Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research.

Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Boccia in Paralympic Games: the evolution from 1984 to 2016 and future perspectives / Bocha en los Juegos Paralímpicos: la evolución de 1984 a 2016 y perspectivas futuras / Boccia nos Jogos Paralímpicos: a evolução de 1984 a 2016 e perspetivas futuras

This study aimed to analyze the participation in Boccia from 1984 to 2016 in Paralympic Games (PG) and envision future perspectives in the parasport. Data was obtained from official International Paralympic Committee webpage, from the first edition (1984) until 2016 and associated to athlete's classification, competitive format and number of played games, the number, nationality and gender of participants, and also the results. The number of athletes participating in PG has steadily increased between 1984 (19) and 2016 (106), the same was observed with relation to represented countries (1984 = 5 vs 2016 = 21) and medal countries (1984 = 5 vs 2012 and 2016 = 11). With respect to athletes' gender, an evident increase was observed, although not continuous throughout the PG editions (male 1984 = 11 vs 2016 = 73 / female 1984 = 8 vs 2016 = 33). Despite the total number of played games increased between 1984 (19) and 2016 (180), this has not been uniform, having even decreased between 2004 (252) and 2012 (161). This evidence is related to factors such as forms of qualification and competition format, that have changed over time, as well as classification system (BC4 was implement in 2004), and pairs and teams' format. It should also be highlighted that, in 1984 edition, PG were performed separating genders. Boccia is a developing parasport with several challenges, namely: i) the continuous increase in participants; ii) gender equally; iii) improvement of classification system; and iv) the competitions format to accommodate an increasing number of participants. (AU)

El objetivo de este estudio fue analizar la evolución de la Bocha de 1984 a 2016 en los Juegos Paralímpicos (JP) y vislumbrar perspectivas futuras en el paradeporte. Los datos se obtuvieron de la página oficial del Comité Paralímpico Internacional, de 1984 a 2016 y asociados a la clasificación de atletas, formato competitivo y número de partidos disputados, número, nacionalidad y sexo de los participantes, así como resultados. El número de atletas que participaron en el JP aumentó de manera constante entre 1984 (19) y 2016 (106), lo mismo se observó para los países representados (1984 = 5 vs 2016 = 21) y países que ganan medallas (1984 = 5 vs 2012 y 2016 = 11). En cuanto al género, se observó un aumento evidente, aunque no continuo a lo largo de las ediciones (masculino 1984 = 11 vs 2016 = 73 / femenino 1984 = 8 vs 2016 = 33). A pesar de la cantidad total de juegos ha aumentado entre 1984 (19) y 2016 (180), este no fue uniforme, incluso disminuyó entre 2004 (252) y 2012 (161). Esta evidencia está relacionada con factores como el modelo de clasificación y el formato de la competición, que ha cambiado con el tiempo, así como el sistema de clasificación (BC4 implementado en 2004) y el formato de parejas y equipos. Cabe señalar también que, en la edición de 1984, los JP se realizaron con separación de género. La Bocha es un paradeporte en desarrollo con varios desafíos, a saber: i) el aumento continuo de participantes; ii) igualdad de género; iii) mejoría del sistema de clasificación; y iv) formato competitivo para acomodar a un número cada vez mayor de participantes. (AU)

