Valoración de la satisfacción materna con la analgesia epidural para el control del dolor del trabajo de parto / Assessment of maternal satisfaction with epidural analgesia for pain control during labour

Objetivos. Conocer el grado de satisfacción y las características sociodemográficas de las pacientes a las que se les realiza la técnica epidural para el trabajo de parto. Material y métodos. Encuesta SERVQHOS administrada con muestreo consecutivo a 140 pacientes que habían recibido técnica anestésica epidural para el control del dolor de parto desde enero hasta junio de 2014 en el Hospital San Pedro. Resultados. Recogidas 140 encuestas. La satisfacción media global (SERVQHOS): 4,4 con desviación estándar (DE):±0,9 con mejor resultado en preguntas subjetivas: (4,3; DE: 0,8) que objetivas (4; DE: 0,9). El 84,3% se mostraron satisfechas con la analgesia epidural y 100% volverían a solicitarla. No hemos encontrados diferencias significativas en relación con la satisfacción con la epidural ni con la percepción del dolor con variables sociodemográficas (edad, nacionalidad, situación laboral, nivel de estudios o estado civil). El 85% (119) eran mujeres españolas y el 14,3%(20) pertenecían a otras nacionalidades. Una paciente no respondió. Respecto al estado civil: 79,3% (111) estaban casadas, 16,4% (23) eran solteras, 1,4% (2) eran viudas o separadas y no contestaron el 2,9% (4). La edad media fue 33,3 (DE: 4.4). Antes de administrar la analgesia epidural, el 93,2% de las españolas definieron el dolor del parto como grave frente al 95% de las mujeres extranjeras pero sin encontrarse diferencias estadísticamente significativas (p=0,279). Conclusiones. La proporción de pacientes satisfechas con la técnica fue muy elevada, siendo los aspectos subjetivos los mejor valorados (trato y confianza en profesionales) (AU)

Background. To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour. Material and Methods. A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro. Results. A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4.4 with standard deviation (SD):±0.9, with the best results being obtained in the subjective ítems: (4.3; SD 0.81) compared to the objective ítems (4; SD: 0.9). The large majority (84.3%) showed satisfaction with the epidural anaesthetic, and 100% would ask for it again. No significant differences were found in epidural satisfaction or pain perception related to socioeconomic variables (age, nationality, employment conditions, education level or marital status). As regards nationality, 119 (85%) were Spanish, and 14.3% (20) of other nationalities, with 1 patient not answering the nationality question. As regards marital status, 79.3% (111) were married, 1.4% (2), single, and 2.9% (4) were widows or separated, and 2.9% (4) did not answer. The mean age was 33.3 years (SD: 4.4). Prior to the administration of the epidural anaesthetic 93.2% of the Spanish citizens group described the pain as severe compared to 95% of the other nationalities group, but this difference had no statistical significance (p=.279). Conclusion. The level of satisfaction reported by the patients with this technique was high, with subjective items (good manners and trust) being appreciated more (AU)

[Assessment of maternal satisfaction with epidural analgesia for pain control during labour]. / Valoración de la satisfacción materna con la analgesia epidural para el control del dolor del trabajo de parto.

BACKGROUND: To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour. MATERIAL AND METHODS: A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro. RESULTS: A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4.4 with standard deviation (SD):±0.9, with the best results being obtained in the subjective ítems: (4.3; SD 0.81) compared to the objective ítems (4; SD: 0.9). The large majority (84.3%) showed satisfaction with the epidural anaesthetic, and 100% would ask for it again. No significant differences were found in epidural satisfaction or pain perception related to socioeconomic variables (age, nationality, employment conditions, education level or marital status). As regards nationality, 119 (85%) were Spanish, and 14.3% (20) of other nationalities, with 1 patient not answering the nationality question. As regards marital status, 79.3% (111) were married, 1.4% (2), single, and 2.9% (4) were widows or separated, and 2.9% (4) did not answer. The mean age was 33.3 years (SD: 4.4). Prior to the administration of the epidural anaesthetic 93.2% of the Spanish citizens group described the pain as severe compared to 95% of the other nationalities group, but this difference had no statistical significance (p=.279). CONCLUSION: The level of satisfaction reported by the patients with this technique was high, with subjective items (good manners and trust) being appreciated more.

