Professional unmet needs in the palliative care field (a scoping review).

BACKGROUND: Palliative care (PC) is oriented to improving the quality of life of patients and their families who are facing problems associated with life-threatening illness. It is a continuously changing and evolving field. Although it is a universal right, there are many barriers to addressing the unmet need for PC, affecting both patient and family as well as health care professionals (HCP). Many studies have highlighted the unmet needs of patients and caregivers, but it is also necessary to understand the needs of HCP in order to better develop PC. It is therefore necessary to identify all those barriers and unmet needs in order to develop and guarantee universal quality PC. METHODS: Bibliography search in relevant databases (PubMed, Cochrane Library, Trip Database) of documents published between 2018 and 2022, both included, written in English or Spanish. Key words-MeSH terms: Palliative Care, Palliative Medicine, Health Personnel, Continuing Education, Health Care Providers; and free text: healthcare professionals, continuous learning, training needs, gap, unmet needs, nursing. Articles about children or teenagers were excluded, as those related to the coronavirus disease 2019 (COVID-19) pandemic. RESULTS: A grand total of 1,150 documents were located and 20 were found through other sources. Additionally, 3 documents were found and kept despite not being included in the timeline previously discussed due to its relevance. Only 20 were finally included in this review. The identified unmet needs throughout the PC continuum have been categorized in three groups: diagnosis/recognition of the patient entering the PC continuum; end-of-life (EoL); and bereavement. Facilitators in PC have been identified in each category. CONCLUSIONS: Given the challenging nature of PC and the lack of knowledge throughout the continuum, addressing the challenges identified may result in meaningful and long-lasting results for both HCP and the patient-family unit. Training would be the answer to most of the unmet needs detected.

First report on natural infection by Dirofilaria repens in a cat in Spain: case report and literature review of feline subcutaneous dirofilariosis in Europe.

Dirofilaria repens is an endemic mosquito-borne pathogen widely spread throughout Europe and other non-Europen regions. Infection by D. repens has been reported in dogs, although little is known about the occurrence and epidemiological features of this nematode in cats. During the surgical procedure within the framework of a trap, neuter and release sterilization program, two female filarial nematodes with spontaneous movement were removed from the internal part of the spermatic cord from asymptomatic stray cat in Spain (Grao de Castellón, Castellon de la Plana, province of Spain). Moreover, the presence of microfilariae was detected by using three different methods, including direct blood smear technique, the microhematocrit tube test, and Knott´s modified test. PCR performed from the nematodes extracted from the spermatic cord and from microfilariae in EDTA-blood sample tested both positive for D. repens. To the authors' knowledge, this is the first report that demonstrates the presence of D. repens in cats in Spain. In this sense, a review of the current scientific status of feline subcutaneous dirofilariosis in Europe was also performed. Future investigations should analyze the epidemiological role of cats in D. repens infection including the prevalence of infection. Veterinarians working in endemic areas should be aware of this infection in cats and their susceptibility.

Enteral nutrition in critically ill patients under vasoactive drug therapy: The NUTRIVAD study.

BACKGROUND: Enteral nutrition (EN) in critically ill patients requiring vasoactive drug (VAD) support is controversial. This study assesses the tolerability and safety of EN in such patients. METHODS: This prospective observational study was conducted in 23 intensive care units (ICUs) over 30 months. Inclusion criteria were a need for VADs and/or mechanic circulatory support (MCS) over a minimum of 48 h, a need for ≥48 h of mechanical ventilation, an estimated life expectancy >72 h, and ≥72 h of ICU stay. Patients with refractory shock were excluded. EN was performed according to established protocols during which descriptive, daily hemodynamic and efficacy, and safety data were collected. An independent research group conducted the statistical analysis. RESULTS: Of 200 patients included, 30 (15%) required MCS and 145 (73%) met early multiorgan dysfunction criteria. Mortality was 24%. Patients needed a mean dose of norepinephrine in the first 48 h of 0.71 mcg/kg/min (95% CI, 0.63-0.8) targeting a mean arterial pressure of 68 mm Hg (95% CI, 67-70) during the first 48 h. EN was started 34 h (95% CI, 31-37) after ICU admission. Mean energy and protein delivered by EN/patient/day were 1159 kcal (95% CI, 1098-1220) and 55.6 g (95% CI, 52.4-58.7), respectively. Daily energy balance during EN/patient/day was -432 (95% CI, -496 to -368). One hundred and fifty-four (77%) patients experienced EN-related complications. However, severe complications, such as mesenteric ischemia, were recorded in only one (0.5%) patient. CONCLUSION: EN in these patients seems feasible, safe, and unrelated to serious complications. Reaching the energy target only through EN is difficult.

