¿Cuánto saben de lactancia los sanitarios del área materno-infantil? Estudio de los 14 hospitales públicos de Castilla y León / How much do healthcare workers in the mother & child health area know about breastfeeding? A study of the 14 public hospitals in Castile & Leon

Introducción: la lactancia materna es un objetivo prioritario en salud pública. Los profesionales sanitarios que trabajan en el área materno-infantil de los centros hospitalarios deben poseer un adecuado nivel de conocimientos de lactancia materna. Material y métodos: estudio descriptivo trasversal realizado durante enero-febrero de 2015 utilizando el cuestionario validado ECola, que se adapta a ginecólogos, matronas y enfermería. Para los técnicos auxiliares de enfermería (TCAE) se utiliza el cuestionario de Temboury Molina MC, modificado por los autores. La población de estudio fueron todos los profesionales sanitarios del área materno-infantil de los 14 hospitales públicos de Castilla y León. Resultados: en total se recibieron 724 cuestionarios (61,0%). Considerando aceptable el 70% de aciertos (16,8 puntos), los profesionales de enfermería presentan un nivel de conocimientos en lactancia bueno (18,19) y significativamente superior (p <0,05) a los médicos (17,01). Las matronas han presentado la media de aciertos mayor (20,03). Los ginecólogos, con 15,24 puntos, poseen un nivel inferior al recomendable. Los TCAE, con 16,93 puntos, manifiestan conocimientos suficientes, pero en el límite inferior. Se observaron diferencias significativas entre los distintos centros hospitalarios. Globalmente, el nivel de conocimientos de los profesionales del área materno-infantil de los hospitales públicos de Castilla y León es suficiente (17,54). Conclusiones: el nivel de conocimientos de los profesionales del área materno-infantil en global es aceptable. Algunas categorías profesionales presentan carencias en aspectos trascendentales para el adecuado manejo de la lactancia materna. Se debe considerar la necesidad de implementar formación en lactancia en los currículos formativos, especialmente ginecólogos y TCAE

Introduction: breastfeeding is a priority objective in public health. Health care professionals involved in the delivery of hospital-based maternal and child health services need to have adequate knowledge of breastfeeding. Material and methods: we conducted a cross-sectional descriptive study in January and February 2015 using the validated questionnaire ECola, which we adapted for administration to gynaecologists, midwives and nurses. To survey nursing assistant technicians (NATs), we adapted the questionnaire developed by Temboury Molina MC, modified by the authors. The study universe consisted of all health care professionals involved in the delivery of maternal and child health services in the 14 public hospitals of Castilla y León. Results: we received a total of 724 questionnaires (61.0%). Having defined a threshold of 70% of correct answers (16.8 points) to define adequate knowledge, nurses had an adequate knowledge of breastfeeding (18.19) that was significantly better (p < 0.05) compared to physicians (17.01). Midwives had the highest mean score (20.03). Gynaecologists, with a mean score of 15.24 points, had a level of knowledge considered inadequate. Nurse assistants, with a mean score of 16.93 points, exhibited adequate knowledge but close to the lower limit. We found statistically significant differences in knowledge between the providers working in different hospitals. Overall, the level of knowledge of professionals working in maternal and child health in public hospitals in Castilla y Leon was adequate (17.54). Conclusions: overall, the level of knowledge of health professionals involved in delivery of maternal and child health services was adequate. Some categories of professionals lacked knowledge in aspects that are essential to the adequate management of breastfeeding. We need to consider the need to include training in breastfeeding in educational curricula, especially those of gynaecologists and NATs

¿Hay que revisar el currículo formativo de ginecología en lactancia materna? / No disponible

No disponible

Electromagnetic assisted endoscopic submucosal dissection is more efficient than water-jet assisted and conventional ESD in experimental model.

