Fragilidad y riesgo de dependencia: el cuestionario de Barber en estudios poblacionales / Frailty and risk of dependency: Barber's questionnaire in population based studies

Introducción: La dependencia funcional es un problema creciente, vinculado al incremento de edad, especialmente en países industrializados. Los estudios poblacionales permiten un acercamiento a la magnitud del problema. Objetivo: El cuestionario de Barber es un instrumento ampliamente utilizado para la detección de riesgo de dependencia, vulnerabilidad o fragilidad en adultos mayores. No se han encontrado trabajos que lo apliquen en estudios poblacionales, en los que, por su sencillez, podría resultar útil. Metodología: Se incluyó el cuestionario en una encuesta de salud, con una muestra representativa (n = 1.882 sujetos) de personas de 65 años o más, de una gran ciudad (Madrid, España) y se presentan las evidencias de validez basada en la estructura interna y la relación con otras variables de tipo convergente y discriminante. Resultados: Se obtuvo una solución unifactorial, con adecuada consistencia interna según varios indicadores multivariados. Se encontraron diferencias significativas por sexo, tanto al nivel de la escala como de los ítems. También aparecieron correlaciones significativas entre la puntuación total de la prueba y la de otras variables, como la calidad de vida relacionada con la salud, la edad y la sensación de soledad. Un 58,1% de la muestra obtuvo puntuaciones que sugieren vulnerabilidad (el 65,3% de las mujeres). Conclusiones: Los resultados sugieren la utilidad del cuestionario de Barber, como prueba fiable y válida, para detectar situaciones de fragilidad o vulnerabilidad en adultos mayores, lo que facilitaría la comparabilidad entre encuestas poblacionales, superando la actual tendencia a incluir decenas de preguntas en otras encuestas de índole regional o nacional (AU)

Introduction: Functional dependence is a growing problem, linked to increasing age, especially in industrialized countries. Population studies allow an approach to the magnitude of the problem. Objectives: Barber's questionnaire is a widely used instrument for the detection of risk of dependence, vulnerability or frailty in older adults. No works have been found that apply it in population-based studies, where, due to its simplicity, it could be useful. Methodology: The questionnaire was included in a Health Survey, with a representative sample (n = 1,882 subjects) of people aged 65 years or more, from a big city (Madrid, Spain) and the evidence of validity is presented based on the internal structure and the relationship with other variables of convergent and discriminant type. Results: A unifactorial solution was obtained, with adequate internal consistency according to several multivariate indicators. Significant differences were found by sex, both at the scale and item level. Significant correlations also appeared between the total test score and other variables, such as health-related quality of life, age, and sense of loneliness. A total of 58.1% of the sample obtained scores suggesting vulnerability (65.3% of the women). Conclusions: The results suggest the usefulness of the Barber questionnaire, as a reliable and valid test, to detect situations of frailty or vulnerability in older adults, which would facilitate comparability between population surveys, overcoming the current tendency to include dozens of questions in other regional or national surveys (AU)

Influence of W doping on the structure, magnetism and exchange bias in Ni47Mn40Sn13-xWxHeusler alloys.

The influence of the W-doping on the martensitic transformation, magnetic properties and exchange bias (EB) effect in the Ni47Mn40Sn13-xWx(x= 0, 0.5, 1, 1.25 at.%) magnetic shape memory alloys has been investigated. It is found that the W-doping causes a simultaneous reduction of both the ferromagnetic (FM) exchange coupling and enhancement of the magnetic anisotropy, leading to a decrease of the magnetic moment of the low-temperature phase and to a higher attainable EB. The magnetic memory measurements reveal the presence of a glassy magnetic ground state, which can significantly impact the reduction of magnetization and enhancement of EB in the studied bulk alloys. It is argued that the glassy magnetic ground state originates from the partial magnetic disorder resulting from the correlation between the antiferromagnetic and FM states. The results demonstrate that the doping by W instead of Sn is an efficient tool to tailor the EB effect in the Ni-Mn-Sn-based Heusler alloys, whereby they are promising for spintronic applications.

