[Informed consent in shared processes]. / Consentimiento informado en procesos compartidos.

Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a diagnostic or therapeutic procedure that must performed by another specialist. In this scenario that involves different professionals, it is reasonable a certain debate about which of them should obtain the informed consent of the patient. The first error would be to pose this process as a confrontation between professionals who derive or delegate their own responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. On the one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a procedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And, since everything is understood as a shared process, it would also be advisable that the physician in charge of the care and follow-up of the patient, and who has taken the initiative to request this technique, had already provided basic information, more focused on the reason for the indication, and that a pre-consent had been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection. And it would be convenient to record this information in the medical record as well.

Consentimiento informado en procesos compartidos / Informed consent in shared processes

La medicina actual tiende a la especialización. Pero también cada vez son más frecuentes los procesoscompartidos o interdisciplinares en que un profesional solicita algún tipo de técnica o un procedimientodiagnóstico o terapéutico que debe realizar otro especialista. En un escenario así, que implica a profesio-nales diferentes, es razonable que surja cierto debate sobre a cuál de ellos le correspondería obtener elconsentimiento informado por parte del paciente. El primer error sería plantear este proceso como un en-frentamiento entre profesionales que derivan o delegan en otro sus propias responsabilidades. Al contra-rio, es preciso entenderlo como de un trabajo en equipo y no como una mera delegación de compromisos.Por una parte, sigue siendo el médico que lleva a cabo la técnica y que, por tanto, mejor la conoce comoprocedimiento y que es experto en la detección precoz y en el manejo de los efectos secundarios, el que de-bería asumir el compromiso de informar sobre este procedimiento y sus perfiles específicos. Y, por ello, esa él a quien le corresponde obtener el oportuno consentimiento informado. Por otra, al entenderlo comoun proceso compartido, lo adecuado sería que el médico responsable del seguimiento del paciente y quees quien ha tomado la iniciativa de solicitar esta técnica hubiese aportado una información elemental, máscentrada en el motivo de la indicación, y que con ello se hubiese obtenido un preconsentimiento, es deciruna aceptación básica o, al menos, un no-rechazo previo a la técnica. Y sería conveniente dejar registro deesta información en la historia clínica.(AU)

Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinaryprocesses in which professionals request some type of technique or a diagnostic or therapeutic procedurethat must performed by another specialist. In this scenario that involves different professionals, it is reaso-nable a certain debate about which of them should obtain the informed consent of the patient. The firsterror would be to pose this process as a confrontation between professionals who derive or delegate theirown responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. Onthe one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a pro-cedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And,since everything is understood as a shared process, it would also be advisable that the physician in chargeof the care and follow-up of the patient, and who has taken the initiative to request this technique, hadalready provided basic information, more focused on the reason for the indication, and that a pre-consenthad been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection.And it would be convenient to record this information in the medical record as well.(AU)

Cuidar y asistir: ¿hijos de un dios menor? / Care and support: children of a lesser god?

El sistema sanitario occidental corre el riesgo de descartar o dejar de lado una proporción importantede pacientes que requieren una atención menos tecnológica y más cercana y humana, que precisan mássoporte y cuidados. En un escenario así, tanto la asistencia cercana y los cuidados como los pacientes quenecesitan estos cuidados –y que no se beneficiarían de tratamientos agresivos o intervencionistas– puedenverse como algo secundario, como hijos de un dios menor. Sería preciso cambiar el paradigma para enten-der que la calidad de la atención no se limita a la tecnología. Y sería necesario también promover la digni-dad de los cuidados de modo que no se contemplen como algo secundario y pasivo, sino que se entiendaque estos cuidados deben ser no solo activos sino también intensos sin perder perfil humano y cercano.Favorecer la dignidad de los cuidados supone también promover la dignidad de todos los pacientes quehan podido quedar marginados o excluidos por parte de un sistema sanitario marcado por la tecnología,la complejidad y que tiene como objetivo la eficiencia.(AU)

Our health system runs the risk of ruling out or neglecting a significant proportion of patients whorequire less technological but closer and humane care, those who require more support and attention.In this scenario, it is easy that both the assistance and close care and the patients who need this care andwho would not benefit from aggressive or interventionist treatments may be considered as secondary: aschildren of a lesser god. It would be necessary to change the paradigm to understand that the quality ofcare is not limited to technology. And it would also be necessary to promote the dignity of care so that it isnot seen as secondary and passive. On the contrary, care should be understood not only as active but alsoas intense without losing its close and human profile. Promoting the dignity of care also means promotingthe dignity of all patients who may have been marginalized or excluded from this health system that ismarked by technology and complexity and whose goal is efficiency.(AU)

[Care and support: children of a lesser god?] / Cuidar y asistir: ¿hijos de un dios menor?