BACKGROUND AND STUDY AIMS: The adequate visualization of the dissection line, inside the submucosal layer, supposes the main challenging issue in ESD. For this reason, several counter traction methods have been developed focused on overcoming this handicap. One of which, Magnetic anchor guided - ESD (MG-ESD) is an attractive alternative. However, the usefulness of this approach has been scarcely assessed and compared with other ESD strategies. Therefore, the aim of this study is to compare three different ESD alternatives in experimental faction. METHODS: This was a prospective non-randomized study, in which three different ESD techniques were performed in an ex-vivo gastric porcine model by an endoscopist slight expertise in ESD: conventional ESD, waterjet assisted ESD and MG-ESD. MG-ESD was performed using two different magnets: inner Neodymiun ringed shape magnet attached to the simulated lesions by an endoclip and external electromagnet connected to a Single Output Adjustable 24V/0.3A Power Supply Unit. RESULTS: Forty-six ESD procedures were performed: 24 conventional ESD, 12 waterjet-assisted ESD and 10 MG-ESD. Average size of the simulated lesions was 33.86 mm. No differences in terms of safety and efficacy were registered between the three approaches. Nevertheless, MG-ESD proved to be faster and more efficient than conventional ESD and water-jet assisted ESD (min per cm 2 10.85 vs. 7.43 vs. 3,41; P  = 0.001). CONCLUSIONS: MG-ESD could be a feasible alternative to conventional ESD even at the beginning of the learning curve. Therefore, researches focused on developing appropriate ESD magnetic devices and further comparative studies must be promoted, in order to assess the reliable usefulness of the magnet-assistance in ESD.

Actinomyces infection as a complication of a post-radiotherapy rectal ulcer.

INTRODUCTION: Pelvic radiotherapy is associated with early and late local complication. Actinomyces bacterium is part of the saprophyte flora, although some infection underlying factors are known , the pathophysiology of the disease is still unexplained. Frequently it is involved in oral, gastrointestinal and respiratory infections. CASE REPORT: We present the description of a clinical case supported with images. So that we have developed a bibliographical research in Pubmed data base including the following key words: Ulcer, rectum, brachitherapy and Actinomyces. The most recent original articles published in the last teen years, related with the pathology observed in the patient of the case, were selected. DISCUSSION: Brachitherapy over pelvic beds ( prostate, cervix and uterus) could be associated with digestive complications specially in the rectum. Those complications might oscillate from mild inflammatory changes in the mucosa to serious damages as ulcers and lack of tissue. This situation increase the risk of opportunistic infections which could endanger the clinical improve of our patients. We suggest to remember those germen in the diagnosis process in other to achieve an early diagnosis and to use a targeted treatment.

Úlcera rectal postradioterapia complicada con infección por Actinomyces / Actinomyces infection as a complication of a post-radiotherapy rectal ulcer

No disponible

Efecto de una intervención educativa enfermera en el manejo de la diabetes gestacional / The effect of an educational intervention by nurses on the management of gestational diabetes

OBJETIVO: evaluar el efecto de una intervención educativa enfermera en el manejo de la diabetes gestacional. MÉTODO: estudio cuasi experimental llevado a cabo en la Consulta de Educación Diabetológica del Hospital General Universitario Gregorio Marañón de Madrid, en mujeres gestantes diagnosticadas de diabetes gestacional/pregestacional, de septiembre de 2013 hasta marzo de 2014. La intervención educativa se realizó individualmente y se estructuró en tres sesiones. Los datos se recogieron mediante un cuestionario auto administrado ad hoc, que incluía variables demográficas, clínicas y de conocimientos sobre la diabetes, así como la escala de ansiedad y depresión de Goldberg y la escala hospitalaria de ansiedad y depresión. Se realizó un análisis descriptivo de todas las variables y el t-test de medidas pareadas para el evaluar la eficacia de la intervención RESULTADOS: participaron 61 mujeres gestantes, de las cuales 33necesitaron tratamiento con insulina. La edad media fue de 37(DE:4,5) años, y la edad gestacional de 24,4 (DE:7,1) semanas. El86,9% presentaba diabetes gestacional vs. el 13,1% que presentaba diabetes pregestacional. Se encontraron diferencias estadísticamente significativas en las medias de puntación de conocimientos antes y después de la intervención (p< 0,01), así como en los niveles de ansiedad y depresión en las escalas utilizadas. CONCLUSIÓN: la mejora en el nivel de conocimientos sobre el manejo y control de la diabetes gestacional ponen de manifiesto los beneficios de la educación diabetológica, favoreciendo la adherencia al tratamiento y la detección precoz de alteraciones emocionales, pudiendo así evitar potenciales complicaciones durante la gestación, el parto y el puerperio

