The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review.

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

The three horizons model applied to medical science.

The three horizons model is a framework that helps manage an organization's innovation strategy. This model considers three aspects (horizons) that should be present in the institution and guide the development of new systems. Applied to medical science, the horizons are considered as paradigms that set the guidelines for clinical knowledge. New technologies can influence this model by causing disruptive changes. Horizon 1 (evidence-based medicine) reflects the current paradigm and emphasizes the aspect of continuous improvement needed to strengthen it, such as with the introduction of the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) methodology. Evidence-based medicine has made it possible to stop performing harmful interventions like autologous bone marrow or stem cell transplantation in cancer treatment for women with early poor prognosis breast cancer or to discontinue the erroneous belief that children should not sleep on their backs to prevent sudden infant death syndrome. Horizon 2 (real-world evidence) refers to a new model in which innovation has generated new capabilities. This change makes it possible to correct weaknesses of the previous paradigm, as in the case of pragmatic clinical trials. Real-world evidence has been used to show that drugs such as tofacitinib are effective without using methotrexate as background or to demonstrate the efficacy of chemotherapy in older patients with stage II colon cancer. Horizon 3 (precision medicine) involves a disruptive innovation, leading to the abandonment of the traditional mechanistic model of medical science and is made possible by the appearance of major advances such as artificial intelligence. Precision medicine has been used to assess the use of retigabine for the treatment of refractory epilepsy or to define a genome-adjusted radiation dose using a biological model to simulate the response to radiotherapy, facilitate dose adjustment and predict outcome in breast cancer.

Major inconsistencies of inferred population genetic structure estimated in a large set of domestic horse breeds using microsatellites.

STRUCTURE remains the most applied software aimed at recovering the true, but unknown, population structure from microsatellite or other genetic markers. About 30% of structure-based studies could not be reproduced (Molecular Ecology, 21, 2012, 4925). Here we use a large set of data from 2,323 horses from 93 domestic breeds plus the Przewalski horse, typed at 15 microsatellites, to evaluate how program settings impact the estimation of the optimal number of population clusters K opt that best describe the observed data. Domestic horses are suited as a test case as there is extensive background knowledge on the history of many breeds and extensive phylogenetic analyses. Different methods based on different genetic assumptions and statistical procedures (dapc, flock, PCoA, and structure with different run scenarios) all revealed general, broad-scale breed relationships that largely reflect known breed histories but diverged how they characterized small-scale patterns. structure failed to consistently identify K opt using the most widespread approach, the ΔK method, despite very large numbers of MCMC iterations (3,000,000) and replicates (100). The interpretation of breed structure over increasing numbers of K, without assuming a K opt, was consistent with known breed histories. The over-reliance on K opt should be replaced by a qualitative description of clustering over increasing K, which is scientifically more honest and has the advantage of being much faster and less computer intensive as lower numbers of MCMC iterations and repetitions suffice for stable results. Very large data sets are highly challenging for cluster analyses, especially when populations with complex genetic histories are investigated.

Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional / Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit

OBJETIVO: Evaluar la influencia del cambio en la gestión de ingresos en una unidad geriátrica de recuperación funcional (UGRF) sobre su actividad y resultados asistenciales. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo. Se recogieron datos registrados desde el año 2000 de la UGRF del Hospital Central Cruz Roja, agrupados en periodos de 4 años, salvo los ingresos centralizados (septiembre de 2016-diciembre de 2018). Los datos recogidos al ingreso fueron Escala Funcional y Mental de Cruz Roja, índice de Barthel, diagnóstico principal motivo del deterioro funcional (que se agrupó en ictus, patología ortopédica y cuadros de inmovilidad multifactorial) y comorbilidad evaluada por el índice de Charlson. Como variables de resultado se estudiaron la ganancia funcional al alta, tanto global como relativa, la estancia hospitalaria, la eficiencia funcional, las altas a residencia y los retraslados a unidad de agudos. Analizamos la relación entre los ingresos realizados de manera centralizada desde una unidad externa y el periodo previo (ingresos gestionados directamente desde la UGRF) en las variables resultados utilizando un análisis multivariante (regresión lineal para variables resultado continuas y regresión logística para las dicotómicas) ajustado por variables al ingreso. RESULTADOS: En el análisis multivariante los pacientes ingresados desde la unidad central presentaron una mayor ganancia funcional global y relativa (diferencia de medias de 3,49 puntos con IC 95%=1,65-5,33 y 12,41% con IC 95%=0,74-24,08, respectivamente), mayor estancia (12,92 días; IC 95%=11,54-14,30) y menor eficiencia (−0,36; IC 95%=−0,16 a −0,57), mayor riesgo de institucionalización (OR 1,61; IC 95%=1,19-2,16) y riesgo de retraslado a unidad de agudos (OR 3,16; IC 95%=2,24-4,47). CONCLUSIONES: El sistema centralizado de ingreso influyó en la mejora de parámetros funcionales, pero a costa de una mayor estancia y una menor eficiencia asistencial, objetivándose un incremento de la institucionalización al alta y de los retraslados a unidades de agudos

