The legitimacy of pain according to sufferers.

Pain is an unpleasant experience that we will all experience in some form over the course of our lives, with chronic pain affecting a significant proportion of the global population. Given these circumstances, this study investigates whether pain is a legitimated phenomenon and considers the processes involved in the creation of such a status. This is an exploratory investigation based on semi-structured interviews with people suffering from chronic pain as a consequence of physical, psychological, emotional, or social circumstances. Our principal objective is to explore the fundamental elements of legitimacy and the processes that bring it into being-i.e., to understand how it is socially constructed. The main finding, however, is that many sufferers of chronic physical, psychiatric/psychological, emotional and social pain perceive that their pain is not considered legitimate when no clear cause can be identified, when the pain prevents them from developing the norms imposed by social roles or when it inhibits them to make a productive contribution to the society in which they live. This is generally due to the disruptive aspect of pain and its impact on the social structure, specifically on productivity, which nowadays constitutes a key element in the legitimation of any social phenomenon.

Body mass index interacts with a genetic-risk score for depression increasing the risk of the disease in high-susceptibility individuals.

Depression is strongly associated with obesity among other chronic physical diseases. The latest mega- and meta-analysis of genome-wide association studies have identified multiple risk loci robustly associated with depression. In this study, we aimed to investigate whether a genetic-risk score (GRS) combining multiple depression risk single nucleotide polymorphisms (SNPs) might have utility in the prediction of this disorder in individuals with obesity. A total of 30 depression-associated SNPs were included in a GRS to predict the risk of depression in a large case-control sample from the Spanish PredictD-CCRT study, a national multicentre, randomized controlled trial, which included 104 cases of depression and 1546 controls. An unweighted GRS was calculated as a summation of the number of risk alleles for depression and incorporated into several logistic regression models with depression status as the main outcome. Constructed models were trained and evaluated in the whole recruited sample. Non-genetic-risk factors were combined with the GRS in several ways across the five predictive models in order to improve predictive ability. An enrichment functional analysis was finally conducted with the aim of providing a general understanding of the biological pathways mapped by analyzed SNPs. We found that an unweighted GRS based on 30 risk loci was significantly associated with a higher risk of depression. Although the GRS itself explained a small amount of variance of depression, we found a significant improvement in the prediction of depression after including some non-genetic-risk factors into the models. The highest predictive ability for depression was achieved when the model included an interaction term between the GRS and the body mass index (BMI), apart from the inclusion of classical demographic information as marginal terms (AUC = 0.71, 95% CI = [0.65, 0.76]). Functional analyses on the 30 SNPs composing the GRS revealed an over-representation of the mapped genes in signaling pathways involved in processes such as extracellular remodeling, proinflammatory regulatory mechanisms, and circadian rhythm alterations. Although the GRS on its own explained a small amount of variance of depression, a significant novel feature of this study is that including non-genetic-risk factors such as BMI together with a GRS came close to the conventional threshold for clinical utility used in ROC analysis and improves the prediction of depression. In this study, the highest predictive ability was achieved by the model combining the GRS and the BMI under an interaction term. Particularly, BMI was identified as a trigger-like risk factor for depression acting in a concerted way with the GRS component. This is an interesting finding since it suggests the existence of a risk overlap between both diseases, and the need for individual depression genetics-risk evaluation in subjects with obesity. This research has therefore potential clinical implications and set the basis for future research directions in exploring the link between depression and obesity-associated disorders. While it is likely that future genome-wide studies with large samples will detect novel genetic variants associated with depression, it seems clear that a combination of genetics and non-genetic information (such is the case of obesity status and other depression comorbidities) will still be needed for the optimization prediction of depression in high-susceptibility individuals.

