[Nutrition in the prevention and healing of chronic wounds. Importance in improving the diabetic foot]. / La nutrición en la prevención y curación de heridas crónicas. Importancia en la mejora del pie diabético.

INTRODUCTION: Nutrition plays an essential role in chronic wound healing as extra nutrients are needed for tissue repair and to restore losses through wound exudate. Insufficient intake of energy, protein, antioxidants (vitamin C, A, and zinc) and vitamin D are common in patients with chronic wounds and have been linked to delayed wound healing and dehiscence. Other risk factors such as obesity, diabetes, advanced age, corticosteroid use, and dehydration can also reduce or impede the healing process, and nutritional screening is important to identify patients with malnutrition. Proteins, amino acids (arginine, glutamine and methionine), vitamins C and A, and zinc have been used as pharmacological nutrients in pressure ulcer healing; however, omega-3 fatty acids, although they appear to slow progression, do not show improved healing rates. In patients with diabetic foot, supplementation with vitamins D, C, A, and E, magnesium, zinc, omega-3 fatty acids, and probiotics reduces ulcer size and improves glycemic control, although they have not been associated with complete healing; however, supplementation with arginine, glutamine, and ß-hydroxy-ß-methylbutyrate does show wound healing, although further evidence is needed to confirm these results.

INTRODUCCIÓN: La nutrición tiene un papel esencial en la cicatrización de las heridas crónicas ya que se necesita un aporte extra de nutrientes en la reparación tisular y para restablecer las pérdidas originadas a través del exudado de la herida. El aporte insuficiente de energía, proteínas, antioxidantes (vitamina C, vitamina A y zinc) y vitamina D es frecuente en los pacientes con heridas crónicas y se ha relacionado con retrasos en la curación y dehiscencia de la herida. También otros factores de riesgo como la obesidad, la diabetes, la edad avanzada, el consumo de glucocorticoides y la deshidratación pueden disminuir o impedir el proceso de la cicatrización, siendo importante la realización de un cribado nutricional para identificar a los pacientes con desnutrición. Las proteínas, los aminoácidos (arginina, glutamina y metionina), las vitaminas C y A, y el zinc se han utilizado como nutrientes farmacológicos para la cicatrización de las úlceras por presión; sin embargo, los ácidos grasos omega-3, aunque parecen disminuir su progresión, no muestran mejores tasas de curación. En los pacientes con pie diabético, la suplementación con vitaminas D, C, A y E, magnesio, zinc y ácidos grasos omega-3, así como la administración de probióticos, reduce el tamaño de la úlcera y mejora el control glucémico, aunque no se han relacionado con una cicatrización completa; sin embargo, la suplementación con arginina, glutamina y ß-hidroxi-ß-metilbutirato logra la curación de la herida, aunque es necesaria una mayor evidencia que confirme estos resultados.

Mortalidad materna y su relación con la distribución de matronas en las regiones de Perú: un estudio ecológico / Maternal mortality and its relationship with the distribution of midwives in the regions of Peru: an ecological study

Objetivo: Determinar la relación entre la distribución de matronas en las regiones de Perú y la mortalidad materna. Metodología: Estudio de diseño ecológico, en el que se obtuvieron, por cada región, la distribución de matronas por cada 1.000 gestantes y la tasa de mortalidad materna. Se usó como fuente de datos los informes del Ministerio de Salud de Perú hasta el año 2015, por la completitud que presentaban. Se evaluó la relación entre las variables mediante una correlación de Spearman, debido a la distribución no normal de las variables, con un intervalo de confianza del 95%. Se utilizó el software QGIS para evaluar la distribución geográfica de las variables. Resultados: La mediana de la tasa de mortalidad materna en Perú fue de 72,9 muertes por cada 100.000 nacidos vivos, mientras que el número de matronas por 1.000 gestantes fue de 22,6. El análisis mostró una relación negativa, que llegó a ser significativa (Rho= –0,397; p= 0,049). Asimismo, se halló que el número de matronas se ha incrementado en un 62,2% y que el número de muertes se ha reducido en un 9,2% durante el periodo 2010-2015. Conclusiones: Existe una relación inversa significativa entre la mortalidad materna y la distribución de matronas en las regiones de Perú. (AU)

Objective: Determine the relationship between the distribution of midwives in the regions of Peru and the maternal mortality. Methodology: Ecological design study where, for each region, the distribution of midwives per thousand pregnant women and the maternal mortality ratio were obtained. The reports of the Ministry of Health of Peru until 2015 were taken as a source of data, due to the completeness that they presented. The relationship between the variables was evaluated using a Spearman correlation, due to the non-normal distribution of the variables, with a confidence level of 95%. The QGIS software was used to evaluate the geographical distribution of the variables. Results: The median maternal mortality ratio in Peru was 72.9 deaths per 100,000 live births, while the number of midwives per 1,000 pregnant women was 22.6. The analysis showed a negative relationship that became significant (Rho= –0.397; p= 0.049). Likewise, it was found that the number of obstetricians has increased by 62.2% and the number of deaths has been reduced by 9.2% during the period from 2010 to 2015. Conclusions: There is a significant inverse relationship between maternal mortality and the distribution of midwives in the regions of Peru. (AU)

La nutrición en la prevención y curación de heridas crónicas. Importancia en la mejora del pie diabético / Nutrition in the prevention and healing of chronic wounds. Importance in improving the diabetic foot