Our health system runs the risk of ruling out or neglecting a significant proportion of patients who require less technological but closer and humane care, those who require more support and attention. In this scenario, it is easy that both the assistance and close care and the patients who need this care and who would not benefit from aggressive or interventionist treatments may be considered as secondary: as children of a lesser god. It would be necessary to change the paradigm to understand that the quality of care is not limited to technology. And it would also be necessary to promote the dignity of care so that it is not seen as secondary and passive. On the contrary, care should be understood not only as active but also as intense without losing its close and human profile. Promoting the dignity of care also means promoting the dignity of all patients who may have been marginalized or excluded from this health system that is marked by technology and complexity and whose goal is efficiency.

Basic Family Relations, Parental Bonding, and Dyadic Adjustment in Families with a Member with Psychosis.

The aim of the current study is to describe and explore basic family relations, parental bonding, and dyadic adjustment in families with offspring diagnosed with a psychotic disorder. The sample was made up of 120 participants, 60 in the clinical group (GCL) and 60 in the comparison group (GCP). All participants were assessed using the basic family relations evaluation questionnaire (CERFB), the parental bonding instrument (PBI), and the dyadic adjustment scale (DAS). The results showed differences between the clinical and comparison groups in terms of perceptions of basic family relations, dyadic adjustment and parental bonding. The clinical group recorded less favorable results for all of these variables. More specifically, the study observed significant differences between the groups in parental function, overprotection and caring. This study deepens our understanding of how family assessment and relational diagnoses can serve as prevention and intervention tools for families affected by a psychotic disorder.

La Intervención Familiar Domiciliaria en Psicosis: Análisis Cualitativo de los Cambios Observados tras la Psicoterapia / Domiciliary family intervention in psychosis: Qualitative analysis of changes noticed after psychotherapy

El objetivo del estudio actual es evaluar los cambios en la estructura, la dinámica familiar y la comunicación durante una intervención familiar domiciliaria con pacientes diagnosticados de trastornos del espectro psicótico que muestran resistencia al tratamiento. Se incluyeron en el estudio un total de 12 familias (36 participantes) con descendencia diagnosticada de trastorno psicótico. Para la recopilación de datos se utilizaron diferentes técnicas cualitativas con el fin de triangular la información que proviene de cada una de ellas: un cuestionario de preguntas abiertas y un cuestionario más profundo para los observadores. Los dos ejes que explican la dinámica relacional más estrechamente ligada a la resistencia al tratamiento de estos pacientes fueron el "clima de confianza-desconfianza" y la "ambiguedad claridad-comunicación". Estos indicadores pueden cambiar dinámicamente e interactuar entre sí con el fin de mejorar el clima familiar y la comunicación

The aim of the current study is to assess the changes in the structure, family dynamics, and communication during a domiciliary family intervention with patients diagnosed with psychotic spectrum disorders showing resistance to treatment. A total of 12 families (36 participants) with offspring diagnosed with psychotic disorder were included. For data collection, different qualitative techniques were used in order to triangulate information coming from each of them: a questionnaire of open questions and a deepening questionnaire for the observers. The two axes that explain the relational dynamics most closely linked to the treatment resistance of these patients were "trust-distrust climate" and "clarity-communicational ambiguity". These indicators can dynamically change and interact with each other for the benefit of improving family climate and communication

The Effects of Parenteral K1 Administration in Pseudoxanthoma Elasticum Patients Versus Controls. A Pilot Study.

INTRODUCTION: Pseudoxanthoma elasticum (PXE) is a rare disease caused by mutations in the ABCC6 gene. Vitamin K1 is involved in the posttranslational carboxylation of some proteins related to inhibition of the calcification process. Our aim was to investigate, in patients affected by PXE, baseline levels of vitamin K1-dependent proteins and -metabolites and whether parenteral administration of phytomenadione was effective in modulating their levels. METHODS: We included eight PXE patients with typical clinical symptoms (skin, retina, and vascular calcification) and two ABCC6 causative mutations; 13 clinically unaffected first-degree patients' relatives (9 carrying one ABCC6 mutation and 4 non-carriers). We assessed urinary vitamin K1 metabolites and serum Glu- and Gla-OC, Gas6 and undercaboxylated prothrombin (PIVKA-II), at baseline and after 1 and 6 weeks after a single intramuscular injection of 10 mg vitamin K1. RESULTS: Comparison of PXE patients, heterozygous, and non-carriers revealed differences in baseline levels of serum MK-4 and of urinary vitamin K metabolites. The response to phytomenadione administration on vitamin K-dependent proteins was similar in all groups. CONCLUSION: The physiological axis between vitamin K1 and vitamin K-dependent proteins is preserved; however, differences in the concentration of vitamin K metabolites and of MK-4 suggest that vitamin K1 metabolism/catabolism could be altered in PXE patients.

