Conjugate treatment with high concentration normobaric oxygen and hyaluronic acid for vaginal atrophy: a prospective study.

OBJECTIVE: Vulvovaginal atrophy is a condition closely related to low circulating estrogen levels, with post-menopause being the main cause. However, patients of childbearing age may also present with these symptoms due to treatments that reduce estrogen production. Local estrogen therapy is the causal treatment of local symptoms, but it is not always accepted and is often abandoned by patients. In recent years, alternative therapies have been proposed: fractional CO2 laser or the conjugate treatment with normobaric oxygen and hyaluronic acid, the latter being the subject of this study. The study aimed to evaluate the effectiveness of conjugate topical treatment with normobaric oxygen and hyaluronic acid. PATIENTS AND METHODS: 50 patients were evaluated and treated with 5 applications of 15 minutes each, every 15 days, with Caressflow®. All patients presented at least one of the symptoms related to vulvovaginal atrophy: dryness, burning, and dyspareunia. In all cases, vulvoscopy, colposcopy, and cervicovaginal cytology were performed. The patients were interviewed with an analogic scale (VAS) concerning the severity of symptoms before and after the treatment. Colposcopy and PAP-smear were assessed by mean of Vaginal Health Index Score (VHI) at baseline and at the end of the treatment. RESULTS: All patients completed the treatment scheme and presented with a significant improvement in subjective symptoms. The colposcopy and PAP-smear performed 10 days after the end of the last treatment showed a significant improvement in the appearance and elasticity of the vaginal epithelium and the cytological picture, which showed, in the sample taken after treatment, hyaluronic acid vesicles within the cell cytoplasm. CONCLUSIONS: This study corroborates the data presented in the latest published papers on the effectiveness of treatment with normobaric O2 and hyaluronic acid on vaginal atrophy. Efficacy has been confirmed both in terms of subjective symptoms reported by the patients and objective improvement at colposcopy and PAP-smear cytology.

Pain extent is associated with Central Sensitization Inventory but not widespread pressure pain sensitivity or psychological variables in women with fibromyalgia.

OBJECTIVE: To investigate the relationship between pain extent, as a clinical sign of central sensitization, and clinical, psychological, and pressure sensitivity in women with fibromyalgia syndrome (FMS). METHOD: In this study, 126 females with FMS completed demographic (age, gender, body mass index, height, weight), clinical (pain history, and pain intensity at rest and during daily living activities), psychological (depression and anxiety levels), and neurophysiological [pressure pain threshold (PPT)] assessments. The Central Sensitization Inventory (CSI) was also used to collect self-reported symptoms of sensitization. Pain extent and frequency maps were obtained from pain drawings using customized software. After conducting a multivariable correlation analysis to determine the relationships between variables, a stepwise linear regression model analysis was performed to identify variables associated with pain extent. RESULTS: Pain extent was positively associated with age (r = 0.17), years with pain (r = 0.27), pain during daily life activities (r = 0.27), and CSI (r = 0.42) (all p < 0.05). The stepwise regression analysis revealed that 27.8% of the pain extent was explained by CSI, age, and years with pain. CONCLUSIONS: This study found that larger pain extent was associated with self-reported outcomes, i.e. CSI, but not neurophysiological outcomes, i.e. PPTs, of sensitization in women with FMS. Older age and a longer history with pain symptoms were also associated with larger pain extent.

Dolor, calidad de vida y salud mental en pacientes con gonalgia por gonartrosis: estudio de casos y controles / Pain, quality of life and mental health in patients with gonalgia due to gonarthrosis: Cases and controls study

