Anaesthesia for electroconvulsive therapy: time for a change?

Introduction: Electroconvulsive therapy (ECT) may be used to treat severe depression and needs a specific general anaesthesia. Important cardiovascular changes occur during the ECT with a parasympathetic induced bradycardia followed by a sympathetic response. A dedicated protocol was designed 6 years ago. The goal of this study was to analyse the management of anaesthesia for ECT in our institution, the adherence to the protocol and the occurrence of adverse events during anaesthesia. Methods: After Institutional Ethics Committee approval, we conducted a retrospective analysis of our anaesthesia protocol for patients scheduled for electroshock therapy during a five years period (2004- 2008). The protocol includes administration of atropine subcutaneously 30 minutes before the procedure, followed by general anaesthesia induced with etomidate (0.2 mg/kg). Suxamethonium (1 mg/kg) is administered after the inflation of a pneumatic tourniquet on the opposite arm, in order to observe the electroshocks convulsive effects. The psychiatrist initiates the convulsive crisis once curarisation is achieved. Face mask ventilation is then applied during the post-ictal phase with closed blood pressure monitoring. : 228 ECT were performed in 25 patients. The median dosage of etomidate was 0.37 mg/kg and suxamethonium 1.20 mg/kg. Hypertension during the ECT procedure was present in 62.7% of cases, tachycardia 23.2% and bradycardia 10.5%. Esmolol was administered in 73.4% of hypertensive patients in a range of 0 to 30 mg. The protocol was followed in half of the cases in regards to atropine administration (50.4%). We observed a significant increase of hypertension (73.9%, p = 0.001) after atropine administration, without effect on heart rate. Conclusions: The management of anaesthesia for ECT is specific and follows a predefined protocol in our institution. Adherence to our protocol was poor. Adverse events are frequent and significant association between the administration of atropine and the incidence of hypertension as well as poor protocol adherence implies reconsideration of our anaesthesia protocol for electroconvulsive therapy and better quality control of the clinical practice.

Paper 3: EUROCAT data quality indicators for population-based registries of congenital anomalies.

The European Surveillance of Congenital Anomalies (EUROCAT) network of population-based congenital anomaly registries is an important source of epidemiologic information on congenital anomalies in Europe covering live births, fetal deaths from 20 weeks gestation, and terminations of pregnancy for fetal anomaly. EUROCAT's policy is to strive for high-quality data, while ensuring consistency and transparency across all member registries. A set of 30 data quality indicators (DQIs) was developed to assess five key elements of data quality: completeness of case ascertainment, accuracy of diagnosis, completeness of information on EUROCAT variables, timeliness of data transmission, and availability of population denominator information. This article describes each of the individual DQIs and presents the output for each registry as well as the EUROCAT (unweighted) average, for 29 full member registries for 2004-2008. This information is also available on the EUROCAT website for previous years. The EUROCAT DQIs allow registries to evaluate their performance in relation to other registries and allows appropriate interpretations to be made of the data collected. The DQIs provide direction for improving data collection and ascertainment, and they allow annual assessment for monitoring continuous improvement. The DQI are constantly reviewed and refined to best document registry procedures and processes regarding data collection, to ensure appropriateness of DQI, and to ensure transparency so that the data collected can make a substantial and useful contribution to epidemiologic research on congenital anomalies.

High Growth Firms and Innovation: an empirical analysis for Spanish firms

This paper analyzes the effect of firms’ innovation activities on their growth performance. In particular, we observe how important innovation is for high-growth firms (HGFs) for an extensive sample of Spanish manufacturing and services firms. The panel data used comprises diverse waves of Spanish CIS over the the period 2004-2008. First, a probit analysis determines whether innovation affects the probability of being a high-growth firm. And second, a quantile regression technique is applied to explore the determinants and characteristics of specific groups of firms (manufacturing versus service firms and high-tech versus low-tech firms). It is revealed that R&D plays a significant role in the probability of becoming a HGF. Investment in internal and external R&D per employee has a positive impact on firm growth (although internal R&D presents a significant impact in the last quantiles, external R&D is significant up to the median). Furthermore, we show evidence that there is a positive impact of employment (sales) growth on the sales (employment) growth. Keywords: high-growth firms, firm growth, innovation activity JEL Classifications: L11, L25, O30

Glucose transporter-1 deficiency syndrome: the expanding clinical and genetic spectrum of a treatable disorder.

