[The necessary response of health services to gender violence. Comprehensive care and provision of integrated services]. / La respuesta necesaria de los servicios de salud ante la violencia de género. Atención integral y prestación de servicios integrados.

Gender violence has multiple and serious consequences for the health of victims and their families, hence the reason for the important role that the health system plays in addressing it. Health professionals have a key role in the response, which must include early detection, care, and follow-up; actions in which primary care, because of its privileged position in the system, can play a fundamental part. This article establishes the necessary characteristics for the intervention to be effective: comprehensive care, multidisciplinary approach, intersectoral coordination, and integrated service provision; all of it community-oriented, person-centered, and adapted to its context (social factors and vulnerabilities) with an intersectional approach. The woman, her sons and daughters, and other cohabitants, as well as the perpetrator, are considered the object of intervention in the response, and specific guidelines for action are provided for detection, care, and follow-up. Reorientation of interventions, with emphasis on a community approach, is also proposed.

Los Cuidadores Informales de Personas Mayores Dependientes: una Revisión de las Intervenciones Psicológicas de los Últimos Diez Años / Informal caregivers for dependent elderly people:A revision of psychological interventions over the last ten years

En las últimas décadas se han realizado diversas revisiones sistemáticas para conocer la eficacia de las intervenciones para cuidadores informales de personas mayores, centrándose mayoritariamente en revisar aspectos específicos (e.g., cuidadores de personas mayores con demencia). Por ello en este trabajo realizamos una revisión actualizada de intervenciones con cuidadores de mayores dependientes en general. Las intervenciones que se incluyen en este trabajo (33) han sido obtenidas de Psicodoc, Psyke, PsycArticles, PsycInfo y Medline. La mayoría de las intervenciones que se aplican son cognitivo-conductuales y obtienen resultados significativos. Principalmente trabajan variables emocionales y carga. El formato de aplicación de las intervenciones es predominantemente grupal, con una eficacia equiparable a las intervenciones individuales. Conviene seguir mejorando las limitaciones que presentan estas intervenciones, entre las que cabe destacar la necesidad de incorporar seguimientos que permitan conocer la estabilidad de los resultados tras la intervención

In recent decades, several systematic reviews have been carried out in order to know the efficacy of interventions for informal caregivers of dependent elderly, mainly focused on reviewing specific features (e.g., caregivers of elderly people with dementia). In this study, we conducted an updated review of interventions for informal caregivers of dependent elderly in general, using methodological restrictive inclusion criteria. Interventions included in this work (33) have been obtained from Psicodoc, Psyke, PsycArticles, PsycInfo, and Medline. The majority of interventions are cognitivebehavioral ones and achieve significant results. They mainly address emotional variables and burden. Interventions are predominantly applied in a group format and their efficacy is comparable to individual interventions. It is advisable to overcome the limitations of these interventions, especially including follow-up periods to know the stability of results after the intervention

Anaemia and red blood cell transfusion in intracranial neurosurgery: a comprehensive review.

Both anaemia and blood transfusion are associated with poor outcomes in the neurosurgical population. Based on the available literature, the optimal haemoglobin concentration for neurologically injured patients appears to be in the range of 9.0-10.0 g dl-1, although the individual risks and benefits should be weighed. Several perioperative blood conservation strategies have been used successfully in neurosurgery, including correction of anaemia and coagulopathy, use of antifibrinolytics, and intraoperative cell salvage. Avoidance of non-steroidal anti-inflammatory drugs and starch-containing solutions is recommended given the potential for platelet dysfunction.

Airborne pollen trends in the Iberian Peninsula.

Airborne pollen monitoring is an effective tool for studying the reproductive phenology of anemophilous plants, an important bioindicator of plant behavior. Recent decades have revealed a trend towards rising airborne pollen concentrations in Europe, attributing these trends to an increase in anthropogenic CO2 emissions and temperature. However, the lack of water availability in southern Europe may prompt a trend towards lower flowering intensity, especially in herbaceous plants. Here we show variations in flowering intensity by analyzing the Annual Pollen Index (API) of 12 anemophilous taxa across 12 locations in the Iberian Peninsula, over the last two decades, and detecting the influence of the North Atlantic Oscillation (NAO). Results revealed differences in the distribution and flowering intensity of anemophilous species. A negative correlation was observed between airborne pollen concentrations and winter averages of the NAO index. This study confirms that changes in rainfall in the Mediterranean region, attributed to climate change, have an important impact on the phenology of plants.

