Implicaciones para la enfermería española del informe de referencia sobre la década del envejecimiento saludable 2021-2030 / Implications for spanish nursing of the reference report for a decade of healthy ageing 2021-2030

La Década del Envejecimiento Saludable reabre oportunidades para invertir en entornos adaptados a las personas mayores y en sistemas integrados de atención sanitaria y social. El objetivo de este trabajo es analizar esas ventanas de oportunidad para Enfermería. El envejecimiento saludable implica que las personas mayores contribuyen a la sociedad durante más tiempo, con oportunidades para gozar de buena salud, y para mantener y desarrollar las capacidades, y que está determinado por la capacidad funcional, la capacidad intrínseca y el entorno físico y social. Para ello, son precisos sistemas sociales y de salud integrados, transformadores y centrados en las personas, en lugar de sistemas basados únicamente en la enfermedad. Enfermería puede contribuir cambiando la forma de pensar, de sentir y de actuar con respecto a la edad y el envejecimiento, ofreciendo una atención integrada y centrada en las personas, adaptando el modelo de cuidados, con el foco en la promoción de la salud y la prevención de la enfermedad, y la atención de las personas mayores potenciando sus capacidades y su autonomía, en especial desde la Atención Primaria. Luchar contra el edadismo, formar a enfermeras en competencia de práctica avanzada, mejorar la accesibilidad, formar a las personas mayores y sus familias en materia digital, investigando sobre estos factores, son oportunidades que vuelve a abrir el Informe sobre la Década del Envejecimiento Saludable para Enfermería. (AU)

The Decade of Healthy Ageing reopens opportunities to invest in age-friendly environments and integrated health and social care systems. The aim of this paper is to analyse these windows of opportunity for Nursing. Healthy ageing implies that older people contribute to society for longer, with opportunities to have good health, and to maintain and develop capabilities, and that it is determined by functional ability, intrinsic capacity and the physical and social environment. This requires integrated, transformative and people-centred health and social systems, rather than systems based on disease. Nursing can contribute by changing the way we think, feel and act about age and ageing, offering integrated and person-centred care, adapting the model of care, with a focus on health promotion and disease prevention, and care for older people by enhancing their capabilities and autonomy, especially in primary care. Fighting against ageism, training nurses in advanced practice competency, improving accessibility, training older people and their families in digital matters, researching on these factors, are opportunities that the Decade of Healthy Ageing Report reopens for Nursing. (AU)

Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala's National Healthcare System: The ACS-GT Registry.

Background: Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system's quality of care based on the Donabedian health model. Methods: The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala's National Healthcare System were included. These represent six out of the country's eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student's t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. Results: One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2-24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. Conclusions: There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used.

Avances en el manejo de la fragilidad en personas mayores. Implicaciones para atención primaria / Advances in management of frailty in the elderly. Implications for primary health care

El concepto teórico de fragilidad está ampliamente aceptado, pero su aplicación a la práctica presenta algunas limitaciones debido a la existencia de múltiples herramientas para su detección precoz y propuestas de intervención. En esta breve revisión de situación, se pretende resumir las últimas evidencias respecto a la detección precoz y el abordaje de la fragilidad en Atención Primaria. El cribado se basa en la detección oportunista de casos mediante búsqueda activa a partir de los 70 años, usando como herramientas una prueba de ejecución y la escala FRAIL. Se aconseja confirmación con el Frailty Index. Su abordaje debe ser multidimensional centrado en el entrenamiento de fuerza muscular, suplementos proteicos y la revisión de la medicación. La fragilidad es evitable, y se necesita poner el foco en la detección precoz. A pesar de los avances en los últimos años, es necesaria más investigación en busca del modelo de atención más eficaz. (AU)

Although the theoretical concept of frailty is widely accepted, its practical application is somehow limited due to the existence of multiple tools related to its early detection and intervention proposals. In this brief review of the situation, the aim is to summarize the latest evidence regarding early detection and management of frailty in Primary Health Care. The screening is based on opportunistic case detection by active search from the age of 70, using a performance test and the FRAIL scale as tools. Confirmation using the Frailty Index is recommended. Its approach should be multidimensional and focusing on muscle strength training, protein supplementation and medication review. Frailty is preventable, and emphasis should be placed on early detection. Despite advances in recent years, more research is needed in order to find the most effective healthcare model. (AU)

Enlargement of Inferior Alveolar Nerve Canal and Mental Neuropathy Associated With B-Cell Lymphoma: A Case Report and Literature Review.

