CONSTANS, a HUB for all seasons: How photoperiod pervades plant physiology regulatory circuits.

How does a plant detect the changing seasons and make important developmental decisions accordingly? How do they incorporate daylength information into their routine physiological processes? Photoperiodism, or the capacity to measure the daylength, is a crucial aspect of plant development that helps plants determine the best time of the year to make vital decisions, such as flowering. The protein CONSTANS (CO) constitutes the central regulator of this sensing mechanism, not only activating florigen production in the leaves but also participating in many physiological aspects in which seasonality is important. Recent discoveries place CO in the center of a gene network that can determine the length of the day and confer seasonal input to aspects of plant development and physiology as important as senescence, seed size, or circadian rhythms. In this review, we discuss the importance of CO protein structure, function, and evolutionary mechanisms that embryophytes have developed to incorporate annual information into their physiology.

Persulfidation protects from oxidative stress under nonphotorespiratory conditions in Arabidopsis.

Hydrogen sulfide is a signaling molecule in plants that regulates essential biological processes through protein persulfidation. However, little is known about sulfide-mediated regulation in relation to photorespiration. Here, we performed label-free quantitative proteomic analysis and observed a high impact on protein persulfidation levels when plants grown under nonphotorespiratory conditions were transferred to air, with 98.7% of the identified proteins being more persulfidated under suppressed photorespiration. Interestingly, a higher level of reactive oxygen species (ROS) was detected under nonphotorespiratory conditions. Analysis of the effect of sulfide on aspects associated with non- or photorespiratory growth conditions has demonstrated that it protects plants grown under suppressed photorespiration. Thus, sulfide amends the imbalance of carbon/nitrogen and restores ATP levels to concentrations like those of air-grown plants; balances the high level of ROS in plants under nonphotorespiratory conditions to reach a cellular redox state similar to that in air-grown plants; and regulates stomatal closure, to decrease the high guard cell ROS levels and induce stomatal aperture. In this way, sulfide signals the CO2 -dependent stomata movement, in the opposite direction of the established abscisic acid-dependent movement. Our findings suggest that the high persulfidation level under suppressed photorespiration reveals an essential role of sulfide signaling under these conditions.

Evolution of Daily Gene Co-expression Patterns from Algae to Plants.

Daily rhythms play a key role in transcriptome regulation in plants and microalgae orchestrating responses that, among other processes, anticipate light transitions that are essential for their metabolism and development. The recent accumulation of genome-wide transcriptomic data generated under alternating light:dark periods from plants and microalgae has made possible integrative and comparative analysis that could contribute to shed light on the evolution of daily rhythms in the green lineage. In this work, RNA-seq and microarray data generated over 24 h periods in different light regimes from the eudicot Arabidopsis thaliana and the microalgae Chlamydomonas reinhardtii and Ostreococcus tauri have been integrated and analyzed using gene co-expression networks. This analysis revealed a reduction in the size of the daily rhythmic transcriptome from around 90% in Ostreococcus, being heavily influenced by light transitions, to around 40% in Arabidopsis, where a certain independence from light transitions can be observed. A novel Multiple Bidirectional Best Hit (MBBH) algorithm was applied to associate single genes with a family of potential orthologues from evolutionary distant species. Gene duplication, amplification and divergence of rhythmic expression profiles seems to have played a central role in the evolution of gene families in the green lineage such as Pseudo Response Regulators (PRRs), CONSTANS-Likes (COLs), and DNA-binding with One Finger (DOFs). Gene clustering and functional enrichment have been used to identify groups of genes with similar rhythmic gene expression patterns. The comparison of gene clusters between species based on potential orthologous relationships has unveiled a low to moderate level of conservation of daily rhythmic expression patterns. However, a strikingly high conservation was found for the gene clusters exhibiting their highest and/or lowest expression value during the light transitions.

Characterization of the Sucrose Phosphate Phosphatase (SPP) Isoforms from Arabidopsis thaliana and Role of the S6PPc Domain in Dimerization.

