"Accept voices©" group intervention for the management of auditory verbal hallucinations-results at 6 and 12 months.

"The Accept Voices© is a useful intervention for the management and acceptance of auditory verbal hallucinations in people with schizophrenia. This study aims at determining if the clinical effects remained at six- and 12-month follow-ups. Results show that participants (N = 22) maintained a decrease in auditory hallucinations, at the six and 12 months follow ups for severity and acceptance of Voices, anxiety and depression. Accept Voices© shows promise as a potential treatment for people with schizophrenia struggling with Voices.

Residentes de familia en estado de alarma / General practitioners residents at emergency state

No disponible

Impact of the group intervention "Accept Voices©" for the management of auditory hallucinations.

AIM OF THE STUDY: The objective of this study was to evaluate the potential impact of a third wave CBT group intervention for the management of auditory hallucinations in patients with schizophrenia. METHOD: 38 patients with schizophrenia presenting with auditory hallucinations, followed in mental health services, participated in six sessions of a group based on acceptance and engagement therapy (ACT). The study followed a repeated single case experimental design (type A-B-A) based on the principle of a control phase followed by an intervention phase and a follow-up phase of similar duration. The various measurements were administered during the control phase, at pre-/post-group and six weeks after the last group session. RESULTS: The results show a significant decrease in auditory hallucinations, as measured by the PSYRATS scale, during the treatment and follow-up phase, compared to the control phase. In addition, the participants saw significant reductions in depressive and anxious symptomatology (assessed with CDSS and SEAS), and increases in coping and acceptance in regards to voices (assessed using a study scale and VAAS). The level of Malevolence beliefs about voices (measured with BAVQ-R) also decreased significantly. CONCLUSIONS: A brief group intervention based acceptance show promise in the reduction of the intensity of auditory hallucinations, depression and anxiety in patients with schizophrenia, while improving their acceptance.

Análisis del grado de cumplimiento de las recomendaciones de las guías de práctica clínica para el diagnóstico y seguimiento de las complicaciones crónicas vasculares en la diabetes tipo 2 en atención primaria / Analysis of the level of compliance to the clinical practice guidelines recommendations for the diagnosis and monitoring of chronic vascular complications in type 2 diabetes in Primary Care

OBJETIVOS: Evaluar el grado de cumplimiento de las recomendaciones de las guías de práctica clínica (GPC) en el diagnóstico y seguimiento de las principales complicaciones crónicas vasculares de los pacientes con diabetes tipo2 (DM2) en atención primaria (AP). MATERIAL Y MÉTODOS: Estudio descriptivo transversal retrospectivo en pacientes de 18 o más años de edad seleccionados consecutivamente a medida que acudieron a la consulta en AP. Los datos de los pacientes se obtuvieron mediante acceso a la historia informatizada, registrándose variables clínicas y analíticas de interés. Se consideró adecuada la determinación y el registro de microalbuminuria (MALB), filtrado glomerular (FG), exploración pies (palpación pulsos, monofilamento o diapasón) y electrocardiograma (ECG) si habían sido realizados de manera anual, y del fondo de ojo (FO) cada dos años. RESULTADOS: Se incluyó a 1.420 pacientes (55,8% varones), con una edad media (DE) de 70,6 (10,8) años y una media de 9,3 (6,2) años de evolución de su diabetes. El índice de masa corporal (IMC) medio (kg/m2) fue de 30,1 (5,4) en mujeres y de 29,5 (4,7) en varones (p = 0,023) y la HbA1c (%), de 6,9 (1,2). El buen control metabólico de la DM se alcanzó en el 63,0% (IC95%: 60,4-65,5). Tenían realizado FO en los dos últimos años 976 pacientes (68,7%; IC95%: 66,2-71,1). La MALB se había realizado a 1.228 pacientes (86,5%; IC95%: 84,6-88,2), el FG estimado a 1.391 (98,0%; IC95%: 97,1-98,6), la exploración de los pulsos del pie a 626 (44,1%; IC95%: 41,5-46,7) y la exploración neurológica a 473 (33,3%; IC95%: 30,8-35,8). CONCLUSIONES: Los resultados de nuestro estudio indican que en una proporción importante de los pacientes con DM2 no se explora la presencia de retinopatía ni de neuropatía. A siete de cada diez pacientes se les ha cribado de retinopatía, uno de cada tres tiene realizada exploración neurológica y uno de cada cuatro tiene realizadas todas las exploraciones recomendadas por las GPC

OBJECTIVE: To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS: A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS: A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS: The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG

[Acceptance of "voices" in people with or without psychiatric disorders: Francophone validation of the 9-item VAAS scale]. / Acceptation des « voix ¼ chez les personnes avec ou sans troubles psychiatriques : validation francophone de l'échelle VAAS à 9 items.