Evaluation of the effectiveness of minimum intervention measures on young offenders

The goal of this study was to analyze the recidivism rate in minor offenders to whom a minimum intervention measure was applied after their first felony or misdemeanor, and to determine the variables associated with recidivism. The sample was made up of 154 minors from the province of Santa Cruz of Tenerife (Canary Islands, Spain). The information was collected from the database of the Minors’ Court. The recidivism rate depends on the measure imposed, ranging between 14 and 40.6%. The degree of agreement between the Technical Team’s proposal and the court decision was 70%. With regard to the variables associated with recidivism, a model was obtained through logistic regression that correctly classified 83.7% of the cases, and was made up of the variables perception of parenting problems, intervention of social services, and social isolation (AU)

El objetivo de este estudio era analizar la tasa de reincidencia en menores infractores a los que se les aplicaba una medida de intervención mínima en su primer delito o falta, y conocer las variables asociadas a la reincidencia. La muestra estuvo compuesta por 154 menores de la provincia de Santa Cruz de Tenerife. La información se extrajo de la base de datos del Juzgado de Menores. La tasa de reincidencia depende de la medida impuesta, variando entre un 14 y un 40.6%. El grado de acuerdo entre la propuesta del Equipo Técnico y la resolución judicial fue del 70%. En cuanto a las variables asociadas a la reincidencia, mediante regresión logística se obtuvo un modelo que clasifica correctamente al 83,7% de los casos, y que está formado por las variables percepción de problemas en la crianza por parte de los padres, intervención de los servicios sociales y aislamiento social (AU)

Manejo del estreñimiento en personas mayores / No disponible

No disponible

Síndrome de fatiga crónica / No disponible

No disponible

Un análisis contextual de la preferencia y el rechazo entre iguales en la escuela / A contextual analysis of peer acceptance and peer rejection at school

El objetivo del presente trabajo es realizar un análisis de la preferencia y el rechazo entre iguales desde una perspectiva contextual, teniendo en cuenta los diferentes escenarios en los que se desarrollan las relaciones sociales. Para ello, se administró un cuestionario sociométrico que combina el método de nominaciones para los diferentes contextos de interacción (académico y ocio) con el método de asignación de atributos perceptivos. La muestra está compuesta por 777 alumnos pertenecientes al 2ºy 3.er ciclo de Primaria y al 1.er ciclo de la ESO. Los principales resultados indican que la preferencia y el rechazo están mediatizados por los contextos interpersonales. Así, mientras que la preferencia está marcada por el contexto académico, el rechazo tiene una connotación trans-contextual. Los porcentajes de los diferentes tipos de preferidos y rechazados no varían entre los cursos analizados. Se identifican algunas características conductuales que diferencian a los distintos tipos de alumnos preferidos y rechazados. Se concluye que es necesario realizar análisis sociométricos contextualizados, ya que las relaciones sociales, y por lo tanto el estatus sociométrico, varían en función del escenario en el que se desarrollen (AU)

The aim of this study is to carryout an analysis of peer acceptance and peer rejection from a contextual perspective, taking into account the different settings in which social relationships develop. A sociometric questionnaire was used that combined the nomination method for different interaction contexts (academic and leisure) with the method of allocation of perceptive attributes. The sample is made up of 777 pupils ranging from the 4th year of primary school to 2nd year of secondary. The main results indicate that acceptance and rejection are influenced by interpersonal contexts. So, whereas peer acceptance is identified with the academic context, peer rejection has a cross-contextual connotation. The percentages of the diverse kinds of acceptance and rejection do not vary among the school courses studied. Some behavioural characteristics that differentiate the kinds of students who are preferred and rejected are identified. In conclusion, contextualised sociometric analyses should be carried out, as social relationships -and therefore, sociometric status- vary depending on the setting in which they take place (AU)

¿Cuál es la combinación de síntomas según padres y maestros más fiable para el diagnóstico de TDAH? / What combination of symptoms according to parents and teachers would be more reliable for the diagnosis of ADHD?

