Análisis de las buenas prácticas de participación ciudadana en las unidades de gestión clínica del Servicio Andaluz de Salud / Analysis of good practices for inhabitant participation in the clinical management units of the Andalusian Health Service (Spain)

Objetivo: Conocer buenas prácticas de participación ciudadana en las unidades de gestión clínica (UGC) del Servicio Andaluz de Salud (SAS) y explorar factores percibidos por profesionales de UGC del SAS que pueden influir en la existencia y la distribución de buenas prácticas de participación ciudadana. Método: Estudio con metodología mixta realizado en Andalucía en dos fases (2013-2015). En la fase 1 (estudio cuantitativo) se realizó un cuestionario online a directores/as de UGC con una comisión de participación ciudadana constituida. En la fase 2 (estudio cualitativo) se realizaron entrevistas semiestructuradas a profesionales del SAS con experiencia en participación ciudadana. Se realizó un análisis descriptivo de la información cuantitativa y un análisis de contenido semántico de la cualitativa. Resultados: En la fase 1 participaron 530 UGC. Las prácticas de participación ciudadana implementadas con mayor frecuencia en las UGC están circunscritas a los niveles de información y consulta. Otras prácticas que suponen una mayor implicación y delegación ciudadana son secundarias. En la fase 2 se entrevistó a 12 profesionales. Los obstáculos identificados por los/las profesionales que pueden afectar a la distribución de buenas prácticas están relacionados con las creencias y las actitudes de la ciudadanía, los/las profesionales, el sistema sanitario y el contexto. Conclusiones: Las principales prácticas de participación ciudadana en las UGC están relacionadas con los niveles más básicos de participación. No se reconocen claramente la manera y los mecanismos que facilitarían el empoderamiento ciudadano en el sistema sanitario (AU)

Objective: To discover good practices for inhabitant participation in the clinical management units (CMUs) of the Andalusian Health Service (AHS) (Spain) and to explore the reasons perceived by CMU and AHS professionals that may influence the presence and distribution of those good practices among the CMU. Methods: Study with mixed methodology carried out in Andalusia (Spain) in two phases (2013-2015). Firstly, an online survey was delivered to the Directors of the CMUs which had set up an inhabitant participation commission. In a second phase, a qualitative study was carried out through semi-structured interviews with professionals from the Andalusian Health Service with previous experience in inhabitant participation. A descriptive analysis of the quantitative information and a semantic content analysis of the qualitative information were carried out. Results: 530 CMUs took part in the survey. The inhabitant participation practices more often implemented in the CMUs are those related to the informing and consultation levels. Twelve professionals were interviewed in the second phase. Other practices with higher inhabitant involvement and delegation are secondary. The barriers which were identified by professionals are related to the beliefs and attitudes of the inhabitants, the professionals, the health system and the environment. Conclusion: The main practices for inhabitant participation in the CMUs are related to the most basic levels of participation. The method and dynamics which facilitate inhabitant empowerment within the health system are not clearly recognized (AU)

[Analysis of good practices for inhabitant participation in the clinical management units of the Andalusian Health Service (Spain)]. / Análisis de las buenas prácticas de participación ciudadana en las unidades de gestión clínica del Servicio Andaluz de Salud.

OBJECTIVE: To discover good practices for inhabitant participation in the clinical management units (CMUs) of the Andalusian Health Service (AHS) (Spain) and to explore the reasons perceived by CMU and AHS professionals that may influence the presence and distribution of those good practices among the CMU. METHODS: Study with mixed methodology carried out in Andalusia (Spain) in two phases (2013-2015). Firstly, an online survey was delivered to the Directors of the CMUs which had set up an inhabitant participation commission. In a second phase, a qualitative study was carried out through semi-structured interviews with professionals from the Andalusian Health Service with previous experience in inhabitant participation. A descriptive analysis of the quantitative information and a semantic content analysis of the qualitative information were carried out. RESULTS: 530 CMUs took part in the survey. The inhabitant participation practices more often implemented in the CMUs are those related to the informing and consultation levels. Twelve professionals were interviewed in the second phase. Other practices with higher inhabitant involvement and delegation are secondary. The barriers which were identified by professionals are related to the beliefs and attitudes of the inhabitants, the professionals, the health system and the environment. CONCLUSION: The main practices for inhabitant participation in the CMUs are related to the most basic levels of participation. The method and dynamics which facilitate inhabitant empowerment within the health system are not clearly recognised.

Insertion, coupling and elimination processes in the reactions of the unsaturated alkyl-bridged complexes [Mo2(η5-C5H5)2(µ-CH2R)(µ-PCy2)(CO)2] (R = H, Ph) with isocyanides and secondary phosphines.

