Efficacy of graded activity versus supervised exercises in patients with chronic non-specific low back pain: protocol of a randomised controlled trial

Abstract Background Low back pain is a relevant public health problem, being an important cause of work absenteeism worldwide, as well as affecting the quality of life of sufferers and their individual functional performances. Supervised active physical routines and of cognitive-behavioral therapies are recommended for the treatment of chronic Low back pain, although evidence to support the effectiveness of different techniques is missing. Accordingly, the aim of this study is to contrast the effectiveness of two types of exercises, graded activity or supervised, in decreasing symptoms of chronic low back pain. Methods/design Sample will consist of 66 patients, blindly allocated into one of two groups: 1) Graded activity which, based on an operant approach, will use time-contingent methods aiming to increase participants’ activity levels; 2) Supervised exercise, where participants will be trained for strengthening, stretching, and motor control targeting different muscle groups. Interventions will last one hour, and will happen twice a week for 6 weeks. Outcomes (pain, disability, quality of life, global perceived effect, return to work, physical activity, physical capacity, and kinesiophobia) will be assessed at baseline, at treatment end, and three and six months after treatment end. Data collection will be conducted by an investigator blinded to treatment allocation. Discussion This project describes the randomisation method that will be used to compare the effectiveness of two different treatments for chronic low back pain: graded activity and supervised exercises. Since optimal approach for patients with chronic back pain have yet not been defined based on evidence, good quality studies on the subject are necessary. Trial registration NCT01719276

Studi sull'immaginario musicale in Euripide

La dissertazione è suddivisa in due capitoli più tre appendici. Nel I capitolo, Musica e dolore, si indagano i casi di metamusicalità in riferimento al dolore, che si intensificano in Euripide: si nota lo sviluppo di una riflessione sul ruolo della mousike rispetto al dolore, espressa attraverso un lessico medico e musicale. Si dimostra che in Euripide si pone il problema di quale scopo abbia la musica, se sia utile, e in quale forma lo sia. Nella prima produzione si teorizza una mousa del lamento come dolce o terapeutica per chi soffre. Molti personaggi, però, mostrano sfiducia nel potere curativo del lamento. Nell’ultima produzione si intensificano gli interrogativi sulla performance del canto, che si connotano come casi metamusicali e metateatrali. Nell’Elena, nell’Ipsipile e nelle Baccanti, E. sembra proporre una terapia ‘omeopatica’ del dolore attraverso la musica orgiastico-dionisiaca. Nel II capitolo, Natura e musica, si sceglie l’Ifigenia Taurica come esempio di mimetismo orchestico-musicale fondato – oltre che su casi di autoreferenzialità – su un immaginario naturale che, ‘facendo musica’, contribuisce all’espressività della choreia e della musica in scena. Si ipotizza inoltre un accompagnamento musicale mimetico rispetto ai suoni della natura e movimenti di danza lineari accanto a formazioni circolari, che sembrano richiamare la ‘doppia natura’ del ditirambo. L’Appendice I, Gli aggettivi poetici ξουθός e ξουθόπτερος: il loro significato e la loro potenzialità allusiva, affronta un caso particolare e problematico di ‘mimetismo lessicale’, innescato dal termine ξουθός e dal composto euripideo ξουθόπτερος. Si dimostra che l’aggettivo indica originariamente un movimento vibratorio, ma sviluppa anche un senso sonoro, ed è quindi un termine evocativo rispetto alla performance. Nell’Appendice II, Il lessico musicale in Euripide, è raccolto il lessico euripideo coreutico-musicale. Nell’Appendice III, La mousike nei drammi euripidei, sono raccolti i riferimenti alla mousike in ogni dramma.