Objetivo: Evaluar el dolor, la calidad de vida y el estado psicológico en pacientes con gonalgia por gonartrosis. Material y métodos: Estudio epidemiológico, multicéntrico, de casos y controles. Se incluyeron 1.152 pacientes (576 con artrosis y 576 sin artrosis) apareados por edad y sexo, procedentes de 63 centros de salud de España. Se les administró la escala visual analógica de dolor de Huskisson y los cuestionarios EuroQol y Goldberg. Se realizó un análisis descriptivo y comparativo de los datos en ambos grupos. Se estudiaron los factores que influían en la CV y salud mental de los pacientes artrósicos con modelos de regresión logística. Resultados: Se incluyeron 576 pacientes casos y 576 controles. El 70,3% eran mujeres en ambos grupos. La puntuación media en la escala visual analógica de los artrósicos fue 65,2±4,9mm correspondiente a una intensidad moderada. El cuestionario EuroQol indicó peor estado de salud (p<0,05) en los pacientes con artrosis en todas sus dimensiones. El cuestionario Goldberg mostró la presencia de psicopatología en el 36,5% (n=209) de los casos, frente a un 14,0% (n=80) en los controles (p<0,001). El dolor fue la variable que afectó a la CV en todas las dimensiones (p<0,001). Conclusiones: Los pacientes con artrosis manifiestan dolor moderado, limitación de la movilidad, del cuidado personal y de las actividades cotidianas que repercute negativamente en su CV y psicológicamente se encuentran más afectados. Es prioritario desarrollar estrategias de autocuidado y tratamiento en estos pacientes para mejorar globalmente su CV (AU)

Objective: To evaluate pain, quality of life and psychological state in patients with gonalgia due to gonarthrosis. Material and methods: Epidemiological, multicenter, case–control study. 1.152 patients were included (576 with arthrosis and 576 without arthrosis) matched by age and sex, from 63 health centers in Spain. The Huskisson Pain Scale (VAS), the EuroQol and Goldberg questionnaires were administered. A descriptive and comparative analysis of the data was carried out in both groups. Factors influencing the quality of life and mental health of arthritic patientes were studied with logistic regression models. Results: 576 case patients and 576 controls were included. 70.3% were women in both groups. The mean score in the VAS score of the arthritic patients was 65±4.9mm corresponding to a moderate intensity. The EQ-5D questionnaire indicated a worse state of health (P<.05) in patients with osteoarthritis in each of its dimensions. In the GHQ-12 questionnaire, the presence of psychopathology was detected in 36.5% (n=209) of patients with osteoarthritis compared to 14.0% (n=80) in controls (P<.001). Pain was the variable that affected quality of life in all dimensions (P<.001). Conclusions: Patients with arthrosis manifest moderate pain due to this disease. They present a limitation of mobility, personal care and daily activities that negatively affects their quality of life and psychologically they are more affected. It is a priority to develop self-care and treatment strategies in this group of subjects to globally improve their quality of life (AU)

[Pain, quality of life and mental health in patients with gonalgia due to gonarthrosis: Cases and controls study]. / Dolor, calidad de vida y salud mental en pacientes con gonalgia por gonartrosis: estudio de casos y controles.

OBJECTIVE: To evaluate pain, quality of life and psychological state in patients with gonalgia due to gonarthrosis. MATERIAL AND METHODS: Epidemiological, multicenter, case-control study. 1.152 patients were included (576 with arthrosis and 576 without arthrosis) matched by age and sex, from 63 health centers in Spain. The Huskisson Pain Scale (VAS), the EuroQol and Goldberg questionnaires were administered. A descriptive and comparative analysis of the data was carried out in both groups. Factors influencing the quality of life and mental health of arthritic patientes were studied with logistic regression models. RESULTS: 576 case patients and 576 controls were included. 70.3% were women in both groups. The mean score in the VAS score of the arthritic patients was 65±4.9mm corresponding to a moderate intensity. The EQ-5D questionnaire indicated a worse state of health (P<.05) in patients with osteoarthritis in each of its dimensions. In the GHQ-12 questionnaire, the presence of psychopathology was detected in 36.5% (n=209) of patients with osteoarthritis compared to 14.0% (n=80) in controls (P<.001). Pain was the variable that affected quality of life in all dimensions (P<.001). CONCLUSIONS: Patients with arthrosis manifest moderate pain due to this disease. They present a limitation of mobility, personal care and daily activities that negatively affects their quality of life and psychologically they are more affected. It is a priority to develop self-care and treatment strategies in this group of subjects to globally improve their quality of life.

Oral and Palmitate Paliperidone Long-Acting Injectable Formulations' Use in Schizophrenia Spectrum Disorders: A Retrospective Cohort Study from the First Episode Psychosis Intervention Program (CRUPEP).