Introducción: El método politético, recogido en el Manual Diagnóstico y Estadístico de los Trastornos Mentales-IV, es el que se plantea tradicionalmente para el diagnóstico de los trastornos por déficit de atención e hiperactividad (TDAH). Sin embargo, es probable que este procedimiento, que conlleva establecer cualquier combinación de 6 ítems, no sea el más adecuado para establecer un diagnóstico de TDAH y que las diferentes combinaciones de ítems tengan desigual peso. Objetivo: Determinar qué combinaciones de ítems de las escalas de inatención e hiperactividad-impulsividad de DuPaul, para padres y maestros, son las más efectivas a la hora de diagnosticar o descartar un TDAH. Resultados: No todas las combinaciones de ítems de padres y maestros obtuvieron el mismo valor predictivo. Todas ellas ofrecieron altos grados de especificidad, pero bajos grados de sensibilidad; es decir, las combinaciones resultaron más efectivas y confiables para descartar este tipo de trastornos que a la hora de diagnosticarlos. Discusión: El método que implica establecer combinaciones de los ítems mejores predictores del TDAH ofreció superiores resultados que los del método politético. No obstante, se requieren futuros estudios con muestras que posean tasas base más elevadas para obtener datos más fiables. Asimismo, sería conveniente emplear un método alternativo para la selección de los sujetos participantes que permita comprobar, posteriormente, la eficacia diagnóstica pura de los diferentes ítems de las escalas de clasificación de los TDAH (AU)

Introduction: The polythetic method used in the DSM is the one proposed traditionally for the diagnosis of Attention Disorders with or without Hyperactivity (ADHD). However, it is possible that the approach which aggregates any combination of 6 items won’t be the optimal method to establish a diagnosis of ADHD, and that the different combinations may not be the same as regards to their ability to predict ADHD. Aim: Determine which combinations of items of DuPaul's inattention and hyperactivity-impulsivity scales (from parent and teacher versions), are the most effective to predict or rule out a diagnosis of ADHD. Results: Not every combination of items from parents and teachers obtained the same predictive value. All of them offered high levels of specificity, but had low sensivity; that is to say, the combinations were more effective and reliable for ruling out the disorder than predicting it. Conclusions: Data show that not every combination of ADHD items has the same predictive value and, therefore, the well-known polythetic method is disputable. The highest predictive value combinations, limitations of the study, and future lines of investigation are analyzed (AU)

[What combination of symptoms according to parents and teachers would be more reliable for the diagnosis of ADHD?]. / ¿Cuál es la combinación de síntomas según padres y maestros más fiable para el diagnóstico de TDAH?

INTRODUCTION: The polythetic method used in the DSM is the one proposed traditionally for the diagnosis of Attention Disorders with or without Hyperactivity (ADHD). However, it is possible that the approach which aggregates any combination of 6 items won't be the optimal method to establish a diagnosis of ADHD, and that the different combinations may not be the same as regards to their ability to predict ADHD. AIM: Determine which combinations of items of DuPaul's inattention and hyperactivity-impulsivity scales (from parent and teacher versions), are the most effective to predict or rule out a diagnosis of ADHD. RESULTS: Not every combination of items from parents and teachers obtained the same predictive value. All of them offered high levels of specificity, but had low sensivity; that is to say, the combinations were more effective and reliable for ruling out the disorder than predicting it. CONCLUSIONS: Data show that not every combination of ADHD items has the same predictive value and, therefore, the well-known polythetic method is disputable. The highest predictive value combinations, limitations of the study, and future lines of investigation are analyzed.

