Quality of websites with patient information about spinal cord injury in Spanish.

STUDY DESIGN: Descriptive, cross-sectional analysis of websites with information on spinal cord injury (SCI) in Spanish. OBJECTIVE: To assess the quality, readability and presence of quality labels on web pages with information about SCI in Spanish. SETTING: The Internet. METHODS: An Internet search was conducted on Google with the keywords 'lesión medular' (spinal cord injury), 'paraplejia' (paraplegia) and 'tetraplejia' (tetraplegia). The first 50 results of each search were included. The quality of websites was assessed with the LIDA tool while the readability was assessed with the Flesch-Szigriszt index and the INFLESZ scale. We also checked the presence of any quality label. RESULTS: After excluding duplicated and irrelevant results, 33 websites were analysed. Only four of them had a quality label. The mean score of the LIDA tool was 61.12% (medium quality), and the worst results were those referring to the reliability of the information. The readability of the web pages was somewhat difficult, with a mean of 48.22 in the Flesch-Szigriszt index. Only eight of the websites showed normal readability. We observed no differences in either the quality or the readability of the websites according to their origin or the presence of quality labels. CONCLUSIONS: The websites analysed present a medium quality. Mainly, they should improve the reliability of their contents and their readability, including more quality labels. For SCI information in Spanish to be understandable and to provide valuable content, websites analysed in our study need to improve the quality parameters.

[Readability and internet accessibility of informative documents for spinal cord injury patients in Spanish]. / Legibilidad de los documentos informativos en español dirigidos a lesionados medulares y accesibles por internet.

BACKGROUND: Patients with spinal cord injuries and their carers have access to leaflets on Internet that they can use as educational material to complement traditional forms of education. The aim of this study is to evaluate the readability of informative documents in Spanish, obtained from Internet and aimed at patients with spinal cord injuries. METHODS: A search was made with the Google search engine using the following key words: recommendation, advice, guide, manual, self-care, education and information, adding spinal cord injury, paraplegia and tetraplegia to each of the terms. We analyzed the first 50 results of each search. The readability of the leaflets was studied with the Flesch-Szigriszt index and the INFLESZ scale, both available on the INFLESZ program. Also indicated were year of publication, country and number of authors of the documents obtained. RESULTS: We obtained 16 documents, developed between 2001 and 2011. Readability oscillated between 43.34 (some-what difficult) and 62 (normal), with an average value of 51.56 (somewhat difficult). Only 4 pamphlets (25%) showed a Flesch-Szigriszt index of ≥ 55 (normal). There was no difference in readability by year, authors or country of publication. CONCLUSIONS: The readability of 75% of the documents studied was "somewhat difficult" according to the INFLESZ scale. These results coincide with previous studies, in both Spanish and English. If the readability of this type of documents is improved, it will be easier to achieve their educational goal.

Ondas de choque en población deportiva y no deportiva: resultados preliminares / Extracorporeal shockwave terapy in sports and non-sports population: preliminary results

Antecedentes: Las alteraciones inflamatorias y calcificantes de las partes blandas son trastornos con importante repercusión económica y social. Su tratamiento puede realizarse con fármacos o con terapia física, ante cuyo fracaso, la cirugía era el último escalón terapéutico existente. En los últimos años se está utilizando una alternativa no quirúrgica para tratarlas: la aplicación de ondas de choque extracorpóreas. El objetivo de este trabajo es comprobar la capacidad para disminuir el dolor en diferentes alteraciones con esta técnica terapéutica y definir las pautas de aplicación. Métodos: Se trataron 18 deportistas y 12 pacientes de la población normal todos con alguna alteración: espolón calcáneo, tendinitis calcificada y no calcificada y fascitis plantar. Los resultados se evaluaron por la escala analógica visual de dolor y por la ecografía, antes y después del tratamiento. Resultados: Hubo un porcentaje de reducción del dolor de 100%, siendo la población normal atendida la que mostró síntomas de una mejor evolución en el período de tiempo evaluado. Conclusiones: Se concluye que agotadas las medidas terapéuticas médicas y de terapia física, el tratamiento con ondas de choque extracorpóreas es una buena alternativa al empleo de la cirugía.