BACKGROUND: Long-acting injectable antipsychotics (LAIs) may be a suitable therapeutic option for those patients in earlier stages of psychosis to avoid relapses and disease progression. Despite that, there is a lack of evidence in the literature regarding the use of LAIs in this profile of patients. METHODS: This is a retrospective cohort analysis to assess the efficacy, tolerability, and pattern of use of palmitate paliperidone long-acting injectable (PPLAI) formulations (1- and 3-month doses) compared to oral paliperidone/risperidone in patients with a nonaffective first episode of psychosis (FEP) over 12 months of follow-up. Relevant sociodemographic and clinical information were assessed, as well as main clinical scales: Positive and Negative Syndrome Scale, Personal and Social Performance Scale, and Clinical Global Impression Scale Improvement and Severity measures. RESULTS: The study included 48 patients, 16 per arm, who were aged 20-50 years and had an FEP. Significant improvements were registered for all treatment groups. Despite that, patients receiving PPLAI 1- and 3-month formulations obtained greater improvements than those in the oral group in the main domains assessed (P < .001). We found no statistically significant differences in hospitalizations between groups. Side effects were presented in 24% of patients. A trend towards reducing antipsychotic doses was observed in 43.8% of patients to achieve the minimum effective dose and avoid the occurrence of side effects. CONCLUSIONS: To our knowledge, this is the first study assessing the use of palmitate paliperidone long-acting formulations versus oral risperidone or paliperidone in FEP. Treatment with PPLAI formulations seems to be an effective therapeutic choice at earlier stages of the disease.

Effects of 12 Weeks of Essential Amino Acids (EAA)-Based Multi-Ingredient Nutritional Supplementation on Muscle Mass, Muscle Strength, Muscle Power and Fatigue in Healthy Elderly Subjects: A Randomized Controlled Double-Blind Study.

OBJECTIVE: To counteract muscle mass, muscle strength and power loss during aging, and to study age-related change of neuromuscular manifestation of fatigue in relation to nutritional supplementation. DESIGN: randomized controlled double-blind study. SETTING: Twice-daily consumption for 12 weeks of an Essential Amino Acids (EAA)-based multi-ingredient nutritional supplement containing EAA, creatine, vitamin D and Muscle Restore Complex®. PARTICIPANTS: 38 healthy elderly subjects (8 male, 30 female; age: 68.91±4.60 years; body weight: 69.40±15.58 kg; height: 1.60±0.09 m) were randomized and allocated in supplement (SUPP) or placebo (PLA) group. Mean Measurements: Vitamin D blood level; Appendicular Lean Mass (ALM); Visceral Adipose Tissue (VAT); Maximal Voluntary Contraction (MVC) and Peak Power (PP); myoelectric descriptors of fatigue: Fractal Dimension and Conduction Velocity initial values (FD iv, CV iv), their rates of change (FD slopes, CV slopes) and the Time to perform the Task (TtT). Mean Results: Significant changes were found in SUPP compared to baseline: Vitamin D (+8.73 ng/ml; p<0.001); ALM (+0.34 kg; p<0.001); VAT (-76.25 g; p<0.001); MVC (+0.52 kg; p<0.001); PP (+4.82 W; p<0.001). Between group analysis (SUPP Vs. PLA) showed improvements: vitamin D blood levels (+11,72 ng/ml; p<0.001); Legs FFM (+443.7 g; p<0.05); ALM (+0.53 kg; p<0.05); MVC (+1.38 kg; p<0.05); PP (+9.87 W; p<0.05). No statistical changes were found for FD iv, CV iv, FD and CV slopes and TtT, either compared to baseline or between groups. Significant correlations between mean differences in SUPP group were also found. CONCLUSION: The study demonstrates that in healthy elderly subjects an EAA-based multi-ingredient nutritional supplementation of 12 weeks is not effective to change myoelectric manifestation of fatigue and TtT failure but can positively affect muscle mass, muscle strength, muscle power and VAT, counterbalancing more than one year of age-related loss of muscle mass and strength.

Colposcopic patterns of vaginal intraepithelial neoplasia: a focus on low-grade lesions.