Enlargement of an inferior alveolar nerve canal (IANC) on radiographic imaging can indicate the presence of a wide variety of pathologic entities. Oral and maxillofacial surgeons have the unique opportunity to regularly examine panoramic radiographs and must exercise proficient clinical judgment when noting abnormal findings on imaging. While malignant processes associated with IANC enlargement are uncommon, these pathologies do occur and may be associated with significant sequelae, especially when accompanied by a delay in diagnosis and in treatment. The purpose of this case report is to describe a case in which a patient presented with mental nerve neuropathy associated with unilateral IANC enlargement on radiography, which was found to be a B-cell lymphoma on biopsy. More importantly, we aim to remind oral and maxillofacial surgeons of this rare presentation of a malignant process so as to promote prompt recognition and referral for appropriate treatment.

Self-Medication of Drugs in Nursing Students from Castile and Leon (Spain).

To determine the prevalence of self-medication in nursing students and their related factors, a transversal, descriptive study was performed on a sample of 378 nursing students. A total of 73.8% of the sample declared having used off-prescription drugs during the last month (2.84;2.26-3.58). A total of 28.9% said they did this because they are familiar with the health problem and its pharmacological solution and 25% deemed that it was a mild health problem. Drugs most commonly used off-prescription were analgesics in 88.91% (3.63;2.74-4.80) of occasions. They were mainly recommended by the students' family (1.31;1.03-1.65) on 58.12% of the cases. Students keep analgesics they take off-prescription in their home first aid kit (4.47;3.28-6.08; p < 0.001). Unlike other studies, 53.2% obtained off-prescription drugs from the home first aid kit (1.13;0.89-1.43; p < 0.001). In addition, they gave advice and recommend drugs they have taken to other people with similar symptoms (1.97;1.59-2.44). A total of 85.72% kept excess drugs after a treatment (6.00;4.50-7.99). Self-medication is related to the storage of unused medicines and giving advice on the use of drugs to other people, among other things. Self-medication of drugs among nursing students is high. Thus, it appears necessary to review the training on rational the use of drugs and responsible self-medication in the discipline's curriculum.

El papel de la enfermería comunitaria en la preparación para la jubilación activa / The role of community nursing in preparation for active retirement

El tránsito hacia la jubilación esperada genera alternativas y posibilidades que pueden afectar al bienestar biopsíquico, y que está relacionado con los índices de satisfacción vital y de calidad de vida de las personas mayores. El enfoque, las expectativas y la situación real con la que se encuentra la persona jubilada pueden necesitar estrategias de encauzamiento en esta etapa de la vida, y son un reto para el individuo, para los profesionales de la salud y para la sociedad. El Sistema Nacional de Salud no contempla programas específicos de preparación para la jubilación en la cartera de servicios de Atención Primaria. En la preparación para esta etapa, además de las cuestiones económicas, hay que prestar especial atención a los factores psicológicos específicos que tienen consecuencias para la salud. Aprovechando las estrategias de envejecimiento activo como proceso de optimización de las oportunidades, la enfermera especialista en Enfermería Familiar y Comunitaria ha de tomar un papel proactivo y preparar a la población diana para esta etapa de sus vidas. Se proponen tres ejes de actuación basados en las oportunidades, el desarrollo de habilidades personales y sociales y la promoción de la salud y la prevención; desde el empoderamiento para la salud, para lo que es necesario el diseño de programas liderados por enfermeras

The transition to the expected retirement generates alternatives and possibilities that can affect the biopsyic well-being, and it's related to the indices of life satisfaction and quality of life of the elderly. The approach, expectations and the real situation that the retiree is facing may need channeling strategies at this stage of life, and it is a challenge for the individual, for health professionals and for society. The National Health System does not contemplate specific retirement preparation programs in the Primary Care services.In preparing for this stage, in addition to economic issues, special attention must be given to specific psychological factors that have health consequences. Taking advantage of active aging strategies as a process for optimizing opportunities, nurses in family and community healthcare must take a proactive role and prepare the target population for this stage of their lives. Three strategic aims are proposed based on opportunities, the development of personal and social skills and the promotion of health and prevention; from the empowerment to health, for which it is necessary to design programs led by nurses

Orthodontic Treatment of Bilateral Impacted Mandibular Canines and a Mupparapu Type 2 Transmigration.