Adipose-derived mesenchymal stem cells (AdMSC) for the treatment of secondary-progressive multiple sclerosis: A triple blinded, placebo controlled, randomized phase I/II safety and feasibility study.

BACKGROUND: Currently available treatments for secondary progressive multiple sclerosis(SPMS) have limited efficacy and/or safety concerns. Adipose-mesenchymal derived stem cells(AdMSCs) represent a promising option and can be readily obtained using minimally invasive procedures. PATIENTS AND METHODS: In this triple-blind, placebo-controlled study, cell samples were obtained from consenting patients by lipectomy and subsequently expanded. Patients were randomized to a single infusion of placebo, low-dose(1x106cells/kg) or high-dose(4x106cells/kg) autologous AdMSC product and followed for 12 months. Safety was monitored recording adverse events, laboratory parameters, vital signs and spirometry. Expanded disability status score (EDSS), magnetic-resonance-imaging, and other measures of possible treatment effects were also recorded. RESULTS: Thirty-four patients underwent lipectomy for AdMSCs collection, were randomized and thirty were infused (11 placebo, 10 low-dose and 9 high-dose); 4 randomized patients were not infused because of karyotype abnormalities in the cell product. Only one serious adverse event was observed in the treatment arms (urinary infection, considered not related to study treatment). No other safety parameters showed changes. Measures of treatment effect showed an inconclusive trend of efficacy. CONCLUSION: Infusion of autologous AdMSCs is safe and feasible in patients with SPMS. Larger studies and probably treatment at earlier phases would be needed to investigate the potential therapeutic benefit of this technique.

Biomarkers and polymorphisms in pancreatic neuroendocrine tumors treated with sunitinib.

Several circulating biomarkers and single nucleotide polymorphisms (SNPs) have been correlated with efficacy and tolerability to antiangiogenic agents. These associations remain unexplored in well-differentiated, metastatic pancreatic neuroendocrine tumors treated with the multitargeted tyrosine kinase inhibitor sunitinib. We have assessed the effect on tumor response at 6 months, overall survival, progression-free survival and safety of 14 SNPs, and 6 soluble proteins. Forty-three patients were recruited. Two SNPs in the vascular endothelial growth factor receptor 3 (VEGFR-3) gene predicted lower overall survival: rs307826 with hazard ratio (HR) 3.67 (confidence interval [CI] 95%, 1.35-10.00) and rs307821 with HR 3.84 (CI 95%, 1.47-10.0). Interleukin-6 was associated with increased mortality: HR 1.06 (CI 95%, 1.01-1.12), and osteopontin was associated with shorter PFS: HR 1.087 (1.01-1.16), independently of Ki-67. Furthermore, levels of osteopontin remained higher at the end of the study in patients considered non-responders: 38.5 ng/mL vs. responders: 18.7 ng/mL, p-value=0.039. Dynamic upward variations were also observed with respect to IL-8 levels in sunitinib-refractory individuals: 28.5 pg/mL at baseline vs. 38.3 pg/mL at 3 months, p-value=0.024. In conclusion, two VEGFR-3 SNPs as well as various serum biomarkers were associated with diverse clinical outcomes in patients with well-differentiated pancreatic neuroendocrine tumors treated with sunitinib.

Evidence and decision algorithm for the withdrawal of antipsychotic treatment in the elderly with dementia and neuropsychiatric symptoms.

PURPOSE: Antipsychotics (APs) are commonly used to manage neuropsychiatric symptoms (NPS) in elderly patients with dementia, even though several large studies have demonstrated an association between AP treatment and increased morbidity and mortality in people with dementia. The aim of this study is to review the scientific literature of the use of AP in the elderly with dementia and to propose an algorithm to assist in decision-making regarding the withdrawal of APs. METHODS: A computerized literature search (MEDLINE: 1966 to December 2016, EMBASE: 1982 to December 2016) was used to locate relevant literature. Keywords in the search included terms from Medical Subject Headings (MESH) and EMBASE thesaurus (EMTREE). The following terms were used in the MESH database and EMTREE thesaurus: Aged, Antipsychotic Agents, Behavioral Symptoms and Dementia. RESULTS: Earlier studies of APs used in elderly patients with dementia suggest that, in most elderly demented patients, APs can be withdrawn with no effect on behaviour. These patients are likely to benefit from the algorithm we propose to assist clinicians in the withdrawal of APs. CONCLUSIONS: In this paper, we review the potential risks and benefits of discontinuing AP treatment in elderly demented patients with NPS and propose an algorithm to assist in decision-making regarding AP withdrawal.