Identifizierung und Charakterisierung von Protein-Biomarkern beim Glaukom

Das Glaukom ist, nach dem Katarakt, die zweithäufigste Ursache für Erblindungen weltweit mit Milionen von Betroffenen, die von dieser zunächst weitgehend symptomfreien neurodegenerativen Erkrankung heimgesucht werden. Die Möglichkeiten auf dem Feld der Diagnose beschränken sich bislang weitestgehend auf die Messung des Augeninnendrucks und der Beurteilung des Augenhintergrundes durch einen erfahrenen Augenarzt. Eine labordiagnostische Prophylaxe ist bis heute nicht verfügbar, die Zahl unerkannter Erkrankungen dementsprechend hoch. Hierdurch geht wertvolle Zeit verloren, die man für eine effektive Therapie nutzen könnte.rnBezüglich der Pathogenese des Glaukoms geht man heute von mehreren, miteinander wechselwirkenden Pathomechanismen aus, zu denen neben mechanischen Einflüssen durch einen erhöhten IOD auch Hypoxie, verminderte Neutrophinversorgung, Exzitotoxizität, oxidativer Stress und eine Beteiligung autoimmuner Prozesse gezählt werden. Unabhängig vom Pathomechanismus folgt stets die Etablierung umfangreicher degenerativer Prozesse im Sehnervenkopf, den retinalen Ganglienzellen und den Axonen des Sehnerven, die letztlich im irreversiblen Untergang dieser Neuronen münden. Diese pathologischen Prozesse im ZNS hinterlassen auf Proteomebene Spuren, die mithilfe moderner massenspektrometrischer Methoden in Kombination mit multivariaten statistischen Methoden detektierbar und als sogenannte Biomarker-Kandidaten mit definiertem Molekulargewicht darstellbar sind. In dieser Arbeit wurde ein „Workflow“ entwickelt, der es ermöglicht, diese Biomarker-Kandidaten im Blutserum und in der Tränenflüssigkeit in einfachen, reproduzierbaren Schritten zu identifizieren und zu charakterisieren. Abweichend von der etablierten Methotik der Bottom-Up-Proteomics musste hierfür eine Methode entsprechend einer Top-Down-Philosophie entwickelt werden, die es erlaubt, die Spuren des Glaukoms im Proteom zu detektieren und zu charakterisieren.rnDies erfolgte in dieser Arbeit durch sowohl massenspektroskopischen Methoden wie SELDI-TOF® und MALDI-Tof-Tof als auch durch Bead-, Gel- und Flüssigkeits-chromatographisch-basierte Separations und Fraktionierungstechniken.rnDie erfolgreiche Kombination dieser Methoden führte zu Identifikationen einer ganzen Reihe von Biomarker-Kandidaten. Unter den identifizierten Proteinen, die bezüglich ihres korrespondierenden SELDI-Peaks im Massenbereich von Biomarker-Kandidaten liegen, finden sich Zytokine und Effektormoleküle der angeborernen Immunität, stressinduzierbare Kinasen, Faktoren, die zum Schutz der Telomeren dienen, Proliferationsmarker, neuronale Antigene und Transportproteine. Darüber hinaus wurden Komponenten identifiziert, die an der neuronalen Neutrophinversorgung beteiligt sind, neuronale Rezeptoren und Antigene, Komponenten des Komplementsystems und des MHC-I-Komplexes. All diese identifizierten Proteine sind bezüglich ihrer Funktion und möglichen Rolle innerhalb der Pathogenese des Glaukoms detailliert beschrieben und charakterisiert. Dies erlaubt einen umfassenden Einblick in alle Pathomechanismen, denen nach heutigem Kenntnisstand, eine Rolle an der Pathogenese des Glaukoms unterstellt wird.rn

Cost of low back pain in Switzerland in 2005

Low back pain (LBP) is the most prevalent health problem in Switzerland and a leading cause of reduced work performance and disability. This study estimated the total cost of LBP in Switzerland in 2005 from a societal perspective using a bottom-up prevalence-based cost-of-illness approach. The study considers more cost categories than are typically investigated and includes the costs associated with a multitude of LBP sufferers who are not under medical care. The findings are based on a questionnaire completed by a sample of 2,507 German-speaking respondents, of whom 1,253 suffered from LBP in the last 4 weeks; 346 of them were receiving medical treatment for their LBP. Direct costs of LBP were estimated at 2.6 billion and direct medical costs at 6.1% of the total healthcare expenditure in Switzerland. Productivity losses were estimated at 4.1 billion with the human capital approach and 2.2 billion with the friction cost approach. Presenteeism was the single most prominent cost category. The total economic burden of LBP to Swiss society was between 1.6 and 2.3% of GDP.