La nutrición tiene un papel esencial en la cicatrización de las heridas crónicas ya que se necesita un aporte extra de nutrientes en la reparación tisular y para restablecer las pérdidas originadas a través del exudado de la herida. El aporte insuficiente de energía, proteínas, antioxidantes (vitamina C, vitamina A y zinc) y vitamina D es frecuente en los pacientes con heridas crónicas y se ha relacionado con retrasos en la curación y dehiscencia de la herida. También otros factores de riesgo como la obesidad, la diabetes, la edad avanzada, el consumo de glucocorticoides y la deshidratación pueden disminuir o impedir el proceso de la cicatrización, siendo importante la realización de un cribado nutricional para identificar a los pacientes con desnutrición. Las proteínas, los aminoácidos (arginina, glutamina y metionina), las vitaminas C y A, y el zinc se han utilizado como nutrientes farmacológicos para la cicatrización de las úlceras por presión; sin embargo, los ácidos grasos omega-3, aunque parecen disminuir su progresión, no muestran mejores tasas de curación. En los pacientes con pie diabético, la suplementación con vitaminas D, C, A y E, magnesio, zinc y ácidos grasos omega-3, así como la administración de probióticos, reduce el tamaño de la úlcera y mejora el control glucémico, aunque no se han relacionado con una cicatrización completa; sin embargo, la suplementación con arginina, glutamina y β-hidroxi-β-metilbutirato logra la curación de la herida, aunque es necesaria una mayor evidencia que confirme estos resultados. (AU)

Nutrition plays an essential role in chronic wound healing as extra nutrients are needed for tissue repair and to restore losses through wound exudate. Insufficient intake of energy, protein, antioxidants (vitamin C, A, and zinc) and vitamin D are common in patients with chronic wounds and have been linked to delayed wound healing and dehiscence. Other risk factors such as obesity, diabetes, advanced age, corticosteroid use, and dehydration can also reduce or impede the healing process, and nutritional screening is important to identify patients with malnutrition. Proteins, amino acids (arginine, glutamine and methionine), vitamins C and A, and zinc have been used as pharmacological nutrients in pressure ulcer healing; however, omega-3 fatty acids, although they appear to slow progression, do not show improved healing rates. In patients with diabetic foot, supplementation with vitamins D, C, A, and E, magnesium, zinc, omega-3 fatty acids, and probiotics reduces ulcer size and improves glycemic control, although they have not been associated with complete healing; however, supplementation with arginine, glutamine, and β-hydroxy-β-methylbutyrate does show wound healing, although further evidence is needed to confirm these results. (AU)

Ser víctima de bullying: prevalencia y factores de vulnerabilidad en adolescentes / Being a victim of bullying: prevalence and vulnerability factors in adolescents

FUNDAMENTOS: La elevada prevalencia del bullying y sus consecuencias lo convierten en un problema de salud pública. OBJETIVO: Evaluar la prevalencia de ser víctima de bullying entre adolescentes de 15 a 18 años y analizar los factores sociodemográficos y de salud que se asocian con la victimización. MÉTODOS: Estudio transversal en 844 estudiantes matriculados en 5 institutos de educación secundaria de Cuenca (España) en el curso académico 2015-2016. Se utilizó un cuestionario autoadministrado que incluía variables sociodemográficas y de salud (afecciones clínicas, discapacidad, peso y talla). Ser víctima de bullying y el resto de variables se midieron mediante subescalas del instrumento KIDSCREEN-52, que mide la calidad de vida relacionada con la salud. RESULTADOS: La prevalencia de bullying fue 29,5 %. Las víctimas de acoso respecto a las no víctimas presentaron puntuaciones inferiores en todas las subescalas de KIDSCREEN-52. El análisis multivariante mostró que ser chico, tener discapacidad/problema de salud (β=2,349), presentar peor estado de ánimo (β=0,952), peor autopercepción (β=0,967), peor relación con los pares (β=0,978), menores recursos económicos (β=0,976) y percibir menor calidad de vida (β=0,892) fueron variables que se asociaron con aumento del riesgo de ser víctima de bullying. CONCLUSIONES: Los adolescentes más vulnerables son aquellos que presentan problemas físicos, psicológicos o sociales y por tanto son los más desprotegidos. Ser acosado tiene efectos nocivos sobre la salud y el desarrollo socioemocional, por lo que es necesario identificar a los adolescentes con un riesgo mayor

FUNDAMENTALS: The higher prevalence of bullying and its consequences make it a public health problem. OBJECTIVE: To evaluate the prevalence of being a victim of school bullying among adolescents aged 15 to 18 years and analyze the sociodemographic and health factors associated with victimization. METHODS: Cross-sectional study in 844 students enrolled in 5 Secondary Schools of Cuenca (Spain) in the academic year 2015-2016. It is a self-administered questionnaire that includes sociodemographic and health variables (clinical conditions, disability, weight and height). Being a victim of intimidation and the rest of the variables were measured using subscales of the KIDSCREEN-52 instrument, which measures the quality of life related to health. RESULTS: The prevalence of bullying was 29.5%. Victims of harassment regarding non-victims presented lower scores in all subscales of KIDSCREEN-52. The multivariate analysis showed that being boy, having a disability / health problem (β = 2,349), worse mood (β = 0,952), worse self-perception (β = 0,967), worse relation with the pairs (β = 0.978), the lowest economic resources (β = 0.976) and the lowest quality of life (β = 0.892) were variables that were associated with an increase in the risk of being a victim of harassment. CONCLUSIONS: The most vulnerable adolescents are those who present physical, psychological or social problems and therefore are more unprotected. Being harassed has harmful effects on health and socio-emotional development, which is why it is necessary to identify adolescents with a higher risk

Validation to the Spanish of the Jefferson empathy scale health professions students version and its psychometric properties in nursing students.