O objetivo deste estudo foi analisar a evolução do Boccia de 1984 a 2016 nos Jogos Paralímpicos (JP) e vislumbrar futuras perspetivas na modalidade paralímpica. Dados foram obtidos da página oficial do Comité Paralímpico Internacional, de 1984 até 2016 e associados à classificação dos atletas, formato competitivo e número de jogos disputados, número, nacionalidade e género dos participantes, e também resultados. O número de atletas participantes nos JP aumentou constantemente entre 1984 (19) e 2016 (106), o mesmo foi observado relativamente aos países representados (1984 = 5 vs 2016 = 21) e países medalhados (1984 = 5 vs 2012 e 2016 = 11). No que respeita ao género, um aumento evidente foi observado, embora não contínuo ao longo das edições (masculino 1984 = 11 vs 2016 = 73 / feminino 1984 = 8 vs 2016 = 33). Apesar do número total de jogos ter aumentado entre 1984 (19) e 2016 (180), este não foi uniforme, tendo mesmo diminuído entre 2004 (252) e 2012 (161). Esta evidência está relacionada com fatores como modelo de qualificação e formato da competição, que mudaram ao longo do tempo, bem como sistema de classificação (BC4 implementada em 2004) e formato de pares e equipas. De realçar ainda que, na edição de 1984, os JP foram realizados com separação de géneros. O Boccia é uma modalidade paralímpica em desenvolvimento com vários desafios, nomeadamente: i) o aumento contínuo de participantes; ii) igualdade de género; iii) melhoria do sistema de classificação; e iv) formato competitivo para acomodar um número crescente de participantes. (AU)

Effects of a 10-week dry-land strength and conditioning program in physical capacities and start of previously federated and regular swimming practitioners / Efecto de un programa de entrenamiento de fuerza y acondicionamiento en seco sobre las habilidades físicas en practicantes federados en natación / O efeito de um programa de treino de força e condicionamento em seco nas capacidades físicas e partida em praticantes regulares de natação previamente federados

The aim of this study was to evaluate the effects of a 10-week strength and conditioning (S&C) program in physical capacities and start in previously federated and regular swimming practitioners. 16 swimmers (9 male, 17.00±2.16 years of age, 179.14±5.76 cm of height and 69.79±3.11 kg of weight; 7 female, 15.86±2.34 years of age, 163.86±4.98 cm of height and 60.19±3.60 kg of weigh) were equality, but randomly separated in two groups (control group and experimental group, CG and EG, respectively). In the pre-test, swimmers performed three starts in two different models, grab start and track start, the best start was registered. Kinematic parameters of the swimming start and time at 15 m were determined. Flexibility, countermovement jump and 3 kg medicine ball throw were also assessed. In post-test, 10-weeks after a regular 2-sessions week specific dry-land S&C program of 60 min was performed by the EG, all tests were repeated. Flexibility, strength and muscular power gains were significant in EG, contrarily to CG. Swimming start flight phase variables improved more in EG compared to CG, with specificities observed in grab and track start but not a linear consequence with performance in 15-m mark in both groups. A 10-week dry-land S&C program can provide benefits in physical capacities in regular swimming practitioners, fact that may improve the initial phase of the swimming start, prior to the underwater moment, which should deserve attention by the coaches in daily training aiming performance enhancement at 15 m. (AU)

El propósito de esto estudio fue evaluar el efecto de un programa de fuerza y acondicionamiento (F&A) en seco de 10 semanas sobre las habilidades físicas y el salto en practicantes habituales de natación previamente federados. 16 nadadores (9 masculino, 17.00±2.16 años de edad, 179.14±5.76 cm de altura y 69.79±3.11 kg de peso and 7 mujer, 15.86±2.34 años de edad, 163.86±4.98 cm de altura y 60.19±3.60 kg de peso) fueron equitativamente, pero al azar divididos en dos grupos (control y experimental, respectivamente, GC e GE). En el pre-test realizaron tres saltos en dos modelos, grab start e track start, siendo el mejor registrado. Se han determinado parámetros cinemáticos del salto en natación y el tiempo a los 15 m. También se evaluaron la flexibilidad, el salto con contramovimiento y el lanzamiento de una pelota medicinal de 3 kg. En el post-test, 10 semanas después de un programa de F&A en seco con 2 sesiones semanales de 60 min interpretado por GE, las pruebas se repitieron. Las mejoras de flexibilidad, fuerza y potencia muscular fueron significativas en el GE, en contraste con el GC. Las variables de la fase de vuelo en el salto mejoraron más en el GE en comparación con el CG, con especificidades observadas en el grab start e track start, pero no una consecuencia lineal con el rendimiento a 15 m en ambos grupos. Un programa de F&A seco de 10 semanas puede promover beneficios en las habilidades físicas de nadadores habituales, hecho que puede mejorar la fase inicial del salto en la natación, previa al momento subacuático, que debe merecer la atención de los entrenadores en las sesiones diarias con el objetivo de a una mejora del rendimiento a 15 m. (AU)