Glucose transporter-1 deficiency syndrome is caused by mutations in the SLC2A1 gene in the majority of patients and results in impaired glucose transport into the brain. From 2004-2008, 132 requests for mutational analysis of the SLC2A1 gene were studied by automated Sanger sequencing and multiplex ligation-dependent probe amplification. Mutations in the SLC2A1 gene were detected in 54 patients (41%) and subsequently in three clinically affected family members. In these 57 patients we identified 49 different mutations, including six multiple exon deletions, six known mutations and 37 novel mutations (13 missense, five nonsense, 13 frame shift, four splice site and two translation initiation mutations). Clinical data were retrospectively collected from referring physicians by means of a questionnaire. Three different phenotypes were recognized: (i) the classical phenotype (84%), subdivided into early-onset (<2 years) (65%) and late-onset (18%); (ii) a non-classical phenotype, with mental retardation and movement disorder, without epilepsy (15%); and (iii) one adult case of glucose transporter-1 deficiency syndrome with minimal symptoms. Recognizing glucose transporter-1 deficiency syndrome is important, since a ketogenic diet was effective in most of the patients with epilepsy (86%) and also reduced movement disorders in 48% of the patients with a classical phenotype and 71% of the patients with a non-classical phenotype. The average delay in diagnosing classical glucose transporter-1 deficiency syndrome was 6.6 years (range 1 month-16 years). Cerebrospinal fluid glucose was below 2.5 mmol/l (range 0.9-2.4 mmol/l) in all patients and cerebrospinal fluid : blood glucose ratio was below 0.50 in all but one patient (range 0.19-0.52). Cerebrospinal fluid lactate was low to normal in all patients. Our relatively large series of 57 patients with glucose transporter-1 deficiency syndrome allowed us to identify correlations between genotype, phenotype and biochemical data. Type of mutation was related to the severity of mental retardation and the presence of complex movement disorders. Cerebrospinal fluid : blood glucose ratio was related to type of mutation and phenotype. In conclusion, a substantial number of the patients with glucose transporter-1 deficiency syndrome do not have epilepsy. Our study demonstrates that a lumbar puncture provides the diagnostic clue to glucose transporter-1 deficiency syndrome and can thereby dramatically reduce diagnostic delay to allow early start of the ketogenic diet.

Mis recetas sin gluten

"Plan para la promoción de la actividad física y la alimentación equilibrada 2004-2008". Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Ciudadanía / Nuestra Salud / Vida sana / Alimentación equilibrada y actividad física / Alimentación y Celiaquía). Esta publicación cuenta con el respaldo de la Asociación Provincial de Celíacos de Sevilla (ASPROCESE) y de la Sociedad Andaluza de Nutrición Clínica y Dietética (SANCYD)

Conflictos sobre lo sano : un estudio sociológico de la alimentación en las clases populares en Andalucía

En cub. posterior: Plan para la promoción de la actividad física y la alimentación equilibrada (2004-2008). Destinado a profesionales interesados en la Promoción de la Salud. Publicado en la página web de la Consejería de Salud y Bienestar social: www.juntadeandalucia.es/salud (Consejería de Salud y Bienestar Social / profesionales / Salud Pública / Promoción de la Salud / Actividad Física y Alimentación Equilibrada / Materiales)

Susceptibility of Biomphalaria straminea from Peixe Angical dam, Tocantins, Brazil to infection with three strains of Schistosoma mansoni

Environmental changes from water resource developmental projects affect the epidemiology of water-associated diseases, as well as malaria and schistosomiasis. Aiming to investigate the occurrence and distribution of freshwater snails of medical and veterinary importance in the area of influence of the Peixe Angical hydroelectric dam, a survey has been conducted over four years (2004-2008). The study has revealed the occurrence of populations of Biomphalaria straminea (Dunker) in all municipalities surrounding the lake. Studies on parasite-mollusc compatibility were undertaken using 35 populations of B. straminea, descendants of specimens obtained from that area and three strains of Schistosoma mansoni (Sambon) (BH, CM and CMO). The main results are as follows: (i) among the 1,314 specimens used, eight had been infected (infection index of 0.6%) with only the BH strain, (ii) for B. straminea populations, the mortality index was 6.8% and, depending on the strain used, the indexes were 4.6%, 8.49% and 19% with BH, CM and CMO strains, respectively, (iii) the infection indexes varied according to the B. straminea populations, ranging from 0-12.5% and (iv) the duration of the precercarial period varied from 25-49 days. These results, in addition to environmental and social changes that took place in the Peixe Angical dam region, indicate the possibility of B. straminea emerging as a schistosomiasis vector in this area.

¿Qué nos dice Internet sobre la naturaleza del terrorismo yihadista?