The ability to empathize with patients has a positive effect on health outcomes and quality of care. This study aimed to evaluate the psychometric characteristics of the Spanish version of the Jefferson Scale of Empathy-Health Profession Student version (JSE-HPS) in a sample of 422 nursing students and to compare their factorial structure with that of the original scale. In this study, the Cronbach α value was 0.828. These analyses showed that the scale has a factorial structure with three dimensions and all the items loaded adequately (>0.36) except for item 18 (0.266). The main factor, ̔Perspective taking̕ grouped 10 items; the second factor, ̔Compassionate care̕, grouped 6 items, and the third factor, ̔Standing in the patient's shoes̕, grouped 3 items; 42.2% of the variance was explained. The results of the confirmatory factor analysis suggest that the Spanish version of the JSE-HPS is a valid and reliable way to evaluate the empathic capacity of nursing students.

¿Es posible detectar casos de acoso escolar a través de la presencia de problemas psicosomáticos? / Is it possible to detect cases of bullying through the presence of psychosomatic problems?

Introducción: la elevada prevalencia del acoso escolar y sus consecuencias lo convierten en un problema de salud pública. Objetivo: analizar, en una población de adolescentes escolarizados, la prevalencia de acoso escolar y su asociación con problemas psicosomáticos. Material y métodos: estudio transversal de una muestra representativa de 844 estudiantes en cinco institutos de educación secundaria (IES) de Cuenca (España). Mediciones principales: acoso escolar mediante la subescala aceptación social del KIDSCREEN-52 y problemas psicosomáticos con la escala PSP. Resultados: la prevalencia de acoso escolar fue del 29,5%, sin deferencias significativas por sexo ni edad. Las chicas y los adolescentes de mayor edad presentaron problemas psicosomáticos significativamente más altos. Tanto en chicas como en chicos, una mayor presencia de estos se asoció con ser víctima de acoso escolar. Las ecuaciones de regresión realizadas para cada uno de los problemas psicosomáticos mostraron que, además de la influencia del sexo y la edad, ser víctima de acoso escolar es un predictor de peor salud psicosomática y de peor calidad de vida. Los modelos que explicaron mayor porcentaje de la varianza fueron el índice de psicosomáticos (21%), sentirse triste (15%), dolor de cabeza (10%) y dolor de estómago (11%). Conclusiones: los problemas psicosomáticos son frecuentes en adolescentes y especialmente entre las víctimas de acoso escolar. Es aconsejable que los profesionales de la salud, especialmente médicos y enfermeras, consideren seriamente la posibilidad de estar ante una víctima de acoso cuando un adolescente exhibe sintomatología psicosomática, especialmente la relacionada con tristeza, dolor de cabeza o de estómago sin causa orgánica aparente

Introduction: the high prevalence of school bullying and its consequences make it a public health problem. Objective: to analyse the prevalence of school bullying and its association with psychosomatic problems in a population of adolescent students. Materials and methods: we conducted a cross-sectional study in a representative sample of 844 students enrolled in 5 secondary education schools (SESs) in the city of Cuenca (Spain). The main assessment instruments were the social acceptance subscale of the KIDSCREEN-52 (bullying) and the PSP scale (psychosomatic problems). Results: the prevalence of being subject to school bullying was 29.5%, with no differences based on age or sex. We found a higher frequency of psychosomatic problems in female and older adolescents. In students of both sexes, a higher frequency of these problems was associated with being bullied. The regression models built for each of the psychosomatic problems showed that, correcting for the influence of sex and age, being bullied is a predictor of psychosomatic problems and a poorer quality of life. The models that explained the largest percentages of the variance where those for the total score in the psychosomatic problem scale (21%), feelings of sadness (15%), headache (10%) and stomach ache (11%). Conclusions: psychosomatic problems are frequent in adolescents, especially those who are victims of school bullying. Health care professionals, especially doctors and nurses, should strongly consider the possibility of bullying when an adolescent exhibits psychosomatic symptoms, especially sadness, headache or stomach ache, with no apparent organic cause

Factores personales y sociales que protegen frente a la victimización por bullying / Personal and social factors which protect against bullying victimization

Objetivo: Determinar la prevalencia de ser víctima de bullying y analizar la influencia de factores personales y sociales sobre este fenómeno en una población de adolescentes. Metodología: Estudio descriptivo, transversal y multicéntrico, realizado entre alumnos de 15-18 años en cinco institutos de educación secundaria de Cuenca durante el curso académico 2015-1016. Las variables de estudio se recogieron mediante un cuestionario autoadministrado que incluyó: edad, sexo, diferentes subescalas del cuestionario KIDSCREEN-52 y la escala de resiliencia CD-RISC 10.Resultados: Se recogieron datos de 844 estudiantes (54% chicas), la edad media de la muestra fue de 16,36 años. La prevalencia de víctimas de bullying fue de 29,5%. El análisis multivariante para los factores personales, mostró que ser chica, ser más resiliente, tener mejor autopercepción y bienestar psicológico, protegen frente a ser víctimas. Mientras que el modelo de factores sociales indicó que tienen también un efecto protector los recursos económicos, las relaciones con los padres, amigos y entorno escolar. Conclusión: El bullying es un fenómeno complejo de elevada prevalencia y gran repercusión social. En nuestro trabajo, las características propias de los adolescentes tales como la capacidad de resistencia y el control emocional, así como las relacionadas con su red social de apoyo, son factores protectores frente al bullying. Las políticas de prevención deben ser multisectoriales y multidisciplinares implicando a la familia, entorno escolar y asistencial y red social. Las enfermeras de atención primaria y especialmente la enfermera escolar, podrían facilitar una mayor coordinación entre los distintos sectores y aunar esfuerzos para promover entornos seguros para nuestros jóvenes