O objetivo deste estudo foi avaliar o efeito de um programa de força e condicionamento (F&C) em seco de 10 semanas nas capacidades físicas e salto em praticantes regulares de natação previamente federados. 16 nadadores (9 masculinos, 17.00±2.16 anos de idade, 179.14±5.76 cm de altura e 69.79±3.11 kg de peso; 7 femininos, 15.86±2.34 anos de idade, 163.86±4.98 cm de altura e 60.19±3.60 kg de peso) foram equitativamente, mas de forma aleatória divididos em dois grupos (controlo e experimental, respetivamente, GC e GE). No pré-teste, nadadores realizaram três saltos em dois modelos, grab start e track start, sendo registado o melhor. Foram determinados parâmetros do salto na natação e o tempo aos 15 m. Flexibilidade, salto em contramovimento e lançamento de bola medicinal de 3 kg foram também avaliados. No pós-teste, 10 semanas após programa de F&C em seco com 2 sessões semanais de 60 min realizado por GE, testes foram repetidos. As melhorias de flexibilidade, força e potência muscular foram significativas no GE, contrariamente ao GC. As variáveis da fase inicial do salto associadas ao voo melhoraram mais no GE comparativamente ao GC, com especificidades observadas no grab start e track start, mas não uma consequência linear com o desempenho aos 15 m em ambos os grupos. Um programa de F&C em seco de 10 semanas pode promover benefícios nas capacidades físicas de praticantes regulares de natação, facto que pode melhorar a fase inicial do salto na natação, anterior ao momento subaquático, que deve merecer atenção pelos treinadores nas sessões diárias visando uma melhoria de desempenho aos 15 m. (AU)

SonoPODography: A new diagnostic technique for visualizing superficial endometriosis.

OBJECTIVE: To perform a pilot diagnostic accuracy study of a novel transvaginal ultrasonography procedure called saline-infusion sonoPODography to predict superficial endometriosis in patients with suspected endometriosis. STUDY DESIGN: A prospective single-center diagnostic accuracy study was performed from September 2019-November 2019. The index test sonoPODography was performed and the results were documented in a standardized fashion. SonoPODography was performed by installing saline into the pouch of Douglas (POD) via an intrauterine balloon catheter to create an acoustic window between the ultrasound probe and surrounding structures. The pelvis was then assessed for the presence or absence of superficial endometriosis using pre-defined features. Direct visualization at laparoscopy and histological assessment of excised endometriosis confirmed the outcome. The diagnostic performance of sonoPODography was evaluated. RESULTS: 42 consecutive participants underwent sonoPODography. Superficial endometriosis was identified by sonoPODography in 24/42 (57.1 %) and in 37/42 (88.1 %) participants by direct visualization at laparoscopy. The overall diagnostic performance of sonoPODography was: accuracy 69.1 %, sensitivity 64.9 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 27.8 %. Amongst those without deep endometriosis/endometriomas/pouch of Douglas obliteration, the diagnostic performance was: accuracy 80.0 %, sensitivity 77.7 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 33.3 %. The pouch of Douglas peritoneum was the most common site of superficial endometriosis. CONCLUSIONS: SonoPODography is a novel ultrasound-based procedure that permits the direct visualization of superficial with respectable diagnostic accuracy. The findings of this pilot study are promising and justify the initiation of a larger outpatient study. SonoPODography may establish new avenues for the non-invasive diagnosis and investigation of endometriosis.

Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication.

