[Inverse correlation between psychotic disorders and tumor development]. / Correlación inversa entre trastornos psicóticos y el desarrollo de tumores.

Patients suffering from psychotic disorders have an increased morbidity compared with control population. Moreover, these patients are prone to habits such as smoking or obesity, which in fact are risk factors for developing neoplasias. OBJECTIVE: The current study is aimed to determine the prevalence of oncologic processes (lung, colon and prostate cancer) among patients diagnosed with psychotic disorders. METHODS: A total of 365 patients from the Hospital Universitario Fundación Alcorcón (HUFA) were included in the study. All of them were diagnosed with a psychotic disorder from 2013 to 2016. RESULTS: Studying the prevalence of oncologic processes (lung, colon and prostate cancer) between both groups revealed a significant reduction in patients diagnosed with a psychotic disorder compared with the control populations (p-value <0,05). CONCLUSIONS: Even though patients diagnosed with a psychotic disorder have a considerable morbidity and several risk factors related with the development of neoplasias, we can conclude that these patients are less likely to suffer from the aforementioned types of cancer.

Neonates with a prenatal diagnosis of hydrops fetalis: A 10-year experience in a tertiary care center.

INTRODUCTION: Hydrops fetalis (HF) is a rare condition with a high mortality. This study analysed the obstetric and perinatal outcomes of antenatally diagnosed HF according to its aetiology and the possibility of intrauterine treatment (IUT). PATIENTS AND METHODS: We carried out a retrospective review of the health records of 164 pregnant women with a prenatal diagnosis of HF in a tertiary care centre between 2011-2021. We analysed prenatal interventions, clinical findings, aetiologies and obstetric and live-born infant outcomes. RESULTS: An invasive prenatal study had been performed in 79.3% cases. The most common aetiologies were genetic disorders (31%), TORCH and parvovirus B19 infections (9.7%) and structural heart diseases (9.1%). Intrauterine treatment was performed in 25.6%, and 74.4% of pregnancies were terminated. Pregnancies with a prenatal diagnosis of genetic or chromosomal disorders had higher rates of elective termination compared to other aetiologies (P < .01). Among all pregnancies, only 25.6% resulted in live births (LBs), most of them preterm. Perinatal and 1-year survival rates were higher in the group that received IUT (P < .001). Among the LBs, structural heart diseases had the worst survival rates, while the aetiology with the best outcomes was tachyarrhythmia. Survival at 1 year of life among those born alive was 70%, but 58.6% of these infants had significant morbidity at discharge. CONCLUSIONS: Despite advances in the management of FH, the poor obstetric prognosis, perinatal mortality and morbidity of survivors is still significant. These data are important for the purpose of counselling families when HF is diagnosed antenatally.

Demographic and clinical characteristics of patients with α1-antitrypsin deficiency genotypes PI*ZZ and PI*SZ in the Spanish registry of EARCO.

Background: The Spanish registry of α1-antitrypsin deficiency (AATD) integrated in the European Alpha-1 Research Collaboration (EARCO) provides information about the characteristics of patients, in particular those with the PI*SZ genotype, which is frequent in Spain. Method: Individuals with severe AATD defined as proteinase inhibitor (PI) genotypes PI*ZZ, PI*SZ and other rare deficient variants were included from February 1, 2020, to February 1, 2022. The analysis focused on a comparison of the characteristics of PI*ZZ and PI*SZ patients. Results: 409 patients were included (53.8% men) with a mean±sd age of 53.5±15.9 years. Genotypes were PI*ZZ in 181 (44.7%), PI*SZ in 163 (40.2%), PI*SS in 29 (7.2%) and other in 32 (7.9%). 271 (67.4%) had lung disease: 175 chronic obstructive pulmonary disease (43.5%), 163 emphysema (40.5%) and 83 bronchiectasis (20.6%). Patients with the PI*SZ genotype were younger, more frequently non-index cases and had a lower frequency of respiratory diseases except asthma compared with PI*ZZ patients. Among patients with respiratory diseases, PI*SZ individuals were significantly older both at onset of symptoms and at diagnosis; only asthma was more frequent in PI*SZ than in PI*ZZ individuals. Twelve PI*SZ patients (15.4%) received augmentation therapy compared with 94 PI*ZZ patients (66.2%; p<0.001). Conclusions: There is a high prevalence of PI*SZ in Spain. Patients with the PI*SZ genotype were older at symptom onset and diagnosis and had less severe lung disease compared with PI*ZZ patients. The prevalence of asthma was higher in PI*SZ, and up to 15% of PI*SZ patients received augmentation therapy.

