Efectividad de la movilidad cervicodorsal con característica socializadora y lúdica con relación al riesgo de caídas en adultos mayores con anteposición de cabeza y cuello: un ensayo clínico aleatorizado / Effectiveness of cervicodorsal mobility testing with socialising and playful features of falls risk in older adults with forward head and neck posture: A randomised clinical trial

Objetivo: El propósito del estudio fue comprobar la efectividad de la movilidad cervicodorsal con característica socializadora y lúdica en relación con el riesgo de caídas en adultos mayores con anteposición de cabeza y cuello. Material y métodos: El presente estudio fue un ensayo clínico aleatorizado con un diseño experimental, longitudinal, basado en la evaluación del riesgo de caídas mediante el Timed Up and Go en 3 grupos de 44 participantes posterior a 16 semanas, divididos en: grupo movilidad cervicodorsal, grupo movilidad cervicodorsal con característica socializadora y lúdica y grupo control que no realizó intervención. Los 132 participantes cumplieron los criterios de inclusión y exclusión: adultos mayores>60 años, con anteposición de cabeza y cuello, índice de masa corporal con sobrepeso y obesidad tipo 1 y sin enfermedades neurológicas, reumatológicas, sistémicas, inmunodepresivas, infecciosas u osteomusculares. Resultados: Hubo cambios estadísticamente significativos en la disminución del riesgo de caídas en ambos grupos que recibieron tratamiento (p<0,05). El grupo movilidad cervicodorsal disminuyó en promedio 5,43 segundos, y el grupo movilidad cervicodorsal con característica socializadora y lúdica disminuyó en promedio 5,78 segundos. Conclusión: La movilidad cervicodorsal con característica socializadora y lúdica fue efectiva en relación con la disminución del riesgo de caídas en adultos mayores con anteposición de cabeza y cuello, no observándose diferencias estadísticamente significativas entre los 2 grupos experimentales.

Objective: The purpose of the study was to assess the effectiveness of cervicodorsal mobility testing with a socialising and playful features in relation to falls risk in older adults with forward head and neck posture. Material and methods: The present study was a randomised clinical trial with a longitudinal, experimental design, based on assessment of falls risk using the Timed Up and Go Test in three groups of 44 participants after 16 weeks, divided into: cervicodorsal mobility group, cervicodorsal mobility group with socialising and playful features and a control group that did not take part in the intervention. The 132 participants met the inclusion and exclusion criteria: older adults>60 years of age, with forward head and neck posture, overweight body mass index and type 1 obesity and with no neurological, rheumatological, systemic, immunosuppressive, infectious, or musculoskeletal diseases. Results: There were statistically significant changes in decrease in falls risk in both groups receiving treatment (p<.05). The cervicodorsal mobility group decreased in risk by an average of 5.43seconds and the cervicodorsal mobility group with socialising and playful features decreased by an average of 5.78seconds. Conclusion: Cervicodorsal mobility with socialising and playful features was effective in reducing the risk for falls in older adults with forward head and neck posture and forward neck posture, and no statistically significant differences were observed between the two experimental groups.

Efectividad de la técnica de liberación de la fascia toracolumbar sobre la resistencia muscular del esternocleidomastoideo bilateral y el ángulo de anteposición de cabeza y cuello / Effectiveness of thoracolumbar myofascial release on increasing sternocleidomastoid resistance and reducing forward head posture angle

Objetivo: el propósito del estudio fue evaluar la efectividad inmediata de la técnica de liberación de la fascia toracolumbar para aumentar la resistencia muscular del esternocleidomastoideo bilateral, y disminuir el ángulo de anteposición de cabeza y cuello en mujeres jóvenes de la Universidad Autónoma de Chile. Material y métodos: este estudio longitudinal, está basado en la medición inmediata (5minutos) de la resistencia muscular (segundos) a través de la prueba de fatiga mediante electromiografía de superficie en el esternocleidomastoideo bilateral, y análisis del ángulo de anteposición de cabeza y cuello posterior a la aplicación de la técnica de liberación de la fascia toracolumbar (TLFT). Las 35 mujeres evaluadas reunieron los criterios de inclusión de: sexo femenino, edad entre 22 y 27 años, sedentarias, estudiantes de nivel superior de la Universidad Autónoma de Chile, anteposición de cabeza y cuello entre 43,8 y 51 grados, índice de masa corporal normal y sobrepeso, sin enfermedades de columna y firmar consentimiento informado. Resultados: hubo cambios estadísticamente significativos de manera inmediata en la resistencia muscular del esternocleidomastoideo, con un aumento de 27,4segundos promedio (p<0,05) y la disminución del ángulo de anteposición de cabeza y cuello de 2,8 grados promedio (p<0,05), posterior a la aplicación de la TLFT. Conclusión: la TLFT produce un efecto inmediato en el aumento de la resistencia muscular del esternocleidomastoideo bilateral y una disminución del ángulo de anteposición de cabeza y cuello en mujeres jóvenes que presenten anteposición de cabeza y cuello

Objective: the aim of this study was to evaluate the effectiveness of thoracolumbar myofascial release to increase the resistance of the sternocleidomastoid (SCM) muscle bilaterally and to decrease the angle of forward head posture in young women enrolled at the Autónoma University of Chile. Material and methods: this longitudinal study was based on the immediate measurement (5minutes) of muscular resistance (seconds) through the fatigue test by means of surface electromyography in the bilateral sternocleidomastoid and analysis of the angle of forward head posture after the application of thoracolumbar myofascial release (TMFR). The 35 women evaluated met the inclusion criteria of female sex, age between 22 and 27 years, sedentary lifestyle, senior students of the Autónoma University of Chile, forward angle head posture between 43.8 and 51 degrees, body mass index indicating normal weight or overweight, and without spinal abnormalities. All participants provided written informed consent. Results: after the application of TMFR, there were statistically significant and immediate changes in the muscular resistance of the sternocleidomastoid with an average increase of 27.4seconds (P<.05) and an average decrease in the forward head posture angle of 2.8 degrees (P<.05). Conclusion: TMFR produces an immediate effect in increasing the muscular resistance of the bilateral sternocleidomastoid and reducing the forward head posture angle in young women with forward head posture