Dental transmigration is a rare condition that mainly affects the mandibular canines. Since the tooth involved is usually impacted and its crown has crossed the midline towards the opposite side, the treatment options frequently are surgical removal or radiographic follow-up, and, in some cases, orthodontic traction is possible. In 2002, Mupparapu presented a classification for lower canines in transmigration according to their position within the mandible. This paper is aimed at describing the orthodontic treatment of a female patient with two impacted mandibular canines, one of them in a Mupparapu type 2 transmigration position (horizontal impaction position near the lower mandibular border and below the incisors' root apices). Additionally, the paper discusses the biomechanical orthodontic design and the alternative treatment options for these complex cases.

Situación de los activos para la salud en España. Estudio descriptivo / Situation of assets for health in Spain. A cross-sectional descriptive study

OBJETIVO: analizar la situación de los recursos que son activos para la salud en España, y su accesibilidad para la población. METODOLOGÍA: estudio descriptivo transversal de los recursos y actividades catalogadas por el Ministerio de Sanidad según la Estrategia de Promoción de la Salud y Prevención del Sistema Nacional de Salud. RESULTADOS: solo hay 5 recursos por 100.000 habitantes. En 4 de las 17 Comunidades Autónomas es significativamente más alto (p < 0.001), con grandes diferencias en el número de actividades por recurso. El 51,36% de los municipios adheridos o en proceso de adhesión a la Estrategia están solo en 4 Comunidades. No hay un acceso equitativo a dichos recursos y actividades. No constan activos para abordar la seguridad y las lesiones no intencionales. CONCLUSIÓN: hay desigualdades territoriales en la disponibilidad de recursos, incluso dentro de las Comunidades. Se proponen cinco líneas de mejora en las que los profesionales de Enfermería de Atención Primaria tienen un papel clave

OBJECTIVE: to analyze the situation of the resources that are active for health in Spain, and its accessibility for the population. METHODS: a cross-sectional descriptive study of the resources and activities cataloged by the Ministry of Health according to the Strategy of Health Promotion and Prevention of the National Health System. RESULTS: there are only 5 resources per 100,000 population. In 4 of the 17 Autonomous Communities it is significantly higher (p <0.001), with large differences in the number of activities per resource. 51.36% of the municipalities joined or in the process of accession to the Strategy are only in 4 Communities. There is no equitable access to such resources and activities. They do not include assets to address safety and unintentional injury. CONCLUSIONS: there are territorial inequalities in the availability of resources, also within the Communities. Five lines of improvement are proposed where Primary Care Nursing professionals play a key role

Prevención de la fragilidad en las personas mayores / Prevention of fragility in elderly people

La fragilidad es actualmente un importante reto de salud pública, tanto en España como en los países de nuestro en-torno, relacionado con el envejecimiento de la población y sus consecuencias, como el aumento de la dependencia. Para mantener la autonomía el abordaje de la fragilidad es uno de los elementos fundamentales para afrontarlo, ya que supone un estado previo a la discapacidad que se puede prevenir, e incluso revertir si se detecta a tiempo. Se estima que entre un 7 y un 12 % de los mayores de 65 años están en una situación de fragilidad que les hace más vulnerables a entrar en situación de dependencia. La fragilidad es más frecuente en las mujeres y aumenta con la edad. Los nuevos conocimientos, y los interrogantes que se abren, cambian el panorama de la prevención, la detección precoz y el tratamiento de la fragilidad. En este sentido, la aparición en el año 2014 del "Documento de consenso sobre la prevención de fragilidad y caídas en la persona mayor", en el marco de la Estrategia de promoción de la salud y prevención en el Sistema Nacional de Salud, del Ministerio de Sanidad, Servicios Sociales e Igualdad, trata de homogeneizar esas cuestiones y establece recomendaciones para la prevención y el cribado de la fragilidad