A randomized trial to assess the efficacy of a psychoeducational intervention on caregiver burden in schizophrenia.

BACKGROUND: Patient's relatives usually care for patients with schizophrenia, and as informal caregivers they experience negative consequences. The aim of the EDUCA-III trial is to test the efficacy of a psychoeducational intervention program (PIP) versus standard care to reduce the caregiver burden at post-intervention (4 months), and at follow-up (8 months). METHOD: A two-arm, evaluator blind, multicentre, randomized controlled trial. The PIP group had 12 weekly group sessions. The control intervention group had the usual support and standard care. Primary outcomes were change scores since baseline on the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ). RESULTS: One hundred and nine caregivers were randomized to PIP and 114 to control condition from 23 research sites. The decrease of ZBI scores was significantly higher on the PIP arm at 4 months (mean difference [MD]=-4.33; 95% CI -7.96, -0.71), and at 8 months (MD=-4.46; 95% CI -7.79, -1.13). There were no significant decreases in the IEQ scores (MD at 4 months=-2.80; 95% CI -6.27, 0.67; MD at 8 months=-2.85; 95% CI -6.51, 0.81). CONCLUSIONS: The PIP condition seems to reduce caregiver burden. TRIAL REGISTRATION: ISRCTN32545295.

EPA guidance on mental health and economic crises in Europe.

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

Prevalencia de cronicidad y multimorbilidad en la población cubierta por el servicio público de teleasistencia de Euskadi: impacto en costes y calidad de la atención / Prevalence and costs of chronicity and multimorbidity in the population covered by the Basque public telecare service

Fundamento. La teleasistencia pública en Euskadi (betiON) es un servicio ofrecido por el Departamento de Empleo y Políticas Sociales del Gobierno Vasco que proporciona atención telefónica a las poblaciones dependientes y de mayor edad, ofreciéndoles comunicación con un centro de atención. Su conexión con dispositivos asistenciales sanitarios permite disponer de sistemas de información que comparten datos de índole sanitaria y social, lo cual posibilita una caracterización de la población atendida y el desarrollo de modelos de provisión integrada social y sanitaria. Objetivo. Describir la distribución de enfermedades crónicas y multimorbilidad entre los usuarios de betiON, estimar el coste de su atención sanitaria, calcular las hospitalizaciones evitables y comparar tales indicadores con la población general. Métodos. Se extrajo información de las bases de datos sanitarias públicas y de betiON. Se caracterizó la población de teleasistencia mayor de 65 años de edad (N=23.742) respecto a variables demográficas, socio-económicas, carga de morbilidad, costes y hospitalizaciones evitables. Se realizaron ajustes indirectos por edad y sexo para comparar la prevalencia de enfermedades con la población general y modelos de regresión para coste y hospitalizaciones evitables. Resultados. En la población de teleasistencia, el promedio de edad es 83 años, el 80% son mujeres, un 55,1% viven solos y residen en zonas más deprimidas. El 42,5% de los varones y 36,5%de las mujeres está afectado por 5 o más patologías crónicas, siendo 4,06 el promedio de enfermedades por persona. Además los costes de su atención sanitaria son más elevados que los de la población general (57%). Ajustando por edad, sexo y morbilidad, no existen diferencias en la tasa de hospitalizaciones evitables con la población general. Conclusiones. Los usuarios de teleasistencia presentan mayor carga de morbilidad, mayor necesidad de atención y condiciones sociales más desfavorables, pese a lo cual la calidad de la atención recibida es equiparable a la población general. La coordinación de servicios sociales y sanitarios a través de la conexión de sistemas de información y la teleasistencia como plataforma de servicios ofrecen oportunidades relevantes de innovación en la intervención sobre esta población (AU)