Cambios en el Índice de Hígado Graso con una intervención con dieta mediterránea: seguimiento de 6 años del ensayo PREDIMED-Málaga / Changes in fatty liver index after consuming a Mediterranean diet: 6-year follow-up of the PREDIMED-Malaga trial

Objetivo: Analizar el efecto sobre el Índice de Hígado Graso (FLI, Fatty Liver Index) de la intervención con dieta mediterránea enriquecida con aceite de oliva virgen extra o frutos secos frente a un grupo control con una dieta baja en grasas. Metodología: Participantes del ensayo PREDIMED-Málaga, libres de enfermedad cardiovascular basalmente, pero con alto riesgo de desarrollarla. Al inicio, al año y a los 3, 5 y 6 años se les realizó mediciones antropométricas y toma de muestras de sangre para calcular el FLI. Se usaron modelos lineales mixtos para explorar los efectos fijos de los 3 grupos de intervención sobre el FLI, y sus interacciones con el tiempo. Resultados: Cumplían los criterios de participación en el estudio 276 participantes. La edad media fue de 67 años, con un 66% de mujeres. La prevalencia basal de HGNA estimado fue del 57%. El cambio temporal del FLI en el grupo control aumentó con el tiempo (1,13±0,4; p=0,006). En el grupo DietMed+AOVE la evolución fue similar a la de este, aunque por debajo (−3,90±1,9; p=0,038), y en DietMed+FS fue significativamente menor (−1,63±0,62; p=0,009). En el DietMed+FS la evolución del cambio del IMC fue 0,100 puntos menor al año en comparación con el grupo control (p=0,004). En el grupo de control, el cambio del perímetro de cintura aumentó significativamente con el tiempo (0,61±0,16cm/año; p<0,001) en contraste con DietMed+AOVE(−0,51±0,22; p=0,019). Conclusiones: La intervención dietética con dieta mediterránea podría retrasar o enlentecer la progresión natural del HGNA, siendo beneficiosa para la prevención y el tratamiento del mismo. No obstante, se necesitan estudios que ayuden a corroborar las conclusiones obtenidas (AU)

Objective: To analyze the effect of an intervention with a Mediterranean diet supplemented with either extra virgin olive oil or nuts, on the fatty liver index (FLI), compared to a low-fat control diet. Methods: Participants of the PREDIMED-Malaga trial, free from cardiovascular disease at baseline, but with a high risk to develop it, were included in this study. Anthropometric measurements were assessed and blood samples were taken to calculate participants’ FLI at study baseline and after one, 3, 5 and 6 years. Mixed linear models were used to explore the fixed effects of the 3 intervention groups on the FLI as well as their interaction with time. Results: A total of 276 participants were included in the study. Average participant age was 67 years, with 66% of participants being women. The baseline prevalence of NAFL was 57%. The change in the FLI of the control group increased significantly over time (1.13±0.41; P=.006). In the MedDiet+EVOO group, the time trend of the change in the FLI was similar to that of the control group, although it was seen to be lower (−3.90±1.9; P=.038). In the MedDiet+Nuts group, the trend was significantly lower than that of the control group (−1.63±0.62; P=.009). In the MedDiet+Nuts group, the trend of changes in participants’ BMI was 0.100 points lower per year compared to the control group (P=.004). In the control group, the change in waist circumference increased significantly over time (0.61±0.16cm/year; P<.001) in contrast to the MedDiet+EVOO group, in which this variable remained stable (−0.51±0.22; P=.019). Conclusions: A dietary intervention consisting of a Mediterranean diet could delay or slow down the natural progression of NAFL, thus, being beneficial for its prevention and treatment. However, further studies supporting these conclusions have yet to be carried out (AU)

Changes in fatty liver index after consuming a Mediterranean diet: 6-year follow-up of the PREDIMED-Malaga trial. / Cambios en el Índice de Hígado Graso con una intervención con dieta mediterránea: seguimiento de 6 años del ensayo PREDIMED-Málaga.