The methyl-bridged complex [Mo2Cp2(µ-Me)(µ-PCy2)(CO)2] (Cp = η(5)-C5H5) reacted with stoichiometric amounts of CN(t)Bu at 243 K to give the C,O:C,O-bridged acyl complex [Mo2Cp2{µ-C,O:C,O-C(O)Me}(µ-PCy2)(CN(t)Bu)(CO)], which at room temperature slowly rearranges into its iminoacyl-bridged isomer [Mo2Cp2(µ-C,N:C,N-MeCN(t)Bu)(µ-PCy2)(CO)2]. In contrast, the C:O-bridged acyl complex [Mo2Cp2{µ-C:O-C(O)Me}(µ-PCy2)(CN(t)Bu)(CO)] was the major product obtained when the above reaction was carried out at room temperature. Density Functional Theory (DFT) was used to find the most likely structures of all these isomers, of which the iminoacyl complex was the absolute minimum. In contrast to the above reactions, up to three molecules of the ligand added rapidly to the methyl complex when using the aryl isocyanides CNR (R = o-C6H4Me, p-C6H4OMe), triggering the coupling between the methyl ligand and one of the cyclopentadienyl groups to give the corresponding methylcyclopentadiene derivatives [Mo2Cp(η(4)-C5H5Me)(µ-PCy2)(CNR)3(CO)]. Carbonylation of the latter complex (R = o-C6H4Me) induced the displacement of the η(4)-bound ligand, but also gave small yields of the hydride derivative [Mo2Cp(η(5)-C5H4Me)(µ-H)(µ-PCy2){CN(o-C6H4Me)}(CO)3] (Mo-Mo = 3.2467(5) Å), the latter resulting from a C-H cleavage in the methylcyclopentadiene ligand. The reaction of the title complexes with phosphines HPR (R' = Et, Ph) gave two major products: the corresponding aldehyde complexes [Mo2Cp2(µ-PCy2)(µ-PR){η(2)-C(O)HR}(CO)] (Mo-Mo = 2.8288(5) Å when R = CH2Ph and R' = Et) and the dicarbonyl complexes [Mo2Cp2(µ-PCy2)(µ-PR)(CO)2], these following from alternative reductive elimination processes, from hydrogen and either acyl or alkyl ligands, respectively.

Reactions of the unsaturated complex [Mo(2)(eta(5)-C(5)H(5))(2)(mu-PEt(2))(2)(CO)(2)] with [Au(PR(3))](+) cations: kinetic preference of the Mo-P bonds as the site of attack of the gold(I) electrophile.

The title complex reacts with [Au(PR(3))](+) cations (PF(6)(-) salts, R = p-tol, Me) in dichloromethane solutions to give first the corresponding agostic-like products [AuMo(2)Cp(2)(mu-PEt(2))(mu(3)-PEt(2))(CO)(2)(PR(3))]PF(6), which then partially rearrange to reach an equilibrium with the hydride-like isomers [AuMo(2)Cp(2)(mu-PEt(2))(2)(CO)(2)(PR(3))]PF(6), the latter being characterized through an X-ray study (R = p-tol, Mo-Mo = 2.8244(2) A). These unsaturated complexes react smoothly with CO (1 atm) to give the corresponding electron-precise derivatives [AuMo(2)Cp(2)(mu-PEt(2))(2)(CO)(3)(PR(3))](+) (Mo-Mo = 3.0438(6) A when R = Me), this implying the rearrangement of the mu(3)-PEt(2) ligand to a more common mu(2)-coordination mode. Density functional theory (DFT) calculations on the dimolybdenum complexes [Mo(2)Cp(2)(mu-PR(2))(2)(CO)(2)] (R = Cy, Et) reveal the presence of a framework M-P bonding orbital high in energy and with the right shape to act as a donor to H(+) and [Au(PR(3))](+) cations, thus explaining the formation of agostic and agostic-like products respectively in these reactions. The unusually high energy of this donor orbital can be related to the close approach of the metal centers in these unsaturated molecules. The carbyne complex [Mo(2)Cp(2)(mu-COMe)(mu-PCy(2))(CO)(2)] reacts with [Au{P(p-tol)(3)}](+) to give the tricarbonyl [AuMo(2)Cp(2)(mu-COMe)(mu-PCy(2))(CO)(3){P(p-tol)(3)}](+) (Mo-Mo = 2.986(1) A), a process most likely initiated by the binding of the gold cation to one of the Mo-P bonds in the carbyne complex.

M-P versus M=M bonds as protonation sites in the organophosphide-bridged complexes [M2Cp2(mu-PR2)(mu-PR'2)(CO)2], (M = Mo, W; R, R' = Ph, Et, Cy).

