Intestinal parasitic infections and their potential risk factors among prison inmates in Valencia, Spain.

BACKGROUND: Despite the fact that prison inmates are a population at higher risk than other groups of suffering from intestinal parasite infections in relation to their living conditions, information about these diseases in prison environments is still scarce. Herein, we analyze the status of intestinal parasite infections in a Spanish prison. METHODS: A cross-sectional study involving 528 inmates was conducted from April to June 2022 among inmates at Centro Penitenciario Picassent (Valencia, Spain). Stool specimens were examined using the direct wet mount technique, the formol-ether concentration technique, and the Ziehl-Neelsen staining method. We used STATA 16.1 for data analysis. We consider a p-value less than 0.05 significant at a 95% confidence level. RESULTS: Of the 528 inmates (471 men and 57 women; a mean age of 41.94 years) enrolled in the study, 83 (15.7%) were infected. Only six species of protozoa were detected. The gut potential microeukaryotic pathobiont Blastocystis sp. was the predominant parasite, accounting for 37 (44.6%) of the infections. Gut parasite amebas (6.6%) and pathobionts (5.3%) were more prevalent than flagellates (2.3%). The prevalence of infection with pathogenic species (8.9%) was similar to that of non-pathogenic species (8.7%). Infection among men (15.2%) was higher than in women (0.6%) (p < 0.0001). In multivariate analysis, the country of birth (AOR = 0.31, 95% CI = 0.18-0.52) and the time spent in prison (AOR = 1.83, 95% CI = 1.06-3.14) were statistically significant associated to intestinal parasite infections (p < 0.0001 and p = 0.028, respectively). CONCLUSION: This study found low levels of intestinal parasite infections in the CPP which could be indicative of the implementation of sanitary measures in prison environments in Spain. The less time spent in prison favor the risk of having infection while the Spanish nationality of inmates could reduce the risk of infection. The main recommendation would be to introduce routine parasitological tests upon foreigners entering prison.

Effects of Exergames and Conventional Physical Therapy on Functional Physical Performance in Older Adults: A Randomized Controlled Trial.

Objective: To evaluate the effects of exergames added to a conventional physical therapy (CPT) program on functional fitness and dynamometric muscle performance for the sit-to-stand (STS) maneuver in older adults and to compare their results concerning a CPT-only intervention. Materials and Methods: Fifty independent older adults were randomly assigned to CPT and exergames (CPT+ExG group; n = 25; age = 71.8 ± 6.8 years) or CPT alone (CPT group; n = 25; age = 71.3 ± 7.4 years). CPT was performed twice a week (60 min/session) for 8 weeks. The CPT+ExG group added exergames for 30 minutes in each session. The Senior Fitness Test was applied, considering the 30-second chair stand test as the primary outcome. Additionally, dynamometric muscle performance during the STS maneuver was assessed. Results: The CPT+ExG group improved the 30-second chair stand (lower body strength), back scratch (upper body flexibility), and 8-foot up-and-go (agility/dynamic balance) tests (all P < 0.05). Both groups improved the kinetic dynamometric variables peak force, peak power, and total work (all P < 0.05). Also, both groups improved the 30-second arm curl test (upper body strength) (P < 0.05), although the increase was higher in the CPT+ExG group compared with the CPT group (time × group; P < 0.05). Conclusion: Adding exergames to a CPT program only significantly increases upper limb strength compared with CPT alone. The findings of this study have implications for the design of future exergame interventions focused on improving STS maneuver performance in older adults.

Incidencia del trauma perineal en mujeres con inmersión en el agua durante el proceso de parto frente a mujeres en proceso de parto convencional / Incidence of perineal trauma in women with immersion in water during the delivery process compared to women undergoing conventional delivery

Objetivo: Determinar la incidencia del trauma perineal en mujeres con inmersión en el agua durante el proceso de parto frente a mujeres con parto convencional. Métodos: Estudio observacional transversal retrospectivo realizado en el Hospital Comarcal d’Inca (Islas Baleares) entre 2017 y 2019. Los sujetos de estudio fueron 100 gestantes de bajo riesgo con expulsivo en bañera de partos (casos) y 100 gestantes seleccionadas aleatoriamente y con las mismas características que el grupo de casos en cuanto a paridad, edad gestacional y edad materna con parto convencional y sin analgesia epidural (controles). Se determinó la incidencia de trauma perineal en ambos grupos mediante un análisis de datos retrospectivo de los resultados perineales. Resultados: Se han obtenido tasas de periné íntegro y trauma perineal de primer grado superiores en parto en agua frente a parto convencional (34 vs. 21 % y 33 vs. 29 %, respectivamente). La incidencia de desgarros de mayor gravedad ha sido inferior en partos en agua frente a partos convencionales (32 vs. 47 % en caso de desgarros de segundo grado, 0 vs. 1 % en desgarros de tercer grado A y 1 vs. 2 % en grado B). Conclusiones: La incidencia y la gravedad de los traumatismos perineales fueron menores en mujeres con expulsivo en agua frente a aquellas con parto convencional sin uso de hidroterapia, independientemente de su edad, paridad y edad gestacional. (AU)

