A tissue-bioengineering strategy for modeling rare human kidney diseases in vivo.

The lack of animal models for some human diseases precludes our understanding of disease mechanisms and our ability to test prospective therapies in vivo. Generation of kidney organoids from Tuberous Sclerosis Complex (TSC) patient-derived-hiPSCs allows us to recapitulate a rare kidney tumor called angiomyolipoma (AML). Organoids derived from TSC2-/- hiPSCs but not from isogenic TSC2+/- or TSC2+/+ hiPSCs share a common transcriptional signature and a myomelanocytic cell phenotype with kidney AMLs, and develop epithelial cysts, replicating two major TSC-associated kidney lesions driven by genetic mechanisms that cannot be consistently recapitulated with transgenic mice. Transplantation of multiple TSC2-/- renal organoids into the kidneys of immunodeficient rats allows us to model AML in vivo for the study of tumor mechanisms, and to test the efficacy of rapamycin-loaded nanoparticles as an approach to rapidly ablate AMLs. Collectively, our experimental approaches represent an innovative and scalable tissue-bioengineering strategy for modeling rare kidney disease in vivo.

Mycobacterium bovis ESAT-6, CFP-10 and EspC antigens show high conservation among field isolates.

ESAT-6, CFP-10 and EspC are virulence factors that have been extensively assayed for bovine and human tuberculosis diagnosis due their potent T-cell inducing activities. While polymorphisms of ESAT-6 and CFP-10 were analyzed, with the description of CFP-10 variants in M. tuberculosis, this fact has not been explored in M. bovis field isolates. The coding sequences of esxA (ESAT-6), esxB (CFP-10) and mb3645c (EspC) from 58 M. bovis strains exhibiting genomic variability (spoligotyping) were analyzed. Two genes -esxA and esxB - remained invariant while mb3645c exhibited one synonymous polymorphism (G to A mutation, position 66bp) in one isolate, compared to M. bovis AF2122/97 reference strain. All isolates exhibited a synonymous nucleotide polymorphism simultaneously (G to A mutation, position 255bp), compared to M. tuberculosis H37Rv reference strain. This study confirms the high conservation for ESAT-6, CFP-10 and EspC in local M. bovis field isolates and reinforce the use of these three antigens in the diagnosis of bovine tuberculosis. Further studies should be performed to globally confirm these findings.

Coexisting with dependence and well-being: the results of a pilot study intervention on 75-99-year-old individuals.

BACKGROUND: The objective of this study is to design and implement an intervention program centered on preventing functional dependence. METHODS: A pre/post quasi-experimental (typical case) design study with a control group was conducted on a group of 75-90-year-old individuals with functional dependence (n = 59) at three nursing homes in Madrid (Spain). The intervention program consists of two types of activities developed simultaneously. Some focused on emotional well-being (nine 90-minute sessions, once per week), whereas others focused on improving participants' physical condition (two 30-minute sessions, twice per week). The simple randomized participants included 59 elderly individuals (Intervention Group = 30, Control Group = 29) (mean age 86.80) [SD, 5. 19]. RESULTS: Fifty-nine participants were analyzed. The results indicate that the program is effective in improving mood, lowering anxiety levels (d = 0.81), and increasing both self-esteem (d = 0.65) and the perception of self-efficacy (d = 1.04). There are improvements in systolic pressure and functional dependence levels are maintained. Linear simple regression (independent variable pre-Barthel) shows that the pre-intervention dependence level can predict self-esteem after the intervention. CONCLUSION: We have demonstrated that the program is innovative with regard to bio-psychosocial care in elderly individuals, is based on actual practice, and is effective in increasing both self-esteem and self-efficacy. These variables positively affect functional capabilities and delay functional dependence.