OBJECTIVES: Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding-sign technique. So far, studies on POD obliteration prediction have focused on tertiary-care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication. METHODS: This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high-volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis-like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics. RESULTS: During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8-10.9%); P < 0.001). CONCLUSIONS: We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three-times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Resultado de supervivencia en una hernia diafragmática congénita grave del lado izquierdo, con y sin oclusión traqueal endoscópica fetal en un país con un tratamiento neonatal subóptimo OBJETIVOS: La obliteración del fondo de saco de Douglas (FSD) puede predecirse con un alto grado de certeza y reproducibilidad usando la técnica del signo deslizante en una ecografía transvaginal dinámica (TVS, por sus siglas en inglés). Hasta ahora, los estudios sobre la predicción de la obliteración del FSD se han centrado en las poblaciones de atención terciaria con alta prevalencia de endometriosis; sin embargo, la obliteración del FSD puede ocurrir en personas con endometriosis asintomática u otras afecciones. El objetivo principal fue determinar la prevalencia de un signo deslizante negativo, como indicador de la obliteración del FSD, en una cohorte de pacientes que se sometieron a TVS por cualquier indicación ginecológica. MÉTODOS: Se trató de un estudio observacional prospectivo de mujeres en una lista consecutiva a quienes se les indicó una TVS ginecológica, realizada en una consulta de ecografía de gran volumen de pacientes entre julio y agosto de 2018. Se documentaron los antecedentes clínicos y quirúrgicos, las indicaciones para la TVS y los hallazgos de la TVS. La prevalencia de la obliteración del FSD confirmada por la TVS, determinada por la interpretación del signo deslizante, se calculó para toda la cohorte y para subgrupos de mujeres con y sin factores de riesgo de endometriosis. El riesgo elevado de endometriosis se definió como el hecho de tener (1) una remisión para TVS debido a dolor pélvico similar a la endometriosis o endometriosis específicamente y/o (2) síntomas o indicios clínicos que sugerían endometriosis. El riesgo bajo se definió como la ausencia de estas características. RESULTADOS: Durante el período de estudio, 1043 mujeres se sometieron a TVS de forma consecutiva. Se analizaron 909 mujeres, tras excluir a las que se sometieron a una ecografía abdominal, las que tenían antecedentes de histerectomía o aquellas para las que faltaban datos. La prevalencia de un signo deslizante negativo en toda la cohorte fue de 47/909 (5,2%). Se observó un signo deslizante negativo en 22/639 (3,4%) de las mujeres con bajo riesgo de endometriosis y en 25/243 (10,3%) de aquellas con alto riesgo de endometriosis (diferencia de proporciones, 6,9% (IC 95%: 2,8-10,9%); P<0,001). CONCLUSIONES: Se demuestra una prevalencia general de un signo deslizante negativo, que sugiere la obliteración del FSD en el 5,2% (o 1/20) de mujeres que se someten a TVS para una indicación ginecológica. La prevalencia del signo deslizante negativo en las mujeres de bajo riesgo no es desdeñable (3,4% o 1/29 mujeres). Estas mujeres son las más propensas a tener endometriosis asintomática u otra etiología importante de obliteración del FSD. La prevalencia de un signo deslizante negativo es aproximadamente tres veces mayor en mujeres con signos y/o síntomas de endometriosis (10,3% vs 3,4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes.