Objective: To determine the prevalence of bullying victimization and to analyze personal and social factors influence over this phenomenon in an adolescent population.Methodology: A descriptive, cross-sectional and multicenter study was carried out in 15-18 years old pupils in five secondary schools of Cuenca during the 2015-16 school year. The variables were collected through a self-administered questionnaire and included age, gender, different subscales of the KIDSCREEN-52 questionnaire and the resilience scale CD-RISC 10.Results: Data were obtained from 844 students (of whom 54% were girls) whose average age was 16.36 years old. The prevalence of bullying victimization was 29,5%. The multivariate analysis for the personal factors showed that being girl, more resilient, having better self-perception and psychological well-being, protect from being victims. Whereas the social factors model indicated that financial resources, parents and peers' relations and school environment do also have a protective effect.Conclusion: Bullying is a complex phenomenon with high prevalence and great social impact. In our work, adolescents' specific characteristics such as resistance capacity and emotional control, as well as the ones related to their social support, are protective factors against bullying. Prevention polices should be multisectoral and multidisciplinary involving the family, school and health environment and social network. Primary care nurses and especially the school nurse could provide greater coordination among the different sectors and join efforts to promote safe environments for our young people

Influencia del estilo de escucha sobre la capacidad empática en estudiantes de Enfermería / Influence of the listening style on the empathic ability among Nursing students

Objetivo: analizar la influencia de los diferentes estilos de escucha sobre la empatía en estudiantes de Enfermería. Método: estudio descriptivo transversal, en estudiantes de Enfermería que han realizado asignaturas de prácticas clínicas (n= 557). Variables de estudio: edad, sexo, empatía (Jefferson Scale of Empathy for Health Professions [JSE-HPS]) y estilos de escucha (The Listening Styles Profile [LSP-16]). Análisis estadístico: análisis bivariante mediante t de Student y coeficiente de correlación de Pearson; análisis multivariante mediante regresión lineal. Resultados: participaron 446 estudiantes (edad media: 22,8 años; 20,4% hombres). Puntuación media en empatía: 118,0 (DE: 12,2). Los valores medios de los estilos de escucha fueron: 12,5 (DE: 1,8) para persona; 9,1 (DE: 2,2) para contenido; 7,5 (DE: 2,7) para acción y 4,8 (DE: 2,8) para tiempo. El análisis multivariado mostró, ajustando por edad y sexo, que la capacidad empática aumenta a mayor puntuación en el estilo centrado de la Persona (ß= 0,243) y, de forma opuesta, disminuye a medida que aumenta el estilo centrado en Tiempo (ß= -0,271). Conclusión: el estilo de escucha orientado a Persona, que se centra en las necesidades y sentimientos del paciente, es el que predomina y aumenta la capacidad empática; mientras que el orientado al Tiempo es característico de los oyentes impacientes y tiene un efecto negativo sobre la empatía. A lo largo de la formación clínica, el alumnado tiene que ser consciente de la influencia de su estilo de escucha durante la interacción con el paciente

Objectives: to analyze the influence of different listening styles on empathy among Nursing students. Method: a descriptive and cross-sectional study among Nursing students who have completed subjects from practical to clinical (n= 557). Study variables; age, gender, empathy (Jefferson Scale of Empathy for Health Professions (JSE-HPS)) and listening styles (The Listening Styles Profile (LSP-16)). Statistical analysis: bivariate analysis through Student's t and Pearson Correlation Coefficient; multivariate analysis through linear regression. Results: in total, 446 students participated (mean age: 22.8 years; 20.4% were male). The mean score in empathy was 118.0 (SD: 12.2). The mean values for listening styles were: 12.5 (SD: 1.8) for People; 9.1 (SD: 2.2) for Contents; 7.5 (SD: 2.7) for Action and 4.8 (SD: 2.8) for Time. The multivariate analysis, adjusted by age and gender, showed that the empathic ability increases when there is a higher score in the People-oriented style (ß= 0.243); and, on the other hand, it is reduced when there is an increase in the Time-oriented style (ß= -0.271). Conclusion: the Person-oriented listening style, which focuses on the needs and feelings by the patient, is the prevailing one and it increases the empathic ability; while the Time-oriented style is characteristic in impatient listeners, and has a negative effect on empathy. During clinical training, students must be aware of the influence of their listening style during their interaction with patients

Influencia de la resiliencia sobre la calidad de vida relacionada con la salud en adolescentes / Influence of resilience on health-related quality of life in adolescents