Estudio de satisfacción del paciente ante la realización de una ecografía en atención primaria / Study of patient satisfaction when performing an ultrasound in Primary Care

Objetivo: Analizar el grado de satisfacción del paciente al realizarle una ecografía diagnóstica por un médico de familia. Material y métodos: Estudio observacional descriptivo transversal, realizado en 2 centros de salud de Madrid, entre diciembre 2015 y marzo 2016, mediante una encuesta anónima que consta de 2 partes: una de elaboración propia que recoge variables sociodemográficas, y una adaptación a nuestros objetivos de la "encuesta de satisfacción a usuarios de centros de salud" incluida en el documento "Evaluación de la satisfacción de los usuarios de los servicios de asistencia sanitaria pública de la Comunidad de Madrid" de la Dirección General de Coordinación a la Atención al Ciudadano y Humanización de la Asistencia Sanitaria, Consejería de Sanidad de Madrid, 2014. Población: Pacientes a quienes su médico de familia les realiza una ecografía con fines diagnósticos. Los pacientes cumplimentan la encuesta transcurridos 15-30 días, minimizando el sesgo de autoridad. La muestra se obtiene por muestreo consecutivo no probabilístico. Resultados: El nivel "satisfecho-muy satisfecho" alcanza el 95% con relación a la aprobación del médico de familia comparado con el especialista del hospital para realizar la ecografía; el 92% elegirían el centro de salud para realizarse una segunda ecografía; el 96% lo recomendaría a terceros; el 95% ven sus expectativas cumplidas. Conclusiones: La realización de una ecografía diagnóstica por médicos de familia es valorada con alto grado de satisfacción por los pacientes. No existen estudios comparables en el ámbito de la atención primaria. Sería necesario hacer estudios multicéntricos para poder generalizar los resultados

Objective: To analyse the level of patient satisfaction when undergoing a diagnostic ultrasound by a family doctor. Material and method: A cross-sectional descriptive observational study was conducted in two health centres in Madrid, between December 2015 and March 2016. An anonymous questionnaire was used, consisting of two parts: one in-house prepared that included the socio-demographic variables, and an adaptation to the study objectives of the "survey of satisfaction of users of health centres" included in the document "Evaluation of the satisfaction of users of public health care services of the Community of Madrid" by the General Directorate of Coordination for Citizen Services and Humanisation of Health Care, Ministry of Health of Madrid, 2014. Population: Patients on whom their family doctor performed an ultrasound for diagnostic purposes. Patients completed the questionnaire after 15 to 30 days, thus minimising the authority bias. The sample was obtained by consecutive non-probabilistic sampling. Results: The level of "satisfied-very satisfied" reached 95%, with the approval of the family doctor compared with the hospital specialist performing the ultrasound. The health centre would be chosen by 92% if they had to undergo an ultrasound for a second time, 96% would recommend it to third parties, and 95% considered that their expectations were met. Conclusions: The performance of a diagnostic ultrasound by family doctors was evaluated with a high level of satisfaction by the patients. There are no comparable studies in the Primary Care field, and multicentre studies would be needed in order to generalise the results obtained

Characterization of the European Sea Bass (Dicentrarchus labrax) Gonadal Transcriptome During Sexual Development.

The European sea bass is one of the most important cultured fish in Europe and has a marked sexual growth dimorphism in favor of females. It is a gonochoristic species with polygenic sex determination, where a combination between still undifferentiated genetic factors and environmental temperature determines sex ratios. The molecular mechanisms responsible for gonadal sex differentiation are still unknown. Here, we sampled fish during the gonadal developmental period (110 to 350 days post fertilization, dpf), and performed a comprehensive transcriptomic study by using a species-specific microarray. This analysis uncovered sex-specific gonadal transcriptomic profiles at each stage of development, identifying larger number of differentially expressed genes in ovaries when compared to testis. The expression patterns of 54 reproduction-related genes were analyzed. We found that hsd17ß10 is a reliable marker of early ovarian differentiation. Further, three genes, pdgfb, snx1, and nfy, not previously related to fish sex differentiation, were tightly associated with testis development in the sea bass. Regarding signaling pathways, lysine degradation, bladder cancer, and NOD-like receptor signaling were enriched for ovarian development while eight pathways including basal transcription factors and steroid biosynthesis were enriched for testis development. Analysis of the transcription factor abundance showed an earlier increase in females than in males. Our results show that, although many players in the sex differentiation pathways are conserved among species, there are peculiarities in gene expression worth exploring. The genes identified in this study illustrate the diversity of players involved in fish sex differentiation and can become potential biomarkers for the management of sex ratios in the European sea bass and perhaps other cultured species.

