The Parietal Lobe in Alzheimer's Disease and Blindness.

The progressive aging of the population will notably increase the burden of those diseases which leads to a disabling situation, such as Alzheimer's disease (AD) and ophthalmological diseases that cause a visual impairment (VI). Eye diseases that cause a VI raise neuroplastic processes in the parietal lobe. Meanwhile, the aforementioned lobe suffers a severe decline throughout AD. From this perspective, diving deeper into the particularities of the parietal lobe is of paramount importance. In this article, we discuss the functions of the parietal lobe, review the parietal anatomical and pathophysiological peculiarities in AD, and also describe some of the changes in the parietal region that occur after VI. Although the alterations in the hippocampus and the temporal lobe have been well documented in AD, the alterations of the parietal lobe have been less thoroughly explored. Recent neuroimaging studies have revealed that some metabolic and perfusion impairments along with a reduction of the white and grey matter could take place in the parietal lobe during AD. Conversely, it has been speculated that blinding ocular diseases induce a remodeling of the parietal region which is observable through the improvement of the integration of multimodal stimuli and in the increase of the volume of this cortical region. Based on current findings concerning the parietal lobe in both pathologies, we hypothesize that the increased activity of the parietal lobe in people with VI may diminish the neurodegeneration of this brain region in those who are visually impaired by oculardiseases.

Evidence-based position paper on the professional practice of Physical and Rehabilitation Medicine for persons with cerebral palsy. The European PRM position (UEMS PRM section).

Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. The aim of this study was to improve physicians' professional practice of Physical and Rehabilitation Medicine for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. A systematic review of the literature including an 18-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. As the result of a Consensus Delphi procedure, 74 recommendations are presented together with the systematic literature review. The PRM physician's role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM program developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients' health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions. This evidence-based position paper is representing the official position of The European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cerebral palsy.

Diferencias epidemiológicas podrían explicar la mayor mortalidad infantil de Chile comparada con Cuba / Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba

INTRODUCCIÓN: Cuba presenta la tasa de mortalidad infantil más baja de Latinoamérica, mientras que Chile presenta una tasa de mortalidad infantil sobre el promedio de los países de la Organización para la Cooperación y el Desarrollo Económico (OECD, Organisation for Economic Cooperation and Development). OBJETIVO: Comparar la epidemiología de la mortalidad infantil entre Chile y Cuba para detectar características que puedan explicar las diferencias encontradas. MÉTODO: Análisis comparativo entre Chile y Cuba de la mortalidad infantil, causas de mortalidad, peso del nacido vivo y edad materna, en el año 2015. RESULTADOS: Cuba presentó menor mortalidad infantil, neonatal precoz y tardía que Chile, sin diferencia en mortalidad posneonatal. Chile presentó una mayor mortalidad infantil por alteraciones del sistema nervioso, sistema urinario, alteraciones cromosómicas, síndrome de dificultad respiratoria y trastornos relacionados con la duración corta de la gestación. Chile presentó mayor frecuencia de madres ≥ 35 años y nacidos vivos (NV) con peso < 2.500 g. No se analizaron los posibles efectos de las inequidades en salud por ausencia de datos. CONCLUSIONES: Es posible atribuir la menor mortalidad infantil de Cuba a: 1) aborto selectivo por malformaciones congénitas y anomalías cromosómicas; 2) menor riesgo epidemiológico de la población de embarazadas cubanas; y 3) menor frecuencia de NV con bajo peso al nacer

INTRODUCTION: Cuba has the lowest infant mortality rate in Latin America, while Chile has an infant mortality rate above the average of Organization for Economic Cooperation and Development (OECD) countries. OBJECTIVE: To compare the epidemiology of infant mortality between Chile and Cuba in order to find characteristics that may explain the differences found. METHOD: Comparative analysis between Chile and Cuba of infant mortality rate, causes of mortality, live birth weight, and maternal age, in 2015. RESULTS: Cuba had a lower infant, neonatal, early and late mortality than Chile, with no differences in post-neonatal mortality. Chile had a higher infant mortality due to, alterations of the nervous system, urinary system, chromosomal alterations, respiratory distress syndrome, and disorders related to the short duration of gestation. Chile had a higher frequency of mothers ≥ 35 years old and live births weighing < 2,500 g. The possible effects of health inequities could not be analyzed due to lack of data. CONCLUSIONS: It is possible to attribute the lower infant mortality rate in Cuba to: selective abortion due to congenital malformations and chromosomal anomalies, lower epidemiological risk of the Cuban pregnant population, and lower frequency of live births with low birth weight

[Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba]. / Diferencias epidemiológicas podrían explicar la mayor mortalidad infantil de Chile comparada con Cuba.

