[Transcultural adaptation and validation of the DASH questionnaire in Mexican healthy volunteers and patients with neurogenic disorders of the upper extremity]. / Adaptación transcultural y validación de la versión mexicana del cuestionario DASH en individuos sanos y pacientes con trastornos neurogénicos del miembro superior.

Background: The Disability of the Arm, Shoulder and Hand (DASH) questionnaire assesses the impact of upper extremity disorders on quality of life. However, its use in the Mexican population has not been formally validated. Objective: To conduct a cultural adaptation and validation of the DASH questionnaire to evaluate the perspective of patients with neurogenic disorders of the upper extremity regarding the impact on their quality of life. Method: We performed an adaptation of the Spanish version of the DASH questionnaire to the Mexican vocabulary and applied it to 478 volunteers. Ceiling effect, floor effect, item-total correlation, descriptive statistics of items and total score, internal consistency, precision, cross-sectional and longitudinal validity were estimated by comparing healthy controls and affected individuals with different disability levels. Results: Our DASH questionnaire version was equivalent to those previously approved and showed homogeneity of the items with respect to the total value of the questionnaire (Cronbach's alpha > 0.96). In addition, it showed an accuracy of 7.25 points and the crosssectional and longitudinal validity was documented with significant differences between groups and subgroups with distinct disability levels. Conclusions: The DASH questionnaire can be used with a high level of confidence in the Mexican population.

Antecedentes: El cuestionario de discapacidad de brazo, hombro y mano (DASH, Disabilities of the Arm, Shoulder and Hand) mide el impacto de patologías del miembro superior en la calidad de vida. Sin embargo, su uso en la población mexicana no ha sido formalmente validado. Objetivo: Realizar la adaptación cultural y validación del cuestionario DASH para conocer la perspectiva de pacientes con trastornos neurogénicos del miembro superior respecto al impacto en su calidad de vida. Método: Se realizó una adaptación al vocabulario mexicano de la versión española del cuestionario DASH y se aplicó en 478 voluntarios. Se estimaron el efecto techo, el efecto suelo, la correlación ítem-total, las medidas de tendencia central de ítems y el puntaje total, la consistencia interna, la precisión y la validez transversal y longitudinal mediante la comparación de individuos sanos y enfermos con diferente nivel de discapacidad. Resultados: Nuestra versión del cuestionario DASH resultó equivalente a las previamente aprobadas y mostró homogeneidad de los ítems respecto al valor total del cuestionario (alfa de Cronbach > 0.96). Además, tuvo una precisión de 7.25 puntos y se documentó la validez transversal y longitudinal con diferencias significativas entre grupos y subgrupos con diferente nivel de discapacidad. Conclusiones: El cuestionario DASH puede ser empleado con un nivel de confianza alto en la población mexicana.

Control inadecuado del dolor agudo postoperatorio: prevalencia, prevención y consecuencias. Revisión de la situación en Latinoamérica / Inadequate management of acute postoperative pain: prevalence, prevention, and consequences. Review of the situation in Latin America

Resumen: Introducción: El dolor postoperatorio tiene un alto impacto, es una de las principales causas médicas de retraso en el alta hospitalaria. Asimismo, es causa frecuente de readmisión hospitalaria, retrasos en la recuperación y mayores costos para el sistema de salud y los pacientes. El objetivo del presente trabajo es conocer mejor la situación del dolor agudo postoperatorio en Latinoamérica mediante una revisión bibliográfica para poder establecer su prevalencia y evaluar su magnitud. Material y métodos: Se efectuó una búsqueda bibliográfica en SciELO y PubMed tratando de recopilar la información más detallada, precisa y actualizada. Resultados: En Latinoamérica la falta de políticas claras para la evaluación y el tratamiento del dolor postoperatorio, así como de formación, conduce a un control inadecuado del mismo con una prevalencia de dolor agudo postoperatorio moderado/severo superior a 40%. Conclusiones: El manejo del dolor agudo postoperatorio continúa siendo un problema en Latinoamérica. Muchos pacientes refieren dolor moderado o severo tras la cirugía, lo que puede conducir a dolor crónico. Se necesitan más estudios al respecto para poder establecer aún con mayor precisión la prevalencia del dolor agudo postoperatorio y los efectos derivados de su pobre control.

Abstract: Introduction: Postoperative pain has a profound impact. It is one of the main causes of delayed hospital discharge and it is associated with hospital readmission, recovery problems, and higher costs both for the healthcare system and the patients. The aim of this work is to shed light on the postoperative acute pain management in Latin America through a review of the literature, in order to have a better understanding of its prevalence and the extent of the problem. Material and methods: A bibliographical search was performed in SciELO and PubMed trying to gather the most precise, detailed and updated information. Results: In Latin America, the absence of clear policies for the evaluation and treatment of postoperative pain, as well as the lack of training, leads to its inadequate control with a prevalence of moderate/severe acute postoperative pain greater than 40%. Conclusions: Postoperative acute pain continues to be a problem in Latin America. Many patients still suffer moderate to severe pain after surgery, leading to a chronic or persistent painful condition. More studies are needed to get a clear picture of the prevalence of acute postoperative pain and the deleterious effects of an inadequate management.

