Quality in diagnostic upper gastrointestinal endoscopy for the detection and surveillance of gastric cancer precursor lesions: Position paper of AEG, SEED and SEAP. / Documento de posicionamiento de la AEG, la SEED y la SEAP sobre calidad de la endoscopia digestiva alta para la detección y vigilancia de las lesiones precursoras de cáncer gástrico.

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.

Documento de posicionamiento de la AEG, la SEED y la SEAP sobre cribado de cáncer gástrico en poblaciones con baja incidencia / Gastric cancer screening in low incidence populations: Position statement of AEG, SEED and SEAP

Este documento de posicionamiento, auspiciado por la Asociación Española de Gastroenterología, la Sociedad Española de Endoscopia Digestiva y la Sociedad Española de Anatomía Patológica, tiene como objetivo establecer recomendaciones para el cribado del cáncer gástrico (CG) en poblaciones con incidencia baja, como la española. Para establecer la calidad de la evidencia y los niveles de recomendación se ha utilizado la metodología basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Se obtuvo el consenso entre expertos mediante un método Delphi. El documento evalúa el cribado en población general, individuos con familiares con CG y lesiones precursoras de CG (LPCG). El objetivo de las intervenciones debe ser la reducción de la mortalidad por CG. Se recomienda el uso de la clasificación OLGIM y determinar el subtipo de metaplasia intestinal (MI) para evaluar las LPCG. No se recomienda establecer cribado poblacional endoscópico de CG ni de Helicobacter pylori. Sin embargo, el documento establece una recomendación fuerte para el tratamiento de H.pylori si se detecta la infección, y su investigación y tratamiento en individuos con antecedentes familiares de CG o con LPCG. En cambio, no se recomienda el uso de test serológicos para detectar LPCG. Se sugiere cribado endoscópico únicamente en los individuos con criterios de CG familiar. En cuanto a los individuos con LPCG, solo se sugiere vigilancia endoscópica ante MI extensa asociada a algún factor de riesgo adicional (MI incompleta y/o antecedentes familiares de CG) tras la resección de lesiones displásicas o en pacientes con displasia sin lesión visible tras una endoscopia digestiva alta de calidad con cromoendoscopia

This positioning document, sponsored by the Asociación Española de Gastroenterología, the Sociedad Española de Endoscopia Digestiva and the Sociedad Española de Anatomía Patológica, aims to establish recommendations for the screening of gastric cancer (GC) in low incidence populations, such as the Spanish. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates screening in the general population, individuals with relatives with GC and subjects with GC precursor lesions (GCPL). The goal of the interventions should be to reduce GC related mortality. We recommend the use of the OLGIM classification and determine the intestinal metaplasia (IM) subtype in the evaluation of GCPL. We do not recommend to establish endoscopic mass screening for GC or Helicobacter pylori. However, the document strongly recommends to treat H.pylori if the infection is detected, and the investigation and treatment in individuals with a family history of GC or with GCPL. Instead, we recommend against the use of serological tests to detect GCPL. Endoscopic screening is suggested only in individuals that meet familial GC criteria. As for individuals with GCPL, endoscopic surveillance is only suggested in extensive IM associated with additional risk factors (incomplete IM and/or a family history of GC), after resection of dysplastic lesions or in patients with dysplasia without visible lesion after a high quality gastroscopy with chromoendoscopy

Gastric cancer screening in low incidence populations: Position statement of AEG, SEED and SEAP. / Documento de posicionamiento de la AEG, la SEED y la SEAP sobre cribado de cáncer gástrico en poblaciones con baja incidencia.

This positioning document, sponsored by the Asociación Española de Gastroenterología, the Sociedad Española de Endoscopia Digestiva and the Sociedad Española de Anatomía Patológica, aims to establish recommendations for the screening of gastric cancer (GC) in low incidence populations, such as the Spanish. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates screening in the general population, individuals with relatives with GC and subjects with GC precursor lesions (GCPL). The goal of the interventions should be to reduce GC related mortality. We recommend the use of the OLGIM classification and determine the intestinal metaplasia (IM) subtype in the evaluation of GCPL. We do not recommend to establish endoscopic mass screening for GC or Helicobacter pylori. However, the document strongly recommends to treat H.pylori if the infection is detected, and the investigation and treatment in individuals with a family history of GC or with GCPL. Instead, we recommend against the use of serological tests to detect GCPL. Endoscopic screening is suggested only in individuals that meet familial GC criteria. As for individuals with GCPL, endoscopic surveillance is only suggested in extensive IM associated with additional risk factors (incomplete IM and/or a family history of GC), after resection of dysplastic lesions or in patients with dysplasia without visible lesion after a high quality gastroscopy with chromoendoscopy.