Asociación de tumor phyllodes y carcinoma ductal infiltrante / Association between phyllodes tumor and infiltrating ductal carcinoma

El diagnóstico de un tumor phyllodes asociado a un carcinoma de mama es muy raro (1-2% de todos los tumores phyllodes). Este tipo de asociación se produce tras la transformación maligna del componente epitelial del tumor phyllodes. Se presenta el caso de una mujer de 46 años, que consulta al presentar un nódulo en mama derecha de rápido crecimiento. Tras valoración clínica, radiológica e histológica, y con el diagnóstico de tumor phyllodes benigno, se practicó una excisión local amplia. El estudio anatomopatológico definitivo informó de la presencia de una tumoración bifásica con un tumor phyllodes de bajo grado de malignidad en el componente estromal y un carcinoma ductal infiltrante en el componente epitelial, presente únicamente en forma de émbolos tumorales en la cápsula del tumor phyllodes

The diagnosis of a phyllodes tumor associated with a breast carcinoma is very rare (1-2% of all phyllodes tumors). This type of association occurs after the malignant transformation of the epitelial component of the phyllodes tumor. We present the case of a 46-year-old woman who consulted for a fast-growing nodule in the right breast. After clinical, radiological and histological evaluation, and with the diagnosis of benign phyllodes tumor, a wide local excision was performed. The anatomopathological study reported the presence of a biphasic tumor with a phyllodes tumor of low grade of malignancy in the stromal component, and an infiltrating ductal carcinoma in the epitelial component, in the form of tumor emboli in the phyllodes tumor capsule

Carcinoma mioepitelial de mama / Myoepithelial carcinoma of the breast

El carcinoma mioepitelial de mama (o mioepitelioma maligno) es un tumor poco frecuente compuesto exclusivamente por células mioepiteliales malignas. Su diagnóstico supone un reto, y viene dado por los hallazgos anatomopatológicos apoyados por las técnicas de inmunohistoquímica. Presentamos un caso clínico y revisión bibliográfica

Myoepithelial carcinoma of the breast (or malignant myoepithelioma) is a rare tumor composed exclusively of malignant myoepithelial cells. Its diagnosis is a challenge and is reached through pathological findings supported by immunohistochemical techniques. We present a case report and a review of the literature

Enfermedad de Paget pigmentada de la mama / Pigmented mammary Paget disease

La enfermedad de Paget pigmentada de la mama es una variante clinicopatológica infrecuente de la enfermedad de Paget, la cual debe incluirse en el diagnóstico diferencial de las lesiones pigmentadas del pezón. Se presenta el caso de una mujer de 49 años que consulta al presentar una mácula pigmentada en el pezón derecho de 9 meses de evolución; y cuyo estudio histológico e inmunohistoquímico permitió diagnosticar una Enfermedad de Paget que se acompaña de una hiperplasia melanocitaria atípica, diferenciándola de un melanoma maligno

Pigmented mammary Paget disease is an uncommon clinicopathological variant of Paget's disease, which should be included in the differential diagnosis of pigmented lesions on the nipple. We present the case of a 49-year-old woman with a 9-month-old pigmented lesión on her right nipple. The histological and immunohistochemical study allowed the diagnosis of a Paget's disease with intense atypical melanocytic hyperplasia, differentiating it from a malignant melanoma

Improving the prediction of the fatty acid profile of olive oils by considering statistically relevant harvests and agro-climatic variables.

BACKGROUND: Fatty acids are the major components in extra virgin olive oil, and they are considered as a quality parameter to its authentication. As fraudulent practices are the most important problem in this sector, fast, reliable and cost-effective techniques, such as Raman spectroscopy, have been successfully applied, in combination with chemometrics, to determine the fatty acid profile of oils. RESULTS: The huge amount of information provided by Raman spectra is reduced in a few orthogonal components of principal component analysis (PCA). The goodness-of-fit of the statistical models including only these PCA factors is considerably increased by introducing dummy variables, associated with the harvest, and some agro-climatic variables (temperature, humidity, wind speed, radiation, precipitation and evapotranspiration). Many of these additional variables are statistically relevant in models using either the global sample or subsamples of Andalusian provinces or olive varieties. CONCLUSIONS: The regression models using only Raman spectral information are clearly improved by the consideration of harvesting time and agro-climatic data, a useful result as trade standard applying to olive oils limits values for disaggregated fatty acids to authenticate olive oils. Nevertheless, the effect (or the statistical relevance) of these variables depends on the specific type of fatty acid, geographical region (province) or olive variety. © 2019 Society of Chemical Industry.