OBJECTIVE: The aim of this study was to evaluate the colposcopic patterns observed in women with a histopathological diagnosis of vaginal intraepithelial neoplasia, with a particular interest in analyzing the colposcopic characteristics of low-grade squamous intraepithelial lesions (LSIL). PATIENTS AND METHODS: Medical charts and colposcopy records of women diagnosed with vaginal intraepithelial neoplasia from January 1995 to December 2015, were analyzed in a multicenter retrospective case series. The abnormal colposcopic patterns observed in women with vaginal LSIL and vaginal high-grade SIL (HSIL) were compared. The vascular patterns and micropapillary pattern were considered separately. RESULTS: Regardless the histopathological grading, in women with vaginal SIL, the grade I abnormal colposcopic findings were more frequent than grade II abnormalities. However, a grade I colposcopy was more commonly observed in women with a biopsy diagnosis of LSIL rather than HSIL (p<0.0001). Similarly, the micropapillary pattern was more frequently observed in women with LSIL (p=0.004), while vascular patterns were observed more frequently in women diagnosed with vaginal HSIL (p<0.0001). In women with grade I colposcopy, the menopausal status and a previous hysterectomy appeared to be associated with the diagnosis of vaginal HSIL. CONCLUSIONS: Grade I abnormal colposcopic findings were more commonly observed in women with vaginal LSIL, as well as the micropapillary pattern. On the other hand, grade II abnormal colposcopy and the presence of vascular patterns were more frequently observed in women with vaginal HSIL.

Serosurvey Reveals Exposure to West Nile Virus in Asymptomatic Horse Populations in Central Spain Prior to Recent Disease Foci.

West Nile fever/encephalitis (WNF) is an infectious disease affecting horses, birds and humans, with a cycle involving birds as natural reservoirs and mosquitoes as transmission vectors. It is a notifiable disease, re-emerging in Europe. In Spain, it first appeared in horses in the south (Andalusia) in 2010, where outbreaks occur every year since. However, in 2014, an outbreak was declared in horses in central Spain, approximately 200 km away from the closest foci in Andalusia. Before that, evidence of West Nile virus (WNV) circulation in central Spain had been obtained only from wildlife, but never in horses. The purpose of this work was to perform a serosurvey to retrospectively detect West Nile virus infections in asymptomatic horses in central Spain from 2011 to 2013, that is before the occurrence of the first outbreaks in the area. For that, serum samples from 369 horses, collected between September 2011 and November 2013 in central Spain, were analysed by ELISA (blocking and IgM) and confirmed by virus neutralization, proving its specificity using parallel titration with another flavivirus (Usutu virus). As a result, 10 of 369 horse serum samples analysed gave positive results by competitive ELISA, 5 of which were confirmed as positive to WNV by virus neutralization (seropositivity rate: 1.35%). One of these WNV seropositive samples was IgM-positive. Chronologically, the first positive samples, including the IgM-positive, corresponded to sera collected in 2012 in Madrid province. From these results, we concluded that WNV circulated in asymptomatic equine populations of central Spain at least since 2012, before the first disease outbreak reported in this area.

Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders.

BACKGROUND: Completion of a pain drawing is a familiar task in those presenting with whiplash-associated disorders (WAD). Some people report pain almost over their entire body. Yet the reasons for larger pain extent have not been fully explored. METHODS: A novel method was applied to quantify pain extent from the pain drawings of 205 individuals with chronic WAD. Pain extent was evaluated in relation to sex, age, educational level, insurance status and financial status. Multiple linear regression analysis was used to verify whether pain extent was associated with other health indicators including perceived pain and disability, health-related quality of life, pain catastrophizing, anxiety, depression and self-efficacy. RESULTS: Pain extent was influenced by sex (χ(2) :10.392, p < 0.001) with larger pain extent in women compared to men (7.88 ± 7.66% vs. 5.40 ± 6.44%). People with unsettled insurance claims (χ(2) : 7.500, p < 0.05) and those with a worse financial situation (χ(2) :12.223, p < 0.01) also had larger pain extent. Multiple linear regression models revealed that, when accounting for age, sex, education, insurance status, financial status and neck pain intensity, pain extent remained associated with perceived disability (p < 0.01), depression (p < 0.05) and self-efficacy (p < 0.001). CONCLUSION: By utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in individuals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD. WHAT DOES THIS STUDY ADD?: Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain. When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy. The pain drawing is useful to support psychological screening in people with chronic WAD.