Compliance and knowledge about glaucoma in patients at tertiary glaucoma units

To document the rate of self-reported compliance and glaucoma-related knowledge in Swiss patients and to identify risk factors for their poor compliance. This was an observational study, including a total of 200 consecutive patients already under glaucoma medication in two Swiss tertiary glaucoma clinics (Geneva and Bern). Personal characteristics, presence of systemic disease, compliance with glaucoma medication, attitude to the ophthalmologist, and glaucoma-related attitudes were ascertained by means of a predetermined questionnaire with 40 questions. Patients were subsequently assessed for the ability to correctly instil placebo eye drops. Non-compliance with glaucoma medication was defined as omitting more than two doses a week as reported by the patient. Logistic regression was used to evaluate how patient characteristics and knowledge about the disease were related to compliance. Overall, 81% (n = 162) of patients reported to be compliant. Forgetfulness was the most frequently cited reason for non-compliance with dosing regimen (63%). Although 90.5% (n = 181) of patients believed glaucoma medication to be efficient, only 28% (n = 56) could correctly define glaucoma. Factors positively associated with compliance were 'knowledge of glaucoma' [adjusted odds ratio (OR) 4.77 (95% CI 1.36-16.70)] and 'getting help for administration of drops' [OR 2.95 (1.25-6.94)]. These findings indicate that despite the comparatively high compliance rate among glaucoma patients, knowledge of glaucoma remains poor in long-term glaucoma sufferers. Improving knowledge about the disease is important since it is positively associated with compliance in our study.

Clinical and genetic characteristics of long QT syndrome

Long QT syndrome (LQTS) is an arrhythmogenic ion channel disorder characterized by severely abnormal ventricular repolarization, which results in prolongation of the electrocardiographic QT interval. The condition is associated with sudden cardiac death due to malignant ventricular arrhythmias similar in form to the hallmark torsade de pointes. Eleven years after the identification of the principle cardiac channels involved in the condition, hundreds of mutations in, to date, 10 genes have been associated with the syndrome. Genetic investigations carried out up until the present have shown that, although the severe form of the disease is sporadic, there are a number of common polymorphisms in genes associated with the condition that may confer susceptibility to the development of torsade de pointes in some individuals, particularly when specific drugs are being administered. Moreover, some polymorphisms have been shown to have regulatory properties that either enhance or counteract a particular mutation's impact. Understanding of the molecular processes underlying the syndrome has enabled treatment to be optimized and has led to better survival among sufferers, thereby demonstrating a key correspondence between genotype, phenotype and therapy. Despite these developments, a quarter of patients do not have mutations in the genes identified to date. Consequently, LQTS continues to be an area of active research. This article contains a summary of the main clinical and genetic developments concerning the syndrome that have taken place during the last decade.

Genome and transcriptome sequencing identifies breeding targets in the orphan crop tef (Eragrostis tef)

Background: Tef (Eragrostis tef), an indigenous cereal critical to food security in the Horn of Africa, is rich in minerals and protein, resistant to many biotic and abiotic stresses and safe for diabetics as well as sufferers of immune reactions to wheat gluten. We present the genome of tef, the first species in the grass subfamily Chloridoideae and the first allotetraploid assembled de novo. We sequenced the tef genome for marker-assisted breeding, to shed light on the molecular mechanisms conferring tef's desirable nutritional and agronomic properties, and to make its genome publicly available as a community resource. Results: The draft genome contains 672 Mbp representing 87% of the genome size estimated from flow cytometry. We also sequenced two transcriptomes, one from a normalized RNA library and another from unnormalized RNASeq data. The normalized RNA library revealed around 38000 transcripts that were then annotated by the SwissProt group. The CoGe comparative genomics platform was used to compare the tef genome to other genomes, notably sorghum. Scaffolds comprising approximately half of the genome size were ordered by syntenic alignment to sorghum producing tef pseudo-chromosomes, which were sorted into A and B genomes as well as compared to the genetic map of tef. The draft genome was used to identify novel SSR markers, investigate target genes for abiotic stress resistance studies, and understand the evolution of the prolamin family of proteins that are responsible for the immune response to gluten. Conclusions: It is highly plausible that breeding targets previously identified in other cereal crops will also be valuable breeding targets in tef. The draft genome and transcriptome will be of great use for identifying these targets for genetic improvement of this orphan crop that is vital for feeding 50 million people in the Horn of Africa.