OBJECTIVE: To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS: A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS: Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (−0.36, 95% CI; −0.16 to −0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS: A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed

[Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit]. / Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional.

OBJECTIVE: To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS: A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS: Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (-0.36, 95% CI; -0.16 to -0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS: A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.

European domestic horses originated in two holocene refugia.

The role of European wild horses in horse domestication is poorly understood. While the fossil record for wild horses in Europe prior to horse domestication is scarce, there have been suggestions that wild populations from various European regions might have contributed to the gene pool of domestic horses. To distinguish between regions where domestic populations are mainly descended from local wild stock and those where horses were largely imported, we investigated patterns of genetic diversity in 24 European horse breeds typed at 12 microsatellite loci. The distribution of high levels of genetic diversity in Europe coincides with the distribution of predominantly open landscapes prior to domestication, as suggested by simulation-based vegetation reconstructions, with breeds from Iberia and the Caspian Sea region having significantly higher genetic diversity than breeds from central Europe and the UK, which were largely forested at the time the first domestic horses appear there. Our results suggest that not only the Eastern steppes, but also the Iberian Peninsula provided refugia for wild horses in the Holocene, and that the genetic contribution of these wild populations to local domestic stock may have been considerable. In contrast, the consistently low levels of diversity in central Europe and the UK suggest that domestic horses in these regions largely derive from horses that were imported from the Eastern refugium, the Iberian refugium, or both.

La Teoría Fundamentada como Metodología de Investigación Cualitativa en Enfermería / Grounded theory as a qualitative research methodology in nursing

La teoría fundamentada (TF) es un diseño de investigación cualitativa, reconocido a nivel internacional, que ha sido utilizado para desarrollar teorías sobre fenómenos de salud relevantes. Sin embargo, en el ámbito de la enfermería española, la TF ha tenido escasa consideración. Por ello, este artículo se centra en esta metodología cualitativa e ilustra su contribución en la investigación enfermera en España y su utilidad para la Enfermería. También, se presentan brevemente las características metodológicas distintivas de la teoría fundamentada (AU)

Grounded theory is a qualitative research design used at an international level. It has been applied as a methodology to develop theories about relevant health phenomena. However, in the Spanish nursing context, grounded theory has received very little attention. This article focuses on this qualitative methodology and illustrates its contribution to nursing research in Spain and its relevance for nursing. Moreover, the main methodological characteristics of grounded theory are briefly presented (AU)

Carcinoma mucoepidermóide: revisão de literatura / Mucoepidermoid carcinoma: review of the literature

O objetivo deste estudo é promover uma revisão de literatura sobre o carcinoma mucoepidermóide, um tumor raro de glândula salivar e ressaltar a importância do diagnóstico histopatológico prévio à cirurgia definitiva, mesmo quando há características de benignidade.

Inbreeding and genetic structure in the endangered Sorraia horse breed: implications for its conservation and management.

The Sorraia horse is a closed breed with reduced effective population size and considered in critical maintained risk status. The breed exists in 2 main breeding populations, one in Portugal and one in Germany, with a smaller population size. A set of 22 microsatellite loci was used to examine genetic diversity and structure of the Sorraia horse breed and to compare individual inbreeding coefficient F, estimated from pedigree data, with individual heterozygosity and mean d(2). The Sorraia horse shows lower levels of microsatellite diversity when compared with other horse breeds. Due to management strategies, there are clear differences in the genetic structure of the 2 main Sorraia horse populations. Individual heterozygosity was shown to be a good estimator, used together with or as an alternative to inbreeding coefficient, in predicting fitness and evaluating the inbreeding level of the Sorraia horse. The information gathered in this study, combined with information available from previous studies, offers an important and wide information base for the future development of an effective breeding management of the Sorraia horse in order to preserve this endangered breed.

Iberian origins of New World horse breeds.

