE. El uso inadecuado de medicamentos fue mayor en los pacientes pluripatológicos con independencia de la herramienta utilizada. Conclusiones: La alta prevalencia de uso inadecuado de medicamentos en pacientes pluripatológicos hace necesario desarrollar estrategias para mejorar la adecuación farmacológica (AU)

Objective: To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). Method: Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. Results: Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. Conclusions: Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed (AU)

[Characteristics of potentially inappropriate prescribing of drugs in elderly polypathological patients]. / Características del uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada.

OBJECTIVE: To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). METHOD: Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. RESULTS: Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. CONCLUSIONS: Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed.

A General Method for Nucleophilic Aromatic Substitution of Aryl Fluorides and Chlorides with Dimethylamine using Hydroxide-Assisted Decomposition of N,N-Dimethylforamide.

A practical and convenient procedure for the nucleophilic aromatic substitution of aryl fluorides and chlorides with dimethylamine was developed using a hydroxide assisted, thermal decomposition of N,N-dimethylforamide. These conditions are tolerant of nitro, nitrile, aldehyde, ketone, and amide groups but will undergo acyl substitution to form amides for methyl esters and acyl chlorides. Isolated yields of the products range from 44 - 98%, with the majority being greater than 70% for seventeen examples.

Elderly patients treated with psychotropic medicines admitted to hospital: associated characteristics and inappropriate use.

PURPOSE: The purpose of this study is to describe the characteristics of older patients treated with psychotropic medicines and the associated factors and to assess their inappropriate use. METHODS: An observational, prospective study was carried out in 672 elderly patients admitted to seven hospitals for a year. A comparison of sociodemographic characteristics, geriatric variables, multimorbidity and the number of prescribed medicines taken in the preceding month before hospitalization between patients treated with psychotropics and those not treated was performed. To assess factors associated with psychotropics, multivariate logistic regression analyses were performed. Inappropriate use was assessed using the Beers and the STOPP criteria. RESULTS: A total of 57.5 % patients (median [Q1-Q3] age 81.7 [78.2-86.1], 65.7 % female) were treated with psychotropics (44.2 % anxiolytics, 22.6 % antidepressants and 10.8 % antipsychotics). Independent factors associated with the use of psychotropics were female gender (OR = 2.3; CI 95 %,1.6-3.5), some degree of disability on admission (slight [OR = 2.2; 1.2-4.2], moderate [OR = 3.2, 1.6-6.6], severe [OR = 3.4; 1.4-8] and very severe [OR = 5.1; 2.0-12.8]) and polypharmacy (5-9 medicines [OR = 3.0; 1.3-6.9] and ≥10 medicines [OR = 6.0; 2.7-13.6]). The associated factors varied depending on the different types of psychotropics. In patients treated with psychotropics, the percentage of those with at least one Beers (61.6 %) or at least one STOPP (71.4 %) criteria was significantly higher in comparison with those not treated with psychotropics (30.7 and 47.7 %, respectively, p < 0.001). CONCLUSIONS: Psychotropics are widely used in the elderly population and often their use is inappropriate. Female gender, a poor functional status and polypharmacy, are the characteristics linked to their use. Interventional strategies should be focused on patients with these characteristics.

Factors influencing psychosocial adjustment and quality of life in Parkinson patients and informal caregivers.

OBJECTIVE: The influence that social conditions and personal attitudes may have on the quality of life (QoL) of Parkinson's disease (PD) patients and informal caregivers does not receive enough attention in health care, as a result of it not being clearly identified, especially in informal caregivers. The aim of this study was to provide a comprehensive analysis of psychosocial adjustment and QoL determinants in PD patients and informal caregivers. METHODS: Ninety-one PD patients and 83 caregivers participated in the study. Multiple regression analyses were performed including benefit finding, coping, disease severity and socio-demographic factors, in order to determine how these aspects influence the psychosocial adjustment and QoL in PD patients and caregivers. RESULTS: Regression models showed that severity of PD was the main predictor of psychosocial adjustment and QoL in patients. Nevertheless, multiple regression analyses also revealed that coping was a significant predictor of psychosocial adjustment in patients and caregivers. Furthermore, psychosocial adjustment was significantly related to QoL in patients and caregivers. Also, coping and benefit finding were predictors of QoL in caregivers but not in patients. CONCLUSIONS: Multidisciplinary interventions aimed at improving PD patients' QoL may have more effective outcomes if education about coping skills, and how these can help towards a positive psychosocial adjustment to illness, were included, and targeted not only at patients, but also at informal caregivers.