Problemática estructural y de funcionamiento de la cadena de valor del jamón ibérico de bellota: el caso de Guijuelo en España

El sector porcino ibérico es un sector típicamente español. La imagen que asocia el consumidor a los productos ibéricos es la correspondiente a los productos elaborados a partir de cerdos ibéricos en explotaciones extensivas, (dehesas), y cebados en montanera. Sin embargo, según los datos publicados por el Ministerio de Agricultura, Alimentación y Medio Ambiente, más de un 70 por ciento de los cerdos ibéricos que se producen en España son criados en granjas intensivas. El sector porcino ibérico está en pleno proceso de cambio, tanto por las variaciones que se derivan de la crisis que sufre el sector, como por las modificaciones que se esperan en la norma de calidad, recientemente acordadas. En este entorno en el que existe una reducción importante de los márgenes comerciales en todos los eslabones de la cadena de valor del jamón ibérico de bellota, adquiere importancia el estudio de su estructura y funcionamiento, la determinación de los aspectos que mejoran la eficiencia económica a lo largo de la misma y su concordancia a lo largo de ella. Así mismo, un sector de los consumidores comienza a buscar productos de calidad, se interesa por productos con determinados etiquetados que garantizan la calidad o unas determinadas prácticas de producción y elaboración, como sucede con los productos ecológicos. Existen numerosos estudios sobre distintos aspectos del sector porcino ibérico, realizados por distintas instituciones, como universidades, instituciones privadas y proyectos europeos. En general, se centran en la mejora de la producción de los cerdos ibéricos o en la mejora de la elaboración de los jamones. La novedad de la investigación realizada en la presente Tesis Doctoral reside en el estudio de los aspectos que determinan la mayor eficiencia económica de la cadena de valor del jamón ibérico de bellota de la denominación de origen de Guijuelo, y en las características que aporta al jamón ibérico de bellota la producción ecológica frente a la convencional. Resumen Los objetivos planteados en esta investigación son la mejora de la cadena de valor del jamón ibérico de bellota de la denominación de origen de Guijuelo, mediante el estudio de la problemática estructural y de funcionamiento de la misma. Como objetivos específicos se proponen la mejora de la eficiencia económica en las relaciones comerciales entre los distintos eslabones de la cadena de valor, y el impulso de la oferta de los productos ecológicos de ibérico, mediante el estudio comparativo de las producciones convencionales y ecológicas. Para alcanzar estos objetivos la metodología utilizada es la cadena de valor agroalimentaria, utilizando como herramientas de análisis el método Delphi y la realización de un análisis DAFO del sector porcino ibérico. Las fuentes de información primarias utilizadas proceden por una parte de la colaboración realizada en el proyecto europeo Q-Porkchains, coordinado por el Dr. Jacques H. Trienekens, y por otra parte de los cuestionarios especialmente diseñados para el análisis Delphi realizado. Las fuentes de información secundarias proceden de artículos académicos publicados, de artículos de revistas especializadas en el sector y de informes y estadísticas publicados por el Ministerio de Agricultura, Alimentación y Medio Ambiente. Las conclusiones de la investigación son las siguientes. Las relaciones comerciales de la cadena de valor estudiada están gestionadas, ya que se otorga gran valor a las relaciones comerciales basadas en la confianza, tanto en el aprovisionamiento de productos como en la venta de los mismos en cada eslabón. Sin embargo, no se gestiona adecuadamente la gama de productos que se oferta a lo largo de la cadena de valor, puesto que los eslabones de la misma obtienen diferente eficiencia económica para el mismo producto. Por otra parte, aunque la denominación de origen de Guijuelo es una marca conocida por el consumidor, el esfuerzo por tener una marca colectiva de calidad no ha sido totalmente satisfactorio, en especial para el eslabón de la distribución. Por esta razón, es importante resaltar que es recomendable la creación de una marca propia que cuide la calidad con especial atención, modificando incluso las empresas integrantes de la cadena de valor si el objetivo de calidad no coincide. Es importante garantizar la calidad del producto al consumidor, mediante la trasmisión la información generada por los informes de inspección y certificación realizados por las entidades correspondientes en relación a la norma de calidad de los productos de cerdo ibérico y por el Consejo Regulador de Guijuelo. Se requiere un estudio detallado de los posibles nichos de mercado para llegar a los clientes que buscan un producto de calidad diferenciada como es el jamón ibérico de denominación de origen de Guijuelo. Dentro de los posibles clientes debe tenerse en consideración al colectivo de personas alérgicas, ya que no se encuentran con facilidad en el mercado productos cárnicos de cerdo libres de alérgenos. Por último, la innovación es muy importante en este sector, y pueden ofertarse nuevos productos que ayuden al acortamiento de la cadena de valor, como podría ser la carne fresca de cerdo ibérico de bellota. La producción ecológica de porcino ibérico, en la actualidad no es significativa. El manejo que se realiza de los cerdos ibéricos convencionales de bellota es muy similar al manejo que se realiza de los cerdos ecológicos, salvo en la alimentación que reciben los cerdos ibéricos antes del cebo en montanera y en los medicamentos permitidos en ambas producciones. La producción de porcino ecológico de bellota puede ser interesante para la exportación. Los jamones ibéricos de bellota dispondrían de un sello que garantiza un manejo tradicional –como se realiza en muchas explotaciones extensivas de cerdos ibéricos de bellota-, y que es apreciado por los consumidores de otros países, dispuestos a pagar por productos de calidad diferenciada. Este tipo de producción quizá podría solventar la limitación al ámbito nacional de la norma de calidad de los productos de cerdo ibérico. La