OBJECTIVE: To investigate the association of maternal circulating 25-hydroxyvitamin D3 [25(OH)D3] concentration with pregnancy and birth outcomes. DESIGN: Prospective cohort study. SETTING: Four geographical areas of Spain, 2003-2008. POPULATION: Of 2382 mother-child pairs participating in the INfancia y Medio Ambiente (INMA) Project. METHODS: Maternal circulating 25(OH)D3 concentration was measured in pregnancy (mean [SD] 13.5 [2.2] weeks of gestation). We tested associations of maternal 25(OH)D3 concentration with pregnancy and birth outcomes. MAIN OUTCOME MEASURES: Gestational diabetes mellitus (GDM), preterm delivery, caesarean section, fetal growth restriction (FGR) and small-for-gestational age (SGA), anthropometric birth outcomes including weight, length and head circumference (HC). RESULTS: Overall, 31.8% and 19.7% of women had vitamin D insufficiency [25(OH)D3 20-29.99 ng/ml] and deficiency [25(OH)D3 < 20 ng/ml], respectively. After adjustment, there was no association between maternal 25(OH)D3 concentration and risk of GDM or preterm delivery. Women with sufficient vitamin D [25(OH)D3 ≥ 30 ng/ml] had a decreased risk of caesarean section by obstructed labour compared with women with vitamin D deficiency [relative risk (RR) = 0.60, 95% CI 0.37, 0.97). Offspring of mothers with higher circulating 25(OH)D3 concentration tended to have smaller HC [coefficient (SE) per doubling concentration of 25(OH)D3, -0.10 (0.05), P = 0.038]. No significant associations were found for other birth outcomes. CONCLUSION: This study did not find any evidence of an association between vitamin D status in pregnancy and GDM, preterm delivery, FGR, SGA and anthropometric birth outcomes. Results suggest that sufficient circulating vitamin D concentration [25(OH)D3 ≥ 30 ng/ml] in pregnancy may reduce the risk of caesarean section by obstructed labour.

Deficit of vitamin D in pregnancy and growth and overweight in the offspring.

BACKGROUND: Maternal vitamin D status during fetal development may influence offspring growth and risk of obesity; however, evidence in humans is limited. OBJECTIVE: To investigate whether maternal circulating 25-hydroxyvitamin D3 (25(OH)D3) concentration in pregnancy is associated with offspring prenatal and postnatal growth and overweight. METHODS: Plasma 25(OH)D3 concentration was measured in pregnant women (median weeks of gestation 14.0, range 13.0-15.0) from the INMA (INfancia y Medio Ambiente) cohort (Spain, 2003-2008) (n = 2358). Offspring femur length (FL), biparietal diameter (BPD), abdominal circumference (AC) and estimated fetal weight (EFW) were evaluated at 12, 20 and 34 weeks of gestation by ultrasound examinations. Fetal overweight was defined either as AC or as EFW ⩾ 90th percentile. Child's anthropometry was recorded at ages 1 and 4 years. Rapid growth was defined as a weight gain z-score of >0.67 from birth to ages 6 months and 1 year. Age- and sex-specific z-scores for body mass index (BMI) were calculated at ages 1 and 4 years (World Health Organization referent); infant's overweight was defined as a BMI z-score ⩾ 85th percentile. RESULTS: We found no association of maternal 25(OH)D3 concentration with FL and a weak inverse association with BPD at 34 weeks. Maternal deficit of 25(OH)D3 (<20 ng ml(-1)) was associated with increased risk of fetal overweight defined as AC ⩾ 90th percentile (odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.01-2.21; P = 0.041) or either as EFW ⩾ 90th percentile (OR = 1.47, 95% CI: 1.00-2.16; P = 0.046). No significant associations were found with rapid growth. Deficit of 25(OH)D3 in pregnancy was associated with an increased risk of overweight in offspring at age 1 year (OR = 1.42, 95% CI: 1.02-1.97; P = 0.039); however, the association was attenuated at age 4 years (OR = 1.19, 95% CI: 0.83-1.72; P = 0.341). CONCLUSIONS: Vitamin D deficiency in pregnancy may increase the risk of prenatal and early postnatal overweight in offspring. Clinical trials are warranted to determine the role of vitamin D in the early origins of obesity.