[Effectiveness of thoracolumbar myofascial release on increasing sternocleidomastoid resistance and reducing forward head posture angle]. / Efectividad de la técnica de liberación de la fascia toracolumbar sobre la resistencia muscular del esternocleidomastoideo bilateral y el ángulo de anteposición de cabeza y cuello.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of thoracolumbar myofascial release to increase the resistance of the sternocleidomastoid (SCM) muscle bilaterally and to decrease the angle of forward head posture in young women enrolled at the Autónoma University of Chile. MATERIAL AND METHODS: This longitudinal study was based on the immediate measurement (5minutes) of muscular resistance (seconds) through the fatigue test by means of surface electromyography in the bilateral sternocleidomastoid and analysis of the angle of forward head posture after the application of thoracolumbar myofascial release (TMFR). The 35 women evaluated met the inclusion criteria of female sex, age between 22 and 27 years, sedentary lifestyle, senior students of the Autónoma University of Chile, forward angle head posture between 43.8 and 51 degrees, body mass index indicating normal weight or overweight, and without spinal abnormalities. All participants provided written informed consent. RESULTS: After the application of TMFR, there were statistically significant and immediate changes in the muscular resistance of the sternocleidomastoid with an average increase of 27.4seconds (P<.05) and an average decrease in the forward head posture angle of 2.8 degrees (P<.05). CONCLUSION: TMFR produces an immediate effect in increasing the muscular resistance of the bilateral sternocleidomastoid and reducing the forward head posture angle in young women with forward head posture.

Competencias en medicina legal para médicos recién egresados: opinión de experto / Competences in legal medicine to recently graduated doctors: expert opinions / Competências em medicina jurídica a médicos recentemente graduados: opiniões de expertos

El escenario actual en el ámbito de la salud y del derecho, plantea cambios que ponen de manifiesto la necesidad de mayor conocimiento en materias concernientes a la medicina legal: la judicialización del ejercicio médico y el aumento exponencial de reclamaciones por malpraxis, demandan una profundización en la formación deontológica. Además, la implementación de la Reforma Procesal Penal, exige fortalecer el nivel judicial y forense, máxime cuando varias disposiciones legales establecen que la actividad pericial no es privativa de los especialistas que laboran en el Servicio Médico Legal. Con el propósito de contribuir a la formación de los futuros médicos en el ámbito de la Medicina Legal considerando las actuales normativas jurídicas involucradas en el área de la salud, se realizó una investigación cualitativa, exploratoria, descriptiva, con una muestra no probabilística, intencionada, por conveniencia, conformada por un médico especialista en Medicina Legal, previa firma Consentimiento Informado. Para recolectar los datos se recurrió a una entrevista en profundidad. El análisis y recogida de ellos se realizó en forma simultánea a través del método de comparación constante, siguiendo un esquema de reducción progresiva. La rigurosidad científica del estudio estuvo determinada por cuatro criterios de rigor: valor de verdad (credibilidad), aplicabilidad (transferibilidad), consistencia (dependencia) y neutralidad (confirmabilidad), realizándose la triangulación por investigadores. En el nivel 1 se encontraron 9 categorías: "muerte", "autopsia", "lesiones", "salud mental", "sexología", "laboratorio forense", "documentos medicolegales", "reforma procesal" y "competencia genérica". En el Nivel 2 se identificaron tres núcleos temáticos "Requisitos de Tanatología en el Plan de Estudio", "Aspectos a considerar en el Plan de Estudio con respecto a Lesionología" y "Relación teórico práctica de los contenidos de Medicina Legal". En el Nivel 3: emerge un dominio cualitativo: "Competencias disciplinares y genéricas a considerar en el Plan de Estudio con respecto a contenidos de la Asignatura de Medicina Legal". Lo disciplinar incluye la Tanatología, Lesionología, Sexología Forense, Evidencia Física. Lo genérico en función a la relación médico paciente y su responsabilidad profesional. Considerando que el propósito del estudio es contribuir a la formación de los futuros médicos en el ámbito de la Medicina Legal mediante el rediseño del programa de la asignatura, a través del experto, se puede deducir que todos los contenidos están explícitos en la actividad curricular. Además, es importante señalar que la terminología utilizada es similar a la consignada a nivel nacional. Sin embargo, las actividades prácticas de estos aprendizajes no están claramente explicitadas. Los resultados corroboran la inexistencia de las competencias disciplinares y genéricas en el ámbito de la Medicina Legal para la labor asistencial de un médico que se desempeña en un Servicio de Urgencia o en la Atención Primaria de Salud. Esto induce a continuar la línea de trabajo en orden a consultar a los egresados(as), en relación a su formación de pregrado en todos los aspectos forenses considerando diferentes áreas y ámbitos laborales.