En los últimos años ha tenido lugar un debate teórico de gran interés sobre la naturaleza organizacional del terrorismo yihadista y su evolución a lo largo de la última década. El centro de dicha discusión ha sido ocupado por dos profesores estadounidenses: Marc Sageman (2004; 2008) y Bruce Hoffman (2008). Mientras que el primero argumenta que la respuesta contraterrorista posterior al 11 de septiembre de 2001 ha originado que el control efectivo de las acciones terroristas se haya desplazado a un nivel de base, dando lugar a una yihad sin líderes donde los grupos terroristas juegan un papel secundario, el segundo sostiene que las organizaciones formales, y mas concretamente Al Qaeda Central, continua ejerciendo un grado sustancial de control estratégico y operativo. Los partidarios de una y otra visión han analizado los complots terroristas ejecutad os o desarticulados en los últimos tiempos, llegando a conclusiones diferentes sobre la naturaleza de los procesos de formación de las células terroristas, su vinculación con organizaciones, y cual es el principal perfil de la amenaza terrorista en Occidente: si el proveniente de células independientes y terroristas por imitación (bunchof guysy wannabessegún la terminología usada por Sageman), o el procedente de la acción de organizaciones formales de alcance global. El propósito de este trabajo es realizar una contribución a este debate académico aportando información procedente del ámbito de las actividades terroristas en Internet. Estos datos aportan nuevos elementos de análisis para el debate sobre la naturaleza organizacional de la amenaza yihadista.

International variation in management of screen-detected ductal carcinoma in situ of the breast.

BACKGROUND: Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. METHODS: We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. RESULTS: Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. CONCLUSIONS: Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.

Candidaturas de grupos independentes nas eleições autárquicas em São Vicente. de 1991 a 2012

O presente trabalho é o resultado de uma pesquisa sobre a candidatura de grupos independentes às eleições autárquicas, em São Vicente, concretamente, entre 1991 e 2012, com o objetivo de analisar o Comportamento do Eleitor do Círculo Eleitoral de São Vicente, durante esse período. O principal desafio é Analisar o Comportamento Eleitoral, em São Vicente, especificamente a relação do Eleitor Sanvicentino com a Candidatura dos grupos Independentes que participaram nas eleições autárquicas, entre 1991 e 2012. A disputa foi entre dois partidos políticos, o MPD (Movimento Para a Democracia), o PAICV (Partido Africano da Independência de Cabo Verde), e um grupo independente, MPRSV (Movimento para o Renascimento de São Vicente), liderado por Onésimo Silveira, que ganhou as eleições autárquicas e, consequentemente, os mandatos de 1991 \1995 e de 1996 a 2000 com maioria absoluta, tanto para a Câmara Municipal como para a Assembleia Municipal. O Movimento Para a Democracia venceu as eleições nos anos 2004/2008/2012 por maioria absoluta, liderado por Isaura Gomes, quer para a Câmara Municipal como para a Assembleia Municipal.

Estudo da Prevalência de Perturbações depressivas nos pacientes da consulta externa

Este trabalho de investigação tem como objectivo o estudo da prevalência das perturbações depressivas nos pacientes da consulta externa do H.A.N. – extensão Trindade, de 2004-2008. A amostra do estudo é constituída por 1499 sujeitos, sendo 317 com perturbações afectivas (34.4 %) do sexo masculino e (65.6%) do sexo feminino). A metodologia utilizada é do tipo prospectivo, em que o objectivo deste estudo é caracterizar um grupo: por sexo, idade, nível de escolaridade, profissão, etc., e neste sentido aproxima-se das pesquisas exploratórias visto que pode se dar uma fundamentação teórica, envolvendo pesquisas bibliográficas, com base nos livros, pesquisas de Internet, artigos científicos. A análise de dados foi efectuada através do programa SPSS (Statistical package for the social science base 15.0 for Windows Evaluation (version, 2008) Verificamos uma prevalência de perturbações afectivas de 21%, mais acentuada no sexo feminino (65.6%), com muitas perturbações comórbidas sobretudo relacionadas com o abuso de substâncias tóxicas. Essas comorbilidades têm maior expressão entre os sujeitos do sexo masculino. Verificamos ainda, uma tendência crescente de diagnóstico dessas perturbações ao longo dos cinco anos estudos. Entre as perturbações depressivas destaca-se o episódio depressivo com uma prevalência de 91.4%

Deu anys de seguiment demogràfic i genètic d"Stachys maritima a Catalunya (2001-2010). Implicacions per a un pla de recuperació.