Enseñar estrategias de afrontamiento a padres de niños con cáncer a través de un cortometraje / Teaching coping strategies to parents of children suffering from cancer using a short film

Este trabajo describe la utilidad de un cortometraje para enseñar estrategias de afrontamiento positivas a los padres de hijos con cáncer. Para la realización del cortometraje se han utilizado los resultados de un trabajo de investigación sobre las estrategias de afrontamiento que utilizan los padres. Los resultados se extrajeron del análisis del discurso delos padres que participaron en un grupo de autoayuda durante ocho sesiones. El cortometraje ha sido evaluado por los psicólogos de todas las asociaciones de padres que forman parte de la Federación de padres de niños enfermos de cáncer. Asimismo, se ha experimentado en sesiones grupales realizadas en las sedes de ASPANION (Asociación de padres de niños oncológicos de la Comunidad Valenciana) de Valencia y Alicante. El 70% de los psicólogos considera que el cortometraje es un recurso válido para enseñar a los padres estrategias de afrontamiento y que es un instrumento dinamizador de las sesiones grupales, ya que se tratan temas que no habían surgido en el grupo anteriormente y se incrementa la comunicación y la participación de los padres (AU)

This paper studies the usefulness of a short film inteaching strategies for parents of children with cáncer to cope with the situation. The short film is based on an analysis of the transcripts from eight sessions of a self-help group. The short film has been evaluated by psychologists working for each of the parent groups belonging to the Federation of parents of children with cancer. Furthermore, the film has been exhibited in group sessions that took place in the Valencia and Alicante branches of ASPANION (Association of Parents with Oncologic Children in the Valencia Region). About 70% of the experts have declared that the film is a valuable resource for teaching useful strategies to parents. The film also improves the group sessions since it addresses a number of issues that had not been addressed before, and it stimulates the participation of, and communication between, parents during the session (AU)

Relaciones padres-médicos en oncología: un enfoque cualitativo / Parent-Doctor relations in oncology: a qualitative approach

El objetivo de este artículo es conocer cómo los padres de niños enfermos de cáncer perciben sus relaciones con el personal sanitario, fundamentalmente con los médicos. Se ha utilizado una metodología de investigación cualitativa y grupal. La muestra la constituyen catorce madres/padres cuyos hijos hace más de dos años que han contraído la enfermedad. Los padres desean información inteligible, detallada y suficiente. La palabra cáncer tiene un gran estigma social, por lo que se intenta evitar cuando se da información a los padres y niños. La comunicación entre los médicos y padres puede tener momentos de tensión en el diagnóstico, recidivas, etc. Los padres confían en la profesionalidad de los médicos y desean que tengan, además de una buena competencia profesional, cualidades humanas. La elaboración de los informes por los médicos es la tarea más criticada por los padres (AU)

We want to learn how parents of children with cancer perceive their relationship with hospital staff, especially with doctors. We used group-based qualitative methodology. The sample is composed of 14 mothers/fathers whose children contracted the disease more than two years previously. All parents want information that is both intelligible and detailed. The word cancer has a strong social stigma and is avoided when giving information to parents and to children. Communication between doctors and parents can lead to situations of tension during diagnosis and relapses. Parents trust the professionalism of doctors. Parents also want doctors to be competent and to have human qualities. The preparation of reports by physicians is the task most criticized by parents (AU)

[Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo]. / Estudio metaanalítico de la eficacia de la maniobra de Epley en el vértigo posicional paroxístico benigno.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the most common conditions that cause the physiognomy of peripheral vertigo. OBJECTIVE: To evaluate the effectiveness of Epley's manoeuvre (EM) in the treatment of BPPV using a critical review of the medical literature and a meta-analysis. METHODS: Searches were made in the databases of MEDLINE (PubMed), in the Cochrane collection (Cochrane Register of controlled studies), BIREME and LILACS (all of them up to December 2008). The search words used were: canalith repositioning procedure, canalith repositioning manoeuvre, Epley manoeuvre, Dix-Hallpike, benign vertigo, benign positional vertigo, benign paroxysmal positional vertigo and BPPV. The meta-analysis was performed using the program RevMan 5.0. RESULTS: The patients on whom an EM was performed had a six and half times more chance of their clinical symptoms improving compared to the control group of patients (OR=6.52; 95% CI, 4.17-10.20). Similarly, the likelihood of having a negative Dix-Hallpike (DH) test are 5 times greater in patients had the EM performed than in those who did not (OR=5.19; 95% CI, 2.41-11.17). CONCLUSIONS: The EM is effective in controlling BPPV.