Assessment of different components of executive function in grief / Evaluación de diferentes componentes de la función ejecutiva en procesos de duelo

BACKGROUND: Intense and complex symptoms of grief seem to be related to a series of biases and difficulties in areas such as attention, autobiographical memory and problem solving. However, studies of neuropsychological performance have reported contradictory evidence. The role of executive function (EF) in bereaved individuals has not been systematically studied by differentiating between its components. METHOD: A total of 38 participants who had experienced the death of a loved one participated in this study. They were divided into two groups based on the intensity of their symptoms. They underwent neuropsychological assessments that included measures of flexibility, inhibition, working memory and emotional decision-making. RESULTS: Group differences were found in the parts of the emotional decision-making task that assessed decisions made under risk. Considering each participant's level of education and emotional variables, the symptoms of grief predicted a substantial variance in their performance in the decision-making task. CONCLUSION: Intense symptoms of grief seem to be related to poorer emotional decision-making performance but not to flexibility, inhibition or working memory

ANTECEDENTES: los sentimientos y complejos síntomas que pueden asociarse al duelo se han relacionado con dificultades en áreas como la atención, la memoria autobiográfica o la resolución de problemas. Aquellos que han evaluado dimensiones neuropsicológicas han mostrado resultados contradictorios, y el rol de las funciones ejecutivas en población adulta experimentando duelo intenso no ha sido estudiado.MÉTODO: tomaron parte un total de 38 participantes que habían experimentado la muerte de un ser querido. Fueron divididos en dos grupos dependiendo de la intensidad de los síntomas de duelo (altos frente a bajos). Realizaron una evaluación neuropsicológica que incluyó tareas de flexibilidad, inhibición, memoria de trabajo y toma de decisiones emocionales. RESULTADOS: se encontraron diferencias entre los grupos en la toma de decisiones emocionales para aquellos bloques centrados en las decisiones de riego. Controlando por el nivel educativo y los niveles de ansiedad los resultados indicaron que los síntomas de duelo predecían una parte importante de la varianza en la toma de decisiones emocionales.CONCLUSIONES: la intensidad del duelo parece ir asociada a dificultades en la toma de decisiones emocionales

Assessment of different components of executive function in grief.

BACKGROUND: Intense and complex symptoms of grief seem to be related to a series of biases and difficulties in areas such as attention, autobiographical memory and problem solving. However, studies of neuropsychological performance have reported contradictory evidence. The role of executive function (EF) in bereaved individuals has not been systematically studied by differentiating between its components. METHOD: A total of 38 participants who had experienced the death of a loved one participated in this study. They were divided into two groups based on the intensity of their symptoms. They underwent neuropsychological assessments that included measures of flexibility, inhibition, working memory and emotional decision-making. RESULTS: Group differences were found in the parts of the emotional decision-making task that assessed decisions made under risk. Considering each participant’s level of education and emotional variables, the symptoms of grief predicted a substantial variance in their performance in the decision-making task. CONCLUSION: Intense symptoms of grief seem to be related to poorer emotional decision-making performance but not to flexibility, inhibition or working memory.

Feelings of loss and grief in parents of children diagnosed with autism spectrum disorder (ASD).

BACKGROUND: Various authors have reported feelings of loss and grief in parents of children with autism spectrum disorder. However, no previous studies have investigated the structure of these feelings. AIMS: To analyze in depth the feelings of loss in parents of children diagnosed with autism spectrum disorder. METHOD: A qualitative study was conducted based on grounded theory. Twenty parents participated through purposive sampling. PROCEDURE: Semi-structured interviews were conducted, asking about different emotional aspects of the upbringing of a child with autism spectrum disorder. Atlas.ti 6.2 program was used for open, axial, and selective coding. RESULTS: The core category that explained the feelings of these parents was unexpected child loss, associated with shock, negation, fear, guilt, anger, and/or sadness. Two processes were identified, one associated with the resolution of grief and the other with obstacles to overcoming it. IMPLICATIONS: Feelings of loss play an important role in explaining the complex emotions experienced by these parents. Different intervention strategies are proposed.