De la residencia a la escuela: la integración social de los menores en acogimiento residencial con el grupo de iguales en el contexto escolar / From residential care to school: peer relationships at school of minors in residential care

En este trabajo se analiza la integración con los iguales en el contexto escolar de los menores en acogimiento residencial, tanto desde la perspectiva de los iguales como la de los profesores. Mediante la aplicación de un cuestionario sociométrico en 50 aulas y un protocolo de valoración para el profesorado, se compara una muestra de 60 menores en acogimiento residencial con una muestra normativa de 843 menores. Los resultados muestran que los menores en acogimiento residencial obtienen mayores índices de rechazo por parte de los compañeros para las tareas académicas, pero no para las actividades de ocio. Asimismo, en comparación con la muestra normativa, son descritos más frecuentemente con adjetivos negativos. Existe un alto índice de acuerdo entre la valoración de los iguales y la de los profesores en aquellos atributos que son más visibles en el aula. Se discuten las implicaciones de estos resultados para la mejora de la adaptación escolar de este colectivo

In this study, peer relationships of minors in residential care in a school context are analysed, both from the perspective of the peers and the teachers. Using a sociometric test and an evaluation protocol for teachers in 50 classrooms, a sample of 60 minors in care is compared to a normative sample of 843 minors. The results show that minors in residential care have a higher rate of rejection by their classmates in academic activities, but not for leisure ones. Furthermore, in comparison with the normative sample, they are more frequently described with negative adjectives. There is a high level of agreement between the peer evaluation and that of the teachers in the most visible aspects in the classroom. The implications of these results for the improvement of the adjustment of this group are discussed

Atención al paciente cocainómano / Healthcare of cocaine-dependent patients

Los pacientes con una adicción a cocaína con frecuencia se resisten a tomar contacto con un centro especializado para pedir ayuda a su problema, a no ser que tengan una motivación alta para dejar de consumir. Sin embargo, la Atención Primaria es la puerta de entrada de la Sanidad Pública y en algún momento dicho paciente acudirá para pedir tratamiento de alguna enfermedad común o para solicitar información sobre su problema de consumo. El profesional de Atención Primaria debe estar preparado y formado para realizar este tipo de intervención, ya que la actuación en una primera consulta con un adicto a cocaína puede ser crucial, debido a que un rasgo típico del paciente es la tendencia a juzgar y valorar los conocimientos que el médico posee antes de depositar su confi anza en el. El médico de familia tiene la capacidad de dar una información objetiva y motivar para que inicie tratamiento si el paciente lo precisa

Cocaine-dependent patients are often resistant to seeking help at specialised centres, unless they have really decided to give up their drug consumption. However, Primary Care is the port of entrance to the Public Health system and at some time or other such patient will go to the Primary Care doctor due to some common illness or to seek information on their drug abuse problem. The Primary Care professional must be well prepared and trained for treating this kind of patient. How the cocaine addiction patient is managed at the fi rst visit is crucial because these patients tend to judge and assess the doctor’s knowledge before placing their trust in him/her. The family doctor must be able to give objective information and encourage the patient to start treatment if so needed

[The predictive value of DSM-IV criteria in the diagnosis of attention deficit hyperactivity disorder and its cultural differences]. / Valor predictivo de los criterios del DSM-IV en el diagnóstico del trastorno por déficit de atención/hiperactividad y sus diferencias culturales.

INTRODUCTION: The most common method used to diagnose attention deficit/hyperactivity disorder (ADHD) is based on the Diagnostic and statistic manual of mental disorders, 4th edition (DSM-IV) criteria. Nevertheless, it is more likely that the categorical system postulated by DSM-IV is not the most appropriate method as it does not consider the possible differences between the diagnostic capacity of the 18 proposed criteria. AIM. To analyze the predictive power of each DSM-IV diagnostic symptoms/criteria for ADHD using DuPaul's ADHD Parent and Teacher Rating Scales. PATIENTS AND METHODS: In a prospective, poblational study to evaluate the prevalence of ADHD the positive predictive power of each item was analyzed for each subtype and informant. A kappa index was applied for positive predictive power to correct the number of accurate predictions based on chance factors, and a ranking of items was established to determinate which ones offered the highest predictive power, comparing parent and teacher ratings. RESULTS: The results suggest that not all DSM-IV criteria are equal with regard to their ability to predict ADHD. The predictive power varies as a function of the informant. Parent and teachers agreed more on hyperactivity and impulsivity items, and showed more significant differences with regard to the American sample. CONCLUSIONS: The approach that aggregates any combination of items will not be the more effective strategy for ruling in a diagnosis of ADHD. To improve the clinical value of these scales making item combinations is recommended, the ones that will have attached a higher clinical weight for ruling in a diagnosis of ADHD.