High-grade vaginal intraepithelial neoplasia and risk of progression to vaginal cancer: a multicentre study of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV).

OBJECTIVE: The aim of this study was to analyse the women with high grade vaginal intraepithelial neoplasia (HG-VaIN), in order to identify a subset of women at higher risk of progression to invasive vaginal cancer. MATERIALS AND METHODS: The medical records of all the women diagnosed with HG-VaIN, and subsequently treated, from January 1995 to December 2013 were analyzed in a multicentre retrospective case series. The rate of progression to invasive vaginal cancer and the potential risk factors were evaluated. RESULTS: 205 women with biopsy diagnosis of HG-VaIN were considered, with a mean follow up of 57 months (range 4-254 months). 12 cases of progression to vaginal squamocellular cancer were observed (5.8%), with a mean time interval from treatment to progression of 54.6 months (range 4-146 months). The rate of progression was significantly higher in women diagnosed with VaIN3 compared with VaIN2 (15.4% vs. 1.4%, p < 0.0001). Women with HG-VaIN and with previous hysterectomy showed a significantly higher rate of progression to invasive vaginal cancer compared to non-hysterectomised women (16.7% vs. 1.4%, p < 0.0001). A higher risk of progression for women with VaIN3 and for women with previous hysterectomy for cervical HPV-related disease was confirmed by multivariable logistic regression analysis. CONCLUSIONS: A higher rate of progression to vaginal cancer was reported in women diagnosed with VaIN3 on biopsy and in women with previous hysterectomy for HPV-related cervical disease. These patients should be considered at higher risk, thus a long lasting and accurate follow up is recommended.

Measuring biological responses at different levels of organisation to assess the effects of diffuse contamination derived from harbour and industrial activities in estuarine areas.

To evaluate the effects of diffuse contamination, biological measurements were applied in a scrap cargo harbour, a marina and an industrial area. Metal accumulation and biomarkers (survival in air, digestive gland and gonad histopathology, lysosomal membrane stability, intralysosomal metal accumulation, transcription of vitellogenin and MT20, peroxisome proliferation and micronuclei formation) were measured in transplanted mussels, together with metrics of benthic invertebrates. Benthic species were classified into ecological groups and univariate indexes were calculated. The marina showed high richness (16) and percentage of opportunistic species (55.1%) and low metal accumulation. Mussels in the scrap cargo harbour showed high metal accumulation, up-regulation of MT20 transcription, reduced health status (LP<6 min) and increased micronuclei frequencies (up to 11.3‰). At the industrial area, low species richness (4) and badly organised assemblages were detected and chemical analyses indicated significant amounts of bioavailable metals. Overall, selected biological measurements showed potential for the assessment of diffuse contamination.

Test-retest reliability of pain extent and pain location using a novel method for pain drawing analysis.

BACKGROUND: Pain drawings (PDs) are an important component of the assessment of a patient with pain. The aim of this work is to present the test-retest reliability of a novel method of quantifying the extent and location of pain. Additionally, the association between PD variables and clinical features in patients with chronic neck pain (CNP) and chronic low back pain (CLBP) was explored. METHODS: Fifty-one patients with CLBP and 56 patients with CNP participated. Each patient shaded two consecutive PDs using a digital tablet. Software was developed to quantify the pain extent, to analyse the pain overlap between PDs and to produce pain frequency maps. Correlations were obtained between pain extent and clinical features including the level of pain intensity, disability, and psychological distress and cognitive function. RESULTS: The intraclass correlation coefficients for pain extent in CLBP and CNP were very high: 0.97 (95% CI: 0.95-0.98) and 0.92 (95% CI: 0.87-0.98), respectively. The Bland Altman showed a mean difference close to zero: 5.4% pixels in CNP group and 3% pixels in the CLBP group. Significant correlations were observed between pain extent and pain intensity in CLBP and CNP and pain extent and disability in CNP. There was no relation between pain extent and the level of distress or cognitive function. CONCLUSIONS: A novel method for the acquisition of PD was presented. Test-retest reliability of reporting pain extent and pain location was supported in people with CNP and CLBP. Future research is needed to establish psychometric properties of PD.