Retos de la troncalidad y su aplicación en el entorno hospitalario / Challenges of the core subjects and their application in the hospital environment

El sistema de formación sanitaria especializada en España dio comienzo oficialmente en el año 1978 con la publicación del RD 2015/1978, aunque, ya antes, hospitales pioneros habían desarrollado programas de formación para médicos internos y residentes. Desde entonces, y desde la entrada en vigor de la Ley 44/2003, de 21 de noviembre, de Ordenación de las Profesiones Sanitarias (LOPS) y sus normas de desarrollo, se han producido muchos avances; si bien, por incidir directamente en desarrollo del proceso de formación sanitaria especializada, pocos han sido tan trascendentes como los derivados de la aplicación de los preceptos recogidos en el RD 639/2014, de 28 de julio, por el que se regula, entre otros aspectos de la formación sanitaria especializada, la troncalidad. Además de la definición de una nueva organización de las especialidades, que agrupa la mayoría de ellas (39 de las 56 existentes) en torno a 5 troncos, uno de los aspectos más novedosos es la incorporación de instrumentos de evaluación, que permitirán medir la adquisición de las competencias incluidas en cada programa formativo. Esto va a requerir un esfuerzo adicional por parte de todos, principalmente tutores y comisiones de docencia, pero sin duda contribuirá a sistematizar y normalizar la supervisión de la formación de todos los residentes, a la par que nos permitirá tener un elemento más para evaluar la calidad de la formación. Además de los tutores y las comisiones de docencia, las comisiones nacionales de especialidad y el Consejo Nacional de Especialidades en Ciencias de Salud, también están llamados a tener un papel muy importante, puesto que en ellos recae el desarrollo, implantación y seguimiento de la troncalidad, velando, entre otras cosas, por la calidad de la formación, al ser responsables de la elaboración de los programas formativos, y por el cumplimiento de los objetivos generales del proceso. Sin duda, la puesta en marcha de este RD 639/2014 nos plantea grandes retos, pero también nos brinda una oportunidad para reflexionar conjuntamente sobre las fortalezas y debilidades de la actual formación sanitaria especializada, para así contribuir a mejorarla, implementando un nuevo modelo que contribuya a fortalecer nuestro sistema sanitario

The Specialized Healthcare Training system through residency (SHT) was first regulated in Spain in 1978 when the Royal Decree (RD) 2015/1978 was published, although prior to that, pioneering hospitals had developed training programs for medical interns and residents. Since then there have been many advances including the far-reaching publication in 2014 of RD 639/2014 which regulates, among other things, the core curricula specialties (named "troncalidades") - the re-specialization of the areas of special training. The implementation of the "troncalidad" project faces several challenges, which are anticipated to stem from the modification of current training structures, the definition of competencies, the accreditation process, evaluation and feedback. The article discusses the vision of the Standing Commission, its current status and the challenges of the implementation of a new model that will strengthen our health care system

Diabetes insípida central como manifestación inicial de histiocitosis de células de Langerhans en paciente adulto / Central diabetes insipidus as the first sign of Langerhans cell histiocytosis in an adult

La histiocitosis de células de Langerhans es una enfermedad que afecta predominantemente a niños, aunque puede diagnosticarse en la edad adulta. En adultos, la infiltración histiocitaria afecta predominantemente a hueso, pulmón y piel, y presenta especial predilección por el eje hipotálamo-hipofisario. Presentamos el caso de un varón de 51 años que inicialmente solo presentaba diabetes insípida central pero que con el paso del tiempo ha desarrollado una enfermedad sistémica con afectación cutánea, pulmonar, ósea, adenohipofisaria y del sistema nervioso central. La respuesta al tratamiento quimioterápico y radioterápico fue excelente y actualmente no se ha observado progresión de la enfermedad.

Langerhans cell histiocytosis is considered a paediatric disease, although it may be diagnosed in adults. The histiocyte infiltration in adults is most frequently in bones, lungs and skin, and shows a particular predilection for hypothalamus-pituitary axis. A case is presented of a 51 year-old man who initially only presented with central insipidus diabetes, and over time developed systemic disease with skin, lungs, bones, pituitary, and central nervous system involvement. Chemotherapy and radiotherapy were effective, and there is currently no progression of the disease.

