El psicólogo en cuidados paliativos / Phsychology in palliative care

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Inequalities in uptake of breast cancer screening in Spain: analysis of a cross-sectional national survey.

OBJECTIVES: Breast cancer remains a public health problem worldwide. Early detection through mammography practice has been shown to be effective in improving survival among women. Nevertheless, it is necessary to have high participation in mammography screening to achieve that goal. The aim of this study is to estimate the adherence to recommended preventive practices for breast cancer (mammography) in Spain and to identify predictors of uptake according to sociodemographic variables, health related variables and lifestyles. STUDY DESIGN: This is a descriptive cross-sectional study based on data from the European Health Interview Survey for Spain. Breast cancer screening included self-reported mammography in the last two years. The age target range was 40-69 years (n = 5771). The following independent variables were analysed: sociodemographic (marital status, educational level, monthly income, and nationality), visit to a general practitioner, chronic conditions and lifestyles. Predictors of mammography adherence were explored using multivariate logistic regression. RESULTS: The screening coverage in the target population was 67.7% (95% CI: 66.2-69.1). Mammography uptake was positively associated with being married, higher educational and income levels, Spanish nationality, having visited a general practitioner in the previous four weeks and suffering from musculoskeletal disease. Otherwise, the youngest age group studied (40-49 years) and obesity was associated with lower adherence to mammography. CONCLUSIONS: Compliance with mammography practice in Spain is acceptable to achieve the goal of reducing mortality from breast cancer among women. However significant inequalities in uptake of breast screening in Spain were found. Future campaigns must aim to improve participation especially among women with disadvantaged socio-economic situations and immigrants.

Squamous cell carcinoma of the lip. A retrospective study of 146 patients.

BACKGROUND: Squamous cell carcinoma of the lip (SCCL) accounts for 90% of all tumours of the oral cavity. We present a series of 146 patients with SCCL studied in our hospital. OBJECTIVE: To evaluate and identify the primary tumour parameters related to local and lymph node recurrence. METHODS: We retrospectively analysed the clinical characteristics, surgical procedures and tumour recurrences of the 146 patients diagnosed with SCCL in Hospital Universitario Fundación Alcorcón (Spain). RESULTS: A total of 122 of the 146 patients (91.7%) showed tumour stage ≤ T1N0M0 at diagnosis, and 11 (8.3%) showed stage >T1N0M0. Local recurrences were observed in 11 of the 146 patients (7.5%), and five patients (3.4%) developed lymph node metastases during follow-up. Kaplan-Meier survival analysis showed an increased tumour size to imply a greater risk of local recurrence (P = 0.025). The probability of local recurrence over the 24 months of follow-up was 1% for tumour stages ≤ T1N0M0 and 20% for stages ≥ T1N0M0. There appears to be a greater tendency towards local relapse in male patients, in smokers, patients living in rural areas, in lower lip tumours and in those patients showing infiltration at physical exploration. Eleven patients (8%) died during follow-up, although in only two of them (18%), SCCL was the cause of death. CONCLUSION: The low tumour stage of our patients may explain the few local and lymph node disease recurrences seen in our study. We have shown tumour size to be directly related to the probability of local recurrence.

Adecuación de la práctica clínica al protocolo de preparación prequirúrgica / No disponible

La elaboración de protocolos y la medida de su cumplimiento mejoran la calidad asistencial. Actividades promovidas por los sistemas de vigilancia de infección nosocomial se deben potenciar y someter a evaluación por afectar al cuidado del paciente, a su calidad de vida y resultados clínicos. La ducha y los enjuagues con clorhexidina forman parte del protocolo de preparación prequirúrgica del paciente y son recomendados en las guías por disminuir la infección de herida quirúrgica y neumonía posquirúrgica. Hemos llevado a cabo un estudio descriptivo transversal de evaluación de la adecuación a estos aspectos del protocolo de preparación requirúrgica en pacientes operados de prótesis de cadera. Se ha encontrado un grado de cumplimiento global del 59%; 88,5% para la ducha con jabón de clorhexidina al menos 24 horas antes de la cirugía y 63% para el colutorio con antiséptico. Estos resultados muestran una necesidad de mejora con medidas correctoras como pueden ser la entrega de normas por escrito y una mayor implicación tanto por parte del personal como del paciente (AU)

