Activation of ERK2 in basolateral amygdala underlies the promoting influence of stress on fear memory and anxiety: influence of midazolam pretreatment.

Exposure to emotionally arousing experiences elicits a robust and persistent memory and enhances anxiety. The amygdala complex plays a key role in stress-induced emotional processing and in the fear memory formation. It is well known that ERK activation in the amygdala is a prerequisite for fear memory consolidation. Moreover, stress elevates p-ERK2 levels in several areas of the brain stress circuitry. Therefore, given that the ERK1/2 cascade is activated following stress and that the role of this cascade is critical in the formation of fear memory, the present study investigated the potential involvement of p-ERK2 in amygdala subnuclei in the promoting influence of stress on fear memory formation and on anxiety-like behavior. A robust and persistent ERK2 activation was noted in the Basolateral amygdala (BLA), which was evident at 5min after restraint and lasted at least one day after the stressful experience. Midazolam, a short-acting benzodiazepine ligand, administered prior to stress prevented the increase in the p-ERK2 level in the BLA. Pretreatment with intra-BLA infusion of U0126 (MEK inhibitor), but not into the adjacent central nucleus of the amygdala, attenuated the stress-induced promoting influence on fear memory formation. Finally, U0126 intra-BLA infusion prevented the enhancement of anxiety-like behavior in stressed animals. These findings suggest that the selective ERK2 activation in BLA following stress exposure is an important mechanism for the occurrence of the promoting influence of stress on fear memory and on anxiety-like behavior.

Hiperfrecuentación: percepción de los profesionales de atención primaria sobre la influencia de factores sociales y de organización del entorno sanitario / Frequent attendance: the primary care professional's perceptions on the influence of social factors and health care system organisation

Hiperfrecuentación. Percepción de los profesionales de atención primaria sobre la influencia de factores sociales y de organización del entorno sanitario. Objetivo. Conocer la percepción de los profesionales sanitarios de atención primaria (AP) sobre aspectos sociales y de organización del entorno sanitario que contribuyen a la hiperfrecuentación. Método. Estudio cualitativo mediante entrevistas semiestructuradas en centros de AP de 6 áreas de salud de la Comunidad de Madrid. Se realizaron 18 entrevistas, 3 por área (2 profesionales de medicina y 1 de enfermería). Se llevó a cabo un muestreo estructural en función de las variables que podían condicionar el discurso: área de salud, profesión, sexo y número de años trabajando. El análisis se realizó por 2 investigadoras, buscando la concordancia entre ambas. Resultados. Dentro de los factores del ámbito social, perciben como determinantes la influencia de los medios de comunicación y la medicalización de la sociedad, la falta de educación sanitaria y de capacidad de autocuidado de la población y factores del contexto del paciente (sociales, laborales y familiares). Como factores de organización, la saturación del sistema sanitario, el funcionamiento de las consultas a demanda, el miedo a posibles demandas del paciente, los protocolos de crónicos, las consultas administrativas, la propia conducta del profesional y la mala coordinación con atención especializada influyen en la hiperfrecuentación. Conclusiones. Según los profesionales de AP, hay múltiples factores del entorno, tanto social como de la organización del sistema de atención, que fomentan la hiperfrecuentación. Dentro del ámbito asistencial de actuación, medidas de tipo organizativo (como trabajo en equipo y coordinación con especializada) contribuirían a controlar la demanda(AU)

Frequent attendance. The primary care professional's perceptions on the influence of social factors and health care system organisation. Objective. To find out the primary care (PC) professional's perceptions on the social factors and healthcare system organisation that influence frequent attendance. Method. A qualitative study using semi-structured interviews in Primary Care Centres of six Health Areas in the Community of Madrid. Eighteen interviews were conducted, three per area (two physicians and one nurse). Structural sampling was carried out with regards to the variables that could influence the discourse: health area, occupation, sex and number of years worked. The transcriptions were analysed by two investigators and an agreement of interpretation was reached. Results. Among the social factors, health professionals perceived as determining factors: the influence of the media and the medicalization of society, lack of health education and self-care abilities of the population and contextual factors of the patient (social, work and family). Among the health care organisation factors that could influence frequent attendance were, system saturation, appointment on demand, fear of potential lawsuits by the patient, chronic patients protocols, administrative consultations, professional behaviour, and poor coordination with specialised care. Conclusions. According to PC professionals, there are multiple environmental factors, both social and healthcare system organisational factors that encourage frequent attendance. Within the scope of health care system, organisational actions (such as teamwork and coordination with specialists) would help to manage demand(AU)

[Frequent attendance: the primary care professional's perceptions on the influence of social factors and health care system organisation]. / Hiperfrecuentación: percepción de los profesionales de atención primaria sobre la influencia de factores sociales y de organización del entorno sanitario.