OBJECTIVES: Hearing voices is a common experience for people with schizophrenia. Perceived voices are in most cases a source of great distress for patients. This experience also exists in the general population and is considered as "non-clinical". Much research has focused on the psychological and neuropsychological mechanisms behind the emergence of voices. With regard to voice persistence factors, the acceptance of the voice-hearing phenomenon is still relatively unexplored. In addition, there are few standardized tools that specifically assess this dimension of voice experience. The Voices Acceptance and Actions Scale (VAAS) is the only validated tool to address voice acceptance in individuals with schizophrenia. However, to date, there is no French version. The objective of this research was to validate the VAAS in a French speaking population. METHOD: Our sample consisted of individuals with schizophrenia (N=65) and voice hearers from the general population (N=321). For the clinical population, individuals with schizophrenia and auditory hallucinations were assessed using the VAAS scale in its two abbreviated versions (9 and 12 items). In order to validate the measure in French, we administered psychopathology scales (BPRS) and voice belief scales (BAVQ-R) for convergent and divergent validity. For the non-clinical population, we administered the VAAS scale online (via LimeSurvey), accompanied by a brief sociodemographic questionnaire (age, sex, country of origin, existence of medical or psychological follow-up). RESULTS: The psychometric properties of the VAAS scale were satisfactory and similar to the original English-language tool for both versions, with a slight advantage for the one with 9-items. The convergent validity measured with the BAVQ-R scale, and the divergent one measured with the BPRS depression subscale, were found to be satisfactory. In addition, the re-test performed 6 weeks after the first test (N=30) was satisfactory for both scales, with a Pearson correlation index greater than 70 (r=0.70; P<0.001 for the VAAS 9 items) and (r=0.79; P<0.001 for the 12 item version). In individuals with schizophrenia (clinical population), the level of voice acceptance was low and strongly correlated with depression. This point seems to corroborate the current data in the field suggesting that voice hearing in this population is associated with significant distress and has a significant impact on their lives. Conversely, the level of acceptance obtained from the non-clinical population was much higher, reflecting a higher level of acceptance in this population. People from the non-clinical population seemed to accept and experience their voices with less distress than people from the clinical population in this study. CONCLUSION: To date, a paucity of studies have investigated the acceptance of auditory hallucinations. Our results support the psychometric validity of the French version of the VAAS, particularly the 9-item version. Furthermore, our study supports the need to continue studying voice acceptance, as it appears to be strongly linked to depression in people with psychiatric disorders such as schizophrenia. In addition, our study is novel in that it also explored, with a standardized tool, the level of voice acceptance in a non-clinical population and found people to be more accepting of the voices they hear and better at living with them. These data provide new evidence to better understand the links between the level of acceptance of voices, their experiences, and depression. Clinically, it seems essential to conduct more systematic and regular evaluations of the level of voice acceptance in those hearing voices. Finally, in terms of rehabilitation, voice acceptance can become a therapeutic target in order to improve the psychological and behavioral functioning of the person.

[Analysis of the level of compliance to the clinical practice guidelines recommendations for the diagnosis and monitoring of chronic vascular complications in type2 diabetes in Primary Care]. / Análisis del grado de cumplimiento de las recomendaciones de las guías de práctica clínica para el diagnóstico y seguimiento de las complicaciones crónicas vasculares en la diabetes tipo 2 en atención primaria.

OBJECTIVE: To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS: A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS: A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS: The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG.

Maternal burn-out: an exploratory study.

INTRODUCTION: Maternal burn-out is a psychological, emotional and physiological condition resulting from the accumulation of various stressors characterised by a moderate but also a chronic and repetitive dimension. Little research has focused on this syndrome. OBJECTIVE: The current study aims to assess maternal burn-out rate and to identify factors associated with this state of exhaustion. METHOD: 263 French mothers aged between 20 and 49 years answered five scales quantifying maternal burn-out, perceived social support, parental stress, depression and anxiety symptoms and history of postnatal depression. RESULTS: About 20% of mothers were affected by maternal burn-out. The main factors related to maternal burn-out were having a child perceived as difficult, history of postnatal depression, anxiety, satisfaction of a balance between professional and personal life and parental stress. CONCLUSION: This research shows the need for further work on maternal burn-out to better understand and prevent this syndrome.

