EL TRASTORNO LÍMITE DE PERSONALIDAD: LA FILOSOFÍA DIALÉCTICA COMO BASE DE LA INTERACCIÓN ENFERMERO PACIENTE

Borderline personality disorder was defined in the nineteenth century as the boundary between psychosis and neurosis. It has three major clinical components: a shaky sense of self, a high level of impulsivity and high affective instability. Due in part to the lack of knowledge of the underlying dynamics, working with patients with BPD is often difficult for nursing staff. The present study aims to propose guidelines that encourage interactive psychotherapy in the care of patients with this disorder. To this objective we conducted a bibliographic search in Nursing and other health science databases (Cochrane, Tripdatabase, Medline, CINAHL and care), using Mesh descriptors: "Borderline personality disorder" AND "therapy" and “Borderline Personality" AND "nursing cares", indexed from 01/01/2000, finally selecting a total of 17 studies for their relevance and relationship to the subject under study. Based on the results, we suggest the use of dialectical philosophy, the basis of dialectical-behavioral therapy developed by Marsha Linehan, a tool that will lead to a better nurse-patient relationship, greater adherence to treatment and greater efficiency in managing time and resources. El trastorno límite de personalidad fue definido ya en el siglo XIX, como límite entre la psicosis y la neurosis. Presenta tres componentes clínicos principales: un inestable sentido del yo, un alto nivel de impulsividad y una elevada inestabilidad afectiva . Debido en parte, a la falta de conocimiento de la dinámica subyacente, el trabajo con pacientes con TLP resulta a menudo difícil para el personal de Enfermería.El presente estudio tiene por objeto proponer orientaciones psicoterapéuticas que favorezcan la interacción en el cuidado de pacientes con este trastorno. Para este fin se lleva a cabo una búsqueda bibliográfica en las principales basos de datos de Enfermería y del resto de ciencias de la salud (Cochrane, Tripdatabase, Medline, CINAHL y CUIDEN), empleando los descriptores Mesh: “Borderline personality disorder” AND “therapy” y“Borderline personality” AND “nursing cares”, indexados a partir del 01/01/2000, seleccionando finalmente un total de 17 estudios por su relevancia y relación con el tema.Atendiendo a los resultados obtenidos, proponemos el empleo de la filosofía dialéctica, base de la terapia dialéctico-comportamental desarrollada por Marsha Linehan, como herramienta que va a conducir a una mejor relación enfermero-paciente, una mayor adherencia al tratamiento y una mayor eficiencia en la gestión de tiempo y recursos

Demethylation of the Coding Region Triggers the Activation of the Human Testis-Specific PDHA2 Gene in Somatic Tissues

Human PDHA2 is a testis-specific gene that codes for the E1α subunit of Pyruvate Dehydrogenase Complex (PDC), a crucial enzyme system in cell energy metabolism. Since activation of the PDHA2 gene in somatic cells could be a new therapeutic approach for PDC deficiency, we aimed to identify the regulatory mechanisms underlying the human PDHA2 gene expression. Functional deletion studies revealed that the −122 to −6 promoter region is indispensable for basal expression of this TATA-less promoter, and suggested a role of an epigenetic program in the control of PDHA2 gene expression. Indeed, treatment of SH-SY5Y cells with the hypomethylating agent 5-Aza-2′-deoxycytidine (DAC) promoted the reactivation of the PDHA2 gene, by inducing the recruitment of the RNA polymerase II to the proximal promoter region and the consequent increase in PDHA2 mRNA levels. Bisulfite sequencing analysis revealed that DAC treatment induced a significant demethylation of the CpG island II (nucleotides +197 to +460) in PDHA2 coding region, while the promoter region remained highly methylated. Taken together with our previous results that show an in vivo correlation between PDHA2 expression and the demethylation of the CpG island II in testis germ cells, the present results show that internal methylation of the PDHA2 gene plays a part in its repression in somatic cells. In conclusion, our data support the novel finding that methylation of the PDHA2 coding region can inhibit gene transcription. This represents a key mechanism for absence of PDHA2 expression in somatic cells and a target for PDC therapy

Environmental benchmarking of building typologies through BIM-based combinatorial case studies

Integrated life-cycle assessment (LCA) tools have emerged as decision-making support for BIM practitioners during the design stage of sustainable projects. However, differences between methodologies applied for determining the environmental impact of buildings produce significant variations in the results obtained, making them difficult to be compared. In this study, a methodology is defined for generating environmental benchmarks for building typologies through a combination of BIM-based LCA tools and machine learning techniques. When applied to an 11-story residential building typology with 92 dwellings by varying the constructive solutions of façades, partitions, roof and thermal insulation materials, results fall within a range from 360 to 430 kgCO2eq/m2. The Random Forest (RF) algorithm is successfully applied for identifying the most decisive variables in the analysis (partitions and façades), and shows signs of being useful for predicting the environmental impact of future constructions and to be applied to the analysis of greater scale urban zones. © 2021 The Author

Condicionantes de acceso a nuevos medicamentos dermatológicos en España: resultados del proyecto EQUIDAD

Resumen: Antecedentes: En España, aunque el Ministerio de Sanidad elabora el informe de posicionamiento terapéutico (IPT) y las condiciones de reembolso de los fármacos, las Comunidades Autónomas (CC. AA.) gestionan los servicios de salud y deciden sobre las condiciones de prescripción en su ámbito territorial. El objetivo del estudio EQUIDAD fue describir los condicionantes para la prescripción de los nuevos fármacos en Dermatología en las CC. AA. y sus posibles diferencias. Material y métodos: Estudio transversal realizado en abril-mayo del 2023. Dos dermatólogos con responsabilidades directivas de cada Comunidad Autónoma (C. A.) informaron sobre los condicionantes autonómicos y locales en la prescripción de los fármacos cuyo IPT para el tratamiento de enfermedades dermatológicas fue publicado en los años 2016-2022. Los datos fueron recogidos mediante un cuestionario online. Resultados: Un total de 33 investigadores de 17 CC. AA. participaron en el estudio. Se observaron inequidades entre CC. AA. para el acceso a los nuevos fármacos. Existieron condicionantes autonómicos adicionales al IPT en psoriasis en el 64,7% de las CC. AA., siendo este porcentaje menor en dermatitis atópica (35,3%) o melanoma (11,8%). El más frecuente fue el requisito de un orden de prescripción previo para el uso del fármaco. En algunas CC. AA. se detectaron además variaciones y condicionantes locales (diferencias entre centros de una misma C. A.). Conclusiones: Existe una multiplicidad de criterios tanto a nivel autonómico como local que añade restricciones adicionales a las establecidas por los IPT y que plantean una situación de inequidad entre los pacientes y los profesionales de las diferentes CC. AA. en el acceso a los nuevos fármacos. Abstract: Background: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. Material and methods: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. Results: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected atthe local level (i.e., differences between hospitals within the same autonomous community). Conclusions: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain