Inequidades en la atención al dolor torácico de origen isquémico en Urgencias desde una perspectiva de género / Inequality in the management of ischemic chest pain in the emergency department from a gender perspective

OBJETIVO: El sexo es determinante en las diferencias con que hombres y mujeres son atendidos en Urgencias. El objetivo de este estudio fue analizar el perfil clínico de los pacientes atendidos en Urgencias por dolor torácico isquémico, y la presencia de inequidades según sexo en el diagnóstico y tratamiento. MÉTODOS: Se realizó un estudio observacional descriptivo de los pacientes que acudieron a Urgencias del Hospital Universitario Miguel Servet (Zaragoza) por dolor torácico isquémico en 2017. Se recogieron variables sociodemográficas y clínicas de tratamiento y evolución mediante la historia clínica. Se realizó análisis bivariante y multivariante mediante el paquete estadístico SPSS. RESULTADOS: Se registraron 351 casos (235 hombres, 116 mujeres). Las mujeres fueron mayores que los hombres (edad mediana de 75,5 años frente a 71,4 años en hombres, p=0,003), acudieron más durante el verano (p=0,021), tomaron con mayor frecuencia benzodiacepinas (p=0,001), antidepresivos (p<0,001) y diuréticos (p=0,039), y presentaron con mayor proporción hipertensión arterial (p=0,001). Los hombres acudieron más durante el otoño (p=0,008) y presentaron más antecedentes de cardiopatía isquémica (p=0,003) e intervención coronaria percutánea (p<0,001). El tiempo de realización del electrocardiograma fue mayor en mujeres (p<0,001), y estas fueron diagnosticadas con mayor frecuencia de dolor torácico atípico (p=0,003), a diferencia de los hombres, más diagnosticados de síndrome coronario agudo (p=0,028) y sometidos a tratamiento invasor (p<0,001). CONCLUSIONES: Existen diferencias según el sexo en los antecedentes, demora en la realización del electrocardiograma y uso de tratamiento invasor. Su consideración desde Urgencias, sin influencia de juicios de valor y con la determinación de valores desagregados por sexo, puede mejorar la atención y evolución de estos pacientes

OBJECTIVE: Sex is a determining factor in the differences with which men and women are treated in the emergency room. The objective was to analyze the profile in patients with chest paint attended in emergency department, and the gender inequalities in the diagnosis and treatment. METHODS: Descriptive observational study of patients, who attended to the Miguel Servet University Hospital emergency department, with ischemic chest pain during 2017. Sociodemographic and clinical variables of treatment and evolution were analyzed. Bivariate and multivariate analysis was performed through the statistical program SPSS. RESULTS: 351 cases were registered (235 men and 116 women). The women were older (median age 75.5 years, against, 71.4 years in men, p=0.003), went to the hospital during summer time (p=0.021) and took most often of benzodiazepines (p=0.001), antidepressants (p<0.001) and diuretics drugs (p=0.039). The women had greater proportion of arterial hypertension (p=0.001). The men came more to the emergency department during autumn period (p=0.008), and had more history of ischemic heart disease (p=0.003) and percutaneous coronary intervention (p<0.001). The time of completion of the first electrocardiogram was greater in women (p<0.001), and were diagnosed with a higher frequency of atypical chest pain (p=0.003), unlike men, more diagnosed of acute coronary syndrome (p=0.028) and subjected to invasive treatment (p<0.001). CONCLUSIONS: There are differences according to sex in the antecedents, delay in performing the first electrocardiogram and use of invasive treatment. Its consideration from the emergency department, without influence of value judgments and with the determination of values disaggregated by sex, can improve the attention and evolution of these patients

Environmental Enrichment Modified Epigenetic Mechanisms in SAMP8 Mouse Hippocampus by Reducing Oxidative Stress and Inflammaging and Achieving Neuroprotection.

With the increase in life expectancy, aging and age-related cognitive impairments are becoming one of the most important issues for human health. At the same time, it has been shown that epigenetic mechanisms are emerging as universally important factors in life expectancy. The Senescence Accelerated Mouse P8 (SAMP8) strain exhibits age-related deterioration evidenced in learning and memory abilities and is a useful model of neurodegenerative disease. In SAMP8, Environmental Enrichment (EE) increased DNA-methylation levels (5-mC) and reduced hydroxymethylation levels (5-hmC), as well as increased histone H3 and H4 acetylation levels. Likewise, we found changes in the hippocampal gene expression of some chromatin-modifying enzyme genes, such as Dnmt3b. Hdac1. Hdac2. Sirt2, and Sirt6. Subsequently, we assessed the effects of EE on neuroprotection-related transcription factors, such as the Nuclear regulatory factor 2 (Nrf2)-Antioxidant Response Element pathway and Nuclear Factor kappa Beta (NF-κB), which play critical roles in inflammation. We found that EE produces an increased expression of antioxidant genes, such as Hmox1. Aox1, and Cox2, and reduced the expression of inflammatory genes such as IL-6 and Cxcl10, all of this within the epigenetic context modified by EE. In conclusion, EE prevents epigenetic changes that promote or drive oxidative stress and inflammaging.