Objective: To determine the incidence of perineal trauma in women with immersion in water during the delivery process compared to women with conventional delivery. Methods: Retrospective cross-sectional observational study carried out at the Hospital Comarcal d’Inca (Balearic Islands) between 2017 and 2019. The study subjects were 100 low-risk pregnant women with dilation and expulsive labor in the delivery tub (cases) and 100 randomly selected pregnant women with the same characteristics as the group of cases in terms of parity, gestational age and maternal age with conventional delivery and without epidural analgesia (controls). The incidence of perineal trauma in both groups was determined by retrospective data analysis of perineal outcomes. Results: Higher rates of intact perineum and first degree perineal trauma have been obtained in water delivery compared to conventional delivery (34% vs 21% and 33% vs 29%, respectively). The incidence of more serious tears has been lower in water deliveries compared to conventional deliveries (32% vs 47% in case of second degree tears, 0% vs 1% in type third A and 1% vs 2% in type third B). Conclusions: The incidence and severity of perineal trauma was lower in women with a water expulsive procedure compared to those with a conventional delivery without the use of hydrotherapy, regardless of their age, parity, and gestational age. (AU)

Anemia and undernutrition in intestinally parasitized schoolchildren from Gakenke district, Northern Province of Rwanda.

BACKGROUND: Rwanda is a sub-Saharan country, where intestinal parasite infections, anemia and undernutrition coexist. The purpose of this research is to study the relationship between intestinal parasite infections and undernutrition/anemia to clarify the priorities of intervention in the rural area of Gakenke district in the Northern Province of Rwanda. MATERIALS AND METHODS: A total of 674 students from Nemba I School, participated in a cross-sectional study, in which their parasitological and nutritional status were analysed. Statistical analysis was performed by χ2 test, univariate analysis and Odds ratios (OR). RESULTS: A total of 95.3% of children presented intestinal parasitism, most of whom (94.5%) infected by protozoa and 36.1% infected by soil-transmitted helminths (STH), with Trichuris trichiura (27.3%) being the most prevalent. Multiple infections were found to be high (83.8%), with protozoa and STH co-infections in 30.6%. STH infections were mainly of low/moderate intensity. Neither infection nor STH infection of any intensity profile, was significantly related to anemia. In addition, STH infection, regardless of the intensity profile, was not associated with stunting, underweight or thinness. There was no difference between genders nor among ages in odds of anemia and nutritional status in STH-infected schoolchildren. CONCLUSION: Multiparasitism remains high among Rwandan schoolchildren and is likely to cause nutritional problems. This work emphasizes the importance of keeping up health programs to reduce the prevalence of infection.

Human Neutrophils Generate Extracellular Vesicles That Modulate Their Functional Responses.

Neutrophils influence innate and adaptive immunity by releasing various cytokines and chemokines, by generating neutrophil extracellular traps (NETs), and by modulating their own survival. Neutrophils also produce extracellular vesicles (EVs) termed ectosomes, which influence the function of other immune cells. Here, we studied neutrophil-derived ectosomes (NDEs) and whether they can modulate autologous neutrophil responses. We first characterized EV production by neutrophils, following MISEV 2018 guidelines to facilitate comparisons with other studies. We found that such EVs are principally NDEs, that they are rapidly released in response to several (but not all) physiological stimuli, and that a number of signaling pathways are involved in the induction of this response. When co-incubated with autologous neutrophils, NDE constituents were rapidly incorporated into recipient cells and this triggered and/or modulated neutrophil responses. The pro-survival effect of GM-CSF, G-CSF, IFNγ, and dexamethasone was reversed; CXCL8 and NET formation were induced in otherwise unstimulated neutrophils; the induction of inflammatory chemokines by TNFα was modulated depending on the activation state of the NDEs' parent cells; and inducible NET generation was attenuated. Our data show that NDE generation modulates neutrophil responses in an autocrine and paracrine manner, and indicate that this probably represents an important aspect of how neutrophils shape their environment and cellular interactions.

Case report: Anterior open bite correction treatment by dental treatment and physical therapy through craniocervical mandibular and occlusal stabilization.