OBJETIVO: Analizar la influencia de la resiliencia sobre las distintas dimensiones de la calidad de vida relacionada con la salud en un grupo de adolescentes escolarizados en la ciudad de Cuenca. MÉTODO: Se realizó un estudio descriptivo, transversal, multicéntrico y polietápico en 5 institutos de Educación Secundaria durante el curso académico 2015-1016. Instrumentos: Cuestionario autoadministrado que incluía variables sociodemográficas y las escalas CD-RISC 10 para evaluar resiliencia y KIDSCREEN-52 para medir la calidad de vida relacionada con la salud. RESULTADOS: Se recogieron datos de 844 estudiantes, de los cuales el 54% fueron chicas y la edad media de la muestra fue de 16,36±1,05 años. Se observaron valores superiores de resiliencia en los chicos. Con respecto a la calidad de vida relacionada con la salud, fue menor en las chicas (salvo en la dimensión de aceptación social) y en el grupo de mayor edad. La resiliencia se asoció significativamente con todas las dimensiones del KIDSCREEN-52 y resultó ser un predictor relevante, especialmente en las dimensiones relacionadas con la salud mental y en todas las que miden relaciones sociales. CONCLUSIÓN: Nuestro estudio aporta evidencias sobre la sinergia calidad de vida relacionada con la salud-resiliencia en adolescentes. La resiliencia se asocia con niveles más elevados de calidad de vida en adolescentes y, al ser menor en chicas, puede ser uno de los factores explicativos de su peor calidad de vida relacionada con la salud

OBJECTIVE: To analyze the influence of resilience on the different dimensions of health-related quality of life in a group of adolescents in Cuenca. METHOD: A descriptive, cross-sectional, multicentre and multistage study was carried out in 5 secondary schools during the 2015-2016 school year. Instruments: A self-administered questionnaire, which included sociodemographic characteristics and the CD-RISC 10 scale to assess resilience together with the KIDSCREEN-52 questionnaire to measure health-related quality of life. RESULTS: Data were obtained from 844 students, of whom 54% were girls and the mean age was 16.36±1.05 years. Higher resilience scores were observed in boys. Health-related quality of life was lower in girls (except in the dimension of social acceptance) and in the oldest group. Resilience was significantly associated with all KIDSCREEN-52 dimensions and proved to be a relevant predictor, especially in the dimensions related with mental health and all those that measure social relationships. CONCLUSIONS: Our study provides evidence on the synergy between health-related quality of life and resilience in adolescents. Resilience is associated with higher levels of quality of life in adolescents and as the scores are lower in girls, it could be one of the explanatory factors for their poorer health-related quality of life

Síntomas psicosomáticos como expresión del deterioro de la calidad de vida relacionada con la salud en adolescentes / Psychosomatic symptoms as an expression of the deterioration of the health-related quality of life in adolescents

Objetivo: Analizar, en una población de adolescentes escolarizados, la relación entre síntomas psicosomáticos y calidad de vida relacionada con la salud (CVRS) diferenciando por sexo y grupo de edad. Diseño: Estudio transversal. Emplazamiento: Cinco Institutos de Educación Secundaria. Participantes: Ochocientos cuarenta y cuatro adolescentes de entre 15 y 18 años que cursaban 3.° y 4.° de Educación Secundaria Obligatoria y Bachillerato. Mediciones principales: CVRS mediante KIDSCREEN-52 y síntomas psicosomáticos con la escala de problemas psicosomáticos (PSP). Resultados: Las chicas y los adolescentes de 17-18 años presentaron síntomas psicosomáticos significativamente más altos, ambos grupos también puntuaron peor en todas las dimensiones de CVRS aunque solo alcanzaron significación las dimensiones relacionadas con bienestar físico, bienestar mental y estado de ánimo y estrés. Todos los síntomas psicosomáticos se asociaron de forma inversa con las 10 dimensiones del KIDSCREEN-52. Los modelos de regresión realizados mostraron que tristeza, dificultad de concentración y dificultad para dormir fueron los predictores de peor CVRS en ambos sexos y grupos de edad, y estas variables explicaron entre un 30 y un 41% de la varianza de la CVRS de los adolescentes. Conclusiones: Los síntomas psicosomáticos son más frecuentes en las chicas y en los adolescentes mayores, y predictores de peor CVRS. Es importante diferenciarlos de afecciones médicas para evitar intervenciones innecesarias. Como expresiones de malestar emocional deben ser evaluados y tratados de forma integral porque interfieren en la vida cotidiana y aumentan la vulnerabilidad propia de la adolescencia

Aim: To analyze, in a population of adolescents in school, the relationship between psychosomatic symptoms and the perception of health-related quality of life (HRQoL), differentiating by gender and age group. Design: Transversal study. Location: Five Secondary Schools. Participants: Eight hundred and forty four adolescents between the ages of 15 and 18 in secondary school. Main measurements: HRQoL using KIDSCREEN-52 and psychosomatic symptoms with the psychosomatic problems scale (PSP). Results: Girls and adolescents aged 17-18 years presented significantly higher psychosomatic symptoms, both groups also scored worse in all dimensions of HRQoL, although only the dimensions related to physical and mental wellness, mood and stress reached significance. All psychosomatic symptoms were inversely associated with the ten dimensions of KIDSCREEN-52. The regression models showed that sadness, concentrating difficulties and sleeping difficulties were the predictors of worse HRQoL in both sexes and age groups and these variables explained between 30 and 41% of the HRQoL variance of the adolescents. Conclusions: Psychosomatic symptoms are frequent especially in girls and in older adolescents and predictors of worse HRQoL. It is important to distinguish them from medical conditions to avoid unnecessary interventions. As expressions of emotional discomfort they must be evaluated and treated in an integral way because they interfere with daily life and increase the vulnerability proper of adolescence

Influence of resilience on health-related quality of life in adolescents. / Influencia de la resiliencia sobre la calidad de vida relacionada con la salud en adolescentes.

