Consensus of the Spanish society of laboratory medicine and the Spanish society of medical oncology on the methodology and criteria for evaluation of circulating tumour markers in breast cancer.

The measurement of circulating tumour markers (TMs) for the diagnosis or monitoring of breast cancer has sometimes been considered of limited utility. In addition to the overinterpretation of irrelevant changes in marker levels, the characteristics of the patient, the disease or other pathologies that can modify them are often not considered in their evaluation. On the other hand, there are recent data on the relationship of TMs with molecular subtypes and on their prognostic value, the knowledge of which may improve their clinical utility. This consensus article arises from a collaboration between the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Medical Oncology (SEOM). It aims to improve the use and interpretation of circulating TMs in breast cancer. The text summarizes the current knowledge and available evidence on the subject and proposes a series of recommendations mainly focussed on the indication, the frequency of testing and the factors that should be considered for correctly interpreting changes in the levels of TMs.

[Treatment of the pelvic floor in males with incomplete spinal cord injury: a systematic review].

Pelvic floor disorders are one of the most common complications in male patients with spinal cord injury. The aim of this review was to analyse the available evidence on the efficacy of different treatments used for pelvic floor dysfunctions in men with incomplete spinal cord injuries. The Scopus, Medline, PEDro, Web of Science, Dialnet, Pubmed and Cochrane databases were consulted for papers in Spanish and English published in the last twenty years. Fifteen articles were included, comprising a total of 706 male patients with incomplete spinal cord injury. In male patients with neurogenic bladder and erectile dysfunction, the best results were obtained with neuromodulation and combined treatments (electrotherapy or acupuncture / electroacupuncture with catheterization or bladder training).

Quality of life in elderly breast cancer patients with localized disease receiving endocrine treatment: a prospective study.

PURPOSE: In this paper we study the quality of life (QoL) of elderly breast cancer patients receiving endocrine treatment (ET). More QoL data on elderly patients treated with ET are needed. Our aims are to study QoL in early-stage breast cancer patients throughout the treatment period and compare the QoL of ET groups. METHODS: 148 patients > 65 years who began ET with either tamoxifen or aromatase inhibitor (AI) completed the EORTC QLQ-C30 and QLQ-BR23 and the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) questionnaires three times over 3 years of ET. Linear mixed-effect models were used to evaluate longitudinal QoL changes. ET group comparisons were conducted after 3 years of treatment via ANCOVA adjusted by basal QoL. RESULTS: QoL scores were high (> 80/100 points) in most QoL areas, with moderate limitations (> 30) in sexual functioning and enjoyment and in future perspective. After 3 years of ET, four QoL areas improved (< 6 points) compared to baseline and 3-month assessments. Hot flushes worsened (8 points) at the 3-month assessment but by 3 years had recovered. AI patients showed more hot flushes, pain and diarrhea and less sexual enjoyment than tamoxifen patients after 3 years of ET (differences 3-12 points). CONCLUSIONS: Results indicate that elderly early-stage breast cancer patients adapted well to their disease and ET treatment over the 3 years. Few QoL differences were observed between ET groups.

SEOM clinical guidelines on cardiovascular toxicity (2018).

One of the most common side effects of cancer treatment is cardiovascular disease, which substantially impacts long-term survivor's prognosis. Cardiotoxicity can be related with either a direct side effect of antitumor therapies or an accelerated development of cardiovascular diseases in the presence of preexisting risk factors. Even though it is widely recognized as an alarming clinical problem, scientific evidence is scarce in the management of these complications in cancer patients. Consequently, current recommendations are based on expert consensus. This Guideline represents SEOM's ongoing commitment to progressing and improving supportive care for cancer patients.

Efectividad de un programa de pilates romana en lumbalgia inespecífica. Estudio piloto / Effectiveness of a program of romana's pilates for non-specific low back pain. A pilot study

Objetivo: comprobar la efectividad del método Pilates Romana para conseguir una mayor flexibilidad de la columna, junto con una mejora en la movilidad de la misma, así como del dolor que presentan en su vida diaria los pacientes. Metodología: ensayo clínico con intención de tratar a treinta pacientes con dolor lumbar inespecífico. Asistieron a 15 sesiones, 2 veces a la semana, del Método Pilates Romana.. Se evaluaron parámetros tales como dolor, test de Schöber, SRS-22 y distancia dedos-suelo. Resultados. Se encontraron diferencias estadísticamente significativas con respecto al dolor (escala EVA), distancia dedos-suelo, test de Schöber (flexibilidad en plano sagital), flexión lateral (flexibilidad en plano frontal) y en varios ítems de la escala SRS-22, con valores de p<0,001. Por ello, este método puede ser usado para mejorar el dolor, la flexibilidad axial, la función y los aspectos relacionados con la calidad de vida (AU)