Sucrose-phosphate phosphatase (SPP) catalyses the final step in the sucrose biosynthesis pathway. Arabidopsis thaliana genome codifies four SPP isoforms. In this study, the four Arabidopsis thaliana genes coding for SPP isoforms have been cloned, expressed in Escherichia coli and the kinetic and regulatory properties of the purified enzymes analysed. SPP2 is the isoform showing the highest activity, with SPP3b and SPP3a showing lower activity levels. No activity was detected for SPP1. We propose that this lack of activity is probably due to the absence of an essential amino acid participating in catalysis and/or in the binding of the substrate, sucrose-6-phosphate (Suc6P). The expression patterns of Arabidopsis SPP genes indicate that SPP2 and SPP3b are the main isoforms expressed in different tissues and organs, although the non-catalytic SPP1 is the main isoform expressed in roots. Thus, SPP1 could have acquired new unknown functions. We also show that the three catalytically active SPPs from Arabidopsis are dimers. By generating a chimeric SPP composed of the monomeric cyanobacterial SPP fused to the higher plant non-catalytic S6PPc domain (from SPP2), we show that the S6PPc domain is responsible for SPP dimerization. This is the first experimental study on the functionality and gene expression pattern of all the SPPs from a single plant species.

Evolución de la atención a domicilio para niños prematuros y de bajo peso de nacimiento desde 2002 hasta 2014 / Changes in homecare for preterm and low-birth-weight infants from 2002 to 2014

INTRODUCCIÓN: La atención domiciliaria (AD) se caracteriza por ofrecer al paciente en su domicilio atención médica y enfermera en igual cantidad y calidad que en el hospital. El objetivo es describir los cambios en la evolución de la AD del neonato en nuestro servicio, desde 2002 hasta 2014. MATERIAL Y MÉTODOS: Se revisa la base de datos de AD analizando las características propias de la AD y las características sociales de la familia en 3 periodos consecutivos. También se presenta una encuesta de satisfacción de los padres. RESULTADOS: En la evolución de la AD en los 3 periodos cabe destacar una disminución del peso al alta hospitalaria (de 1.880g en el periodo 2002-2006 a 1.850g en el periodo 2011-2014; p = 0,006) y al alta definitiva (de 2.187g a 2.163g; p = 0,001), un aumento de la duración de la AD (de 10 a 11 días; p = 0,007) y una menor incidencia de rehospitalizaciones (del 3,4 al 1,3%; p = 0,019) Las características sociales de la familia muestran una mayor edad materna con más hijos vivos previos, un contexto familiar mejor adaptado en una vivienda más correcta y un aumento de la lactancia materna exclusiva al alta hospitalaria (del 25,5 al 49,0%; p < 0,001). La valoración global del programa es ≥ 7/10 en el 98,8% de respuestas. CONCLUSIONES: Los resultados de la AD del prematuro y recién nacido de bajo peso han ido mejorando a lo largo del tiempo, permitiendo ahorrar aproximadamente 10-11 días de ingreso hospitalario, sin menoscabar la calidad asistencial ni disminuir la satisfacción familiar

INTRODUCTION: Homecare (HC) is a service offering home medical and nursing care to the patient at home in equal quantity and quality as in the hospital. The aim of the article is to describe the changes in the HC of preterm and full-term low-birth-weight infants in our department from 2002-2014. MATERIAL AND METHODS: The HC database is revised. The characteristics of the newborns and the social characteristics of the family in three consecutive time periods are analysed. A satisfaction survey of parents is also presented. RESULTS: The main changes in HC include a decrease in the weight at discharge (from 1880g in the 2002-2006 period to 1850g in the 2011-2014 period; P=.006) and at the end of HC (from 2187g to 2163g; P=.001), an increase in the duration of HC (from 10 to 11 days; P=.007) and a lower incidence of new hospitalization (from 3.4% to 1.3%; P=.019) The social characteristics of the family show a higher maternal age with more previous alive children, a family context better suited with a more appropriate housing, and an increase in exclusive breastfeeding at hospital discharge (from 25.5% to 49.0%; P<.001). The overall assessment of the program is ≥7/10 in 98.8% of responses. CONCLUSIONS: The results of the HC of preterm and low-birth-weight infants have improved over time, saving approximately 10-11 days of hospitalisation, and without compromising the quality of care or reducing family satisfaction