Assessment of Emotional Experience and Emotional Recognition in Complicated Grief.

There is substantial evidence of bias in the processing of emotion in people with complicated grief (CG). Previous studies have tended to assess the expression of emotion in CG, but other aspects of emotion (mainly emotion recognition, and the subjective aspects of emotion) have not been addressed, despite their importance for practicing clinicians. A quasi-experimental design with two matched groups (Complicated Grief, N = 24 and Non-Complicated Grief, N = 20) was carried out. The Facial Expression of Emotion Test (emotion recognition), a set of pictures from the International Affective Picture System (subjective experience of emotion) and the Symptom Checklist 90 Revised (psychopathology) were employed. The CG group showed lower scores on the dimension of valence for specific conditions on the IAPS, related to the subjective experience of emotion. In addition, they presented higher values of psychopathology. In contrast, statistically significant results were not found for the recognition of emotion. In conclusion, from a neuropsychological point of view, the subjective aspects of emotion and psychopathology seem central in explaining the experience of those with CG. These results are clinically significant for psychotherapists and psychoanalysts working in the field of grief and loss.

Feelings of loss in parents of children with infantile cerebral palsy.

BACKGROUND: Raising a child diagnosed with infantile cerebral palsy is a challenge for families and causes many changes in their lifestyle. When the diagnosis is unexpected, feelings related to loss and hard-to-manage emotions such as uncertainty and bewilderment can arise. OBJECTIVE: To identify how feelings of loss are structured in fathers and mothers of children diagnosed with infantile cerebral palsy. METHODS: A qualitative design with based on a grounded theory approach was used. Twenty-four participants were selected to participate in the research from San Cecilio Clinical Hospital in the city of Granada (Spain). The sampling procedure was purposive based on inclusion and exclusion criteria and ended when data saturation was acquired. The participants were interviewed according to a script developed ad hoc. Data were collected during 2012. The interviews were analyzed with Atlas.ti 6.2 software, using the sequence suggested by Straus and Corbin including open, axial and selective codification. RESULTS: The analysis led to the identification of the main category, "Experiences of loss." The codes contributing to explain these experiences were "Shock," "Hope," "Traumatic Experience," "Feelings related to loss," "Ideal Child" and "Acceptance of the Child." CONCLUSIONS: These parents experience feelings of loss of the ideal child, which are more complex in the first stage of the diagnosis and when the severity of the cerebral palsy is greater. Emotional intervention on the part of health care providers is needed to aid parents in facing the various obstacles encountered throughout their child's up-bringing.

Neuropsychological function, anxiety, depression and pain impact in fibromyalgia patients

Cognitive deficits have a significant impact on the daily performance of fibromyalgia patients. This paper analyzes executive functioning and decision-making performance, and the relationships between these functions and pain, anxiety, depression and medication in fibromyalgia patients. A group of fibromyalgia patients (FG) (n = 85) was compared with a healthy control group (CG) (n = 85) in their performance in the Wisconsin Card Sorting Test (WCST) and the Iowa Gambling Task (IGT). In the WCST, results showed a percentage of non-perseverative errors significantly higher in the CG than in the FG (p = .026), the other variables (percentage of perseverative errors, number of categories and failures to maintain set) showed no significant differences. In relation to decision-making (IGT), once the rules had been learnt, the FG made fewer advantageous choices than the CG, but these differences were not statistically significant (p = .325). In the FG, pain severity (p = .010) and impact on daily activities (p = .016) interfered with decision-making, unlike anxiety, depression or medication, which did no relate to it. In executive function, pain and impact on daily activities were associated with the percentage of perseverative errors (p = .051) and the number of categories (p = .031), whereas pain severity was related to failures to maintain set (p = .039), indicative of increased distractibility and poor attentional ability. In conclusion, FG showed normal performance in executive functioning and decision-making. Moreover, pain was associated with neuropsychological functioning whereas anxiety, depression and medication were not (AU)