Ten years of demographic and genetic monitoring of Stachys maritima in Catalonia (2001-2010). Implications for a recovery plan.- Stachys maritima is a species typical of the coastal dunes, with a wide distribution within the Mediterranean Basin. In spite of this, the species shows a clear regression. In Catalonia, it has been observed an important reduction of its populations since early 20th century, where it has disappeared from several localities in which it was relatively common (Tarragonès, Barcelonès). Herein we present the results of the demographic monitoring of the species during the last 10 years (2001-2010) in the known localities in Catalonia. Besides corroborating the disappearance (northern Sant Martí d'Empúries), the re-discovering (Llobregat Delta beach) and the detection of new populations (inner dunes of the Montgrí), a large year-to-year fluctuation of the monitored populations is stated; the possible reasons are discussed. In addition, the present work also includes the results of the allozyme diversity analysis of the new detected populations as well as the rediscoveries of the period 2004-2008, which were not included in a former study of genetic diversity carried out in 2002-2003. It is necessary to emphasize that the contribution of the new populations to the genetic diversity of Stachys maritima is very small, which can be attributed to their limited population size and /or to founder effects. Despite that the species is included in the Annex 2 ('En Perill d'Extinció') within the Catàleg de Flora Amenaçada de Catalunya (Catalogue of Endangered Flora of Catalonia), and some 'soft' conservation measures have been applied at local level (signposting of the beach accesses, environmental education, etc.) coupled with other more significant measures (e.g. translocation of individuals discovered in an artificial sandbank), it would be necessary the coordinated action and the scientific support of any initiative of conservation that could be carried out. The general frame to initiate actions of conservation should be the recovery plan of Stachys maritima, whose draft and application is mandatory in accordance to the Catàleg.

Terveydenhoitaja lapsiin kohdistuvan perheväkivallan tunnistajana ja siihen puuttujana neuvolassa : artikkeli Terveydenhoitaja-lehteen

Opinnäytetyön tarkoituksena oli kirjoittaa artikkeli. Opinnäytetyössä on kirjallisuuskatsaus, jonka tutkimustieto koostuu lapsiin kohdistuvasta perheväkivallasta, sen tunnistamisesta ja siihen puuttumisesta. Opinnäytetyö kuuluu Lapsiperheiden terveyden edistäminen 2004-2008 projektiin. Opinnäytetyössä käytetty aineisto on viimeisen kymmenen vuoden aikana julkaistua. Aineistossa on väitöskirjoja ja tutkimuksia, Stakesin oppaita, ammattihenkilöstön toimintaohjeita ja asiantuntija artikkeleita. Poikkeuksellisesti myös kaksi aikaisemmin projektiin tehtyä opinnäytetyötä olivat lähteinä. Lapsiin kohdistuvan perheväkivallan tunnistamisen ja puuttumisen tiedetään olevan haasteellista. Terveydenhoitajat pitävät tärkeänä puuttumista, mutta tarvitsevat neuvolatyön tueksi lisää tietoa lapsiin kohdistuvan perheväkivallan tunnistamisesta ja yhteisiä ohjeita sekä toimintamalleja. Opinnäytetyössä käsitellään tunnistamista helpottavia riskitekijöitä ja lapsessa olevia perheväkivallan tunnusmerkkejä. Perheväkivallan vaikutukset voivat olla lapselle kohtalokkaat ja sitä vakavammat mitä pienemmästä lapsesta on kysymys. Opinnäytetyöstä kirjoitetun artikkelin oli tarkoitus antaa tietoa terveydenhoitajille siitä miten tunnistaa lapsiin kohdistuvaa perheväkivaltaa ja miten puuttua siihen. Artikkeli (LIITE 2) kirjoitettiin käytännön läheisestä näkökulmasta. Lapsiin kohdistuvan perheväkivallan tunnistamisen voi tehdä yksi ihminen, mutta tarvitaan eri asiantuntijuuden osaamisen yhdistämistä perheen auttamiseen ja tukitoimien järjestämiseen.

Isa Aspin kokoelma

Kokoelma sisältää ensimmäisen suomenkielisen naislyyrikon, Jyväskylän seminaarissa opiskelleen Isa Aspin (1853-1872) kirjallista jäämistöä: mm. päiväkirjamuistiinpanoja, käsikirjoituksia, kirjeenvaihtoa • Isa Aspin päiväkirjoja, runoja, sekä erilaisia kirjeitä: 81 irtol., 7 vihkosta • Sally Thauvonin kirjeitä Isa Aspille: 65 kpl • Isa Aspin kirjeitä Sally Thauvonille: 44 kpl • Isa Aspin äidinkielen harjoituksia Jyväskylän seminaarissa 1871-72: 2 vihkoa • Puolangan pappilan pohjapiirros: 2 kpl • Isa Aspin toimittamia lastenlehtiä: 21 kpl, runoja, kirjeitä ym.: 27 kpl • Isa Aspin piirtämä Jyväskylän kartta: 1 kpl • Ehiökortteja, osoitettu: Isa Asp, Louise Asp ja Sally Thauvon: 19 kpl, Norma-luettelon numerot 1 III ja 2 (=1 IV)