Longitudinal study of sports injuries in practitioners of aerobic gymnastics competition / Estudo longitudinal de lesões esportivas em praticantes de ginástica aeróbica de competição / Estudio longitudinal de lesiones deportivas en practicantes de gimnasia aeróbica de competición

ABSTRACTIntroduction:Aerobic gymnastics, since its membership in the International Gymnastics Federation, has undergone changes in its regulations.Objective:To analyze the injuries found in Spanish aerobic gymnastics athletes during different editions of the Code of Points.Methods:A descriptive, longitudinal and compara-tive study was carried out on the epidemiology of injuries in aerobic gymnastics published during different editions of the Code of Points.Results:It highlights that the number of injuries decreased from 156 to 38 last year. This decline has been related to the restriction on the number of difficulties in the exercise and the number of elements to be performed on the floor. However, they have increased the number and value of the difficulties.Conclusions:Therefore, it is concluded that the changes made in the regulations are intended to safeguard the health of athletes and ensure that competition develops at its best artistic and technical aspect.

RESUMOIntrodução:A ginástica aeróbica, desde sua adesão à Federação Internacional de Ginástica, passou por mudanças em seus regulamentos.Objetivo:Analisar as lesões encontradas nos atletas espanhóis de ginástica aeróbica durante as diferentes edições do Código de Pontos.Métodos:Realizou-se um estudo descritivo, longitudinal e comparativo sobre a epidemiologia de lesões na ginástica aeróbica publicado durante as diferentes edições do Código de Pontos.ResultadosSalienta-se que o número de lesões diminuiu de 156 para 38 no ano passado. Este declínio tem sido relacionado com a limitação do número de dificuldades no exercício e o número de elementos a serem feitos no solo. No entanto, eles aumentaram o número e valor das dificuldades.Conclusões:Portanto, concluiu-se que as modificações feitas nos regulamentos destinam-se a salvaguardar a saúde dos atletas e garantir que a competição se desenvolva no seu melhor aspecto artístico e técnico.

RESUMENIntroducción:La gimnasia aeróbica desde su pertenencia a la Federación Internacional de Gimnasia ha sufrido cam-bios en su reglamentación.Objetivo:Analizar las lesiones que los deportistas españoles de gimnasia aeróbica presentaron durante las diferentes ediciones del Código de Puntuación.Métodos:Se ha realizado un estudio descriptivo, longitudinal y comparativo sobre la epidemiología de las lesiones en la gimnasia aeróbica publicado durante las diferentes ediciones del Código de Puntuación.Resultados:El estudio destaca la disminución del número de lesiones, de 156 a 38 en el último año. Esta disminución ha tenido relación con la restricción del número de dificultades en el ejercicio y la cantidad de elementos a realizar en el suelo. Sin embargo, han aumentado el número y el valor de las dificultades.Conclusiones:Por tanto, han concluido que las modificaciones que se realizan en la reglamentación tienen como objetivo velar por la salud de los deportistas y garantizar que la competición se desarrolle en su máximo esplendor artístico y técnico.

Análise da incidência lesional na ginástica aeróbica espanhola de elite / Analysis of incidence of injury in Spanish elite in aerobic gymnastics

INTRODUÇÃO: A ginástica aeróbica (GA) é uma disciplina que possui exigências físicas específicas e treinamento adequado para prevenir ou minimizar a ocorrência de lesões esportivas. OBJETIVO: Analisar a incidência de lesões na GA e a sua vinculação com fatores de treinamento MÉTODO: Realizou-se um estudo em 40 desportistas valencianos com idades compreendidas entre nove e 17 anos. O procedimento de coleta de informações foi através de um questionário de morbidade. A variável dependente foram as lesões durante a temporada 2009-2010 e as variáveis independentes principais foram a carga de treinamento, o material de proteção, superfície de treinamento, gesto técnico e tipo de lesão e zona corporal lesionada. RESULTADOS: As lesões mais reincidentes foram as relacionadas a ligamentos, afetando por igual os membros superior e inferior. A metade das lesões ocorreu após a realização dos saltos, apesar do uso de algum material de proteção, além de terem ocorrido no início da temporada. Relações significativas entre o número de lesões e a experiência, os dias de treinamento e o número de competições (p < 0,05) foram encontradas. CONCLUSÕES: O número de lesões diminuiu enquanto o uso de medidas de proteção, com destaque para as munhequeiras, aumentou. Metade das lesões produziu-se durante o período de aprendizagem técnica de dificuldades.