Background: Inflammatory and calcifying diseases of the soft tissues are disorders having significant economical and social repercussions. They can be treated with drugs or physical therapy, and if these fail, surgery used to be the last existing therapeutic step. In recent years, a non-surgical alternative is being used to treat them, the application of extracorporeal shock waves. This work aims to verify the capacity of this therapeutic technique to diminish pain and to define its application rules. Method: We treated 18 athletes and 12 patients from normal population with heel spurs, calcified and noncalcified tendonitis and plantar fasciitis. The results were evaluated with a visual analogical scale of pain and by echography, prior to treatment and after. Results: The treatment was effective in 100% of the subjects. Conclusions: We conclude that once the medical therapeutic and the physical therapy measures are used up, treatment with shock waves is a good alternative to using surgery.

Legibilidad de los documentos informativos en español dirigidos a lesionados medulares y accesibles por internet / Readability and internet accessibility of informative documents for spinal cord injury patients in Spanish

Fundamento: Los lesionados medulares y sus cuidadores tienen acceso en internet a folletos que pueden usar como complemento educativo frente a formas tradicionales de educación. El objetivo del estudio es valorar la legibilidad de los documentos informativos en español, obtenidos de internet y dirigidos a lesionados medulares. Material y métodos: Se realizó una búsqueda en el buscador Google con las siguientes palabras clave: recomendación, consejo, guía, manual, autocuidado, educación e información, añadiendo lesión medular, paraplejia o tetraplejia con cada uno de los términos. Analizamos los primeras 50 resultados de cada búsqueda. La legibilidad de los folletos se estudió con los índices de Flesch-Szigriszt y el grado INFLESZ, ambos disponibles en el programa INFLESZ. También se indicó el año de publicación, el país y el número de autores de los documentos obtenidos. Resultados: Se obtuvieron 16 documentos, elaborados entre 2001 y 2011. La legibilidad osciló entre 43,34 (algo difícil) y 62 (normal), con un valor medio de 51,56 (algo difícil). Solo 4 folletos (25%) presentaron un índice de Flesch-Szigriszt ≥ 55 (normal). No hay diferencias en la legibilidad según el año, los autores o el país de edición. Conclusiones: La legibilidad del 75% de los documentos estudiados es "algo difícil" según la escala INFLESZ. Estos resultados coinciden con estudios previos, tanto en español como en inglés. Si conseguimos mejorar la legibilidad de este tipo de documentos, su objetivo educativo será más fácil de alcanzar (AU)

Background: Patients with spinal cord injuries and their carers have access to leaflets on Internet that they can use as educational material to complement traditional forms of education. The aim of this study is to evaluate the readability of informative documents in Spanish, obtained from Internet and aimed at patients with spinal cord injuries. Methods: A search was made with the Google search engine using the following key words: recommendation, advice, guide, manual, self-care, education and information, adding spinal cord injury, paraplegia and tetraplegia to each of the terms. We analyzed the first 50 results of each search. The readability of the leaflets was studied with the Flesch-Szigriszt index and the INFLESZ scale, both available on the INFLESZ program. Also indicated were year of publication, country and number of authors of the documents obtained. Results: We obtained 16 documents, developed between 2001 and 2011. Readability oscillated between 43.34 (somewhat difficult) and 62 (normal), with an average value of 51.56 (somewhat difficult). Only 4 pamphlets (25%) showed a Flesch-Szigriszt index of ≥ 55 (normal). There was no difference in readability by year, authors or country of publication. Conclusions: The readability of 75% of the documents studied was "somewhat difficult" according to the INFLESZ scale. These results coincide with previous studies, in both Spanish and English. If the readability of this type of documents is improved, it will be easier to achieve their educational goal (AU)

[Extracorporeal shockwave terapy in sports and non-sports population. Preliminary results]. / Ondas de choque en población deportiva y no deportiva: resultados preliminares.

BACKGROUND: Inflammatory and calcifying diseases of the soft tissues are disorders having significant economical and social repercussions. They can be treated with drugs or physical therapy, and if these fail, surgery used to be the last existing therapeutic step. In recent years, a non-surgical alternative is being used to treat them, the application of extracorporeal shock waves. This work aims to verify the capacity of this therapeutic technique to diminish pain and to define its application rules. METHOD: We treated 18 athletes and 12 patients from normal population with heel spurs, calcified and noncalcified tendonitis and plantar fasciitis. The results were evaluated with a visual analogical scale of pain and by echography, prior to treatment and after. RESULTS: The treatment was effective in 100% of the subjects. CONCLUSIONS: We conclude that once the medical therapeutic and the physical therapy measures are used up, treatment with shock waves is a good alternative to using surgery.

