Health in Down syndrome: creating a conceptual model.

BACKGROUND: Down syndrome (DS) has a unique medical and psychological profile that could impact how health is defined on three dimensions: physical, social and mental well-being. METHODS: In 2021, we presented our proposed conceptual model to three expert panels, four focus groups of parents of individuals with DS age 0-21 years and four focus groups of individuals with DS age 13-21 years through videoconferencing technology. Participants gave feedback and discussed the concept of health in DS. RESULTS: Feedback from participants resulted in iterative refinement of our model, retaining the three dimensions of health, and modifying constructs within those dimensions. Experts and parents agreed that individuals with DS have unique health concerns that necessitate the creation and validation of a syndrome-specific health model. We present key themes that we identified and a final conceptual model of health for individuals with DS. CONCLUSION: Health in DS is a multi-dimensional, multi-construct model focused on relevant constructs of causal and effect indicators. This conceptual model can be used in future research to develop a syndrome-specific measure of health status.

[Relative clavicle shortening in pediatric fractures: its importance when selecting conservative treatment]. / Acortamiento relativo de clavícula en fracturas pediátricas: Su importancia en la decisión del tratamiento conservador.

BACKGROUND: Clavicle fractures represent 2-15% of pediatric fractures. The literature suggests operating on patients over 9 years of age with major shortening or severe comminution in the fracture line. However, no one establishes shortening or angulation parameters for conservative treatment in children. In pediatric patients it is important to take into account relative shortening, that is, the one caused by a fracture when compared with the length of the healthy clavicle. OBJECTIVE: To know the effect of relative clavicle shortening on movement in pediatric fractures treated conservatively. MATERIAL AND METHODS: Retrospective, longitudinal, observational study. We radiographically measured the relative shortening of the fractured clavicle comparing it with the healthy side at the time of the fracture and after fracture healing. Shortening was expressed in percentages. The following views were used: comparative anteroposterior view of the shoulders and panoramic view of both shoulders. Patients were divided into 2 groups: under 9 years and 9-15 years of age. RESULTS: We analyzed 94 fractures; 31 in females and 63 in males. No pseudoarthrosis or symptomatic malunion occurred. The prognosis was good regardless of the initial shortening percentage. Age and shortening are proportionally related with the rehabilitation period and the restoration of painless ranges of motion. The value ranges recorded for shortening were 9.5 to 28%. CONCLUSIONS: The surgical indications for shortening resulting from pediatric clavicle fractures should be revised. We have observed good results despite major shortening and total displacement.

Evaluación del proceso asistencial del cáncer de mama en el año 2004 en un distrito sanitario / Evaluation of breast cancer care processes in the year 2004 in a district care health

Introducción: El modelo de gestión por procesos, implantado en Andalucía en el año 2001, incluye el proceso asistencial de cáncer de mama. Los objetivos del presente estudio son analizar el grado de implantación de dicho proeso en el año 2004, describir los antecedentes familiares, personales y de enfermedad actual, analizar el grado de cumplimentación del documento de solicitud de estudio de imagen (DSEI) y comparar el diagnóstico de presunción y certeza de las pacientes derivadas al hospital. Pacientes y métodos: Se realiza un estudio descriptivo de 517 DSEI procedentes de 18 zonas. Se analiza la tasa de solicitudes por zonas básicas de salud, el grado de cumplimentación en el DSEI de las 20 variables que lo integran, los antecedentes o enfermedad actual y la concordancia entre Atención Primaria y especializada. Resultados: Las tasas de solicitud oscilaron entre 0,22 y 12,11 por 1.000 mujeres. Sólo en 38 casos (6,4%) se consideró que estaba bien cumplimentado el DSEI. El mayor número de DSEI se cumplimentaron entre los 40 y 49 años (45%). El 30% de las mujeres tenían antecedentes familiares. La presencia de un nódulo fue el motivo de consulta más solicitado (48,6%). Fueron derivadas a los hospitales 172 mujeres (33,26%), de las 122 estudiadas 16 (10,67%) fueron diagnosticadas de nódulos benignos y 12 casos (8%), como mamas patológicas. Conclusiones: Desigual implantación del proceso. El estudio es más solicitado entre los 30-40 años y en los casos con antecedentes familiares de riesgo. La tumoración mama-ria y el dolor referido son los motivos de consulta más frecuentes. La concordancia entre Atención Primaria y especializada está entre la encontrada en la bibliografía (AU)