Campañas de vacunación contra las enfermedades víricas en España durante el siglo XX: una visión desde la prensa (1951-1986) / Vaccination campaigns against viral diseases in Spain during the 20th Century: a view from the press (1951-1986)

Desde finales del siglo XIX, fue posible luchar contra varias de las enfermedades víricas (rabia, viruela, gripe, polio, sarampión, rubéola y parotiditis), que, a lo largo del siglo XX, afectaron masivamente a la población adulta e infantil, a través de programas de vacunación que se establecieron una vez que estuvieron disponibles vacunas seguras para prevenirlas. España fue adoptando estas medidas preventivas progresivamente, especialmente a partir de su incorporación a la Organización Mundial de la Salud (OMS) en 1951. Cuando se promulgó la Ley General de Sanidad, en 1986, algunas de estas enfermedades habían podido controlarse y/o eliminarse mediante la vacunación sistemática. El tratamiento que ha realizado la prensa nacional de estos hechos ha sido escasamente estudiado. Este artículo tiene como objetivo analizar la repercusión en la prensa nacional de las campañas de vacunación contra estas enfermedades víricas hasta el año 1986 y comprobar si los medios de comunicación escritos reflejaron las medidas epidemiológicas globales adoptadas por la OMS para combatirlas. Junto a ello, estudiar su posible influencia, tanto en la puesta en marcha de políticas públicas de vacunación, como en el modo de transmitir dicha información a la población en los diferentes contextos sociopolíticos y científico-sanitarios cambiantes del periodo estudiado

Since the end of the 19th century, it has been possible to fight against several viral diseases (smallpox, rabies, influenza, polio, measles, rubella and mumps) that, during the 20th century, had a massive effect on the adult and child population through vaccination programmes established when safe vaccines were available to prevent such diseases. Spain progressively incorporated these preventive measures, especially after its incorporation into the World Health Organization (WHO) in 1951. By the time the General Health Law was enacted in 1986, it had been possible to control and/or eliminate some of these diseases through systematic vaccination. The treatment and monitoring that the Spanish national press has given to the implementation of the vaccination campaigns against these diseases has been little studied. Therefore, the objectives of this paper are to analyse the repercussions in the national press of the vaccination campaigns against these viral diseases between 1951 and 1986 and to check whether the written media reflected the global epidemiological measures adopted by WHO to combat them. Besides, to study its possible influence both in the development of public policies of vaccination and in the way how this information was transmitted to the population during the different socio-political and scientific contexts in the studied period

Consultas por lesiones autoinfligidas durante la pandemia por COVID 2019. Análisis 2017-2021 en cuatro jurisdicciones argentinas / Consultations for self-inflicted injuries during the 2019 COVID pandemic. Analysis 2017-2021 in four Argentine jurisdictions

ANTECEDENTES La pandemia por COVID-19 y las medidas preventivas frente al contagio modificaron de manera dramática la vida de las personas. Se ha debatido acerca de las posibles repercusiones de tales cambios en la salud mental de la población y en particular en la conducta suicida. OBJETIVO Describir las consultas por lesiones autoinfligidas en servicios de emergencia seleccionados de cuatro jurisdicciones de Argentina durante el primer año de pandemia en relación con los años 2017 a 2019, focalizando en los meses de febrero, julio y octubre del período bajo estudio. DISEÑO Estudio descriptivo de corte transversal, con análisis de fuentes secundarias, de tres hospitales generales y tres neuropsiquiátricos de cuatro jurisdicciones de Argentina. Los datos se procesaron con el programa Epidat 3.1, calculándose estadísticos descriptivos. RESULTADOS En todo el período se relevaron 452 casos de conducta suicida, analizándose 411. El 73% de los casos fueron en el período previo al 2020. Se observa un aumento en la tasa de consultas por lesiones autoinfligidas en el periodo de pandemia en comparación con el anterior, siendo particularmente significativo en los hospitales neuropsiquiátricos. En la comparación por período (pre-pandemia y pandemia) la derivación a otro establecimiento presentó mayor proporción en el segundo período (pandemia). En cuanto al mecanismo de ocurrencia, el envenenamiento fue menor en el segundo período (pandemia) y el uso de objetos cortantes fue menor en el primer período (pre-pandemia).

La autopercepción del apoyo social del paciente con enfermedad crónica, mediado por tecnología / Self-Perception of Technology-Aided Social Support in Patients with Chronic Diseases / A autopercepção do apoio social do paciente com doença crônica, mediado pela tecnologia