[Teaching coping strategies to parents of children suffering from cancer using a short film]. / Enseñar estrategias de afrontamiento a padres de niños con cáncer a través de un cortometraje.

This paper studies the usefulness of a short film in teaching strategies for parents of children with cancer to cope with the situation. The short film is based on an analysis of the transcripts from eight sessions of a self-help group. The short film has been evaluated by psychologists working for each of the parent groups belonging to the Federation of parents of children with cancer. Furthermore, the film has been exhibited in group sessions that took place in the Valencia and Alicante branches of ASPANION (Association of Parents with Oncologic Children in the Valencia Region). About 70% of the experts have declared that the film is a valuable resource for teaching useful strategies to parents. The film also improves the group sessions since it addresses a number of issues that had not been addressed before, and it stimulates the participation of, and communication between, parents during the session.

[Parent-doctor relations in oncology: a qualitative approach]. / Relaciones padres-médicos en oncología: un enfoque cualitativo.

We want to learn how parents of children with cancer perceive their relationship with hospital staff, especially with doctors. We used group-based qualitative methodology. The sample is composed of 14 mothers/fathers whose children contracted the disease more than two years previously. All parents want information that is both intelligible and detailed. The word cancer has a strong social stigma and is avoided when giving information to parents and to children. Communication between doctors and parents can lead to situations of tension during diagnosis and relapses. Parents trust the professionalism of doctors. Parents also want doctors to be competent and to have human qualities. The preparation of reports by physicians is the task most criticized by parents.

Iodine intake in a population of pregnant women: INMA mother and child cohort study, Spain.

BACKGROUND: Monitoring iodine status during pregnancy is essential to prevent iodine-related disorders. The objectives of this study are to estimate iodine intake and excretion, to assess their association and to evaluate the compliance of the recommendations in a multicentre cohort of pregnant women. METHODS: Cross-sectional data on maternal iodine nutritional status, compiled between weeks 8 and 22 of gestation in three Spanish areas (Valencia, Gipuzkoa and Sabadell), were analysed. Information on iodine intake from diet, salt and supplements was estimated through questionnaires. Spot urine samples were analysed for urinary iodine concentration (UIC). Tobit regression analysis was used to assess the association between iodine intake and UIC. RESULTS: 1522 women were included in the study. Median UIC was 134 (IQR 80-218) µg/l in Valencia, 168 (IQR 108-272) µg/l in Gipuzkoa and 94 (IQR 57-151) µg/l in Sabadell. 48.9% of Valencian women consumed iodine supplements, 93.3% in Gipuzkoa and 11.0% in Sabadell. Prevalence of iodised salt consumption was 50.5% in the whole sample. UIC was associated with intake of supplements, iodised salt, dietary iodine and water. UIC levels were lower than expected according to the estimated iodine intake. CONCLUSION: Median UIC reflected iodine deficiency according to WHO reference levels, except in Gipuzkoa where supplements are widely consumed. It is necessary to strengthen iodised salt consumption since it is already far from the objective proposed of coverage of 90% of households. More data would be valuable to assess the correspondence between iodine intake and excretion during pregnancy.

Quantitative study of Leydig cell populations in mice exposed to low doses of cadmium.

Leydig cell morphological changes were evaluated using morphometric and stereological methods in male mice exposed to low doses of cadmium. A possible reversibility of the changes after cadmium withdrawal was also considered. Nuclear morphological parameters and stereological densities of the Leydig cell population were lower in the cadmium-exposed groups than in the control. The withdrawal of cadmium did not lead to any significant recovery of the morphological parameters. Nevertheless, numerical density increased significantly in the withdrawn groups, suggesting that the hyperplasia of interstitial cells could try to relieve morphological damage after cadmium withdrawal.