UNLABELLED: FREQUENT ATTENDANCE: The primary care professional's perceptions on the influence of social factors and health care system organisation. OBJECTIVE: To find out the primary care (PC) professional's perceptions on the social factors and healthcare system organisation that influence frequent attendance. METHOD: A qualitative study using semi-structured interviews in Primary Care Centres of six Health Areas in the Community of Madrid. Eighteen interviews were conducted, three per area (two physicians and one nurse). Structural sampling was carried out with regards to the variables that could influence the discourse: health area, occupation, sex and number of years worked. The transcriptions were analysed by two investigators and an agreement of interpretation was reached. RESULTS: Among the social factors, health professionals perceived as determining factors: the influence of the media and the medicalization of society, lack of health education and self-care abilities of the population and contextual factors of the patient (social, work and family). Among the health care organisation factors that could influence frequent attendance were, system saturation, appointment on demand, fear of potential lawsuits by the patient, chronic patients protocols, administrative consultations, professional behaviour, and poor coordination with specialised care. CONCLUSIONS: According to PC professionals, there are multiple environmental factors, both social and healthcare system organisational factors that encourage frequent attendance. Within the scope of health care system, organisational actions (such as teamwork and coordination with specialists) would help to manage demand.

Differential regulation of Notch ligands in dendritic cells upon interaction with T helper cells.

The Notch signalling pathway has recently been linked to T helper 1 (Th1)/T helper 2 (Th2) cell polarization via a mechanism involving differential expression of Notch ligands, Delta-like and Jagged, in antigen-presenting cells. However, whether stimuli other than pathogen-derived factors are involved in the regulation of Notch ligand expression in dendritic cells (DCs) remains unknown. Here, we address the effect of T helper cells (Th1 and Th2) on Delta-like 4 and Jagged 2 expression in bone marrow-derived DCs. We demonstrate that both Th1 and Th2 cells induce Delta-like 4 mRNA expression in DCs, in a process that is, in part, mediated by CD40 signalling. In contrast, only Th2 cells induce a significant increase in Jagged 2 mRNA levels in DCs. Additionally, we show that IL-4, a hallmark Th2 cytokine, plays a role in Jagged 2 expression, as evidenced by the fact that cholera toxin, a Th2-promoting stimulus, induces Jagged 2 mRNA expression in DCs only in the presence of IL-4. Finally, we demonstrate that DCs also express Notch 1 and that this expression is downregulated by IL-4. These data suggest that Notch ligands are differentially regulated in DCs: Delta-like 4 is regulated by T helper cells and by pathogen-derived Th1 stimuli, whereas Jagged 2 is regulated by Th2 cells and pathogen-derived Th2-promoting stimuli. Based on our results, we propose that the positive feedback loop that Th2 cells exert on T cell polarization may involve the induction of Jagged 2 expression in DCs.

Hiperfrecuentación: percepción de los profesionales de atención primaria sobre su definición, motivos, situaciones y la relación con los pacientes hiperfrecuentadores / Frequent attendance: Primary Care Professional's perceptions of definitions, motives, situations and relationships with frequent attenders patients

