Factores de estrés del estudiantado ante las prácticas clínicas en Ciencias de la Salud

Las prácticas clínicas son un elemento fundamental en la formación del alumnado de Ciencias de la Salud, especialmente en las áreas de Enfermería y Podología. El entorno a nivel clínico suele proporcionar muchos estímulos generadores de estrés, sin embargo son muy poco investigados. Por ello, es importante conocer las situaciones percibidas como más estresantes por el alumnado en el desarrollo de sus prácticas clínicas para intervenir con actividades educativas de entrenamiento en estrategias de afrontamiento, para reducir no sólo los estresores más comunes sino para intervenir de modo que se favorezca un aprendizaje autónomo y reflexivo además de instaurarse como aprendizaje para toda la vida. Se desarrolló, en este sentido, un modelo docente innovador a través de técnicas y metodologías basadas en Tecnologías de la Información y Comunicación (TIC), simulaciones y resolución de casos clínicos realesUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Effect of Spatiotemporal Parameters on the Gait of Children Aged from 6 to 12 Years in Podiatric Tests: A Cross Sectional Study

The use of lower limb tests in the paediatric population is of great importance for diagnostic evaluations. The aim of this study is to understand the relationship between the tests performed on the feet and ankles, covering all of its planes, and the spatiotemporal parameters of children’s gait. Methods: It is a cross-sectional observational study. Children aged between 6 and 12 years participated. Measurements were carried out in 2022. An analysis of three tests used to assess the feet and ankles (FPI, the ankle lunge test, and the lunge test), as well as a kinematic analysis of gait using OptoGait as a measurement tool, was performed. Results: The spatiotemporal parameters show how Jack’s Test is significant in the propulsion phase in its % parameter, with a p-value of 0.05 and a mean difference of 0.67%. Additionally, in the lunge test, we studied the % of midstance in the left foot, with a mean difference between the positive test and the 10 cm test of 10.76 (p value of 0.04). Conclusions: The diagnostic analysis of the functional limitation of the first toe (Jack’s test) is correlated with the spaciotemporal parameter of propulsion, as well as the lunge test, which is also correlated with the midstance phase of gait.Funding for open access charge: Universidad de Málag

Extremadura-Portugal: Una guía para la cooperación transfronteriza

El presente libro pretende servir de guía práctica para que los actores interesados en la cooperación transfronteriza entre Extremadura y Portugal puedan disponer de las herramientas concretas con las que llevarla a cabo. La obra analiza tanto el marco jurídico actual de la cooperación transfronteriza, con los instrumentos ya existentes, como los diferentes sectores de políticas públicas en los que se dan prácticas de intercambio entre Extremadura y las regiones portuguesas vecinas. Asimismo, intenta aclarar la asimetría institucional, administrativa y política existente a ambos lados de la frontera común, la Raya, pues las diferencias competenciales y de articulación interna en dichos ámbitos constituye, a día de hoy, uno de los obstáculos principales para profundizar en una cooperación transfronteriza cada vez más oportuna y necesaria.This book aims to serve as a practical guide so that stakeholders interested in cross-border cooperation between Extremadura and Portugal can have the specific tools with which to carry it out. The book analyzes both the current legal framework for cross-border cooperation, with existing instruments, and the different public policy sectors in which exchange practices take place between Extremadura and neighboring Portuguese regions. Likewise, it attempts to clarify the institutional, administrative and political asymmetry existing on both sides of the common border, La Raya, since the differences in competence and internal articulation in these areas constitute, today, one of the main obstacles to deepening a increasingly timely and necessary cross-border cooperation

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Predictive model to identify the risk of losing protective sensibility of the foot in patients with diabetes mellitus.

Diabetic neuropathy is defined as the presence of symptoms and signs of peripheral nerve dysfunction in diabetics. The aim of this study is to develop a predictive logistic model to identify the risk of losing protective sensitivity in the foot. This descriptive cross-sectional study included 111 patients diagnosed with diabetes mellitus. Participants completed a questionnaire designed to evaluate neuropathic symptoms, and multivariate analysis was subsequently performed to identify an optimal predictive model. The explanatory capacity was evaluated by calculating the R2 coefficient of Nagelkerke. Predictive capacity was evaluated by calculating sensitivity, specificity, and estimation of the area under the receiver operational curve. Protective sensitivity loss was detected in 19.1% of participants. Variables associated by multivariate analysis were: educational level (OR: 31.4, 95% CI: 2.5-383.3, P = .007) and two items from the questionnaire: one related to bleeding and wet socks (OR: 28.3, 95% CI: 3.7-215.9, P = .001) and the other related to electrical sensations (OR: 52.9, 95% CI: 4.3-643.9, P = .002), which were both statistically significant. The predictive model included the variables of age, sex, duration of diabetes, and educational level, and it had a sensitivity of 81.3% and a specificity of 95.5%. This model has a high predictive capacity to identify patients at risk of developing sensory neuropathy

Tracing Gene Expression Through Detection of β-galactosidase Activity in Whole Mouse Embryos