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Funciones y situación actual de la intervención de los psicólogos en cuidados paliativos / No disponible

Los psicólogos tienen un papel crucial en los procesos de fin de vida. Dentro de éstos, los cuidados paliativos son una de las áreas con más desarrollo en los últimos años, proponiendo un cuidado holístico e integral. Sin embargo, las funciones y roles de los psicólogos no están del todo claros. Por ello, se ha realizado una revisión teórica, buscando los estudios que ponen de relevancia su papel, funciones, así como la formación específica que deberían tener los psicólogos que trabajen en esta área. La mayoría subrayan la triple intervención con el paciente, la familia y el equipo sanitario. Funciones de evaluación e intervención psicológica, así como de prevención del burnout y del duelo aparecen como destacadas. La formación no está reglada aunque se está intentando buscar un currículum común

Psychologists have a crucial role in end-of-life processes. Within them, palliative care is one of the most developed areas and it is based on an holistic approach. However, the role of psychologists in this area is not clear. In order to clarify their function, a theoretical review has been carried out. The objective was to identify and integrate into a narrative the roles and functions of psychologist working in palliative care, as well as topics related to specific formation. Most of the articles reviewed outlined an intervention based on three axis: the patient, the family and the health care team. Functions such as psychological assessment, prevention of burnout and intervention on bereaved people appears as central. Specialized training and formation is not regulated, although recent proposals are trying to elaborate a common curriculum

Neuropsychological function, anxiety, depression and pain impact in fibromyalgia patients.

Cognitive deficits have a significant impact on the daily performance of fibromyalgia patients. This paper analyzes executive functioning and decision-making performance, and the relationships between these functions and pain, anxiety, depression and medication in fibromyalgia patients. A group of fibromyalgia patients (FG) (n = 85) was compared with a healthy control group (CG) (n = 85) in their performance in the Wisconsin Card Sorting Test (WCST) and the Iowa Gambling Task (IGT). In the WCST, results showed a percentage of non-perseverative errors significantly higher in the CG than in the FG (p = .026), the other variables (percentage of perseverative errors, number of categories and failures to maintain set) showed no significant differences. In relation to decision-making (IGT), once the rules had been learnt, the FG made fewer advantageous choices than the CG, but these differences were not statistically significant (p = .325). In the FG, pain severity (p = .010) and impact on daily activities (p = .016) interfered with decision-making, unlike anxiety, depression or medication, which did no relate to it. In executive function, pain and impact on daily activities were associated with the percentage of perseverative errors (p = .051) and the number of categories (p = .031), whereas pain severity was related to failures to maintain set (p = .039), indicative of increased distractibility and poor attentional ability. In conclusion, FG showed normal performance in executive functioning and decision-making. Moreover, pain was associated with neuropsychological functioning whereas anxiety, depression and medication were not.

Experiencias y obstáculos de los psicólogos en el acompañamiento de los procesos de fin de vida / Experiences and obstacles of psychologists in the accompaniment of end-of-life processes

Los psicólogos están encargados de realizar la atención emocional a los pacientes que se encuentran en procesos de fin de vida. No se conocen cuáles son las experiencias, los obstáculos y problemas con que se encuentran al intervenir en estos casos, siendo éste el principal objetivo de la investigación. Para ello se realizó un estudio cualitativo de tipo fenomenológico utilizando entrevistas en profundidad, que se analizaron con el software Atlas.ti siguiendo una codificación abierta. La muestra estuvo compuesta por 15 psicólogos que desempeñaban su labor en cuidados paliativos, otras unidades hospitalarias (oncología, salud mental, urgencias y atención temprana) o intervenían de manera privada en la provincia de Granada (España). Los resultados muestran la variedad de experiencias en esta intervención, así como la existencia de diferentes obstáculos que dependen del momento de intervención, de las características propias del paciente o la familia, las emociones del psicólogo, o la organización sanitaria. Se ponen de relevancia cómo los propios sentimientos de los psicólogos pueden influir en su intervención, y se propone la necesidad de una formación para superar los diferentes obstáculos que plantea la intervención en el final de vida (AU)