falta de claridad y unanimidad en el sector sobre la calidad de los productos de ibéricos que se percibe en los cambios previstos en la legislación, y el interés del eslabón de la industria elaboradora de jamones en calidades no ligadas a producciones extensivas sino intensivas, por su mayor volumen de ventas y sus mejores rendimientos, mueven a los productores de “ibérico puro de bellota” a desmarcarse del sector “ibérico”, donde el peso del producto ibérico cruzado de pienso tiene mucho peso en las decisiones que se toman. The Iberian pork industry is a typically Spanish industry. The associated image by the consumer to these products corresponds to products made from Iberian pigs in extensive farms (meadows), and fattened in open range. However, according to data released by the Ministry of Agriculture, Food and Environment, more than 70 percent of the Iberian pigs produced in Spain are raised on factory farms. The Iberian pork industry is in process of change, both by modifications resulting from the crisis in the sector, and the expected ones in the quality standard, recently agreed. In this environment where there is a significant reduction in trade margins in all links of the value chain of Iberian ham, becomes important to study its structure and operation, identifying the aspects that improve economic efficiency along the value chain and their concordance along it. Likewise, part of the consumers begins searching for quality products, they are interested in certain products that guarantee some sort of quality or production and processing practices, like organic products. There are several studies on various aspects of the Iberian pork industry, made by different institutions, such as universities, private institutions and some European projects. In general, their goal is focused on improving the Iberian hog production or on improving the elaboration of hams. The novelty of the research conducted in this PhD thesis lies in the study of the aspects that determine the economic efficiency of the value chain of Iberian ham from Guijuelo designation of origin, and the comparison between the features that organic or conventional production of Iberian ham brings to it. The objectives propound in this research are the improvement of the value chain of Iberian ham from Guijuelo designation of origin, through the study of its structural and operational problematic. The proposed specific objectives are the improvement of the economic efficiency Resumen in trade relations between the different links in the value chain, and the promotion of the supply of Iberian organic pork products, through the comparative study of conventional and organic productions. In order to achieve these objectives, the used methodology is the agrifood value chain, using as analysis tools the Delphi method, and a SWOT analysis of the Iberian pork industry. The primary sources of information come partly from the collaboration in the European project Q-Porkchains, coordinated by Dr. Jacques Trienekens, and partly from the questionnaires specially designed for the Delphi analysis performed. The secondary sources come from published academic papers, specialized journal articles and reports published by the Ministry of Agriculture, Food and Environment. The research conclusions are as follows. Trade relations in the studied value chain are managed, as it is granted a great value to business relationships based on trust, both in the supply of products and in the sale in each link. However, the portfolio that is offered throughout the value chain is not properly managed, since the economic efficiency obtained for the same product is different in each link. Moreover, although the designation of origin of Guijuelo is a well-known brand, the effort made to acquire a collective quality trademark has not been entirely satisfactory, especially in the distribution link. Due to it, it is important to highlight that it is recommended to create a brand focused on quality, and indeed to change the firms integrating the vale chain, if the goal is not shared by all the companies. It is essential to ensure the quality of the product to the consumer, through the transmission of the available information related to the quality standard of Iberian pork products and of the Guijuelo Regulating Council. A detailed study of potential niche markets is required, in order to reach customers looking for a differentiated quality product as Iberian ham of Guijuelo designation of origin. It should be taken into consideration the group of allergy sufferers as potential customers, as they do not easily find pork products in the market free of allergens. Innovation is very important in this industry, and new products could be commercialized that help to shorten the value chain, as fresh acorn Iberian pork. Nowadays, the organic production of Iberian pork products is not significant. The operation is very similar in both conventional and organic production of Iberian pork products, except in the food received by Iberian hogs and the sort of medicinal treatments allowed in each production. The organic acorn Iberian pork production could be interesting for export. Acorn Iberian hams would have a well-known hallmark, which guarantees a traditional production, -as it is done in many extensive holdings of Iberian acorn-pigs-, and that is appreciated by consumers in other countries This niche of consumers could pay for differentiated quality products. Perhaps, this sort of production could solve the limitation to national scope of the quality standard of Iberian pork products. The lack of clarity and unanimity in the industry on the quality of Iberian pork products has been perceived in the agreed changes of the legislation as well as the interest of the processing industry in hams of quality categories which are not linked to extensive but intensive productions, due to their higher sales volume and better yields. This situation pushed "acorn pure Iberian " pigs farmers to split from the Iberian industry, where the importance of cross Iberian pig from intensive farms is growing so high that they can influence the negotiations and decisions taken inside and outside the industry.