BACKGROUND: The opinion on whether a patient with an anterior open bite should be treated surgically or not is controversial. These patients generally suffer from associated discomfort due to their occlusal instability and musculoskeletal pain. CLINICAL PRESENTATION: A 60-year-old woman visited the clinic with dental mobility of her upper central incisors as her chief complaint. She had a severe anterior open bite, with a history of continuous grinding and multiple dental restorations in poor condition. Additionally, she suffered neck pain with movement restrictions. CONCLUSION: Dentists can evaluate and treat patients with an anterior open bite using this integrative model (physical therapy/dentistry) as a possible alternative as part of the treatment for anterior open bite patients.

Calidad del sueño de las mujeres gestantes en el primer trimestre del embarazo / Quality of sleep in pregnant women during their first trimester of pregnancy

Objetivo: conocer la calidad del sueño de mujeres gestantes en su primer trimestre de embarazo y la influencia de presentar antecedente de aborto espontáneo de primer trimestre (AEPT) en gestaciones previas.Método: estudio descriptivo transversal en mujeres gestantes de 5-12 semanas, de Ciudad Real. Se recogió información del perfil de la gestante y se usó el índice de Calidad de Sueño de Pittsburgh (PSQI), que incluye siete áreas: calidad de sueño subjetiva, latencia de sueño, duración del dormir, eficiencia habitual de sueño, alteraciones del sueño, uso de medicamentos para dormir y disfunción diurna. Análisis de datos descriptivo y analítico. Se consideraron significativas las diferencias si p< 0,05.Resultados: participaron 110 mujeres gestantes. El PSQI mostró que un 85% de las gestantes sin antecedentes personales de AEPT (n= 47) tenía PSQI < 7 o facilidad para dormir; un 13% (n= 7) presentaba PSQI= 8-14 o dificultad media y un 2% (n= 1) tenía PSQI > 15 o dificultad severa para dormir. En cuanto a las que sí contaban con historia de AEPT, un 65% (n= 36) tenía PSQI < 7, un 31% (n= 17) presentaba PSQI= 8-14 y un 4% (n= 2) obtuvo PSQI >15. Existían diferencias estadísticamente significativas (p < 0,05) en todas las áreas que comprenden el PSQI, excepto en la utilización de medicación para dormir.Conclusiones: la calidad del sueño de las mujeres gestantes sin antecedentes de AEPT es mejor que la de aquellas que sí los tienen. El estado de salud actual de la mujer embarazada, los eventos estresantes, los hábitos tóxicos durante la gestación y los antecedentes de alteraciones del sueño fueron las variables que estaban condicionando la calidad del sueño de la muestra de estudio.(AU)

Objective: to understand the quality of sleep in pregnant women during their first trimester of pregnancy, and the influence of a past history of first trimester miscarriage in previous pregnancies.Method: a cross-sectional descriptive study in women from Ciudad Real in their 5-to-12 weeks of pregnancy. Information was collected about the pregnant women profiles, and the Pittsburgh Sleep Quality Index (PSQI) was used, which includes seven areas: subjective quality of sleep, sleep latency, sleep duration, typical sleep efficiency, sleep alterations, use of sleeping medications, and daytime dysfunction. There was descriptive and analytical data analysis; differences were considered significant if p< 0.05.Results: the study included 110 pregnant women. The PSQI showed that 85% of women without personal history of first trimester miscarriage (n= 47) had a PSQI< 7 or ease sleeping; 13% (n= 7) presented PSQI= 8-14 or intermediate difficulty, and 2% (n= 1) presented PSQI> 15 or severe difficulties to sleep. Regarding those with a history of first trimester miscarriage, 65% (n= 36) had a PSQI< 7, 31% (n= 17) presented a PSQI= 8-14, and 4% (n= 2) reached a PSQI> 15. There were statistically significant differences (p< 0.05) in all PSQI areas, except in the use of sleep medication.Conclusions: the quality of sleep was better in pregnant women without a history of first trimester miscarriage than in those who presented it. The current health status of the pregnant woman, stressful events, toxic habits during pregnancy and a history of sleep alterations were the variables which determined the quality of sleep in the study sample.(AU)

Evidence for Transmission of Taenia solium Taeniasis/Cysticercosis in a Rural Area of Northern Rwanda.