Fragility is currently an important public health challenge, both in Spain and in the countries of our environment, related to the aging of the population and its consequences, such as the in-crease in dependence. To maintain autonomy, the approach to frailty is one of the fundamental elements to face it, since it sup-poses a pre-disability state that can be prevented, and even re-versed if it is detected in time. It is estimated that between 7 and 12 % of those over 65 are in a situation of fragility that makes them more vulnerable to becoming dependent. Fragility is more frequent in women and increases with age. The new knowledge and the questions that are opened, change the landscape of prevention, early detection and the treatment of frailty. In 2014 it is published the "Consensus document on the prevention of frailty and falls in the elderly", within the framework of the Strategy for the promotion of health and prevention in the National Health System, of the Ministry of Health, Social Services and Equality, tries to homogenize these issues, and establishes recommendations for the prevention and screening of fragity

Atypical ischemic repolarization in right bundle branch block.

A 70-year-old male presented to emergency room 16 h after the onset of acute chest pain. Initial ECG showed sinus rhythm with a wide QRS and right bundle branch block (RBBB) with concordant and symmetric T waves in V1-V2. A plausible explanation for the atypical positive T waves in leads V1-V2 in conjunction with RBBB could be non-reperfused lateral MI (LMI) as a "mirror-image" of inverted T waves in the posterior leads V7-V9. Coronary angiography showed total thrombotic occlusion TIMI thrombus grade 5 of the circumflex artery. One ECG expression of circumflex artery occlusion is isolated LMI.

Case report: Posterior myocardial infarction in presence of right bundle branch block: an old concept with new findings.

BACKGROUND: The diagnosis of acute ischaemic coronary syndromes in presence of an intra-ventricular conduction disturbance represents a clinical challenge. In the cardiac segmentation model the posterior wall is replaced by the basal inferior segment. However, in the clinical scenario of acute coronary syndrome the concept of posterior myocardial infarction (PMI) endures. The association of a PMI and right bundle branch block (RBBB) is a rare condition characterised by broad R waves and ventricular repolarization disorders in right precordial leads in both entities, which could lead to misinterpretation and delay in reperfusion therapy. CASE SUMMARY: We describe a case report of a 74-year-old man with acute chest pain and an electrocardiogram with broad R waves, a 4 mm ST-segment downsloping (excessively discordant) in right precordial leads, RBBB, and ST-segment elevation in posterior leads. There was resolution of ST-segment downsloping in right precordial leads after percutaneous coronary intervention and stenting of the circumflex artery, with disturbance of the repolarization process only attributable to RBBB. DISCUSSION: Patients with acute chest pain with RBBB and a ST segment with an excessive downsloping (out of proportion of what is expected in isolated RBBB) suggest PMI with occlusion of the circumflex coronary artery.

[Promoting Intergenerational Relationships as a Strategy to Face the Challenges of Demographic Aging]. / La promoción de las relaciones intergeneracionales como estrategia para afrontar los desafíos del envejecimiento poblacional.

Nowadays, social and health representatives are putting the focus on emerging need: promote intergenerational programs and practices to generate spaces of encounter and collaboration between people of different ages. According to it, the purpose of intergenerational practices should be to achieve as aim for a society for all ages, regardless of age, an expression proposed by United Nations, not only to integrate all ages but to respond to their needs and provide them a higher quality of life.

Análisis de género en la concordancia entre profesionales y progenitores en la valoración de los signos del trastorno por déficit de atención con o sin hiperactividad de los hijos / Gender analysis in the agreement in assessing the signs between professionals and parents whose children have attention deficit and/or hyperactivity disorder