INTRODUCTION: Cuba has the lowest infant mortality rate in Latin America, while Chile has an infant mortality rate above the average of Organization for Economic Cooperation and Development (OECD) countries. OBJECTIVE: To compare the epidemiology of infant mortality between Chile and Cuba in order to find characteristics that may explain the differences found. METHOD: Comparative analysis between Chile and Cuba of infant mortality rate, causes of mortality, live birth weight, and maternal age, in 2015. RESULTS: Cuba had a lower infant, neonatal, early and late mortality than Chile, with no differences in post-neonatal mortality. Chile had a higher infant mortality due to, alterations of the nervous system, urinary system, chromosomal alterations, respiratory distress syndrome, and disorders related to the short duration of gestation. Chile had a higher frequency of mothers ≥ 35 years old and live births weighing <2,500 g. The possible effects of health inequities could not be analyzed due to lack of data. CONCLUSIONS: It is possible to attribute the lower infant mortality rate in Cuba to: selective abortion due to congenital malformations and chromosomal anomalies, lower epidemiological risk of the Cuban pregnant population, and lower frequency of live births with low birth weight.

El Efecto Placebo en el Tratamiento del Dolor Musculoesquelético Cervical: un Ensayo Clínico Aleatorizado / The placebo effect in the treatment of musculoskeletal neck pain: A randomized clinical trial

Se ha estudiado el efecto placebo en el dolor musculoesquelético cervical ampliamente. Se deriva del contexto de la intervención y es común a todas ellas. Las últimas investigaciones apuntan a que Kinesio Taping podría ser una forma de efecto placebo. A través del presente estudio se prende analizar si el Kinesio Taping es una forma de efecto placebo en sujetos con dolor musculoesquelético cervical. Se comparó el efecto del Kinesio Taping con el de un placebo. Tras analizar 30 sujetos, los resultados muestran que el efecto clínico del Kinesio Taping es similar al de un placebo. Las expectativas, el condicionamiento o la sugestión pueden estar muy relacionadas con el efecto clínico en los pacientes

Placebo effect has been widely studied in musculoskeletal neck pain treatment. This effect derives from the therapeutic context and is common to all of them. Latest research suggests Kinesio Taping could be a kind of placebo effect. This clinical trial analizes if Kinesio Taping could be a kind of placebo effect in subjects with musculoskeletal neck pain. Kinesio Taping was compared with a placebo. After analyzing 30 subjects, the results show that Kinesio Taping clinical effects are similar to placebo. Expectations, conditioning, or suggestion could be very closely related to clinical effect in patients

European Framework of Rehabilitation Services Types: the perspective of the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists.

BACKGROUND: Effectiveness in health services is achieved if desired clinical outcomes are reached. In rehabilitation the relevant clinical outcome is functioning, with the International Classification of Functioning, Disability and Health (ICF) as the reference system for the standardized reporting of functioning outcomes. To foster the implementation of the ICF in clinical quality management (CQM) across the rehabilitation services continuum, the UEMS-PRM Section and Board approved an ICF implementation action plan that includes the identification of types of currently provided rehabilitation services in Europe. The objective of this paper is to report on the development of a European framework of rehabilitation service types that can provide the foundation for the standardized reporting of functioning outcomes and CQM programs. METHODS: A multistage consensus process involving delegates (participants) from the UEMS-PRM Section and Board as well as external experts across European regions comprised the development of an initial framework by an editorial group, two feedback rounds via e-mail and a deliberation by the UEMS-PRM Section and Board in its September 2018 meeting in Stockholm (Sweden). In the first feedback round, participants were asked whether: 1) the initial framework of service types exists in their respective country: 2) the description represents the service type: and 3) an existing service type was missing. Based on the first-round results, the framework proposal was modified by the editorial group. In the second feedback round, participants were asked to confirm or comment on each of the service types in the revised framework. Based on the second-round results, the framework proposal was again modified and presented for discussion, revision and approval at the Stockholm meeting. RESULTS: In the first feedback round, eight rehabilitation services were added to the framework proposal and two service types that were deemed "missing" were not included. In the second round, all seven initially proposed and six of the added service types were reconfirmed, while two of the added service types were not supported. Based on deliberations at the Stockholm meeting, some modifications were made to the proposed framework, and the UEMS-PRM general assembly approved a European Framework of Rehabilitation Service Types that comprises of: Rehabilitation in acute care, General post-acute rehabilitation, Specialized post-acute rehabilitation, General outpatient rehabilitation, Specialized outpatient rehabilitation, General day rehabilitation, Specialized day rehabilitation, Vocational rehabilitation, Rehabilitation in the community, Rehabilitation services at home (incl. nursing home), Rehabilitation for specific groups of persons with disability, Rehabilitation in social assistance, Specialized lifelong follow-up rehabilitation, and Rehabilitation in medical health resorts. CONCLUSIONS: The European Framework of Rehabilitation Services Types presented in this paper will be continuously updated according to new and emerging service types. Next steps of the UEMS-PRM effort to implement the ICF in rehabilitation include the specification of clinical assessment schedules for each service type and case studies illustrating service provision across the spectrum of rehabilitation service types. The European Framework will enable the accountable reporting of functioning outcomes at the national level and the continuous improvement of rehabilitation service provision in CQM.