Aim: to test the effectiveness of the Romana's Pilates method to obtain increased flexibility, improvements in mobility, and reduced pain in daily life. Methodology: a clinical trial with intention-to-treat thirty patients with non-specific low back pain. Participants attended 15 sessions, twice a week. The Romana's Pilates method was taught by an external physiotherapist. Parameters such as pain, the Schober test, and the SRS-22 were evaluated. Results: Statistically significant differences in pain (VAS), the Schober test (flexibility in sagittal plane), lateral flexion (flexibility in frontal plane) and several items of the SRS-22 scale were found, with p <0.001. This method may be used to improve pain, axial flexibility, function and aspects related to the quality of life of patients (AU)

Parálisis cerebral infantil y el uso de sistemas de posicionamiento para el control postural: estado actual del arte / Childhood cerebral palsy and the use of positioning systems to control body posture: Current practices

Introducción: Una de las consecuencias de la mala calidad en el control postural de los niños con parálisis cerebral es la luxación de caderas. Esto es debido a la falta de carga de peso en las posiciones de sedestación y bipedestación. Para ello, se puede hacer uso de ayudas ortésicas para evitar su aparición o progresión. Objetivo: El objetivo de este estudio es analizar la efectividad de dichos sistemas de posicionamiento en el control postural de pacientes con parálisis cerebral, y discutir estos hallazgos a la luz de lo que pueda ser de interés para la neurología. Discusión Se seleccionaron un total de 18 artículos de intervenciones de la parálisis cerebral infantil que abordaban el ámbito de la postura y su mantenimiento en posiciones idóneas para evitar deformidades y problemática relacionada. Los principales resultados terapéuticos fueron: combinación de toxina botulínica junto con ortesis, que reduce la incidencia en la luxación de caderas, aunque estos resultados no fueron significativos, y el empleo de sistemas de posicionamiento en 3 posturas diferentes, que supone un descenso en el empleo de la toxina botulínica y de las intervenciones quirúrgicas en niños menores de 5 años. El inconveniente es que resultan muy incómodos. Conclusión: El empleo de sistemas de control postural produce beneficios en el control de las deformidades de cadera en niños con parálisis cerebral. Sin embargo, su utilización debe ser prolongada en el tiempo para que los efectos sean objetivos (AU)

Introduction: One of the consequences of poor postural control in children with cerebral palsy is hip dislocation. This is due to the lack of weight-bearing in the sitting and standing positions. Orthotic aids can be used to prevent onset and/or progression. Objective: The aim of this study is to analyse the effectiveness of positioning systems in achieving postural control in patients with cerebral palsy, and discuss these findings with an emphasis on what may be of interest in the field of neurology. Discussion: We selected a total of 18 articles on interventions in cerebral palsy addressing posture and maintenance of ideal postures to prevent deformities and related problems. The main therapeutic approaches employed combinations of botulinum toxin and orthoses, which reduced the incidence of hip dislocation although these results were not significant. On the other hand, using positioning systems in 3 different positions decreases use of botulinum toxin and surgery in children under 5 years old. The drawback is that these systems are very uncomfortable. Conclusion: Postural control systems helps control hip deformities in children with cerebral palsy. However, these systems must be used for prolonged periods of time before their effects can be observed (AU)

Tratamiento complementario de la fibrosis quística con terapia acuática. A propósito de un caso / Supplementary treatment of cystic fibrosis with hydrotherapy. A case report

Antecedentes y objetivo: La fibrosis quística (FQ) produce una afectación multisistémica, por lo que la hidroterapia puede aportar numerosos beneficios en su tratamiento. El objetivo de este estudio es la presentación de la efectividad de un programa de hidroterapia en una paciente pediátrica con FQ. Descripción del caso: Niña de 23 meses de edad con FQ que presenta dificultad respiratoria. Intervención: El programa de tratamiento consiste en la realización de 5 sesiones de hidroterapia de 30 min de duración cada una. Resultados: Se muestran mejoras en los signos vitales y las capacidades de la paciente (movilización de secreciones y expectoración), generando efectos positivos sobre su calidad de vida. Discusión: Otros autores han relacionado este tipo de tratamiento con trastornos respiratorios en edades pediátricas y en edad adulta, confirmando igualmente los beneficios que se han obtenido en el caso clínico planteado