Introdución: el apoyo social ha sido un componente fundamental para el cuidado de la persona con enfermedad crónica; por lo tanto, conocer la percepción que se tiene de este y cómo la tecnología es un medio para fortalecerlo es relevante en la formulación de los planteamientos de cuidado que se implementan en las instituciones de salud. Objetivo: determinar el efecto de la intervención Alguien apoya al que cuida en las percepciones de apoyo social que tienen los enfermos crónicos de un servicio de consulta externa en una institución pública de Girardot (Cundinamarca, Colombia). Método: estudio de tipo cuantitativo-preexperimental, con una muestra de 116 personas con enfermedad crónica. Se realizó una caracterización sociodemográfica, de condiciones para el cuidado y nivel de apropiación de las tecnologías de los pacientes usando la ficha Caracterización de la Persona con Enfermedad Crónica o GCPC-UN-P. Como estrategia se desarrollaron tres talleres aplicando la intervención Alguien apoya al que cuida al grupo experimental y se midió la percepción de apoyo social antes de la intervención y después de esta, utilizando el Cuestionario MOS de Soporte Social Percibido. Resultados: el efecto de la intervención fue estadísticamente significativo (p < 0,05) y cada uno de los factores que la componen: apoyo emocional, informacional, apoyo instrumental e interacción positiva afectiva. Conclusiones: las intervenciones con el uso de recursos audiovisuales son efectivas como apoyo para los pacientes; y aquí la televisión y la radio son los medios en los cuales se encuentra mayor apropiación en esta población.

Introduction: Social support has been an essential component essential in taking care of people with chronic diseases. Therefore, when planning the health care to be provided in the health centers it is important to know how the social support is perceived and how the technology is useful to strengthen it. Objective: To determine the effect of the intervention 'Supporting the Caregiver' on the social support perceptions by the chronic patients who attend to the outpatient services at a public health center in Girardot (Cundinamarca, Colombia). Methods: It is a quantitative pre-experimental study with a sample of 116 chronic-disease patients. Sociodemographic characteristics were outlined in relation to the care conditions and level of technology adoption by the patients, as measured with the instrument 'Characterization of a Patient with a Chronic Disease or GCPC-UN-P'. The strategy consisted in three workshops applying the intervention 'Supporting the Caregiver' to the experimental group and measuring the social support perception both before and after the intervention based on the MOS questionnaire for perceived social support. Results: The effect of the intervention was statistically significant (p < 0.05) as well as each factor making part of it: emotional support, informational support, instrumental support and affective positive interaction. Conclusions: Interventions with audiovisual resources are effective when providing support to these patients; the radio and television are the media most embraced among this population.

Introdução: O apoio social tem sido um componente fundamental para o cuidado da pessoa com doença crónica; porém, conhecer a percepção que dele se tem e como a tecnologia é um médio para fortalecê-lo é relevante na formulação das abordagens de cuidado implementadas nas instituições de saúde. Objetivo: Determinar o efeito da intervenção Alguém apoia o cuidador nas percepções de apoio social que os doentes crônicos têm de um serviço de consulta externa em uma instituição pública de Girardot (Cundinamarca, Colômbia). Método: Estudo quantitativo-pré-experimental, com amostra de 116 pessoas com doença crônica. Uma caracterização sociodemográfica de condições para o cuidado e nível de apropriação das tecnologias dos pacientes foi feita usando o formato Caracterização da Pessoa com Doença Crônica ou GCPC-UN-P. Como estratégia três oficinas foram desenvolvidas aplicando a intervenção Alguém apoia o cuidador ao grupo experimental e foi mensurada a percepção de apoio social antes e depois da intervenção, usando o Questionário MOS de Suporte Social Percebido Resultados: O efeito da intervenção foi estatisticamente significante (p < 0,05) e cada um dos fatores que a compõem: apoio emocional, informacional, apoio instrumental e interação positiva afetiva. Conclusões: As intervenções com o uso de recursos audiovisuais são efetivas como apoio para pacientes; e aqui a televisão e a rádio são os médios pelos quais maior apropriação é encontrada nessa população.

Carga financiera del cuidado familiar del enfermo crónico en la Región Andina de Colombia / The Financial Burden of Family Care of the Chronically Ill in the Colombian Andean Region / Carga financeira do cuidado familiar do doente crónico na região andina da Colômbia

Introducción Describir y analizar la carga financiera del cuidado familiar del enfermo crónico en la Región Andina de Colombia. Materiales y métodos: Estudio que hace parte del 'Programa para la disminución de la carga de la enfermedad crónica en Colombia'. Su muestra la constituyeron 92 familias que residen en la región Andina de Colombia. Se emplearon los instrumentos "GCPC-UN- D", para caracterizar a los sujetos y la Encuesta "Costo financiero del cuidado de la Enfermedad crónica", para conocer el consumo real efectivo familiar. La Carga financiera atribuible al cuidado familiar se determinó bajo la metodología Caracol. Resultados: Los costos que más agobian a las familias de la Región Andina colombiana son, en su orden, los de salud, transporte, vivienda, alimentación y comunicaciones. El consumo real efectivo familiar se modifica al cuidar a una persona con enfermedad crónica. Discusión: Las familias colombianas que residen en la región Andina del país tienen una elevada carga financiera atribuible al cuidado de una persona con enfermedad crónica.