Desaceleración en la reducción de la mortalidad materna en Chile impide alcanzar el 5° Objetivo de Desarrollo del Milenio / Slowdown in reducing maternal mortality in Chile prevents reach the 5th Millennium Development Goal

Antecedentes: en Chile, a pesar de la importante reducción de la mortalidad materna en la década de los 90, los avances distan de los objetivos comprometidos. Objetivos: analizar la tendencia de la razón de mortalidad materna (RMM) en Chile desde 1990 al 2015 y de factores epidemiológicos que afectan el cumplimiento del 5° Objetivo del Mileno (5°OM). Métodos: estudio observacional a nivel nacional. Analizamos la tendencia del cambio porcentual anual promedio (CPAP) y puntos de inflexión de la RMM junto con la evolución de los nacimientos, muertes maternas y sus causas. Además, analizamos los nacimientos por edad y la distribución de la razón de mortalidad materna por edad y por causa de muerte materna. Resultados: en Chile la RMM se redujo un 61% entre 1990 y 2015, con una inflexión desde el 2001 (IC 95% 1997 a 2004) demostrando dos periodos: 1990-2001 (CPAP -6,97%; IC 95% -8,63 a -5,29) y 2001-2015 (CPAP -0,66%; IC 95% -2,40 a 1,10). En el segundo período la tasa de natalidad disminuyó con menor pendiente, los nacimientos de madres de 15-29 años disminuyeron, mientras que en los otros estratos de edad los nacimientos aumentaron. En ambos períodos las primeras causas de muerte fueron hipertensión arterial, enfermedades concurrentes y aborto. En el segundo período la muerte materna por hipertensión arterial y aborto se redujo, mientras que por enfermedades concurrentes aumentó. Conclusiones: en Chile la RMM es estacionaria desde el 2001 y se asocia a cambios en la distribución en la edad materna y causas de muerte. (AU)

Background: in Chile, despite the significant reduction in maternal mortality in the 1990s, the advances are far from the committed objectives. Aim: To analyze trends of the maternal mortality ratio (MMR) in Chile from 1990 to 2015 and epidemiologic factors that threaten the5th Millennium Goal. Methods: an observational study at the country level. We performed a trend analysis of the average annual percent change (AAPC) and models for joint point analyses for MMR, births, maternal deaths and their causes. In addition, we assessed the Odds Ratios for births by maternal age and the distribution of the maternal mortality rate by maternal age and main death causes. Results: in Chile, a reduction of 61% in MMR was observed from 1990 to 2015 with a trend join point in 2001 (CI 95% 1997 to 2004) indicating two periods: 1990-2001 (AAPC -6.97%; 95% CI -8.63 to -5.29) and 2001-2015 (AAPC - 0.66%; 95% CI -2.4 to 1.10). In the second period the birth rate decreased with a lower slope, the births of mothers in the age group 15-29 decreased, while in the other age groups the births increased. In both periods, main maternal death causes were hypertension, concurrent illness, and abortion. In the second period, maternal deaths associated to hypertension and abortion decreased, whereas deaths associated to concurrent illness increased. Conclusions: in Chile, MMR has been stationary since 2001 and is associated with changes in the distribution of maternal age and causes of death.(AU)

Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section).