Motivaciones y experiencias emocionales del primer equipo multidisciplinario hospitalario entrenado para atender casos de Ébola en Andalucía (2014-2016) / Motivations and emotional experiences of the first hospital multidisciplinary team trained to care for people with Ebola in Andalusia, Spain (2014-2016)

Objetivo: El Hospital Universitario Virgen del Rocío (HUVR) de Sevilla fue elegido centro referente andaluz para atender posibles casos de contagio de Ébola. Tras la alerta sanitaria (OMS, 2014) se conformó un equipo de profesionales voluntarios sanitarios/as y no sanitarios/as, que recibió entrenamiento y atendió un posible caso. Se plantea como objetivo comprender sus motivaciones y experiencias emocionales, e identificar los elementos que facilitan y dificultan su funcionamiento. Método: Estudio cualitativo, interpretativo y fenomenológico. Unidad de observación: equipo de profesionales del HUVR entrenado para atender casos de Ébola. Unidades de análisis: trabajo en equipo, motivaciones, emociones. Se realizan tres entrevistas a informantes clave y tres grupos de discusión; participan 23 profesionales de 60 que integran el equipo (2014-2016). Se analizan con QSRNUDISTVivo10 (análisis de contenido) las categorías: motivaciones, emociones, elementos influyentes en el funcionamiento. Validez: se triangularon fuentes de datos, técnicas, perspectivas disciplinarias y se expusieron los resultados al equipo de profesionales, que mostró su acuerdo. Resultados: Perciben interés formativo, responsabilidad profesional, autoestima profesional, atracción por el riesgo o lealtad al líder como motivaciones para ofrecerse voluntariamente. Expresan su evolución emocional, del miedo y estrés original al autocontrol de la presión, tranquilidad y confianza, a través de la formación y cohesión del equipo, elementos esenciales para su funcionamiento. La familia, el servicio de origen, los recursos, los medios de comunicación y la gestión de las emociones influyen, facilitando o entorpeciendo el éxito del equipo. Conclusión: Conocer los factores que les motivan e influyen puede servir para orientar la gestión de equipos multidisciplinarios eficaces y satisfechos en casos de alertas sanitarias (AU)

Objective: The Hospital Universitario Virgen del Rocío (HUVR) of Seville was chosen as the reference Andalusian site to treat possible cases of Ebola. After the health alert (WHO, 2014), a voluntary group of healthcare and non-healthcare professionals was set up, which, after being trained, treated a possible case. In this light, the aim is to understand the motivations and emotional experiences of this group and to identify the facilitators of and obstacles to its operation. Method: Qualitative, interpretative and phenomenological study. Observation unit: professional team of the HUVR trained to treat Ebola cases. Analysis units: teamwork, motivations and emotions. Three interviews with key informants were conducted, as well as three discussion groups involving 23 of the 60 team members (2014-2016). A content analysis of the motivations, emotions and elements affecting the team's operation was conducted with QSRNUDISTVivo10. Validity: data sources, techniques and disciplinary perspectives were triangulated. The results were presented to the team, which duly agreed with the findings. Results: Training, professional responsibility, professional self-esteem, risk appetite or loyalty to the leader stood out as motivations to voluntarily join the team. Emotional experiences evolved from fear and stress to self-pressure control, while essential elements for the team's operation were found to be calmness and confidence based on training and teamwork. Family, source department, resources, communication media and emotional management were facilitators of or obstacles to the team's success. Conclusion: An understanding of the key motivational and influential factors may be important in the management of effective and successful multidisciplinary teams during health alerts (AU)

[Changes in homecare for preterm and low-birth-weight infants from 2002 to 2014]. / Evolución de la atención a domicilio para niños prematuros y de bajo peso de nacimiento desde 2002 hasta 2014.