Background and objective: Cystic Fibrosis (CF) leads to a multisystemic involvement. Hydrotherapy shows many positive effects. The aim of this study is to show the effectiveness of a hydrotherapy program in a patient with CF. Case description: The patient is a 23 month-old girl with CF and respiratory distress. Intervention: The treatment program consisted of the fulfilment of five 30-minute hydrotherapy sessions. Results: There was an improvement in in patient vital signs and capacities (mainly in terms of mobilisation of secretions and expectoration), generating positive effects on her quality of life. Discussion: Other authors have associated this type of treatment with respiratory disorders, and have confirmed its benefits in paediatric and adult patients, including those obtained in the case presented

[Efficacy of the application of kinesio tape in patients with stroke]. / Eficacia de la aplicacion del vendaje neuromuscular en accidentes cerebrovasculares.

AIMS: To review the effects achieved by the kinesio tape in patients with stroke in scientific studies published on date and to discuss these findings may be of interest to neurology. DEVELOPMENT: An exhaustive search in the main scientific databases using keywords such as kinesio tape, kinesiotaping, musculoskeletal tape, taping medical concept was carried out. Citations of selected articles and scientific papers published on the website of the Spanish Association of Neuromuscular Bandage were analyzed. Experimental, quasi-experimental, clinical trials and case studies published were used, without limit date, with therapeutical treatment purpose provide important results. Eight articles have met the inclusion criteria. There are eight studies that examine the effect on kinesio tape on lower limb, gait and balance in this kind of therapy, even upper limb and swallowing problems that these patients could present. CONCLUSION: The kinesio tape in neurological patients can be a complementary technique that empirically provides benefits. However, better methodological quality studies demonstrating the effects attributed to him are still needed.

TITLE: Eficacia de la aplicacion del vendaje neuromuscular en accidentes cerebrovasculares.Objetivos. Revisar la efectividad del vendaje neuromuscular (kinesio tape) en pacientes con accidente cerebrovascular en los estudios cientificos publicados hasta la fecha y discutir estos hallazgos a la luz de lo que pueda ser de interes para la neurologia. Desarrollo. Busqueda exhaustiva en las principales bases de datos cientificas utilizando palabras clave como kinesio tape, kinesiotaping y vendaje neuromuscular, asi como analisis de las citas bibliograficas de los articulos seleccionados y los estudios publicados en la pagina oficial de la Asociacion Española de Vendaje Neuromuscular. Se han admitido estudios cuantitativos experimentales, cuasiexperimentales y estudios de casos, sin limite de fecha, con finalidad terapeutica del vendaje neuromuscular, y que han aportado resultados importantes. Ocho articulos han cumplido los criterios de inclusion. Existen estudios que muestran el tratamiento de los miembros inferiores, la marcha y el equilibrio con este tipo de terapia, asi como de los miembros superiores, y los problemas de deglucion que estos pacientes pueden presentar. Conclusion. El vendaje neuromuscular en patologia neurologica en adultos puede ser una tecnica complementaria que, empiricamente, aporta beneficios, pero aun se precisan estudios de mejor calidad metodologica que evidencien los efectos que se le atribuyen.

Childhood cerebral palsy and the use of positioning systems to control body posture: Current practices. / Parálisis cerebral infantil y el uso de sistemas de posicionamiento para el control postural: estado actual del arte.

INTRODUCTION: One of the consequences of poor postural control in children with cerebral palsy is hip dislocation. This is due to the lack of weight-bearing in the sitting and standing positions. Orthotic aids can be used to prevent onset and/or progression. OBJECTIVE: The aim of this study is to analyse the effectiveness of positioning systems in achieving postural control in patients with cerebral palsy, and discuss these findings with an emphasis on what may be of interest in the field of neurology. DISCUSSION: We selected a total of 18 articles on interventions in cerebral palsy addressing posture and maintenance of ideal postures to prevent deformities and related problems. The main therapeutic approaches employed combinations of botulinum toxin and orthoses, which reduced the incidence of hip dislocation although these results were not significant. On the other hand, using positioning systems in 3 different positions decreases use of botulinum toxin and surgery in children under 5 years old. The drawback is that these systems are very uncomfortable. CONCLUSION: Postural control systems helps control hip deformities in children with cerebral palsy. However, these systems must be used for prolonged periods of time before their effects can be observed.