Objective: To describe and analyze the financial burden of family care of the chronically ill in the Colombian Andean region. Materials and methods: This study is part of the Program for the Reduction of the burden of chronic disease in Colombia. The sample included 92 families residing in the Colombian Andean region. The Instruments "GCPC-UN- D" were used to characterize the subjects and the Survey Financial cost of chronic disease care of Montoya et al, to identify the real effective household consumption. The financial burden attributable to family care was determined under the Caracol methodology. Results: Costs that most afflict families of the Colombian Andean Region are in their order health, transportation, housing, food and communications. Family caring for a person with chronic illness affects its effective household consumption. Discussion: Colombian families residing in the Andean region of the country have a high financial burden attributable to caring for a person with chronic disease.

Introdução: Descrever e analisar a carga financeira do cuidado familiar do doente crónico na Região Andina da Colômbia. Materiais e métodos: Estudo que faz parte do Programa para a diminuição da carga da doença crónica na Colômbia. A sua amostra a constituíram 92 famílias que residem na região Andina da Colômbia. Se empregaram os instrumentos "GCPC-UN- D" para caracterizar aos sujeitos e o Questionário "Custo financeiro do cuidado da Doença crónica" para conhecer o consumo real efetivo familiar. A carga financeira atribuível ao cuidado familiar se determinou sob a metodologia caracol. Resultados: os custos que mais afligem às famílias da Região Andina colombiana são em sua ordem, os de saúde, transporte, vivenda, alimentação e comunicações. O consumo real efetivo familiar se modifica ao cuidar a uma pessoa com doença crónica. Discussão: as famílias colombianas que residem na região Andina do País têm uma elevada carga financeira atribuível ao cuidado de uma pessoa com doença crónica na Colômbia.

Impacto de la hipotermia durante la intervención quirúrgica de craneosinostosis / Impact of hypothermia during craniosynostosis repair surgery

Introduction: Hypotherrma is recognized as a risk factor for perioperative complications in paediatric patients. High surgical risk procedures serve as a model of exposure to that risk factor. In particular, surgical correction of craniosynostosis serves as a model for measuring the impact of hypothermia. Objective: To assess hypothermia-related morbidity and mortality in paediatric patients taken to craniosynostosis correction. Methodology: Historical cohort study of patients taken to craniosynostosis correction and exposed to hypothermia. Results: With prior approval of the Ethics Committee of the institution, 54 records were included in the analysis. No statistically significant differences were found between hypothermia and its impact in terms of morbidity and mortality (death, major bleeding, massive haemorrhage massive transfusion, disseminated intravascular coagulation, need for vasopressor support, mechanical ventilation time and length of stay, including admission to the intensive care unit). A clinically significant increase in bleeding (severe and massive) and severe hypothermia was found (28.6% vs. 40% and 14.3% vs. 40%, respectively). Conclusions: No statistical differences were found in terms of morbidity and mortality with severe hypothermia (and moderate/severe hypothermia).

Introducción: La hipotermia es un reconocido factor de riesgo de complicaciones peri-operatorias en pacientes pediátricos. Para el estudio de sus impactos, las cirugias de alto riesgo quirúrgico se comportan como un modelo de exposición a dicho factor de riesgo. En este punto, la correcion quirurgica de Craneosinostosis se comporta como un modelo para la medición de los impactos de la hipotermia. Objetivo: Evaluar morbilidad y mortalidad relacionada a hipotermia en pacientes pediátricos llevados a corrección de Craneosinostosis. Metodologia: Estudio de Cohorte Histórico en pacientes pediátricos llevados a corrección de Craneosinostosis expuestos a hipotermia. Resultados: Previa aprobación del Comité de Ética Institucional, incluimos 54 registros en el análisis. No encontramos diferencias estadisticamente significativas entre Hipotermia e Impactos en terminos de morbimortalidad (Mortalidad, Hemorragia Severa, Hemorragia Masiva, Trasfusión Masiva, Coagulación Intravascular Diseminada, Necesidad de Soporte Vasopresor y Tiempos de Ventilacion Mecanica, y Hospitalización, incluso en Cuidado Intensivo). Hallamos un aumento clinicamente significativo en la hemorragia (severa y masiva) e Hipotermia Severa, (28.6% Vs. 40% y 14.3% Vs. 40%, respectivamente). Conclusiones: La hipotermia severa (y moderada a severa) no demostro en nuestros pacientes diferencias estadisticas para morbilidad y mortalidad.