Sarcoidosis. Disease progression based on radiological and functional course: Predictive factors.

BACKGROUND: Sarcoidosis is a multiorgan granulomatous disease with a variable course. OOBJECTIVES: The purpose of this study is to identify the patients that are more likely to experience disease progression. METHODS: A retrospective study in patients ≥18 years. Pulmonary function and radiological stage (Scadding criteria) were assessed at diagnosis, and at 1, 3 and 5 years. Sarcoidosis progression was established based on deterioration of radiological or pulmonary function (decrease ≥10% of FVC and/or ≥15% of diffusing capacity of the lung (DLCO). RESULTS: The sample included 277 caucasian patients [mean age, 50±13.6; 69.7% between 31-60 years; 56.3% men]. In total, 65% had stage II sarcoidosis, whereas only 8.3% had stage III/IV disease. Mean pulmonary function (FVC, FEV1, FEV1/FVC and DLCO) at diagnosis was 103±21.8, 96±22.2, 76.2±8 and 81.7±21.7, respectively. The percentage of patients with normal FVC and DLCO was 72.2% and 51.8%, respectively. Radiological stage did not change significantly during follow-up (5 years; p=0.080) and only progressed in 13 patients (5.7%). At 3 years, FVC improved, whereas DLCO exacerbated significantly (p<0.001 for the two). Disease progressed in 34.5% of the patients (57/165) whose pulmonary function and radiological stage were available (both baseline and at 3 years). Age was associated with disease progression [OR=1.04 (95%CI=1.01, 1.06)]. Risk increased by 4% for each year older a patient was at diagnosis. CONCLUSIONS: At 3 years, a third of patients experienced sarcoidosis progression. Age was the only factor associated with disease prognosis.

Neonatos con diagnóstico prenatal de hidrops fetal: experiencia durante 10 años en un centro de tercer nivel / Neonates with a prenatal diagnosis of hydrops fetalis: A 10-year experience in a tertiary care center

Introducción: El hidrops fetal (HF) es una condición rara con una alta mortalidad. Este estudio analiza la evolución obstétrica y perinatal de los diagnósticos prenatales de HF, relacionándola con la etiología y el tratamiento intrauterino (TIU) recibido. Pacientes y métodos: Se revisaron 164 gestantes con diagnóstico prenatal de HF entre 2011 y 2021. Se registraron intervenciones prenatales, hallazgos clínicos, etiologías y resultados de los recién nacidos vivos. Resultados: Se realizó un estudio invasivo prenatal en el 79,3% de los pacientes. Las etiologías mayoritarias fueron alteraciones genéticas (31%), infecciones TORCH y por parvovirus B19 (9,7%), y cardiopatías estructurales (9,1%). En el 25,6% se realizó TIU, y entre todas las gestaciones, el 74,4% fueron interrumpidas. Las alteraciones genéticas tuvieron tasas más altas de interrupción legal del embarazo respecto a otras etiologías (p<0,01). Del total, solo nacieron el 25,6% de los fetos, la mayoría pretérmino. Los que recibieron TIU gozaron de mayores tasas de supervivencia perinatal y al año de vida (p<0,001). De entre aquellos nacimientos, las cardiopatías estructurales presentaron las peores tasas de supervivencia, mientras que las causas con mejor pronóstico fueron las taquiarritmias. La supervivencia al año de vida entre aquellos recién nacidos vivos fue del 70%, pero el 58,6% asociaron morbilidad significativa al alta. Conclusiones: A pesar de los avances en el manejo del HF, el mal pronóstico obstétrico, la mortalidad perinatal y la morbilidad de los supervivientes siguen siendo significativos. Estos datos son importantes para asesorar a las familias que reciben un diagnóstico prenatal de HF.(AU)