Iodine levels and thyroid hormones in healthy pregnant women and birth weight of their offspring.

INTRODUCTION: The fetus is most vulnerable to severe iodine deficiency and hypothyroidism during pregnancy. The effects of mild iodine deficiency and subclinical hypothyroidism are poorly known. The present study assesses the association between thyroid hormones (TH)s and urinary iodine concentration (UIC) in healthy pregnant women and the birth weight of their children. METHODS: About 657 pregnant women were recruited in Sabadell and followed until delivery. The association between THs during the first trimester, UIC during the first and third trimesters, and birth weight was studied in 557, 251, and 528 mother-newborn pairs respectively, using linear and logistic regression models adjusted for potential confounders. Only 239 women had all the data available (thyroid function and UIC at the first and third trimesters). Six percent of newborns were classified as small for gestational age (SGA). RESULTS: The median UIC was 95 and 104 microg/l during the first and third trimesters respectively. Women with the third trimester UICs between 100 and 149 microg/l had lower risk of having an SGA newborn than women with UICs below 50 microg/l (adjusted OR (95%CI): 0.15 (0.03-0.76). There was no significant reduction in SGA among mothers with higher UICs. Lower free thyroxine and higher TSH levels during the first trimester were not associated with birth weight or SGA. Nevertheless, the analyses were repeated including only those women with all the data available, and high TSH levels became statistically significantly associated with lower birth weight and higher risk of SGA. CONCLUSIONS: The present study suggests that iodine status during pregnancy may be related to prenatal growth in healthy women.

[History of epistaxis since the ancient times to the first half of the XXth century]. / Historia de la epistaxis desde la antigüedad clásica hasta la primera mitad del siglo XX.

Epistaxis is one of the more frequent entities in the otolaryngological practice. The term is attributed to CULLEN (1785). Since them, multiple theories concerning etiology, clinical manifestacions, diagnosis and management have been reported in the medical literature. Nevertheless, an impressive improvement of awareness about these questions have emerged in the last half of past century. The objective of this work is to revise the history of epistaxis since the ancient times to the first half of the 20th century.

[Frontal pyomucocele]. / Piomucole frontal.

Mucoceles are strictly defined as chronic, expanding, mucosa-lined lesions of the frontal sinus and containing insipissated secretion. We present a 48-years-old female who complains right periorbital and frontal swelling of approximately 1,5 years duration. Radiological and exploratory findings confirm the diagnosis of infected mucocele (pyomucocele). Under general anesthesia an endoscopic sinus surgery was performed. One year later, the patient is alive and well with no evidence of primary disease.

[Neurotrophic action of insulin-like growth factor-I in the inner ear]. / Acciones neurotróficas del factor de crecimiento similar a la insulina de tipo I en el oído interno.

INTRODUCTION: Loss of hearing constitutes one of the most frequent disabling sensory impairments in the developed world. Different therapeutic approaches are currently being studied, including treatment with stem cells, genetic manipulation and pharmacological protection. AIM: To evaluate the role played by insulin-like growth factor-I (IGF-I) in the development, maintenance and repair of auditory functioning. DEVELOPMENT: Proper development of the inner ear is dependent on a suitable coordination of the cell processes of proliferation, differentiation, neurogenesis and programmed cell death, which are regulated by different factors, one of which is IGF-I. During the embryogenesis of the inner ear, this factor is expressed in abundance and is essential for cell survival and maintaining neuronal precursors. Studies conducted in Igf-1-/- null mice have highlighted its importance in the development and continued functioning of the inner ear. Mice with a deficit in this gene display morphological disorders that correspond to severe functional deficiencies, which are confirmed by analysing brainstem auditory evoked potentials. A deficit of IGF-I in humans is also accompanied by profound sensory hypoacusis. CONCLUSIONS: In a scenario like this, IGF-I appears as a key factor in the development of auditory functioning and a candidate for regenerative therapy of the inner ear.