¿Es Posible el Uso de la Postpartum Depression Screening Scale Short Form en la Depresión Antenatal? / Postpartum Depression Screening Scale Short Form: Is it possible to use it for antenatal depression?

El objetivo fue analizar la validez de la Escala de Depresión Posparto, forma abreviada (PDSS-SF) en la detección de los síntomas de depresión prenatal mediante el uso del cuestionario Patient Health Questionnaire-9 (PHQ-9) como gold standard. La muestra del presente estudio estuvo conformada por 449 gestantes reclutadas en el Hospital Clínico San Carlos de Madrid (España). Se utilizó un análisis de curva ROC. Los resultados indican que el área bajo la curva ROC para la depresión menor, moderada y severa fue .86, p < .001, .95, p < .001, y .99, p < .001, respectivamente. La sensibilidad y especificidad fueron .70 y .81 para la depresión menor con un punto de corte de 11, .85 y .88 para depresión moderada con un punto de corte de 14 y 1 y .99 con un punto de corte de 23 para depresión severa. Los resultados de PDSS-SF proporcionan una buena consistencia interna y muestran combinaciones satisfactorias de sensibilidad y especificidad. La PDSS-SF es una herramienta precisa para evaluar la depresión prenatal

The aim of this study was to obtain the construct validity of the short form of the Postpartum Depression Scale (PDSS-SF) for screening antenatal depression symptoms by means of the Patient Health Questionnaire-9 (PHQ-9) as a gold standard. The sample consisted of 449 pregnant women recruited in the Hospital Clínico San Carlos, Madrid, Spain. A ROC analysis was used. The results show the the area under the ROC curve for minor, moderate, and severe depression was .86, p < .001, .95, p < .001, and .99, p < .001, respectively. The sensitivity and specificity were .70 and .81 for minor depression, with 11 as a cutoff score, .85 and .88 for moderate depression, with 14 as a cutoff score, and 1 and .99, with 23 as a cutoff score for severe depression. The results of the PDSS-SF provide a good internal consistency, significant validity and reliability, and showed satisfactory combinations of sensitivity and specificity. The PDSS-SF is an accurate tool to evaluate antenatal depression

Angiosarcoma de mama radioinducido / Radiotherapy-induced angiosarcoma of the breast

El angiosarcoma radioinducido de mama tras tratamiento quirúrgico conservador y radioterapia complementaria en una paciente con cáncer de mama es una entidad poco frecuente, de difícil diagnóstico y mal pronóstico. Se presenta el caso de una mujer de 71 años, con antecedentes personales de carcinoma ductal infiltrante de mama izquierda, a la que se practicó tumorectomía y linfadenectomía axilar (pT1cpN0M0), y recibió tratamiento adyuvante con radioterapia y hormonoterapia. 77 meses después del tratamiento, la paciente consultó al presentar una lesión cutánea en la mama izquierda. Tras valoración clínica, radiológica e histológica y con el diagnóstico de angiosarcoma de mama, se practicó mastectomía izquierda. Posteriormente no recibió tratamiento complementario

Radiotherapy-induced angiosarcoma of the breast after conservative surgical treatment and complementary radiotherapy in a patient with breast cancer is a rare condition, with both difficult diagnosis and poor prognosis. We present the case of a 71-year-old woman with a personal history of infiltrating ductal carcinoma of the left breast, who underwent tumorectomy and axillary lymphadenectomy (pT1cpN0M0), and received adjuvant treatment with radiotherapy and hormone therapy. 77 months after treatment, the patient consulted with a skin lesion on her left breast. After clinical, radiological and histological assessment and with the diagnosis of angiosarcoma of the breast, a mastectomy of her left breast was performed. The patient did not receive complementary treatment

Carcinoma de células acinares de mama / Primary acinic cell carcinoma of the breast