Introduction: The model for care management proesses implanted in Andalusia since 2001 includes the care management process for breast cancer. This study has aimed to analyze the degree of implementation of this process in the year 2004, describing the family and personal backgrounds, and current disease, analyzing analyze the degree in which the application document for the imaging study (ADIS) was filled out, and comparing the diagnostic presumption and certainty of the patients referred to the hospital. Patients and methods: We conducted a descriptive study of 517 ADIS from 18 areas. The rate of applications for Basic Health Zone, degree in which the 20 variables of the ADIS were filled out, the backgrounds or current disease and agreement between the primary and specialized care. Results: The application rates ranged between 0.22 and 12, 11 per 1000 women. It was considered that the ADIS was well filled out in only 38 (6.4%). The largest numbers of ADIS were between 40 and 49 years (45%). A total of 30% of the women had a family background. The presence of a nodule was the most common reason for consultation (48.6%). A total of 172 women (33.26%) were referred to the hospital. Of the 122 studied, 16 (10.67%) were diagnosed with benign nodules and 12 cases (8%) has breast conditions. Conclusions: The implantation of the process is unequal. There is increased application between 30-40 years and with those having a family background of risk. The breast tumor and pain reported are the most common reasons for consultation. The agreement between primary and specialized care coincides with that found in the literature (AU)

Validación de la dosis de diálisis medida con el Monitor de Aclaración en Línea (OCM) y el Kt/v de Daugirdas '93. Aplicación práctica en una unidad de hemodiálisis / Assessment of the average dose of dialysis with the on line clarification monitor (OCM) and the Daugirdas 93 kt/v. Its practical application in a hemodialysis unit

Introducción: La morbimortalidad de los pacientes en tratamiento con hemodiálisis depende, entre otras cosas, de la edad, enfermedad de base y calidad del tratamiento. El índice Kt/V es el parámetro de referencia de la medición de la dosis de diálisis. El método de la dialisancia iónica (OCM, FMC) determina el Kt/V en tiempo real, mediante el aclaramiento de electrolitos. La evaluación de la relación entre Kt/V medido por OCM y método Daugirdas 93 ha sido el objetivo del estudio. Material y Métodos: Se estudiaron prospectivamente 24 pacientes anúricos, de edad 64.75 ñ 18.24 años, 16.7 por ciento mujeres y 20.8 por ciento diabéticos. Las membranas utilizadas fueron polisulfona de alta permeabilidad (1.8 m2) y helixone (1.4 m2) . El cálculo del Kt/V de Daugirdas 93 se realizó de acuerdo con NKF-DOQl y el de OCM se determinó en la sesión intermedia durante 3 semanas consecutivas. Los datos fueron procesados con SPSS 11.0 utilizando regresión lineal, análisis de la varianza y t-student. Se consideró estadísticamente significativo p< 0.05. El test de concordancia Bland-Altman se utilizo para validar el método. Resultados: La OCM tiene una estrecha relación con el Kt/V de Daugirdas 93 (1.29 ñ 0.2 vs. 1.32 ñ 0.2, p <0.001, r2=0.96, SEE: 0.08). El test de concordancia Bland Altman mostró r2=0.05. No encontramos diferencias significativas con el resto de parámetros. Conclusiones: La dosis determinada mediante OCM se correlaciona con el Kt/V de Daugirdas 93. Su aplicación, sin suponer sobrecarga de trabajo, permite el control adecuado de la diálisis. Mejora la calidad del tratamiento, y por consiguiente disminuye la morbimortalidad (AU)

Lactoferrin in tears in contact lens wearers.

PURPOSE: The purpose of this study was to examine the concentration of lactoferrin in 126 healthy subjects before being fitted with contact lenses. We obtained repeat measurements 9 months following contact lens fitting in patients who developed giant papillary conjunctivitis and in those who were successful contact lens wearers. METHODS: We accomplished tear stimulation by the use of Allyl sulphide, a non-toxic organic compound. We measured lactoferrin by the radial immuno-diffusion technique. RESULTS: We found a significant decrease of lactoferrin levels in the tears of patients with giant papillary conjunctivitis.