Efecto de la toxina botulínica tipo A en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica / Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae

Objetivo: Valorar el efecto del tratamiento con infiltraciones de toxina botulínica tipo A (TXB-A) en la funcionalidad facial, las sincinesias y la calidad de vida en pacientes con secuelas de parálisis facial periférica (PFP). Material y métodos: Presentamos un estudio prospectivo con una muestra de 20 pacientes con secuelas de PFP (15 mujeres, 5 varones) a los que se infiltró TXB-A (Botox® o Xeomin®). Todos los pacientes realizaron previamente un tratamiento personalizado basado en la reeducación neuromuscular. Se realizó una evaluación clínica previa a las infiltraciones y otra al cabo de 4 semanas. El efecto de las infiltraciones sobre la funcionalidad facial fue valorado mediante la escala Sunnybrook Facial Grading System (SFGS); el efecto sobre la calidad de vida se evaluó a través del cuestionario Facial Clinimetric Evaluation Scale (FaCE), y el efecto sobre la reducción de sincinesias se estudió utilizando el Synkinesis Assessment Questionnaire (SAQ). Resultados: La media de los valores del SFGS se incrementó tras el tratamiento con TXB-A, de 64,8 a 69,9 (p = 0,004). También se incrementó la media de los valores del FaCE Total, de 52,42 a 64,5 (p < 0,001), y la media de la subescala Social del FaCE, de 61,15 a 78,44 (p < 0,001). La media de los valores del SAQ disminuyó con las infiltraciones de TXB-A, de 46,22 a 37,55 (p = 0,001). Conclusiones: Las infiltraciones de TXB-A incrementan la funcionalidad facial, mejoran la calidad de vida y reducen las sincinesias en pacientes con secuelas de PFP.(AU)

Objectives: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). Material and methods: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. Results: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P = .004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P < .001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P < .001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P = .001). Conclusions: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.(AU)

Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae.

OBJECTIVES: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox© or Xeomin©) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.

Effect of botulinum toxin typeA in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. / Efecto de la toxina botulínica tipoA en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica.

OBJECTIVES: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.

Correlación entre deficiencia, afectación psicológica, discapacidad y calidad de vida en la parálisis facial periférica / Correlations between impairment, psychological distress, disability, and quality of life in peripheral facial palsy

Introducción: El objetivo de este trabajo es analizar la correlación entre escalas de deficiencia, afectación psicológica, discapacidad y calidad de vida en personas que han sufrido una parálisis facial periférica (PFP). Material y métodos: Se realizó un estudio transversal retrospectivo con 30 pacientes que habían presentado una PFP cuya resolución fue incompleta. Se utilizaron cuestionarios de deficiencia (Sunnybrook Facial Grading System [FGS]), afectación psicológica (Hospital Anxiety and Depression Scale [HADS]), discapacidad (Facial Disability Index [FDI]) y calidad de vida (Facial Clinimetric Evaluation Scale [FaCE]). Resultados: No encontramos correlación entre FGS y HADS, ni entre FGS y FDI Social. Existe correlación entre FGS y FDI Física (r = 0,54; p < 0,01), FDI total (r = 0,4; p < 0,05), FaCE total (ρ = 0,66; p < 0,01) y FaCE Social (ρ = 0,5;p < 0,01). Observamos correlación entre HADS Ansiedad y FDI Física (r = -0,47; p < 0,01), FDI Social (r = -0,47; p < 0,01), FDI Total (r = -0,55; p < 0,01), FaCE Total (ρ = -0,49; p < 0,01) y FaCE Social (ρ = -0,46; p < 0,05). También entre HADS Depresión y FDI Física (r=-0,61; p < 0,01), FDI Social (r=-0,53; p < 0,01), FDI Total (r = -0,66; p < 0,01), FaCE Total (ρ = -0,67; p < 0,01) y FaCE Social (ρ = -0,68; p < 0,01). Encontramos correlación entre FDI Física y FaCE Total (ρ = 0,87; p < 0,01) y FaCE Social (ρ = 0,74; p < 0,01), FDI Social y FaCE Total (ρ = 0,66; p < 0,01) y FaCE Social (ρ = 0,72; p < 0,01), y FDI Total y FaCE Total (ρ = 0,87; p < 0,01) y FaCE Social (ρ = 0,84; p < 0,01). Conclusión: En nuestro grupo de estudio, los pacientes con mayor déficit presentan mayor discapacidad física y global y peor calidad de vida, aunque no mayor discapacidad social ni mayor afectación psicológica. Los pacientes con mayor discapacidad presentan mayor afectación psicológica y peor calidad de vida. Los pacientes con mayor afectación psicológica presentan peor calidad de vida