Psychologists are responsible for the emotional care to patients who are in end-of-life processes. Little is known about the experiences, the obstacles and problems they face when addressing such complex situations, so the main objective of this research is to understand and explore what they are. A qualitative phenomenological design was performed, using semi structured interviews, which were analyzed with the software Atlas.ti following an open coding. The sample consisted of 15 psychologists who perform their work in palliative care, other hospital units (oncology, mental health, emergency and early intervention) or privately involved in the province of Granada (Spain). The results show how psychologists contact with patients in end-of-life processes, as well as the variety of both positive and negative experiences in their speech. It is shown the existence of various obstacles that have to do with the timing of intervention, characteristics of the patient or family, with the emotions of the psychologist, as well as the health organization. This study shows how the feelings of the psychologists can influence their intervention, which raises the need for a specific training where they can learn different strategies to overcome the obstacles posed by intervention at the end-of-life (AU)

Actitudes y afrontamiento ante la muerte en padres de niños de primaria / Coping and attitudes towards death in parents of children in elementary school

La muerte es uno de los acontecimientos que causan más miedo en la infancia y adolescencia y, el modo de tratarlo repercute en el desarrollo cognitivo y emocional. Los objetivos de este estudio han sido conocer cuáles son las actitudes y el miedo hacia la muerte de padres con niños en edad escolar, e identificar variables relacionadas con actitudes y modos de afrontamiento adaptativos. Participaron 224 padres de familia con una edad media de 40,76 (DT= 5,11). Se emplearon una entrevista ad hoc, la “Escala multidimensional de miedo a la muerte”, el “Perfil revisado de actitudes hacia la muerte” y la “Escala de Bugen de afrontamiento de la muerte”. Los resultados ponen de manifiesto que los padres de familia con mayor nivel educativo son aquellos que presentan actitudes más adaptativas y niveles de miedo menores ante la muerte y que las mujeres manifiestan tener mayor miedo a la muerte que los hombres. Los programas de educación para la muerte pueden beneficiar a todas las personas, desde la niñez hasta edades avanzadas (AU)

Death is one of the events that causes more fear during childhood and adolescence, and the way it is treated affects cognitive and emotional development significantly. The aims of this study are: (i) to examine the attitudes and fears towards death in families who have schoolchildren; and (ii) to identify variables related to adaptive attitudes and coping styles regarding death. 224 parents participated in the study, with a mean age of 40.76 years old (SD=5.11). The following instruments were used in the study: a semi-structured interview designed ad hoc, the Multidimensional Scale of Fear to Death, the Revised Profile of Attitudes towards Death, and the Bugen Scale of Coping with Death. Results show that parents with a higher education degree have more adaptive attitudes and lower levels of fear towards death and that women show more fear towards death than men. Education about death can be beneficial for people in all age groups

How healthy are clones and their progeny: 5 years of field experience.

There is considerable concern regarding the health of cloned cattle and their safety as a source of food. The objective was to summarize 5 years of commercial experience with cloning in three countries (United States, Argentina and Brazil). Overall, only 9% of transferred embryos resulted in calves; efficiency ranged from 0 to 45% (most were from 1 to 10%, but 24% of cell lines never produced live calves). There was no significant difference in pregnancy rate following transfer of one versus two embryos. Before 90 days of gestation, two ultrasound markers for embryo death were found, either crown rump length (CRL) or heart beat less than 7.5mm and 150bpm, respectively, were observed alone or together in 27% of clones that died. In addition, after 100 days of pregnancy, placental edema, hydrops fetalis and increased abdominal circumference size were used as ultrasound findings of a fetus at risk of loss. At 114 days of gestation, abdominal circumference in clones that died was statistically larger than in clones that survived alive to term and from MOET- and IVF-derived pregnancies (P<0.05). Since elective cesarean section (C-section) was partially replaced by natural or assisted parturition, C-section rates decreased from 100% in 2000 to 54% in 2005. On average, 42% of cloned calves died between delivery and 150 days of life; the most common abnormalities were: enlarged umbilical cord (37%), respiratory problems (19%), calves depressed/prolonged recumbency (20%) and contracted flexor tendons (21%). From 11 blood parameters evaluated during the first week of life, lactate decreased twice and glucose doubled its original value from 24h to 7 days. Adult cloned females had normal breeding and calving rates and cloned bulls produced good quality semen and had normal fertility when used for AI or natural mating. In conclusion, cloning had no risks qualitatively different from those encountered in animals involved in modern agricultural practices, although the frequency of the risks appeared to be increased in cattle during the early portions of the life cycle of cattle clones.