El carcinoma de células acinares primario de mama es un tumor raro que muestra similitudes con neoplasias de las glándulas salivales; y aunque pertenece al grupo de carcinomas de mama "triple negativos", su comportamiento biológico parece ser más favorable. Se presenta el caso de una mujer de 54 años, sin antecedentes oncoginecológicos, remitida a la consulta de patología mamaria para valoración por mamografía de screening que informa de BIRADS IV en mama derecha. A la exploración física, las mamas y axilas son normales a la inspección y a la palpación, tratándose de una lesión no palpable. El estudio citológico tras punción ecoguiada informa de sospecha de malignidad, motivo por el cual se practica biopsia excisional radioguiada que informa de la presencia de un carcinoma de células acinares de mama. Se realizó tratamiento quirúrgico conservador en mama-axila derecha y recibió radioterapia adyuvante. Tras 6 años del diagnóstico, se encuentra libre de enfermedad

Primary acinic cell carcinoma of the breast is a rare tumor that shows similarities with neoplasms of the salivary glands; and although it belongs to the group of "triple negative" breast cancer, its biological behavior seems to be more favorable. We present the case of a 54-year-old woman, with no gynecological cáncer history, referred to the mammary pathology office for evaluation after mammography screening that reports BIRADS IV in the right breast. On physical examination, the breasts and axillas are normal to inspection and palpation, being this the case of a non-palpable lesion. The cytological study after echoguided puncture reports suspicion of malignancy, which is why a radioguided excisional biopsy is performed, which shows the presence of an acinic cell carcinoma of the breast. Conservative surgical treatment is performed in the right breast-axilla, together adjuvant radiotherapy. 6 years after diagnosis, the patient is free of disease

Disminución de la incidencia de úlceras por presión en sacro y talones en pacientes ingresados en cuidados intensivos / Reduction in the incidence of pressure ulcers in sacrum and heels in patients hospitalized in the intensive care unit

INTRODUCCIÓN: la aparición de úlceras por presión (UPP) es un buen indicador de la calidad asistencial; su control y monitorización es una responsabilidad de los profesionales de Enfermería como actividad básica de seguridad clínica. OBJETIVOS: disminuir las tasas de incidencia de úlceras por presión en la Unidad de Cuidados Intensivos. Determinar la eficacia de los apósitos preventivos de espuma de adhesión atraumática (Mepilex Border Sacrum® y Mepilex Heel®). RESULTADOS: se desarrollaron 11 úlceras por presión, n= 10 en rama de medidas estándar de prevención, y n= 1 en la rama de tratamiento (sacro), 10 UPP en zona sacra y una en talones. La incidencia de úlceras por presión en la muestra fue del 10,47%, 5,07 puntos inferior a la incidencia media en el presente medio, siendo la diferencia estadísticamente significativa. CONCLUSIÓN: parece razonable, a la luz de los resultados, que se establezca un protocolo de apósitos preventivos (Mepilex Border Sacrum® y Mepilex Heel®) en zonas de mayor riesgo de padecer UPP (sacro y talones) en aquellos pacientes con un Braden objetivo de riesgo para padecer dichas UPP igual o inferior a 13-14 y con enfermedades crónicas graves

INTRODUCTION: the presence of pressure ulcers (PUs) is a good indicator of quality of care; nursing professionals are responsible for their control and monitoring as a basic activity within clinical safety. OBJECTIVES: to reduce the incidence rates of pressure ulcers in the Intensive Care Unit. To determine the efficacy of the preventive shaped foam dressings with non-traumatic adhesion (Mepilex Border Sacrum and Mepilex Heel). RESULTS: eleven pressure ulcers were developed, n= 10 in the arm with standard prevention measures, and n= 1 in the treatment arm (sacrum), 10 PUs in the sacral region and one in the heels. There was a 10.47% incidence of pressure ulcers in our sample, 5.07 scores below the mean incidence in the current setting, with a statistically significant difference. CONCLUSION: it seems reasonable, given the results, to establish a protocol for preventive dressings (Mepilex Border Sacrum and Mepilex Heel) in the areas at higher risk of PUs (sacrum and heels), in those patients with a ≤13-14 risk of PUs according to the Braden Scale, and with severe chronic diseases