The current scenario in the field of health and law, poses changes which seek for more knowledge in matters concerning legal medicine: the prosecution of medical practice and the exponential increase in claims for malpractice, seeking a deepening of ethics training. In addition, the implementation of the Criminal Procedure Reform requires strengthening the judicial and forensic level, especially when several statutory provisions establish the expert activity is not exclusive to the specialists working in the Legal Medical Service. In order to contribute the training of future doctors in the field of Legal Medicine considering the current legal regulations involved in the area of health, a qualitative research was conducted, exploratory, descriptive, with a non-probabilistic, intentional sample, convenience, made by a medical specialist in Legal, Medicine prior Informed Consent signature. To collect the data an in-depth interview was used to. The analysis and collection of them was conducted simultaneously through the constant comparison method, following a progressive reduction scheme. The scientific rigor of the study was determined by four criteria of rigor: truth value (credibility), applicability (portability), consistency (dependence) and neutral (Confirmability), carried out by researcher's triangulation. At level 1, 9 categories were found: "Death," "autopsy", "injury", "mental health," "sexology", "forensic laboratory", "legal medical documents", "judicial reform" and "generic competition". At Level 2 three important thems were identified "Thanatology requirements in the Curriculum", "Aspects to consider in the Study Plan regarding "damage" (Lesionología) and "practical theoretical ratio of the contents of Legal Medicine". In level 3: qualitative domain emerges: "Disciplinary competences and generic to be considered in the Study Plan regarding contents of the Subject of Legal Medicine". The discipline includes Thanatology, Damage (Lesionología), Forensic Sexology, Physical Evidence. The generic depending on the doctor-patient relationship and professional responsibility. Whereas the purpose of the study is to contribute to the training of future doctors in the field of Legal Medicine by redesigning the program of the subject, through the expert, one can deduce that all of the contents are explicit in the curricular activity. It is also important to point out that the terminology used is similar to that recorded nationally. However, the practical activities of these learnings are not clearly explicit. The results confirm the existence of disciplinary and generic in the field of Legal Medicine for the welfare work of a doctor who serves on an emergency service or primary health care. This leads to continue the line of work in order to consult graduates (as), in relation to their undergraduate training in all aspects forensic considering different areas and fields of work.

O cenário atual no campo da saúde e do direito, Propõe mudanças que procuram mais conhecimentos em matéria de medicina legal: O julgamento da prática médica eo aumento exponencial de reclamações por negligência, Buscando um aprofundamento do treinamento em ética. Além, a implementação da Reforma Processual Penal requer o fortalecimento do nível judicial e forense, especialmente quando várias disposições legais estabelecem que a actividade de peritos não é exclusiva dos especialistas que trabalham no Serviço Jurídico Médico. A fim de contribuir com a formação de futuros médicos no campo da Medicina Legal considerando as atuais normas legais envolvidas na área de saúde, foi realizada uma investigação qualitativa, exploratório, descritivo, com uma amostra não-probabilística, intencional, conveniência, feita por um médico especialista em Legal, Medicina assinatura de Consentimento Livre e Esclarecido. Para recopilar os dados são utilizados numa entrevista em profundidade. A análise e coleta dos mesmos foi realizada simultaneamente através do método de comparação constante, Seguindo um esquema de redução progressiva. O rigor científico do estudo foi determinado por quatro critérios de rigor: valor de verdade (credibilidade), aplicabilidade (portabilidade), consistência (dependência) e neutro (Confirmabilidade), realizado pela triangulação do investigação No nível 1, foram encontradas 9 categorias: "morte", "autópsia", "lesão", "saúde mental", "sexologia", "laboratório forense", "documentos médicos legais", "reforma judicial" e "concorrência genérica". No Nível 2 foram identificados três temas importantes "requisitos de Tanatologia no Currículo", "Aspectos a considerar no Plano de Estudo referentes ao" dano "(Lesionología) e" razão teórica prática dos conteúdos da Medicina Legal "". No nível 3: domínio qualitativo emerge: "Competências disciplinares e genéricas a serem consideradas no Plano de Estudo sobre os conteúdos do Sujeito de Medicina Legal". A disciplina inclui Thanatology, daño (Lesionología), Sexología Forense, Evidencia Física. El genérico depende de la relación médico-paciente y de la responsabilidad profesional. Considerando que o objectivo do estudo é contribuir para a formação dos futuros médicos no campo da medicina forense por redesenhar o programa do assunto através do perito, se pode deduzir a totalidade do conteúdo são explícitos na actividade curricular. Também é importante ressaltar que a terminologia utilizada é semelhante à registrada nacionalmente. No entanto, as atividades práticas desses aprendizados não são claramente explícitas. Os resultados confirmam a existência de disciplina e genéricos no campo da Medicina Legal para o trabalho assistencial de um médico que presta serviços de emergência ou cuidados primários de saúde. Isto leva a continuar a linha de trabalho, a fim de consultar os graduados, em relação à sua formação de graduação em todos os aspectos Considerando diferentes áreas forense e campos de trabalho.

Aprendizaje basado en problemas (ABP) como estrategia para adquisición de competencias genéricas: estudiantes de nutrición y dietética, Universidad de La Frontera / Problem-based learning as a strategy for acquisition of generic skills: students of nutrition and dietetics, Universidad de La Frontera

The study of generic skills in the training of health professionals has become an instrument of increasing value to the institutions of higher education and health centers. In order to know in detail the opinions of students of the career of nutrition and dietetics of the Faculty of Medicine, Universidad de La Frontera, Temuco-Chile related to the generic competences acquired during their training process, 5th year students took part in two focus groups, after signing an informed consent. The analysis of data followed a scheme of progressive reduction of them, validating by triangulation of researchers. The results represent the consistency that must exist between study and educational plan didactics in the development of the generic competences, so necessary nowadays for the work insertion of health professionals.

El estudio de competencias genéricas en la formación de profesionales de la salud se ha convertido en un instrumento de valor creciente para las instituciones de educación superior y centros asistenciales. Con el objetivo de conocer en detalle las opiniones del alumnado de la Carrera de Nutrición y Dietética, de la Facultad de Medicina de la Universidad de La Frontera, Temuco-Chile relacionadas con las competencias genéricas adquiridas durante su proceso de formación, se realizó una investigación cualitativa, mediante estudio de caso. Participaron estudiantes de 5° año en dos grupos focales, previa firma de consentimiento informado. El análisis de datos siguió un esquema de reducción progresiva de ellos, validándose por triangulación de investigadores. Los resultados representan la congruencia que debe existir entre el plan de estudio y didáctica educativa en el desarrollo de competencias genéricas, tan necesarias en el mundo actual para la inserción laboral de profesionales de la salud.

A randomized clinical trial with two doses of an enteral diabetes-specific suplements in elderly patients with diabetes mellitus type 2.