ObjetivoConocer la percepción de los profesionales sanitarios de atención primaria (AP) sobre los criterios para definir la hiperfrecuentación, así como sus percepciones sobre los motivos de las visitas de los pacientes denominados hiperfrecuentadores, las situaciones asociadas al fenómeno y su relación con ellos.MétodoEstudio cualitativo mediante entrevistas semiestructuradas abiertas en centros de AP de 6 áreas de salud de la Comunidad de Madrid. Se realizaron 18 entrevistas, 3 por área (2 profesionales de medicina y uno de enfermería). Se llevó a cabo un muestreo estructural en función de las variables que podían condicionar el discurso: área de salud, profesión, sexo y número de años de trabajo. Dos investigadoras realizaron el análisis y buscaron la concordancia entre ambas.ResultadosLos profesionales definen la hiperfrecuentación por una serie de criterios cualitativos en los que el número de visitas tiene poca importancia. Acuden por problemas médicos relacionados con enfermedades crónicas pero también por motivos psicosociales o laborales. Hay hiperfrecuentadores de todas las edades y de ambos sexos, y la relación médico-paciente depende de cada caso concreto.ConclusionesSegún los profesionales de AP, la definición de un paciente como hiperfrecuentador no depende del número sino de la calidad de la visita. Las razones de consulta y las características de los pacientes son múltiples, por lo que no se puede determinar un perfil único. Un factor común en los discursos es que muchos de los hiperfrecuentadores acuden a consulta por problemáticas psicosociales, por lo que sería de gran ayuda agilizar la coordinación con recursos psicosociales para conseguir consultas de AP más eficientes y efectivas(AU)

ObjectiveTo find out how health professionals in Primary Care (PC) perceive the definition criteria for frequent attendance, as well as their perceptions of the reasons for the visits of patients referred to as frequent attenders, their situations and their relationships with them.MethodWe performed a qualitative study using semi-structured interviews in Primary Care centers of six health areas of the Community of Madrid. Eighteen interviews were conducted, three per area (two physicians and one nurse). Structural sampling was carried out with regards to the variables that could influence the discourse: health area, occupation, sex and number of years worked. The transcriptions were analyzed by two investigators who gave a consensus interpretation.ResultsThe proportion of frequent attenders varies according to each professional and it is defined more by quality reasons than by number of visits. They make appointments associated with chronic diseases, but also for psychosocial or work problems. There are frequent attenders of all ages and both sexes, and the doctor-patient relationship depends on each individual case.ConclusionsFrequent attendance is defined by the professionals by a number of qualitative criteria in which the number of visits is of little importance. The reasons for consultation and patient characteristics are numerous, so a unique profile cannot be determined. A common factor in the discourses is that many of the frequent attenders’ reasons for consultation were psychosocial problems, so streamlining coordination with psychosocial resources would help to make PC consultations more efficient and effective(AU)

[Frequent attendance: primary care professional's perceptions of definitions, motives, situations and relationships with frequent attenders patients]. / Hiperfrecuentación: percepción de los profesionales de atención primaria sobre su definición, motivos, situaciones y la relación con los pacientes hiperfrecuentadores.

OBJECTIVE: To find out how health professionals in Primary Care (PC) perceive the definition criteria for frequent attendance, as well as their perceptions of the reasons for the visits of patients referred to as frequent attenders, their situations and their relationships with them. METHOD: We performed a qualitative study using semi-structured interviews in Primary Care centers of six health areas of the Community of Madrid. Eighteen interviews were conducted, three per area (two physicians and one nurse). Structural sampling was carried out with regards to the variables that could influence the discourse: health area, occupation, sex and number of years worked. The transcriptions were analyzed by two investigators who gave a consensus interpretation. RESULTS: The proportion of frequent attenders varies according to each professional and it is defined more by quality reasons than by number of visits. They make appointments associated with chronic diseases, but also for psychosocial or work problems. There are frequent attenders of all ages and both sexes, and the doctor-patient relationship depends on each individual case. CONCLUSIONS: Frequent attendance is defined by the professionals by a number of qualitative criteria in which the number of visits is of little importance. The reasons for consultation and patient characteristics are numerous, so a unique profile cannot be determined. A common factor in the discourses is that many of the frequent attenders' reasons for consultation were psychosocial problems, so streamlining coordination with psychosocial resources would help to make PC consultations more efficient and effective.

Laurin-Sandrow syndrome (mirror hands and feet and nasal defects): description of a new case.

A child with complete syndactyly of cup shaped hands and mirror polysyndactyly of the feet, together with a nasal defect, was identified out of a total of 1,031,439 livebirths. She had a pattern of multiple congenital anomalies which was similar to that first described by Laurin et al in 1964 and by Sandrow et al in 1970. Two more cases with a similar pattern of congenital anomalies have recently been published so this is the fifth reported case with this constellation.