Adaptación y validación al español del cuestionario Aid to Capacity Evaluation (ACE), para la valoración de la capacidad del paciente en la toma de decisiones médicas / The adaptation and validation to Spanish of the questionnaire Aid to capacity evaluation (ACE), for the assessment of the ability of patients in medical decision-making

OBJETIVO: Adaptar al español y validar la escala Aid to Capacity Evaluation, diseñada para evaluar la capacidad del adulto para la toma de decisiones médicas, tanto en procesos de diagnóstico como de tratamiento para su enfermedad. DISEÑO: Observacional de validación prospectiva. Emplazamiento: Atención primaria y hospitalaria de la Zona Básica de Salud de Jaén. PARTICIPANTES: Ciento veintinueve pacientes. MEDICIONES PRINCIPALES: Cuestionario que incluía variables sociodemográficas, variables relativas a la decisión (ámbito, tipo de decisión, necesidad de consentimiento informado escrito), valoración de la capacidad con la escala Aid to Capacity Evaluation y otras relativas a la comorbilidad (hipoacusia, alcoholismo, nivel cognitivo con el Mini-Examen Cognoscitivo, y depresión mediante el test Goldberg o el Yesavage). RESULTADOS: La herramienta se considera viable. Las conclusiones del panel de expertos fueron favorables. El resultado de la validez de criterio, al comparar los resultados con la valoración de los expertos (forense y psiquiatra) fue muy satisfactorio (p < 0,001). La fiabilidad intraobservador fue baja, con un índice kappa de 0,135. La fiabilidad interobservador fue alta, con un índice kappa de 0,74. La consistencia interna obtuvo un α de Cronbach de 0,645 para el modelo reducido de 6 ítems. CONCLUSIONES: La adaptación al español de la escala Aid to Capacity Evaluation muestra una adecuada validez de constructo y consistencia interna. Su utilización contribuiría a la identificación de pacientes incapaces de tomar una determinada decisión médica y/o de otorgar un consentimiento informado

OBJECTIVE: To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. DESIGN: Observational study of prospective validation. SETTING: Primary and hospital care of the basic health area of Jaen. PARTICIPANTS: One hundred twenty-nine PATIENTS: MAIN MEASUREMENTS: Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). RESULTS: The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P < .001). The intra-observer reliability was low (kappa = 0,135). Interobserver reliability remained high (kappa = 0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. CONCLUSIONS: The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent

[The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making]. / Adaptación y validación al español del cuestionario Aid to Capacity Evaluation (ACE) , para la valoración de la capacidad del paciente en la toma de decisiones médicas.

OBJECTIVE: To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. DESIGN: Observational study of prospective validation. SETTING: Primary and hospital care of the basic health area of Jaen. PARTICIPANTS: One hundred twenty-nine patients. MAIN MEASUREMENTS: Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). RESULTS: The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. CONCLUSIONS: The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent.

Carcinoma de células pequeñas de mama / Oat cell carcinoma of the breast

El cáncer de células pequeñas de mama es un cáncer raro y agresivo sin un tratamiento protocolizado debido a los pocos casos descritos. Presentamos el caso de una paciente de 64 años que acude a la Unidad de Patología Mamaria para estudio de nódulo de mama izquierda con diagnóstico de carcinoma ductal infiltrante de células pequeñas de mama (AU)

Oat cell breast cancer is a rare and aggressive form of cancer. Because only a few cases have been described in the literature, there is no standard treatment. We report the case of a 64-year-old woman who attended our unit for investigation of a node in her left breast that was diagnosed as infiltrative oat-cell breast carcinoma (AU)

Prevención del deterioro de la integridad cutánea en el sacro mediante la aplicación de una espuma de adhesión atraumática / Prevention of deterioration of the cutaneous integrity in the sacral area through the application of an atraumatic self-adherent foam dressing