OBJECTIVES: The aim of our study was to investigate whether two different daily doses of a high monounsaturated fatty acid (MUFA) specific diabetes enteral formula could improve nutritional variables as well as metabolic parameters. PATIENTS AND METHODS: We conducted a randomized, open-label, multicenter, parallel group study. 27 patients with diabetes mellitus type 2 with recent weight loss were randomized to one of two study groups: group 1 (two cans per day) and group 2 (three cans per day) for a ten week period. RESULTS: A significative decrease of HbA1c was detected in both groups. The decrease 0.98% (confidence interval 95% 0.19-1.88) was higher in group 2 than group 1 0.60% (confidence interval 95% 0.14-1.04). A significant increase of weight, body mass index, fat mass, albumin, prealbumin and transferrin was observed in both groups without statistical differences in this improvement between both groups. The increase of weight 4.59kg (confidence interval 95% 1.71-9.49) was higher in group 2 than group 1 1.46% (confidence interval 95% 0.39-2.54). Gastrointestinal tolerance (diarrhea episodes) with both formulas was good, without statistical differences (7.60% vs 7.14%: ns). CONCLUSIONS: A high monounsaturated fatty acid diabetes-specific supplement improved HbA1c and nutritional status. These improvements were higher with three supplements than with two per day.

Association of anthropometric and biochemical markers with length of stay and mortality in the hospital.

INTRODUCTION: Malnutrition is associated with patient outcome, hospital stay and costs. The objective of our study was evaluated the relationship of different anthropometric and biochemical nutritional markers with hospital stance (days) and mortality. PATIENTS AND METHODS: A sample of 3087 hospitalized patients in a Universitary Hospital was enrolled. Nutritional status was assessed from anthropometric variables; body mass index (BMI), weight, weight loss in previous three months, tricipital skin fold thickness, midarm muscle circumference and midarm muscle area. Biochemical evaluation was assessed with albumin, prealbumin, transferrin and lymphocytes. Length of hospital stance and mortality were recorded. RESULTS: A total of 3087 patients were enrolled, mean age was 67.7±18.3 years, weight 63.3±15,7 kg and BMI 23.7±6.8, with a weight loss (3 months) of 6.3±4.6 kg. Length of stay was 24.7±22.1 days. A total of 2583 patients were discharged. Hospital discharge data showed 87.8% of patients went home, and a 12.2% of patients were discharged to a secondary Hospital. A (n=504) 16.3% of patients died. In the multivariate analysis with a dependent variable [length of stay (days)], only albumin levels remained as an independent predictor in the model (F=2.9; p < 0.05), with an increase of 3.1 days in hospital stay (CI 95%: 0.4-5.8) with each decrease of 1 g/dl of albumin. In multivariate analysis, an independent factor that decrease mortality was high albumin levels (hazard ratio: 0.41; 95% CI: 0.22-0.80), adjusted by age and sex. CONCLUSIONS: Our study shows a significant association among serum albumin levels with length of stay in hospital and mortality.

A randomized clinical trial with two doses of a omega 3 fatty acids oral and arginine enhanced formula in clinical and biochemical parameters of head and neck cancer ambulatory patients.

INTRODUCTION: Postsurgical patients with head and neck cancer could have a high rate of ambulatory complications. The aim was to investigate whether oral ambulatory nutrition of head and neck cancer patients with recent weight loss, using two different doses of an omega 3 fatty acids and arginine enhanced diets could improve nutritional parameters. DESIGN: At Hospital discharge post surgical head and neck cancer patients (n=37) were asked to consume two or three cans per day of a designed omega 3 fatty acid and arginine enhanced supplement for a twelve week period. RESULTS: Albumin, prealbumin, transferrin and lymphocytes levels improved in both groups. Weight, fat mass and fat free mass improved during supplementation in group II (3 bricks per day). No differences were detected in anthropometric parameters in group I. Gastrointestinal tolerance with both formulas was good, no episodes were reported. There are no differences between both formulas on postsurgical complications rates. CONCLUSIONS: Omega 3 and arginine enhanced formulas improved blood protein concentrations and lymphocyte levels in ambulatory postoperative head and neck cancer patients. A high dose of arginine and omega 3 fatty acids formula improved weight, too.

Experience over 12 years with home enteral nutrition in a healthcare area of Spain.

BACKGROUND: The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study the outcome, as well as the clinical and epidemiological characteristics, of these patients. The present study aimed to analyse the incidence and characteristics of a cohort of patients on home enteral nutrition (HEN) over 12 years. MATERIALS AND METHODS: A prospective observational study was performed between January 1999 and December 2010. All adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. RESULTS: The incidence of HEN ranged between 9.52 per 100, 000 inhabitants in 2001 to 30.0 per 100,000 inhabitants in 2009. HEN was administered orally in 472 patients (68.28%) (group 1), and through a nasogastric tube in 168 patients (24.30%), a percutaneous enteral gastrostomy tube in 47 patients (6.80%) and a jejunostomy in four patients (0.60%) (group 2; 219 patients). During the course of HEN, 31 patients had diarrhoea (4.5%), 17 patients had constipation and 12 patients had nausea. The mean (SD) duration of HEN was 159.9 (97) days. In multivariable analysis, an independent factor associated with death was age (hazard ratio = 1.03; 95% confidence interval - 1.01-1.05), adjusted by sex, route and diagnosis. CONCLUSIONS: HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.

Effect of a commercial hypocaloric diet in weight loss and post surgical morbidities in obese patients with chronic arthropathy, a randomized clinical trial.