Background. The public telecare service in Euskadi (betiON)is a service offered by the Department of Employment and Social Policy of the Basque Government and offers telephone support to elderly and disabled populations, providing communication with an assistance centre. This connection with healthcare devices allows implementing shared information systems with health and social data, which enable a characterization of the attended population and the development of integrated models for health and social provision. Objective. To describe the distribution of chronic diseases and multimorbidity among users of betiON, to estimate the cost of their health care and to compare these indicators with those of the general population. Methods. We extracted information from betiON and public healthcare databases. We characterized telecare population above 65 years (N = 23.742) and compared it with the total Euskadi one (N = 2.262.707) with respect to demographic, socio-economic burden, costs and ambulatory care sensitive conditions. Results. In the telecare population, the average age is 83 years, 80% are women, 55,1% live alone and dwell in poorer neighborhoods. A 42,5% of males and 36,5% of women are affected by five or more chronic conditions, averaging 4,06 pathologies per person. Also they exhibit higher healthcare costs than the general population. Conclusions. Telecare users have a higher disease burden, greater need for healthcare and unfavorable social conditions. Telecare provides an opportunity for innovation and intervention, through coordination of social and healthcare services (AU)

[Prevalence and costs of chronicity and multimorbidity in the population covered by the Basque public telecare service]. / Prevalencia de cronicidad y multimorbilidad en la población cubierta por el servicio público de teleasistencia de Euskadi: impacto en costes y calidad.

BACKGROUND: The public telecare service in the Basque Autonomous Community (betiON) is a service offered by the Department of Employment and Social Policy of the Basque Government and offers telephone support to elderly and disabled populations, providing communication with an assistance centre. This connection with health care devices makes it possible to implement shared information systems with health and social data, which enable a characterization of the population attended to and the development of integrated models for health and social provision. OBJECTIVE: To describe the distribution of chronic diseases and multimorbidity among users of betiON, to estimate the cost of their health care and to compare these indicators with those of the general population. METHODS: We extracted information from betiON and public healthcare databases. We characterized the telecare population above 65 years (N = 23.742) and compared it with the total population in the Basque Autonomous Community (N = 2.262.707) with respect to variables in demography socio-economic burden, costs and ambulatory care conditions. RESULTS: In the telecare population, the average age is 83 years, 80% are women, 55.1% live alone and reside in poorer neighbourhoods. Forty-two point five per cent of males and 36.5% of women are affected by five or more chronic conditions, averaging 4.06 pathologies per person. They also show higher healthcare costs than the general population. CONCLUSIONS: Telecare users have a higher disease burden, greater need for healthcare and unfavourable social conditions. Telecare provides an opportunity for innovation and intervention, through the coordination of social and healthcare services.

Análisis factoriales confirmatorios de la escala de sobrecarga de zarit / No disponible

Introducción. La escala de sobrecarga de Zarit (ZBi) se utiliza para evaluar la sobrecarga que experimentan los cuidadores informales de personas con discapacidades o dependencias. como escala acumulativa, la ZBi debería evaluar el constructo latente de sobrecarga desde una perspectiva unidimensional. Sin embargo, diferentes análisis factoriales han indicado que presenta una estructura multidimensional, lo que puede ser importante para una correcta interpretación de la escala. Objetivos. Analizar y comparar el ajuste de las diferentes estructuras factoriales propuestas para la ZBi mediante Análisis Factorial confirmatorio (..) (AU)

Introduction. The Zarit Burden interview (ZBi) is usually applied to assess the burden experienced by caregivers of persons with severe functional limitations. As a measurement scale giving a total score, the ZBi implicitly assumes that the latent construct it measures is unidimensional. However several factorial analyses of the ZBi have reported instead a multidimensional structure, what can be relevant for a correct interpretation. Aims. to analyze and to compare the fit of the factorial structures so far reported for the ZBi by using confirmatory factor analyses (cFA) applied to (..) (AU)

Correlación entre los hallazgos clínicos, radiológicos e histopatológicos en el cáncer de laringe, hipofaringe y orofaringe / Correlation between clinical, radiological and histopathological findings in laryngeal, hypopharyngeal and oropharyngeal cancer