BACKGROUND: Stroke is a major cause of disability worldwide, with an expected rise of global burden in the next twenty years throughout Europe. This EBPP represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with stroke. The aim of this study is to improve PRM physicians' professional practice for persons with stroke in order to promote their functioning and enhance quality of life. METHODS: A systematic review of the literature including a ten-year period and a consensus procedure by means of a Delphi process has been performed involving the delegates of all European countries represented in the UEMS PRM Section. RESULTS: The systematic literature review is reported together with 78 recommendations resulting from the Delphi procedure. CONCLUSIONS: The professional role of PRM physicians for persons with stroke is to improve specialized rehabilitation services worldwide in different settings and to organize and manage the comprehensive rehabilitation programme for stroke survivors considering all impairments, comorbidities and complications, activity limitations and participation restrictions as well as personal and environmental factors.

Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for Adults with Acquired Brain Injury. The European PRM position (UEMS PRM Section).

BACKGROUND: Acquired brain injury (ABI) is damage to the brain that occurs after birth caused either by a traumatic or by a nontraumatic injury. The rehabilitation process following ABI should be performed by a multi-professional team, working in an interdisciplinary way, with the aim of organizing a comprehensive and holistic approach to persons with every severity of ABI. This Evidence Based Position Paper represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with ABI. The aim was to formulate recommendations on the PRM physician's professional practice for persons with ABI in order to promote their functioning and enhance quality of life. METHODS: This paper has been developed according to the methodology defined by the Professional Practice Committee of the UEMS-PRM Section: a systematic literature search has been performed in PubMed and Core Clinical Journals. On the basis of the selected papers, recommendations have been made as a result of five Delphi rounds. RESULTS: The literature review as well as thirty-one recommendations are presented. CONCLUSIONS: The expert consensus is that structured, comprehensive and holistic rehabilitation program delivered by the multi-professional team, working in an interdisciplinary way, with the leadership and coordination of the PRM physician, is likely to be effective, especially for those with severe disability after brain injury.

Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with acute and chronic pain. The European PRM position (UEMS PRM Section).

BACKGROUND: Pain is a frequent complaint from patients undergoing rehabilitation. It can be a major problem and can lead to several activity limitations and participation restrictions. For this reason, when the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the European Union of Medical Specialists (UEMS) decided to prepare evidence-based practice position papers (EBPPs) on the most relevant fields of PRM, a paper on the role of the PRM specialist on pain conditions was also included. The goals of this paper are to provide recommendations on the PRM physician's role in pain management; how to address this major problem and what is the best evidence-based approach for the PRM physician in acute and chronic pain conditions. This paper follows the methodology defined by the Professional Practice Committee of the UEMS-PRM Section. METHODS: A systematic literature search in PubMed was carried out and the results obtained from filtered papers were subjected to four Delphi rounds. RESULTS: Fifteen recommendations were obtained from the Consensus Process and systematic review and were approved by all of the delegates of the UEMS-PRM Section. It is recommended that PRM physicians focus on pain as a primary aim of their interventions, in whatever field they are applying their competencies. It is also recommended that the approach to pain focuses either on reducing the symptoms and improving functioning/reducing disability or recurrences and improving the health condition in the long term avoiding chronicity. CONCLUSIONS: Every PRM specialist encounters the problem of pain and some specialize in this field and their role is greater than that of the regular PRM doctor. Based on the evidence available, it is reasonable to determine the role of the physiatrist in managing pain.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section).

INTRODUCTION: Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions. EVIDENCE ACQUISITION: A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS: The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure. CONCLUSIONS: The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.

Mayor mortalidad materna por aborto en Cuba que en Chile, 2000-2015 / Higher maternal mortality from abortion in Cuba than in Chile, 2000-2015