Biochemical and physiological changes during fruit development and ripening of two sweet cherry varieties with different levels of cracking tolerance.

The aim of this study was to investigate the biochemical and metabolic changes, related to oxidative stress, ethylene and respiration, cell wall modification and primary metabolism, between a high ('Prime Giant') and a low ('Cristalina') cracking susceptible sweet cherry cultivar during growth and ripening. While cherries are referred as a non-climacteric fruit, our results show that an increase of endogenous ethylene production at earlier fruit developmental stages is parallel to colour development and softening during growth. Higher cracking susceptibility was clearly associated to a higher fruit growth rate and accompanied by an increase net CO2 and ethylene production, on a cherry basis, leading to an enhanced accumulation of oxidative stress markers (i.e. H2O2 and MDA). As observed in other fruit species (i.e. tomatoes) higher cracking susceptibility was also related to enhanced activity of cell wall-modifying enzymes which in turn occurred in parallel to the ethylene rise. Overall, these results suggest that cracking development may be a more complex phenomenon than a mere consequence of altered fruit water absorption or turgor and point out the importance of ethylene on sweet cherry ripening and cracking development.

Psicoterapia dinámica breve realizada en una unidad de agudos hospitalaria de salud mental. A propósito de un caso / Brief dinamic psychotherapy conducted in the hospital unit for acute mental health patients. A case report

Se expone una experiencia en psicoterapia dinámica breve realizada en un varón de 48 años, ingresado en una Unidad de Agudos Hospitalaria de Salud Mental. Modelo de psicoterapia breve dirigida a trabajar la afectividad del paciente, haciendo del sentimiento el foco terapéutico y de la adquisición de un mejor manejo de éstos, el objetivo principal. Con el propósito de obtener herramientas psicoterapéuticas útiles allí donde la limitación temporal es un hándicap fundamental(AU)

We describe a brief psychotherapy experience made on a 48 year old man admitted to the Hospital Units for Acute Mental Health Patients. This psychotherapeutical model is directed to work the patient’s emotions, making his feelings the therapeutic focal point. The main objective of this brief psychotherapy was the acquisition of better management of the patient’s emotions and feelings. We aim at gaining useful psychotherapeutic tools where time is a major handicap(AU)

Psiquiatría transcultural. A propósito de un caso / Cross Cultural Psychiatry. Report of a case

Aspectos socio-culturales resultan determinantes en el manejo, evaluación, diagnóstico, y tratamiento de los pacientes inmigrantes. Se presenta un caso de un varón nigeriano que es traído al Servicio de Urgencias del Hospital de Valme por trastorno de conducta y gestos autolesivos realizados en vía pública (AU)

Socio-cultural aspects were decisive in immigrant patient management, evaluation, diagnosis and treatment. We present the case of a Nigerian male who is brought to Valme Hospital Emergency Department for behavioral disorder and self-inflected injury in public spaces (AU)

Influence of the presence of monoglyceride on the interfacial properties of wheat gluten.

BACKGROUND: The physical stability of several food systems depends strongly on their interfacial properties, which may be modified by adding proteins and low-molecular-weight surfactants to their formulation. This study deals with the possibility of using wheat gluten to alter the surface and interfacial properties of an aqueous system, considering the effects of protein concentration, pH and the presence of monostearin. RESULTS: It was generally found that the surface tension decreased as the protein concentration increased, reaching a minimum value at 0.5 g kg(-1). The influence of protein concentration on surface tension was much greater than the effect of pH owing to the low ionic character of wheat gluten protein. At acidic and alkaline pH values the interfacial viscosity of the protein system underwent a significant increase with time. The addition of monostearin either promoted the displacement of protein molecules at the interface or generated an interfacial mixed film with surface tension values lower than those of both single components, depending on the pH. CONCLUSION: The results obtained indicate that gluten can contribute to the stabilisation of air/water and oil/water interfaces in some food systems (emulsions, foams, etc.).

Impact of a primary care intervention on smoking, drinking, diet, weight, sun exposure, and work risk in families with cancer experience.