Evaluación de la calidad de las páginas webs de los hospitales del Sistema Sanitario Público de Andalucía / Evaluation of the Andalusia Public Health System hospital websites in the period 2010-2012

Objetivos: Evaluar la calidad, la accesibilidad y la presencia de herramientas 2.0 de las páginas webs de los hospitales del Sistema Sanitario Público de Andalucía. Métodos: Estudio observacional descriptivo durante el periodo 2010-2012. Las variables analizadas fueron: calidad, accesibilidad y presencia de herramientas 2.0. La calidad se evaluó mediante el cuestionario de Bermúdez-Tamayo, la accesibilidad con la herramienta Test de Accesibilidad Web y las herramientas 2.0 por observación directa. Resultados: Disponían de página web en 2010, 31 de los 45 hospitales (68,9%), incrementándose hasta 34 (75,5%) en 2012. La puntuación media + desviación estándar (DE) del cuestionario de calidad Bermúdez Tamayo fue de 11,1 + 3,8 puntos en 2010 y de 12,3 + 3,9 puntos en el año 2012, observándose una diferencia entre las medias de 0,25 (IC del 95%, 0,00 a 0,50) estadísticamente significativa (p = 0,007). En la evaluación de la accesibilidad, solo 7 páginas webs (n = 31) en 2010 y 10 (n = 34) en 2012 cumplían criterios legales de accesibilidad. El uso de herramientas 2.0 se incrementó a lo largo del estudio. En 2010 disponían de este tipo de herramientas el 19,4% (n = 6) de las páginas webs de los hospitales y en 2012 el 58,8% (n = 20). Conclusiones: La calidad evaluada con el cuestionario Bermúdez-Tamayo, en general, fue buena. Sin embargo, se observó un incumplimiento de la legislación en materia de accesibilidad, que debe ser revisada y adaptada a la normativa legal vigente. Se constató la incipiente utilización de los recursos web 2.0 como estrategias de educación y comunicación en materia de salud (AU)

Objectives: Evaluate the quality, accessibility and presence of Web 2.0 tools in the Andalusia Public Health System hospitals websites Methods: Observational, descriptive study carried out between 2010 and 2012. The variables analyzed were: quality, accessibility and innovation. The quality was evaluated using a Bermudez-Tamayo questionnaire. Accessibility was measured using the Web Accessibility Test (TAW) tool. Web 2.0 tools were identified by direct observation. Results: A total of 31 of the 45 hospitals (68.9%) had a website in the year 2010, increasing to 34 (75.5%) in 2012. The average score + standard deviation (SD) of the Bermudez-Tamayo quality questionnaire was 11.1 + 3.8 points in 2010, and 12.3 + 3.9 points in 2012, observing a statistically significant difference of 0.25 being observed between the means (P=.007), 95% CI; 0.00 to 0.50) In the accessibility evaluation only 7 websites (n = 31) in 2010, and 10 (n = 34) in 2012, fulfilled the legal criteria for accessibility. The use of Web 2.0 tools has increased throughout the study. In 2010, 19.4% (n = 6) of the hospital websites had this type of tool, in comparison to 58.8% (n = 20) in 2012. Conclusions: In general, the quality of the websites studied is good. However, current legislation regarding accessibility is not fulfilled and must be revised and adapted to the current legal rules. There is an incipient use of Web 2.0 resources as education and communication strategies with regard to health

[Evaluation of the Andalusia Public Health System hospital websites in the period 2010-2012]. / Evaluación de la calidad de las páginas webs de los hospitales del Sistema Sanitario Público de Andalucía.