La correcta clasificación en los tumores tiene consecuencias importantes para planificar el tratamiento en los pacientes con cáncer de laringe, hipofaringe y orofaringe. El objetivo de este trabajo es estudiar la correlación del estadíaje clínico, radiológico y patológico con la finalidad de valorar si la tomografía computarizada (TC) es eficaz en el diagnóstico del estadio de las diferentes localizaciones tumorales. Realizamos un estudio retrospectivo de 34 pacientes con cáncer faringolaríngeo atendidos en el Hospital Príncipe de Asturias entre los años 1994-1998. La metodología seguida fue la siguiente: 1. Historia clínica y exploración ORL. 2. TC de cabeza y cuello. 3. Laringoscopia directa con toma de biopsia. 4. Cirugía y posterior estadiaje patológico de la pieza extirpada. Las lesiones fueron estadiadas según la clasificación TNM-UICC. Primero se realizó el estadiaje clínico, después el radiológico y posteriormente se comparó con el patológico obtenido tras la cirugía. Los resultados que se presentan confirman que la información aportada por la TC y la laringoscopia combinadas mejora la correlación del estadiaje clínico y anatomopatológico en el cáncer de laringe, hipofaringe y orofaringe (AU)

The correct staging of the tumors has important consequences in the planning of the treatment in the patients with cancer of larynx, hypopharynx and oropharynx. The objective of this paper is to study the correlation of the clinical, radiologic and pathologic staging with the purpose to evaluate if the computed tomography (CT) is effective in the diagnostic of the stage in the different tumoral findings. We did a retrospective study in 34 patients with pharynx and larynx cancer in the "Hospital Universitario Príncipe de Asturias" between the years 1994-1998. The method was: 1. Clinical history and ENT examination. 2. Head and neck CT. 3. Direct laryngoscopy and biopsy. 4. Surgical treatment and posterior pathologic staging of the removed specimen. The lesions were studied according the TNM-UICC classification with the T and N stage. The first thing to do was the clinical stage then the radiologic stage and at last compare it with the pathologic stage after surgical removal. The results are presented in percentages and confirm that the clinical and radiologic combined information improve the correlation between clinical and pathologic staging in the cancer of larynx, hypopharynx and oropharynx (AU)

Factors influencing protease production by two Antarctic strains of Stenotrophomonas maltophilia.

The influence of culture medium buffer capacity, the supplementation of culture medium with L-ala and the requirement of calcium for exoprotease production by Antarctic psychrotrophic Stenotrophomonas maltophilia strains ANT-1-1 and ANT-7-1 were examined. When increasing concentrations of calcium chloride (0 to 0.3 g l-1) were added to culture media, maximum protease production yields increased 70-75% (ANT-1-1) and 50% (ANT-7-1), while biomass levels showed little difference. Calcium was also necessary for optimal activity of proteases. L-ala had no effect on protease production. The reduction in buffer capacity, with the consequent change in external pH, had a positive effect, enhancing protease yields. Secretion of proteases into the medium started at the beginning of the stationary phase, corresponding with a rise in pH values up to pH 8.7 and was maximal at 36 h of culture. These results indicate that the regulation of calcium concentration and buffer capacity and also pH monitoring are factors to be considered when the design of an industrial culture medium and the optimisation of protease production processes using these Antarctic strains are concerned.

Factors influencing protease production by two Antarctic strains of Stenotrophomonas maltophilia

The influence of culture medium buffer capacity, the supplementation of culture medium with L-ala and the requirement of calcium for exoprotease production by Antarctic psychrotrophic Stenotrophomonas maltophilia strains ANT-1-1 and ANT-7-1 were examined. When increasing concentrations of calcium chloride (0 to 0.3 g l-1) were added to culture media, maximum protease production yields increased 70-75 (ANT-1-1) and 50 (ANT-7-1), while biomass levels showed little difference. Calcium was also necessary for optimal activity of proteases. L-ala had no effect on protease production. The reduction in buffer capacity, with the consequent change in external pH, had a positive effect, enhancing protease yields. Secretion of proteases into the medium started at the beginning of the stationary phase, corresponding with a rise in pH values up to pH 8.7 and was maximal at 36 h of culture. These results indicate that the regulation of calcium concentration and buffer capacity and also pH monitoring are factors to be considered when the design of an industrial culture medium and the optimisation of protease production processes using these Antarctic strains are concerned.