OBJECTIVE: to assess the effect of a nursing educational intervention on the management of gestational diabetes. METHOD: quasi-experimental study conducted at the Diabetes Education Unit of the Hospital General Universitario Gregorio Marañón in Madrid, with pregnant women diagnosed with gestational / pre-gestational diabetes, from September, 2013 to March, 2014. The educational intervention was conducted individually, and structured into three sessions. Data were collected through an ad hoc self-administered questionnaire, which included demographical and clinical variables, as well as knowledge about diabetes, and the anxiety and depression scales both by Goldberg and the hospital. A descriptive analysis of all variables was conducted, and the t-test for paired variables was used to assess the efficacy of the intervention. RESULTS: the study included 61 pregnant women; 33 of them needed treatment with insulin. Their mean age was 37 years (SD:4.5), and their gestational age was 24.4 weeks (SD:7:1). 86.9% of the women presented gestational diabetes, vs. 13.1% who presented pre-gestational diabetes. There were statistically significant differences in the mean scores for knowledge before and after the intervention (p< 0.01), as well as in the levels of anxiety and depression according to the scales used. CONCLUSION: the improvement in the level of knowledge about management and control of gestational diabetes brings to light the benefits of diabetes education, encouraging treatment compliance and an early detection of emotional distress, and therefore allowing to prevent potential complications during pregnancy, labour and puerperium

Percepción de riesgo en alumnos de Enfermería / Risk perception in nursing students

El objetivo de este estudio, es analizar la producción científica que existe sobre la relación entre la percepción de riesgo y los accidentes en la práctica clínica en alumnos/as de Enfermería. Se realizó una búsqueda sistemática en las bases de datos MEDLINE y CUIDEN, así como en el fondo documental del Instituto Nacional de Seguridad e Higiene en el Trabajo, recopilando publicaciones comprendidas entre 1992 y 2010. Se analizaron un total de 89 artículos. Entre los campos temáticos emergentes se encuentran: entorno laboral, medidas preventivas, factores psicosociales. Se llega a la conclusión de que existe una carencia de estudios que demuestren de forma explícita el papel que la percepción de riesgo juega en el riesgo real al que los alumnos de enfermería se ven expuestos, por lo que se plantea la necesidad de investigar en esta línea, para así poder mejorar la seguridad de los alumnos de enfermería (AU)

The objective of this study is to analyze the scientific production that exists about the relationship between the risk perception and the accidents during the clinical practice in nursing students. A systematic search was carried out in the data bases MEDLINE and CUIDEN, and also in the documentary heritage of the National Institute of Safety and Hygiene at Work, gathering publications from 1992 to 2010. A total of 89 articles were analyzed. Among the resulting thematic fields are: work setting, step measurements, psychosocial factors. As a conclusion, a lack of studies which prove in an explicit way the role that the real risk perception that the nursing students are exposed to exists. So, the necessity to go on in this line is set out, in order to improve the safety of nursing students (AU)

Perceived influence of oral health upon quality of life in heart transplant patients.

OBJECTIVE: A study was made of heart transplant patient perception of the influence of oral health upon quality of life, based on the Oral Health Impact Profile (OHIP-49) questionnaire validated for Spanish speaking subjects. DESIGN: A cross-sectional evaluation was made of the heart transplant patients followed-up on in the Heart Transplantation Unit of Reina Sofía University Hospital (Spain), using the OHIP-49 questionnaire. The included patients were all over age 18 and signed the corresponding informed consent to participation in the study. The data were entered in a database and analyzed using the SPSS statistical package. RESULTS: A total of 150 heart transplant patients (118 males and 32 females, with a mean age of 54.94 years; range 19-79) were studied. The subjects showed a poor perceived influence of oral health upon quality of life, with a mean score of 24.43 out of a possible total of 196 points. Women showed significantly improved perception of the influence of oral health upon quality of life versus men. CONCLUSIONS: The subjects in our study showed a poor perceived influence of oral health upon quality of life.

