Prevalencia y factores de riesgo de úlceras por presión

ObjetivoConocer la prevalencia de úlceras por presión (UPP) en pacientes incapacitados de una Zona Básica de Salud (ZBS) y caracterizar los factores de riesgo asociados a su aparición.DiseñoEstudio transversal observacional.EmplazamientoZBS Rincón de la Victoria (Málaga).ParticipantesPacientes incluidos en el Programa de Incapacitados (n = 178), de la ZBS, residentes en su domicilio o en una residencia geriátrica.MedicionesCuestionario específico con variables sociodemográficas y de salud. Para la valoración de factores de riesgo asociados con la formación de UPP, se utilizó la Escala de Norton Modificada (ENM). La variable resultado de interés fue la presencia o ausencia de UPP, localización y grado. El denominador para el cálculo de la prevalencia ha sido el total de pacientes valorados.ResultadosLa prevalencia fue del 12,9%. La característica sociodemográfica más significativa asociada con la presencia de úlceras en estos pacientes fue el nivel de instrucción del cuidador. Se constata asociación de determinadas variables del estado de salud del paciente con aparición de UPP.ConclusionesLos resultados alertan a la necesidad de la realización de protocolos diagnósticos y de intervención comunitaria para reducir la presentación de UPP en pacientes incapacitados que viven en la comunidad.ObjectivesTo study prevalence of pressure ulcers among functionally impaired patients in the community and evaluate risk factors associated with the development of pressure ulcers in these patients.DesignCross-sectional, observational study.SettingCommunity dwellers served by the Primary Health Care Area of Rincón de la Victoria in Málaga.ParticipantsAll patients included in the «Impaired Patient Programme» (n=178).MethodsA questionnaire was developed to ascertain demographic and health characteristics. Risk factors were evaluated with the Modified Norton Scale. The outcome variable of interest was presence or absence of pressure ulcers, their location and grade. The denominator used for the calculation of the prevalence was the total of evaluated patients.ResultsPrevalence of pressure ulcers in our Basic Health Area was 12.9%. The most important sociodemographic characteristic associated with the presence of pressure ulcers in these patients was the educational attainment of the caregiver. Health varaibles of the patient were also associated with the risk of developing ulcers.ConclusionsResults indicate the need of diagnostic protocols with standardised instruments and prevention plans to reduce pressure ulcers in the community. Longitudinal studies are needed to evaluate interventions in this area

Coping strategies and postpartum depressive symptoms: A structural equation modelling approach

BACKGROUND: Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks. METHODS: A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression. RESULTS: Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism. CONCLUSIONS: Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.Gobierno de España. Instituto de Salud Carlos III (ISCIII)Spanish Psychiatric Genetics and Genotyping networkRTAGeneralitat de Cataluny

Research Letter: Is neuroticism a risk factor for postpartum depression?

Although the relationship between personality and depressive illness is complex (Shea, 2005), there is empirical evidence that some personality features such as neuroticism, harm avoidance, introversion, dependency, self-criticism or perfectionism are related to depressive illness risk (Gunderson et al. 1999).This work was supported by the Instituto Carlos III (Spanish Ministry of Health; grant numbers P1041635, PI041783, PI041779, PI0411761, PI041791, PI041766 and PI041782), as well as the Spanish Psychiatric Genetics and Genotyping network G03/184, RTA (RD06/001/1009), and Generalitat de Catalunya, SGR2009/1435).Ye

Cannabinoid CB1 receptor antagonism markedly increases dopamine receptor-mediated stereotypies

The contribution of the endocannabinoid system to dopamine-mediated disorganized behavior in schizophrenia is discussed. We used a model of concurrent stimulation of dopamine D1 and D2 receptors to evaluate the role of this system in dopamine-mediated stereotypies measured in a hole-board test. Pretreatment with the cannabinoid CB1 receptor antagonist N-(piperidin-1-yl)-5-(4-chlorophenyl)-1-(2,4-dichloro-phenyl)-4-methyl-1H-pyrazole-3-carboxamide (SR141716A; 1 mg/kg) potentiated stereotyped behavior induced by coadministration of the dopamine D1 receptor agonist SKF 38393 (0.05, 0.1 and 1 mg/kg) and the dopamine D2 receptor agonist quinpirole (0.25 mg/kg). Thus, the endocannabinoid system acts as a brake for abnormal behavior associated with dopaminergic overactivation. © 2007 Elsevier B.V. All rights reserved.Peer Reviewe