Cysticercosis is a parasitic infection caused by the metacestode larval stage (cysticercus) of Taenia solium. In humans, cysticercosis may infect the central nervous system and cause neurocysticercosis, which is responsible for over 50,000 deaths per year worldwide and is the major cause of preventable epilepsy cases, especially in low-income countries. Cysticercosis infection is endemic in many less developed countries where poor hygiene conditions and free-range pig management favor their transmission. A cross-sectional study was conducted in 680 children from a rural primary school in Gakenke district (Northern province of Rwanda). Stool samples were collected from participants and analyzed using the Kato-Katz method (KK), formol-ether concentration (FEC), and/or copro-antigen enzyme-linked immunosorbent assay (CoAg-ELISA) to detect taeniasis. Blood samples were collected and analyzed using enzyme-linked immunoelectrotransfer blot (EITB) and antigen enzyme-linked immunosorbent assay (Ag-ELISA) to detect human cysticercosis. The overall proportion of taeniasis positivity was 0.3% (2/680), and both cases were also confirmed by CoAg-ELISA. A total of 13.3% (76/572) of the children studied were positive to cysticercosis (T. solium-specific serum antibodies detected by EITB), of whom 38.0% (27/71) had viable cysticercus (T. solium antigens by Ag-ELISA). This study provides evidence of the highest cysticercosis prevalence reported in Rwanda in children to date. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for T. solium control are needed in Gakenke district.

Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy.

Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN: Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS: In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS: GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.

Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy.

Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN: Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS: In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS: GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.

Espesantes comerciales clásicos y de nueva generación. Cualidades organolépticas y utilidad en las pruebas diagnósticas de la disfagia / Classic and new-generation commercial thickeners. Organoleptic qualities and usefulness in the diagnostic tests of dysphagia

INTRODUCCIÓN: los espesantes son muy utilizados en los trastornos de la deglución, tanto para su diagnóstico como para conseguir una alimentación segura y eficaz. Recientemente se han comercializado en el mercado español productos compuestos por gomas con el fin de mejorar las cualidades organolépticas y físicas de los alimentos espesados. OBJETIVO: comparar agentes espesantes de ámbito clínico comercializados en España y verificar sus características organolépticas y físicas para ser utilizados en los procedimientos diagnósticos y en la alimentación del paciente con disfagia. MÉTODO: se valoraron las propiedades organolépticas (apariencia, color, olor, sabor y regusto) y físicas (solubilidad y estabilidad) de ocho espesantes (4 clásicos con almidón y 4 nuevos a base de gomas) en una muestra de 44 sujetos sanos. Además, se estudió su utilidad en las pruebas diagnósticas al mezclarlos con colorantes y contrastes hidrosolubles. RESULTADOS Y CONCLUSIONES: los espesantes de nueva generación, a base de gomas, obtienen en general mejores puntuaciones en sus cualidades físicas y organolépticas con respecto a los espesantes convencionales. Los espesantes con almidón son más adecuados en las pruebas diagnósticas, ya que los espesantes con gomas presentan algunas peculiaridades en las mezclas con colorantes y contrastes que deben ser tenidas en cuenta en dichas pruebas

INTRODUCTION: thickeners are widely used in swallowing disorders, both for diagnosis and to achieve a safe and effective diet. Recently, products composed of gums have been commercialized in the Spanish market in order to improve the organoleptic and physical qualities of thickened foods. OBJECTIVE: to compare thickening agents of clinical scope marketed in Spain, and to verify their organoleptic and physical characteristics, to be used in the diagnostic procedures and the feeding of patients with dysphagia. METHOD: the organoleptic (appearance, colour, smell, taste, aftertaste) and physical (solubility, stability) properties of eight thickeners (4 classic starch-based and 4 new gum-based) were assessed in a sample of 44 healthy subjects. In addition, their usefulness in diagnostic tests was studied by mixing them with dyes and water-soluble contrasts. RESULTS AND CONCLUSIONS: new-generation thickeners, based on gums, generally obtain better scores for their physical and organoleptic qualities than conventional thickeners. Starch thickeners are more suitable for diagnostic tests, as gum thickeners present some peculiarities in their mixtures with dyes and contrasts that must be taken into account in diagnostic tests

Evaluación de patrones de apego en niños prematuros, estudio comparativo con niños nacidos a término / Assessment of attachment patterns in preterm children, comparative study with children born at term

Resumen Se presentan resultados preliminares de una investigación en curso que se realiza en un centro público de salud de la ciudad de La Banda, provincia de Santiago del Estero, que propone evaluar la incidencia de la prematuridad en el estilo de apego del niño. Se evalúan niños nacidos prematuros y nacidos a término entre 12 y 24 meses. Se parte de la idea de que características de la prematuridad, tales como la internación en neonatología y las manifestaciones conductuales y emocionales diferentes a las de niños nacidos a término, pueden introducir diferencias en el apego. La muestra estuvo integrada por 30 díadas madre-bebé correspondientes a dos grupos: (A) compuesto por díadas madre-bebé prematuro, y (B) de control, compuesto por díadas madre-bebé no prematuro. Para evaluar el apego, se utilizó la escala Procedimiento Argentino de la Situación Extraña (Rodríguez y Oiberman, 2013) y se recopiló información sociodemográfica de determinadas variables que pudieran estar asociadas a la calidad del apego de los infantes con sus madres (edad materna, estado civil, trabajo materno, género del niño y tiempo de internación del niño). Los resultados muestran que no existen diferencias con significación estadística entre los grupos estudiados en la calidad del apego. Se encontró relación entre el tiempo de internación y la distribución de apego, siendo que a mayor frecuencia de apego seguro, menor tiempo de internación del niño. Este estudio es uno de los primeros en analizar la distribución del apego en infantes nacidos prematuros en Sudamérica.