[Study of patient satisfaction when performing an ultrasound in Primary Care]. / Estudio de satisfacción del paciente ante la realización de una ecografía en atención primaria.

OBJECTIVE: To analyse the level of patient satisfaction when undergoing a diagnostic ultrasound by a family doctor. MATERIAL AND METHOD: A cross-sectional descriptive observational study was conducted in two health centres in Madrid, between December 2015 and March 2016. An anonymous questionnaire was used, consisting of two parts: one in-house prepared that included the socio-demographic variables, and an adaptation to the study objectives of the "survey of satisfaction of users of health centres" included in the document "Evaluation of the satisfaction of users of public health care services of the Community of Madrid" by the General Directorate of Coordination for Citizen Services and Humanisation of Health Care, Ministry of Health of Madrid, 2014. POPULATION: Patients on whom their family doctor performed an ultrasound for diagnostic purposes. Patients completed the questionnaire after 15 to 30 days, thus minimising the authority bias. The sample was obtained by consecutive non-probabilistic sampling. RESULTS: The level of "satisfied-very satisfied" reached 95%, with the approval of the family doctor compared with the hospital specialist performing the ultrasound. The health centre would be chosen by 92% if they had to undergo an ultrasound for a second time, 96% would recommend it to third parties, and 95% considered that their expectations were met. CONCLUSIONS: The performance of a diagnostic ultrasound by family doctors was evaluated with a high level of satisfaction by the patients. There are no comparable studies in the Primary Care field, and multicentre studies would be needed in order to generalise the results obtained.

Radiographic and computed tomographic appearance of tracheal collapse with axial rotation in four dogs.

Tracheal collapse with axial rotation was diagnosed in four dogs. Radiographs showed increased tracheal dorsoventral height at the caudal cervical and thoracic inlet with and apparent intraluminal soft tissue opacity, mimicking an intraluminal tracheal foreign body. Computed tomography confirmed dorsoventral tracheal collapse with axial rotation in all dogs. Short-term outcome with medical treatment of all dogs was excellent.

A high migratory capacity of donor T-cells in response to the lymph node homing receptor CCR7 increases the incidence and severity of GvHD.

The pathogenesis of GvHD involves migration of donor T-cells into the secondary lymphoid organs in the recipient, which is steered by two homing molecules, CD62L and CCR7. Therefore, we investigated whether the migratory capacity of donor T-cells is associated with GvHD. This single center prospective study included 85 donor-recipient pairs. In vitro chemotaxis assays of the lymphocytes of the apheresis product were performed in parallel to the analysis of CD62L and CCR7 by flow cytometry. The migratory index to the CCR7 ligands, CCL19 and CCL21, was higher in T-cells from donors whose recipients will develop GvHD. Similarly, the acute GvHD (aGvHD) group received higher percentage of CD4+CCR7+ T-cells, whereas chronic GvHD (cGvHD) patients were transplanted with higher percentages of CD8+CCR7+ T-cells compared with the non-GvHD group. These results were confirmed when patients were subdivided according to degrees of severity. Further, multivariate analysis confirmed that the proportions of CCR7+ CD4+ and CCR7+ CD8+ T-cells are risk factors for the development and severity of aGvHD and cGvHD, respectively. Functional experiments demonstrated that CCR7+ T-cells exhibited higher potential for activation than CCR7- T-cells did. We therefore propose that the selective depletion of CCR7-expressing T-cells may be an effective preventive therapy for GvHD.

Development of an in vitro system for functional studies of ovarian follicular cells in European sea bass (Dicentrarchus labrax).

The layers of follicular cells surrounding the oocyte and the interactions among them and the germ cells are critical for the successful maintenance of the ovarian functions. We have set up the isolation procedure and culture conditions of sea bass ovarian follicular cells. Their behaviour at three different physiological temperatures (25, 18 and 15 °C) was evaluated by verifying their steroidogenic capacity along time together with the expression of follicular specific genes (cyp19a1, fshr, lhr and star). These characteristics revealed this culture as a good in vitro alternative to short term in vivo studies at the level of the ovarian follicle. Moreover, to evaluate the suitability of this system for gene function studies conditions for transient transfection of plasmid DNA were optimized. Finally, the characteristics of the follicular culture were not affected by freezing and thawing cycles what facilitates the performance of experiments independently of the reproductive season. In conclusion, we have developed an in vitro homologous system that enables functional and gene expression studies and resembles the in vivo situation in the ovarian follicle.