OBJETIVO: determinar si la aplicación de una espuma de adhesión traumática (Mepilex Border Sacrum®) disminuye o retrasa la aparición de lesiones en la zona del sacro en los pacientes que presentan un elevado riesgo de desarrollar úlceras por presión (UPP).MÉTODO: ensayo clínico no aleatorizado. La procedencia de los participantes fueron los servicios de Geriatría, Cuidados Paliativos, Oncohematología y la Unidad de Cuidados Intensivos del Hospital Universitario Lucus Augusti, así como la Residencia Asistida de Personas mayores de Castro de Riberas de Lea Sarquavitae.Pasaron a formar parte del grupo de intervención los individuos hospitalizados que presentaban al momento de entraren el estudio un riesgo elevado de desarrollar UPP (entre 6y 12 puntos en la escala de Braden). El grupo control lo formaron los individuos cuyo riesgo al ingreso era bajo o moderado (≥ 13puntos de la escala Braden). El estudio fue aprobado por el Comité Ético de Investigación Clínica de Galicia. RESULTADOS: formaron parte del estudio 46 individuos en cada grupo. En el grupo en el que se aplicó la espuma de adhesión traumática, se produjo un número de eventos de alteración cutánea mucho menor que en el que no se aplicó (2 vs. 20, respectivamente).A su vez, la incidencia de individuos que desarrollaron heridas fue de un 10% menor en el grupo de la espuma. También se observó que el número de días que se tardaba en desarrollar una lesión era significativamente mayor en el grupo de pacientes a los que se les había puesto la espuma de adhesión atraumática (p< 0,05).CONCLUSIONES: la espuma de adhesión atraumática Mepilex Border Sacrum® podría utilizarse como elemento preventivo del deterioro de la integridad cutánea en el sacro, dado que disminuye o retrasa la aparición de lesiones en dicha zona en pacientes que presentan un elevado riesgo de desarrollar úlceras por presión (UPP)

OBJECTIVE: to determine if the application of an atraumatic self-adherent foam dressing (Mepilex Border Sacrum®) will reduce or delay the presentation of lesions in the sacral area in those patients with a high risk of developing pressure ulcers. METHOD: non-randomized clinical trial. The participants were patients from the Geriatrics, Palliative Care and Oncohaematology Departments and the Intensive Care Unit of the Hospital Universitario Lucus Augusti, as well as from the Assisted Living Home for Elderly People Castro de Riberas de Lea Sarquavitae.T he intervention group was formed by those hospitalized persons who presented a high risk of developing pressure ulcers(between 6 and 12 points in the Braden Scale). The control group included those individuals who had low or moderate risk (≥13points in the Braden Scale) at admission. The study was approved by the Ethical Committee for Clinical Research in Galicia. RESULTS: there were 46 individuals in each arm of the study. Within the group in which the atraumatic self-adherent foam dressing was applied, there was a much lower number of cutaneous alteration events than in the group where it was notapplied (2 vs 20, respectively). At the same time, the number of individuals who developed lesions was 10% lower in the foam dressing group. It was always observed that the number of days required for developing a lesion was significantly higher in the group of patients who had received the atraumatic selfadherentfoam dressing (p < 0.05).CONCLUSIONS: the Mepilex Border Sacrum® atraumatic selfadherentfoam dressing could be used as a preventive element for the deterioration of cutaneous integrity in the sacral area, given that it reduces or delays the presentation of lesions in said area in patients with a high risk of developing pressure ulcers

Hipotiroidismo en tratamiento en el Área de Salud de Guadalajara (España): características y prevalencia estimadas a partir del consumo de hormona tiroidea / Hypothyroidism under treatment in the Guadalajara (Spain) health care area: characteristics and prevalence based on the intake of thyroid hormone