Living with chronic illness in adults: a concept analysis.

AIMS AND OBJECTIVES: To report an analysis of the concept of Living with chronic illness in adults, using Rodger's evolutionary analytical methodology. BACKGROUND: In the literature, several qualitative studies exist that address the question of Living with chronic illness from the adult patient's perspective. However, the lack of clarity and consensus among the existing studies renders this concept ambiguous when it is analysed in depth. DESIGN: A narrative review. METHODS: A systematic search has been carried out on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Embase, Cuiden, Dialnet and Scielo. This was limited to articles published in either Spanish or English, from 2003-2013. RESULTS: Living with chronic illness is a complex, dynamic, cyclic and multidimensional process, and involves the development of five different attributes: Acceptance, Coping, Self-management, Integration and Adjustment. Depending on how these attributes operate, there are four different ways of living which can result from the process of Living with chronic illness: (1) Disavowal, (2) False Normality, (3) The New Normal and (4) Disruption. CONCLUSIONS: This paper contributes to the understanding of the concept 'Living with chronic illness'. Findings in this analysis have to be evaluated with caution and further research is needed on this topic to confirm them. Also, more studies in evaluating how patients live a long-term condition are recommended to foster patient-centred care. RELEVANCE TO CLINICAL PRACTICE: Findings generated from this concept analysis can raise awareness of Living with chronic illness so that this process could be assessed in a correct and uniform way in the clinical community and improved when needed.

Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors.

BACKGROUND: Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population. METHODS: In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists. RESULTS: A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86-90) years. The median medicines taken during the month prior to admission was 10 (7-13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1). CONCLUSIONS: Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.

Inappropriate prescribing to older patients admitted to hospital: a comparison of different tools of misprescribing and underprescribing.

PURPOSE: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. METHODS: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. RESULTS: 672 patients [median age (Q1-Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<0.001) was observed. Polypharmacy (≥ 10 medicines) was the strongest predictor of IP [OR=11.34 95% confidence interval (CI) 4.96-25.94], PIMs [OR=14.16, 95% CI 6.44-31.12], Beers-listed PIMs [OR=8.19, 95% CI 3.01-22.28] and STOPP-listed PIMs [OR=8.21, 95% CI 3.47-19.44]. PIMs was the strongest predictor of PPOs [OR=2.79, 95% CI 1.81-4.28]. CONCLUSIONS: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.

Marcadores bioquímicos, nutricionales y actividad antioxidante en el síndrome metabólico / Biochemical and nutritional markers and antioxidant activity in metabolic syndrome

ANTECEDENTES Y OBJETIVOS: 1) Valorar nutricionalmente la dieta seguida por los pacientes con síndrome metabólico, y 2) analizar bioquímicamente el nivel de oxidación-reducción en los pacientes con síndrome metabólico. MATERIAL Y MÉTODO: Se trata de un estudio transversal realizado a pacientes con síndrome metabólico de la Región de Murcia. Se seleccionaron 53 individuos, 33 con síndrome metabólico y 20 sin él (grupo control). La intervención realizada consistió en la cumplimentación de una encuesta recordatorio y un test para valorar nutricionalmente la ingesta dietética, además de la determinación de variables antropométricas y analíticas que incluyen variables relacionas con la actividad antioxidante. RESULTADOS: La actividad antioxidante en ambos grupos analizados está dentro de los límites normales (1,7 ± 0,2 mmol/l en el grupo control y 1,8 ± 0,1 mmol/l en el grupo con síndrome metabólico; ns). La enzima superóxido dismutasa no presenta diferencias significativas entre ambos grupos. Los valores medios de glutatión reductasa (U/l) son superiores en el grupo control que en los pacientes con SM (p < 0,05). Respecto a los biomarcadores de estrés oxidativo, los valores medios de isoprostanos son superiores en el grupo control (4,9 ± 6,2 ng/ml) que en los pacientes con SM (3,5 ± 3,9 ng/ml; p < 0,05). Los valores de LDL oxidadas tienden a ser superiores en los enfermos con SM (96 ± 23,2 U/l) que en el grupo control (86,2 ± 17,3 U/l), no observándose diferencias significativas. Conclusiones Existe una tendencia a un peor perfil nutricional y bioquímico de los pacientes que presentan síndrome metabólico. También tienden a presentar un mayor grado de estrés