INTRODUCTION: Homecare (HC) is a service offering home medical and nursing care to the patient at home in equal quantity and quality as in the hospital. The aim of the article is to describe the changes in the HC of preterm and full-term low-birth-weight infants in our department from 2002-2014. MATERIAL AND METHODS: The HC database is revised. The characteristics of the newborns and the social characteristics of the family in three consecutive time periods are analysed. A satisfaction survey of parents is also presented. RESULTS: The main changes in HC include a decrease in the weight at discharge (from 1880g in the 2002-2006 period to 1850g in the 2011-2014 period; P=.006) and at the end of HC (from 2187g to 2163g; P=.001), an increase in the duration of HC (from 10 to 11 days; P=.007) and a lower incidence of new hospitalization (from 3.4% to 1.3%; P=.019) The social characteristics of the family show a higher maternal age with more previous alive children, a family context better suited with a more appropriate housing, and an increase in exclusive breastfeeding at hospital discharge (from 25.5% to 49.0%; P<.001). The overall assessment of the program is ≥7/10 in 98.8% of responses. CONCLUSIONS: The results of the HC of preterm and low-birth-weight infants have improved over time, saving approximately 10-11 days of hospitalisation, and without compromising the quality of care or reducing family satisfaction.

Papel del laboratorio clínico en la gestión de la demanda: un nuevo horizonte / The role of clinical laboratories in the management of the demand for analyses: a new horizon

Introducción. Es necesario establecer estrategias en el laboratorio clínico para adecuar la demanda analítica a las necesidades clínicas (gestión de la demanda analítica). Material y métodos. Se definieron una serie de indicadores de «sobreutilización de pruebas de laboratorio», según criterios de medicina basada en la evidencia durante los años 2012 y 2013, para medir el uso excesivo del laboratorio y se procedió a cuantificar, en términos de eficiencia (costes), el ahorro que suponía a la organización no realizar este grupo de pruebas innecesarias y, en algunos casos, redundantes. Resultados. El porcentaje de sobreutilización del laboratorio en las distintas magnitudes estudiadas osciló de 9,2 al 95,6%, según distintas áreas de conocimiento en el laboratorio, en el año 2012; y entre 4,6 al 96% en 2013. Esto ha generado un ahorro total de 90.954,84 euros en 2012 y de 121.749,26 euros en el año 2013. Destaca que el 8% de los estudios genéticos solicitados correspondían a pacientes a los que ya se le había realizado dicha prueba; sin embargo sus resultados no habían sido consultados por los clínicos peticionarios. Conclusiones. Nuestra estrategia ha supuesto un importante ahorro económico para la organización y para el área sanitaria. El papel del facultativo del laboratorio clínico en la gestión de la demanda analítica para adecuar las solicitudes a la evidencia científica es hoy clave en el ámbito sanitario, que busca más que nunca la optimización de los recursos y la eficiencia (AU)

Introduction. Strategies need to be established in clinical laboratories in order to cope with the continuous demand for analyses to be carried out (analytical demand management). Materials and methods. A group of quality indicators, defined as «laboratory tests overuse indicators», were introduced according to evidence-based medical criteria during a two-year period, 2012 and 2013, to assist in the management of the constant demand for analyses and to quantify, by employing efficiency terms (costs), the accumulated savings after the removal of unnecessary and, sometimes, redundant tests. Results. The percentage of rejected clinical tests, based on taking into account the newly introduced overuse quality indicators, and according to the various clinical laboratory areas, ranged between 9.2 and 95.6% in 2012, and between 4.6 and 96% in 2013. This has resulted in a total saving of 90,954.84 euros and 121,749.26 euros in each year, respectively. It should be emphasized that 8% of the requested genetic studies corresponded to patients who had already undergone such laboratory tests. However, the medical staff had not reviewed their results. Conclusions. Our strategy has resulted in important savings for the organization and the health system overall. The role of clinical laboratory professionals in the management of the demand for analyses, according to evidence-based medical criteria, has become crucial in healthcare and seeks, more than ever, efficiency and optimization of the available resources (AU)

Photoperiodic control of carbon distribution during the floral transition in Arabidopsis.

