Centro sanitario integral Alto Palancia: ejemplo de modernización y acercamiento de la asistencia especializada al ciudadano / Comprehensive health care center Alto Palancia: example of modernization and approach of specialized care to the citizen

Introducción y objetivo: La lejanía de la atención especializada se ha ido acortando progresivamente gracias a la creación de centros sanitarios más próximos a la población. Muchos de estos centros se establecen como modelo de modernización de la asistencia especializada, integrada con atención primaria, con un nivel muy elevado de satisfacción de sus usuarios. Un ejemplo de ello lo tenemos en el Centro Sanitario Integral Alto Palancia. El objetivo es analizar la mejora de la actividad asistencial desarrollada en el centro a raíz de la instauración progresiva de los nuevos modelos asistenciales, así como conocer la opinión de los usuarios respecto de la asistencia especializada recibida. Material y métodos: Analizamos la mejora de la actividad asistencial a través de indicadores, que comparamos con años precedentes. Para determinar el grado de satisfacción de los usuarios realizamos una encuesta de opinión de pacientes y familiares atendidos en el centro. El tamaño muestral fue de 96 entrevistas, estratificadas por edad y sexo, en las que se evaluaron un total de 10 ítems. Resultados: Hemos reducido el número de consultas de asistencia especializada en un 17 por ciento, y se ha pasado de un índice de frecuentación de 2,7 en el año 2001 a 2,49 en 2002. El tiempo de demora para primera visita es actualmente inferior a 15 días. El 24 por ciento de primeras visitas se realizan en régimen de "consulta única". De los pacientes dados de alta en atención especializada con un plan de seguimiento para atención primaria, solo el 18 por ciento se han remitido de nuevo al especialista. La encuesta de opinión muestra una valoración media alta (7,9 sobre 10), y los ítems mejor valorados son "la cercanía del centro" (9,1) y la "calidad de la atención" (8,5). Conclusiones: La proximidad o acercamiento al ciudadano y el modelo innovador de asistencia integral constituyen las particularidades fundamentales del centro, que junto a los demás elementos de modernización determinan la eficiencia y el alto nivel de satisfacción y calidad percibida por los usuarios (AU)

Influence of light/dark, seasonal and lunar cycles on the nuclear size of the pinealocytes of the rat.

Morphological and physiological studies suggest a possible division of the pineal parenchyma into an external or "cortical" and another central or "medullar" layer. We have studied the possible influence of the light/dark, seasonal and lunar cycles on the nuclear size of the pinealocytes of the rat in both the hypothetical "cortical" and "medullar" layers. Forty male Wistar rats were used. Experiment was carried out in two seasons, winter and spring, two lunar phases, full moon and new moon, and the two circadian phases, photophase and scotophase. The nuclear volume of the pinealocytes, calculated from the Jacobj's formula, was the karyometric parameter used as measurement of the nuclear size. Main results showed that nuclear volume of the cortical pinealocytes was greater than that of the medullar pinealocytes only during the photophases of winter new-moon days and spring full moon days, whereas in all the remaining situations, the greater nuclear sizes were found in the pinealocytes of the medullar layer. These results support the existence of independent morphological variations of the pinealocyte in the central and peripheral zones of the pineal gland.

Influence of light/dark, seasonal and lunar cycles on serum melatonin levels and synaptic bodies number of the pineal gland of the rat.

Synaptic bodies (SB) are ultrastructural organelles observed in the pinealocytes of mammals. According to its shape, they have been classified into synaptic ribbons (SR), synaptic spherules (SS), and intermediate synaptic bodies (ISB). They have been related to the melatonin regulation and production mechanisms of the pineal gland. Circadian and circannual fluctuations of both melatonin and SB have been reported. The possibility that other external factors, apart from light-dark or seasonal cycles, might influence pineal function has been suggested. We studied the evolution of the number of SB and serum melatonin levels not only during light-dark and seasonal phases but also during lunar cycles. Forty male wistar rats were used. Experiment was first carried out in winter and repeated identically in spring. Each season, one group of animals was killed during the new-moon days and a second group during the full-moon days: half of both groups in the photophase and the other half in the scotophase. The number of SB was measured at electron microscopic level whereas serum melatonin levels were determined by radioimmunoassay techniques. Main results showed that SR number and serum melatonin levels were higher during scotophases, winter and full-moon days. The SS only showed a light predominance during winter, whereas predominance of the ISB was found only during the scotophases. These results support the influence of the photophasic factors on the SR and ISB variations. In the case of the SS the influence of the lunar cycles is always dependent on the other factors. Finally, the serum level of melatonin is clearly influenced by the photophasic rhythms and the seasonal periods but not by the lunar cycles.

Pineal "synaptic" ribbons evolution over a 24 hour period during two different photoluminous seasons, a comparative and statistical analysis.

A comparative statistical analysis of "synaptic ribbons" evolution over a 24 hour period during two different photoluminous seasons (September, and winter) is carried out. Seventy male rats were used. Statistical analysis involved the Kolmogorov-Smirnov test, variance analysis, the Student t-test and Pearson's correlation test. The results show that "synaptic ribbons" evolve during the circadian phase and through two different seasons, with a clear and marked influence of point-time (p < 0.0001) and season (p < 0.0001).

Morphometric and structural study of the pineal gland of the Wistar rat subjected to the pulse action of a 52 Gauss, (50 Hz) magnetic field. Evolutive analysis over 21 days.

A study is made of the pinealocyte karyometric index and pineal gland ultrastructure in 60 male Wistar rats (250 g on average) sacrificed 1, 3, 7, 15 and 21 days after commencing application of a magnetic field (intensity, 52 Gauss; frequency, 50 Hz) for a period of 30 minutes daily. A progressive decrease was observed in karyometric index corresponding to both the peripheral and central gland region, with a significant difference between the two after 3 and 7 days (p less than 0.0001). A significant increase in lipid activity was also seen during the same period. Pineal gland structural organization during the experimental period is evaluated at both light and electron microscope level.