INTRODUCTION: The aim of our study was to evaluate in patients with obesity and surgical indication of orthopaedic surgery for chronic osteoarthritis (hip or knee), the impact on weight loss, metabolic control and post surgical co morbidities of a hypocaloric commercial formula (Optisource®) versus conventional nutritional advice before orthopaedic surgery. MATERIALS AND METHODS: 40 patients were randomized in both branches: diet I with lunch and dinner substituted by two Optisource® (1109.3 kcal/day, 166.4 g of carbohydrates (60%), 63 g of proteins (23%), 21.3 g of lipids 17%) and intervention II with nutritional counselling that decreases 500 cal/day of the previous dietary intake. Previous and after 3 months of the treatment, a nutritional and biochemical study was realized. Postsurgical co-morbities have been recorded. RESULTS: 20 patients finished in each group. The improvement in weight (-7.56 ± 5.2 kg vs -5.18 ± 5.1 kg: p < 0.05), body mass index (-3.15 ± 2.2 vs -2.1 ± 1.9 kg/m2: p < 0.05), fat mass (-5.5 ± 5.9 kg vs -3.0 ± 2.6 kg: p < 0.05), insulin (-3.6 ± 3.8 mUI/L vs -3.0 ± 2.6) p < 0.05) and HOMA (-0.5 4 ± 1.2 vs -0.33 ± 1.14): p < 0.05) was higher in group I than in group II. All post surgical recorded parameters such as minutes of orthopaedic surgery, length of stay, vein thrombosis episodes, general infections complications, haemoglobin levels and days till independence of walking were similar in both groups. CONCLUSIONS: Obese patients with chronic osteoarthritis subsidiary of surgery, lose more weight, fat mass and improve more resistance to insulin treated with a mixed diet with a commercial formula hypocaloric that patients treated only with dietary advice.

Effect of a hypocaloric diet with a commertial formula in weight loss and quality of life in obese patients with chronic osteoarthritis / Efecto de una dieta hipocalórica con una fórmula comercial en la pérdida de peso y calidad de vida en pacientes con osteoartritis crónica

Background: The aim of our study was to evaluate in patients with obesity and chronic osteoarthritis the impact on quality of life and metabolic control of a dietary intervention with a hypocaloric commercial formula. Methods: A sample of 55 obese patients with chronic osteoarthritis was enrolled. The study consisted of a 12-week weight reduction program where the participants received an oral diet replaced with 2 bricks of Optisource Plus®. Results: In order to assess the effect of weight loss on different parameters, patients were divided in two groups by the median of weight loss percentage (9%); group 1 (< 9%) and group 2 (> 9%). In group 2, patients showed an improvement in total SF-36 score (4.0 ± 6.1 points), physical function domain of SF 36 (1.8 ± 3.4 points), role physical domain of SF 36 (0.6 ± 1.6 points) and vitality domain of SF 36 (2.7 ± 4.6 points) improved. Total score of WOMAC test (- 8.2 ± 15.0 points), function domain of WOMAC test (- 6.5 ± 10.6 points) and stiffness domain of WOMAC test (-0.7 ± 2.1 points) improved, too. Conclusion: The effect on metabolic response, functionality and quality of life was better in patients with a percentage of weight loss > 9% than patients with a lower weight loss (AU)

Introducción: El objetivo de nuestro estudio fue evaluar en pacientes obesos con osteoartritis crónica el impacto sobre la calidad de vida y el control metabólico de una intervención dietética con una formula comercial hipocalórica. Material y métodos: Se evaluó una muestra de 55 pacientes obesos con osteoartritis crónica. EL estudió consistió en un programa de 12 semanas de reducción de peso en el que los paciente recibían al día dos envases de Optisource Plus®. Resultados: Se dividieron a los pacientes en dos grupos, uno que perdió menos de un 9% (grupo 1) y el grupo 2 (más de 9% de pérdida de peso). Los pacientes en el grupo 2 mostraron una mejoria en la puntuacion total del test de calidad de vida SF-36 (4,0 ± 6,1 puntos), en el campo de la función física del SF 36 (1,8 ± 3,4 puntos), el en campo del componente físico del SF 36 (0,6 ± 1,6 puntos) y en el campo de la vitalidad del SF 36 (2,7 ± 4,6 puntos). También mejoraron de manera significativa, la puntuación total del test específico de calidad de vida para osteoartritis WOMAC (-8,2 ± 15,0 puntos), el dominio funcional del test WOMAC (- 6.5+/-10.6 puntos) y el dominio de la rigidez del test WOMAC (-0,7 ± 2,1 puntos). Conclusión: El efecto sobre la calidad de vida fue superior en el grupo con porcentaje de pérdida de peso > 9% con la formula hipocalórica comercial (AU)

Opinión de estudiantes de enfermería sobre el examen clínico objetivo estructurado / Nursing students’ opinion about the objective structured clinical examination

Investigación educativa bajo el paradigma cualitativo, a través de un estudio de caso, cuyo objetivo es conocer el significado que tiene para los estudiantes de segundo año de la Carrera de Enfermería el sistema de evaluación ECOE al finalizar la práctica clínica, Módulo Enfermería Básica del Niño, Adolescente y Adulto, del cuarto nivel académico, año 2007. Los estudiantes a partir de sus historias personales individuales, al final del ECOE respondieron una encuesta semiestructurada donde debían mencionar ventajas, desventajas, sugerencias. El análisis de datos siguió el esquema de Miles y Huberman, a través de la reducción progresiva de ellos (separación de unidades, agrupamiento, identificación y clasificación de elementos), disposición, transformación y obtención de conclusiones verificables, validándose a través de la triangulación por investigadores. En las ventajas se identificaron 88 unidades de significado, finalizando en tres dominios cualitativos “proceso de evaluación”, “reconocimiento de competencias genéricas adquiridas en el proceso de evaluación ECOE” y “proceso de gestión y administración del ECOE”. En las desventajas hubo 139 unidades de significado, originando dos dominios cualitativos “reconocimiento de competencias genéricas adquiridas en el proceso de evaluación ECOE” y “proceso de gestión y administración del ECOE”. Los resultados evidencian que el ECOE al igual que cualquier sistema de evaluación provoca en los estudiantes ansiedad, estrés. Reconocen que mide destrezas, actitudes y favorece la retroalimentación con el examinador. Para futuros ECOE, de acuerdo a las opiniones de los educandos, se debe considerar el momento de su aplicación y minimizar el tiempo de espera para ser examinados.

Educational research under qualitative paradigm through a case study aiming to raise awareness of the meaning that OSCE assessment system has for second year Nursing students at the end of the clinical practice of Basic Nursing in child, adolescent and adult modules, given in the fourth level, 2007. At the end of the OSCE and from their own personal stories the students answered a semi-structured survey where they had to mention advantages, disadvantages and suggestions. Data analysis followed the scheme proposed by Miles and Huberman (1994), through the progressive reduction of the data (separate units, clustering, identification and classification of items), provision, processing and obtaining verifiable findings, validating them through researcher triangulation. As for the advantages, 88 units of meanings were identified, ending up in three qualitative domains “evaluation process”, “recognition of generic skills acquired in the OSCE assessment process” and “administration and process management of the OSCE.” 139 units of meanings were identified as disadvantages, creating two qualitative domains: “recognition of generic skills acquired in the OSCE assessment process” and “process management and administration of the OSCE”. The results of this study show that the OSCE as well as any system of student assessment results in anxiety and stress. However, they recognize that measures skills, attitudes and encourages feedback from the examiner. For future, according to the student opinions OSCE should consider the time of application and minimize the time out for examination.

Effect of a hypocaloric diet with a commercial formula in weight loss and quality of life in obese patients with chronic osteoarthritis.

BACKGROUND: The aim of our study was to evaluate in patients with obesity and chronic osteoarthritis the impact on quality of life and metabolic control of a dietary intervention with a hypocaloric commercial formula. METHODS: A sample of 55 obese patients with chronic osteoarthritis was enrolled. The study consisted of a 12-week weight reduction program where the participants received an oral diet replaced with 2 bricks of Optisource Plus®. RESULTS: In order to assess the effect of weight loss on different parameters, patients were divided in two groups by the median of weight loss percentage (9%); group 1 (< 9%) and group 2 (> 9%). In group 2, patients showed an improvement in total SF-36 score (4.0 ± 6.1 points), physical function domain of SF 36 (1.8 ± 3.4 points), role physical domain of SF 36 (0.6 ± 1.6 points) and vitality domain of SF 36 (2.7 ± 4.6 points) improved. Total score of WOMAC test (- 8.2 ± 15.0 points), function domain of WOMAC test (- 6.5 ± 10.6 points) and stiffness domain of WOMAC test (-0.7 ± 2.1 points) improved, too. CONCLUSION: The effect on metabolic response, functionality and quality of life was better in patients with a percentage of weight loss > 9% than patients with a lower weight loss.

Cinta suburetral transobturatriz libre de tensión para el tratamiento de la incontinencia de orina de esfuerzo: 3 años de seguimiento / Tension-free subureteral tape for stress urinary incontinence

Objetivos: Evaluar nuestros resultados en la corrección de la incontinencia de orina de esfuerzo (IOE) con una técnica de cinta suburetral transobturatriz modificada (TOTm) con malla desnuda de polipropileno y anestesia local, midiendo efectividad, calidad de vida y grado de satisfacción por 3 años de seguimiento. Método: Evaluación prospectiva de 56 pacientes operadas entre los años 2003 y 2005, con IOE moderada o severa, según diagnóstico por clínica y cistometría simple. Se logró realizar un seguimiento del 87 por ciento de las pacientes, por 37,9 meses (19-51 meses). Se realizó control con examen físico y se aplicó una encuesta de satisfacción en visita domiciliaria por un grupo independiente de encuestadores. Resultados: Un 88 por ciento de las pacientes se encuentra sin IOE en el examen físico. A la encuesta de satisfacción, las pacientes manifestaron sentirse mejor o mucho mejor en frecuencia miccional diurna (79 por ciento), disfunción del vaciamiento vesical (69 por ciento), dolor pelviano (58 por ciento), urgeincontinencia (84 por ciento) y función sexual (53 por ciento). Un 90 por ciento manifiesta sentirse mejor o mucho mejor de la IOE que antes de la operación. La urgencia o urgeincontinencia de novo apareció en un 6 por ciento. Conclusiones: La técnica TOTm utilizada por nuestro grupo tiene resultados comparables con las técnicas TOT originales, con mejoría significativa en la calidad de vida de las pacientes.

Objective: To review our results in the correction of stress urinary incontinence (SUI) with a modified TOT technique using polypropylene mesh and local anesthesia, measuring effectiveness, quality of life and degree of satisfaction during 3 years of follow-up. Method: Prospective evaluation of 56 patients operated between 2003 and 2005, with modérate or severe SUI, or mixed urinary incontinence with effort predominance, according to clinical diagnosis and simple cystometry. A follow-up of 87 percent of the patients over a period of 37.9 months (19-51 months) was achieved. A physical examination was realized and a survey of satisfaction was applied by a team of independent interviewers on home visits. Results: On physical examination, 88 percent of patients are without SUI. In the survey of satisfaction, the patients manifested feeling better or much better in terms of daytime voiding frequency (79 percent), voiding dysfunction (69 percent), groin pain (58 percent), urge incontinence (84 percent) and sexual function (53 percent); 90 percent manifested feeling better or much better about their SUI than before the operation. De novo urgency or urge incontinence appeared in 6 percent. Conclusions: The modified TOT technique used by our group obtains results that are comparable to those of the original TOT techniques, with a significant improvement in the quality of life of patients.

[Problem based learning from the perspective of tutors]. / Aprendizaje basado en problemas multiprofesional: Estudio cualitativo desde la perspectiva de los tutores.

BACKGROUND: Problem based learning is a student centered learning technique that develops deductive, constructive and reasoning capacities among the students. Teachers must adapt to this paradigm of constructing rather than transmitting knowledge. AIM: To interpret the importance of tutors in problem based learning during a module of Health research and management given to medical, nursing, physical therapy, midwifery, technology and nutrition students. MATERIAL AND METHODS: Eight teachers that participated in a module using problem based learning accepted to participate in an in depth interview. The qualitative analysis of the textual information recorded, was performed using the ATLAS software. RESULTS: We identified 662 meaning units, grouped in 29 descriptive categories, with eight emerging meta categories. The sequential and cross-generated qualitative analysis generated four domains: competence among students, competence of teachers, student-centered learning and evaluation process. CONCLUSIONS: Multiprofessional problem based learning contributes to the development of generic competences among future health professionals, such as multidisciplinary work, critical capacity and social skills. Teachers must shelter the students in the context of their problems and social situation.

[Effects of a diet with products in texture modified diets in elderly ambulatory patients]. / Efecto de una dieta con productos modificados de textura en pacientes ancianos ambulatorios.

BACKGROUND: Decrease in the capacity to deglution solids and liquids is a problem in many people, this problem decreases quality of life. The main objective of our work was to evaluate the influence in elderly ambulatory patients with dysphagia of a texture modified diet ready to use on nutritional parameters and quality of life. METHODS: We enrolled 29 patients from Nutrition Department with dysphagia and an age over 70 years. Patients received a texture modified diet supplemented with dehydrated nutritional products (Resource Ready) (1,633 kcal, 59,9 g proteins (16%), 52,1 g lipids (29%), 231,7 g carbohydrates (57%), 11,1g de fiber, 82 mg cholesterol). Before and after 3 months of starting the treatment, we recorded a blood analysis, nutritional anthropometric evaluation (tricipital skinfold, midarm circumference, midarm muscle circumference, weight, height and body mass index), a bipolar bioimpedance and a dietary questionnaire of 3 days. SF36 as a questionnaire of quality of life was used before and after nutritional treatment. RESULTS: A total of 29 patients were recruited with a sex distribution of (18 females and 11 males), and an average age of 79,5+8,59 years. A 25,7% of patients had head and neck tumors, a 24% dementia and a 41,3% chronic neurological deterioration. After treatment, we detected an improvement in weight, fat mass, fat free mass, total proteins, albumin, transferrin and lymphocytes. Caloric, protein fat and carbohydrate intakes increased in a significative way. Caloric intake corrected by weight improved (26.1 +/- 5.7 cal/kg vs 28.9 +/- 4.5 cal/kg: p < 0.05). Quality of life improved significantly (SF 36 score 94.7 +/- 15 points vs 99.3 +/- 10 points; p < 0.05). CONCLUSION: A texture modified diet with dehydrated nutritional products improved dietary intake, nutritional status and quality of life of ambulatory elderly patients with dysphagia.

Efecto de una dieta con productos modificados de textura en pacientes ancianos ambulatorios / Effect of texture modified diets in elderly ambulatory patients

Fundamentos: Las dificultades para deglutir alimentos y bebidas son un problema en la vida de muchas personas, constituyendo un claro detrimento en su calidad de vida, sobre todo en pacientes ancianos. El objetivo de nuestro trabajo es evaluar en pacientes ancianos ambulatorios con disfagia la influencia en variables nutricionales bioquímicas y antropométricas, así como en la calidad de vida de una dieta comercial modificada de textura lista para su uso incluida en la dieta oral de estos pacientes. Métodos: Estudiamos un total de 29 pacientes en la Consultade Nutrición con disfagia y una edad superior a 70años. Los pacientes recibieron una dieta modificada de textura y suplementada con un producto listo para su uso(Resource Ready®) (1.633 kcal, 59,9 g proteínas (16%), 52,1g Lípidos (29%), 231,7 g Hidratos de carbono (57%), 11,1gde Fibra, 82 mg Colesterol). Antes de iniciar la dieta y a los 3 meses de seguimiento a los pacientes se les realizó una analítica, una valoración antropométrica (pliegue tricipital, circunferencia muscular del brazo, circunferencia del brazo, peso, talla, índice de masa corporal), impedanciometría tetrapolar, una encuesta nutricional de 3 días, así como el cuestionario de calidad de vida SF36. Resultados: Se reclutaron un total de 29 pacientes con una distribución por sexo de (18 mujeres y 11 varones), con una edad media de 79,5 ± 8,59 años. Un total de 25,7% presentaban un tumor de vía digestiva alta, un 24% demencia y un 41,3% otras alteraciones neurológicas. Se detectó una mejoría significativa en el peso, masa magra y masa magra de los pacientes tratados, con un aumento significativo de los niveles de proteínas totales, transferrína, albúmina y linfocitos. Las ingestas calórica, proteica, grasa y de hidratos de carbono aumentaron significativamente en términos absolutos. La ingesta calórica corregida por kg de peso mejoró significativamente (26,1 ± 5,7 cal/kg vs 28,9 ± 4,5 cal/kg: p < 0,05). Se detectó una mejoría estadísticamente significativa en lapuntuación media del test de calidad de vida SF 36 (94,7 ± 15 puntos vs 99,3 ± 10 puntos; p < 0,05). Conclusión: Nuestro trabajo muestra como la utilización de productos nutricionales modificados de textura y listos para su uso produce un incremento en la ingesta de esos pacientes con mejoría en parámetros bioquímicos y antropométricos y de la calidad de vida (AU)