OBJECTIVES: Evaluate the quality, accessibility and presence of Web 2.0 tools in the Andalusia Public Health System hospitals websites METHODS: Observational, descriptive study carried out between 2010 and 2012. The variables analyzed were: quality, accessibility and innovation. The quality was evaluated using a Bermudez-Tamayo questionnaire. Accessibility was measured using the Web Accessibility Test (TAW) tool. Web 2.0 tools were identified by direct observation. RESULTS: A total of 31 of the 45 hospitals (68.9%) had a website in the year 2010, increasing to 34 (75.5%) in 2012. The average score+standard deviation (SD) of the Bermudez-Tamayo quality questionnaire was 11.1+3.8 points in 2010, and 12.3+3.9 points in 2012, observing a statistically significant difference of 0.25 being observed between the means (P=.007), 95% CI; 0.00 to 0.50) In the accessibility evaluation only 7 websites (n=31) in 2010, and 10 (n=34) in 2012, fulfilled the legal criteria for accessibility. The use of Web 2.0 tools has increased throughout the study. In 2010, 19.4% (n=6) of the hospital websites had this type of tool, in comparison to 58.8% (n=20) in 2012. CONCLUSIONS: In general, the quality of the websites studied is good. However, current legislation regarding accessibility is not fulfilled and must be revised and adapted to the current legal rules. There is an incipient use of Web 2.0 resources as education and communication strategies with regard to health.

Assessing the effects of treated and untreated urban discharges to estuarine and coastal waters applying selected biomarkers on caged mussels.

To assess effects of urban discharges, biomarkers were measured in caged mussels in northern Iberian Peninsula. Lysosomal membrane stability and histopathology of gonad and digestive gland were analysed as general effect biomarkers. Exposure to specific pollutants was evaluated by autometallographical detection of metals, peroxisomal acyl-CoA oxidase activity, micronucleus test and transcription levels of vitellogenin and MT20 genes. Health status of mussels was impaired after 3 days of caging at the untreated outfall discharge and at the waste water treatment plant effluent discharge to the estuary. The most relevant finding was the significant up-regulation of vitellogenin gene transcription in male mussels exposed to the untreated outfall discharge. Metals and xenoestrogenic endocrine disruptors were bioavailable in some discharges and disturbed the health status of mussels. Biomarkers were effective in the assessment of effects of urban discharges and could be implemented in operative controls required to assess the risks associated to effluent discharges.

Novel conserved segments are associated with differential expression patterns for Pinaceae dehydrins.

Dehydrins are thought to play an essential role in the response, acclimation and tolerance to different abiotic stresses, such as cold and drought. These proteins have been classified into five groups according to the presence of conserved and repeated motifs in their amino acid sequence. Due to their putative functions in the response to stress, dehydrins have been often used as candidate genes in studies on population variability and local adaptation to environmental conditions. However, little is still known regarding the differential role played by such groups or the mechanism underlying their function. Based on the sequences corresponding to dehydrins available in public databases we have isolated eight different dehydrins from cDNA of Pinus pinaster. We have obtained also their genomic sequences and identified their intron/exon structure. Quantitative RT-PCR analysis of their expression pattern in needles, stems and roots during a severe and prolonged drought stress, similar to the ones trees must face in nature, is also reported. Additionally, we have identified two amino acid motifs highly conserved and repeated in Pinaceae dehydrins and absent in angiosperms, presumably related to the divergent expression profiles observed.

Estudio evaluativo sobre una herramienta informática de gestión enfermera en el periodo 2005-2010 / Assessment of a software application tool for managing nursing care processes in the period 2005-2010

Objetivos. Identificar beneficios y dificultades en la aplicación informática. Método. Estudio evaluativo de la herramienta informática Azahar utilizada en la gestión del proceso enfermero. La población de estudio fueron las enfermeras usuarias del sistema en hospitalización y las beneficiarias del mismo en Atención Primaria; en cada grupo la selección se realizó al azar y el número lo determinó la saturación de los datos. Técnicas de recogida de datos: entrevistas en profundidad y grupo de discusión. Resultados. Las enfermeras consideraron que lo más beneficioso y de utilidad en la herramienta son la valoración inicial y el informe de alta de continuidad de cuidados; así mismo identifican como ventajoso que registre todos los datos del proceso enfermero garantizando la calidad. Los inconvenientes y debilidades los relacionaron con estar sometidas a continuas variabilidades en su cotidianeidad asistencial; un aumento de carga de trabajo impide realizar siempre el registro informático, haciéndolo en papel, lo que supone una duplicidad en los registros; consideraron así mismo que el sistema operativo de la herramienta informática debe mejorar en cuanto a simplicidad y operatividad. Conclusión. La simplicidad en la herramienta y la adecuación en las cargas de trabajo, favorecerían la utilización de la misma y como consecuencia unos cuidados continuados (AU)