[Plantar pressure platform as clinical assesment tool in the analysis of foot posture with the foot posture index]. / Die Druckmessplattform als klinisch-diagnostisches Instrument zur Analyse der Fußstatik nach dem Foot Posture Index.

BACKGROUND: The foot posture index is a static measurement that splits up the foot posture into neutral, pronatus and supinatus. However, the relation between the foot posture and the plantar pressure standards is not well known. For this, the objective of this research is to check the relationship between the foot posture and plantar pressure standard. SUBJECTS AND MATERIAL: 144 participants (101 women and 43 men), mean age 25.4 ± 6.3 years, were measured for the FPI. The pedobarometric measurement was made with the plantar pressure platform, we measured total surface (cm2), mean pressure (kPa) and maximum pressure (kPa), these measurements were correlated with the FPI measurements. RESULTS: 288 feet were analysed with regard to the correlation between point 5 of FPI (medial arch height) and the plantar surface total area (p = 0.038): lower arch height and supinated foot are related to the maximum pressure points with p = 0.029. The total contact surface can be determined with the final score of the FPI, the scores of FPI 3, 5 and 6 FPI (r2 = 0.059, p < 0.001) with a 5.9 % prediction. CONCLUSION: The supinatus foot is correlated statistically significantly through the maximum pressure and the plantar surface with the pronatus foot.

Exploring the potential of Burkholderia sacchari to produce polyhydroxyalkanoates.

AIM: Evaluation of the capability of Burkholderia sacchari to incorporate different monomers into polyhydroxyalkanoates (PHA). METHODS AND RESULTS: Thirty different carbon sources were evaluated as cosubstrates for B. sacchari growing on glucose with the intention to promote the incorporation of different monomers into the PHA produced by this species. With odd-numbered fatty acids, incorporation of the 3HV monomer was achieved, up to 65 mol% in the case of valerate. With 4-hydroxybutyrate, incorporation of 4HB was obtained, representing 9·1 mol%. With hexanoic acid, the production of P3HB-co-3HHx was achieved, containing up to 1·6 mol% of 3HHx. The molar fraction of 3HHx was found to be dependent on the ratio of glucose to hexanoic acid supplied. Metabolic flux analysis revealed a high efficiency of B. sacchari in converting carbon sources into P3HB-co-3HHx. Nevertheless, hexanoic acid was only poorly converted to 3HHx. CONCLUSIONS: Burkholderia sacchari is able to incorporate 3HV, 4HB and 3HHx in PHA containing mainly 3HB. The 3HHx content of P3HB-co-3HHx can be controlled by varying the glucose to hexanoic acid ratio. Burkholderia sacchari is highly efficient in converting carbon sources into PHA; however, only 2% of the hexanoic acid supplied could be converted to 3HHx. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report describing an approach to modulate the composition of P3HB-co-3HHx produced by bacteria using mixtures of carbohydrate and hexanoic acid as carbon source.

Estudio del patrón de presiones plantares en pies con hallux valgus mediante un sistema de plantillas instrumentadas / Study of plantar pressure patterns by means of instrumented insoles in subjects with hallux valgus

Introducción. Las presiones que soporta el antepié en una patología como el hallux valgus ha sido un tema discutido, con resultados dispares. Este artículo pretende comparar las presiones soportadas por el antepié en un grupo de pies normales y en un grupo de pies con hallux valgus leves o moderados. Material y métodos. Se realiza un estudio en 60 sujetos (30 con hallux valgus y 30 con pies sanos), que son analizados con el sistema Biofoot/IBV de plantillas instrumentadas. El sistema emplea unas finas plantillas (0,7 mm de grosor) con 64 sensores piezoeléctricos. Se analiza la presión máxima en siete regiones, las cinco cabezas metatarsales, el hallux y los dedos menores. Resultados. Los picos máximos de presión en el grupo control se localizaron significativamente en segunda y tercera cabeza metatarsal (p = 0,001). El grupo de pies con hallux valgus registraron picos en la primera cabeza y en el ha- llux (p = 0,001). La localización de los picos de presión en el primer radio sugiere la pronación como factor desencadenante del hallux valgus. Conclusiones. Los sistemas de plantillas instrumentadas son excelentes para analizar las presiones normales y patológicas. Son necesarios estudios más amplios para llegar a conclusiones más precisas. Se abren diferentes vías de investigación, como el estudio de las presiones a cadencias y velocidades determinadas y con diferentes calzados