Abstract Preliminary results of an ongoing investigation are presented in a public health center in the city of La Banda, province of Santiago del Estero, which aims to assess the incidence of prematurity in the child's attachment style. Children born preterm and full-term are evaluated during the second year of life (12-24 months). It is based on the idea that some characteristics of prematurity, such as hospitalization in neonatology and behavioral and emotional manifestations different from that of children born at term, can introduce differences in the way of linking. The sample consisted of 30 mother-baby dyads corresponding to two groups: group A, composed of mother- premature baby dyads, and a control group B, composed of mother-non-premature baby dyads, 15 of these correspond to mother/premature son and 15 to mother/non premature child. Fifteen girls and 15 males were studied. Healthy children were selected for the non-premature children control group (without previous pathologies). The mothers were between 22 and 37 years old and the children between 12 and 24 months old. To assess the attachment, the Argentine Procedure of the Strange Situation scale was used (Rodríguez and Oiberman, 2013) and socio-demographic information of certain variables that could be associated with the quality of attachment of infants with their mothers (maternal age, marital status, maternal work, child's gender and time of child's admission) was compiled. The Argentine Procedure of the Strange Situation is a controlled laboratory procedure consisting of observation in a double-mirror room, where the infant and his mother are evaluated in 8 episodes of 3 minutes each, in which the mother separates from and meets with her son, together with the presence of a stranger. For the statistical analysis of the data obtained, the statistical package for social sciences was used (SPSS). The research has the endorsement of the Institutional Committee of Ethics of Research in Health (CIEIS) corresponding to the Ministry of Health and Social development of Santiago del Estero, which certifies that the investigation complies with the ethical requirements. The results show that there are no statistical significant differences among the groups studied in the quality of attachment. Although it can be observed that the percentage of safe attachment is lower in premature infants in relation to children born at term, 60 % and 73 % respectively, this difference does not become significant at the statistical level. It should be taken into account that in this study we worked with a small simple; perhaps in a broader number of members of each group the results have significant differences. Similarly, no relationship was found between the socio-demographic variables studied and the style of attachment of the child. It was found that, in the case of premature born children, the time of hospitalization is related to the quality of attachment, most children who had a safe attachment style are those who had fewer days of hospitalization (less than 15 days). This study may be considered one of the first in South America to analyze the frequency of adherence patterns in premature early childhood, with the use of the argentine adaptation of the instrument that has more validation in the subject of attachment. These first results of the research in progress have certain limitations: one of them is the number of cases analyzed, and a second one was that the work was done with moderate and late preterm. It would be interesting to analyze the results of a study including children born with extreme prematurity (before 28 weeks).

Alterations of the HPA Axis Observed in Patients with Major Depressive Disorder and Their Relation to Early Life Stress: A Systematic Review.

BACKGROUND: Alterations of the hypothalamic-pituitary-adrenal (HPA) axis are common in patients diagnosed with major depressive disorder (MDD). Nevertheless, these alterations are not found in every patient. There is evidence to indicate a possible mediating role of early life stress (ELS) in the relation between dysfunction of the HPA axis and MDD. We conducted a systematic review to understand if the alterations of the HPA axis commonly found in patients with MDD are due to early life stress or are caused by the disorder itself. METHODS: The review was conducted by following the PRISMA guidelines. Original articles were found in PubMed and via a manual search. Only studies whose design allowed comparison of the HPA functioning in the 4 groups no-MDD/no-ELS, MDD/no-ELS, no-MDD/ELS, and MDD/ELS were included. RESULTS: Hyperactivity or hypoactivity of the HPA axis was found in 8 articles. A greater number of abnormalities and a higher rate of posttraumatic stress disorder comorbidity were found in the MDD/ELS group. Dysfunction of the HPA axis was also found in the no-MDD/ELS groups. CONCLUSION: HPA dysfunction found in MDD seems to be more related to the presence of ELS rather than to the MDD itself. Future studies are needed to clarify the exact mechanisms involved.