Introduction: This paper analyses the correlations between scores on scales assessing impairment, psychological distress, disability, and quality of life in patients with peripheral facial palsy (PFP). Material and methods: We conducted a retrospective cross-sectional study including 30 patients in whom PFP had not resolved completely. We used tools for assessing impairment (Sunnybrook Facial Grading System [FGS]), psychological distress (Hospital Anxiety and Depression Scale [HADS]), disability (Facial Disability Index [FDI]), and quality of life (Facial Clinimetric Evaluation [FaCE] scale). Results: We found no correlations between FGS and HADS scores, or between FGS and FDI social function scores. However, we did find a correlation between FGS and FDI physical function scores (r = 0.54; P < .01), FDI total score (r=0.4; P < .05), FaCE total scores (ρ = 0.66; P < .01), and FaCE social function scores (ρ=0.5; P < .01). We also observed a correlation between HADS Anxiety scores and FDI physical function (r = -0.47; P < .01), FDI social function (r = -0.47; P < .01), FDI total (r = -0.55; P < .01), FaCE total (ρ= - 0.49; P < .01), and FaCE social scores (ρ = -0.46; P < .05). Significant correlations were also found between HADS Depression scores and FDI physical function (r = - 0.61; P < .01), FDI social function (r = -0.53; P < .01), FDI total (r = - 0.66; P < .01), FaCE total (ρ = - 0.67; P < .01), and FaCE social scores (ρ = -0.68; P < .01), between FDI physical function scores and FaCE total scores (ρ = 0.87; P < .01) and FaCE social function (ρ = 0.74; P < .01), between FDI social function and FaCE total (ρ = 0.66; P < .01) and FaCE social function scores (ρ = 0.72; P < .01), and between FDI total scores and FaCE total (ρ = 0,87; P < .01) and FaCE social function scores (ρ = 0.84; P < .01). Conclusion: In our sample, patients with more severe impairment displayed greater physical and global disability and poorer quality of life without significantly higher levels of social disability and psychological distress. Patients with more disability experienced greater psychological distress and had a poorer quality of life. Lastly, patients with more psychological distress also had a poorer quality of life

Correlations between impairment, psychological distress, disability, and quality of life in peripheral facial palsy. / Correlación entre deficiencia, afectación psicológica, discapacidad y calidad de vida en la parálisis facial periférica.

INTRODUCTION: This paper analyses the correlations between scores on scales assessing impairment, psychological distress, disability, and quality of life in patients with peripheral facial palsy (PFP). MATERIAL AND METHODS: We conducted a retrospective cross-sectional study including 30 patients in whom PFP had not resolved completely. We used tools for assessing impairment (Sunnybrook Facial Grading System [FGS]), psychological distress (Hospital Anxiety and Depression Scale [HADS]), disability (Facial Disability Index [FDI]), and quality of life (Facial Clinimetric Evaluation [FaCE] scale). RESULTS: We found no correlations between FGS and HADS scores, or between FGS and FDI social function scores. However, we did find a correlation between FGS and FDI physical function scores (r=0.54; P<.01), FDI total score (r=0.4; P<.05), FaCE total scores (ρ=0.66; P<.01), and FaCE social function scores (ρ=0.5; P<.01). We also observed a correlation between HADS Anxiety scores and FDI physical function (r=-0.47; P<.01), FDI social function (r=-0.47; P<.01), FDI total (r=-0.55; P<.01), FaCE total (ρ=-0.49; P<.01), and FaCE social scores (ρ=-0.46; P<.05). Significant correlations were also found between HADS Depression scores and FDI physical function (r=-0.61; P<.01), FDI social function (r=-0.53; P<.01), FDI total (r=-0.66; P<.01), FaCE total (ρ=-0.67; P<.01), and FaCE social scores (ρ=-0.68; P<.01), between FDI physical function scores and FaCE total scores (ρ=0.87; P<.01) and FaCE social function (ρ=0.74; P<.01), between FDI social function and FaCE total (ρ=0.66; P<.01) and FaCE social function scores (ρ=0.72; P<.01), and between FDI total scores and FaCE total (ρ = 0,87; P<.01) and FaCE social function scores (ρ=0.84; P<.01). CONCLUSION: In our sample, patients with more severe impairment displayed greater physical and global disability and poorer quality of life without significantly higher levels of social disability and psychological distress. Patients with more disability experienced greater psychological distress and had a poorer quality of life. Lastly, patients with more psychological distress also had a poorer quality of life.