Introduction. The pressures exerted on the forefoot in a condition like hallux valgus have been the subject of much debate, with dissimilar results. This article aims to compare the pressures borne by the forefoot in a group of normal feet with those it bears in a group of feet with mild or moderate hallux valgus. Materials and methods. A study was performed of 60 subjects (30 with hallux valgus and 30 with normal feet), who were analyzed with the Biofoot/IBV instrumented insole system. The system uses a series of thin insoles (0.7 mm-thick) with 64 piezoelectric sensors. Maximum pressure was analyzed in seven regions, i.e. the five metatarsal heads, the hallux and the lesser rays. Results. Maximum pressure peaks in the control group were measured significantly in the second and third metatarsal heads (p = 0.001). The hallux valgus group had its pressure peaks at the first metatarsal head and at the hallux (p = 0.001). The presence of pressure peaks at the first ray points to pronation as the factor leading to hallux valgus. Conclusions. Instrumented insole systems are an excellent tool to analyze normal and pathological pressures. More detailed studies are necessary to come to more definite conclusions. In future, different research ways could be followed such as the study of pressures at pre-established values of cadence and speed of gait and with different kinds of footwear

Estudio baropodométrico de los valores de presión plantar en pies no patológicos / Baropodometry study of plantar pressure values in normal feet

Introducción. El objetivo de este estudio fue evaluar las presiones plantares normales en sujetos sanos mediante baropodometría electrónica. Material y métodos. Cuarenta y seis sujetos sanos fueron analizados con el sistema Biofootì de plantillas instrumentadas. El sistema emplea unas plantillas con 64 sensores piezoeléctricos. Se midieron las presiones en el talón, mediopié y antepié en 6 segundos de grabación para cada sujeto. El pico de presión máxima y la presión media fue calculado y analizado. Resultados. La media del tiempo de contacto fue de 0,81 segundos (desviación estándar [DE] 0,08) en el pie derecho, y 0,82 segundos (DE 0,09) en el izquierdo. La cadencia fue de 105,6 (± 8,4) pasos por minuto. El pico máximo de presión y presión media en el retropié fue de 750 y 253 kPa, respectivamente. En el mediopié el pico de presión fue de 400 kPa y la presión media de 65 kPa. En el antepié los valores encontrados fueron de 1.240 kPa para el pico de presión y de 220 kPa para la presión media. Discusión. Los picos de presión más elevados se encontraron en el antepié, seguidos del retropié y por último en el mediopié. En relación a la presión media, el porcentaje de apoyo del talón es del 46,4 %, el del mediopié de un 12 % y el del antepié de un 41,6 %. Con el número de pacientes analizados no se encontró correlación entre cadencia y presiones, aunque el peso presentaba una correlación significativa y positiva con los valores de presión en todas las zonas

Background. This study aimed to evaluate normal plantar pressures in healthy subjects using an electronic baropodometry. Material and methods. Forty-six healthy subjects, with no clear foot or lower limb diseases, were analyzed with the Biofootì (IBV, Valencia, Spain) in-shoe system. The Biofoot system uses insoles with 64 piezoelectric sensors. Heel, midfoot and forefoot pressures were measured in 6 second recordings for each subjects. Maximum pressure peak and mean pressure was calculated and analyzed. Results. Mean contact time was 0.81 (standard deviation [SD] 0.08) seconds in the right foot and 0.82 (SD 0.09) seconds in the left foot. Walking cadency was 105.6 (SD 8.4) steps per minute. Maximum peak and mean pressure in the heel was 750 and 253 kPa, respectively. In the midfoot, peak pressure was 400 kPa and mean pressure 65 kPa. The values found in the forefoot was 1,240 kPa for pressure peak and 220 kPa for mean pressure. Discussion. The highest pressure peaks were found in the forefoot, followed by the heel and finally in the midfoot. In relationship to mean pressure, percentage of heel support is 46.4 %, that of the midfoot 12 % and forefoot 41.6 %. No correlation was found between cadence and pressure values with the number of patients analyzed in this study, however, there was a significant and positive correlation of weight with the pressure values in all the regions