RESUMEN Antecedentes: La muerte materna por aborto inseguro es un severo problema de salud pública, países con leyes de aborto liberales tendrían menor riesgo de aborto inseguro y de mortalidad por aborto. Cuba tiene una legislación que no penaliza el aborto inducido, mientras en Chile es ilegal en todos los casos hasta su reciente despenalización en 3 causales. Objetivo: Se postula que Cuba tendría una menor mortalidad materna por aborto que Chile, por lo que se propone comparar la evolución de la razón de mortalidad materna por aborto entre ambos países, en el período 2000-2015. Material y Método: Los datos crudos de muertes asociadas al aborto y nacidos vivos se obtienen de las bases de datos de estadísticas vitales de ambos países. La oportunidad relativa de muerte se estima según Odds Ratio (OR) con intervalo de confianza del 95% (IC 95%) de las razones de mortalidad materna. Resultados: La razón de muerte materna asociada al aborto fue mayor en Cuba que en Chile (OR: 1,91; IC 95%: 1,331 a 2,739; p=0,0004). Se observa una tendencia al descenso en Cuba y mientras no se observan cambios en Chile. Conclusiones: Contrario a lo postulado basado en las diferentes legislaciones de ambos países, en el período 2000-2015, Cuba presentó mayor razón de mortalidad materna asociada al aborto que Chile. Se comentan posibles condicionantes de la diferencia encontrada.

ABSTRACT Background: Maternal death due to unsafe abortion is a severe public health problem; countries with liberal abortion laws would have a lower risk of unsafe abortion and abortion mortality. Cuba has a legislation that does not penalize induced abortion, while in Chile it is illegal in all cases until its recent decriminalization in 3 grounds. Objective: It is postulated that Cuba would have a lower maternal mortality due to abortion than Chile, for which purpose it is proposed to compare the evolution of the maternal mortality by abortion between both countries, in the period 2000-2015. Material and Method: Raw data on deaths associated with abortion and live births are obtained from the vital statistics databases of both countries. The relative chance of death is estimated according to the Odds Ratio (OR) with a 95% confidence interval (95% CI) of the maternal mortality. Results: The maternal death rate associated with abortion was higher in Cuba than in Chile (OR: 1.91, 95% CI: 1.331 to 2.739; p = 0.0004). A downward trend is observed in Cuba and without changes in Chile. Conclusions: Contrary to the postulate based on the different legislations of both countries, in the period 20002015, Cuba had a higher maternal mortality associated with abortion than Chile. Possible conditioning factors of the difference found are discussed.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with respiratory conditions. The European PRM position (UEMS PRM Section).

Chronic respiratory conditions are among the top causes of death and disability. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for people with chronic respiratory conditions in order to promote their functioning and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with twenty-three recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of chronic respiratory conditions is to lead pulmonary rehabilitation programs in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with chronic respiratory conditions. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with respiratory conditions.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with cardiovascular conditions. The European PRM position (UEMS PRM Section).

Cardiovascular conditions are significant causes of mortality and morbidity leading to substantial disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for people with cardiovascular conditions in order to promote their functioning and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of cardiovascular conditions is to lead cardiac rehabilitation programs in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with cardiovascular conditions. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cardiovascular conditions.

Evidence based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for ageing people with disabilities. The European PRM position (UEMS PRM Section).

Ageing people with disabilities (APwDs) are faced with challenges of ageing which is straightforwardly related to disability that adds to the burden related to their early-onset disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for APwDs (as a distinct group from those who are disabled due to the ageing process) in order to promote their functioning properties and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with the 30 recommendations resulting from the Delphi procedure. The professional role of PRM physicians in relation to APwDs is extending, expanding and/or improving health-related rehabilitation services worldwide in various settings (getting beyond the rehabilitation facilities) emphasizing the concept of integrated care with collaboration across other sectors to meet the specific needs of APwDs. This evidence based position paper (EBPP) represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in APwDs.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with obesity and related comorbidities. The European PRM position (UEMS PRM Section).

INTRODUCTION: The WHO world health statistics report in 2015 shows that in Europe the overall obesity rate among adults is 21.5% in males and 24.5% in females. Obesity has important consequences for morbidity, disability and quality of life. The aim of the paper was to improve physical and rehabilitation medicine physicians' professional practice for the rehabilitation of patients with obesity and related comorbidities. EVIDENCE ACQUISITION: A systematic review of the literature and a Consensus procedure by means of a Delphi method process has been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS: The systematic literature review is reported together with the 13 recommendations from the Delphi procedure. CONCLUSIONS: The professional role of PRM physicians in obesity is to propose a complete PRM treatment for the patients considering the comorbidities, impairments, activity limitations and participation restrictions, providing medical care and leadership to the multidisciplinary team, coordinating the individual PRM project developed in team in agreement with the patient and his family/care givers.

Burnout syndrome prevalence in physiotherapists.