Protocols production and the measurement of their compliance are useful to improve health assistance quality. Surveillance infection at hospital is a process to evaluate because it affects to patient care, life quality and clinical results. Shower and rinsing with clorhexidine are part of pre-surgical patient preparation and they are recommended in the guides because they reduce surgical wound infection and post-surgical pneumonia. This study evaluates the compliance and appropriatness of several activities in pre-surgical preparation (shower and oropharyngeal wash with clorhexidine). Transverse study of adaptation to some activities of a protocol of pre-surgical patient preparation in hip replacement. Average comparation is carried out with t student and percentage of protocol adaptation. Global compliance grade was 59%, of which 88,5% was for the shower with clorhexidine with at least 24 hours before surgery and 63% was regarding mouthwash. The use of protocols must be bound to systematic evaluation of its compliance (AU)

Injerto autólogo de grasa en la edad pediátrica: análisisvolumétrico en la cara / Autologous fat graft in paediatric age: volumetric analysis on the face

La biocompatibilidad y la disponibilidad del tejido adiposo han avalado su uso frecuente como injerto para la reconstrucción de las partes blandas de la cara, sobre todo en pacientes pediátricos, en los que se apreció mayor supervivencia y en los que la implantación de otro tipo de materiales puede traer complicaciones y dejar secuelas graves a edades muy tempranas. Se ha realizado un análisis de la supervivencia con el método estereológico, para cuantificar objetivamente la tasa de prendimiento de los injertos y estudiar las diferencias entre los grupos adulto e infantil. Dicho análisis volumétrico evidenció una alta supervivencia de los injertos de grasa en los niños (93 por ciento), significativamente mayor que en los adultos (63 por ciento) a los 15 meses de seguimiento, permitiéndonos concluir que esta técnica ofrece una garantía de éxito real, aunque parcial y transitoria, y unos resultados clínicos satisfactorios en pacientes pediátricos seleccionados (AU)

[Syphilitic penile pseudotumor. Report of a case]. / Pseudotumor peneano luético. Presentación de un caso.

The syphilis is a venereal disease of sexual transmission that incidence is increasing in several groups populations. We report a case of a patient with secondary syphilis who consulted for an atypical solid mass to penile. The clinical evolution, histological examination and analytical tests confirmed the diagnosis of genital syphilis having a satisfactory response to specific antibiotic treatment. The epidemiological, clinical, diagnostic aspects and therapeutic of the genital ulcer disease are discussed.

Pleomorphic sclerotic fibroma.

We report the clinical and histologic features of 2 cutaneous tumors demonstrating many of the usual features of sclerotic fibroma, an entity that is well described in the literature. Our cases differed from the usual form of sclerotic fibroma in that they demonstrated marked focal cellular pleomorphism without increased mitotic activity. We suggest the term pleomorphic sclerotic fibroma for these lesions.

[Bladder schistosomiasis: report of 2 new cases with different anatomoclinical features and review of the literature]. / Esquistosomiasis vesical: aportación de dos nuevos casos con presentaciones anatomo-clínicas diferentes y revisión de la literatura.

This paper reports two cases of vesical schistosomiasis in two black patients treated in this Service over the last three years. A description is made of the different anatomo-clinical presentations of these two cases, commenting on the characteristics of this disease, its pathogenesis, diagnosis and treatment, and stressing the slight increase in its frequency in our environment as a consequence of the increased migratory movements of people from endemic regions into our country.

Polyorchidism in a newborn: case report and review of the literature.

A case of polyorchidism in a newborn is reported. The left scrotum contained two testes sharing the same epididymis and vas deferens. The histometric testicular parameters were normal in the three testes, except for a slightly reduced tubular fertility index in the supernumerary testis.