Heterometrías de extremidades inferiores / Heterometry of lower limbs

La heterometría de los miembros inferiores es una alteración frecuente que repercute en todo el aparato locomotor. Existen dos tipos de heterometrías, la estructural y la funcional. La estructural se debe a diferencias de longitud en alguno de los segmentos óseos (fémur y/o tibia), y causa un desequilibrio en los niveles glúteos, pélvicos y escapulares. La funcional se caracteriza por estar causada por diferentes apoyos podálicos, principalmente por pronación asimétrica. Esta posición puede aparentar una heterometría estructural, aunque la causa no está en la diferente medida de los segmentos óseos. El tratamiento que puede realizarse desde el punto de vista podológico es diferente, ya que la estructural requiere la inclusión de un alza en el soporte plantar. La funcional en cambio no requiere de alza, sino de la diferente corrección de la posición en cada pie

The heterometry is a frequent alteration that rebounds in the whole apparatus locomotive. There is two types of heterometry, the estructural and the functional one exist. The structural one is due to differences of longitude in some of the bony segments (femur and/or tibia), and it causes an imbalance of gluteal, pelvic and scapular levels. The functional one is characterized to be caused by different foot loadings, mainly for asymmetric pronation. This position can look a structural heterometry, although the cause is not in the different measure of the bony segments. The treatment that can be carried out from the podologist point of view is different, since the structural one requires the inclusion of a material in the support to plant. The functional one on the other hand doesn't require of rise, but of the different correction of the position in each foot

Fascitis Plantar. Tratamiento ortopodológico / Plantar fascitis. Orthopodologic treatment

La fascitis plantar es la causa más frecuente de talalgia y consiste en la inflamación del origen de la fascia a nivel de la tuberosidad antero-interna del calcáneo. Produce dolor localizado en la zona antero-interna del talón, que puede irradiarse hacia el borde interno del pie. Tras el proceso inflamatorio, si la patología persiste de forma prolongada, pueden producirse cambios degenerativos. Generalmente los pacientes presentan alteraciones biomecánicas asociadas como causa etiológica de la fascitis. Estas alteraciones biomecánicas pueden ser el exceso de pronación, pie cavo, pie equino, seudoequino o cavo anterior y asimetrías en la longitud de las extremidades inferiores. Todas estas alteraciones son susceptibles de ser tratadas mediante tratamiento ortopodológico con soportes plantares. El uso de los tratamientos ortopodológicos permite la función normal del pie desde su posición neutra evitando compensaciones, que son las que producen el aumento de tensión y por tanto la inflamación de la fascia. Existen estudios que evidencian que el tratamiento ortopodológico personalizado es eficaz en el tratamiento de la fascitis plantar cuando la causa es una alteración biomecánica

Plantar fasciitis is a condition characterized by heel pain. Is the most common cause of heel pain. Plantar fasciitis is the inflammation of the fascia at its origin on the calcaneus. Is characterized by pain located in the antero-internal area of the calcaneus that can be irradiated toward the internal border of the foot. After the inflammatory process, if the pathology persists in a lingering way, degenerative changes can take place. The subjects generally present associated biomechanical alterations as aetiological cause of the fasciitis. These biomechanical alterations could be pronación excess, pes cavus, equine foot, metatarsal pes cavus, or unequeal leg length. All of this conditions are susceptible of being treated by ortopaedic treatment with foot orthoses. The use of foot orthoses allows the normal function of the foot from its neuter position avoiding compensations, understanding that these compensations produces the increase of tension and therefore the inflammation of the fascia. Some studies evidence that the personalized foot orthoses are effective in the treatment of plantar fasciitis when the cause is a biomechanical desequilibre

Biomecánica de las prótesis de rodilla / Biomechanics of the knee prosthesis

Las prótesis totales de rodilla constituyen uno de los implantesmás colocados en el ámbito de la ortopedia. El númerode modelos existentes en el mercado es muy elevadoy todos tienen sus características. A pesar de ello podemosagrupar las artroplastias de rodilla por estas caracterísricas,siendo las prótesis de platillo móvil el grupo más novedoso.Revisamos la bibliogrfía más reciente sobre la biomecánicade las prótesis totales de rodilla, englobando aspectos comolos materiales, el polietileno, la fijación, la geometría ola presencia del ligamento cruzado posterior para entenderen profundidad el funcionemiento de una PTR