Environmental Enrichment Improves Behavior, Cognition, and Brain Functional Markers in Young Senescence-Accelerated Prone Mice (SAMP8).

The environment in which organisms live can greatly influence their development. Consequently, environmental enrichment (EE) is progressively recognized as an important component in the improvement of brain function and development. It has been demonstrated that rodents raised under EE conditions exhibit favorable neuroanatomical effects that improve their learning, spatial memory, and behavioral performance. Here, by using senescence-accelerated prone mice (SAMP8) and these as a model of adverse genetic conditions for brain development, we determined the effect of EE by raising these mice during early life under favorable conditions. We found a better generalized performance of SAMP8 under EE in the results of four behavioral and learning tests. In addition, we demonstrated broad molecular correlation in the hippocampus by an increase in NeuN and Ki67 expression, as well as an increase in the expression of neurotrophic factors, such as pleiotrophin (PTN) and brain-derived neurotrophic factor (BDNF), with a parallel decrease in neurodegenerative markers such as GSK3, amyloid-beta precursor protein, and phosphorylated beta-catenin, and a reduction of SBDP120, Bax, GFAP, and interleukin-6 (IL-6), resulting in a neuroprotective panorama. Globally, it can be concluded that EE applied to SAMP8 at young ages resulted in epigenetic regulatory mechanisms that give rise to significant beneficial effects at the molecular, cellular, and behavioral levels during brain development, particularly in the hippocampus.

Nueva estructura para la enseñanza-aprendizaje de la materia de enfermería clínica en los estudios de Grado de Enfermería / A new structure for the teaching-learning of the subject of clinical nursing in Nursing Degree studies

En el Grado de Enfermería, los cambios requeridos para la adaptación al Espacio Europeo de Educación Superior se han orientado a la introducción de novedades metodológicas que han propiciado la génesis de nuevos enfoques para la enseñanza y el aprendizaje, con el objetivo último de disminuir los desajustes que en algunas ocasiones se han detectado entre la teoría y la práctica. En esta línea, partiendo de las necesidades actuales de la formación en relación a la materia de enfermería clínica del grado y de las competencias profesionales, se inició un proceso de reflexión y análisis que originó una nueva estructura organizativa de la materia. Este nuevo enfoque nace con el objetivo fundamental de mejorar la docencia de la enfermería clínica, actualizando la forma de enseñar la enfermería y los cuidados enfermeros. Lejos del modelo biomédico centrado en la enfermedad que ha imperado hasta ahora, el nuevo enfoque parte de una visión profundamente enfermera y, en consecuencia, hace explícitos los cuidados de la persona con un trastorno real o potencial de la salud. Los resultados de la implementación de esta nueva estructura en la asignatura 'Enfermería clínica I' de segundo curso de grado ponen de manifiesto que hay una mejora en la precisión diagnóstica y en la etapa de planificación del proceso enfermero, así como en la identificación de la responsabilidad profesional en los ejes autónomo e interdisciplinar (AU)

In Nursing Degree there have been many changes for adapting to the European Higher Education Area aimed to changing methodologies, but have also given rise to new approaches to teaching and learning. Their ultimate goal is to reduce the maladjustments have sometimes been found between theory and practice. Based on the education needs in the field of clinical nursing and also in professional competences, began a process of reflection and analysis resulted in a new organizational structure of matter. This new approach starts with the fundamental objective of improving the teaching of clinical nursing, updating the way we teach nursing and nursing care. Away from the biomedical model focused on the disease that has prevailed until now, the new approach comes from a nursing perspective, and therefore, makes explicit the care of the person with an actual or potential health disturbance. The results of implementing this new approach to the subject 'Clinical Nursing I' in second year of degree studies, show that the new structure represents an improvement in diagnostic accuracy and planning in the nursing process and the identification of responsibility in the independent and interdisciplinary professional axes (AU)