The unsaturated complexes [W2Cp2(mu-PR2)(mu-PR'2)(CO)2] (Cp = eta5-C5H5; R = R' = Ph, Et; R = Et, R' = Ph) react with HBF4.OEt2 at 243 K in dichloromethane solution to give the corresponding complexes [W2Cp2(H)(mu-PR2)(mu-PR'2)(CO)2]BF4, which contain a terminal hydride ligand. The latter rearrange at room temperature to give [W2Cp2(mu-H)(mu-PR2)(mu-PR'2)(CO)2]BF4, which display a bridging hydride and carbonyl ligands arranged parallel to each other (W-W = 2.7589(8) A when R = R' = Ph). This explains why the removal of a proton from the latter gives first the unstable isomer cis-[W2Cp2(mu-PPh2)2(CO)2]. The molybdenum complex [Mo2Cp2(mu-PPh2)2(CO)2] behaves similarly, and thus the thermally unstable new complexes [Mo2Cp2(H)(mu-PPh2)2(CO)2]BF4 and cis-[Mo2Cp2(mu-PPh2)2(CO)2] could be characterized. In contrast, related dimolybdenum complexes having electron-rich phosphide ligands behave differently. Thus, the complexes [Mo2Cp2(mu-PR2)2(CO)2] (R = Cy, Et) react with HBF4.OEt2 to give first the agostic type phosphine-bridged complexes [Mo2Cp2(mu-PR2)(mu-kappa2-HPR2)(CO)2]BF4 (Mo-Mo = 2.748(4) A for R = Cy). These complexes experience intramolecular exchange of the agostic H atom between the two inequivalent P positions and at room-temperature reach a proton-catalyzed equilibrium with their hydride-bridged tautomers [ratio agostic/hydride = 10 (R = Cy), 30 (R = Et)]. The mixed-phosphide complex [Mo2Cp2(mu-PCy2)(mu-PPh2)(CO)2] behaves similarly, except that protonation now occurs specifically at the dicyclohexylphosphide ligand [ratio agostic/hydride = 0.5]. The reaction of the agostic complex [Mo2Cp2(mu-PCy2)(mu-kappa2-HPCy2)(CO)2]BF4 with CN(t)Bu gave mono- or disubstituted hydride derivatives [Mo2Cp2(mu-H)(mu-PCy2)2(CO)2-x(CNtBu)x]BF4 (Mo-Mo = 2.7901(7) A for x = 1). The photochemical removal of a CO ligand from the agostic complex also gives a hydride derivative, the triply bonded complex [Mo2Cp2(H)(mu-PCy2)2(CO)]BF4 (Mo-Mo = 2.537(2) A). Protonation of [Mo2Cp2(mu-PCy2)2(mu-CO)] gives the hydroxycarbyne derivative [Mo2Cp2(mu-COH)(mu-PCy2)2]BF4, which does not transform into its hydride isomer.

[Vitamin D and bone health: is there a need to review supplementation in osteoporosis risk population?]. / Vitamina D y salud ósea: 'es necesario revisar la administración de sus suplementos en poblaciones de riesgo de osteoporosis?

Vitamin D is an essential hormone for achieving an optimal bone physiology. There is no universal consensus nowadays on the definition of hypovitaminosis D and cut-off values have been refined in the last years. The aim of this review is to analyze vitamin D deficiency among osteoporosis risk populations, including elderly and postmenopausal women, in Spain and other countries. We also review vitamin D supplementation: current clinical guidelines, last clinical studies, safety, and prescription schemes.

Vitamina D y salud ósea: ¿es necesario revisar la administración de sus suplementos en poblaciones de riesgo de osteoporosis? / Vitamin D and bone health: is there a need to review supplementation in osteoporosis risk population?

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[Study of polymorphism of Fc gamma IIa receptors in Chilean patients with systemic lupus erythematosus]. / Estudio del polimorfismo de receptores Fc gamma IIa en pacientes chilenos con lupus eritematoso sistémico.