OBJECTIVE: To analyze the effect of an intervention with a Mediterranean diet supplemented with either extra virgin olive oil or nuts, on the fatty liver index (FLI), compared to a low-fat control diet. METHODS: Participants of the PREDIMED-Malaga trial, free from cardiovascular disease at baseline, but with a high risk to develop it, were included in this study. Anthropometric measurements were assessed and blood samples were taken to calculate participants' FLI at study baseline and after one, 3, 5 and 6 years. Mixed linear models were used to explore the fixed effects of the 3 intervention groups on the FLI as well as their interaction with time. RESULTS: A total of 276 participants were included in the study. Average participant age was 67 years, with 66% of participants being women. The baseline prevalence of NAFL was 57%. The change in the FLI of the control group increased significantly over time (1.13±0.41; P=.006). In the MedDiet+EVOO group, the time trend of the change in the FLI was similar to that of the control group, although it was seen to be lower (-3.90±1.9; P=.038). In the MedDiet+Nuts group, the trend was significantly lower than that of the control group (-1.63±0.62; P=.009). In the MedDiet+Nuts group, the trend of changes in participants' BMI was 0.100 points lower per year compared to the control group (P=.004). In the control group, the change in waist circumference increased significantly over time (0.61±0.16cm/year; P<.001) in contrast to the MedDiet+EVOO group, in which this variable remained stable (-0.51±0.22; P=.019). CONCLUSIONS: A dietary intervention consisting of a Mediterranean diet could delay or slow down the natural progression of NAFL, thus, being beneficial for its prevention and treatment. However, further studies supporting these conclusions have yet to be carried out.

Equity, barriers and cancer disparities: study of the Spanish Society of Medical Oncology on the access to oncologic drugs in the Spanish Regions.

PURPOSE: The Spanish Society of Medical Oncology (SEOM) has conducted a study on the access to oncologic drugs across the 17 Spanish Regions with the aim of identifying potential heterogeneities and making proposals for eliminating the barriers identified at the different levels. METHODS: An Expert Panel made up of medical oncologists designed a survey on certain indications approved for 11 drugs in the approach of breast cancer, melanoma, lung cancer, prostate cancer and support treatment. This survey was sent to 144 National Health System (NHS) hospitals. RESULTS: 77 hospitals answered the survey. The information modules analysed were: scope of the Commission that establishes binding decisions related to drug access; conditions, stages and periods of drug application, approval and administration processes; barriers to accessing drugs. CONCLUSIONS: The study shows variability in drug access. The SEOM makes proposals addressed to reducing the differences identified and homogenizing drug access conditions.

Molecular Profiling of Circulating Tumour Cells Identifies Notch1 as a Principal Regulator in Advanced Non-Small Cell Lung Cancer.

Knowledge on the molecular mechanisms underlying metastasis colonization in Non-Small Cell Lung Cancer (NSCLC) remains incomplete. A complete overview integrating driver mutations, primary tumour heterogeneity and overt metastasis lacks the dynamic contribution of disseminating metastatic cells due to the inaccessibility to the molecular profiling of Circulating Tumour Cells (CTCs). By combining immunoisolation and whole genome amplification, we performed a global gene expression analysis of EpCAM positive CTCs from advanced NSCLC patients. We identified an EpCAM+ CTC-specific expression profile in NSCLC patients mostly associated with cellular movement, cell adhesion and cell-to-cell signalling mediated by PI3K/AKT, ERK1/2 and NF-kB pathways. NOTCH1 emerged as a driver connecting active signalling pathways, with a reduced number of related candidate genes (NOTCH1, PTP4A3, LGALS3 and ITGB3) being further validated by RT-qPCR on an independent cohort of NSCLC patients. In addition, these markers demonstrated high prognostic value for Progression-Free Survival (PFS). In conclusion, molecular characterization of EpCAM+ CTCs from advanced NSCLC patients provided with highly specific biomarkers with potential applicability as a "liquid biopsy" for monitoring of NSCLC patients and confirmed NOTCH1 as a potential therapeutic target to block lung cancer dissemination.

EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10).

PURPOSE: This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR) gene in non-small-cell lung cancer (NSCLC) patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. PATIENTS AND METHODS: All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens) and serum samples. RESULTS: Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6%) had EGFR mutations (84% sensitizing mutations). EGFR mutation was found in serum in 14 (8.1%) patients (of 174 evaluable). Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52%, respectively. All but two patients received gefitinib. Median progression-free survival and overall survival were 10 (95% confidence interval: 4.8-15.3) months and 17.8 (95% confidence interval: 13.9-21.6) months, respectively, in patients carrying sensitizing mutations. CONCLUSION: The incidence of EGFR mutations in Galicia is consistent with previous data in Spain. Our results also support the feasibility of EGFR testing to guide treatment decision making using tumor tissue or cytology samples, or serum samples if tumor specimens are unavailable. These findings also confirm that first-line gefitinib is an active treatment option in Caucasians with EGFR mutation-positive NSCLC.