Cronicidad de los trastornos del estado de ánimo: relaciones con actitudes ognitivas disfuncionales y con alteraciones de la personalidad / Chronicity of mood disorders: their relationship with dysfunctional cognitive attitudes and personality alterations

El objetivo del trabajo fue evaluar la triple relación entre la cronicidad detrastornos del estado de ánimo, actitudes cognitivas disfuncionales y comorbilidadcon alteraciones de personalidad. Se esperaría que a mayor cronicidadse presentase mayor comorbilidad y mayores puntuaciones en actitudes disfuncionales.Participaron 37 pacientes ambulatorios diagnosticados con trastornosdepresivos asignados a dos grupos en función de la cronicidad de sudepresión. Se utilizaron los siguientes instrumentos: Inventario Clínico Multiaxialde Millon (MCMI-II) (1999), Cuestionario de Ansiedad Estado-Rasgo deSpielberger (STAI) (1982), Inventario de Depresión de Beck (BDI) (1961) y Escala de Actitudes Disfuncionales de Weissman y Beck (DAS) (1978). De acuerdocon las hipótesis, no hubo diferencias entre los grupos en la Escala de ActitudesDisfuncionales y se encontró una alta comorbilidad entre trastornos depersonalidad y depresivos. Sin embargo, aunque la tendencia fue en la líneade lo esperado, no encontramos diferencias significativas entre grupos en latriple relación. Se cuestiona el alto grado de cronificación con que los pacientesson derivados a los Servicios Especializados de Salud Mental

The objective of this study was to assess the triple relationship between thechronicity of mood disorders, the co-morbidity with personality alterations andthe dysfunctional cognitive attitudes. The prediction is that the higher thechronicity the higher the probability of co-morbidity and the dysfunctional attitudesscores. A sample of 37 outpatients diagnosed with depressive disorderswas assigned to two different groups according to the chronicity of theirdepression. A number of self-report measures were administered: Millon’sClinical Inventory-II (MCMI-II) (1999), Spielberger’s State-Trait Anxiety Inventory(STAI) (1982), Beck’s Depression Inventory (BDI)(1961), and Weissman andBeck’s Dysfunctional Attitudes Scale (DAS) (1978). As hypothesized, therewere no between-group differences in the Dysfunctional Attitude Scale. Therewas a high co-morbidity between mood and personality disorders. However,no between-group differences were found in the triple relationship, althoughthe tendency was as expected. The high degree of chronicity of patients sentto specialized Mental Health Services is questioned

Transrectal Doppler sonography for evaluation of uterine blood flow throughout pregnancy in 13 cows.