Flowering is a crucial process that demands substantial resources. Carbon metabolism must be coordinated with development through a control mechanism that optimizes fitness for any physiological need and growth stage of the plant. However, how sugar allocation is controlled during the floral transition is unknown. Recently, the role of a CONSTANS (CO) ortholog (Cr-CO) in the control of the photoperiod response in the green alga Chlamydomonas reinhardtii and its influence on starch metabolism was demonstrated. In this work, we show that transitory starch accumulation and glycan composition during the floral transition in Arabidopsis thaliana are regulated by photoperiod. Employing a multidisciplinary approach, we demonstrate a role for CO in regulating the level and timing of expression of the GRANULE BOUND STARCH SYNTHASE (GBSS) gene. Furthermore, we provide a detailed characterization of a GBSS mutant involved in transitory starch synthesis and analyze its flowering time phenotype in relation to its altered capacity to synthesize amylose and to modify the plant free sugar content. Photoperiod modification of starch homeostasis by CO may be crucial for increasing the sugar mobilization demanded by the floral transition. This finding contributes to our understanding of the flowering process.

¿Debemos informar al paciente cuando sucede un error asistencial? Apuntes para la reflexión / Should we inform the patient when a medical error occurs? Food for thought

Fundamento. La seguridad asistencial pasa por el compromiso de todos los estamentos de la asistencia sanitaria con los valores de la cultura de seguridad. Uno de estos valores es la transparencia, es decir, informar al paciente cuando existe un cambio no deseado en su proceso clínico. Objetivo. Argumentar y ofrecer datos para la reflexión sobre la necesidad de informar al paciente cuando sucede un error asistencial grave. Método. Revisión bibliográfica. Hem d’informar el pacient quan succeeix un error assistencial? Apunts per a la reflexió M. Glòria Moretones-Suñol, Josep Figueras-Aloy, Sandra Parés-Tercero, Rocío Cortés-Albuixech, Lourdes Arroyo-Gili, M. Teresa Esqué-Ruíz Servei de Neonatologia. Hospital Clínic-Maternitat. ICGON. Barcelona Resultados. Se organizan en 5 apartados que se refieren al paciente, el profesional, aspectos legales, ética y repercusión sobre la seguridad asistencial. Conclusiones. La mayor parte de los pacientes desean ser informados. Cuando el profesional se equivoca con consecuencias graves para la salud del paciente, las emociones negativas y los prejuicios obstaculizan el camino hacia la resolución del error abocando a su perpetuación. Hablar con el paciente ayuda a recuperar la confianza en uno mismo y refuerza la relación. No hablar del error pone los propios intereses por delante de los del paciente y viola los principios éticos de la profesión. El cambio a favor de la seguridad requiere estrategias que no culpabilicen y basadas en la confianza, con el compromiso de pacientes, organizaciones, profesionales y sociedad. Los profesionales deberían ser instruidos en cómo hacer frente a la situación con actitud respetuosa y dialogante, y a pedir perdón(AU)

Background. Patient safety needs the commitment of all health care levels with the values of a safety culture. One of those values is transparency, i.e., to inform the patient when there is an unwanted change in their clinical process. Objective. To review and analyze data on the need to inform the patient when a medical error has occurred. Method. Literature review. Results. The paper is organized in five sections that refer to the patient, the health care provider, the legal aspects, the ethics, and the impact on safety. Conclusions. Most patients would like to be kept informed. When medical errors with serious consequences for the patient occur, the negative emotions and the prejudices that follow obstruct the proper resolution of the error, thus leading to its perpetuation. To inform the patient helps recover the self-confidence and strengthens the relationships. To avoid discussing the error places the provider’s own interests above the patient’s and violates the ethical principles of the profession. Improvements in patient safety require trust-based strategies that do not penalize, and that integrate a compromise of patients, healthcare organizations and providers, and society. The healthcare professionals should be trained on how to apologize and deal with this situation with a very respectful attitude(AU)

The AtNHX1 exchanger mediates potassium compartmentation in vacuoles of transgenic tomato.