Influencia de factores negativos del contexto de trabajo en desgaste psíquico de trabajadores en Colombia / Influence of negative factors in the context of work in psychological exhaustion of workers in Colombia / Influéncia de fatores negativos do contexto de trabalho i desgaste psíquico de trabalhadores i Colômbia

Objetivo: Identificar la influencia que la percepción sobre los factores de contexto de trabajo tiene sobre desgaste psíquico en trabajadores de Centro Oriente y Suroccidente en Colombia en 2013. Materiales y Métodos: Diseño no experimental, transversal, cuantitativo. Muestra no probabilística, seleccionada por conveniencia, 193 trabajadores de población laboral de diversos sectores empresariales. Instrumento: batería para estudio de condiciones de trabajo de carácter psicosocial "CTCPS-MAC" validada para población iberoamericana, evalúa cuatro dimensiones: contexto de trabajo, contenido de trabajo, factores individuales y desgaste psíquico e incluye 14 factores psicosociales. El tipo de investigación es descriptivo, comparativo y correlacional de tipo multivariante. El análisis de datos y los resultados de los instrumentos se hicieron en el programa IBM SPSS Statistics 21. Resultados: cultura organizacional [p = 0,000 Exp (B) = 9,300] y formación técnica o superior [p = 0,001 Exp (B) = 5,600] infieren mayor riesgo para provocar desgaste psíquico cognitivo-emocional. A nivel conductual el rol [p = 0,000 Exp (B) = 30,714] y las relaciones interpersonales en el trabajo [p = 0,001 Exp (B) = 16,381]. El trabajador con formación técnica o superior y percepción nociva de cultura de empresa tiene una probabilidad del 70,70% de desgaste psíquico cognitivo-emocional. Una mala percepción de rol y de las relaciones interpersonales una probabilidad del 35,10% de desgaste psíquico conductual. Conclusiones: El estudio permite profundizar en el conocimiento de factores psicosociales de contexto de trabajo y muestran la importancia que, una buena cultura de organización y gestión, adecuado papel o rol en la organización y buenas relaciones interpersonales en el trabajo, tienen en la consecución de una organización saludable, promotora de salud y bienestar en todos sus integrantes.

Objective: To identify the influence that the perception on the factors of work context have on the psychological exhaustion of workers in Central East and South-Western Colombia in 2013. Materials and Methods: Non-experimental, cross-sectional and quantitative design. Non-probabilistic sample, selected for convenience, 193 workers from the working population of various business sectors. Instruments: battery for the study of working conditions of psychosocial character "CTCPS-MAC" validated for Iberoamerican population. It evaluates four dimensions: work context, work content, individual factors and psychological exhaustion, and includes 14 psychosocial factors. The research is descriptive, comparative and co-relational of multivariate type. Data analysis and results of the instruments were analyzed through IBM SPSS Statistics 21. Results: The organizational culture [p = 0.000 Exp (B) = 9.300] and technical training or higher education [p = 0.001 Exp (B) = 5.600] cause higher risk to end up in psychological cognitive-emotional exhaustion. At the behavioral level, the role [p = 0.000 Exp (B) = 30.714] and the interpersonal relationships at work [p = 0.001 Exp (B) = 16.381] are the exhaustion cause. The workers with technical training or higher education and a harmful perception of the company culture has a 70.70% chance of psychological cognitive-emotional exhaustion. A bad perception of the role and of interpersonal relationships represent a 35.10% possibility of psychological behavioral exhaustion. Conclusions: This study allows deeper understanding of psychosocial factors of work context and shows the importance that a good organizational culture and management, an appropriate role in the organization and good interpersonal relationships at work, have in achieving a healthy organization that promotes health and wellness in all its members.

Objetivo: Identificar a influencia que a percepção sobre os fatores de contexto de trabalho tem sobre desgaste psíquico em trabalhadores de Centro Oriente e Sul ocidente em Colômbia em 2013. Materiais e Métodos: Desenho no experimental, transversal, qualitativo. Mostra no probabilístico, selecionada por conveniência, 193 trabalhadores de povoação laboral de diversos setores empresariais. Instrumento: bateria para estudo de condições de trabalho de caráter psicossocial "CTCPS-MAC" validada para povoação ibero-americana, avalia quatro dimensões: contexto de trabalho, conteúdo de trabalho, fatores individuais e desgastes psíquico e inclui 14 fatores psicossociais. O tipo de pesquisa é descritiva, comparativa e correlacional de tipo multivariante. O analise de dados e os resultados dos instrumentos se fizeram no programa IBM SPSS Statistics 21. Resultados: cultura organizacional [p = 0,000 Exp (B) = 9,300] e formação técnica ou superior [p = 0,001 Exp (B) = 5,600] inferem maior risco para provocar desgaste psíquico cognitivo-emocional. A nível conductual o rol [p = 0,000 Exp (B) = 30,714] e as relaciones interpessoais no trabalho [p = 0,001 Exp (B) = 16,381]. O trabalhador com formação técnica ou superior e percepção nociva de cultura tem uma probabilidade do 70,70% de desgaste psíquico cognitivo-emocional. Uma má percepção de rol e das relações interpessoais uma probabilidade do 35,10% de desgaste psíquico conductual. Conclusões: O estudo permite aprofundar no conhecimento de fatores psicossociais de contexto de trabalho e mostram a importância que, uma boa cultura de organização e gestão, adequada papel o rol na organização e boas relaciones interpessoais no trabalho, tem na consecução de uma organização saudável, promotora de saúde e bem estar em todos seus integrantes.