Once weekly from 30 to 270 days of gestation in 13 cows, Doppler ultrasound scanning (triplex Doppler system) was done to assess blood-flow parameters of both median uterine arteries. Resistance, velocity and volume indices were measured. Resistance index values were negatively correlated to all other blood-flow parameters (P<0.05), but there were positive correlations between velocity and volume indices (P<0.05). Resistance indices were lower, and velocity and volume indices were significantly higher in the median uterine artery ipsilateral versus contralateral to the fetus. Resistance indices decreased continuously during the first 36 weeks of pregnancy. Velocity values rose three-fold, whereas the area increased 20-fold and the volume increased 17-fold by the end of gestation (P<0.05). Birth weight of calves was positively correlated with blood-flow volume (r=0.34) but negatively correlated with the resistance index (r=-0.45). There were no significant differences between male versus female calves (at any stage of gestation) in the resistance, time-average maximum velocity, and volume indices (P>0.05). In conclusion, arterial blood flow was monitored with transrectal Doppler sonography in both median uterine arteries weekly throughout pregnancy in cattle; this could be very valuable for monitoring pregnancies at high risk for abnormalities of the placenta, fetus or both, e.g. cloned calves.

[Preoperative prophylactic pacemakers: apropos of their indication in a disputed case]. / Marcapasos profiláctico preoperatorio: a propósito de su indicación en un caso controvertido.

The criteria for preoperative use of pacemakers are not unanimously agreed upon. Certain cases require careful assessment to weigh potential benefits against inherent risks in placing the device. Although external transcutaneous pacemakers, whose use circumvents the risks of transvenous insertion, have been available for years, such devices are not always appropriate, depending on the flow disorder involved or the type of surgery that will be performed. We report the case of a 75-year-old woman who was a candidate for surgery requiring general anesthesia (lumboperitoneal shunt due to chronic adult hydrocephaly). Although her condition did not initially call for prophylactic use of a pacemaker before surgery, changes soon developed that necessitated insertion of a temporary transvenous device for surgery and insertion of a permanent pacemaker the day after surgery.

Marcapasos profiláctico preoperatorio: a propósito de su indicación en un caso controvertido / Prophylactic pacemaker use before surgery: a report of application in a controversial case

La criterios para la indicación de un marcapasos profiláctico preoperatorio no son unánimes y existen determinados casos que requieren una valoración cuidadosa, que sopese los potenciales beneficios frente a los riesgos inherentes a la colocación de dicho dispositivo. Aunque desde hace unos años disponemos de marcapasos externos transcutáneos, que evitan los riesgos derivados de la inserción transvenosa, éstos no son adecuados en todos los casos, y dependen del trastorno de conducción existente y del tipo de cirugía que se vaya a realizar.Presentamos el caso de una paciente de 75 años propuesta para intervención quirúrgica que requería anestesia general (derivación lumboperitoneal por hidrocefalia crónica del adulto) y que, aunque inicialmente no reunía criterios para la utilización de un marcapasos profiláctico preoperatorio, en muy poco tiempo cambió la indicación, siendo necesaria la inserción de un dispositivo transvenoso temporal para la intervención quirúrgica, y que precisó de la colocación de un marcapasos definitivo el día siguiente a la cirugía (AU)

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Sarikaya: toward community self-reliance in health and family planning.

PIP: The Sarikaya Project of the Philippine Ministry of Health's National Family Planning Office was conceived as an innovative approach to providing information, education, and communication on health, nutrition, and family planning using the services of neighborhood leaders who can gain the cooperation and participation of community members in health and family planning programs. The Sarikaya worker (SW) serves as the link between the community and the Ministry of Health. Selection of SWs is a collaborative effort of the Barangay Health Service midwife, the community, and the barangay council. SWs are trained by the BHS midwife in a 5-day seminar which includes an orientation to the role and function of the Sarikaya Project, health and family planning IEC, and 1st aid. SWs undertake activities in family planning, maternal and child health, nutrition, environmental sanitation, communicable disease control, and emergency treatment. As volunteers, the SWs receive no compensation except for a nominal training allowance. The SW relies on the BHS midwife for technical and logistical support, on the health committee of the barangay council for coordination and administrative support, and on informal community leaders for guidance and advice. Pilot testing of the sarikaya project was undertaken in 1979, when 241 workers were trained. Results of early evaluations were encouraging, and plans were made to expand the project in 1980.^ieng