Peculiaridades anatómicas que influyen en la voz erigmofónica / Anatomical peculiarities having an influence on esophageal voice

La laringectomía total ocasiona un cambio morfológico trascendente en el aparato vocal, que altera totalmente el mecanismo fisiológico de la voz. Objetivo: describir aspectos claves de la morfología del aparato vocal de las personas que utilizan la voz erigmofónica para su comunicación. Material y método: estudio prospectivo de 15 pacientes laringectomizados que utilizan voz erigmofónica en los que se aplicaron los test VHI-30, CAPE-V y una exploración clínica y endoscópica, destacando los aspectos morfológicos que podrían influir en la voz. Resultados: el VHI-30 revela que perciben su voz como limitación leve y moderada. El CAPE-V indica una afectación media y grave. El VHI-30 (grados leve y moderado) se relaciona significativamente con la severidad global del CAPE-V. En la exploración clínica de la cavidad oral y el traqueostoma no se observan alteraciones que se relacionen con la valoración del CAPE-V. La exploración endoscópica muestra tendencias entre volúmenes y áreas de la cavidad faríngea y del esófago con el CAPE-V, pero sin llegar a valores significativos. Las formas de botón y diafragma del segmento faringoesofágico exhiben una tendencia similar. Conclusiones: la calidad de la voz erigmofónica percibida por el explorador dependería, en cierta medida, de las características anatómicas del nuevo aparato vocal del laringectomizado

Total laryngectomy causes a morphological change in the vocal apparatus, which totally alters the physiological mechanism of the voice. Aim: the objective of this article is to describe key aspects of the vocal apparatus morphology of patients who use the esophageal voice to communicate. Material and method: prospective study of 15 patients with esophageal voice in which the VHI-30, CAPE-V and a clinical and endoscopic exploration were performed, highlighting the morphological aspects that could influence the voice. Results: the VHI-30 reveals that they perceive their voice as a mild and moderate limitation. The CAPE-V indicates a medium and severe affectation. Both tests are significantly related in the mild and severe grades of VHI with the global severity of CAPE-V. The clinical exploration of the oral cavity and tracheostoma doesn't show that its variables present a trend with CAPE-V. Endoscopic exploration shows trends in the relationship between volumes and areas of the pharyngeal cavity and esophagus with the CAPE-V, but without reaching significant values. The button and diaphragm shapes of the pharyngoesophageal segment exhibit the same tendency. Conclusions: the variables studied indicate that the quality of the esophageal voice would depend, to some extent, on the anatomical characteristics of the new laryngectomized vocal apparatus

Overdosing of benzodiazepines/Z-drugs and falls in older adults: Costs for the health system.

INTRODUCTION: Benzodiazepines and Z drugs (BZD/Z drugs) are commonly used for the treatment of insomnia and anxiety in older adults for long periods of time. Given the physiological and metabolic characteristics of this group of patients, they are more prone to the adverse effects of these drugs which include falls. The recommendations for use of BZD/Z drugs include the need to adjust the dose and select those with a short half-life, to avoid adverse events, which as well as potentially affecting patient outcome, increase healthcare costs. In this study, we have evaluated the hospital-related costs associated with falls in older adults who use BZD/Z drugs at doses higher than recommended for this age group. METHODS: We conducted a cross-sectional observational study assessing the BZD/Z drug prescriptions of older adults attending the emergency department after a fall. Cost analysis was performed for cases in which the prescriptions exceeded the maximum recommended dose for this age group. RESULTS: A total of 40.6% of the prescriptions recorded were higher than the defined daily dose in older adults (DDDolderadults). Of the 57 patients who used BZD/Z drugs at higher-than-recommended doses, 53 experienced trauma and 33 required hospitalisation. The costs associated with emergency department services, tests performed and hospitalisation amounted to €1850/patient. CONCLUSIONS: Appropriate dosage of BZD/Z drugs in older adults could reduce both patient suffering and costs for the health system.

Prescripción de benzodiacepinas y caídas en mujeres y hombres ancianos / Benzodiazepine prescriptions and falls in older men and women