Histone Deacetylase Activity Modulates Alternative Splicing

There is increasing evidence to suggest that splicing decisions are largely made when the nascent RNA is still associated with chromatin. Here we demonstrate that activity of histone deacetylases (HDACs) influences splice site selection. Using splicing-sensitive microarrays, we identified ∼700 genes whose splicing was altered after HDAC inhibition. We provided evidence that HDAC inhibition induced histone H4 acetylation and increased RNA Polymerase II (Pol II) processivity along an alternatively spliced element. In addition, HDAC inhibition reduced co-transcriptional association of the splicing regulator SRp40 with the target fibronectin exon. We further showed that the depletion of HDAC1 had similar effect on fibronectin alternative splicing as global HDAC inhibition. Importantly, this effect was reversed upon expression of mouse HDAC1 but not a catalytically inactive mutant. These results provide a molecular insight into a complex modulation of splicing by HDACs and chromatin modifications

Incremento en la utilización de servicios hospitalarios por las personas mayores de 55 años: envejecimiento poblacional y respuesta del sistema de servicios de salud

Objetivo: Examinar los cambios en la tasa de hospitalización entre 1985 y 1994 en España y en Andalucía, y estimar la proporción atribuible al envejecimiento poblacional. Métodos: Se calcula el incremento de las tasas de hospitalización entre 1985 y 1994. Se estiman las altas esperadas en 1994 multiplicando las tasas de hospitalización de 1985 por la población en 1994 para cada grupo de edad. Resultados: Entre 1985 y 1994 se produjo un incremento en la tasa de hospitalización en los mayores de 55 años. El incremento oscila entre el 20,01% (de 55 a 64 años) y el 52% (> 75 años); y el porcentaje atribuible al envejecimiento poblacional es pequeño (2,8-14,8%). Conclusión: El aumento en la tasa de hospitalización en mayores de 55 años se explica parcialmente por el envejecimiento poblacional, atribuible a la demanda y a la oferta de servicios

Incremento en la utilización de servicios hospitalarios por las personas mayores de 55 años: envejecimiento poblacional y respuesta del sistema de servicios de salud Increase in hospital services utilization by persons aged 55 years or older: population ageing and response of the health system

Objetivo: Examinar los cambios en la tasa de hospitalización entre 1985 y 1994 en España y en Andalucía, y estimar la proporción atribuible al envejecimiento poblacional. Métodos: Se calcula el incremento de las tasas de hospitalización entre 1985 y 1994. Se estiman las altas esperadas en 1994 multiplicando las tasas de hospitalización de 1985 por la población en 1994 para cada grupo de edad. Resultados: Entre 1985 y 1994 se produjo un incremento en la tasa de hospitalización en los mayores de 55 años. El incremento oscila entre el 20,01% (de 55 a 64 años) y el 52% (> 75 años); y el porcentaje atribuible al envejecimiento poblacional es pequeño (2,8-14,8%). Conclusión: El aumento en la tasa de hospitalización en mayores de 55 años se explica parcialmente por el envejecimiento poblacional, atribuible a la demanda y a la oferta de servicios.<br>Objectives: To examine changes in hospital service utilization between 1985 and 1994 in Spain and Andalucía and to estimate the proportion of change due to population ageing. Methods: The increase in hospitalization rates between 1985 and 1994 was calculated. Expected hospital discharges in 1994, were calculated by multiplying hospital discharge rates in 1985 by the population in 1994 for each age group. Results: Between 1985 and 1994 hospitalization rates increased among persons aged 55 years old order. The increase ranged from 20.01% (55-64 years old) to 52% (more than 75 years old). The percentage of this increase due to population ageing was slight (range: 2.8 to 14.8%). Conclusions: The increase in hospitalization rates among persons aged 55 years old or older is only partially explained by population ageing, which can be attributed to supply and demand of services