Detection of Anisakis simplex-induced basophil activation by flow cytometry.

BACKGROUND: Laboratory diagnosis of anisakidosis is based on specific serum IgE detection. Recently, detection of allergen-induced basophil activation by flow cytometry has been proposed as a valuable tool for allergy diagnosis. OBJECTIVE: To evaluate if detection of Anisakis-induced basophil activation by flow cytometry is a useful tool in the diagnosis of Anisakis allergy. METHODS: Patients with Anisakis allergy (A.s.+, n = 37), patients reporting chronic urticaria or abdominal pain unrelated to fish ingestion (A.s.-, n = 51), and healthy controls (n = 12) were studied. Specific IgE to Anisakis simplex (A. simplex) was quantified with CAP-FEIA method, and basophil activation test was performed with three different concentrations of an Anisakis crude extract. Basophil gating was performed with CD123 and HLA-DR, and cellular activation was measured with CD63. RESULTS: A.s.+ patients showed significantly higher age and total IgE levels than did the A.s.- patients. Specific IgE to A. simplex correlated with the activated basophil percentages obtained with 15 microg/mL (r = 0.80; P < 0.001), 1.5 microg/mL (r = 0.84; P < 0.001), and 0.15 microg/mL (r = 0.82; P < 0.001) of A. simplex crude extract. Nine individuals (3 in the A.s.+ group and 6 in the A.s.- group) were nonresponders to basophil stimulation with anti-IgE. Five A.s.- patients showed positive IgE values to A. simplex while the basophil activation test was negative. According to the receiver operating characteristics curves performed between A.s.+ vs. A.s.- and A.s.+ vs. healthy controls, the cutoff for a positive basophil activation test was >or=21% (specificity = 96%, sensitivity = 100%), and 16% (sensitivity and specificity of 100%) respectively. When nonresponders were included in the A.s.+ vs. A.s.- analysis, sensitivity decreased to 95%. Multivariate logistic analysis showed that the specific basophil activation was a factor independently associated with clinical symptoms of A. simplex allergy. CONCLUSIONS: Detection of A. simplex-induced basophil activation by flow cytometry is a useful laboratory technique for the diagnosis of anisakidosis, supplementing specific IgE determinations.

CD106 and activated-CD29 are expressed on myelomatous bone marrow plasma cells and their downregulation is associated with tumour progression.

Malignant plasma cells (PC) from multiple myeloma (MM) patients characteristically home to the bone marrow (BM). High numbers of tumour cells are found in the peripheral blood (PB) only at end-stage disease (secondary plasma cell leukaemia, PCL) in a minority of patients. Using flow cytometric and fluorescence in situ hybridization (FISH) analysis, a high percentage of tumoral BM PC from untreated patients was found to express CD106. In addition, these cells also expressed an activated form of CD29, as determined using the CD29 activation reporter monoclonal antibody HUTS-21. Adhesion-binding experiments showed that CD106+-activated CD29+ BM PC from these patients adhered to fibronectin (FN) in a CD29/CD49d-dependent manner. In contrast, marrow PC from progressive patients and BM or circulating malignant cells from secondary PCL patients expressed lower levels or were negative for CD106 and activated CD29, respectively, with a decreased or zero ability to adhere to FN. The expression of constitutive CD29 and CD49d, however, was similar during disease progression. We conclude that BM myelomatous cells co-express CD106 and a functionally active form of CD29. Moreover, our results suggest that the loss of expression and/or function of these antigens are associated with the progression of MM and may explain the exit of tumoral cells from the BM.