The Escherichia coli LacZ gene, encoding β-galactosidase, is largely used as a reporter for gene expression and as a tracer in cell lineage studies. The classical histochemical reaction is based on the hydrolysis of the substrate X-gal in combination with ferric and ferrous ions, which produces an insoluble blue precipitate that is easy to visualize. Therefore, β-galactosidase activity serves as a marker for the expression pattern of the gene of interest as the development proceeds. Here we describe the standard protocol for the detection of β-galactosidase activity in early whole mouse embryos and the subsequent method for paraffin sectioning and counterstaining. Additionally, a procedure for clarifying whole embryos is provided to better visualize X-gal staining in deeper regions of the embryo. Consistent results are obtained by performing this procedure, although optimization of reaction conditions is needed to minimize background activity. Limitations in the assay should be also considered, particularly regarding the size of the embryo in whole mount staining. Our protocol provides a sensitive and a reliable method for β- galactosidase detection during the mouse development that can be further applied to the cryostat sections as well as whole organs. Thus, the dynamic gene expression patterns throughout development can be easily analyzed by using this protocol in whole embryos, but also detailed expression at the cellular level can be assessed after paraffin sectioning.2017UEM011.108 JCR (2018) Q3, 41/69 Multidisciplinary Sciences0.665 SJR (2018) Q1, 75/411 Chemical Engineering (miscellaneous); Q2, 87/263 Biochemistry, Genetics and Molecular Biology (miscellaneous); Q3, 28/57 Immunology and Microbiology (miscellaneous), 87/154 Neuroscience (miscellaneous)No data IDR 2018UE

Tracing Gene Expression Through Detection of β-galactosidase Activity in Whole Mouse Embryos

Depto. de Genética, Fisiología y MicrobiologíaFac. de Ciencias BiológicasTRUEpu

Melatonin diminishes oxidative damage in sperm cells, improving assisted reproductive techniques

Los procedimientos de preparación de esperma son un generador potencial de daño en el ADN inducido por el estrés oxidativo, lo que conduce a una caída dramática en la fertilidad. Un número creciente de estudios sugiere que la melatonina reduce el estrés oxidativo inducido por la manipulación. Sin embargo, se sabe muy poco sobre el papel conservador de la melatonina en el medio de preparación de esperma durante los procedimientos de reproducción asistida. Para lograr este objetivo, el semen se dividió en dos fracciones y se preincubó con y sin melatonina 1 mM. Posteriormente, ambas fracciones se dividieron en dos subfracciones para realizar un baño en presencia y ausencia de melatonina 1 mM. El marcado con anti-CD46 y antipactivo caspasa-3 permitió el monitoreo de la reacción del acrosoma y la apoptosis por citometría de flujo. La fragmentación y la compactación del ADN espermático se analizaron mediante tinción con yoduro de propidio. Las muestras de normozoospermia y oligozoospermia que se preincubaron con melatonina experimentaron un aumento significativo en la proporción de espermatozoides adecuados y una reducción de la activación de caspasa-3. Además, la preincubación con melatonina mejoró la migración de espermatozoides con ADN compactado en muestras oligozoospérmicas (P <0.05) y evitó la fragmentación del ADN en muestras normozoospérmicas (P <0.05). A la luz de los resultados actuales, la capacidad citoprotectora y la inocuidad de la melatonina lo convierten en un gran candidato para ser aplicado en técnicas de reproducción asistida para prevenir el daño oxidativo iatrogénico.Sperm preparation procedures are a potential generator of oxidative stress-induced DNA damage, which leads to a dramatic drop in fertility. An increasing number of studies suggest that melatonin reduces the oxidative stress induced by manipulation. However, very little is known about the preservative role of melatonin in sperm preparation medium during assisted reproduction procedures. For this aim to be achieved, semen was divided into two fractions and preincubated with and without 1 mM melatonin. Afterwards, both fractions were divided into two subfractions to perform swim-up in the presence and absence of 1 mM melatonin. Labeling with anti-CD46 and antiactive caspase-3 allowed the monitoring of acrosome reaction and apoptosis by flow cytometry. Sperm DNA fragmentation and compaction were analyzed through propidium iodide staining. The normozoospermic and oligozoospermic samples that were preincubated with melatonin underwent a significant increase in the ratio of adequate spermatozoa and a reduction of caspase-3 activation. Additionally, preincubation with melatonin enhanced the migration of sperm cells with compacted DNA in oligozoospermic samples (P < 0.05) and prevented DNA fragmentation in normozoospermic samples (P < 0.05). In light of the current results, the cytoprotective capacity and innocuousness of melatonin make it a great candidate to be applied in assisted reproduction techniques in order to prevent iatrogenic oxidative damage.• Angelini Farmacéutica S.A. Ayuda • Junta de Extremadura y Fondo Social Europeo. Ayuda GR15051/BB021 • Gobierno de Extremadura y Fondo Social Europeo. Ayuda. Beca postdoctoral P01 401, para Javier Espino Palma • Fundación Tatiana Pérez de Guzmán el Bueno. Beca predoctoral para Ana María Marchena LópezpeerReviewe

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation

Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

International audienceImportance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE).Objective: To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT.Design, setting, and participants: This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection.Main outcomes and measures: Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE.Results: A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%).Conclusions and relevance: Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT