[E-consultation as a tool for the relationship between Primary Care and Endocrinology. Impact of COVID-19 epidemic in its use]. / La e-consulta como herramienta para la relación entre Atención Primaria y Endocrinología. Impacto de la epidemia por COVID-19 en su uso.

INTRODUCTION: Electronic consultation (eConsultation) can precede, complete, or replace visits to the specialist. OBJECTIVE: To describe the profile of eConsultations issued from Primary Care (PC) to the Endocrinology Unit since their implementation in our hospital, to assess the response time and to evaluate changes in trends in relation to the COVID19 pandemic. A secondary objective is to evaluate the degree of satisfaction of PC specialists with this tool. MATERIAL AND METHODS: An observational retrospective study of Endocrinology eConsultations conducted from June 2019 to October 2020 analysing 2periods: pre-COVID and post-COVID. The degree of satisfaction of the Family and Community Medicine specialists was assessed by means of a questionnaire. RESULTS: 391 eConsultations were answered (69 pre-COVID and 322 post-COVID). The response time was less than 24h in 85% of them. A total of 35.3% were resolved without the need for visits or additional tests. Thyroid pathology was the most consulted. The incidence was significantly higher in the post-COVID period. The proportion of high resolution was significantly higher in the pre-COVID period. There were no differences in the rest of the parameters analysed in both periods. Thirty-nine point 2percent of PC specialists answered the survey. The degree of satisfaction of PC specialists was high. A total of 92.7% considered that the tool met their expectations and 90.5% were satisfied or very satisfied with its use. CONCLUSION: The COVID epidemic has driven the use of eConsultation in Endocrinology, which makes it possible to precede, complete or replace visits to the specialist, with a high degree of user satisfaction.

Fathers matter too! Lived experience of pedagogical hope in raising children with Down syndrome.

BACKGROUND: Pedagogical hope is a fundamental disposition for raising children. This attitude among fathers of children with Down syndrome (DS) plays an essential role in their children's development. This phenomenological study sought to explore fathers' lived experiences and to reflect on what it means to be a pedagogically hopeful father of a child with DS. METHODS: Max van Manen's hermeneutic-phenomenological method was applied. Phenomenological interviews were held with 10 fathers of children with DS in Spain, Ecuador and Scotland. Anecdotal narratives from the transcribed interviews were analysed based on philosophical, philological and human science methods. RESULTS: The four eidetic themes in the phenomenological text show how a pedagogically hopeful father (1) is realistic; (2) believes in the strengths of his child with DS; (3) trusts in his positive influence; and (4) is open to unexpected surprises. CONCLUSIONS: Lived experiences of pedagogical hope reveal fathers' fundamental roles in stimulating the utmost development of their child's capabilities. Reflecting on this pedagogical attitude will undoubtedly encourage fathers, educators and health care professionals to make the most of this disposition and enhance their relationship with their children with DS.

[Family typology and deterioration related to opioids use, in a methadone treatment patients group]. / Tipología familiar y deterioro asociado al consumo de opiáceos, en un grupo depacientes en tratamiento con metadona.

In this article the familiar functioning of subjects addict to opioids included in a maintenance programme with methadone will be analyzed, trying to identify whether belonging to one type of family (family typology) or another, according to Olson's Familiar Functioning Model, is related to the level of deterioration or severity of addiction of the different areas associated to consumption . The sample is composed by 69 subjects (N=69) users of the Servicio de Atención a las Drogodependencias (SAD) in Centro de Servicios Sociales Comunitarios del Ayuntamiento de Alcalá de Guadaíra (Seville). In order to evaluate the functioning and the family typology of these subjects the Escala de Cohesión y Adaptación Familiar--CAF-1--Spanish version of FACES III was used. In order to evaluate the level of deterioration, the Spanish version of the 5th edition of the personal, clinical semistructured interview Addiction Severity Index--ASI4--was applied. The results indicate that the subjects included in balanced families present more addiction severity in two dimensions of the ASI: Alcohol and Employment/Support and are, moreover, the ones that take greater doses of methadone.

Tipología familiar y deterioro asociado al consumo de opiáceos, en un grupo de pacientes en tratamiento con metadona / Family typology and deterioration related to opioids use, in a methadone treatment patients group

En este artículo se analiza el funcionamiento familiar de los sujetos adictos a opiáceos incluidos en un programa de mantenimiento con metadona, tratando de identificar si la pertenencia a un tipo u otro de familia (tipología familiar) según el Modelo de Funcionamiento Familiar de Olson, se relaciona con el nivel de deterioro o severidad de la adicción de las distintas áreas asociadas al consumo. La muestra está compuesta por 69 sujetos (N=69) usuarios del Servicio de Atención a las Drogodependencias (SAD) del Centro de Servicios Sociales Comunitarios del Ayuntamiento de Alcalá de Guadaíra (Sevilla). Para evaluar el funcionamiento y la tipología familiar, de estos sujetos se utilizó la Escala de Cohesión y Adaptación Familiar –CAF-1, versión española del FACES III2. Para evaluar el nivel de deterioro, aplicamos la versión española 3 de la 5ª edición de la entrevista clínica personal semiestructurada Addiction Severity Index-ASI4. Los resultados obtenidos nos indican que los sujetos incluidos en familias equilibradas presentan más severidad de la adicción en dos dimensiones del ASI: Alcohol y Empleo/Apoyo y son, además, los que consumen una dosis más elevada de metadona (AU)

In this article the familiar functioning of subjects addict to opioids included in a maintenance programme with methadone will be analized, trying to identify whether belonging to one type of family (family typology) or another according to Olson’s Familiar Functioning Model, is related to the level of deterioration or severity of addiction of the different areas associated to consumption . The sampleis composed by 69 subjects (N=69) users of the Servicio de Atención a las Drogodependencias (SAD) in Centro de Servicios Sociales Comunitarios del Ayuntamiento de Alcalá de Guadaíra (Seville). In order to evaluate the functioning and the family typology of these subjects the Escalade Cohesión y Adaptación Familiar –CAF-1, Spanish version of FACES III was used 2. In order to evaluate the level of deterioration, the Spanish version3 of the 5th edition ofthe personal, clinical semistructured interview Addiction Severity Index-ASI4 was applied. The results indicate that the subjects included in balanced families present more addiction severity in two dimensions of the ASI: Alcohol and Employment/ Support and are, moreover, the onesthat take greater doses of methadone (AU)

Efectividad del calzado ortopédico pronador en el tratamiento postoperatorio de niños con pie equino varo congénito idiopático rígido / Effectiveness of the corrective shoes in the posoperative treatment of equinovarus deformities in children

El uso de calzado ortopedico en el tratamiento postoperatorio del pie equino varo congenito idiopatico (PEVCI) es motivo de controversia. Con el fin de conocer la efectividad del uso del calzado con modificaciones especiales (botas pronadoras) en el manejo postoperatorio del paciente con PEVCI, a quienes se les efectuó una liberación posterointerna ampliada (LIPA), se realizó un estudio experimental clinico controlado ciego, que comparó dos intervenciones: al primer grupo se le formuló zapato ortopedico (botas pronadoras), al segundo se le asigno zapato normal. Para la evaluación se utilizaron los enterizos de Turco modificados. Los resultados se clasificaron como buenos regulares y malos. Se presenta un analisis interno con el objeto de detectar diferencias entre los grupos. Hasta el momento no se han encontrado diferencias por lo que se autoriza la continuación del estudio para definir con mayor precisión la efectividad de la intervención

[Health and social services: needs, preferences and their use by the elderly following hospitalization]. / Servicios sanitarios y sociales: necesidades, preferencias y utilización por los ancianos tras un episodio de hospitalización.

BACKGROUND: Many processes behind the admission to hospital of elderly people can lead to a deterioration in their health at the time of discharge. The aims of the study are to assess the dependency on and need for socio-health care required by elderly people aged over 64 when discharged from a hospital for acute cases, the help that patients prefer and the help that they actually receive one month following their discharge. METHODS: A total of 193 patients aged over 64 and admitted to a hospital in Valencia between February and April 1994 were studied. Information on socio-demographic characteristics, self-care capacity, mental state, main diagnosis and co-morbidity was obtained by means of an interview at the time of admission and the medical record. A multidisciplinary team evaluated the socio-health care required in each case. A second interview, one month after discharge from hospital, gathered data on the actual care received. RESULTS: At the time of admission, 17% of the patients needed partial care and 21% full care. 23% were candidates for receiving home help, 9% to be treated as out-patients and 6% in a chronic illness hospital. Most of the patients asked to live at home. One month after discharge from hospital, only 2% of patients were receiving home help, none were being treated as out-patients or in a chronic illness hospital and 3% had once again admitted to a hospital for acute cases. 8% of the patients who were living at home alone before being admitted to hospital and 5% of those who were living with someone else had gone to live with relatives. CONCLUSIONS: The reality observed reflects the lack of socio-health resources. In many cases, this situation leads families to take on the care of the elderly themselves.

[Upper digestive hemorrhage caused by ulcerated periampullary leiomyoma]. / Hemorragia digestiva alta por un leiomioma periampular ulcerado.

Duodenal leiomyoma represents a very unusual cause for acute gastrointestinal bleeding. The authors report the case of a 49-year-old male with a massive bleeding from an ulcerated duodenal leiomyoma involving the ampulla of Vater. An emergency Whipple's pancreaticoduodenectomy was carried out under suspicion of local malignancy. It is emphasized that the proper diagnosis of smooth muscle tumors is often difficult, both clinically and from the pathological point of view.

Cytoplasmic estradiol binding sites in testis of fertile and infertile men.

Free cytoplasmic estradiol receptor was determined in testicular biopsies from six adults showing various primary testicular disorders, and in testicular tissue obtained at autopsy from 18 males of various ages. Estradiol receptors were found in all cases examined. Receptor concentration varied during testicular maturation and from one patient to another. The presence of the receptor at an early stage of development and the changes observed in its concentration during testicular maturation and dysfunction support the idea that estradiol may play, through its receptor interaction, an important role in the regulation of testicular steroidogenesis during postnatal human development.