Obsessive-compulsive disorder in the perinatal period: Epidemiology, phenomenology, pathogenesis, and treatment / Trastorno obsesivo-compulsivo durante el período perinatal: epidemiología, fenomenología, etiopatogenia y tratamiento

The aim of this review is to describe the main theoretical findings and research conclusions about obsessive-compulsive disorder (OCD) in the perinatal period. On one hand, epidemiological studies show that the risk of OCD onset and/or exacerbation could increase in this period, particularly in the puerperium. Phenomenologically, in this stage aggressive and contamination obsessions are very common and are related to the fetusor newborn. On the other hand, regarding OCD pathogenesis in thisperiod, there is indirect evidence to suggest the participation of neuroendocrine (e.g. female gonadal steroids and oxytocin) and cognitive behavioral variables (e.g. hyper-responsibility, threat overestimation, and mental control).In terms of research, more empirical studies are needed to contrast these specific vulnerability factors. Moreover, no empirically validated psychotherapeutic treatments (controlled trials) adapted to this OCD subgroup were found, although some studies highlight the role of cognitive behavioural therapy (CBT) as an effective intervention in the context of selective primary prevention

El objetivo de la presente revisión teórica es describir los principales hallazgos e investigaciones sobre el trastorno obsesivo-compulsivo (TOC) durante el período perinatal. Por una parte, los estudios epidemiológicos señalan que en esta etapa aumenta el riesgo de debut y/o exacerbación del TOC, especialmente en el puerperio. A nivel fenomenológico, predominan las obsesiones agresivas y de contaminación relacionadas con la figura del feto o neonato. En cuanto a su etiopatogenia, existen evidencias indirectas para postular la participación de variables neuroendocrinas (p.e. esteroides gonadales femeninos y oxitocina) y cognitivo-conductuales (p.e. hiperresponsabilidad, sobreestimación de la amenaza y control mental), siendo necesaria una mayor contrastación empírica de estos correlatos y/o factores de vulnerabilidad específicos. En el ámbito interventivo, se carece de ensayos clínicos aleatorizados con grupo control adaptados a las características idiosincrásicas de este subgrupo de sujetos con TOC. Así mismo, se destaca el papel de la terapia cognitivo-conductual (TCC) en el marco de la prevención primaria selectiva

Condiciones de trabajo psicosociales y desgaste psíquico en trabajadores de diversos sectores empresariales de Centro-Oriente, Suroccidente y región Caribe en Colombia / Psychosocial working conditions and psychological exhaustion in workers of various business sectors in Center Orient, South Occidental and Caribbean Region in Colombia

Objetivo:Determinar la percepción de trabajadores de distintos sectores empresariales de Colombia sobre los factores psicosociales presentes en su entorno laboral y la relación entre los factores psicosociales nocivos y los síntomas subjetivos y alteraciones de la salud. Materiales y métodos: Estudio no experimental, transversal y cuantitativo. Participaron 370 trabajadores, de diferentes sectores empresariales de Colombia (Centro-Oriente, Suroc-cidente y región Caribe). Instrumento: batería para el estudio de las condiciones de trabajo de carácter psicosocial(CTCPS-MAC), validada para población iberoamericana, permite evaluar cuatro dimensiones: Contexto de trabajo, Contenido de trabajo, Factores individuales y Desgaste psíquico e incluye catorce factores psicosociales. Los datos se analizaron con IBM SPSS statistics 21. Se realizó análisis bivariado y regresión logística multivariante de factores psicosociales nocivos y desgaste psíquico. Resultados:Los factores formación, baja médica, contexto de trabajo, contenido de trabajo y factores individuales están asociados en este estudio con desgaste psíquico. El contexto de trabajo es la variable que infiere mayor riesgo (p=0.000; Exp (B)= 5.355) para provocar desgaste psíquico, seguida de la formación técnica o superior y del contenido del trabajo. Conclusiones: Si bien aquellos trabajadores cuya percepción nociva del contexto de trabajo (interrelación trabajo-vida familiar/personal, cultura de la organización, gestión de la empresa, etc.), del contenido de trabajo (concepción tareas, carga y ritmo de trabajo, etc.) y los que tienen formación técnica o superior tienen mayor probabilidad de padecer desgaste psíquico, se observan aspectos positivos de las condiciones de trabajo psicosocial y su influencia en los trabajadores y en las organizaciones.