NHX-type antiporters in the tonoplast have been reported to increase the salt tolerance of various plants species, and are thought to mediate the compartmentation of Na(+) in vacuoles. However, all isoforms characterized so far catalyze both Na(+)/H(+) and K(+)/H(+) exchange. Here, we show that AtNHX1 has a critical involvement in the subcellular partitioning of K(+), which in turn affects plant K(+) nutrition and Na(+) tolerance. Transgenic tomato plants overexpressing AtNHX1 had larger K(+) vacuolar pools in all growth conditions tested, but no consistent enhancement of Na(+) accumulation was observed under salt stress. Plants overexpressing AtNHX1 have a greater capacity to retain intracellular K(+) and to withstand salt-shock. Under K(+)-limiting conditions, greater K(+) compartmentation in the vacuole occurred at the expense of the cytosolic K(+) pool, which was lower in transgenic plants. This caused the early activation of the high-affinity K(+) uptake system, enhanced K(+) uptake by roots, and increased the K(+) content in plant tissues and the xylem sap of transformed plants. Our results strongly suggest that NHX proteins are likely candidates for the H(+)-linked K(+) transport that is thought to facilitate active K(+) uptake at the tonoplast, and the partitioning of K(+) between vacuole and cytosol.

Setting the stage for school health-promoting programmes for deaf children in Spain.

Implementing health-promoting programmes for the most excluded and at-risk social groups forms a key part of any efforts to address underserved populations and reduce health inequalities in society. However, many at-risk children, particularly children in deaf communities, are not reached, or are poorly served, by health-promoting programmes within the school setting. This is so because schools are effective as health-promoting environments for d/Deaf children only to the extent that they properly address their unique communication needs and ensure they are both able and enabled to learn in a communication-rich and supportive psycho-social environment. This article examines how the usually separate strands of school health promotion and d/Deaf education might be woven together and illustrates research with deaf community members that involves them and gives their perspective. The primary objective of this study was to map deaf pilot bilingual education programmes in Spain-one of the first countries to ratify the Convention on the Rights of Persons with Disabilities (United Nations. (2006) Convention on the Rights of Persons with Disabilities, Resolution A/RES/61/106.)-with particular attention to their compliance to the Convention's article 24. Following pre-testing, 516 key informants were surveyed by mail (response rate: 42.08%) by using a snow-ball key-informant approach, within a Participatory Action Research framework, at a national, regional and local level. The results show that although some schools have achieved recommended standards, bilingual programmes are in various stages of formulation and implementation and are far from being equally distributed across the country, with only four regions concentrating more than 70% of these practices. This uneven geographical distribution of programmes probably reflects more basic differences in the priority given by regions, provinces, and municipalities to the deaf community's needs and rights as an important policy objective and may reinforce or widen inequalities by favouring or discriminating rather than achieving access and equity for this noticeably overlooked community.

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Modelos de atención a los síntomas somáticos sin causa orgánica. De los trastornos fisiopatológicos al malestar de las mujeres / Attention models to somatic symptoms without organic cause: from phisiopathologic disorders to malaise of women