Sistemas de ayuda al diagnóstico y a la terapia funcional en enfermedades neurodegenerativas

El incremento de la esperanza de vida en los países desarrollados (más de 80 años en 2013), está suponiendo un crecimiento considerable en la incidencia y prevalencia de enfermedades discapacitantes, que si bien pueden aparecer a edades tempranas, son más frecuentes en la tercera edad, o en sus inmediaciones. Enfermedades neuro-degenerativas que suponen un gran hándicap funcional, pues algunas de ellas están asociadas a movimientos involuntarios de determinadas partes del cuerpo, sobre todo de las extremidades. Tareas cotidianas como la ingesta de alimento, vestirse, escribir, interactuar con el ordenador, etc… pueden llegar a ser grandes retos para las personas que las padecen. El diagnóstico precoz y certero resulta fundamental para la prescripción de la terapia o tratamiento óptimo. Teniendo en cuenta incluso que en muchos casos, por desgracia la mayoría, sólo se puede actuar para mitigar los síntomas, y no para sanarlos, al menos de momento. Aun así, acertar de manera temprana en el diagnóstico supone proporcionar al enfermo una mayor calidad de vida durante mucho más tiempo, por lo cual el esfuerzo merece, y mucho, la pena. Los enfermos de Párkinson y de temblor esencial suponen un porcentaje importante de la casuística clínica en los trastornos del movimiento que impiden llevar una vida normal, que producen una discapacidad física y una no menos importante exclusión social. Las vías de tratamiento son dispares de ahí que sea crítico acertar en el diagnóstico lo antes posible. Hasta la actualidad, los profesionales y expertos en medicina, utilizan unas escalas cualitativas para diferenciar la patología y su grado de afectación. Dichas escalas también se utilizan para efectuar un seguimiento clínico y registrar la historia del paciente. En esta tesis se propone una serie de métodos de análisis y de identificación/clasificación de los tipos de temblor asociados a la enfermedad de Párkinson y el temblor esencial. Empleando técnicas de inteligencia artificial basadas en clasificadores inteligentes: redes neuronales (MLP y LVQ) y máquinas de soporte vectorial (SVM), a partir del desarrollo e implantación de un sistema para la medida y análisis objetiva del temblor: DIMETER. Dicho sistema además de ser una herramienta eficaz para la ayuda al diagnóstico, presenta también las capacidades necesarias para proporcionar un seguimiento riguroso y fiable de la evolución de cada paciente. ABSTRACT The increase in life expectancy in developed countries in more than 80 years (data belongs to 2013), is assuming considerable growth in the incidence and prevalence of disabling diseases. Although they may appear at an early age, they are more common in the elderly ages or in its vicinity. Nuero-degenerative diseases that are a major functional handicap, as some of them are associated with involuntary movements of certain body parts, especially of the limbs. Everyday tasks such as food intake, dressing, writing, interact with the computer, etc ... can become large debris for people who suffer. Early and accurate diagnosis is crucial for prescribing optimal therapy or treatment. Even taking into account that in many cases, unfortunately the majority, can only act to mitigate the symptoms, not to cure them, at least for now. Nevertheless, early diagnosis may provide the patient a better quality of life for much longer time, so the effort is worth, and much, grief. Sufferers of Parkinson's and essential tremor represent a significant percentage of clinical casuistry in movement disorders