ANTECEDENTES: Las alteraciones inflamatorias y calcificantes de las partes blandas son trastornos con importante repercusión económica y social. Su tratamiento puede realizarse con fármacos o con terapia física, ante cuyo fracaso, la cirugía era el último escalón terapéutico existente. En los últimos años se está utilizando una alternativa no quirúrgica para tratarlas: la aplicación de ondas de choque extracorpóreas. El objetivo de este trabajo es comprobar la capacidad para disminuir el dolor en diferentes alteraciones con esta técnica terapéutica y definir las pautas de aplicación. MÉTODOS: Se trataron 18 deportistas y 12 pacientes de la población normal todos con alguna alteración: espolón calcáneo, tendinitis calcificada y no calcificada y fascitis plantar. Los resultados se evaluaron por la escala analógica visual de dolor y por la ecografía, antes y después del tratamiento. RESULTADOS: Hubo un porcentaje de reducción del dolor de 100%, siendo la población normal atendida la que mostró síntomas de una mejor evolución en el período de tiempo evaluado. CONCLUSIONES: Se concluye que agotadas las medidas terapéuticas médicas y de terapia física, el tratamiento con ondas de choque extracorpóreas es una buena alternativa al empleo de la cirugía.

[Evolution and characteristics of primary care patients with painful shoulder]. / Evolución y características de los pacientes con hombro doloroso en atención primaria.

OBJECTIVES: To describe the population attending teaching health centres in Area V, Asturias, to consult for painful shoulder. To describe the examination, diagnosis, treatment and clinical response. DESIGN: Longitudinal, descriptive study. SETTING: Teaching health centres in Area V, Asturias. PARTICIPANTS: Patients consulting because of pain in their shoulders in October and November 2002. MAIN MEASUREMENTS: Two measurements, the first of which in December 2002 appraised age, sex, job, time off work, arc of pain, flection, internal-external rotation, and diagnostic impression. The second, in May 2003, assessed evolution, x-rays, echography, medication, infiltration, physiotherapy, exercises at home, referral to specialist, and final diagnosis. Bivariant and kappa index descriptive analyses were run. RESULTS: 110 cases, 58.2% women and 41.8% men, with an average age of 57 (95% CI, 54.17-59.79), were included. 52.7% were retired; no particular job predominated; 7.3% were off work; 30% had had no examination of arc of movement; 70% evolved satisfactorily. The most common diagnosis was cuff tendinitis, with initial and final diagnosis coinciding well. 77.4% of patients took NSAIDs; 16% were infiltrated; 32.1% did physiotherapy; and 36.8%, exercises at home. 65.1% had no x-ray and only 6.6% had echographies, all of which found something. There was no statistically significant relationship between medication or infiltration and favourable evolution; and there was, between physiotherapy or exercises and favourable evolution. CONCLUSIONS: Most patients were middle-aged, women, pensioners, and had little time off work. Two-thirds evolved well. Examinations were incomplete and few complementary tests were run.

Evolución y características de los pacientes con hombro doloroso en atención primaria / Evolution and characteristics of primary care patients with painful shoulder

Objetivo. Describir el tipo de población que consulta por hombro doloroso en atención primaria en Asturias. Describir la exploración, el diagnóstico, los tratamientos utilizados y la respuesta clínica. Diseño. Estudio descriptivo, longitudinal. Emplazamiento. Centros de salud docentes del Área V de Asturias. Participantes. Pacientes que consultaron por dolor de hombro en octubre y noviembre de 2002. Mediciones principales. Características de los pacientes: edad, sexo, profesión, baja laboral, arco doloroso, flexión, rotación internaexterna e impresión diagnóstica. A los 5 meses se registraron los datos sobre su evolución, radiografías, ecografías, fármacos, infiltraciones, fisioterapia, ejercicios en el domicilio, derivación especializada y diagnóstico final. Resultados. Se recogieron 110 casos (58,2%, mujeres y 41,8%, varones), con una media de edad de 57 años (intervalo de confianza [IC] del 95%, 54,17-59,79). El 52,7% estaba jubilado. El 7,3% se encontraba en situación de baja laboral. En un 30% no se disponía de la exploración de ningún arco de movimiento. El 70% de los pacientes evolucionó satisfactoriamente. El diagnóstico más frecuente fue la tendinitis de manguito, y la concordancia entre los diagnósticos inicial y final fue buena. Un 77,4% tomó antiinflamatorios no esteroideos (AINE). El 16% recibió infiltraciones.Un 32,1% realizó fisioterapia y un 36,8%, ejercicios en el domicilio. En el 65,1% de los pacientes no se hizo ninguna radiografía y sólo se efectuó una ecografía en el 6,6%. La evolución favorable no se asoció estadísticamente con los fármacos o la infiltración, y sí con la fisioterapia y los ejercicios. Conclusiones. La mayoría de pacientes con hombro doloroso son mujeres, de mediana edad y pensionistas. Más del 60% evoluciona satisfactoriamente. La exploración realizada suele ser incompleta y con pocas pruebas complementarias