Prediction of Postpartum Depression Using Multilayer Perceptrons and Pruning

[EN] Objective: The main goal of this paper is to obtain a classification model based on feed-forward multilayer perceptrons in order to improve postpartum depression prediction during the 32 weeks after childbirth with a high sensitivity and specificity and to develop a tool to be integrated in a decision support system for clinicians. Materials and Methods: Multilayer perceptrons were trained on data from 1397 women who had just given birth, from seven Spanish general hospitals, including clinical, environmental and genetic variables. A prospective cohort study was made just after delivery, at 8 weeks and at 32 weeks after delivery. The models were evaluated with the geometric mean of accuracies using a hold-out strategy. Results: Multilayer perceptrons showed good performance (high sensitivity and specificity) as predictive models for postpartum depression. Conclusions: The use of these models in a decision support system can be clinically evaluated in future work. The analysis of the models by pruning leads to a qualitative interpretation of the influence of each variable in the interest of clinical protocols.This work was partially funded by the Spanish Ministerio de Sanidad (PIC41635, Vulnerabilidad genetico-ambiental a la depresion posparto, 2006-2008) and the Instituto de Salud Carlos III (RETICS Combiomed, RD07/0067/2001). The authors acknowledge to Programa Torres Quevedo from Ministerio de Educacion y Ciencia, co-founded by the European Social Fund (PTQ05-02-03386 and PTQ-08-01-06802)Tortajada, S.; Garcia-Gomez, JM.; Vicente, J.; Sanjuán, J.; De Frutos, R.; Martín-Santos, R.; García-Esteve, L.... (2009). Prediction of Postpartum Depression Using Multilayer Perceptrons and Pruning. Methods of Information in Medicine. 48(3):291-298. https://doi.org/10.3414/ME0562S29129848

Research Letter: is neuroticism a risk factor for postpartum depression?

Although the relationship between personality and depressive illness is complex (Shea, 2005), there is empirical evidence that some personality features such as neuroticism, harm avoidance, introversion, dependency, self-criticism or perfectionism are related to depressive illness risk (Gunderson et al. 1999). Moreover, personality traits, especially neuroticism, may explain the increased prevalence of depression among females (Goodwin & Gotlib, 2004). Few studies have explored neuroticism, extraversion and psychoticism as risk factors for depression after an event as stressful as childbirth. Pitt (1968) was the first author to report high scores on neuroticism and low scores on extraversion among postpartum depressed women. Similar results were found in a comparison of mothers with and without postpartum depressive symptoms (Dudley et al. 2001; Podolska et al. 2010). A case-control study comparing women with recurrent major depression with and without a history of postpartum depression found no personality trait differences between them; however, those with a history of postpartum depression showed higher neuroticism and psychoticism and lower extraversion than controls. These results suggested that these traits did not confer a specific risk for the postnatal onset episodes (Jones et al. 2010). Prospective studies have also studied the link between personality and postpartum depression; however, these data are not conclusive due to methodological limitations, such as sample size (Kumar & Robson, 1984; Watson et al. 1984; Areias et al. 1991; Boyce et al. 1991; Matthey et al. 2000), selection bias (Kumar & Robson, 1984; Areias et al. 1991; Boyce et al. 1991; Matthey et al. 2000), or depression assessment (self-report measures versus clinical diagnosis: Boyce et al. 1991; Matthey et al. 2000; Dudley et al. 2001; Saisto et al. 2001; Van Bussel et al. 2009) or because the authors did not take into account confounding factors such as stressful life events or social support (Watson et al. 1984; Kumar & Robson, 1984; Boyce et al. 1991; Matthey et al. 2000; Saisto et al. 2001; Verkerk et al. 2005; Van Bussel et al. 2009). (See Supplementary material, Table S1.)The aim of this paper was to extend the previous knowledge of the role of neuroticism, extroversion and psychoticism as risk factors for postpartum depression (depression symptomatology and clinical diagnosis) considering psychosocial variables in a large cohort of women from the general population.Peer Reviewe