BACKGROUND: Modifying multiple behavior risks is a promising approach to reduce cancer risk. Primary prevention advices of the European Code against Cancer were included in an educational intervention (EI) using social cognitive theories for motivating families with cancer experiences to adopt six cancer prevention behaviors. METHODS: A randomized clinical controlled trial recruited 3,031 patients from Primary Care among cancer patients' relatives. The experimental group (EG) received four EI, one EI every six months, focused on tobacco, alcohol, diet, weight, sun and work, and based on social cognitive models. The impact of the first three EI was calculated measuring at baseline and 18 months later: (a) The percentage of people with each risk behavior; (b) The score reached in a Total Cancer Behavioral Risk (TCBR) indicator; (c) The Odds Ratios at the post-test. RESULTS: Five risk behaviors decreased significantly more (p<0.01) in the EG than in the CG: Smoking (OR=0.662), drinking (OR=0.504), diet (OR=0.542), weight (OR=0.698), and sun (OR=0.389). The TCBR indicator also decreased an average of nearly 5 points (28.42 vs. 23.82), significantly more (p<0.001) in the EG. CONCLUSION: Families with cancer experiences changed five cancer risk behaviors when approached in Primary Care with interventions based on social cognitive models.

Attitude to primary prevention advice of the european code against cancer in relatives of cancer patients: implication for the development of preventive / Actitud hacia los consejos de prevención primaria del Código Europeo contra el cáncer, en parientes de pacientes con cáncer: implicaciones para el desarrollo de programas preventivos

Achieving a preventive attitude is the first step in eliminating cancer risk behaviours. This cross-sectional study evaluated the attitude towards the European Code against Cancer, in 3,031 relatives of cancer patients. The study looked for keys to improve attitude by means of educational interventions. Attitude was evaluated using a questionnaire with 63 items and a Likert’s scale. Measured from -2 to +2 , the mean score was 0.905 [0.894 - 0.971]. Five per cent had a mean score under 0.38 and another 5% over 1.46. A multivariate analysis found that age, sex and level of education were significantly associated with attitude: young men with a low cultural level were those with the lowest preventive attitude. The family history of cancer was not associated with attitude. Educational interventions should modify the perceived advantages of smoking and drinking, and the disadvantages related to preventive diet and sun and workplace protection

Conseguir una actitud preventiva es esencial para eliminar conductas de riesgo de cáncer. Se describe la actitud hacia el Código Europeo contra el Cáncer de 3.031 parientes de cancerosos. Se buscan claves para mejorar la actitud mediante intervenciones educativas. La actitud se evaluó con cuestionario de 63 ítems y escala de Likert: medida de -2 to +2, la puntuación media fue 0.905 [0.894 - 0.971]. Un 5% tuvo una media inferior a 0,38 y otro 5% superior a 1,46. En un análisis multivariante, edad, sexo y nivel de educación se asociaron significativamente con la actitud: los hombres jóvenes con bajo nivel cultural son los que tienen actitud preventiva menor. La historia familiar de cáncer no se asoció con la actitud. La clave de programas preventivos es modificar las ventajas percibidas por fumar y beber alcohol, y las desventajas de la prevención relacionada con la dieta, el sol y el trabajo

Impact of cigarette advertising on smoking behaviour in Spanish adolescents as measured using recognition of billboard advertising.

BACKGROUND: Cross-sectional studies provide empirical support for associations between advertising and adolescent smoking. The aim of this study was to investigate the relationship between Spanish adolescent smoking behaviour and prior awareness of cigarette advertisements on billboards, using a prospective design. METHODS: 3,664 Spanish children aged 13 and 14 years filled in self-completion questionnaires at baseline, and 6, 12, and 18 months later (cohort study). Slides of three advertisements were projected at baseline. A multivariate logistic regression analysis was carried out to detect possible association between number of identified tobacco advertisements brands at baseline and smoking status along time, controlling ASE Model smoking determinants, smoking prevention interventions, age, gender and socio-economic status. RESULTS: The more advertisements identified at baseline, the greater was the risk of being a smoker (p<0.0001). Final percentages of smokers were 15.8%, 16.3%, 19.3%, and 32.6%, respectively, for zero, one, two and three advertisements recognized. When confounders were controlled, the probability of being a smoker increased with the number of advertisements identified [OR 1.26 (95% CI: 1.09-1.46) after 6 months, OR 1.18 (95% CI: 1.03-1.35) after 12 months and 1.15 (95% CI: 1.02-1.30)] after 18 months. It is possible the association would have been even greater if there had not been a differential loss of smokers from the sample. CONCLUSION: Increased awareness of cigarette advertising was associated with a higher smoking incidence and an increased risk of Spanish children becoming smokers. It is, therefore, imperative that cigarette advertising should be banned as a matter of urgency.

¿Cuántas determinaciones de presión arterial son necesarias en consulta para una evaluación adecuada del control de presión arterial? / How many blood pressure measurement are necessary in a consultation to adequately evaluate the control of blood pressure?

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