Factors influencing protease production by two Antarctic strains of Stenotrophomonas maltophilia

The influence of culture medium buffer capacity, the supplementation of culture medium with L-ala and the requirement of calcium for exoprotease production by Antarctic psychrotrophic Stenotrophomonas maltophilia strains ANT-1-1 and ANT-7-1 were examined. When increasing concentrations of calcium chloride (0 to 0.3 g l-1) were added to culture media, maximum protease production yields increased 70-75 (ANT-1-1) and 50 (ANT-7-1), while biomass levels showed little difference. Calcium was also necessary for optimal activity of proteases. L-ala had no effect on protease production. The reduction in buffer capacity, with the consequent change in external pH, had a positive effect, enhancing protease yields. Secretion of proteases into the medium started at the beginning of the stationary phase, corresponding with a rise in pH values up to pH 8.7 and was maximal at 36 h of culture. These results indicate that the regulation of calcium concentration and buffer capacity and also pH monitoring are factors to be considered when the design of an industrial culture medium and the optimisation of protease production processes using these Antarctic strains are concerned.(AU)

[Correlation of clinical, radiologic, and histopathologic findings in laryngeal, hypopharyngeal, and oropharyngeal cancer]. / Correlación entre los hallazgos clínicos, radiológicos e histopatológicos en el cáncer de laringe, hipofaringe y orofaringe.

The correct staging of the tumors has important consequences in the planning of the treatment in the patients with cancer of larynx, hypopharynx and oropharynx. The objective of this paper is to study the correlation of the clinical, radiologic and pathologic staging with the purpose to evaluate if the computed tomography (CT) is effective in the diagnostic of the stage in the different tumoral findings. We did a retrospective study in 34 patients with pharynx and larynx cancer in the "Hospital Universitario Príncipe de Asturias" between the years 1994-1998. The method was: 1. Clinical history and ENT examination. 2. Head and neck CT. 3. Direct laryngoscopy and biopsy. 4. Surgical treatment and posterior pathologic staging of the removed specimen. The lesions were studied according the TNM-UICC classification with the T and N stage. The first thing to do was the clinical stage then the radiologic stage and at last compare it with the pathologic stage after surgical removal. The results are presented in percentages and confirm that the clinical and radiologic combined information improve the correlation between clinical and pathologic staging in the cancer of larynx, hypopharynx and oropharynx.

Factors influencing protease production by two Antarctic strains of Stenotrophomonas maltophilia.

The influence of culture medium buffer capacity, the supplementation of culture medium with L-ala and the requirement of calcium for exoprotease production by Antarctic psychrotrophic Stenotrophomonas maltophilia strains ANT-1-1 and ANT-7-1 were examined. When increasing concentrations of calcium chloride (0 to 0.3 g l-1) were added to culture media, maximum protease production yields increased 70-75

(ANT-1-1) and 50

(ANT-7-1), while biomass levels showed little difference. Calcium was also necessary for optimal activity of proteases. L-ala had no effect on protease production. The reduction in buffer capacity, with the consequent change in external pH, had a positive effect, enhancing protease yields. Secretion of proteases into the medium started at the beginning of the stationary phase, corresponding with a rise in pH values up to pH 8.7 and was maximal at 36 h of culture. These results indicate that the regulation of calcium concentration and buffer capacity and also pH monitoring are factors to be considered when the design of an industrial culture medium and the optimisation of protease production processes using these Antarctic strains are concerned.

Purification and characterization of an acid proteinase from mesophilic Mucor sp. solid-state cultures.

The fourth-day extract of a solid-state culture of the mesophilic Mucor sp. (M-105) strain showed a high milk-clotting activity and a clotting/proteolytic activity ratio similar to that of commercial preparations from microbial origin used in cheese manufacture. After ultrafiltration of the crude extract, the milk-clotting proteinase was purified in two steps: ion-exchange followed by size-exclusion chromatography. Enzyme homogeneity was assessed by HPLC, SDS-PAGE and N-terminal residue determination. A pI value of 4.21 was obtained and a molecular weight of 33 kDa was calculated from size-exclusion chromatography and SDS-PAGE data. The optimum pH for proteolytic activity towards dimethylcasein was in the 3.0-3.5 range. The proteinase retained 26 and 13% of its proteolytic activity after a 30-min incubation period, at pH 5.0 and 50 and 60 degrees C, respectively. This evidenced a lower heat stability than that of the thermophilic enzymes currently used in the cheese industry and also than that of bovine chymosin. The enzyme was fully inhibited by pepstatin A and no effect was observed with PMSF, p-CMPS or EDTA. The N-terminal amino acid sequence: GTGTVPVTDDGNLNEYYXTVTVGXP was compared with those from other fungal enzymes.