BACKGROUND AND OBJECTIVES: 1) Nutritional assessment of the diet followed by patients with metabolic syndrome, and 2) biochemical analysis of the oxidation-reduction level in patients with metabolic syndrome. MATERIAL AND METHODS: A cross-sectional study was conducted in patients with metabolic syndrome in Murcia. Fifty-three patients, 33 with and 20 without (control group) metabolic syndrome, were selected. The intervention consisted of completion of a recall survey and a test to nutritionally assess dietary intake. Anthropometric and laboratory variables, including those related to antioxidant activity, were also tested. RESULTS: Antioxidant activity was within normal limits in both groups (1.7 ± 0.2 mmol/L in the control group and 1.8 ± 0.1 mmol/L in the metabolic syndrome group) (NS). Superoxide dismutase levels were not significantly different between the groups. Mean glutathione reductase levels (U/L) were higher in the control group as compared to patients with metabolic syndrome (P < .05). As regards oxidative stress biomarkers, mean isoprostane levels were higher in the control group (4.9 ± 6.2 ng/mL) than in metabolic syndrome patients (3.5 ± 3.9 ng/mL) (P < .05). Oxidized LDL values tended to be higher in metabolic syndrome patients (96 ± 23.2 U/L) as compared to the control group (86.2 ± 17.3 U/L), but differences were not significant. CONCLUSIONS: There is a trend to a poorer nutritional and biochemical profile in patients with metabolic syndrome, who also tend to have a greater degree of oxidative stress

Recipiente alternativo, utilizado en los procederes de enfermería para la administración de medicamentos por vía oral / An alternative container used for oral administration of medication in the nursing process

Se realizó una innovación tecnológica para la confección de un recipiente que se utiliza en la administración de medicamentos por vía oral, por déficit del original en las salas hospitalarias. En la confección del recipiente se utilizó la tapa protectora y la parte superior del frasco de suero fisiológico, una vez que ha sido utilizado. La parte superior del frasco se utilizó como base, colocando la tapa protectora en forma de recipiente, como resultado se obtuvo el vaso o copa. El recipiente elaborado se utilizó en la docencia, con los estudiantes de la carrera de Técnico en Enfermería de la Filial Universitaria de Ciencias Médicas Dr. Mario Muñoz Monroy de Las Tunas. Los estudiantes realizaron los procederes de enfermería para la administración de medicamentos por vía oral con el recipiente confeccionado (AU)

A technical innovation was developed to make a container for the oral administration of medication because of the severe shortage of the original one in the hospital rooms. For making the container, the protective top and the upper part of the physiological solution bottle were used, once it had been discarded. The upper part of the bottle was used as a base, placing the protective top as the shape of the container, and so obtaining the glass or goblet. The container was used for teaching the students of Nursing Technician Degree Course at Dr. Mario Muñoz Monroy Medical Sciences University Affiliate in Las Tunas. The students developed the nursing process for the oral administration of medication using the container that had been made up (AU)

Experiencias de colaboradores tuneros en la República Democrática de Timor-Leste / Experiences of collaborators from Las Tunas in the Democratic Republic of East Timor

En la presente comunicación breve se relatan las experiencias de una enfermera que se desempeñó profesionalmente en la asistencia médica y la docencia en la República Democrática de Timor Leste. A través de las vivencias compartidas se ponen de manifiesto los valores humanos que caracterizan al personal de la salud cubana, entre ellos: el humanismo, la responsabilidad, la laboriosidad y la solidaridad, características que muestran un ejemplo del papel de la mujer cubana en la Revolución (AU)

In this brief communication, the experiences of a nurse who got along professionally in teaching and giving medical assistance in the Democratic Republic of East Timor are related. By means of sharing personal experience, the Cuban health workers human values are highlighted, such as humanism, responsibility, industriousness and solidarity, characteristics that show an example of the role of the Cuban women in the Revolution (AU)

Biochemical and nutritional markers and antioxidant activity in metabolic syndrome.