Background: Decrease in the capacity to deglution solids and liquids is a problem in many people, this problem decreases quality of life. The main objective of our work was to evaluate the influence in elderly ambulatory patients with dysphagia of a texture modified diet ready to use on nutritional parameters and quality of life. Methods: We enrolled 29 patients from Nutrition Departament with dysphagia and an age over 70 years. Patients received a texture modified diet supplemented with dehydrated nutritional products (Resource Ready®) (1,633 kcal, 59,9 g proteins (16%), 52,1 g lipids (29%), 231,7 g carbohydrates (57%), 11,1g de fiber, 82 mg cholesterol). Before and after 3 months of starting the treatment, we recorded a blood analysis, nutritional anthropometric evaluation (tricipital skinfold, midarm circumference, midarm muscle circumference, weight, height and body mass index), a bipolar bioimpedance and a dietary questionnaire of 3 days. SF36 as a questionnaire of quality of life was used before and after nutritional treatment. Results: A total of 29 patients were recluted with a sex distribution of (18 females and 11 males), and an average age of 79,5+8,59 years. A 25,7% of patients had head and neck tumors, a 24% dementia and a 41,3% chronic neurological deterioration. After treatment, we detected an improvement in weight, fat mass, fat free mass, total proteins, albumin, transferrin and lymphocytes. Caloric, protein fat and carbohydrate intakes increased in a significative way. Caloric intake corrected by weight improved (26.1 ± 5.7 cal/kg vs 28.9 ± 4.5 cal/kg: p < 0.05). Quality of life improved significantly (SF 36 score 94.7 ± 15 points vs 99.3 ± 10 points; p < 0.05). Conclusion: A texture modified diet with dehydrated nutritional products improved dietary intake, nutritional status and quality of life of ambulatory elderly patients with dysphagia (AU)

Aprendizaje basado en problemas multiprofesional: Estudio cualitativo desde la perspectiva de los tutores / Problem based learning from the perspective of tutors

Background: Problem based learning is a student centered learning technique that develops deductive, constructive and reasoning capacities among the students. Teachers must adapt to this paradigm of constructing rather than transmitting knowledge. Aim: To interpret the importance of tutors in problem based learning during a module of Health research and management given to medical, nursing, physical therapy, midwifery, technology and nutrition students. Material and methods: Eight teachers that participated in a module using problem based learning accepted to particípate in an in depth interview. The qualitative analysis of the textual information recorded, was performed using the ATLAS software. Results: We identiñed 662 meaning units, grouped in 29 descriptive categories, with eight emerging meta categories. The sequential and cross-generated qualitative analysis generated four domains: competence among students, competence of teachers, student-centered learning and evaluation process. Conclusions: Multiprofessional problem based learning contríbutes to the development of generic competences among future health professionals, such as multidisciplinary work, critical capacity and social skills. Teachers must shelter the students in the context of their problems and social situation.

A randomized clinical trial with two enteral diabetes-specific supplements in patients with diabetes mellitus type 2: metabolic effects.

The aim of this study was to investigate whether two specific diabetes enteral formulas could improve nutritional as well as metabolic parameters in elderly patients with diabetes mellitus type 2. A population of 30 elderly patients with diabetes mellitus type 2 with recent weight loss was recruited. At basal time diabetic patients were asked to consume randomly two cans per day of two different specially designed high monounsaturated fatty acid diabetes-specific supplement: one with 49.95% of calories provided by fats (I), the second with a 34% of calories provided by fats (II), for a ten week period. A significative decrease of glucose (119.8 +/- 42 vs 95.1 +/- 16.8 mg/dl: p < 0.05) and Hbalc (8.2 +/- 2.8 vs 5.8 +/- 0.7%: p < 0.05) levels was observed in group I with a significant increase in serum albumin levels (3.1 +/- 0.8 vs 3.5 +/- 0.5 g/dl: p < 0.05). A significant increase of serum albumin (3.1 +/- 0.4 vs 3.7 +/- 0.6 g/dl: p < 0.05) and total proteins (6.3 +/- 0.5 vs 6.9 +/- 0.3 g/dl: p < 0.05) was observed in group II. Patients of group II had a significant improvement in weight (56.5 +/- 16 vs 58.3 +/- 15 kg: p < 0.05), body mass index (21.8 +/- 5.6 vs 22.5 +/- 5.3 kg/m2: p < 0.05) and fat mass (15.7 +/- 6.4 vs 16.9 +/- 6.2 kg: p < 0.05). In conclusion, high monounsaturated fatty acid diabetes-specific enteral supplement improved glucose, HbAlc and albumin levels. A diabetes-specific supplement with lower fat percentage than the first improved weight and protein levels without significative metabolic effects.

[Comparison of short term acceptability of three oral nutritional supplements]. / Comparación de la aceptabilidad de tres suplementos nutricionales.

BACKGROUND: Although liquid supplements are formulated to provide extra energy, minerals, vitamins and proteins, much of the success of supplementation depends upon the acceptability of the product and the ability of the patients to take large volumes over a period of time. OBJECTIVE: This study was set up to evaluate the acceptability by haematological cancer patients of 3 commercially available nutritional supplements. DESIGN: A population of 32 haematological cancer patients with reduced food intakes (less than 50% of calorie requirements by Harrist Benedict formula) was enrolled. Supplements were randomly assigned to each patient. Patients could try the drinks over 2 days period. They were asked to rate the acceptability of supplement, rating the product with a visual scale from 1 to 5 points with five parameters (color, taste, smell, texture, and temperature). RESULTS: Ten patients received first ONS (oral nutritional supplements), 12 second ONS, and 10 third ONS. No epidemiological differences were detected among three groups. Total calorie and macronutrient consumption improved with all supplements. Average values of color, taste, smell, temperature and texture were similar on three oral nutritional supplements (ONS). Analogic scale was analyze in a categoric way with frequencies, too. Frequencies of 1 and 2 points (very good and good responses) with taste were better with second ONS (85%; p < 0.05) than first ONS (50%) and third ONS (55.5%). Frequencies with smell were better with second ONS (83.3%; p < 0.05) than first (55.5%) and third ONS (62.5%). Frequencies with texture were higher in first ONS (90%; p < 0.05) and second ONS (100%; p < 0.05) than third ONS (66.7%). Temperature and color frequencies were similar in all ONS. CONCLUSIONS: Oral nutritional supplements had different acceptability in haematological cancer patients. Taste, smell and texture could be better in some ONS in these patients.