Interferones una opción terapéutica moderna en el tratamiento de los carcinomas basocelulares / Interferons Modern Therapeutic Option in the Treatment of Basal Cell Carcinomas

El carcinoma basocelular es la neoplasia maligna de piel de mayor frecuencia que afecta mayoritariamente a las personas de la raza blanca. Se relaciona etiológicamente el potencial efecto carcinogénico a la explosión acumulativa de los rayos ultravioletas y con el deterioro de la capa de ozono este fenómeno tiende a aumentar en los últimos años, por tanto, la búsquedas de alternativas de tratamiento eficaces y seguros constituye una prioridad para los sistemas de salud como respuesta a este creciente problema de salud. Los interferones son productos biotecnológicos considerados modificadores de la respuesta biológica que por sus propiedades antiproliferativas y antiantigénicas se emplean en la terapéutica moderna del basotelioma. Se realizó una revisión en las principales base de datos, se seleccionaron 46 artículos que actualizan los aspectos, moleculares y estudios clínicos que justifican el empleo de la inmunoterapia y esencialmente los interferones como una estrategia eficaz y segura en el tratamiento de este tipo de neoplasia.

Basocellular carcinoma is a skin malignant neoplasia that primarily affects white race people. Potential carcinogenic effect is etiologically related to the accumulative explosion of ultraviolet rays, with the deterioration of the ozone layer this phenomenon tends to increase in the last few years, thus the search of efficacious and safe alternative treatments constitutes a health system priority. Interferons are biotechnological products known to modify the biological response that, due to its antiproliferative and antiantigenic properties, are employed in modern therapy of basothelioma. A revision was carried out in the main databases, choosing 46 articles that update the molecular aspects and the clinical trials that justify the use of immune therapy, and essentially, the interferons, as a safe and efficacious strategy in the treatment of this type of neoplasia.

Interferones una opción terapéutica moderna en el tratamiento de los carcinomas basocelulares / Interferons Modern Therapeutic Option in the Treatment of Basal Cell Carcinomas

El carcinoma basocelular es la neoplasia maligna de piel de mayor frecuencia que afecta mayoritariamente a las personas de la raza blanca. Se relaciona etiológicamente el potencial efecto carcinogénico a la explosión acumulativa de los rayos ultravioletas y con el deterioro de la capa de ozono este fenómeno tiende a aumentar en los últimos años, por tanto, la búsquedas de alternativas de tratamiento eficaces y seguros constituye una prioridad para los sistemas de salud como respuesta a este creciente problema de salud. Los interferones son productos biotecnológicos considerados modificadores de la respuesta biológica que por sus propiedades antiproliferativas y antiantigénicas se emplean en la terapéutica moderna del basotelioma. Se realizó una revisión en las principales base de datos, se seleccionaron 46 artículos que actualizan los aspectos, moleculares y estudios clínicos que justifican el empleo de la inmunoterapia y esencialmente los interferones como una estrategia eficaz y segura en el tratamiento de este tipo de neoplasia(AU)

Basocellular carcinoma is a skin malignant neoplasia that primarily affects white race people. Potential carcinogenic effect is etiologically related to the accumulative explosion of ultraviolet rays, with the deterioration of the ozone layer this phenomenon tends to increase in the last few years, thus the search of efficacious and safe alternative treatments constitutes a health system priority. Interferons are biotechnological products known to modify the biological response that, due to its antiproliferative and antiantigenic properties, are employed in modern therapy of basothelioma. A revision was carried out in the main databases, choosing 46 articles that update the molecular aspects and the clinical trials that justify the use of immune therapy, and essentially, the interferons, as a safe and efficacious strategy in the treatment of this type of neoplasia(AU)

El video como soporte social a cuidadores de personas con enfermedad crónica, Girardot 2010 / The video as social support for caregivers of people with chronic disease, Girardot 2010

Objetivo: Describir la efectividad de la tecnología del video como soporte social en cuidadores familiares de personas con enfermedad crónica en la ciudad de Girardot. Metodología: El diseño metodológico utilizado fue de tipo evaluativo y el grupo muestra estuvo conformado por 50 cuidadores familiares. Resultados: Los principales resultados revelan una alta satisfacción con el uso del video en la mayoría de cuidadores familiares. Se realizaron dos preguntas abiertas adicionales cuyas respuestas confirman los datos arrojados por el instrumento. Estas respuestas mostraron también que hay una diferencia con respecto al apoyo recibido habitualmente en cuanto a la claridad y profundidad de las temáticas impartidas.

Objetivo: Demostrar a eficácia da tecnologia de vídeo como apoio social, para os cuidadores familiares de pessoas com doenças crônicas na cidade de Girardot. Metodologia: O desenho metodológico foi avaliativo e a amostra foi constituída por 50 cuidadores. Resultados: Os principais resultados mostram alto grau de satisfação com o uso de vídeo na maioria dos cuidadores familiares. Duas perguntas adicionais abertas cujas respostas confirmam os dados produzidos pelo instrumento foram realizadas. Estas respostas também mostraram que há uma diferença no que diz respeito ao apoio recebido regularmente sobre a clareza e profundidade dos tópicos dados.