BACKGROUND AND OBJECTIVES: 1) Nutritional assessment of the diet followed by patients with metabolic syndrome, and 2) biochemical analysis of the oxidation-reduction level in patients with metabolic syndrome. MATERIAL AND METHODS: A cross-sectional study was conducted in patients with metabolic syndrome in Murcia. Fifty-three patients, 33 with and 20 without (control group) metabolic syndrome, were selected. The intervention consisted of completion of a recall survey and a test to nutritionally assess dietary intake. Anthropometric and laboratory variables, including those related to antioxidant activity, were also tested. RESULTS: Antioxidant activity was within normal limits in both groups (1.7 ± 0.2 mmol/L in the control group and 1.8 ± 0.1 mmol/L in the metabolic syndrome group) (NS). Superoxide dismutase levels were not significantly different between the groups. Mean glutathione reductase levels (U/L) were higher in the control group as compared to patients with metabolic syndrome (P<.05). As regards oxidative stress biomarkers, mean isoprostane levels were higher in the control group (4.9 ± 6.2 ng/mL) than in metabolic syndrome patients (3.5 ± 3.9 ng/mL) (P<.05). Oxidized LDL values tended to be higher in metabolic syndrome patients (96 ± 23.2U/L) as compared to the control group (86.2 ± 17.3 U/L), but differences were not significant. CONCLUSIONS: There is a trend to a poorer nutritional and biochemical profile in patients with metabolic syndrome, who also tend to have a greater degree of oxidative stress.

An inter-rater reliability study of the prescribing indicated medications quality indicators of the Assessing Care Of Vulnerable Elders (ACOVE) 3 criteria as a potentially inappropriate prescribing tool.

PURPOSE: There are limited tools to assess potential prescribing omissions (PPOs) or underprescribing in the elderly. The ACOVE project defines comprehensive quality care indicators for older people and some of these indicators focused on appropriate use of medicines. The aim of the present study was to assess the inter-rater reliability between observers using the ACOVE 3 prescribing indicated medications indicators and compare it with the inter-rater reliability obtained for the Screening Tool of Older Person's Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. METHODS: In the context of an observational and multicentric study of a cohort of 672 patients 75 years and older who were hospitalized in Internal Medicine services of seven Spanish hospitals, an inter-rater reliability study using the ACOVE selected indicators and the STOPP/START criteria was carried out between April 2011 and March 2012. Three patients were randomly selected in each participating hospital, one for each four months of study. RESULTS: A total of 21 patients (mean (SD) age of 84.3 (5.6) years, 57.1% female) were included in the inter-rater reliability study. For the STOPP, START and ACOVE criteria, the median kappa coefficient for the seven hospital analyses was 0.97, 0.92 and 0.95, respectively. Out of 123 total indicators in only 7 (5.7%) was the kappa coefficient value below 0.75. Only for 2 (5.6%) of the 37 studies selected ACOVE quality indicators was the kappa coefficient value less than 0.75. CONCLUSIONS: A high inter-rater reliability was obtained for the selected underprescribing quality indicators of ACOVE 3. These quality indicators may be considered a useful tool in detecting underprescribing to the elderly patients.

Adolescencia y embarazo desde una perspectiva teórica / Teenage pregnancy and from a theoretical perspective

Se realiza una revisión bibliográfica en el Policlínico Universitario Emilio Daudinot Bueno sobre el embarazo en la adolescencia donde se abordan temas importantes tales como, los aspectos teóricos en función de tratar de manera diferente el embarazo en la adolescencia. La salud de los adolescentes y jóvenes es un elemento básico para el avance social, económico y político de un país. Los cambios que ocurren desde el punto de vista biológico, psicológico y social hacen que sea la adolescencia, después de la infancia, la etapa más vulnerable del ciclo vital (AU)

A literature review at the Policlinic Emilio Daudinot Bueno is done on pregnancy in adolescence where important topics such as the theoretical aspects in terms of treating pregnancy in adolescence are performed. The health of adolescents and young people is a key element in the social, economic and political development of a country. The changes that occur from biological, psychological and social points make the adolescence, after childhood, the most vulnerable stage of the life cycle

Una nueva visión teórica del embarazo en la adolescencia / A new theoretical view of teenage pregnancy

Se realiza una revisión bibliográfica en el Policlínico Universitario Emilio Daudinot Bueno sobre el embarazo en la adolescencia donde se abordan temas importantes tales como: conceptualización y aspectos demográficos de la adolescencia, evolución histórica del embarazo en la adolescencia en Cuba y en el mundo, factores predisponentes y determinantes del embarazo(AU)

A bibliographical reviews is done at the Policlinic Emilio Daudinot Bueno on teen pregnancy where ,important issues are addressed such as: conceptualization and demographic aspects of adolescence, historical evolution of teenage pregnancy in Cuba and in the world, determining pregnancy and predisposing factors