OBJECTIVE: To analyze the influence of resilience on the different dimensions of health-related quality of life in a group of adolescents in Cuenca. METHOD: A descriptive, cross-sectional, multicentre and multistage study was carried out in 5 secondary schools during the 2015-2016 school year. INSTRUMENTS: A self-administered questionnaire, which included sociodemographic characteristics and the CD-RISC 10 scale to assess resilience together with the KIDSCREEN-52 questionnaire to measure health-related quality of life. RESULTS: Data were obtained from 844 students, of whom 54% were girls and the mean age was 16.36±1.05 years. Higher resilience scores were observed in boys. Health-related quality of life was lower in girls (except in the dimension of social acceptance) and in the oldest group. Resilience was significantly associated with all KIDSCREEN-52 dimensions and proved to be a relevant predictor, especially in the dimensions related with mental health and all those that measure social relationships. CONCLUSION: Our study provides evidence on the synergy between health-related quality of life and resilience in adolescents. Resilience is associated with higher levels of quality of life in adolescents and as the scores are lower in girls, it could be one of the explanatory factors for their poorer health-related quality of life.

[Psychosomatic symptoms as an expression of the deterioration of the health-related quality of life in adolescents]. / Síntomas psicosomáticos como expresión del deterioro de la calidad de vida relacionada con la salud en adolescentes.

AIM: To analyze, in a population of adolescents in school, the relationship between psychosomatic symptoms and the perception of health-related quality of life (HRQoL), differentiating by gender and age group. DESIGN: Transversal study. LOCATION: Five Secondary Schools. PARTICIPANTS: Eight hundred and forty four adolescents between the ages of 15 and 18 in secondary school. MAIN MEASUREMENTS: HRQoL using KIDSCREEN-52 and psychosomatic symptoms with the psychosomatic problems scale (PSP). RESULTS: Girls and adolescents aged 17-18 years presented significantly higher psychosomatic symptoms, both groups also scored worse in all dimensions of HRQoL, although only the dimensions related to physical and mental wellness, mood and stress reached significance. All psychosomatic symptoms were inversely associated with the ten dimensions of KIDSCREEN-52. The regression models showed that sadness, concentrating difficulties and sleeping difficulties were the predictors of worse HRQoL in both sexes and age groups and these variables explained between 30 and 41% of the HRQoL variance of the adolescents. CONCLUSIONS: Psychosomatic symptoms are frequent especially in girls and in older adolescents and predictors of worse HRQoL. It is important to distinguish them from medical conditions to avoid unnecessary interventions. As expressions of emotional discomfort they must be evaluated and treated in an integral way because they interfere with daily life and increase the vulnerability proper of adolescence.

Prevalence of musculoskeletal disorders and rheumatic disease in the Warao, Kari'ña, and Chaima indigenous populations of Monagas State, Venezuela.

This study aimed to estimate the prevalence of musculoskeletal disorders and rheumatic diseases in the Warao, Kari'ña, and Chaima indigenous populations of Monagas State, Venezuela. A cross-sectional, analytical, community-based study was conducted in 1537 indigenous subjects ≥18 years old (38.6 % male, mean age 41.4 ± 17.5 years). The cross-culturally validated Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) diagnostic questionnaire was applied. Subjects with a positive COPCORD diagnosis (either historic or current pain) were evaluated by primary care physicians and rheumatologists. A descriptive analysis was performed and comparisons made using analysis of variance and the chi-square test. Pain in the last 7 days was reported by 32.9 %, with pain intensity, according to a Likert-type scale [no pain, 195 (38.5 %); minimal pain, 231 (45.6 %); strong pain, 68 (13.4 %); intense pain, 5 (0.9 %)], 38.0 % reported historical pain, and 641 (41.7 %) had either historic or current pain. Of the COPCORD-positive subjects, pain most frequently occurred in the knee, back, and hands. Musculoskeletal and rheumatic diseases included osteoarthritis (14.1 %), back pain (12.4 %), rheumatic regional pain syndromes (RRPS) (9.7 %), undifferentiated arthritis (1.5 %), rheumatoid arthritis (1.1 %), and fibromyalgia (0.5 %). Chaima (18.3 %) and Kari'ña (15.6 %) subjects had a high prevalence of osteoarthritis, and Warao subjects had a high prevalence of low back pain (13.8 %). The prevalence of RRPS was high in all three ethnic groups. The Chaima group had the highest prevalence of rheumatic diseases, with 2.0 % having rheumatoid arthritis. This study provides useful information for health care policy-making in indigenous communities.

Culture-sensitive adaptation and validation of the community-oriented program for the control of rheumatic diseases methodology for rheumatic disease in Latin American indigenous populations.

The purpose of the study is to validate a culturally sensitive adaptation of the community-oriented program for the control of rheumatic diseases (COPCORD) methodology in several Latin American indigenous populations. The COPCORD Spanish questionnaire was translated and back-translated into seven indigenous languages: Warao, Kariña and Chaima (Venezuela), Mixteco, Maya-Yucateco and Raramuri (Mexico) and Qom (Argentina). The questionnaire was administered to almost 100 subjects in each community with the assistance of bilingual translators. Individuals with pain, stiffness or swelling in any part of the body in the previous 7 days and/or at any point in life were evaluated by physicians to confirm a diagnosis according to criteria for rheumatic diseases. Overall, individuals did not understand the use of a 0-10 visual analog scale for pain intensity and severity grading and preferred a Likert scale comprising four items for pain intensity (no pain, minimal pain, strong pain, and intense pain). They were unable to discriminate between pain intensity and pain severity, so only pain intensity was included. For validation, 702 subjects (286 male, 416 female, mean age 42.7 ± 18.3 years) were interviewed in their own language. In the last 7 days, 198 (28.2 %) subjects reported having musculoskeletal pain, and 90 (45.4 %) of these had intense pain. Compared with the physician-confirmed diagnosis, the COPCORD questionnaire had 73.8 % sensitivity, 72.9 % specificity, a positive likelihood ratio of 2.7 and area under the receiver operating characteristic curve of 0.73. The COPCORD questionnaire is a valid screening tool for rheumatic diseases in indigenous Latin American populations.