Objetivo. A pesar de las advertencias de numerosas asociaciones profesionales, las benzodiacepinas (BZD) y los hipnóticos Z (Z) son ampliamente prescritos a los ancianos ya que son especialmente susceptibles de padecer insomnio y ansiedad, pero a su vez resultan especialmente sensibles a la aparición de efectos secundarios a dichos medicamentos. En este estudio evaluamos la prescripción de BZD/Z en una muestra de ancianos (≥65) que se presentan en el servicio de urgencias de un hospital por haber sufrido una caída. Métodos. Recogimos información del tipo, número y dosis de los fármacos BZD/Z prescritos y exploramos la presencia de diferencias de género en dicha prescripción. Resultados. Las BZD/Z habían sido prescritas a un 43,6% de la muestra (n=654), más frecuentemente a las mujeres. El 78,4% de las prescripciones fueron de BZD/Z de vida media corta. La mayoría de los pacientes (83,5%) tomaban solamente un fármaco BZD/Z, pero un 16,5% consumían más de una BZD/Z, sin diferencias de género. Un 58% de los pacientes consumían dosis de BZD/Z más elevadas que las recomendadas para ancianos, siendo la proporción significativamente más elevada para los hombres (70% vs. 53,1%). Conclusiones. Alrededor de un 40% de los ancianos que acuden a un servicio de urgencias por haber sufrido una caída se encontraban tomando BZD/Z. Hemos hallado algunas diferencias de género en la prescripción de BZD/Z, especialmente en la prescripción por encima de la dosis recomendada para ancianos y de fármacos de vida media larga (AU)

Objective. Despite cautions by professional associations, benzodiazepines (BZD) and Z hypnotics (BZD/Z) are widely prescribed to older adults who are particularly susceptible to insomnia and anxiety, but who are also more sensitive to drugs adverse events. In this study, we assessed the prescription of BZD/Z drugs in a sample of older adults (≥65) who presented for emergency care after a fall. Methods. We collected the type, number and dose of BZD/Z drugs prescribed and explored gender differences in the prescription. Results. BZD/Z drugs were prescribed to 43.6% of the sample (n=654) and more frequently to women; 78.4% of prescriptions were for BZD/Z drugs with a short half-life. The majority of patients (83.5%) were prescribed only one type of BZD/Z, but 16.5% had been prescribed multiple BZD/Z drugs, with no gender difference. Doses higher than those recommended for older adults were prescribed to 58% of patients, being the doses significantly higher for men compared to women (70.0% vs 53.1%). Conclusions. Over 40% of older adults presenting for emergency care after a fall had previously been prescribed BZD/Z drugs. Some important gender differences in the prescription of BZD/Z drugs were seen, especially prescription above the recommended dose and of drugs with a long-half life (AU)

Benzodiazepine prescriptions and falls in older men and women. / Prescripción de benzodiacepinas y caídas en mujeres y hombres ancianos.

OBJECTIVE: Despite cautions by professional associations, benzodiazepines (BZD) and Z hypnotics (BZD/Z) are widely prescribed to older adults who are particularly susceptible to insomnia and anxiety, but who are also more sensitive to drugs adverse events. In this study, we assessed the prescription of BZD/Z drugs in a sample of older adults (≥65) who presented for emergency care after a fall. METHODS: We collected the type, number and dose of BZD/Z drugs prescribed and explored gender differences in the prescription. RESULTS: BZD/Z drugs were prescribed to 43.6% of the sample (n=654) and more frequently to women; 78.4% of prescriptions were for BZD/Z drugs with a short half-life. The majority of patients (83.5%) were prescribed only one type of BZD/Z, but 16.5% had been prescribed multiple BZD/Z drugs, with no gender difference. Doses higher than those recommended for older adults were prescribed to 58% of patients, being the doses significantly higher for men compared to women (70.0% vs 53.1%). CONCLUSIONS: Over 40% of older adults presenting for emergency care after a fall had previously been prescribed BZD/Z drugs. Some important gender differences in the prescription of BZD/Z drugs were seen, especially prescription above the recommended dose and of drugs with a long-half life.

Estudio comparativo del consumo de comida basura en ancianos del ámbito rural frente al ámbito urbano / Comparative study of the fast food consumption in elder people living rural areas versus urban areas

Objetivo: analizar el consumo de comida basura en ancianos del ámbito rural y del ámbito urbano, comprobando si hay diferencias significativas entre ambos grupos. Método: estudio descriptivo transversal en 346 ancianos con una horquilla de edad de 65-95 años, residentes en Porzuna y Madrid. Recogida de datos: encuesta autoadministrada con escala Likert. Análisis de datos: Chi-cuadrado, valor de significación p, intervalos de confianza. Resultados: un 27% de los ancianos rurales (n=46; DE=16,26; IC95%=53,87-61,13) y un 39% de los ancianos urbanitas (n=69) consumen comida basura, existiendo diferencias significativas: X2(1) = 6,1052; X2 crítico = 3,8415; p = 0,014 < 0,05. Si hablamos de las repercusiones en la salud, un 45% de los ancianos rurales (n=42; DE=14,14; IC95%=48,84-55,16) y un 90% de los urbanos (n=62) las percibe como negativas, sin que existan diferencias estadísticamente significativas: X2(1) = 0,067; X2 crítico = 3,8415; p = 0,7957 > 0,05. Discusión: la Escuela de Administración de Empresas ha registrado en España un ascenso del gasto en comida basura por habitante del 49,65% respecto a 2014. Según García y Villalobos su consumo en ancianos se debe a la disminución de poder adquisitivo, la muerte del cónyuge y/o la falta de apoyo social. Conclusiones: existen diferencias estadísticamente significativas en el consumo de comida basura, pero no en la percepción que tienen los ancianos de ambos grupos sobre su estado de salud derivada de su consumo