Análisis de los factores que influyen en la afectación psicológica, la capacidad funcional y la calidad de vida en pacientes con parálisis facial periférica / Analysis of factors contributing to psychological distress, functional capacity and quality of life in patients with peripheral facial palsy

Introducción y objetivos. El objetivo de este trabajo es analizar diferentes factores que pueden influir en la afectación psicológica, la capacidad funcional y la calidad de vida en personas que han sufrido una parálisis facial periférica (PFP) no resuelta completamente. Material y métodos. Se realizó un estudio transversal retrospectivo con 31 pacientes que habían sufrido una PFP cuya resolución fue incompleta. Los factores analizados fueron: severidad, edad, sexo, lateralidad, etiología, grado de lesión inicial del nervio, tiempo de evolución, estado civil y ocupación laboral. Se utilizaron cuestionarios de afectación psicológica (Escala de Ansiedad y Depresión Hospitalaria [HADS]), discapacidad (Índice de Discapacidad Facial [FDI]) y calidad de vida (Facial Clinimetric Evaluation Scale [FaCE]). Resultados. El factor más relevante fue la severidad, con correlaciones estadísticamente significativas con el FaCE total (r=0,596; p<0,01), el FaCE social (r=0,444; p<0,05), el FDI física (r=0,539; p<0,01), y el FDI total (r=0,395; p<0,05). La edad se correlacionaba con el FDI social (r=0,36; p<0,05). Los que tenían pareja presentaban mayor discapacidad, con diferencias de medias estadísticamente significativas en el FDI física (p<0,01) y el FDI total (p<0,01). Trabajar de cara al público asociaba una peor calidad de vida, con diferencias estadísticamente significativas en el FaCE total (p<0,05). Conclusión. La severidad de la PFP tiene una correlación directa con la discapacidad y la calidad de vida. La edad influye en la discapacidad social. El estado civil se asocia con la discapacidad y el trabajo con la calidad de vida. La influencia del resto de factores es poco relevante (AU)

Introduction and objectives. The aim of this study was to analyse various factors that can contribute to psychological distress, functional capacity and quality of life in people with incompletely resolved peripheral facial palsy (PFP). Material and methods. We performed a retrospective cross-sectional study in 31 patients with incompletely resolved PFP. The factors analysed were: severity, age, gender, laterality, aetiology, degree of initial nerve injury, duration, marital status and occupation. Psychological distress was assessed through the Hospital Anxiety and Depression Scale (HADS), disability through the Facial Disability Index (FDI) and quality of life through the Facial Clinimetric Evaluation Scale (FaCE) questionnaires. Results. The most important factor was severity, with statistically significant correlations with FaCE Total (r=0.596; p<0.01), FaCE Social (r=0.444; p<0.05), FDI Physical (r=0.539; p<0.01), and FDI Total (r=0.395; p<0.05). Age was correlated with FDI Social (r=0.36; p<0.05). Patients with a partner showed more disability, with statistically significant differences in mean scores of FDI Physical (p<0.01) and FDI Total (p<0.01). Working with the public was associated with lower quality of life, with statistically significant differences in FaCE Total (p<0.05). Conclusion. The severity of PFP is directly correlated with disability and quality of life. Age influences social disability. Marital status is associated with disability and occupation with quality of life. The other factors studied had little influence (AU)

An Early Pleistocene hominin mandible from Atapuerca-TD6, Spain.

We present a mandible recovered in 2003 from the Aurora Stratum of the TD6 level of the Gran Dolina site (Sierra de Atapuerca, northern Spain). The specimen, catalogued as ATD6-96, adds to the hominin sample recovered from this site in 1994-1996, and assigned to Homo antecessor. ATD6-96 is the left half of a gracile mandible belonging to a probably female adult individual with premolars and molars in place. This mandible shows a primitive structural pattern shared with all African and Asian Homo species. However, it is small and exhibits a remarkable gracility, a trait shared only with the Early and Middle Pleistocene Chinese hominins. Furthermore, none of the mandibular features considered apomorphic in the European Middle and Early Upper Pleistocene hominin lineage are present in ATD6-96. This evidence reinforces the taxonomic identity of H. antecessor and is consistent with the hypothesis of a close relationship between this species and Homo sapiens.

Short human occupations in the Middle Palaeolithic level I of the Abric Romani rock-shelter (Capellades, Barcelona, Spain).