Objective: To describe the effectiveness of using video technology as a social support for family caregivers of people with chronic illness in the city of Girardot. Methodology: The research design was evaluative. The sample group consisted of 50 family caregivers. Results: The main results show that most family caregivers are highly satisfied with the use of video. We enquired two additional open questions, whose answers confirm the data we found with the instrument. These answers also showed that there is a difference in the clearness and depth of the subjects taught with respect to the support usually received.

Registro Sanitario, logros, debilidades y proyecciones al cierre del 2013 / The Health Registry, achievements, weaknesses and projections at the close of 2013

Se presenta un breve comentario acerca del trabajo desarrollado por el Registro Sanitario en el año 2013, con la finalidad de informar a los interesados en este tema sobre los logros, debilidades y proyecciones de trabajo que se ha trazado este colectivo de especialistas para los próximos años.(AU)

A brief commentary is presented about the work done by the Health Registry in the year 2013, with the purpose of informing those interested in the topic about the achievements, weaknesses and work projections set by this team of specialists for the coming years.(AU)

Registro Sanitario, logros, debilidades y proyecciones al cierre del 2013 / The Health Registry, achievements, weaknesses and projections at the close of 2013

Se presenta un breve comentario acerca del trabajo desarrollado por el Registro Sanitario en el año 2013, con la finalidad de informar a los interesados en este tema sobre los logros, debilidades y proyecciones de trabajo que se ha trazado este colectivo de especialistas para los próximos años(AU)

A brief commentary is presented about the work done by the Health Registry in the year 2013, with the purpose of informing those interested in the topic about the achievements, weaknesses and work projections set by this team of specialists for the coming years(AU)

La sexualidad pregenital desligada y actuada en el adulto / Pregenital sexuality unbound and enacted in the adult

El desarrollo sexual va parejo al desarrollo emocional del niño. Una experiencia de gratificación y satisfacción suficientemente sostenida en el tiempo con el primer objeto de amor, permitirán al niño dirigir sus deseos hacia el padre y demás adultos próximos y hacia otros niños, abriéndose con ello a la cultura. En esta experiencia relacional irá desplegando sus necesidades y deseos, su amor y su agresividad, y progresará desde las relaciones parciales hasta el logro de poder aceptar al otro como diferente, fuera de su control omnipotente y por ello fuente tanto de deseo como de frustración. Más tarde, ya en la adolescencia, el púber volverá a cuestionar todas sus relaciones, ideas e ilusiones, para abrirse definitivamente a la genitalidad y ésta le confrontará con su incompletud y necesidad del otro para satisfacer distintos deseos, entre ellos los sexuales. Tanto la calidad del encuentro relacional como el ejercicio de la sexualidad, estarán estrechamente relacionadas con el desarrollo psíquico y con sus posibles fallas y déficits (AU)

Secual development goes hand in hand with the emotional development of the chihld. An experience of gratification and satisfaction sustined sufficiency over time with the early love object will enable the child to direct his desires towards the father and other significant adults and towards other children, opening up to culture along with it. In this relational experience he will be gradually unfolding his needs and desires, his love and his aggressiveness, and will progress from partial relationships until attaining the ability to accept the other as other, outside of his omnipotent control, and for that reason as much a source of desire as of frustration. Later, now during adolescence, the pubescent will again call into question all of his relationships, ideas and hopes, to open up definitively to genitality; this will bring him face to face with his incompleteness and his need of the other to satisfy different desires, including the sexual ones. Both the quality of the relationa encounter as well as the exercise of sexuality will be closely linked to his psycic development and with his potential flaws, failures and limitations (AU)

Distintos tiempos de las transformaciones psíquicas en el trabajo con un niño / Different timings for psychical transformation in working with a child

Lo que permite a un niño (y posteriormente al adolescente y al adulto) utilizar su capacidad creativa y transformadora de lo inquietante, es la identificación con un objeto con función de réverie. Si dicha función es insuficiente, abundará la intolerancia a la realidad y la tendencia a la identificación proyectiva. Además, el niño permanecerá en la búsqueda constante del buen objeto y en la reanimación del objeto muerto (resultante de la vivencia de no contención emocional por parte del adulto), como forma de contrarrestar un dolor psíquico insoportable. El niño se identifica con el objeto madre que contiene y gratifica y también al objeto insuficiente o fallido, dando así lugar a un psiquismo poblado por objetos buenos y malos. En el encuentro con su analista, podrá ir sintiendo, figurando y posteriormente poniendo palabras, a todo aquello que ha quedado fijado en el psiquismo de forma devastadora. Ello permitirá al niño ir viviendo la experiencia de transformación y creación de un estado de cosas internamente más favorables para su vida (AU)