Objetivo. Nos proponemos estimar la prevalencia del hipotiroidismo tratado en nuestra Área de Salud a partir de la prescripción de hormona tiroidea. Describimos asimismo sus características y diferencias en base a diversos factores sociodemográficos. Diseño. Estudio descriptivo de corte transversal. Emplazamiento. Área Sanitaria de Guadalajara (España). Participantes. Sujetos en tratamiento con levotiroxina por hipotiroidismo incluidos en tarjeta sanitaria durante el año 2009. Mediciones Principales. Se evaluaron la distribución por sexo, edad y lugar de residencia, previo ajuste de tasas. Otras variables analizadas fueron el tipo de hipotiroidismo, última dosis prescrita y niveles de TSH, comparando en función de variables sociodemográficas. Resultados. Un 3,3% de la población (IC 95%: 3,3-3,4) recibió tratamiento con levotiroxina (5,8% mujeres y 1,0% varones), observando la tasa más elevada en mujeres mayores de 65 años (11,9%). La tasa ajustada fue 38,8/1000 (IC 95%: 37,7-40,0) para el medio urbano y 34,6/1000 (IC 95%: 33,4-35,8) para el rural. Edad media de 56,6 años (DE: 18,2). Se asume origen autoinmune en el 76% de los casos con causa reconocible, utilizando una dosis media de 76,84mcg/día. Un 76,2% de los pacientes presentaron un rango correcto de TSH. Conclusiones. El hipotiroidismo subclínico es un proceso frecuente entre los usuarios de un Centro de Salud y mayoritariamente tiene origen autoinmune. El diagnóstico es más frecuente en el sexo femenino y en población mayor. Existe habitualmente un buen control de las cifras de TSH. Las diferencias geográficas son poco relevantes(AU)

Objective. It is our aim to estimate the prevalence of hypothyroidism treated in our health care area from the prescription of thyroid hormone. Likewise, we describe its characteristics and differences on the basis of various socio-demographic factors. Design. Cross sectional descriptive-type study. Location. Guadalajara (Spain) health care area. Participants. Subjects under treatment with levothyroxine for hypothyroidism included on health card throughout the year 2009. Main Measures. Distribution by gender, age and place of residence, after rate adjustment. Other analyzed variables were the type of hypothyroidism, last prescribed dosage and TSH levels, compared according to socio-demographic variables. Results. 3,3% of the population (IC 95%: 3,3-3,4) were treated with levothyroxine (5,8% female y 1,0% male), with the highest rate being seen in women over 65 years old (11,9%). The adjusted rate was 38,8/1000 (IC 95%: 37,7-40,0) for urban areas and 34,6/1000 (IC 95%: 33,4-35,8) for rural areas. Average age 56,6 years (DE: 18,2). An autoimmune origin is assumed in 76% of cases with a recognizable cause, using an average dose of 76,84mcg/day. 76,2% of the patients showed a correct level TSH. Conclusions. Subclinical hypothyroidism is a frequent complaint among Health Centre users and has a chiefly autoimmune origin. Diagnosis is more frequent in females and in older members of the population. TSH figures are usually closely checked. Geographical differences of little significance(AU)

Effect of chlorin structure on theoretical electronic absorption spectra and on the energy released by porphyrin-based photosensitizers.

In this work eight porphyrins (p) and eight chlorins (c) are theoretically characterized [BLYP/6-31G(d)] in their singlet and triplet states. Nine of them (1p, 1c, 2p, 3p, 4p, 5p, 6c, 7c, and 8c) have already been synthesized and are in trial use in photodynamic therapy (PDT). The seven remaining were built up as chlorins analogous to porphyrins 2p-5p and porphyrins analogous to chlorins 6c-8c. The aim is to investigate the effect of the chlorin structure on the Q-band of electronic spectra at BLYP/6-31G(d) (gas phase, methanol solution) and at BHANDHLYP/6-31+G(d) (methanol solution), and on the triplet --> singlet energy emission, as these two factors determine the quality of a good photosensitizer. It is found that meso substituents lead to greater geometry distortions than beta-substituents in both porphyrins and chlorins and in both singlet and triplet states. In methanol solution, chlorin-like structures with beta substitution present significantly red-shifted Q-bands in comparison with their porphyrin analogues, so they would be better photosensitizers than porphyrins. Concerning to the triplet --> singlet energy emission calculated in methanol solution, three porphyrins (4p, 6p, and 8p) and all the studied substituted chlorins could be useful to generate active (1)O2. 4c would be the best photosensitizer, as it absorbs the largest wavelength in the therapeutic window (approximately 690 nm) and releases the amount of energy closest to the required one (1.22 eV).