that prevent a normal life, leading to physical disability and not least social exclusion. There are various treatment methods, which makes it necessary the immediate diagnosis. Up to date, professionals and medical experts, use a qualitative scale to differentiate the disease and degree of involvement. Therefore, those scales are used in clinical follow-up. In this thesis, several methods of analysis and identification / classification of types of tremor associated with Parkinson's disease and essential tremor are proposed. Using artificial intelligence techniques based on intelligent classification: neural networks (MLP and LVQ) and support vector machines (SVM), starting from the development and implementation of a system for measuring and objective analysis of the tremor: DIMETER. This system besides being an effective tool to aid diagnosis, it also has the necessary capabilities to provide a rigorous and reliable monitoring of the evolution of each patient.

Psoriasis. Tipología, tratamiento y cuidados de enfermería

Revisión, presentación y síntesis de las diversas tipologías de la psoriasis y de los tratamientos desarrollados -desde aquellos más comunes a los más novedosos-. Se exponen los cuidados de enfermería más frecuentes. Teniendo en cuenta la cronicidad, evolución por brotes, y afectación tanto física como psicológica del paciente, el rol de la enfermera es esencial en la adaptación e independencia del enfermo con psoriasis.

Memorial meeting: Israel Friedlaender, Bernard Cantor whose lives were sacrificed July 5, 1920 in the cause of Israel ...

Mode of access: Internet.

Latent class and genetic analysis does not support migraine with aura and migraine without aura as separate entities

Latent class and genetic analyses were used to identify subgroups of migraine sufferers in a community sample of 6,265 Australian twins (55% female) aged 25-36 who had completed an interview based on International Headache Society UHS) criteria. Consistent with prevalence rates from other population-based studies, 703 (20%) female and 250 (9%) male twins satisfied the IHS criteria for migraine without aura (MO), and of these, 432 (13%) female and 166 (6%) male twins satisfied the criteria for migraine with aura (MA) as indicated by visual symptoms. Latent class analysis (LCA) of IHS symptoms identified three major symptomatic classes, representing 1) a mild form of recurrent nonmigrainous headache, 2) a moderately severe form of migraine, typically without visual aura symptoms (although 40% of individuals in this class were positive for aura), and 3) a severe form of migraine typically with visual aura symptoms (although 24% of individuals were negative for aura). Using the LCA classification, many more individuals were considered affected to some degree than when using IHS criteria (35% vs. 13%). Furthermore, genetic model fitting indicated a greater genetic contribution to migraine using the LCA classification (heritability, h(2) =0.40; 95% CI, 0.29-0.46) compared with the IHS classification (h(2)=0.36; 95% CI, 0.22-0.42). Exploratory latent class modeling, fitting up to 10 classes, did not identify classes corresponding to either the IHS MO or MA classification. Our data indicate the existence of a continuum of severity, with MA more severe but not etiologically distinct from MO. In searching for predisposing genes, we should therefore expect to find some genes that may underlie all major recurrent headache subtypes, with modifying genetic or environmental factors that may lead to differential expression of the liability for migraine. (C) 2004 Wiley-Liss, Inc.