SEOM Clinical Guideline of fertility preservation and reproduction in cancer patients (2016).

Chemotherapy and radiotherapy often result in reduced fertility in cancer patients. With increasing survival rates, fertility is an important quality-of-life concern for many young cancer patients. Around 70-75% of young cancer survivors are interested in parenthood but the numbers of patients who access fertility preservation techniques prior to treatment are significantly lower. Moreover, despite existing guidelines, healthcare professionals do not address fertility preservation issues adequately. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to cancer treatment.

Efectos de un programa de prevención de caídas con Ai Chi acuático en pacientes diagnosticados de parkinson / Effects of an Ai Chi fall prevention programme for patients with Parkinson's disease

Introducción: Un síntoma principal de la enfermedad de Parkinson es la alta incidencia en caídas y deterioro en el equilibrio, tanto estático como dinámico. El objetivo de este estudio es determinar el efecto de un programa de entrenamiento de Ai Chi acuático sobre la prevención de caídas en pacientes con Parkinson, mejorando su autonomía funcional y su percepción del dolor físico. Método: Quince pacientes diagnosticados de Parkinson (Hoehn y Yahr, rango: 1-3) participaron en un programa de intervención de Ai Chi acuático de 10 semanas de duración, con sesiones 2 veces por semana. Se emplearon las escalas EVA de dolor, Tinetti de equilibrio y marcha y el test Get up and Go. Resultados: Los resultados se obtuvieron aplicando la prueba de Friedman para 3 muestras relacionadas, en los pacientes antes de la terapia, después de la terapia y al mes de la terapia. Los datos obtenidos mostraron una mejoría significativa (p < 0,001) al comparar los resultados mostrados en las 3 mediciones, donde los valores de percepción de dolor, equilibrio y funcionalidad en marcha han disminuido significativamente, incluso al mes de finalizar las mismas los pacientes seguían mostrando mejoría y mantenimiento en sus resultados. Conclusión: Un programa de Ai Chi en el agua parece ser un tratamiento factible para los pacientes diagnosticados con EP en un grado leve y moderado en el tratamiento del dolor, equilibrio y capacidad funcional

Introduction: One of the main symptoms of Parkinson's disease is the high incidence of falls occurring due to the decline of both static and dynamic balance. The aim of this study is to determine the effect of an Ai Chi programme designed to prevent falls in patients with Parkinson's disease by improving both functional independence and perception of physical pain. Methods: Fifteen patients diagnosed with Parkinson's disease (Hoehn and Yahr stages 1-3) participated in a 10-week Ai Chi programme consisting of 30 to 45-minute aquatic exercise sessions twice a week. The assessment measures used in this study were the pain visual analogue scale (VAS), the Tinetti gait and balance assessment tool, and the Timed Get up and Go test. Results: The results were calculated by applying the Friedman test to 3 related measurements: patients at baseline, at post-treatment (at the end of the 10 week programme) and after one month of follow-up. The data obtained showed a significant improvement (p < .001) in scores for pain perception, balance, and gait function after the treatment programme. Furthermore, patients continued to show significant improvements and the benefits remained at the one-month follow-up visit. Conclusion: Ai Chi is a promising and feasible aquatic treatment for improving pain perception, balance, and functional capacity in patients diagnosed with mild or moderate Parkinson's disease

Erratum:Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery.

In this article published in Volume 21, issue 5, the authors' names were incorrectly stated in the Pubmed abstract as: "Ignacio Arraras J(1), Juan Illarramendi J, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Angel Dominguez M, Vera R.". The correct authors' names are: "Arraras JI(1), Illarramendi JJ, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Dominguez MA, Vera R.". This error appeared only in the PubMed database and not in the print form of the Journal.

Effects of an Ai Chi fall prevention programme for patients with Parkinson's disease.