Introduction: Hydrops fetalis (HF) is a rare condition with a high mortality. This study analysed the obstetric and perinatal outcomes of antenatally diagnosed HF according to its aetiology and the possibility of intrauterine treatment (IUT). Patients and methods: We carried out a retrospective review of the health records of 164 pregnant women with a prenatal diagnosis of HF in a tertiary care centre between 2011 and 2021. We analysed prenatal interventions, clinical findings, aetiologies and obstetric and live-born infant outcomes. Results: An invasive prenatal study had been performed in 79.3% cases. The most common aetiologies were genetic disorders (31%), TORCH and parvovirus B19 infections (9.7%) and structural heart diseases (9.1%). Intrauterine treatment was performed in 25.6%, and 74.4% of pregnancies were terminated. Pregnancies with a prenatal diagnosis of genetic or chromosomal disorders had higher rates of elective termination compared to other aetiologies (P<.01). Among all pregnancies, only 25.6% resulted in live births (LBs), most of them preterm. Perinatal and 1-year survival rates were higher in the group that received IUT (P<.001). Among the LBs, structural heart diseases had the worst survival rates, while the aetiology with the best outcomes was tachyarrhythmia. Survival at 1year of life among those born alive was 70%, but 58.6% of these infants had significant morbidity at discharge. Conclusions: Despite advances in the management of FH, the poor obstetric prognosis, perinatal mortality and morbidity of survivors is still significant. These data are important for the purpose of counselling families when HF is diagnosed antenatally.(AU)

[Silence pact from the perspective of caretakers of palliative care patients]. / El pacto de silencio desde la perspectiva de las personas cuidadoras de pacientes paliativos.

OBJECTIVES: To determine why terminally-ill patients, family caregivers and health care providers make a pact of silence about the terminal status of the patient, and to identify the attitudes, experiences and opinions of family caregivers concerning the conspiracy of silence in palliative care. METHODS: A qualitative phenomenological study based on an interpretive analysis, conducted in Primary Health Care, Seville, Spain. Study dimensions: knowledge of the diagnosis and prognosis of the condition; disclosure of information; reaction to information received, feelings and approach to death; information disclosed to the patient and reasons behind partial disclosure; communication between patients, families, and health care providers. STUDY POPULATION: Family caregivers of patients on palliative care suspicious about a pact of silence. RESULTS: Family caregivers hamper professional-patient communication; use of deceit to conceal the truth; suspicion that the patient knows the truth; the clinician conceals the truth; paternalist attitudes; feelings of sadness, grief, resignation, acceptance of the disease. CONCLUSIONS: The pact of silence has negative effects on coping with death, quality of life in the last days of life, and mourning. Communication between patients, health care providers, and families should be improved to prevent the pact of silence, and help patients cope with death.

Engagement en estudiantes universitarios de la salud / Engagement in health university students

Identificar el engagement en los estudiantes de primer año de odontología de la Universidad Autónoma de Sinaloa. Estudio cuantitativo, transversal, correlacional, aplica la escala de UWES (Utrecht Work Engagement Scale) versión de 19 ítems con respuestas que van desde 1 = ninguna vez, 2 = pocas veces al año, 3 = pocas veces al mes, 4 = pocas veces por semana y 5 = todos los días, dicha escala integra tres factores: vigor, dedicación y absorción. La muestra fue seleccionada aleatoriamente, por conveniencia, conformándose por 145 estudiantes. Se realizó análisis de frecuencia estadística y correlacional en SPSS v.20. El 33.1% fueron hombres, 64.1% mujeres y 2.8% no contestó este rubro. La µ de la dimensión de vigor fue de 3.96, para absorción 4.11 y en dedicación 4.70. Por tanto, al resultar los valores de media mayor a 3, los estudiantes de odontología son «engaged¼, es decir, estudiantes comprometidos. Siendo la dimensión de dedicación la mejor puntada indicando que son entusiastas, están inspirados y tienen orgullo de su profesión. En el análisis de correlación de Pearson por dimensiones, se encontró que: vigor correlaciona con la variable de absorción (r = 0.529**, p < 0.000) y dedicación (r = 0.249**, p < 0.003). A su vez, la variable de dedicación correlaciona con absorción (r = 0.275**, p < 0.001). Y el análisis de confiabilidad de la escala total fue de 0.70. Se concluye que los estudiantes de odontología son comprometidos, tienen energía ante sus estudios y disfrutan de las actividades académicas (AU)