Objectives. To describe the population attending teaching health centres in Area V, Asturias, to consult for painful shoulder.To describe the examination, diagnosis, treatment and clinical response. Design. Longitudinal, descriptive study. Setting. Teaching health centres in Area V, Asturias. Participants. Patients consulting because of pain in their shoulders in October and November 2002. Main measurements. Two measurements, the first of which in December 2002 appraised age, sex, job, time off work, arc of pain, flection, internal-external rotation, and diagnostic impression. The second, in May 2003, assessed evolution, x-rays, echography, medication, infiltration, physiotherapy, exercises at home, referral to specialist, and final diagnosis. Bivariant and kappa index descriptive analyses were run. Results. 110 cases, 58.2% women and 41.8% men, with an average age of 57 (95% CI, 54.17-59.79), were included. 52.7% were retired; no particular job predominated; 7.3% were off work; 30% had had no examination of arc of movement; 70% evolved satisfactorily. The most common diagnosis was cuff tendinitis, with initial and final diagnosis coinciding well. 77.4% of patients took NSAIDs; 16% were infiltrated; 32.1% did physiotherapy; and 36.8%, exercises at home. 65.1% had no x-ray and only 6.6% had echographies, all of which found something. There was no statistically significant relationship between medication or infiltration and favourable evolution; and there was, between physiotherapy or exercises and favourable evolution. Conclusions. Most patients were middle-aged, women, pensioners, and had little time off work.Two-thirds evolved well. Examinations were incomplete and few complementary tests were run

Bases de datos bibliográficas y recuperación de la información en Rehabilitación / Bibliographic databases and recovery of information in Rehabilitation

Las revisiones sistemáticas de la literatura científica obligan a una búsqueda y análisis bibliográfico exhaustivo y con criterios predeterminados. El artículo analiza el proceso de recuperación de la información científica con aplicaciones concretas a las revisiones sistemáticas en Rehabilitación y Medicina Física. Las principales bases de datos bibliográficas en medicina son Medline, Embase, Scisearch, Current Contents y Pascal, aunque Amed, Cinahl y Rehabdata tienen un contenido más rico en revistas de Rehabilitación. Pese a que la búsqueda bibliográfica electrónica ha supuesto un gran avance, no está exenta de limitaciones. Para conseguir una revisión sistemática se deben consultar al menos dos bases de datos distintas y ampliar la búsqueda con una revisión manual de la bibliografía. Los catálogos de publicaciones médicas permiten localizar las bibliotecas con revistas de nuestro interés. Los artículos los obtendremos mediante préstamos, consultando nuestra hemeroteca médica más cercana, lo cual supondrá un desembolso económico, aunque cada vez hay más revistas en internet de acceso gratuito y completo. Otras alternativas para conseguir los artículos son el CINDOC y distintas empresas de internet como Articles Direct, CINAHL-Express o Ingenta (AU)

Dificultades perceptivas y cognitivas en personas con ictus cerebral: detección y estrategias de compensación y superación / Perceptive and cognitive difficulties in persons with brain stroke: detection and compensation strategies

Los trastornos perceptivos y cognitivos tras el ictus constituyen un conjunto de alteraciones que pese a relacionarse habitualmente con un mal pronóstico no tienen una definición, diagnóstico ni tratamiento claramente establecidos. El trastorno perceptivo más frecuente es la negligencia, considerada más un síndrome con manifestaciones variadas que un déficit neurológico singular. Se presenta hasta en el 82 por ciento de los ictus del hemisferio derecho y en una proporción algo menor tras un ictus del hemisferio izquierdo. Pese a la abundancia de pruebas diagnósticas, existe una baja correlación entre las mismas, aunque el Behavioural Inattention Test ha demostrado una alta correlación con el comportamiento real de los pacientes. Abundan las diferencias metodológicas en los estudios sobre la importancia pronóstica de la negligencia. Además de unas recomendaciones generales, revisamos los tratamientos que se han mostrado efectivos para mejorar la negligencia.Las principales áreas cognitivas afectadas tras un ictus cerebral son la atención, la memoria, la orientación y la capacidad para resolver problemas, aunque varios estudios epidemiológicos también han valorado la aparición de demencia. Las pruebas de screening tienen deficiencias evidentes, pero su uso es habitual, destacando el MiniMental o el Mini-Examen Cognoscitivo, el Neurobehavioral Cognitive Status Examination y el CAMGOG. La influencia negativa de los trastornos cognitivos sobre el pronóstico tras el ictus se manifiesta como un mayor riesgo de fallecimiento, de recurrencia del accidente cerebrovascular o de mayor dependencia funcional, aunque un deterioro cognitivo leve o moderado no se considere criterio de exclusión para recibir tratamiento rehabilitador. El uso de fármacos y la Rehabilitación Cognitiva, aunque lejos de estar asentados, están ofreciendo cada vez resultados más positivos. Presentamos los principios generales y recomendaciones para mejorar los trastornos de atención, orientación, memoria y capacidad de resolución de problemas (AU)

