Efectividad de la técnica de Biofeedback anorectal mediante el test de expulsión de balón en pacientes con estreñimiento funcional

Màster en Lideratge i Gestió d'Infermeria, Universitat de Barcelona. Escola Universitària d'Infermeria, curs: 2018-2019, Director: Ana Belén FernándezObjetivo: Evaluar la efectividad de la técnica del Biofeedback mediante el test de expulsión de balón, en pacientes con estreñimiento funcional. Ámbito del estudio: Unidad de pruebas Funcionales Digestivas del Hospital Vall d’Hebrón. Metodología: Estudio cuantitativo cuasi-experimental longitudinal, prospectivo. Sujetos de estudio: Pacientes de la Unidad de Pruebas Funcionales del Hospital Vall d’Hebrón, con diagnóstico de estreñimiento funcional, que cumplan los criterios de inclusión. Muestra: Se utilizará la técnica de muestreo no probabilístico por conveniencia. Implicaciones para la práctica: El estreñimiento es un problema importante no solo por su prevalencia sino también por sus repercusiones personales, sociales, laborales y económicas. Los gastos de asistencia sanitaria y tratamiento del estreñimiento son muy significativos. Una de las metas más importantes, es dar a conocer el papel destacado, de la enfermera en esta unidad, con una de las técnicas que aplicamos y que ayudan a mejorar la calidad de vida de un gran porcentaje de pacientes

Evolución de la mortalidad infantil, neonatal y postneonatal en Andalucía, 1975-1998

Fundamento: La mortalidad infantil, y sus componentes neonatal y postneonatal, son importantes indicadores de salud, lo cual justifica su análisis periódico incluso en países desarrollados donde sus tasas han descendido considerablemente. El objetivo de este estudio es describir las modificaciones registradas en dichas tasas en Andalucía en el último cuarto de siglo. Métodos: Se han calculado las tasas anuales de mortalidad infantil, neonatal precoz y tardía, así como post-neonatal en 1975-1998. Mediante regresión de Poisson se han estimado los porcentajes anuales de cambio de las tasas en los dos intervalos de 1975-1986 y 1987-1998 así como en el periodo completo 1975-1998. Se ha analizado también la mortalidad proporcional por causas infecciosas, respiratorias, congénitas, afecciones originadas en el periodo perinatal y el resto de causas, así como la razón de tasas de mortalidad por afecciones originadas en el periodo perinatal y para el total de causas, en el quinquenio 1994-98 respecto al quinquenio 1975-79, en los periodos infantil, neonatal (precoz y tardío) y postneonatal. Resultados: Los mayores descensos porcentuales se han producido en la mortalidad neonatal precoz (6,38%) y tardía (4,6%). La razón de tasas de mortalidad por afecciones originadas en el periodo perinatal entre 1994-98 y 1975-79 es 10 para la mortalidad postneonatal mientras que es inferior a 1 para la mortalidad neonatal tardía (0,63), precoz (0,33) e infantil (0,30). Conclusiones: La mortalidad en los periodos infantil, neonatal precoz, tardío y post-neonatal ha descendido acusadamente entre 1975 y 1998. El riesgo de fallecer por afecciones originadas en el periodo perinatal de los niños con más de 4 semanas y menos de 1 año de vida (periodo postneonatal) se ha multiplicado por diez entre 1975-79 y 1994-98

Evolución de la mortalidad por accidentes infantiles y su distribución geográfica en España (1975-1994)