Objectives. To identify problems and critical points in the software application. Method. Assessment of the implementation of the software tool "Azahar" used to manage nursing care processes. The monitored population consisted of nurses who were users of the tool, at the Hospital and those who benefited from it in Primary Care. Each group was selected randomly and the number was determined by data saturation. A qualitative approach was employed using in-depth interviews and group discussion as data collection techniques. Results. The nurses considered that the most beneficial and useful application of the tool was the initial assessment and the continuity of care release forms, as well as the recording of all data on the nursing process to ensure quality. The disadvantages and weaknesses identified were associated with the continuous variability in their daily care. The nurses related an increase in workload with the impossibility of entering the records into the computer, making paper records, thus duplicating the recording process. Likewise, they consider that the operating system of the software should be improved in terms of simplicity and functionality. Conclusion. The simplicity of the tool and the adjustment of workloads would favour its use and as a result, continuity of care (AU)

[Assessment of a software application tool for managing nursing care processes in the period 2005-2010]. / Estudio evaluativo sobre una herramienta informática de gestión enfermera en el periodo 2005-2010.

OBJECTIVES: To identify problems and critical points in the software application. METHOD: Assessment of the implementation of the software tool "Azahar" used to manage nursing care processes. The monitored population consisted of nurses who were users of the tool, at the Hospital and those who benefited from it in Primary Care. Each group was selected randomly and the number was determined by data saturation. A qualitative approach was employed using in-depth interviews and group discussion as data collection techniques. RESULTS: The nurses considered that the most beneficial and useful application of the tool was the initial assessment and the continuity of care release forms, as well as the recording of all data on the nursing process to ensure quality. The disadvantages and weaknesses identified were associated with the continuous variability in their daily care. The nurses related an increase in workload with the impossibility of entering the records into the computer, making paper records, thus duplicating the recording process. Likewise, they consider that the operating system of the software should be improved in terms of simplicity and functionality. CONCLUSION: The simplicity of the tool and the adjustment of workloads would favour its use and as a result, continuity of care.

An electromyographic study of the vastii muscles during open and closed kinetic chain submaximal isometric exercises.

BACKGROUND: Rehabilitation programs for patients with patellofemoral dysfunction aim to recruit the vastus medialis obliquus muscle (VMO) in an attempt to reduce pain and to improve patellar tracking. OBJECTIVES: The aim of the present study was to use surface EMG to assess the effectiveness of two isometric submaximal contractions (10% and 60% of maximal voluntary contraction, MVC) in promoting preferential activation of VMO over vastus medialis longus (VML) and vastus lateralis (VL) in open and closed kinetic chain isometric exercises with the knee joint fixed at 30, 60 and 90 degrees of flexion. METHODS AND MEASURES: Surface electromyography (EMG) signals were recorded with linear adhesive arrays of four electrodes from fourteen healthy young men (age 23.5±3.2, mean±SD) during isometric knee extension contractions at 10% and 60% of the maximum voluntary contraction (MVC) for 1 min and 20 s respectively at 30, 60 and 90 degrees of knee flexion. Initial values and rate of change (slope) of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated. RESULTS: Comparisons between the force levels produced at 10% and 60% MVC revealed that the initial values of ARV and CV for the VL, VML and VMO muscle were greater at 60% MVC compared to 10% MVC (3-way ANOVA; F=536; p<0.001, F=49: p<0.01 for ARV and CV respectively). Comparisons between the different muscles demonstrated lower initial values of CV for VMO compared to VL and VLM at 10% and 60% of MVC (F=15; p<0.05). In addition, initial estimates of ARV were higher for VMO compared to VML at both force levels (F=66; p<0.05). Comparisons between open and closed kinetic chain exercises revealed higher initial estimates of ARV for open kinetic chain knee extension at both force levels (F=62; p<0.01). In addition, the absolute value of MNF slope appeared to increase at higher angles for closed kinetic chain at 60% MVC while it was minimum at 60° degrees for open kinetic chain. No significant differences were observed in the rate of change of CV and MNF among the three muscles. CONCLUSIONS: Based on the results of this study, both open and closed kinetic chain exercise similarly activate the three portions of the quadriceps muscle, suggesting that selective training of the vastii muscle is not achievable in these conditions.