El Trastorno por Déficit de Atención con o sin Hiperactividad (TDAH) es la enfermedad neuropsiquiátrica crónica más prevalente en pediatría, interfiere en el desarrollo normal del niño y trasciende a la adolescencia y la vida adulta. El diagnóstico se desarrollará si el niño muestra los síntomas principales de falta de atención o hiperactividad-impulsividad, con consecuencias en distintos aspectos de la vida cotidiana, tales como los logros académicos, la vida familiar o las interacciones sociales con los otros niños. Estos síntomas aparecerán a lo largo de la vida de diferentes maneras. Cuando el niño es pequeño, la hiperactividad y la impulsividad prevalecerán, pero a medida que el niño crece, será más evidentes la distraibilidad y la dificultad para recordar cosas y hechos. El objetivo de este estudio ha sido analizar si hay diferencias en la valoración de los signos del TDAH entre padres y madres en comparación con el diagnóstico del profesional sanitario, según el sexo de los niños y el subtipo del trastorno. Se llevó a cabo un estudio observacional y descriptivo de la información proporcionada por padres y madres en el cuestionario Vanderbilt. Participaron un total de 78 casos de niños y niñas diagnosticados de TDAH con edades entre los 6 y 16 años que acudieron a la Consulta de Neuropediatría del Hospital Valle del Nalón (Asturias) entre octubre de 2011 y marzo de 2013. Respecto al diagnóstico de déficit de atención, la media de respuestas positivas otorgadas por las madres (7.38 ± 1.81) es superior a la de los padres (6.47 ± 2.46). Lo mismo sucede en el caso del diagnóstico de hiperactividad/impulsividad, con una media de puntuaciones de las madres (5.80 ± 2.90) con una respuesta positiva superior a las de los padres (4.74 ± 3.04). Se ha observado que las madres muestran un mayor porcentaje de concordancia con el diagnóstico médico (86.3 %) cuando el hijo es una niña que cuando es un niño (66 %), mientras que para los padres el porcentaje de concordancia fue menor, del 50 %, cuando el hijo es niña, y del 44.6 % cuando es niño (AU)

The attention deficit hyperactivity disorder (ADHD) is the most prevalent chronic neuropsychiatric illness in childhood. It interferes with normal development of children. Its impact transcends childhood to appear in adolescence and adulthood. Diagnosis would be developed if the child shows the main symptoms of inattention and/or hyperactivity-impulsivity, with consequences in different aspects of daily life, such as academic achievements, family life or social interactions with other children. These symptoms will come up along life in different ways. When the child is young, hyperactivity and impulsivity prevail, but as he/she grows, the dispersion and difficulty to remember things and facts will become more evident. The aim of the study was to assess with the Vanderbilt scale, based on DSM-IV diagnostic criteria, the differences of the impact of ADHD among parents, in comparison to the medical diagnosis. A retrospective study was carried out by using this questionnaire, which completed by both parents individually. A total of 78 children took part in this study, all of them diagnosed with ADHD, with ages ranging from 6 to 16 years old, who attended to Neuropedriatics at Valle del Nalón Hospital (Asturias), between October 2011 and March 2013. Regarding attention deficit, the average of positive responses given by mothers (7.38 ± 1.81) was higher than that offered by fathers (6.47 ± 2.46). The same is true for hyperactivity/impulsivity, with average scores of mothers (5.80 ± 2.90) which were one positive response higher than those given by male parents (4.74 ± 3.04). Mothers show a higher percentage of agreement with the medical diagnosis (86.3 %) when the child was a girl and 66 % with boys, whereas for fathers the percentage of agreement was less than 50 % female children and 44.6 % for male children (AU)

[Gender Analysis in the Agreement in Assessing the Signs Between Professionals and Parents Whose Children Have Attention Deficit and/or Hyperactivity Disorder]. / Análisis de género en la concordancia entre profesionales y progenitors en la Valoración de los Signos del Trastorino por Déficit de Atención Con o sin Hiperactividad de los Hijos.

The attention deficit hyperactivity disorder (ADHD) is the most prevalent chronic neuropsychiatric illness in childhood. It interferes with normal development of children. Its impact transcends childhood to appear in adolescence and adulthood. Diagnosis would be developed if the child shows the main symptoms of inattention and/or hyperactivity-impulsivity, with consequences in different aspects of daily life, such as academic achievements, family life or social interactions with other children. These symptoms will come up along life in different ways. When the child is young, hyperactivity and impulsivity prevail, but as he/she grows, the dispersion and difficulty to remember things and facts will become more evident. The aim of the study was to assess with the Vanderbilt scale, based on DSM-IV diagnostic criteria, the differences of the impact of ADHD among parents, in comparison to the medical diagnosis. A retrospective study was carried out by using this questionnaire, which completed by both parents individually. A total of 78 children took part in this study, all of them diagnosed with ages ranging from 6 to 16 years old, who attended to Neuropedriatics at VAlle del Nalón Hospital(Asturias), between October 2011 and March 2013. Regarding attention deficit, the average responses given by mothers (7.38 ± 1.81) was higher than that offered by fathers (647 ± 2/46). The same is true for hyperactivity/impulsivity, with average scores of mothers (5.80 ± 2.90) which were one positive response higher than those given by male patients (4.74 ± 3.04). Mothers show a higher percentage of agreement with the medical diagnosis (86.3%) when the child was a girl and 66% with boys, whereas for fathers the percentage of agreement was less than 50% female children and 44.6% for male children.