Physical activity, fitness, and metabolic syndrome in young adults.

PURPOSE: Our objective was to analyze the association between different intensities of physical activity (PA), physical fitness, and metabolic syndrome (MS) in young adults. METHODS: Cross-sectional study including 275 university students, 18-30 years old, from Cuenca, Spain. We evaluated (a) physical activity using accelerometry, (b) aerobic capacity (VO2max), and (c) muscle strength, by a muscle strength index calculated as the sum of the standardized z score of handgrip dynamometry/weight and standing broad jump. An MS index was estimated by summing standardized z scores of waist circumference, ratio of triglycerides to high-density lipoprotein, mean arterial blood pressure, and HOMA-IR. RESULTS: The mean scores of MS index and HOMAIR were significantly higher and the VO2max significantly lower for individuals who did not perform 20 min or more per week of vigorous physical activity. However, those who performed 250 min/week of moderate physical activity showed no significant differences in either VO2max or the MS index when compared with individuals who did not perform this level of activity. The MS index was lower in those with medium-high levels of aerobic capacity. In addition, individuals with medium-high levels of muscular fitness showed lower waist circumference and a lower MS index. CONCLUSIONS: VO2max and muscle strength are negatively associated with metabolic risk. 20-min/week of vigorous physical activity was associated with lower cardiometabolic risk in young adults; moderate physical activity did not show association with lower cardiometabolic risk.

[Relationship between weight status, physical fitness levels and blood pressure components in young women]. / Relación entre estatus ponderal, nivel de condición física y componentes de la presión arterial en mujeres de entre 18 y 30 años de edad.

BACKGROUND: As far as we know there are not studies that analyze jointly the relationship between obesity, cardiorespiratory fitness and muscle strength with blood pressure (BP).We aimed to determine the relationship between BMI and physical fitness with components of BP in young women. METHODS: cross-sectional study in 407 women aged 18-to-30 years. VARIABLES: weight, height, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP: DBP+[0,333× (SBP-DBP)]) and pulse pressure (PP: SBP-DBP), and physical fitness (cardiorespiratory fitness and muscle strength). RESULTS: Mean age of participants was 20.1 ± 4.4 years. Mean SBP, DBP, MAP and PP were respectively: women with normal weight 108,0 ± 8.9, 67.7 ± 6.7, 81.1 ± 6.8 and 40.3 ± 6, 6 mmHg; in obese women 123.1 ± 8.9, 80.5 ± 6.2, 94.7 ± 6.5 and 42.5 ± 6.2 mmHg; in those with low aerobic capacity 110.9 ± 9.9, 70.5 ± 7.6, 84.0 ± 7.7 and 40.3 ± 7.3 mmHg, and in those with high aerobic capacity 107.4 ± 9.3, 67.0 ± 7.0, 80.4 ± 7.2 and 40.4 ± 6.6 mmHg. Muscle strength was not statistically associated with any of the components of PA (p> 0.05). In multiple linear regression models of SBP was associated with BMI and muscle strength index (p = ≤ 0.05), DBP and MAP with BMI, index of muscle strength and aerobic capacity (p = ≤ 0.05), and PP with BMI (p = <0.05). CONCLUSIONS: In young women BMI and muscle strength have a direct relationship with BP, and cardiorespiratory fitness an inverse relationship; however the latter is not associated with SBP and PP.

Relación entre estatus ponderal, nivel de condición física y componentes de la presión arterial en mujeres de entre 18 y 30 años de edad / Relationship between Weight status, physical fitness levels and blood pressure components in young women

Fundamentos: Hasta donde conocemos, la relación entre la obesidad, la capacidad aeróbica y la fuerza muscular con la presión arterial (PA) no se ha analizado conjuntamente. Nuestro objetivo fue estimar la relación entre el estatus ponderal y la condición física con los componentes de la PA en mujeres jóvenes. Métodos: Estudio transversal en 407 mujeres de 18-30 años. Se evaluó: peso, talla, índice de masa corporal (IMC), presión arterial sistólica (PAS), diastólica (PAD), media (PAM:PAD+[0,333x(PASPAD)]), y de pulso (PP: PAS-PAD) y condición física (capacidad aeróbica y fuerza muscular). Resultados: La edad media de las participantes fue de 20,1± 4,4 años. La media de la PAS, PAD, PAM y de PP fue respectivamente: en las mujeres con normopeso 108,0±8,9, 67,7±6,7, 81,1±6,8 y 40,3±6,6 mmHg; en las mujeres con obesidad 123,1±8,9, 80,5±6,2, 94,7±6,5 y 42,5±6,2 mmHg; en las que tienen capacidad aeróbica baja 110,9±9,9, 70,5±7,6, 84,0±7,7 y 40,3±7,3 mmHg; y en las que tienen capacidad aeróbica alta 107,4±9,3, 67,0±7,0, 80,4±7,2 y 40,4±6,6 mmHg. La fuerza muscular no se asoció estadísticamente con ninguno de los componentes de PA (p>0,05). En modelos de regresión lineal múltiple la PAS se asoció con el IMC y el índice de fuerza muscular (p= ≤0,05); la PAD y la PAM con el IMC, el índice de fuerza muscular y la capacidad aeróbica (p= ≤0,05); y la PP con el IMC (p= <0,05). Conclusiones: En mujeres jóvenes el IMC y la fuerza muscular mantienen una relación directa con la PA, y la capacidad aeróbica una relación inversa, si bien esta última no se asocia con la PAS ni con la PP(AU)