Los síntomas somáticos sin causa orgánica (SSCO) permanecenmédicamente inexplicados. Su abordaje podría estar limitado por unconcepto biologicista de la salud. Diversas teorías críticas estudianfactores contextuales, de género y subjetivos para los SSCO y susmodelos de atención. El objetivo de este trabajo ha sido revisar literaturaespañola (1995-2002) explorando modelos explicativos y deatención a los SSCO relacionándolos con las teorías subyacentessobre salud. Se realizó búsqueda en Medline, Sociologycal Abstracts,Psycinfo, Doyma, Google y Scirus, bajo palabras clave: Genderand health, Primary care, Somatic complaints and women or gender,Fibromialgy, Chronic fatigue, Functional syndromes, Feministstudies and primary care, malaise women. Seleccionando 31 artículos.Se clasificaron según teorías sobre salud: biomédica, psicosocial,socialista, biopsicosocial, ecosocial, psicoanalítica y feminista.Después, se identificaron modelos explicativos/de atención por bloquesteóricos según: términos utilizados para SSCO; factores causales/asociados; modelos de atención; factores relación médicopaciente.En el marco biomédico se encuentran: explicaciones fisiopatológicas;atención directiva, centrada en la visión médica, tendentea adaptación del enfermo a su cronicidad con tratamientos sintomáticosy antidepresivos. En modelos teóricos críticos: relacionansíntomas con contexto social, experiencias subjetivas y de género;centrado en la visión de la/el paciente; evitan la medicalización, dirigidoa construir el significado subjetivo de los síntomas, al empoderamientode la mujer y su autorresponsabilidad. Conviene reconocerla existencia de teorías alternativas a la biomédica que amplían lacomprensión de los SSCO, incluyendo factores contextuales, degénero y subjetivos asociados al proceso de salud-enfermedad, queproducen modelos de atención con mayor potencial de atención integral

Somatic symptoms of no identifiable organic cause remainmedically unexplained and have been delved into to only a limiteddegree from a biologicist conception of health. Different critical theoriesstudy contextual, gender-related and subjective factors forSomatic Symptoms of No Identifiable Organic Cause and their caremodels. This study has been aimed at reviewing published Spanishstudies (1995-2002) exploring explanatory SSNIOC's by relatingthem to the underlying health theories. A search was run in Medline,Sociologycal Abstracts, Psycinfo, Doyma, Google and Scirus, usingthe key words: Gender and health, Primary care, Somatic complaintsand women or gender, Fibromialgy, Chronic fatigue, Functionalsyndromes, Feminist studies and primary care, malaise women, atotal of 31 articles having been selected and classified by health theories:biomedical, psychosocial, socialist, biopsychosocial, ecosocial,psychoanalytical and feminist.. Explanatory/care models werethen identified by theory-related blocks, according to: terms use forSNIOC's; related/causal factors, care models, physician-patient relationshipfactors.Within the biomedical framework, physicpathological, directivecare explanations were found focusing on the medical viewpoint,tending toward adapting the patient to his/her degree of chronicitywith symptomatic and antidepressant treatments. In critical theorymodels: symptoms are related to the social context, subjective genderexperiences, focusing on the patient viewpoint; avoiding medicalization,aimed at constructing the subjective significance of thesymptoms, on empowering the woman and on her taking responsibilityfor herself. It is advisable to recognize the existence of theoriesalternative to biomedical theory which broaden the comprehensionof SSNIOC's, by including contextual, gender-related subjective factorsrelated to the wellness-illness process which give rise to caremodels of greater integral care potential

Evaluación de la utilización de la administración de fármacos mediante la técnica de inhalación / Evaluation of drug administration using inhalation techniques

El objetivo de este estudio fue evaluar el grado de conocimiento de la técnica de inhalación en atención primaria e identificar los pasos en los que se cometen más errores. Se estudió a 93 pacientes revisando la técnica, siguiendo recomendaciones nacionales, que fue incorrecta en el 80,65 por ciento de los casos. El error más frecuente fue "no realizar la espiración lentamente y esperar 30 s para la siguiente dosis". El sistema con mejores resultados fue el dispositivo de polvo seco.Se concluye que existe un elevado número de pacientes que realizan incorrectamente la técnica de inhalación, y se considera imprescindible el desarrollo de programas de educación sanitaria que incidan sobre los errores detectados durante el análisis (AU)