Erradicación de diabetes en Guatemala: un sueño posible / A dream to achieve: diabetes erradication in Guatemala

La diabetes mellitus es un problema de salud con alcances económicos y sociales. La prevalencia mundial está aumentando: se estima que para 1985 había 30 millones de personas con diabetes, 177 millones en el año 2000 y se estima que para el año 2030 habrá 438 millones de diabéticos. En Guatemala el 8% de la población tiene diabetes y se desconoce el porcentaje no diagnosticado y en pre-diabetes; además el país tiene índices de obesidad, sobrepeso y sedentarismo altos, situación que predispone a la aparición de la enfermedad. En el mundo cada 6 segundos muere alguien a causa de complicaciones relacionadas con diabetes y en Guatemala ocupa la tercera causa de mortalidad general. Existen varios tipos de diabetes, sin embargo, el ensayo se enfoca en la diabetes tipo 2 debido a que representa el 90% de los casos pero sobre todo por que es prevenible. Para el autor existen tres momentos importantes de los pacientes diabéticos: (1) paciente sano y con riesgo qué enfermará de diabetes, (2) paciente diabético que tendrá complicaciones y (3) pacientes con complicaciones que morirán. En los tres momentos se puede intervenir directamente, sin embargo, existen deficiencias como la ausencia de programas de prevención y la ineficiencia del sistema asistencial público. El autor propone posibles soluciones en base a evidencia científica para detener el aumento de casos de diabetes mellitus, disminuir las complicaciones micro y macro vasculares en los pacientes y principalmente, generar una cultura preventiva en Guatemala.

Diabetes is a health problem with social and economic consequences. The worldwide prevalence of diabetes is raising; by 1985 there were 30 million of people with diabetes, 177 million by the year 2000 and it is estimated that in 2030 there will be around 438 million people with diabetes. The prevalence of diabetes in Guatemala it’s around 8% of the population, however it is unknown the prevalence of the underdiagnosed and pre-diabetes. Guatemala has high obesity, overweight and sedentary index which increase the risk of diabetes. Worldwide every 6 seconds somebody dies as a consequence of diabetes and in Guatemala represents the third cause in general mortality. The analysis is made about type 2 diabetes which represents 90% of all diabetes and in general is preventable. The author proposes 3 moments in the diabetes natural history: (1) healthy patients that will become diabetics, (2) diabetics who will have a complication related to the disease and (3) complicated patients who will decease. During these three moments there are interventions to be done, however there are non-preventable programs and the inefficiency of the public assistant system. The author proposes possible solutions in base of scientific evidence to stop the raising of diabetes, lowering micro and macro vascular complications and overall to generate a preventive culture in Guatemala.

[Pain in the elderly]. / Dolor en al anciano.

Pain leads to unpleasant sensory or emotional experience for any individual. In the elderly, given their biopsychosocial characteristics, the pain requires a specific approach, different from other age groups: this is the objective of this article, which dealt with the different types of pain, the assessment and treatment of the same.

[The functional assessment as comprehensive geriatric assessment axis]. / La valoración funcional como eje de la valoración geriátrica integral.

The comprehensive geriatric assessment (VGI) is a diagnostic process dynamic, structured, multidimensional and interdisciplinary to detect problems and needs of older people to develop an intervention strategy, although scientific evidence should not apply to all groups elderly. The VGI is developed by an interdisciplinary team, which plays a key role nursing. The framework nurse and nursing conceptual models, especially the 11 functional health patterns, enable the multidimensional assessment and subsequent intervention. The VGI covers four areas, clinic, mental, social and functional, although its axis, its importance and globalization concept is functional assessment. For this we have the history, physical examination and a series of specific instruments, geriatric assessment scales. They are a complement to, not only the VGI axis.