Identify the engagement in the first year dentistry students of the Autonomous University of Sinaloa. Quantitative, cross-sectional, correlational study, applies the scale of UWES (Utrecht Work Engagement Scale), version of 19 items with answers ranging from 1 = none, 2 = few times a year, 3 = few times a month, 4 = few times a week and 5 = every day, this scale includes 3 factors: vigor, dedication and absorption. The sample was selected randomly, for convenience, consisting of 145 students. Statistical and correlation frequency analysis was performed in SPSS v.20. 33.1% are men, 64.1% women and 2.8% did not answer the gender item. The µ of the vigor dimension was 3.96, for absorption 4.11 and in dedication 4.70. Therefore, when the average values are greater than 3, the dentistry students are engaged. Being the dedication dimension the best stitch indicating that they are enthusiastic, inspired and proud of their profession. In the Pearson correlation analysis by dimensions, it was found that: force correlates with the absorption variable (r = 0.529**, p < 0.000) and dedication (r = 0.249**, p < 0.003). In turn, the dedication variable correlates with absorption (r = 0.275**, p < 0.001). And the reliability analysis of the total scale was 0.70. It is concluded that dentistry students are committed, have energy before their studies and enjoy academic activities (AU)

Impacto del aprendizaje basado en problemas en estudiantes de salud humana / Impact of problem-based learning on the student of human health

Introducción: Las universidades quieren estudiantes entusiasmados, interesados, comprometidos con su aprendizaje; por ende, el docente, a través de estrategias de enseñanza, promueve en ellos un estado mental positivo para que dediquen tiempo y acciones para absorber el conocimiento y la habilidad con los que retribuirán a la sociedad. El aprendizaje basado en problemas constituye una estrategia didáctica que inicia con un problema real, en la cual el estudiante busca una solución. Objetivo: Analizar el impacto de la estrategia aprendizaje basado en problemas en el estudiante en salud humana. Métodos: Se realizó una búsqueda documental en las bases de datos Dialnet, Conricyt, Pubmed, Tesiunam y Google Académico. Se analizó el contenido de 60 estudios nacionales e internacionales publicados desde 2009 hasta 2017, de los cuales se retomaron 28, que detallaban el impacto del aprendizaje basado en problemas en el estudiante: 23 internacionales y 5 nacionales. Resultados: El aprendizaje basado en problemas influye en el aprendizaje significativo y autodirigido, porque los alumnos presentan un grado de satisfacción que genera un cambio en sus emociones y un aumento en el compromiso académico. De igual manera, impacta favorablemente en el rendimiento académico. Desde la opinión de los estudiantes, es una estrategia atractiva, efectiva y agradable en comparación con la enseñanza tradicional, ya que estimula la motivación, e incentiva el compromiso académico del estudiante que aprende en el contexto clínico. Conclusiones: El aprendizaje basado en problemas promueve el desarrollo de competencias clínicas, el compromiso académico, el aprendizaje autodirigido, significativo y activo, el rendimiento académico, la motivación y la participación, lo que da satisfacción y bienestar al estudiante. También estimula el pensamiento crítico, facilita la interacción alumno-alumno, y disminuye la presencia del burnout y el estrés. Finalmente desarrolla la metacognición(AU)