INTRODUCTION: Aerobic Gymnastics (GA) is a gymnastic discipline that requires specific physical needs and proper training to prevent or minimize the occurrence of sports injuries. OBJECTIVE: To analyze the incidence of injuries in the GA and its relationship with training factors. METHODS: A study with 40 Valencian athletes aged between 9 and 17 years was performed. Data was collected through a questionnaire of morbidity. The dependent variable was the injuries during the 2009-2010 season and the main independent variables were the training load, the protective equipment, training surface, technical movements and type of injury and body part injured. RESULTS: The most recurrent injuries were the ones related to ligaments, affecting both the upper and lower limbs. Half of the injuries occurred after performing jumps, despite the use of protective equipment and took place at the beginning of the season. Significant correlation was found between the number of injuries and the experience, training days and number of competitions (p <0.05). CONCLUSIONS: the number of injuries has decreased and the use of protective equipment has increased, with special attention to wristbands. Half of the injuries occurred during the learning period of technical difficulties.

Una mirada a la familia de pandillas en San Juan de Lurigancho / A look at the family gang in San Juan de Lurigancho

La familia es el principal medio socializador y responsable primario del comportamiento adolescente. Cuando la familia no cumple esta función, los adolescentes buscan una solución en las pandillas las cuales constituyen un espacio alternativo al que sus integrantes recurren, para compensar la necesidad de comunicación y vínculos afectivos, así como para desarrollar un sentido de pertenencia. Objetivo: conocer el entorno familiar de los integrantes de una pandilla. Material y métodos: el estudio se realizó en la Urb. San Gabriel, Distrito de San Juan de Lurigancho durante noviembre y diciembre del 2008. Fue descriptivo de corte transversal, con una población de 40 integrantes de 15 a 24 años. Para obtener los resultados se utilizó el paquete SPSS versión 12 aplicándose el análisis descriptivo. Resultados: los resultados muestran que los encuestados presentan familias con las siguientes características: las familias monoparentales alcanzan el 45 por ciento (n = 18), la dinámica familiar muestra que hay una mala relación intrafamiliar en el 77,5 por ciento (n = 31) de los casos, con un mayor porcentaje la familia permisiva; puesto que el 62, 5 por ciento (n = 25) presenta las características mencionadas, las necesidades que requieren los adolescentes y jóvenes no son satisfechas en el 97,5 por ciento (n = 39) de ellos. Conclusiones: estos datos se pueden relacionar con una gran característica, esta es la falta de comunicación productiva que tiene con su familia, la cual podría tomarse como un eje fundamental para que los adolescentes y jóvenes se sientanà.

The family is the primary means of socialization and adolescent behavior primarily responsible. When the family does not fulfill this function, teenagers seek a solution in the gangs that constitute an area of alternative, that its members use to offset the need for communication and bonding, and to develop a sense of belonging. Objective: To know the family circle of members of a gang. This is a descriptive and cross-sectional study. Material and methods: The study was conducted in the area of the San Gabriel Development, in the district of San Juan de Lurigancho during November and December 2008. Study was descriptive and cross sectional, population consisted of 40 members from 15 to 24 years that were part of the analysis. The data obtained was analyzed with the statistical package SPSS version 12 applying a descriptive analysis. Results: The results show that the total of 40 members polled have families members with the following characteristics: the single-parent families increased to 45 per cent (n = 18), the family dynamics shows that there is a bad family relationship in 77.5 per cent (n = 31) of cases, presenting a high percentage permissive family; and that 62.5 per cent (n = 25) present these characteristics, the necessities required by the teenagers and youngsters are not met in 97.5 per cent (n = 39) of the cases. Conclusions: These data can be related to a main characteristic, which could be seen as a cornerstone for adolescents and young people to feel helpless and emotionally abandoned, this is given by the lack of productive communication they have with their families.

Parámetros de práctica para el manejo del dolor en cáncer: Grupo de Consenso para el Manejo del Dolor en Cáncer / Practice guidelines for cancer pain management: Task Force for Cancer Pain Management

El dolor por cáncer es un problema frecuente en nuestro medio, se presenta en 80 a 90 % de los pacientes y en aproximadamente 90 % de ellos se resuelve con medidas relativamente sencillas. No obstante, aproximadamente 40 % de los pacientes se encuentra insatisfecho con el médico o la enfermera respecto al manejo de su dolor. Por tal motivo, se convocó a un grupo de consenso con la finalidad de generar parámetros de práctica clínica fundamentados en la evidencia publicada y en la opinión de los expertos. Este grupo estuvo integrado por 31 médicos líderes de opinión es este campo, quienes con base en 599 documentos emitieron esta serie de recomendaciones, identificadas cada una según su nivel de evidencia.

Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.