Fossil records, archaeological proofs, and historical documents report that horses persisted continuously in the Iberian Peninsula since the Pleistocene and were taken to the American continent (New World) in the 15th century. To investigate the variation within the mitochondrial DNA (mtDNA) control region of Iberian and New World horse breeds, to analyze their relationships, and to test the historical origin of New World horses, a total of 153 samples, representing 30 Iberian and New World breeds, were analyzed by sequencing mtDNA control region fragments. Fifty-four haplotypes were found and assigned to seven haplogroups. Reduced levels of variation found for the Menorquina, Sorraia, and Sulphur Mustang breeds are consistent with experienced bottlenecks or limited number of founders. For all diversity indices, Iberian breeds showed higher diversity values than South American and North American breeds. Although, the results show that the Iberian and New World breeds stem from multiple origins, we present a set of genetic data revealing a high frequency of Iberian haplotypes in New World breeds, which is consistent with historical documentation.

Genetic structure of an endangered Portuguese semiferal pony breed, the Garrano.

The present study intends to survey the genetic variability of an endangered semiferal Portuguese native pony breed, the Garrano. Thirteen microsatellite markers were examined in 277 animals born in 1998, belonging to eight subpopulations corresponding to eight northern Portuguese geographic regions. Mean heterozygosity (H(o)) in the Garrano breed was 0.732, ranging from 0.531 to 0.857 across subpopulations. Allelic frequencies and diversity differed significantly between regions, suggesting the existence of genetic differentiation within the breed confirmed by the population differentiation estimator F(ST). Allele sharing genetic distance (Dps) was used to determine the relationship between the analyzed subpopulations, some of which are diverging significantly from the others. Relationships among six Iberian horse breeds (including the Garrano) were assessed through the restricted maximum likelihood method, which clusters the Garrano with another Celtic pony, the Spanish Asturcon, traditionally bred in geographical continuity with the Garrano. Results reveal a statistically significant deficit of heterozygotes within the Garrano breed (F(IT) = 0.031, p < 0.05). Regular monitoring should therefore be implemented so that the effect of genetic drift within subpopulations, enhanced by inbreeding, may be successfully minimized.

[Effects of cisapride on QT interval in children]. / Efecto de la cisaprida sobre el intervalo QT en niños.

This prospective study evaluated the effects of cisapride on corrected QT interval (QTc) in infants and children. From October 2000 to March 2003 two electrocardiograms (ECG) were obtained for 175 children (ranging in age from 1.5 months to 16.8 years), before and after 15 days of treatment with cisapride (0.2 mg/kg/dose, 3-4 times/day). A single posttreatment ECG was also obtained for 24 patients (ranging in age from 1.5 month to 15.8 years). No statistically significant differences were found between the mean QTc interval before (0.390 [0.018 s]) and after treatment (0.391 [0.018 s]). In patients for whom only a posttreatment ECG recording was performed, mean QTc interval was 0.399 (0.018 s). The QTc interval was never longer than 0.450 s in any of the children. In our experience the use of cisapride at therapeutic doses in infants and children who have no associated risk factors does not significantly prolong QTc interval.

Efectos de la cisaprida sobre el intervalo QT en niños / Effects of cisapride on QT interval in children

Se valoró de forma prospectiva el efecto en el intervalo QT corregido (QTc) del tratamiento con cisaprida en niños. Desde octubre de 2000 a marzo de 2003, se realizó un electrocardiograma (ECG) basal y otro a los 15 días de tratamiento con cisaprida (o,2 mg/kg/dosis, 3-4 veces/día) a 175 niños (edad entre 1, 5 meses y 15, 8 años). No se encontraron diferencias estadísticamente significativas entre el intervalo QTc medio basal (0, 390 +- 0, 018 s) y postratamiento (0, 391+-0,018 s). En los enfermos con un único ECG postratamineto, el intervalo QTc medio fue de 0, 399+-0,018 s. En ningún caso el intervalo QTc superó los 0,450 s. Según nuestra experiencia, la utilización de cisaprida en dosis terapéticas en niños sin factores de riesgo asociados no prolonga significativamente el intervalo QTc (AU)

Variation in the mitochondrial control region sequence between the two maternal lines of the Sorraia horse breed

The mitochondrial control region sequence was compared between the two surviving matrilineal lineages of the Sorraia horse. Two haplotypes were found, showing three differences between them. The reduced number of surviving maternal lineages emphasizes the importance of establishing a conservation plan for this endangered breed