El final de la vida en la infancia y la adolescencia: aspectos éticos y jurídicos en la atención sanitaria

Coordinadores: María J. Escudero Carretero, Pablo Simón Lorda

Leiomiosarcoma de vesícula seminal. Presentación de un caso

Aims: Leiomyosarcoma of the seminal vesicle is extremely rare and very little information is available on how best it should be treated. The advantage of adjuvant therapy treatment is unclear. Methods and results: We report a case of leiomyosarcoma arising from the seminal vesicle in a 65-year-old man. Conclusion: Leiomyosarcoma is a malignant neoplasm with a poor prognosis and radical surgical excision is the treatment of choice.

Análisis del modelo salutogénico en España: aplicación en salud pública e implicaciones para el modelo de activos en salud

This article seeks to provide an in depth review about one of the most revolutionary and influential methods used in understanding the variables and processes that explain human health. Based on a new vision in the analysis of the consequences of theNazi Holocaust, a doctor-sociologist—Aaron Antonovsky— managed to influence medicine and behavioral science by facilitating the keys for the optimal development of public health today. Despite the fact that this theory began appearing in the1970s in the 20th century, its real development and expansion have been seen in recent years. In fact, in Spain, there is littlescientific literature that analyses the theoretic keys of the model in depth. This work seek to cover this gap; to achieve this objective, it first presents how the construct of salutogenesis arose, the social-cultural context that promoted it, as well as the importance public health acquires today. This is the aim of this work, which analyses the theoretical bases of the salutogenesis model,with specific emphasis on its background and precursors, aswell as its inception, development and current expansion

Estrategia para la seguridad del paciente en el SSPA 2011-2014

En soporte papel, está acompañada por el "Análisis de la implementación de la Estrategia para la Seguridad del Paciente en el SSPA 2006-2010."

Análisis de la implementación de la estrategia para la seguridad del paciente en el SSPA 2006-2010

Es la evaluación del desarrollo de la implantación de la "Estrategia para la Seguridad del Paciente 2006-2010" en Andalucía.En soporte papel, acompaña a la "Estrategia para la seguridad del paciente en el SSPA 2011-2014".

Carcinoma verrugoso de vagina. Presentacion de un caso

Verrucous carcinoma of the vagina is a rare neoplasm. This entity is a slow-growing, locally invasive but generally nonmetastasizing neoplasm, with a characteristic gross and microscopic appearance. We report a case of verrucous carcinoma of the vagina in a postmenopausal woman diagnosed 4 years after transvaginal hysterectomy for grade 4 uterine prolapse. We also discuss the differential diagnosis and treatment.Verrucous carcinoma of the vagina is a rare neoplasm. The differential diagnosis includes typical squamous cell carcinoma, warty carcinoma, and condyloma acuminatum. Surgery remains the most effective treatment.

Actividad en Hospital de Día Quirúrgico en los Hospitales del SSPA. Año 2010

This report has used the MDS to meet the sigueintes questions: How do they compare ambulatory surgery and inpatient surgery?. Who is involved with outpatient surgery?. What are the most common outpatient major interventions?. How is distributed outpatient surgery by age and sex?

Paternity and health services. Qualitative research on men's experiences during pregnancy, delivery and postpartum of theirs partners

Background: Little research has been carried out with regards to the inclusion of men during the birth process. The objective of this paper involves exploring the needs and expectations of the health services manifested by a group of fathers as a result of their experience during the birth process. Methods: Qualitative research was carried out in Granada in 2004 via individual interviews with fathers who showed shared responsibility in the upbringing. The profile is: employment, medium-high educational level, one or more child: 0-6 months of age. The transcript was subsequently submitted to hermeneutic analysis. Results: Some semantic constructs are: 1) Health Services do not concede the women as protagonists, 2) Birth process is depending on the body. Fathers can only support and fight for the relevance of men, 3) Men seem like “invisible”, 4) Health services inhibit their participation, and 5) have dealings with fathers according to their gender roles. The participants address the relationship between expectations of care during the birth process and unsatisfied demands, and the manner in which they employ the obstacles encountered within health services that inhibit their participation as arguments that confirm their separation from the process. Conclusions: This paper draws attention to the limited scope of the provision of healthcare during the birth process in terms of protagonism afforded to fathers. Indeed, despite their requisitory discourse, the interviewees manifest contradictory attitudes in the face of changes that require them to make commitments. We identify elements that could be improved to adapt services to the needs of fathers and vice versa.