What allows a child (and later the adolescent and adult that this child becomes) to utilize his creativity and his capacity to transform what disturbs him, is the process of identification with an object which has the function of reverie. If this function is insufficient, the results will be an intolerance of reality and a tendency towards the use of projective identification. In addition, the child will be constantly searching for the good object as well as trying to reanimate the dead object (which comes from the experience of not being sufficiently contained by the adult), as a way of managing unbearable psychic pain. The child identifies with the maternal object that gratifies and contains, but also with the object that is inadequate or has failed him, thus giving rise to a mind populated by both good and bad objects. In meeting with the analyst, the child can begin to feel, represent and then later put into words, that which has been fixed in the mind in a damaging way. This will permit the child to gradually live the experience of transformation, creating and internal state which better equips him for his life ahead (AU)

Incidencia y factores de riesgo de gastroenteritis en los peregrinos del Camino de Santiago durante el verano de 2008 en el camino francés / Incidence and risk factors for acute gastroenteritis among pilgrims following the French way to Santiago de Compostela (Spain) in summer 2008

Objetivos Conocer la incidencia de gastroenteritis aguda en los peregrinos del Camino de Santiago, los factores de riesgo asociados y su caracterización microbiológica. Métodos Se diseñaron dos estudios simultáneos, uno transversal mediante encuestas autocumplimentadas de peregrinos llegados a Santiago y otro de casos y controles a los peregrinos en el camino. Se hizo un análisis multivariado mediante regresión logística. Resultados En el estudio transversal la densidad de incidencia fue de 23,5 episodios de gastroenteritis aguda por 1.000 peregrinos-día (intervalo de confianza del 95% [IC95%]: 18,9–29,4/103). En el estudio de casos y controles los factores de mayor riesgo fueron la edad <20 años (odds ratio [OR]=4,72; IC95%: 2,16–10,28), viajar en grupo (tres personas o más) (OR=1,49; IC95%: 0,98–2,28) y consumir agua no embotellada (OR=2,09; IC95%: 0,91–4,82). Norovirus fue el microorganismo aislado con más frecuencia (56%).Conclusiones Ser peregrino menor de 20 años, realizar el camino en grupo y consumir agua no embotellada se asocian con un mayor riesgo de presentar gastroenteritis aguda (AU)

Objectives To determine the incidence of acute gastroenteritis in pilgrims on St. James’ Way, as well as associated risk factors and microbiological characteristics. Methods Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression. Results In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/103 pilgrims-day (95% CI: 18.9–2.4/103). In the case-control study, the major risk factors were age <20 years (OR=4.72; 95% CI: 2.16–10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98–2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91–4.82). The most frequent etiologic agent was norovirus (56%).Conclusions Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis (AU)

[Incidence and risk factors for acute gastroenteritis among pilgrims following the French way to Santiago de Compostela (Spain) in 2008]. / Incidencia y factores de riesgo de gastroenteritis en los peregrinos del Camino de Santiago durante el verano de 2008 en el camino francés.

OBJECTIVES: To determine the incidence of acute gastroenteritis in pilgrims on St. James' Way, as well as associated risk factors and microbiological characteristics. METHODS: Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression. RESULTS: In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/10³ pilgrims-day (95% CI: 18.9-2.4/10³. In the case-control study, the major risk factors were age <20 years (OR=4.72; 95% CI: 2.16-10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98-2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91-4.82). The most frequent etiologic agent was norovirus (56%). CONCLUSIONS: Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis.

Bowel bacterial overgrowth as another cause of malnutrition, inflammation, and atherosclerosis syndrome in peritoneal dialysis patients.

Bowel bacterial overgrowth syndrome (BBOS) is an important cause of gastrointestinal (GI) abnormalities. Proinflammatory cytokines (PICs) are excessively produced and accumulate because of kidney failure in dialysis patients who experience chronic infections such as BBOS. We explored the association between GL function, BBOS, and the malnutrition, inflammation, and atherosclerosis (MIA) syndrome. We studied GI malabsorption and maldigestion by analyzing fecal starch, sugar, fat, and nitrogen; intestinal protein permeability (alpha1-antitrypsin fecal clearance); and fecal chymotrypsin. We evaluated BBOS by breath hydrogen test (BHT) after a 3-day fat-and-carbohydrate-overload diet. Positive BHT was present in 10 patients, showing a high prevalence of GI macronutrient malabsorption and maldigestion, and compared with the other patients, the highest plasma levels of tumor necrosis factor alpha and interleukin 6 and lower levels of albumin and prealbumin. Those 10 patients were treated with a combination of several antibiotics, including neomycin, amoxicillin-clavulanate, and quinolones. Between 2 and 3 months later, the BHT, markers of nutrition, and PIC were re-tested. All treated patients showed an improvement in nutrition status and a lesser inflammatory pattern. The BBOS infectious process is found frequently in dialysis patients in association with GI malabsorption and maldigestion, malnutrition, and systemic inflammation. Hyperproduction of PIC because of BBOS induces MIA through a double pathway: GI disorders and deleterious systemic effects.