[Study of the brachial plexus by magnetic resonance]. / Estudio del plexo braquial por resonancia magnética.

OBJECTIVE: Magnetic resonance (MR) is considered to be the best method available at present for diagnosis of lesions of the brachial plexus. In this study we analyze our experience in patients with pathology of the brachial plexus. MATERIAL AND METHODS: Between August 1991 and March 1997 we did magnetic resonance studies on 42 patients with pathology of the brachial plexus. Our protocols included T1, T2 axial spin-echo sequences with 5 mm cuts and coronal echo of a T1-3D gradient with 2 mm cuts, together with a T1 coronal spin-echo, with cuts 2 mm in width. RESULTS: The causes found were: traumatic 16 patients (38%), pathology of bone 2 (4.7%), 19 tumours (45.2%) with breast cancer being commonest, and no obvious aetiology in 5 (11.9%). CONCLUSIONS: MR is the technique of choice for study of pathology of the brachial plexus of traumatic or tumour origin. In some patients, 11.9% in our series, no aetiology could be detected using MR.

Vertebral and metacarpal morphometry as indicators of nutritional improvement.

Because of the importance of nutrition in the development of bone mass, we studied the nutritional state, and bone state by means of metacarpal radiogrammetric measurements and vertebral morphometry in a group of 40 premenopausal women born between 1960 and 1970, mean age 29 +/- 5 years, and in another group of 40 postmenopausal women born between 1934 and 1944, mean age 55 +/- 4 years. Both groups were considered normal, the main characteristic distinguishing them being that the women born between 1934 and 1944 grew up in a period of widespread malnutrition in Spain and the women born between 1960 and 1970 grew up in a period of normal nutrition. Protein, carbohydrate and fat intake in these two periods differed significantly (p < 0.0001 in the three cases by Fischer's exact test). The values of the metacarpal measurements, anterior height of the dorsal vertebrae from T-4 to T-12, and posterior height from L-1 to L-4 between the premenopausal and postmenopausal groups of women were significantly different (p < 0.001) (Anova test). These findings show the importance of nutrition in the development of bone mass during childhood.

Solid state production of a Mucor bacilliformis acid protease.

Acid protease production by a local strain of Mucor bacilliformis was performed by solid state cultivation on different agricultural by-products as substrate. The effects of different parameters on enzyme biosynthesis were studied: Wheat bran wetted at 120% with a 200 mM HCl solution and inoculated with 5 x 10(5) spores/g produced a milk clotting activity of 7500 U/g bran after 72 h cultivation at 24 degrees C.

Gastric emphysema in a child with congenital duodenal diaphragm.

The presence of gas in the wall of the stomach in a child is a rare condition and usually indicates necrotising enterocolitis. We report a case of gastric emphysema in a 20-day-old baby girl with duodenal obstruction due to a congenital duodenal diaphragm. This association is extremely rare and has been described only once in the literature.

[Current and suitable organization of the Basque Health System. Opinion of the managing level]. / Cultura organizativa actual e idónea del Sistema Vasco de Salud. Opinión del nivel directivo.

Osasuna Zainduz (caring our health), a planned change tor the public health care services, is being implemented in the Basque Country. A questionnaire discriminant terms passed to all the managers of the Basque Health Service is analysed to assess its actual and optimum organizational culture. We looked at significant differences between means, comparing actual and optimum profiles. All the differences of means were highly significant (P < 0.00001); performance based salaries (6.19) and identification with the organization (5.82) were the highest. New management styles based on information and communication, tolerance with conflicts and risks, as well as support from managers were identified through regression analysis as key success criteria for such our organization.