Introduction: Universities want students who are enthusiastic, interested and committed to their learning; therefore, the teacher, through teaching strategies, promotes in them a positive state of mind so that they dedicate time and actions to absorb the knowledge and ability with which they will give back to society. Problem-based learning constitutes a didactic strategy that begins with a real problem, in which the student seeks a solution. Objective: To analyze the impact of the problem-based learning strategy on the student in human health. Methods: A documentary search was carried out in the databases Dialnet, Conricyt, Pubmed, Tesiunam, and Google Scholar. The content of 60 national and international studies published from 2009 to 2017 was analyzed, of which 28 were taken on a second time, which detailed the impact of problem-based student learning: 23 international and 5 national. Results: Problem-based learning influences meaningful and self-directed learning, because students present a degree of satisfaction that generates a change in their emotions and an increase in academic commitment. Similarly, it impacts favorably on academic performance. From the students' opinion, it is an attractive, effective and enjoyable strategy compared to traditional teaching, since it stimulates motivation and encourages the academic commitment of the student who learns in the clinical context. Conclusions: Problem-based learning promotes the development of clinical skills, academic commitment, self-directed, meaningful and active learning, academic performance, motivation and participation, which gives satisfaction and well-being to the student. It also stimulates critical thinking, facilitates interaction among students, and decreases the presence of burnout and stress. Finally, it develops metacognition(AU)

El pacto de silencio desde la perspectiva de las personas cuidadoras de pacientes paliativos / Silence pact from the perspective of caretakers of palliative care patients

La conspiración o pacto de silencio es el acuerdo por parte de familiares y profesionales de ocultar información sobre su proceso al paciente en situación terminal. OBJETIVOS: Conocer por qué se produce el pacto de silencio entre pacientes en situación terminal, sus cuidadores y profesionales sanitarios, explorar e identificar las actitudes, vivencias y opiniones de las personas cuidadoras familiares al mantener la conspiración de silencio a pacientes paliativos. METODOLOGÍA: Estudio cualitativo con enfoque fenomenológico. Realizado en Atención Primaria en la provincia de Sevilla. Recogida de datos mediante entrevista semiestructurada audiograbadas. Exploración de las áreas de la comunicación: conocimiento sobre diagnóstico y pronóstico de la enfermedad; transmisión de la información; reacción sobre las noticias recibidas; información conocida por el paciente, motivos; comunicación con la familia; comunicación con los profesionales sanitarios y afrontamiento ante la muerte. Análisis interpretativo. Población de estudio: Personas cuidadoras familiares de pacientes en cuidados paliativos, con sospecha de pacto de silencio. Elección de los participantes de forma intencional, hasta saturación de la información. Los resultados son: Bloqueo de la comunicación profesional-paciente por parte de la familia; engaños, mentiras para mantener el ocultamiento; sospecha de que el paciente conoce la verdad; ocultamiento del médico/a responsable de su proceso al paciente, atención paternalista; sentimientos de tristeza, pena, resignación, tranquilidad ante la enfermedad. CONCLUSIONES: El pacto de silencio tiene consecuencias en el afrontamiento de la muerte, calidad de vida de los últimos días y duelo. La comunicación entre pacientes, sus familias y profesionales sanitarios debería mejorar para prevenir el pacto de silencio y así ayudarles a afrontar la muerte

OBJECTIVES: To determine why terminally-ill patients, family caregivers and health care providers make a pact of silence about the terminal status of the patient, and to identify the attitudes, experiences and opinions of family caregivers concerning the conspiracy of silence in palliative care. METHODS: A qualitative phenomenological study based on an interpretive analysis, conducted in Primary Health Care, Seville, Spain. Study dimensions: knowledge of the diagnosis and prognosis of the condition; disclosure of information; reaction to information received, feelings and approach to death; information disclosed to the patient and reasons behind partial disclosure; communication between patients, families, and health care providers. Study population: Family caregivers of patients on palliative care suspicious about a pact of silence. RESULTS: Family caregivers hamper professional-patient communication; use of deceit to conceal the truth; suspicion that the patient knows the truth; the clinician conceals the truth; paternalist attitudes; feelings of sadness, grief, resignation, acceptance of the disease. CONCLUSIONS: The pact of silence has negative effects on coping with death, quality of life in the last days of life, and mourning.communication between patients, health care providers, and families should be improved to prevent the pact of silence, and help patients cope with death