Valor predictivo de los criterios del DSM-IV en el diagnóstico del trastorno por déficit de atención/hiperactividad y sus diferencias culturales / The predictive value of DSM-IV criteria in the diagnosis of attention deficit hyperactivity disorder and its cultural differences

Introducción. Para el diagnóstico del trastorno por déficit de atención/hiperactividad (TDAH), el método más utilizado se basa en los criterios del Manual diagnóstico y estadístico de los trastornos mentales, 4.ª edición (DSM-IV). Sin embargo, es probable que el sistema categorial postulado por el DSM-IV no sea el más apropiado al no plantear que puede haber diferencias en la capacidad diagnóstica de los 18 criterios propuestos. Objetivo. Analizar el poder predictivo de cada uno de los síntomas/criterios diagnósticos del DSM-IV para el TDAH a través de las escalas comportamentales de DuPaul para maestros y padres. Pacientes y métodos. En un estudio poblacional prospectivo para evaluar la prevalencia del TDAH, se analizó el valor predictivo positivo de cada ítem para cada subtipo y evaluador. El valor predictivo positivo se corrigió a través del índice de congruencia kappa y se estableció un ranking entre ítems para determinar cuáles son los que ofrecen un mayor poder predictivo al comparar entre maestros y padres. Resultados. Los resultados sugieren que no todos los criterios del DSM-IV tienen la misma capacidad predictiva. El poder predictivo de los ítems varía según el evaluador. Los padres y profesores coincidían más en los ítems de hiperactividad e impulsividad, y mostraban mayores diferencias con la muestra americana. Conclusiones. El enfoque de agregar cualquier combinación de ítems no será el más acertado al efectuar diagnósticos. Para mejorar el valor clínico de las escalas, se recomienda realizar combinaciones de ítems a las que se les pueda acabar concediendo un peso clínico mayor en la detección y diagnóstico de niños con TDAH

Introduction. The most common method used to diagnose attention deficit/hyperactivity disorder (ADHD) is based on the Diagnostic and statistic manual of mental disorders, 4th edition (DSM-IV) criteria. Nevertheless, it is more likely that the categorical system postulated by DSM-IV is not the most appropriate method as it does not consider the possible differences between the diagnostic capacity of the 18 proposed criteria. Aim. To analyze the predictive power of each DSM-IV diagnostic symptoms/criteria for ADHD using DuPaul’s ADHD Parent and Teacher Rating Scales. Patients and methods. In a prospective, poblational study to evaluate the prevalence of ADHD the positive predictive power of each item was analyzed for each subtype and informant. A kappa index was applied for positive predictive power to correct the number of accurate predictions based on chance factors, and a ranking of items was established to determinate which ones offered the highest predictive power, comparing parent and teacher ratings. Results. The results suggest that not all DSM-IV criteria are equal with regard to their ability to predict ADHD. The predictive power varies as a function of the informant. Parent and teachers agreed more on hyperactivity and impulsivity items, and showed more significant differences with regard to the American sample. Conclusions. The approach that aggregates any combination of items will not be the more effective strategy for ruling in a diagnosis of ADHD. To improve the clinical value of these scales making item combinations is recommended, the ones that will have attached a higher clinical weight for ruling in a diagnosis of ADHD

[Disseminated Mycobacterium chelonae infection during HIV. ]. / Infection disséminée à Mycobacterium chelonae au cours de l'infection à VIH.