Fundamentos: En los países desarrollados los accidentes infantiles ocupan los primeros lugares como causa de mortalidad. El objetivo de este trabajo es describir su evolución en España desde 1975 a 1994, así como su distribución por Comunidades Autónomas. Método: Con las defunciones por accidentes y las poblaciones de España y sus Comunidades Autónomas de 1 a 14 años de las estadísticas oficiales de mortalidad se han calculado los siguientes indicadores: porcentajes sobre el total de defunciones, tasas brutas de mortalidad, tasas ajustadas por edad, tasas específicas por grupos de edad y riesgos relativos. Estos indicadores han sido calculados por género, año de defunción y Comunidad Autónoma. Resultados: Entre 1975 y 1994 se ha reducido la mortalidad por accidentes infantiles en España, en un 3% anual en las niñas y en un 3,5% en los niños. La razón niños/niñas se ha mantenido alrededor de 2. Los accidentes de tráfico han supuesto en torno al 50%. Aragón presentaba el riego relativo más bajo tanto en niñas como en niños, con 0,54 y 0,57 respectivamente, y Galicia el más alto con 1,73 en niñas y 1,91 en niños. El porcentaje sobre el total de defunciones infantiles fue muy variable entre las Comunidades Autónomas, mientras que el porcentaje de accidentes de tráfico estuvo alrededor del 50% en todas las Comunidades Autónomas. Conclusiones: En España la mortalidad por accidentes infantiles ha descendido de una manera notable, en la actualidad se estima que los niños mueren un 50% menos que en 1975. La distribución por Comunidades Autónomas presenta grandes diferencias

Conditioning by a Previous Experience Impairs the Rewarding Value of a Comfort Meal

Pavlovian conditioning; Digestive well-being; Eating behaviourCondicionamiento pavloviano; Bienestar digestivo; Conducta alimentariaCondicionament pavlovià; Benestar digestiu; Conducta alimentàriaBackground. Meal ingestion induces a postprandial experience that involves homeostatic and hedonic sensations. Our aim was to determine the effect of aversive conditioning on the postprandial reward of a comfort meal. Methods: A sham-controlled, randomised, parallel, single-blind study was performed on 12 healthy women (6 per group). A comfort meal was tested before and after coupling the meal with an aversive sensation (conditioning intervention), induced by infusion of lipids via a thin naso-duodenal catheter; in the pre- and post-conditioning tests and in the control group, a sham infusion was performed. Participants were instructed that two recipes of a tasty humus would be tested; however, the same meal was administered with a colour additive in the conditioning and post-conditioning tests. Digestive well-being (primary outcome) was measured every 10 min before and 60 min after ingestion using graded scales. Results: In the aversive conditioning group, the comfort meal in the pre-conditioning test induced a pleasant postprandial experience, which was significantly lower in the post-conditioning test; the effect of aversive conditioning (change from pre- to post-conditioning) was significant as compared to sham conditioning in the control group, which showed no differences between study days. Conclusion: The hedonic postprandial response to a comfort meal in healthy women is impaired by aversive conditioning. ClinicalTrials.gov ID: NCT04938934.The present study was supported in part by the Ministerio de Ciencia e Innovación (Agencia Estatal de Investigación, PID2021-122295OB-I00). Ciberehd is funded by the Instituto de Salud Carlos III. D.M.L received support from the Israeli Medical Association and from the Israel Gastroenterological Association

Reversal of Conditioned Food Aversion Using a Cognitive Intervention : A Sham-Controlled, Randomized, Parallel Study

Background: Aversive conditioning weakens the gratifying value of a comfort meal. The aim was to determine the effect of a cognitive intervention to reverse aversive conditioning and restore hedonic postprandial response. Methods: This was a randomized, sham-controlled, single-blind, parallel study that was conducted on 12 healthy women (n = 6 in each group). The reward value of a comfort meal was measured on different days: at initial exposure, after aversive conditioning (administration of the same meal with a masked fat overload on the previous day) and after a cognitive intervention (disclosing the aversive conditioning paradigm in the test group vs. no explanation in the control group). The primary outcome, digestive wellbeing, was determined using graded scales at regular intervals before and after ingestion. Results: At initial exposure, the comfort meal produced a rewarding experience that was impaired using aversive conditioning; upon re-exposure to the original meal, the cognitive intervention increased meal wanting and liking; improved digestive wellbeing and mood; tended to reduce postprandial satiety, bloating/fullness; and abolished discomfort/pain, thereby restoring the hedonic value of the comfort meal. By contrast, sham intervention had no effects, and the postprandial sensations remained like the responses to the offending meal. Conclusion: In this proof-of-concept study, we demonstrate that in healthy women, a mild, short-term acquired aversion to a comfort meal can be reversed using a cognitive intervention