Oportunidades de mejora del servicio de metadona en atención primaria, desde el punto de vista profesional

Objective: To identify and prioritize improvement opportunities, according to the European Foundation for Quality Management model (EFQM) model, of the methadone dispensing service in Andalusian Primary Health Care, from the point of view of professionals. Method: Delphi consensus method, implemented from September 2007 to March 2008 by means of three rounds of interviews with questionnaires administered by electronic mail to 39 professionals. The Panel of experts was made up of Dispensers and Prescribers of methadone as well as Coordinators of welfare services from the Methadone Treatment Program (MTP). Selection criteria were: Being in active employment with a minimum of 3 years experience. Sample diversification variables: Professional role, geographical environment and type of habitat. Recruitment: By means of key professional bodies from different institutions. Results: 48 improvement opportunities were identified. Thirteen of these obtained a high level of agreement in the final round. According to the EFQM model, the dimensions that obtained the most consensus in relation to improving the care service were: Leadership, Alliances and Resources. The dimension that caused the greatest disagreement was Processes. Conclusions: In spite of its having been implemented since 1997 in Andalusian Primary Health Care, the methadone dispensing service is at an implementation phase, rather than what could be classed as a fully deployed stage

La gripe A desde la teoría de la elección racional: propuestas para la toma de decisiones de políticas preventivas

This article is a reflection on the social uncertainty caused by Influenza A and on the consequences that it can have on decision making in health promotion policies. We use concepts and metaphors of the Rational Choice Theory, among them, the “ingratitude effect” or the “distrust effect”, as we analyse how these can become obstacles for the efficiency of prevention policies. Then, we focus on the information asymmetry of the principal-agent relationship, and we propose measures to diminish the “moral risk” that they cause. We finish by advancing some proposals for designing lines and strategies of action in health promotion policies.

Differential expression of THOC1 and ALY mRNP biogenesis/export factors in human cancers

One key step in gene expression is the biogenesis of mRNA ribonucleoparticle complexes (mRNPs). Formation of the mRNP requires the participation of a number of conserved factors such as the THO complex. THO interacts physically and functionally with the Sub2/UAP56 RNA-dependent ATPase, and the Yra1/REF1/ALY RNA-binding protein linking transcription, mRNA export and genome integrity. Given the link between genome instability and cancer, we have performed a comparative analysis of the expression patterns of THOC1, a THO complex subunit, and ALY in tumor samples.

Increased neurotransmitter release at the neuromuscular junction in a mouse model of polyglutamine disease.

In Huntington's disease (HD), the expansion of polyglutamine (polyQ) repeats at the N terminus of the ubiquitous protein huntingtin (htt) leads to neurodegeneration in specific brain areas. Neurons degenerating in HD develop synaptic dysfunctions. However, it is unknown whether mutant htt impacts synaptic function in general. To investigate that, we have focused on the nerve terminals of motor neurons that typically do not degenerate in HD. Here, we have studied synaptic transmission at the neuromuscular junction of transgenic mice expressing a mutant form of htt (R6/1 mice). We have found that the size and frequency of miniature endplate potentials are similar in R6/1 and control mice. In contrast, the amplitude of evoked endplate potentials in R6/1 mice is increased compared to controls. Consistent with a presynaptic increase of release probability, synaptic depression under high-frequency stimulation is higher in R6/1 mice. In addition, no changes were detected in the size and dynamics of the recycling synaptic vesicle pool. Moreover, we have found increased amounts of the synaptic vesicle proteins synaptobrevin 1,2/VAMP 1,2 and cysteine string protein-α, and the SNARE protein SNAP-25, concomitant with normal levels of other synaptic vesicle markers. Our results reveal that the transgenic expression of a mutant form of htt leads to an unexpected gain of synaptic function. That phenotype is likely not secondary to neurodegeneration and might be due to a primary deregulation in synaptic protein levels. Our findings could be relevant to understand synaptic toxic effects of proteins with abnormal polyQ repeats.

Association analysis of urotensin II gene (UTS2) and flanking regions with biochemical parameters related to insulin resistance.

Background. Urotensin II (UII) is a potent vasoconstrictor peptide, which signals through a G-protein coupled receptor (GPCR) known as GPR14 or urotensin receptor (UTR). UII exerts a broad spectrum of actions in several systems such as vascular cell, heart muscle or pancreas, where it inhibits insulin release. Objective. Given the reported role of UII in insulin secretion, we have performed a genetic association analysis of the UTS2 gene and flanking regions with biochemical parameters related to insulin resistance (fasting glucose, glucose 2 hours after a glucose overload, fasting insulin and insulin resistance estimated as HOMA). Results and Conclusions. We have identified several polymorphisms associated with the analysed clinical traits, not only at the UTS2 gene, but also in thePER3 gene, located upstream from UTS2. Our results are compatible with a role for UII in glucose homeostasis and diabetes although we cannot rule out the possibility that PER3 gene may underlie the reported associations.