INTRODUCTION: An atypical mycobacterium, Mycobacterium chelonae is a saprophyte germ in the environment, but rarely pathogenic. A few disseminated infections can be noted in immunodepressed patients. OBSERVATION: A 30 year-old man infected by HIV was hospitalised for deterioration in his general status of health with, on clinical examination, pallor, several superficial lymph nodes and hepatosplenomegaly. A biopsy of an axillary node and the liver revealed numerous granulomas with many atypical M. chelonae-like mycobacteria. Adapted treatment led to complete remission. DISCUSSION: Immunodepression facilitates the occurrence of M. chelonae infections, often of severe evolution and leading to dissemination. This mycobacterium is resistant to many antibiotics.

[Antimicrobial susceptibility of the bloodstream infections: a study in a nonteaching hospital]. / Estudio de sensibilidad antibiótica en las bacteriemias de un hospital secundario.

BACKGROUND: To try established antimicrobial susceptibility patterns and frequency of both nosocomial and community-acquired bloodstream infections and and to try identified the prognostic factors that can be modified. MATERIAL AND METHODS: A prospective study of 310 bloodstream infections with clinical significance detected in a non teaching hospital over period from October 2000-2001. A blood culture were identified by Bact-Alert system and the confirmation was performed by MicroScan system; an antimicrobial susceptibility test was performed by reference microdilution methods as described by NCCLS. We studied sentinel antimicrobial/organism combinations with potential clinical importance. Data were computerized using SPSS. Qualitative variables were compared using the X2 test or the Fisher exact test, and quantitative variables with t Student or ANOVA. RESULTS: Gram positive and Candida were frequently recovered in nosocomial bloodstreams. The proportion of oxacillin-resistant S. aureus isolates was 24% and the penicillin resistant pneumococci was 14%. Vancomycin was universal active against gram positive. Gram negatives were often recovered in community bloodstream. The proportion of EBSL E. coli isolates was < 2% and the proportion of multiresistance Pseudomonas aeruginosa was higher among UCI isolates. An independent risk factors for death identified after multivariate analysis was the inappropriate antimicrobial therapy OR 2.6. CONCLUSIONS: Ongoing surveillance of microbial pathogens and their resistance profiles is essential on local scale and permit the selection of appropriate antibiotic therapy which would be reduce the mortality.

Estudio de sensibilidad antibiótica en las bacteriemias de un hospital secundario / Antimicrobial susceptibility of the bloodstream infections: a study in a nonteaching hospital

Objetivo: Conocer los patógenos prevalentes y los patrones de resistencia de las bacteriemias nosocomiales y adquiridas. Material y métodos: Estudio prospectivo de 310 bacteriemias "significativas" detectadas en un hospital no universitario en el periodo octubre 2000-2001. Los hemocultivos se detectaron por el sistema Bact-Alert y la identificación definitiva se efectuó con el sistema MicroScan, con estudio de sensibilidad por el método de microdilución de referencia (NCLSS). Se estudiaron combinaciones "centinela" con relevancia clínica. El análisis estadístico utilizó el programa SPSS. El análisis univariante utilizó para variables cuantitativas t Student y para cualitativa test X2 o t Fisher. Resultados: Los gram positivos y las levaduras predominaron en las nosocomiales. Hubo un 24 por ciento de MARSA y un 14 por ciento de neumococos penicilina resistentes. La vancomicina mantuvo una sensibilidad universal. Los gram negativos dominaron en las comunitarias, E. coli (40 por ciento) con una prevalencia de EBSL < 2 por ciento. Destacamos las tasas de multiresistencia para P. aeruginosa en las unidades de agudos. Un análisis de regresión logística reveló al tratamiento empírico inadecuado como un factor independiente de mortalidad (OR 2,6). Conclusiones: La necesidad de un sistema de vigilancia que permita conocer la prevalencia y resistencia de los microorganimos locales y establecer terapéuticas empíricas adecuadas que permitan reducir la mortalidad (AU)

Cómo podemos hacer difícil un diagnóstico fácil. A propósito de un caso de diabetes mellitus tipo I / How to make an esasy diagnosis difficult. Based on one case of type 1 diabetes mellitus

Se relata un paciente en que tanto la sintomatología como la anamnesis son compatibles con anorexia nerviosa y en el que un análisis rutinario de orina coloca al médico en la pista del verdadero diagnóstico: diabetes mellitus tipo I (AU)