Influence of eating schedule on the postprandial response : Gender differences

This work was supported in part by the Spanish Ministry of Economy and Competitiveness. Ciberehd is funded by the Instituto de Salud Carlos III. The research leading to these results has received funding from the People Programme of the EU's 7th Framework Programme under REA grant agreement no. 607652 (ITN NeuroGut). Dr Monrroy was supported by a grant from Pontificia Universidad Católica de Chile.Ingestion of a meal induces conscious sensations depending of the characteristics of the meal and the predisposition of the eater. We hypothesized that the eating schedule plays a conditioning role, specifically, that an extemporaneous meal is less rewarding than when eaten at the habitual schedule. We conducted a randomized parallel trial in 10 women and 10 men comparing the responses to a consistent savoury lunch-type meal (stewed beans) eaten at the habitual afternoon schedule or at an unconventional time in the morning. Schedule and gender differences were analyzed by repeated measures analysis of covariance. In women, the sensory experience induced by the probe meal, particularly postprandial satisfaction, was weaker when eaten at an unconventional time for breakfast. Men were resilient to the schedule effect and experienced the same sensations regardless of the timing of ingestion; the effect of the eating schedule was significantly more pronounced in women for fullness (F(1,55) = 14.9; p < 0.001), digestive well-being (F(1,36.8) = 22.3; p < 0.001), mood (F(1,12.4) = 13.8; p < 0.001), and anxiety (F(1,11.9) = 10.9; p = 0.001). No differences in the physiological responses induced by the afternoon and morning meals were detected either in women or men. Our data indicate that women are more susceptible to changes in meal schedule than men

Meal enjoyment and tolerance in women and men

Various conditioning factors influence the sensory response to a meal (inducible factors). We hypothesized that inherent characteristics of the eater (constitutive factors) also play a role. The aim of this proof-of-concept study was to determine the role of gender, as an individual constitutive factor, on the meal-related experience. Randomized parallel trial in 10 women and 10 men, comparing the sensations before, during, and after stepwise ingestion of a comfort meal up to full satiation. Comparisons were performed by repeated Analysis of Covariance (ANCOVA) measures. During stepwise ingestion, satisfaction initially increased up to a peak, and later decreased down to a nadir at the point of full satiation. Interestingly, the amount of food consumed at the well-being peak was lower, and induced significantly less fullness in women than in men. Hence, men required a larger meal load and stronger homeostatic sensations to achieve satisfaction. The same pattern was observed at the level of full satiation: men ate more and still experienced positive well-being, whereas in women, well-being scores dropped below pre-meal level. The effect of gender on the ingestion experience suggests that other constitutive factors of the eater may also influence responses to meals

Acute Stress Regulates Sex-Related Molecular Responses in the Human Jejunal Mucosa: Implications for Irritable Bowel Syndrome

Estrés agudo; Barrera intestinal; SexoEstrès agut; Barrera intestinal; SexeCute stress; Intestinal barrier; SexIrritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder linked to intestinal barrier dysfunction and life stress. We have previously reported that female sex per se determines an increased susceptibility to intestinal barrier dysfunction after cold pain stress (CPS). We aimed to identify sex-related molecular differences in response to CPS in healthy subjects to understand the origin of sex bias predominance in IBS. In 13 healthy males and 21 females, two consecutive jejunal biopsies were obtained using Watson’s capsule, at baseline, and ninety minutes after CPS. Total mucosal RNA and protein were isolated from jejunal biopsies. Expression of genes related to epithelial barrier (CLDN1, CLDN2, OCLN, ZO-1, and ZO-3), mast cell (MC) activation (TPSAB1, SERPINA1), and the glucocorticoid receptor (NR3C1) were analyzed using RT-qPCR. NR3C1, ZO-1 and OCLN protein expression were evaluated through immunohistochemistry and western blot, and mucosal inflammation through MC, lymphocyte, and eosinophil numbering. Autonomic, hormonal, and psychological responses to CPS were monitored. We found an increase in jejunal MCs, a reduced CLDN1 and OCLN expression, and an increased CLDN2 and SERPINA1 expression 90 min after CPS. We also found a significant decrease in ZO-1, OCLN, and NR3C1 gene expression, and a decrease in OCLN protein expression only in females, when compared to males. CPS induced a significant increase in blood pressure, plasma cortisol and ACTH, and subjective stress perception in all participants. Specific and independent sex-related molecular responses in epithelial barrier regulation are unraveled by acute stress in the jejunum of healthy subjects and may partially explain female predominance in IBS.Supported in part by Fondo Europeo de Desarrollo Regional (FEDER), Fondo de Investigación Sanitaria and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Subdirección General de Investigación Sanitaria, Ministerio de Economiá y Competitividad: CM08/00229 (BL); CM10/00155 (MP); EII2011-0035, CD15/00010, and MV17-00043 (BKRJ.); FI12/00254 (ESR.), PI17/0190 (JS), PI12/00314 and PI15/00301 (CAC), CIBEREHD CB06/04/0021 (JS, CAC.); Vall d’Hebron Institut de Recerca, Programa de becas predoctorales Amics de Vall d’Hebron: PRED-VHIR-2014-018 (MF), PRED-VHIR-2016-53 34 (CPC.)