The antlepileptic Materia Medica of Pedoacus Dioscorides

Since it was written about the middle of the 1st Century AD, and up to comparatively recent times, the great Herbal, or Materia Medica, of Dioscorides provided medicine with its chief source of information about what were then considered therapeutic substances. The work contained data on various materials of botanical, biological and mineral origin which were claimed to provide benefit to sufferers from epilepsy, though often with no clear underlying rationale for their use. Some of these materials continued to be used as antiepileptic remedies over many centuries till they were finally recognised to be without useful effect in the disorder. The longest survivor amongst the Dioscoridean antiepileptic remedies was a rather esoteric one, viz. two stones taken from the belly of a young swallow during the rising phase of the moon and also whilst the swallow's parent birds were absent from the nest. The stones, or one of them, were worn against the skin of the seizure sufferer. The use of the swallow stones for epilepsy was recommended as late as in the writings of Thomas Willis (1675). (C) 2004 Elsevier Ltd. All rights reserved.

The estrogen receptor 1 G594A polymorphism is associated with migraine susceptibility in two independent case/control groups

Migraine is a painful and debilitating disorder with a significant genetic component. Steroid hormones, in particular estrogen, have long been considered to play a role in migraine, as variations in hormone levels are associated with migraine onset in many sufferers of the disorder. Steroid hormones mediate their activity via hormone receptors, which have a wide tissue distribution. Estrogen receptors have been localized to the brain in regions considered to be involved in migraine pathogenesis. Hence it is possible that genetic variation in the estrogen receptor gene may play a role in migraine susceptibility. This study thus examined the estrogen receptor 1 (ESRalpha) gene for a potential role in migraine pathogenesis and susceptibility. A population-based cohort of 224 migraine sufferers and 224 matched controls were genotyped for the G594A polymorphism located in exon 8 of the ESR1 gene. Statistical analysis indicated a significant difference between migraineurs and non-migraineurs in both the allele frequencies (P=0.003) and genotype distributions (P=0.008) in this sample. An independent follow-up study was then undertaken using this marker in an additional population-based cohort of 260 migraine sufferers and 260 matched controls. This resulted in a significant association between the two groups with regard to allele frequencies (P=8x10(-6)) and genotype distributions (P=4x10(-5)). Our findings support the hypothesis that genetic variation in hormone receptors, in particular the ESR1 gene, may play a role in migraine.

Bone loss in Crohn's disease: Exercise as a potential countermeasure

Crohn's disease (CD) is associated with a number of secondary conditions including osteoporosis, which increases the risk of bone fracture. The cause of metabolic bone disease in this Population is believed to be multifactorial and may include the disease itself and associated inflammation, high-close corticosteroid use, weight loss and malabsorption, a lack of exercise and physical activity, and all underlying genetic predisposition to bone loss. Reduced bone mineral density has been reported in between 5% to 80% of CD sufferers, although it is generally believed that approximately 40% of patients suffer from osteopenia and 15% from osteoporosis. Recent studies Suggest a small but significantly increased risk of fracture compared with healthy controls and, perhaps, sufferers of other gastrointestinal disorders Such as ulcerative colitis. The role of physical activity and exercise in the prevention and treatment of CD-related bone loss has received little attention, despite the benefits of specific exercises being well documented in healthy populations. This article reviews the prevalence of and risk factors for low bone mass in CD patients and examines various treatments for osteoporosis in these patients, with a particular focus on physical activity.