Objective: to analyze the consumption of junk food in elder people living in rural and urban areas, as well as to verify if there are significant differences between both. Method: cross-sectional descriptive study in 346 elder people in a fork of age 65-95 years, living in Porzuna and Madrid. Data collection: self-administered survey with Likert scale. Data analysis: Chi-square, significance value p, confidence intervals. Results: 27% of rural elder people (n=46, SD=16,26; CI95%=53,87-61,13) and 39% of urban elder people (n=69) consume junk food, with significant differences: X2(1) = 6,1052; X2 crítico = 3,8415; p = 0,014 < 0,05. If we talk about the consequences in elder people's health, 45% of the rural elder people (n=42, SD=14,14; CI95%=48,84-55,16) and 90% of the urban elder people (n=62) perceive them as negative without statistically significant differences: X2(1) = 0,067; X2 crítico = 3,8415; p = 0,7957 > 0,05. Discussion: the Business School has registered in Spain an increase in spending on "junk food" per capita of 49.65% compared to 2014. According to Garcia and Villalobos, their consumption in the elderly is due to the decrease in purchasing power, wife's death and/or the lack of social support. Conclusions: there are statistically significant differences in the consumption of "junk food", but not in the perception that the elderly of both groups have about their state of health derived from their consumption

Estudio comparativo del consumo de comida basura en ancianos del ámbito rural frente al ámbito urbano / Comparative study of the fast food consumption in elder people living rural area versus urban areas

Objetivo: analizar el consumo de comida basura en ancianos del ámbito rural y del ámbito urbano, comprobando si hay diferencias significativas entre ambos grupos. Método: estudio descriptivo transversal en 346 ancianos con una horquilla de edad de 65-95 años, residentes en Porzuna y Madrid. Recogida de datos: encuesta autoadministrada con escala Likert. Análisis de datos: Chi-cuadrado, valor de significación p, intervalos de confianza. Resultados: un 27% de los ancianos rurales (n=46; DE=16,26; IC95%=53,87-61,13) y un 39% de los ancianos urbanitas (n=69) consumen comida basura, existiendo diferencias significativas: X2(1) = 6,1052; X2 crítico = 3,8415; p = 0,014 < 0,05. Si hablamos de las repercusiones en la salud, un 45% de los ancianos rurales (n=42; DE=14,14; IC95%=48,84-55,16) y un 90% de los urbanos (n=62) las percibe como negativas, sin que existan diferencias estadísticamente significativas: X2(1) = 0,067; X2 crítico = 3,8415; p = 0,7957 > 0,05. Discusión: la Escuela de Administración de Empresas ha registrado en España un ascenso del gasto en comida basura por habitante del 49,65% respecto a 2014. Según García y Villalobos su consumo en ancianos se debe a la disminución de poder adquisitivo, la muerte del cónyuge y/o la falta de apoyo social. Conclusiones: existen diferencias estadísticamente significativas en el consumo de comida basura, pero no en la percepción que tienen los ancianos de ambos grupos sobre su estado de salud derivada de su consumo

Objective: to analyze the consumption of junk food in elder people living in rural and urban areas, as well as to verify if there are significant differences between both. Method: cross-sectional descriptive study in 346 elder people in a fork of age 65-95 years, living in Porzuna and Madrid. Data collection: self-administered survey with Likert scale. Data analysis: Chi-square, significance value p, confidence intervals. Results: 27% of rural elder people (n=46, SD=16,26; CI95%=53,87-61,13) and 39% of urban elder people (n=69) consume junk food, with significant differences: X2(1) = 6,1052; X2 crítico = 3,8415; p = 0,014 < 0,05. If we talk about the consequences in elder people's health, 45% of the rural elder people (n=42, SD=14,14; CI95%=48,84-55,16) and 90% of the urban elder people (n=62) perceive them as negative without statistically significant differences: X2(1) = 0,067; X2 crítico = 3,8415; p = 0,7957 > 0,05. an increase in spending on "junk food" per capita of 49.65% compared to 2014. According to Garcia and Villalobos, their consumption in the elderly is due to the decrease in purchasing power, wife's death and/or the lack of social support. Conclusions: there are statistically significant differences in the consumption of "junk food", but not in the perception that the elderly of both groups have about their state of health derived from their consumption