Mucosal Plasma Cell Activation and Proximity to Nerve Fibres Are Associated with Glycocalyx Reduction in Diarrhoea-Predominant Irritable Bowel Syndrome: Jejunal Barrier Alterations Underlying Clinical Manifestations

Intestinal barrier dysfunction; Intestinal glycocalyx; Mucosal nerve fibresDisfunción de la barrera intestinal; Glicocálix intestinal; Fibras nerviosas de la mucosaDisfunció de la barrera intestinal; Glicocàlix intestinal; Fibres nervioses de la mucosaIrritable bowel syndrome (IBS) is a disorder of brain-gut interaction characterised by abdominal pain and changes in bowel habits. In the diarrhoea subtype (IBS-D), altered epithelial barrier and mucosal immune activation are associated with clinical manifestations. We aimed to further evaluate plasma cells and epithelial integrity to gain understanding of IBS-D pathophysiology. One mucosal jejunal biopsy and one stool sample were obtained from healthy controls and IBS-D patients. Gastrointestinal symptoms, stress, and depression scores were recorded. In the jejunal mucosa, RNAseq and gene set enrichment analyses were performed. A morphometric analysis by electron microscopy quantified plasma cell activation and proximity to enteric nerves and glycocalyx thickness. Immunoglobulins concentration was assessed in the stool. IBS-D patients showed differential expression of humoral pathways compared to controls. Activation and proximity of plasma cells to nerves and IgG concentration were also higher in IBS-D. Glycocalyx thickness was lower in IBS-D compared to controls, and this reduction correlated with plasma cell activation, proximity to nerves, and clinical symptoms. These results support humoral activity and loss of epithelial integrity as important contributors to gut dysfunction and clinical manifestations in IBS-D. Additional studies are needed to identify the triggers of these alterations to better define IBS-D pathophysiology.This study was funded in part by Fondo Europeo de Desarrollo Regional (FEDER), Fondo de Investigación Sanitaria and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Subdirección General de Investigación Sanitaria, Ministerio de Economía y Competitividad: CP18/00116 (C.M.), PI19/01643 (B.L.); PI17/01443 (D.G.); PI15/00301 (C.A.-C.), PI17/0190 (J.S.), PI19/01643 & CPII16/00031, (M.V.); CIBEREHD CB06/04/0021 (F.A., C.A.-C., J.S., M.V.); Ministerio de Educación, Dirección General de Investigación: SAF 2016-76648-R (F.A.); Agència de Gestió d’Ajuts Universitaris i de Recerca, de la Generalitat de Catalunya: 2014 SGR 1285 (F.A.); Vall d’Hebron Institut de Recerca, Programa de becas predoctorales Amics de Vall d’Hebron: PRED-VHIR-2016-34 (C.P.-C.), PRED-VHIR-2014-018 (M.F.), the Swedish Research Council dnr 2019-00653 (J.-P.G.M.), and the European Union’s Horizon research and innovation programme 2020, grant no. 848228 (E.E., A.R.-U., B.L., C.A.-C., J.S.)