Effect of streptozotocin-induced diabetes and islet transplantation in proximal skeletal muscle: a histochemical and morphometric analysis.

The effect of pancreatic islet transplantation on the development of diabetic myopathy in streptozotocin-induced diabetic Lewis rats was examined histochemically and morphometrically in a proximal striated (rectus femoris) muscle. Diabetes was induced by streptozotocin administration, and diabetic animals were transplanted by intraportal grafts 6 weeks later. Islet-transplanted rats returned to euglycemia usually within the first 24 hours after transplantation and remained euglycemic over the subsequent 12-week observation period. Transplanted animals were compared with age-matched nontransplanted diabetic rats and nondiabetic age-matched control rats. Successful isotransplantation completely prevented the characteristic fast twitch (type IIB, glycolytic) fiber atrophy and also the changes in the fiber-type relative percentages, with prevention of the significant increase in the frequency of slow twitch oxidative (type I) and fast oxidative/glycolytic (type IIA) fibers at the expense of fast twitch glycolytic (type IIB) fibers. The histochemical appearance of all fiber types studied from muscles in transplanted rats was identical to equivalent fibers in age-matched control rats. Our data suggest that diabetic muscle pathology could be reversed and the progression of diabetic amyotrophy halted through the restoration of a euglycemic state by successful pancreatic islet transplantation, at least in short-term experimental diabetes.

Ultrastructural study of neuromuscular junction in rectus femoris muscle of streptozotocin-diabetic rats.

The neuromuscular junctions (NMJ) from rectus femoris muscle in streptozotocin (STZ)-induced diabetic rats were examined by electron microscopy eight weeks after the STZ injection. When compared to controls and vehicle-injected groups, both the axon terminal and the junctional sarcoplasm showed serious alterations including mitochondrial degeneration, presence of myeloid bodies, breakdown of presynaptic membrane and changes in the form of the synaptic vesicles. The results suggest that NMJ can contribute to the pathogenesis of diabetic proximal myopathy.

Proximal skeletal muscle alterations in streptozotocin-diabetic rats: a histochemical and morphometric analysis.

The response of rat quadriceps muscle fibers to chronic streptozotocin (STZ) diabetes was studied. Transverse sections of rectus femoris muscle from diabetic and weight-matched control rats were assayed for myofibrilar adenosine triphosphatase (ATPase) and nicotinamide adenine dinucleotide-tetrazolium reductase (NADH-TR). A quantitative analysis was carried out by an automatic interactive analysis system focused on the fiber type size and distribution. STZ-induced diabetes caused important effects in this muscle, with changes in the distribution of oxidative enzyme reactions, type I fiber hypertrophy, and type II fiber atrophy, which was greater in type IIB than in type IIA. It is concluded that hypoinsulinism produces morphological alterations in proximal skeletal muscle fibers that are similar to those of neurogenic myopathy. Thus the pathological changes in these mammalian muscle fibers could explain the clinical syndrome seen in diabetic patients called "diabetic symmetrical proximal motor neuropathy," perhaps the least understood of the major neuropathic complications of diabetes.

Morphological abnormalities in the sural nerve from patients with peripheral vascular disease.

The present paper has been written in order to determine the morphological alterations in the sural nerve from patients with chronic arteriosclerotic occlusive disease. Eight patients with Peripheral Vascular Disease (PVD) and six age-matched control subjects were studied. Morphometric data revealed two groups of patients, one of them with mild disease (n = 5), and the other one with severe damage (n = 3), consisting in loss of myelinated fibres and increase in the number of small fibres (p less than 0.05). Teased nerve fibres and electron microscopic studies also showed two types of patients, with respect to the myelin or the axonal alterations. The unmyelinated fibre population was affected equally in both groups. In conclusion, this study supports the idea that ischemia is able to cause structural alterations in the peripheral nerve, and that it can play a role in the development of neuropathy.