Vasculitis de Wegener: diferentes presentaciones pulmonares en el diagnóstico inicial y durante la evolución de la enfermedad / Wegener granulomatosis: different pulmonary abnormalities at initial diagnostic and during the course of disease

La enfermedad de Wegener es una vasculitis granulomatosa necrotizante, con afectación característica del tracto respiratorio superior, pulmones y riñones. El 90% de los pacientes tienen afectación pulmonar y los hallazgos radiográficos más frecuentes son nódulos o masas bilaterales múltiples que pueden mostrar cavitación. También se puede presentar como consolidación lobar o segmentaria o como hemorragia pulmonar difusa. El reconocimiento precoz de las alteraciones específicas es crítico para realizar un diagnóstico apropiado y para reducir la morbi-mortalidad. Con el objetivo de lograr una mejor caracterización de las distintas manifestaciones torácicas de esta entidad presentamos cuatro casos que muestran sus distintas manifestaciones radiológicas.

Wegener granulomatosis is a necrotizing granulomatous vasculitis that affects the upper respiratory tract, lungs, and kidneys. At least 90% of patients have pulmonary involvement, and the typical radiographic findings are bilateral multiple nodules or masslike lesions, some of which show cavitation. Other frequent findings are consolidations or diffuse pulmonary hemorrhage. Early recognition of specific abnormalities is critical for appropriate intervention and reduced morbidity. To better characterize the diversity of thoracic manifestations in this disease we present four cases to show different radiologic findings in this population.

Cuidando al cuidador: efectos de un programa educativo / Caring for the Caregiver: Effects of an Educational Program / Cuidar ao cuidador: efeitos de um programa educativo

El presente estudio muestra los resultados de la investigación Efectos del programa `Cuidando al cuidador´ en un grupo de cuidadores familiares de los municipios de Girardot y Flandes vinculados a la Universidad de Cundinamarca, adelantada en un período de 12 meses. Objetivo: evaluar la efectividad del programa desarrollado por la Universidad Nacional de Colombia, en cuidadores familiares de personas con enfermedad crónica, en las citadas ciudades de los departamentos de Cundinamarca y Tolima, Colombia. Método: se utilizó el Inventario de Habilidad de Cuidado (CAI -Care Ability Inventory) propuesto por Ngozi O. Nkongho, y se aplicó como pre y posprueba. El estudio es cuasiexperimental y se realizó con 72 cuidadores familiares, que se distribuyeron en dos grupos; uno de control, formado por 35 personas, y otro experimental, integrado por 37 cuidadores. Resultados: los hallazgos señalan la efectividad del programa para desarrollar las dimensiones de conocimiento y paciencia en el grupo experimental. La dimensión de valor permaneció inmodificable tanto en el grupo de control como en el experimental, lo cual indica que el programa no fue efectivo para incrementar el valor como dimensión de cuidado.

This study examines the results of a 12-month research project entitled Effects of the ‘Caring for Caregivers’ ¨Program on a Group of Family Caregivers in the Cities of Girardot and Flandes in Association with the University of Cundinamarca. Objective: Assess the effectiveness of the aforementioned program, which was conducted by the National University of Colombia for family caregivers of chronically ill persons in the aforementioned cities in the Departments of Cundinamarca and Tolima (Colombia). Method: The Care Ability Inventory (CAI) proposed by Ngozi O. Nkongho was applied as a pre and post-test. The study is quasi-experimental and involved 72 family caregivers distributed into two groups: a control group made up of 35 persons and an experimental group of 37 caregivers. Results: The findings demonstrate the effectiveness of the program in helping the experimental group to develop know-how and patience. The value aspect remained unchanged in both the control group and the experimental group, which indicates the program was not effective in terms of increasing value as a dimension of care.

Neste estudo mostram-se os resultados da pesquisa Efeitos do programa ‘Cuidar ao cuidador’ em um grupo de cuidadores familiares nos municípios de Girardot e Flandes, vinculados à Universidade de Cundinamarca levada a cabo durante 12 meses. Objetivo: avaliar a efetividade do programa desenvolvido pela Universidade Nacional de Colômbia em cuidadores familiares de pes-soas com doença crônica, nas ditas cidades do departamentos de Cundinamarca e Tolima, Colômbia. Método: foi utilizado o instrumento Inventario de habilidade de Cuidado (CAI; Care Ability Inventory), proposto por Ngozi O. Nkongho. Foi aplicado como pré e pós-prova. O estudo, quase-experimental, foi realizado com 72 cuidadores familiares distribuídos em dois grupos: um de controle, constituído por 35 pessoas, e outro experimental, formado pelos 37 cuidadores restantes. Resultados: os achados assinalam a efetividade do programa para desenvolver as dimensões de conhecimento e paciência no grupo experimental. A dimensão de valor permaneceu invariável no grupo de controle e no experimental. Isso mostra que o programa não foi efetivo para aumentar o valor como dimensão de cuidado.