INTRODUCTION: One of the main symptoms of Parkinson's disease is the high incidence of falls occurring due to the decline of both static and dynamic balance. The aim of this study is to determine the effect of an Ai Chi programme designed to prevent falls in patients with Parkinson's disease by improving both functional independence and perception of physical pain. METHODS: Fifteen patients diagnosed with Parkinson's disease (Hoehn and Yahr stages 1-3) participated in a 10-week Ai Chi programme consisting of 30 to 45-minute aquatic exercise sessions twice a week. The assessment measures used in this study were the pain visual analogue scale (VAS), the Tinetti gait and balance assessment tool, and the Timed Get up and Go test. RESULTS: The results were calculated by applying the Friedman test to 3 related measurements: patients at baseline, at post-treatment (at the end of the 10 week programme) and after one month of follow-up. The data obtained showed a significant improvement (p <.001) in scores for pain perception, balance, and gait function after the treatment programme. Furthermore, patients continued to show significant improvements and the benefits remained at the one-month follow-up visit. CONCLUSION: Ai Chi is a promising and feasible aquatic treatment for improving pain perception, balance, and functional capacity in patients diagnosed with mild or moderate Parkinson's disease.

The Impact of Hydroxyethyl Starch Use in Deceased Organ Donors on the Development of Delayed Graft Function in Kidney Transplant Recipients: A Propensity-Adjusted Analysis.

Our objective was to evaluate the impact of hydroxyethyl starch (HES) use in organ donors after neurologic determination of death (DNDD) on recipient renal graft outcomes. The following data elements were prospectively collected for every DNDD managed by a single organ procurement organization from June 2011 to July 2013: demographics; critical care endpoints; treatments, including the use of HES; graft cold ischemia time (CIT); and the occurrence of recipient delayed graft function (DGF, dialysis in the first week after transplantation). Logistic regression was performed to identify independent predictors of DGF with a p-value <0.05. The results were then adjusted for each donor's calculated propensity to receive HES. Nine hundred eighty-six kidneys were transplanted from 529 donors. Forty-two percent received HES (1217 ± 528 mL) and 35% developed DGF. Kidneys from DNDDs who received HES had a higher crude rate of DGF (41% vs. 31%, p < 0.001). After accounting for the propensity to receive HES, independent predictors of DGF were age (OR 1.02 [1.01-1.04] per year), CIT (OR 1.04[1.02-1.06] per hour), creatinine (OR 1.5 [1.32-1.72] per mg/dL) and HES use (OR 1.41 [1.02-1.95]). HES use during donor management was independently associated with a 41% increase in the risk of DGF in kidney transplant recipients.

Riesgo percibido sobre tabaquismo y tendencia de consumo-exposición en madres con recién nacidos de bajo peso / No disponible

Objetivos. Determinar la tendencia del consumo y exposición al tabaco de madres con recién nacidos de bajo peso antes y durante el embarazo, y describir la percepción de riesgo que tienen estas en relación con el tabaquismo. Pacientes y método. Diseño observacional descriptivo en el que se aplicó un cuestionario específico a las madres cuyos recién nacidos (con peso inferior a 2.500 gramos) se encontraban ingresados en la Unidad de Neonatología del Hospital Universitario Reina Sofía de Córdoba. El cuestionario recogía variables sociodemográficas, así como las relacionadas con la exposición al humo ambiental del tabaco durante la gestación y la salud materno-infantil percibida. Resultados. Se incluyeron en el estudio un total de65 mujeres. El 56,9% estaban expuestas al humo del tabaco en el hogar. Abandonaron el tabaquismo en un mes determinado del embarazo el 35,4% de las mujeres. El 92,3% opinaban que era muy/bastante probable que el humo del tabaco afecte a la salud de su hijo/a. Conclusiones. Las madres muestran una elevada percepción de riesgo en relación con el tabaquismo. Sin embargo, se encuentran expuestas al humo ambiental derivado del mismo en sus hogares. Además, la gran mayoría abandona o reduce el consumo de tabaco durante el primer trimestre del embarazo (AU)

Objectives. To determine the trend of consumption and exposure to tobacco in mothers with low birth weight newborns before and during pregnancy and describe the perception of risk that they have in relation to smoking. Patients and methods. The study was observational and descriptive. A specific questionnaire was administered to the mothers whose infants (weighing less than2.500 grams) were admitted to the Neonatal Unit of the Reina Sofia University Hospital in Córdoba. The questionnaire included sociodemographic variables and those related to exposure to environmental tobacco smoke during pregnancy and perceived maternal-child health. Results. 65 mothers were included in the analysis.56.9% of them were exposed to tobacco smoke at home. 35.4% gave up smoking in a given month of pregnancy. 92.3% of women felt it was very/quite likely that tobacco smoke affected the health of theirs on/daughter. Conclusions. The mothers show a high perception of risk in relation to smoking. They are exposed to secondhand smoke in their homes. Most mothers give up or reduce the consumption of tobacco during the first trimester of pregnancy (AU)