Tratamiento de la hemorragia uterina posparto mediante taponamiento mecánico con balón intrauterino / Management of postpartum hemorrhage with uterine balloon tamponade

Objetivo: Demostrar la utilidad del taponamiento mecánico del útero con balón en el tratamiento de la hemorragia posparto. Material y métodos: 5 gestantes a término, tratadas por hemorragia posparto precoz. El criterio para colocar el balón fue el sangrado persistente a pesar del tratamiento farmacológico. Resultados: La colocación del balón fue exitosa en el 100% de los casos. El descenso medio de hemoglobina fue de 3,2g/dl (rango [r]=1-5) y se requirió una media de 3 concentrados de hematíes por paciente (r=0-6). El volumen medio de suero por balón fue de 312ml (r=160-420) y el tiempo medio de tratamiento fue de 22h (r=: 12-30). Conclusiones: El taponamiento uterino con balón constituye un método eficiente para el control de la hemorragia uterina posparto. Su aplicación no precisa entrenamiento y puede evitar la cirugía. Por su fácil manejo y coste asequible, es aplicable en cualquier medio hospitalario (AU)

Objective: To demonstrate the usefulness of uterine balloon tamponade in postpartum hemorrhage. Material and methods: Five term pregnancies with postpartum hemorrhage were studied. The criterion for balloon placement was persistent bleeding despite pharmacological treatment. Results: Balloon placement was successful in 100% of the patients. The mean decrease in hemoglobin was 3.2g/dl (range: 1-5) and an average of three units of packed red blood cells per patient were required (range: 0-6). The mean volume of saline solution per balloon was 312ml (range: 160-420) and the mean duration of treatment was 22hours (range: 12-30). Conclusions: Uterine balloon tamponade is an efficient method to control postpartum hemorrhage. Training is not required for the application of this technique, which can obviate the need for surgery. Because of its ease of use and reasonable cost, this method can be used in any hospital setting (AU)

Revisión de la literatura sobre medidas psicométricas para personas con un trastorno de la alimentación / Literature review and psychometric instruments for people with eating disorder

Se presenta una revisión sistemática de los objetivos clínicos y las características psicométricas de los instrumentos de evaluación creados para personas con un Trastorno de la Conducta Alimentaria (TCA). Asimismo se valoran las deficiencias y las competencias de cada instrumento. La búsqueda bibliográfica se realizó consultando las bases de datos de Medline y Premedline (OVID), EBSCO, PsychInfo (1974-2003), PUB MED, buscadores de Internet y Catalogo de TEA ediciones. Se encontraron 30 instrumentos creados en lengua inglesa y 4 instrumentos en castellano. Todos los instrumentos en castellano eran adaptaciones de cuestionarios creados originalmente en otros países. Los instrumentos cumplían una gran variedad de propósitos clínicos (emitir un diagnóstico, detectar un TCA en la población, evaluar las conductas y cogniciones básicas) pero ninguno de ellos tenía como objetivo medir Calidad de Vida Relacionada con la Salud (CVRS) en personas con un TCA (AU)

A systematic review of clinical purpose and psychometric characteristics of measures designed for people with eating disorders (ED) is presented. Likewise, capabilities and weaknesses of each measure are assessed. A literature search was made, consulting the following databases: Medline and Premedline (OVID), EBSCO, PsychInfo (1974-2003), PUB MED, Internet search engines (mainly Google) and TEA Ediciones Catalogue. Thirty of the instruments found were in English and four were adaptations to Spanish -none of them were originally issued in Spanish. The measures met a range of clinical purposes such as issuing a diagnosis, screening eating disorders and assessing basic behaviors and cognition. None of the instruments were intended to measure health related quality of life in eating disorders (AU)