This paper presents a multidisciplinary study on the size of the occupied surfaces, provisioning strategies and behaviour planning at the Romani rock-shelter, using the Middle Palaeolithic record of the level i. This level is dated around 46.000 BP through U/Th ages. A behavioural interpretation is proposed, which emphasises the activities and the systemic value of the archaeological artefacts and structures. Occupation patterns are identified on the basis of the accumulations formed by human activities. These archaeological accumulations, consisting of artefacts and hearths, are easily defined visually as spatial units. The relationships between these accumulations, established by means of refitted remains, indicate that differences can be established between: 1) small and medium-sized occupation surfaces; 2) restricted and diversified provisioning strategies. This variability suggests that different modes of occupation are represented in the same archaeological level. The human activities reveal the generalization of fire technology. In almost all sizes of the occupation surfaces, the exploitation of vegetal resources near the Abric Romani marks the threshold of the restricted provisioning strategy. Limited use and fragmented knapping activities are recorded in the lithic assemblage. Faunal remains show differential transport. The exploitation of lithic, faunal and vegetal resources characterizes the diversified provisioning strategy. The small occupation surfaces and restricted provisioning strategies suggest short settlements in the Abric Romani. This shorter occupation model complements the longer diversified provisioning strategy recorded in both small and medium-sized occupied surfaces. The selection of precise elements for transport and the possible deferred consumption in the diversified provision strategy suggest an individual supply. In this respect, Neanderthal occupations in the Romani rock-shelter show a direct relation to: 1) hunting strategic resources; 2) high, linear mobility.

[Documented immunization coverage in second-year primary schoolchildren from the province of Valladolid]. / Cobertura vacunal documentada en los escolares de segundo curso de educación primaria de la provincia de Valladolid.

OBJECTIVE: To estimate the documented immunization coverage and degree to which schoolchildren's vaccination cards are kept up to date. METHODS: Transversal descriptive study of children in the second year of primary education in the province of Valladolid during the 1999-2000 academic year. The sample consisted of 698 children with a participation rate of 82%. The percentage of children whose immunization schedule was up to date in accordance with their age, that of children with additional vaccinations and the accuracy of the vaccination cards was quantified. Information was collected through a questionnaire on vaccination cards or, for children without one, from their medical history. RESULTS: The documented immunization coverage was 99.3% (95% CI: 98.6-99.9) for the first three dose of diphtheria toxoid, tetanus toxoid and pertussis vaccine and poliomyelitis vaccine, 98.9% (95% CI: 97.7-99.5) for the measles, mumps and rubella vaccine and 95% (95% CI: 93.4-96.7) for all doses up to the age of six. In addition, 7.2% (95% CI: 5.3-9.2) were immunized against hepatitis B, 14.4% (95% CI: 11.6-17) against Haemophilus influenzae type B and 90.3% (95% CI: 88-92.5) against meningococal A + C. A total of 84.4% of vaccination cards were correctly filled in (95% CI: 81.7-87.2). CONCLUSIONS: Systematic immunization coverage in the schoolchildren was high. Because of their accuracy, vaccination cards were a useful tool for determining immunization coverage. Both the accuracy of the vaccination card and the incidence of non-systematic immunization were higher in urban areas.

Cobertura vacunal documentada en los escolares de segundo curso de educación primaria de la provincia de Valladolid / Documented immunization coverage in second-year primary schoolchildren from the province of Valladolid [Spain]

Objetivo: Estimar la cobertura vacunal documentada y la calidad de cumplimentación de la cartilla de vacunación en escolares. Métodos: Estudio descriptivo transversal en escolares de segundo de educación primaria de la provincia de Valladolid durante el curso 1999-2000. Se seleccionaron mediante muestreo por conglomerados 698 sujetos, y se alcanzó una participación del 82 por ciento. Se cuantificó el porcentaje de escolares con calendario completo de acuerdo con su edad, porcentaje de vacunas adicionales y calidad de cumplimentación de la cartilla. La información se obtuvo a partir de la cartilla de vacunación mediante un cuestionario, y a través de la historia clínica en aquellos que no la presentaron. Resultados: La cobertura documentada para las tres primeras dosis de DTP y polio es del 99,3 por ciento (intervalo de confianza [IC] del 95 por ciento: 98,6-99,9), para triple viral es del 98,9 por ciento (IC del 95 por ciento: 97,7-99,5) y para el total de dosis hasta los 6 años es del 95 por ciento (IC del 95 por ciento: 93,4-96,7). De manera adicional, un 7,2 por ciento (IC del 95 por ciento: 5,3-9,2) está vacunado de la hepatitis B, un 14,4 por ciento (IC del 95 por ciento: 11,6-17) de Haemophilus influenzae tipo b y un 90,3 por ciento (IC del 95 por ciento: 88-92,5) de antimeningocócica A + C. La calidad de cumplimentación se consideró buena en el 84,4 por ciento (IC del 95 por ciento: 81,7-87,2) de las cartillas. Conclusiones: En escolares la cobertura vacunal sistemática y la antimeningocócica A + C es alta. La buena calidad de la cartilla permite utilizarla para determinar la cobertura vacunal. Tanto la calidad del documento como el hecho de haber recibido alguna vacuna no sistemática es mayor en el área urbana (AU)