Análisis biomecánico de la marcha en población pediátrica con lesión medular. Revisión de la casuística de una unidad de biomecánica hospitalaria / Biomechanic analysis of gait in the pediatric population of spinal cord injury. a review of the casuistics of a hospital biomechanics unit

Objetivo del estudio. Describir las características de los pacientes lesionados medulares en edad pediátrica cuyo patrón de marcha fue analizado en la Unidad de Biomecánica y Ayudas Técnicas del Hospital Nacional de Parapléjicos de Toledo. Material y métodos. Se realizó un estudio retrospectivo incluyendo a todos los pacientes que asistieron a la unidad, analizados entre enero de 2006 y marzo de 2010, edad inferior a 18 años, que fuesen pacientes ambulantes con/ sin ayudas técnicas e independencia de marcha con distancia mínima de 10 metros. Resultados. De los 48 pacientes incluidos en este estudio, el 53,1% eran varones frente al 46,9% de pacientes de sexo femenino. Las edades comprendidas están entre los dos años de edad hasta los 18 años, con una edad media de 12 años (+/- 2,31). La etiología de la lesión medular fue: traumática (29,16%), congénita (33,33%), neoplásica (8,33%) entre otros. En cuanto al nivel de lesión medular, en el 31,25% fueron lesiones cervicales, en el 29,16% fueron lumbares, en un 16,66% fueron dorsales, en el 2,08% fueron sacras y en el 20,83% el origen no fue medular. Conclusiones. La incidencia de lesión medular en edad pediátrica es muy pequeña, pero supone un gran reto asistencial, personal y social. La revisión bibliográfica realizada muestra la escasez de estudios referentes a esta patología y en pacientes en edades similares; así como estudios sobre el patrón de marcha que presentan estos pacientes(AU)

Objective. To describe the characteristics of patients with spinal cord injury in pediatric age whose gait pattern was analyzed in the Biomechanics and Technical Care Unit of the National Paraplegics Hospital of Toledo (Spain). Material and methods. A retrospective study including all patients attending the unit and analyzed between January 2006 and March 2010, younger than 18 years, who were outpatients with or without technical aids and independence of gait with a minimum distance of 10 meters. Results. A total of 48 patients were included in this study: 53.1% males, 46.9% female. Ages ranges from 2 to 18 years with a mean age of 12 years (+/- 2.31). The bone marrow lesion etiology was traumatic (29.16%), congenital (33.33%), neoplasm (8.33%) among others. Injury levels was cervical (31.25%), lumbar (29.16%), non-spinal origin (20.83%), dorsal (16.66%) and sacral (2.08%). Conclusion. The incidence of pediatric spinal cord injury is very small, but poses a great personal and social and care challenge. The review of the literature shows the lack of studies regarding this disease in patients of similar age as well as studies on the gait pattern in these patients(AU)

Presión asistencial y demora en las salas de fisioterapia de atención primaria en Andalucía / Health care pressure and delay in the physiotherapy rooms of primary care in Andalucia

IntroducciónLa puesta en marcha del Plan de Apoyo de las Familias Andaluzas (Decreto 137/2002) ha supuesto una reforma bastante positiva para la fisioterapia de atención primaria (AP) en Andalucía, si bien esta ha sido lenta, irregular, con recursos insuficientes y poco homogéneos.ObjetivosConocer la variabilidad de las ratios «fisioterapeuta de AP por habitantes» en todas las salas de Andalucía, observar su influencia en los indicadores asistenciales de los que se dispone y hallar los factores de riesgo que afectan a los tiempos de espera para el inicio del tratamiento fisioterápico.Material y métodosEstudio observacional descriptivo ecológico. Periodo de estudio: primer semestre de 2008. Fuente de información: Sistema de Información para la Gestión de AP. El análisis estadístico realizado se ha valorado de acuerdo a los criterios psicométricos de escalas numéricas. Se ha utilizado análisis bivariante, regresión lineal, regresión logística y análisis multivariante.ResultadosExiste una gran variabilidad de ratio fisioterapeuta de AP por habitantes en las salas de fisioterapia de Andalucía. Se ha obtenido una ecuación que calcula la probabilidad de demora en días para el inicio de tratamiento fisioterápico de un paciente con derivación normal que depende, especialmente, de la cantidad de población asignada al fisioterapeuta de AP y de la demora que provoca la derivación de pacientes preferentes. Habiendo comprobado la relación que existe entre estas variables, parece conveniente y prioritario el incremento de los recursos humanos en las salas con ratios elevadas(AU)