BACKGROUND: Polymorphisms of Fc receptors for IgG (Fc gamma R) have been proposed as a genetic factor that influences susceptibility for systemic lupus erythematosus (SLE). Human Fc gamma RIIa has 2 codominantly expressed alleles, H131 and R131, which differ at amino acid position 131 in the second extracellular domain (histidine or arginine respectively) and differ substantially in their ability to bind human IgG2. The H131 allele binds IgG2 efficiently, whereas R131 binds it poorly. Because IgG2 is a poor activator of the classical complement pathway, the H131 is essential for the disposal of IgG2 immune complexes. AIM: To determine the distribution of Fc gamma RIIA genes in a cohort of Chilean SLE patients, with or without a history of lupus nephritis. PATIENTS AND METHODS: We studied 52 Chilean SLE patients fulfilling the 1982 American College of Rheumatology (ACR) criteria, 20 of whom had a history of nephritis, and 44 ethnically matched disease-free controls. Fc gamma RIIa allotypes were genotyped by PCR. RESULTS: No significant association was observed between the low affinity Fc gamma RII receptor (FcgRIIa-R131) and the presence of SLE or lupus nephritis. However, genotype frequencies in SLE patients but not in controls, departed from the proportions predicted by the Hardy-Weinberg equilibrium, suggesting this locus might be related to the disease. CONCLUSIONS: Our results suggest that in Chilean patients with SLE, as well as in many other populations, the R131 allotype is not a major factor predisposing to the development of SLE or lupus nephritis.

Resonancia magnética en la dilatación del ventrículo terminal / Magnetic resonance in the dilation of terminal ventricle

Objetivo: Describir los hallazgos por resonancia magnética (RM) en cuatro casos de dilatación del ventrículo terminal. Material y Métodos: Hemos estudiado cuatro pacientes, todas ellas mujeres, con una edad media de 39 años. Los estudios fueron realizados con un imán de 1T y las secuencias empleadas fueron sagitales y axiales potenciadas en T1 y T2 y sagitales y axiales potenciadas en T1 tras la administración de gadolinio. El seguimiento ha sido clínico y mediante RM. Resultados: Las cuatro pacientes estudiadas acudían por lumbalgia. Las imágenes de RM demostraron la presencia de una lesión quística localizada en el cono medular, de contorno bien definido y que en el estudio realizado con gadolinio no presentaba ningún tipo de realce. En tres casos disponemos de un control de RM a los dos años y la imagen no ha variado, en el cuarto caso de más reciente diagnóstico no disponemos de control. Conclusión: El ventrículo terminal es la cavidad ependimaria situada en el cono medular. Puede presentar una dilatación y es necesario conocer su existencia, su localización típica y características de señal para poder diagnosticarlo y diferenciarlo de tumoraciones quísticas en esta localización, que pueden presentar un aspecto por RM similar (AU)

Alta prevalencia de deficiencia de vitamina D en mujeres posmenopáusicas de una consulta reumatológica en Madrid. Evaluación de dos pautas de prescripción de vitamina D / High prevalence of vitamin D deficiency in postmenopausal women in a outpatient rheumatological clinic from Madrid area (Spain). Evaluation of two forms of vitamin D prescription

Fundamento: Se ha descrito una elevada frecuencia de deficiencia de vitamina D en la población senil en Europa, pero hay poca información sobre la prevalencia de deficiencia de esta vitamina en la población posmenopáusica en países mediterráneos. El objetivo de este estudio ha sido valorar su prevalencia en mujeres posmenopáusicas procedentes de una consulta reumatológica y evaluar la vitamina D durante un año tras dos pautas de tratamiento. Pacientes y métodos: Se valoró el 25(OH)D3 (calcidiol) sérico en 171 mujeres posmenopáusicas (111 con osteoporosis y 60 sin ella) procedentes de una consulta de reumatología en Madrid. Un grupo seleccionado de 83 mujeres con concentraciones de calcidiol inferiores a 10 ng/ml fue aleatorizado en dos grupos: al grupo I se le prescribieron 800 U/día de vitamina D3 y 1 g/día de calcio, y al grupo II una dosis de 80.000 U de vitamina D3 en forma de calcidiol, seguida de 800 U/día de vitamina D3 junto a 1 g/día de calcio. El calcidiol se cuantificó por RIA en situación basal y a los 3, 6 y 12 meses de tratamiento. Se establecieron tres puntos de corte: 10, 15 y 20 ng/ml de calcidiol para calcular la prevalencia de deficiencia. Resultados: Los porcentajes de mujeres con deficiencia de vitamina D considerada como calcidiol < 10, < 15 o < 20 ng/ml fueron: el 35,3, el 64,1 y el 87,1 por ciento, respectivamente. Tras el tratamiento el calcidiol en el grupo II fue mayor que en el grupo I a los 3 meses. El porcentaje de mujeres con concentraciones superiores a 10 y 15 ng/ml fue mayor en el grupo II que en el grupo I. Sin embargo, los valores de calcidiol se igualaron a los 6 y 12 meses. Conclusión: Se observa una elevada prevalencia de deficiencia de vitamina D en un grupo de mujeres posmenopáusicas que acudieron a una consulta reumatológica en Madrid. Ambas pautas de administración de vitamina D parecen ser insuficientes para mantener las concentraciones adecuadas de calcidiol sérico. Debería considerarse una pauta de 80.000 U dos veces al año. (AU)