Afectación multiorgánica por Streptococcus constellatus en paciente VIH positivo y carga viral negativa / Disseminated infection due to Streptococcus constellatus in and HIV patient with negative viral load

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[Botulinum toxin: clinical uses and anesthetic implications]. / Toxina botulínica: usos clínicos e implicaciones anestésicas.

Botulinum toxin, a neurotoxin responsible for botulism, is at present used to treat anomalous muscle contractions. Administration to children and relatively uncooperative patients requires general anesthesia, which should be selected taking into consideration the special characteristics of the surgical procedure and the possible interactions of anesthetic drugs and the toxin.

[A sickness called unemployment: a long-term unemployment. Association of Community Development (ACD)]. / Una enfermedad llamada paro: la trastienda del desempleo del larga duración. Asociación para el Desarrollo Comunitario (ADC).

OBJECTIVES: The general objective of this investigation is to know the possible consequences of long-term unemployment on the family and social environment, as well as the mechanisms which lead to the appearance of health problems among long-term unemployed people. METHODS: The subjects of this study were long-term unemployed people of 35 to 55 years of age of the municipal term of Madrid, with families depending on them. This is a qualitative-intensive investigation, with special emphasis on the individual, social, sanitary and economical aspects. The instrument of common measurement was the combination of the discussion group integrated by five people, during approximately 120 minutes, with focused and individual interviews (48) over a semistructured script, during approximately 60 minutes, using recording instruments (audio tape). RESULTS: During the development of the discussion group a worsening of the psychological health and family situation was observed as a consequence of remaining unemployed. In the more thorough interviews we could detect clear differences according to the impact of unemployment on health depending on the low socioeconomical area, women and older unemployed people. CONCLUSIONS: The effects of unemployment on health cannot be isolated from other underlying bad social and economical conditions, that is to say, from social, economical, educative inequalities, etc., previous to the unemployment situation.

[Plasma exchange with very low molecular weight heparin CY 222. Biological profile and therapeutic value]. / Echanges plasmatiques sous héparine de très faible masse moléculaire CY 222. Profil biologique et intérêt thérapeutique.

In a clinical, between-patient study we investigated the effects of a VLMW Heparin fragment (CY 222) versus standard heparin (SH) in plasma exchanges (n = 10) on coagulation factors (CF). Fibrinogen (FGN), II, V, VIIF + X, IX, XI, XII, VIIIc, VIIIRag, VIIIvwf and ATIII, ProtC, ProtS, Plasminogen (PGN), Activated Thromboplastin time (APTT), Prothrombin time (PT), Thrombin time (TT), anti factor Xa (Axa), DDimer, Platelet count. Heparin was administered as a bolus and by infusion during the session, CY 222 as a bolus dose only; 1 to 1.5 plasma volume was exchanged with substitution by 5% albumin. Results (mean, s.d.) at the end of the session (End) and 4 hours later (T4) were analyzed and showed no differences between groups (with CY 222 and with SH) for technical and clinical findings. Biologically, CF were similar in both groups except for Factor XII levels at the end of the session, and Factors II, V, XII at T4. Prolonged APTT in all samples appear related to low FGN. Significant differences in Axa activities were found for each treatment when compared with its own standard, suggesting different ranges of activities of both drugs. Changes in D-dimer levels differed during the session and four hours after the session with the drug tested, and could be related to their mode of administration. Clinical efficiency and tolerance were excellent both with CY 222 and SH.

[Prognostic value of cerebrospinal fluid fibrinolytic activity in meningeal hemorrhages as a result of aneurysm rupture]. / Intérêt pronostique de l'activité fibrinolytique du l.c.r. dans les hémorragies méningées par rupture anévrysmale.

26 patients with subarachnoid hemorrhage from ruptured cerebral aneurysms have been reviewed. Fibrinolytic activity of the C.S.F. has been evaluated by the dosage of Fibrin/Fibrinogen degradation products (F.D.P.). When patients have developed clinical signs of ischemia, F.D.P. levels were significantly higher than in those without neurological deficit. Even, if the detection of F.D.P. seems directly correlated to the presence of blood in the C.S.F., there is no direct relation between their level and the importance of S.A.H. as shown by C.T. scan. However when F.D.P. levels are greater than 80 mcg/ml, there is a high risk of vasospasm with clinical signs.