IntroductionThe setting up of the ‘Supportive Plan for Andalusian Families’ (Decree 137/2002) has resulted in a very positive reform for the Andalusian Primary Health Care Physiotherapy, even though it has been slow and irregular, with deficient and not very homogeneous resources.ObjectivesTo know the variability for Primary Health Care physiotherapist/inhabitant ratio in all of the Andalusian rooms, to observe its influence on all the available care indicators, and to find the risk factors that may affect the waiting times to initiation of physiotherapy treatment.Material and methodsEcological, descriptive, observational study. Study period: first half of 2008 (January to June). Information source: Information System for Primary Health Care Management. The statistical analysis performed was carried out in accordance with psychometric criteria of numerical scales. Bivariate analysis, linear regression, logistic regression and multivariate analysis were used.ResultsThere is high variability in the Primary Health Care physiotherapist/inhabitant ratio in Andalusian physiotherapy rooms. An equation has been obtained for the calculation of the ‘days of delay probability’ until the initiation of physiotherapy for a normal-referred patient. The research shows how this probability of delay depends mainly on the total population assigned to each Primary Health Care physiotherapist, and on the delay caused by priority-referred patients. Having confirmed the relationship between these variables, increasing the human resources in those rooms with higher ratios seems to be an advisable and high priority action(AU)

Esclerosis múltiple y técnicas de relajación / Multiple sclerosis and relaxation technique

Objetivos: Realizar un análisis bibliográfico de las corrientes de tratamiento en técnicas de relajación más efectivas y utilizadas en la esclerosis múltiple y ver qué técnica/s en concreto muestra/n mayor grado de efectividad.Material y métodosSe consultaron las siguientes fuentes de datos: Cochrane Library Plus, PEDro, LILACS, Medline, CINAHL, Bandolier, AMED, EMBASE, PsychINFO, Psycharticles, AMA. Para ello se seleccionaron ensayos clínicos controlados y aleatorios, cuyos integrantes eran personas con un diagnóstico definido de esclerosis múltiple y que fueron sometidas a técnicas de relajación.ResultadosSe localizaron treinta y cinco artículos en las bases de datos mencionadas anteriormente, sólo dos fueron incluidos en esta revisión.ConclusiónSe puede decir que, potencialmente, las técnicas de relajación (yoga y entrenamiento autógeno, concretamente) pueden brindar beneficios en diferentes dimensiones de la enfermedad (vitalidad, fatiga, depresión), pudiendo mejorar su calidad de vida (A)

To analyze the bibliography on the treatment trends in those relaxation techniques that are the most effective and used in multiple sclerosis and to discover which techniques show the greatest degree of efficiency.Material and methodsWe consulted the following data sources: Cochrane Library Plus, PEDro, LILACS, Medline, CINAHL, Bandolier, AMED, Embase, Psychinfo, Psycharticles, AMA. Selection of studies. Randomized controlled clinical trials, that included subjects with a definite diagnosis of multiple sclerosis and who were subjected to relaxation techniques were selected.ResultsThirty-five articles were located in the previously-mentioned databases but only two have been included in this review.ConclusionPotentially, it could be stated that relaxation techniques (yoga and autogenic training, in particular) may provide benefits in different dimensions of the disease (vitality, fatigue, depression) and may improve quality of life (AU)

[Hormonal therapy in breast cancer]. / Tratamiento hormonal del cáncer de mama.

Hormonal therapy has been the first systemic treatment against breast cancer. Up to now Tamoxifen and ovarian supression/ablation were the best optionts we had to treat early breast cancer as advancer disease. The advent of aromatase inhibitors, new SERMS and antistrogen Fulvestrant have supoused a great advance in the treatment of this disease and at the same time have complicated the election of the optimal drug for each patient. This article tries to review the aviable treatment options insiting on its indications.