Total knee prostheses (TKAs) are one of the most frequentimplants we use like orthpaedists. There are a largenumber of models and all of them have their characteristics.Despite of it we can group TKAs in avery few ones inwhich mobile-bearing arthroplasty in the newness. We reviewthe literature about biomechanics of TKAs includingmaterials, UHMWPE, fixation of the prostheses, geometryor presence of the cruciate posterior ligament to really understandarthroplasty working

Biomecánica de la rodilla / Biomechanics of the knee

La biomecánica de la rodilla todavía no se conoce exactamente.Diversos patrones se han establecido, pero ningunoha alcanzado el funcionamiento real de la articulación.Revisamos la bibliografía y presentamos la evolucióndel entendimiento del movimiento de la rodilla hasta llegaral modelo de seis grados de libertad en la zona patelofemoraly en la tibiofemoral. Este modelo parece ser el másaproximado a la realidad en cuanto a la cinemática de larodilla

Knee´s biomechanics is not well known yet. A largenumber of patterns has been stablished, but neither ofthem has reached the right articular movement. We reviewthe literature and present the understanding about kneemovement until six grades of freedom model in patello-femoraland tibio-femoral zones. This model seems to be themost approximate to reality in knee kinematics

El pie en el síndrome de Rubinstein-Taybi / The foot in Rubinstein-Taybi syndrome

El síndrome de Rubinstein-Taybi (SRT) es una enfermedad genética rara, multisistémica y de expresión clínica variable. Se caracteriza por retraso mental, primeros dedos de manos y pies anormalmente anchos y rasgos faciales característicos.Este síndrome es poco común y, aunque en ocasiones se hereda con carácter autosómico dominante, la mayoría de los casos se deben a una mutación genética durante el desarrollo fetal.Los afectados por este síndrome pueden presentar problemas en las extremidades inferiores; por ello, el conocimiento del síndrome puede ayudar a plantear alternativas de tratamiento eficaces.En este artículo se presenta el caso de una paciente de 14 años de edad con SRT con alteraciones en las extremidades inferiores, tales como luxación de la rodilla derecha, sindactilia completa y simple de segundo y tercer dedos del pie, pie cavo y marcha inestable. Se aborda el tema del tratamiento ortopédico aplicado a esta paciente (AU)

The development of a quality information system: a case study of Mexico.

One of the primary obstacles in the implementation of continuous quality improvement (CQI) programmes in developing countries is the lack of timely and appropriate information for decentralized decision-making. The integrated quality information system (QIS) described herein demonstrates Mexico's unique effort to package four separate, yet mutually reinforcing, tools for the generation and use of quality-related information at all levels of the Mexican national health care system. The QIS is one element of the continuous quality improvement programme administered by the Secretariat of Health in Mexico. Mexico's QIS was designed to be flexible and capable of adapting to local needs, while at the same time allowing for the standardization of health care quality assurance indicators, and subsequent ability to measure and compare the quality performance of health facilities nationwide. The flexibility of the system extends to permit the optimal use of available data by health care managers at all levels of the health care system, as well as the generation of new information in important areas often neglected in more traditional information systems. Mexico's QIS consists of four integrated components: 1) a set of client and provider surveys, to assess specific issues in the quality of health services delivered; 2) client and provider national satisfaction surveys; 3) a sentinel health events strategy; and 4) a national Comparative Performance Evaluation System, for use by the Secretariate of Health for the quality assessment of state and provincial health care services (internal benchmarking). The QIS represents another step in Mexico's ongoing effort to use data for effective decision-making in the planning, monitoring and evaluation of services delivered by the national health care system. The design and application of Mexico's QIS provides a model for decentralized decision-making that could prove useful for developing countries, where the effective use of quality indicators is often limited. Further, the system could serve as a mechanism for motivating positive change in the way information is collected and used in the process of ensuring high quality health care service delivery.

Frecuencia de metástasis tireocervicales con tiroides no aumentado: revisión estadística / Incidence of thyrocervical metastases with non-increased thyroid: a statistical review

Se presenta 31 operados de carcinoma del tiroides en los que el tipo papilar constituyó casi la mitad de la serie (49 porciento). Se seleccionaron las distintas variedades para tres grupos, según la relación entre volumen de la glándula, y existencia de metástasis cervicales o no de la operación. Se estudió el grupo en que la glándula era normal y había una o más metástasis en el cuello en el momento de la intervención, que en ocasiones tenían hasta 10 años de evolución. Se señalan los diagnósticos que se hicieron de las mismas, valor del gammagrama, tipo de intervención quirúrgica y evolución de los operados que pudieron ser chequeados (AU)