Background: As far as we know there are not studies that analyze jointly the relationship between obesity, cardiorespiratory fitness and muscle strength with blood pressure (BP).We aimed to determine the relationship between BMI and physical fitness with components of BP in young women. Methods: cross- sectional study in 407 women aged 18-to-30 years. Variables: weight, height, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP: DBP+[0,333× (SBP-DBP)]) and pulse pressure (PP: SBP-DBP), and physical fitness (cardiorespiratory fitness and muscle strength). Results: Mean age of participants was 20.1 ± 4.4 years. Mean SBP, DBP,MAP and PP were respectively: women with normal weight 108,0 ± 8.9, 67.7 ± 6.7, 81.1 ± 6.8 and 40.3 ± 6, 6 mmHg; in obese women 123.1 ± 8.9, 80.5 ± 6.2, 94.7 ± 6.5 and 42.5 ± 6.2 mmHg; in those with low aerobic capacity 110.9 ± 9.9, 70.5 ± 7.6, 84.0 ± 7.7 and 40.3 ± 7.3 mmHg, and in those with high aerobic capacity 107.4 ± 9.3, 67.0 ± 7.0, 80.4 ± 7.2 and 40.4 ± 6.6 mmHg. Muscle strength was not statistically associated with any of the components of PA(p> 0.05). In multiple linear regression models of SBP was associated with BMI and muscle strength index (p = ≤ 0.05), DBP and MAP with BMI, index of muscle strength and aerobic capacity (p = ≤ 0.05), and PPwith BMI (p = <0.05). Conclusions: In young women BMI and muscle strength have a direct relationship with BP, and cardiorespiratory fitness an inverse relationship; however the latter is not associated with SBP and PP(AU)

Angiotomographically-proven left innominate vein occlusion in dialysis patients with prior left internal jugular vein catheterization presenting with arm swelling after ipsilateral access creation: report of four cases.

Central vein occlusion (CVO) is not uncommonly observed after hemodialysis (HD) catheter placement and it may prevent subsequent ipsilateral arteriovenous (AV) access creation. Right internal jugular vein catheterization (RJVC) appears to be the insertion site with the lowest incidence of CVO, but little is known about the incidence of CVO following left internal jugular vein catheterization (LJVC). We report on four patients with left innominate vein occlusion after LJVC who developed severe arm swelling after ipsilateral AV access creation. In three of the four cases swelling appeared 12-26 months after access creation, and in the fourth, swelling developed immediately after surgery while the catheter was still in place. Two patients underwent access ligation and in the remainder the arm swelling improved either spontaneously or after LJVC removal. LJVC is not as safe as RJVC as an insertion route for HD catheter placement in terms of CVO frequency.

Medición del impacto ocasionado por ruidos esporádicos de corta duración / Measurement of the impact produced by short duration occasional noises

Las leyes, ordenanzas y normas nacionales vigentes en Venezuela en materia de contaminación ambiental por ruido utilizan parámetros que no detectan los ruidos esporádicos de corta duración. El parámetro utilizado hasta ahora para este tipo de ruido es el nivel estadístico L10, el cual solo registra ruidos que exceden el 10 por ciento del tiempo de medición, dejando sin posibilidad de diagnóstico aquellos ruidos que, siendo molestos en forma individual, tienen una duración inferior. En el presente trabajo se midió el impacto ocasionado por ruidos esporádicos de corta duración, utilizando el parámetro Sound Exposure Level (SEL), que se aplica internacionalmente para evaluar el ruido provocado por el paso de trenes, helicópteros y aviones. Se establecieron tiempos de medición de 15min por cada hora de medición, durante los cuales se generaron ruidos de 20s de duración caracterizados por un SEL de 70dBA. Se analizaron tres casos de estudio que permitieron demostrar que este tipo de ruido, aun cuando pueda llegar a ser intermitente, pasa desapercibido cuando se utilizan los parámetros establecidos, pudiendo ocasionar molestias importantes que en la actualidad no son consideradas. Las mediciones indican que se debería incluir el SEL como parámetro adicional para medir el efecto contaminante de este tipo de ruido, y establecer los niveles correspondientes discriminados por tipo de zona y por período (diurno o nocturno)

Vein wall dissection: a rare puncture-related complication of brachiocephalic fistula. Gray-scale and color Doppler sonographic findings.

We describe a case of brachiocephalic fistula vein wall dissection (VWD) occurring in a 36-year-old female hemodialysis patient. Unlike subcutaneous or subfascial infiltrations for which the mechanism is blood extravasation, VWD seems to be due to disruption of the fistula vein layers caused by misplacement of the outflow (venous) needle bevel. In this setting, the pressure of the dialysis blood pump acts as the driving force of the dissecting column, extending it proximally. Gray-scale and color Doppler sonography proved to be very useful in the differential diagnosis of VWD, particularly with thrombosis of the fistula. Sonography also helped us decide when to resume cannulations.