Objective: Determine the perception of workers in different business sectors in Colombia, on psychosocial factors that are present in their work environment and the relationship between negative psychosocial factors and subjective symptoms and health disorders. Materials and methods: Non-experimental, cross-sectional and quantitative study. 370 employees participated from different business sectors in Colombia (Central East, Southwestern, and Caribbean Region). Instruments: battery for the study of working conditions of psychosocial character (CTCPS-MAC) validated in Latin American population, which allows evaluating four dimensions: work context, work content, individual factors and psychological exhaustion and includes fourteen psychosocial factors. Data was analyzed with IBM SPSS statistics 21. It was performed a bivariate analysis and multivariate logistic regression of adverse psychosocial factors and psychological exhaustion. Results: Factors formation, sick leave, work context, work content and individual factors are associated in this study with psychological exhaustion. The work context is the variable that infers increased risk (p = 0.000, Exp (B) = 5.355) to cause psychological exhaustion, followed by technical or higher education and work content. Conclusions: Although those workers with a noxious perception of work context (interrelation between work and family and personal life, organizational culture, company management, etc.), content of work (tasks content, load and work rate, etc.), and those with technical or higher education, have more probability to suffer psychological exhaustion, positive aspects of psychosocial work conditions and their impact on workers and organizations are observed.

Representaciones sociales sobre la práctica odontológica en un grupo de profesionistas de la salud en Guadalajara (México) / Social Representations about Dental Practice in a Group Health Professionals in Guadalajara (México)

Objetivo: Reconocer las representaciones sociales que un grupo de profesionistas tiene sobre la práctica profesional del odontólogo. Material y métodos: La metodología empleada fue de tipo cualitativa, con apoyo de técnicas etnográficas; se realizaron entrevistas en profundidad a 29 profesionistas de la salud, de ambos sexos, durante el periodo 2010-2011. El análisis de la información obtenida se realizó mediante codificación abierta, axial y selectiva. Resultados: Se identificó las categorías de miedo al dolor y mala relación entre paciente-dentista como parte de la representación social de la práctica dental. Conclusiones: Los resultados muestran que el dolor y los miedos a la asistencia odontológica afectan negativamente a la viabilidad del tratamiento y, por ende, repercute de forma desfavorable en la salud dental de los entrevistados.

Objective: To recognize the social representations that a group of professionals have over the professional practice of dentistry. Material and methods: The methodology employed was of qualitative and ethnographic, through In-depth interviews to 29 health professionals of both sexes during the period 20102011. The analysis of data obtained was performed using open, axial and selective coding. Results: The results show social representation linked to fear to pain and a bad relationship patient-dentist during dental practice. Conclusions: The results show that the pain and fears of dental treatment adversely affect the viability of treatment and therefore an adverse impact on dental health of respondents.

Evaluation of Circulating Tumor Cells and Related Events as Prognostic Factors and Surrogate Biomarkers in Advanced NSCLC Patients Receiving First-Line Systemic Treatment.

In the present study we investigated the prognostic value of Circulating Tumour Cells (CTC) and their utility for therapy monitoring in non-small cell lung cancer (NSCLC). A total of 43 patients newly diagnosed with NSCLC were prospectively enrolled. Blood samples were obtained before the 1st, 2nd and 5th cycles of chemotherapy and analyzed using CellSearch technology. Both CTC and CTC-related objects (not morphological standard or broken epithelial cells) were counted. At baseline 18 (41.9%) patients were positive for intact CTC count and 10 (23.2%) of them had ≥5 CTC, while CK positive events were found in 79.1% of patients. The group of patients with CTC ³5 at baseline presented worse PFS and OS than those with <5 CTC (p = 0.034 and p = 0.008, respectively). Additionally, high levels of total CK positive events were associated with poor prognosis in the group of patients with <5 CTC. Regarding therapy monitoring, patients presenting increased levels of CTC during the treatment demonstrated lower OS and PFS rates. All these data supported the value of CTC as a prognostic biomarker and as a surrogate indicator of chemotherapy effectiveness in advanced NSCLC patients, with the additional value of analyzing other "objects" such as apoptotic CTC or CK fragments to guide the clinical management of these patients.