Maltrato y discapacidad visual / Maltreatment and visual disorders

El presente artículo pretende dar a conocer una investigación, que sobre maltrato y discapacidad visual, recientemente hemos terminado un equipo de cuatro investigadores de la Universidad Autónoma de Madrid y de trabajadores de la ONCE, lo cual nos ha permitidounir en este trabajo conocimientos teóricos y experiencia profesional de muchos años detrabajo con esta población.Esta investigación se ha realizado con el 70 por ciento de la población total de alumnos discapacitados visuales escolarizados en centros ordinarios de educación, de entre 9 y 16 años de la Comunidad Autónoma de Madrid, incluyendo también a famillas y profesores.Viene a cubrir además una importante laguna inves-tigadora en este campo, aspecto este de gran relevancia, si se quieren ajustar los programas de apoyo y planificar las intervenciones con estos alumnos, teniendo en cuenta y procurando diseñar actuacionesque, partiendo de la realidad puedan mejorar la convivencia de las aulas en general y que laintegración de los alumnos con discapacidad visual y su inclusión en los centros con un menor coste personal para este colectivo

This paper presents a recent research on maltreatment and visual disorders done by a research team both from the Autonomous University of Madrid and from the ONCE[literally, Spanish Association of Blind People]. This has allowed us to put together knowledge and long experience in the field.A sample consisting of 70 percent of visually impaired students in primary and secondary education schools of the Autonomous Community of Madrid, aged 9 to 16 wasused. Families and teachers were also surveyed.This study fills an important gap in research in this field. This is very relevant for adjusting support programs, planning interventions with these students, with the aim of improving the living together in classrooms, the integration of students with visual disorders and their access to schools where they would pay a lower personal price

Hyperphosphorylation of microtubule-associated protein tau in senescence-accelerated mouse (SAM).

Tau is a neuronal microtubule-associated protein found predominantly on axons. Tau phosphorylation regulates both normal and pathological functions of this protein. Hyperphosphorylation impairs the microtubule binding function of tau, resulting in the destabilization of microtubules in brain, ultimately leading to the degeneration of the affected neurons. Numerous serine/threonine kinases, including GSK-3beta and Cdk5 can phosphorylate tau. SAMR1 and SAMP8 are murine strains of senescence. We show an increase in hyperphosphorylated forms of tau in SAMP8 (senescent mice) in comparison with resistant strain SAMR1. Moreover, an increase in Cdk5 expression and activation is described but analysis of GSK3beta isoforms failed to show differences in SAMP8 in comparison to age-matched SAMR1. In conclusion, tau hyperphosphorylation occurs in SAMP-8 (early senescent) mice, indicating a link between aging and tau modifications in this murine model.

Los componentes de género. Y su relación con la enfermería / Gender components and their relation with nursing

En este artículo se hace un esfuerzo teórico por explicar la relación de los componentes de género con la profesión enfermera, a fin de facilitar una mayor comprensión de este concepto. Para ejemplificar esta relación entre el género y la enfermería se referencian la mayoría de los artículos publicados en las revistas de enfermería nacionales, que utilizan el término género como palabra clave. Esta aproximación refuerza la necesidad de un análisis desde la perspectiva de género en la profesión. Además aporta un modelo teórico para entender el género

This article explains the theorical bases of gender components related to nursing profession in order to provide a better understanding of gender issue. With the aim to describe the relation between nursing and gender, the articles published in the national nursing reviews with the word gender as keyword, they are revised and used like examples. This approach requires a gender analysis and the mainstreaming of this perspective in the profession. Moreover, a framework to understand the concept of gender is offered