OBJECTIVE:: To evaluate burnout syndrome in its three aspects, jointly as well as independently, in physiotherapists from the Extremadura region (Spain). METHOD:: Analytic descriptive epidemiological transversal trial in primary care and institutional practice, with physiotherapists practicing in Extremadura who met the inclusion criteria, after having signed an informed consent form. Emotional exhaustion, depersonalization and low professional accomplishment were the outcomes measured. RESULTS:: Physiotherapists from Extremadura show a 65.23 point level of burnout syndrome, according to the Maslach Burnout Inventory questionnaire. Therefore, they are positioned in the middle of the rating scale for the syndrome, and very near to the high level at starting score of 66 points. CONCLUSION:: Physiotherapists in Extremadura present moderate scores for the three dimensions of burnout syndrome, namely, emotional exhaustion, depersonalization and low professional accomplishment. For this reason, they are in the moderate level of the syndrome and very near to the high level, which starts at a score of 66 points. No relation between burnout syndrome and age has been found in our study.

Burnout syndrome prevalence in physiotherapists

Summary Objective: To evaluate burnout syndrome in its three aspects, jointly as well as independently, in physiotherapists from the Extremadura region (Spain). Method: Analytic descriptive epidemiological transversal trial in primary care and institutional practice, with physiotherapists practicing in Extremadura who met the inclusion criteria, after having signed an informed consent form. Emotional exhaustion, depersonalization and low professional accomplishment were the outcomes measured. Results: Physiotherapists from Extremadura show a 65.23 point level of burnout syndrome, according to the Maslach Burnout Inventory questionnaire. Therefore, they are positioned in the middle of the rating scale for the syndrome, and very near to the high level at starting score of 66 points. Conclusion: Physiotherapists in Extremadura present moderate scores for the three dimensions of burnout syndrome, namely, emotional exhaustion, depersonalization and low professional accomplishment. For this reason, they are in the moderate level of the syndrome and very near to the high level, which starts at a score of 66 points. No relation between burnout syndrome and age has been found in our study.

Evidence based position paper on physical and rehabilitation medicine (PRM) practice for people with spinal deformities during growth. The European PRM position (UEMS PRM Section).

INTRODUCTION: Scoliosis and other spinal deformities involve 3-4% of the population during growth. Their so-called conservative treatment is in the field of competence of physical and rehabilitation medicine (PRM) physicians. This evidence based position paper represents the official position of the European Union through the European Union of Medical Specialists (UEMS) - PRM Section. The aim of the paper was to improve PRM specialists' professional practice for patients with spinal deformities during growth. EVIDENCE ACQUISITION: A systematic review of the literature and a Consensus procedure with 26 recommendations by means of a Delphi method process has been performed involving the delegates of all European countries represented in the UEMS-PRM Section. EVIDENCE SYNTHESIS: the systematic literature review is reported together with 26 recommendations coming from the Consensus Delphi procedure. CONCLUSIONS: The professional role of PRM physicians in spinal deformities during growth is to propose a complete PRM treatment for the patients considering all the concurring diseases and pathologies, impairments, activity limitations and participation restrictions. The PRM physician's role is to coordinate the individual PRM project developed in team with other health professionals and medical specialists, in agreement with the patient and his family, according to the specific medical diagnoses.

Aumento de la mortalidad infantil en niños con síndrome de Down: Chile 1997-2013 / Rising infant mortality in down syndrome in Chile from 1997 to 2013

Background: Down syndrome (DS) is associated with higher child mortality especially due to cardiac malformations. Aim: To describe the trend in Chilean infant mortality in DS in the period 1997-2013 as compared to the general population without DS. Material and Methods: Raw data on infant deaths were extracted from the yearbooks of vital statistics of the National Institute of Statistics. The mortality risk associated to DS, relative to population without DS was estimated. Results: There were 456 deaths in infants with DS during the study period (59 early neonatal deaths, 70 late neonatal deaths and 327 post-neonatal deaths). The trend in infant mortality rate in DS was ascending (r: 0.53, p = 0.03), with an average annual percentage change of 4.6% (95% confidence interval (CI) 0.4-9.0%; p < 0.01). Compared to the population without DS, the risk of early neonatal death was lower in DS (Odds ratio (OR) 0.14, 95% CI 0.11-0.19; p < 0.01) whereas the risk of post-neonatal death was higher (OR 4.74, 95% CI 3.85-5.85; p < 0.01). Conclusions: Infant mortality in Down syndrome has an increasing trend. We postulate that these children are not accessing timely cardiac surgery, the main therapeutic tool to reduce the death risk in the first year of life.