La capacidad de los pacientes para tomar decisiones: una tarea todavía pendiente.

La evaluación de la capacidad constituye un reto abierto para el modelo de relación clínica basado en la idea de consentimiento informado

La psiquiatría y la salud mental en el tardofranquismo: las misiones de los expertos de la OMS y la labor del PANAP

Revisamos el inicio de los programas de asistencia técnica de la OrganizaciónMundial de la Salud (OMS) relacionados con la salud mental que, desde mediadosde los años 60, se llevaron a cabo en España, en colaboración con la Dirección Generalde Sanidad (DGS) y el Patronato Nacional de Asistencia Psiquiátrica (PANAP), organismovinculado a la DGS. El trabajo utiliza como fuentes fundamentales informes inéditos deexpertos de la OMS, resultado de visitas y misiones realizadas a España entre 1965 y1975. El PANAP y la DGS tuvieron un cambio en sus orientaciones a partir de 1964, en elcontexto del tardofranquismo, orientando sus acciones y esfuerzos hacia una aproximaciónpsicosocial y salubrista, muy alineadas con las políticas de la OMS en salud mental.Asimismo, hay que destacar toda la labor de formación/propaganda/divulgación sanitariaa través de libros, revistas (Salud Mental), publicaciones (Cuadernos para la Educación enSalud Mental) y documentales en cine y televisión (noticiario NO-DO)

Una visión de la asistencia psiquiátrica gallega en el siglo XX: Manuel Cabaleiro Goás.

Sin resumen

Una visión de la asistencia psiquiátrica gallega en el siglo XX: Manuel Cabaleiro Goás.

Sin resumen

Effects of Berberine on the Chondrogenic Differentiation of Embryonic Limb Skeletal Progenitors

Introduction: Berberine (BBR) is an isoquinoline plant alkaloid with demonstrated anti-inflammatory, anti-tumor and immunosuppressive pharmacological properties that functions via multiple signaling pathways and epigenetic modulators. Numerous studies have proposed BBR as a promising therapeutic agent for joint cartilage degeneration, and other connective tissue diseases. Purpose and methods: This work aimed to evaluate the effects of BBR on the growth and differentiation of embryonic skeletal progenitors using the limb mesoderm micromass culture assay. Results: Our findings show that at difference of its apoptotic influence on a variety of tumor tissues, cell death was not induced in skeletal progenitors by the addition of 12 or 25 µM BBR concentration to the culture medium. Morphological and transcriptional analysis revealed dual and opposite effects of BBR treatments on chondrogenesis depending on the stage of differentiation of the cultured progenitors. At early stage of culture, BBR was a potent chondrogenic inhibitor, while chondrogenesis was intensified in treatments at advanced stages of culture. The chondrogenic promoting effect was accompanied by a moderate upregulation of gene markers of prehypertrophic cartilage, including ColXa1, alkaline phosphatase Alpl, Runx2, and Indian Hedgehog Ihh. We further observed a positive transcriptional influence of BBR in the expression of DNA methyltransferase genes, Dnmt1, Dnmt3a and Dnmt3b, suggesting a potential involvement of epigenetic factors in its effects. Conclusion: Our study uncovers a new pharmacological influence of BBR in cartilage differentiation that must be taken into account in designing clinical protocols for its employment in the treatment of cartilage degenerative diseases

Confluence of Cellular Degradation Pathways During Interdigital Tissue Remodeling in Embryonic Tetrapods

Digits develop in the distal part of the embryonic limb primordium as radial prechondrogenic condensations separated by undifferentiated mesoderm. In a short time interval the interdigital mesoderm undergoes massive degeneration to determine the formation of free digits. This fascinating process has often been considered as an altruistic cell suicide that is evolutionarily-regulated in species with different degrees of digit webbing. Initial descriptions of interdigit remodeling considered lysosomes as the primary cause of the degenerative process. However, the functional significance of lysosomes lost interest among researcher and was displaced to a secondary role because the introduction of the term apoptosis. Accumulating evidence in recent decades has revealed that, far from being a unique method of embryonic cell death, apoptosis is only one among several redundant dying mechanisms accounting for the elimination of tissues during embryonic development. Developmental cell senescence has emerged in the last decade as a primary factor implicated in interdigit remodeling. Our review proposes that cell senescence is the biological process identified by vital staining in embryonic models and implicates lysosomes in programmed cell death. We review major structural changes associated with interdigit remodeling that may be driven by cell senescence. Furthermore, the identification of cell senescence lacking tissue degeneration, associated with the maturation of the digit tendons at the same stages of interdigital remodeling, allowed us to distinguish between two functionally distinct types of embryonic cell senescence, "constructive" and "destructive."This work was supported by a grant (BFU2017-84046-P) from the Spanish Science and Innovation Ministry to JM

Infancia, familias e Internet: un enfoque cualitativo sobre activos para la salud

Objective: To explore the views of the Internet in childhood, identifying both health assets and risks. Method: A qualitative study was performed using 14 focus groups, eight of which comprised boys and girls, four of which comprised parents and two of which were mixed (children and parents) in primary schools in urban and rural settings in Andalusia (Spain). Teachers in these schools were also asked to complete an online questionnaire using LimeSurvey. This study involved 114 individuals: 64 pupils (33 girls and 31 boys), 28 parents (18 mothers and 10 fathers), and 22 teachers (14 women and 8 men). Analysis of manifest content and underlying meanings was carried out. QSR NVivo 9 software was used to facilitate analysis and make it systematic. Results: Our findings show how the differences in the way parents and children understand health and wellbeing affect the way they discuss the Internet and health. The discussion of results looks at the implications of computer literacy for public health and wellbeing, particularly with regard to health assets. Conclusions: Parents and children understand the contribution of the Internet to health and wellbeing differently. Whilst parents emphasize the risks (unsafe environment, relationships and quality of information, social networks, physical problems and addiction), the children emphasize the assets offered by the Internet.Objetivo: Explorar la visión de Internet en la infancia, identificando riesgos y activos para la salud. Método: Estudio cualitativo con 14 grupos focales: ocho con niños y niñas, cuatro con familias y dos mixtos con niños/as y familias en centros de educación primaria de los ámbitos rural y urbano en Andalucía (España). También se aplicó un cuestionario on-line al profesorado de los centros educativos. En total participaron 114 personas (33 chicas y 31 chicos; 18 madres y 10 padres; 14 maestras y 8 maestros). Se llevó a cabo un análisis de contenido manifiesto y contenido latente, utilizando el software QSR NVivo 9 para facilitar dicho análisis y hacerlo más sistemático. Resultados: Los resultados ponen de manifiesto cómo la forma diferencial de entender la salud y el bienestar entre padres/madres e hijos/as influye en la orientación de los discursos sobre Internet y salud. Los resultados son discutidos ampliando el debate existente en torno a las implicaciones en salud pública de la alfabetización digital y su conexión con el enfoque de activos para la salud. Conclusión: Las familias y la infancia entienden la contribución de Internet a la salud y al bienestar de manera muy diferente. Mientras los padres y las madres enfatizan los riesgos (ambiente inseguro, relaciones y calidad de la información, redes sociales, problemas físicos y adicciones), los/las niños/as se centran en enfatizar las potencialidades de Internet, descritas como activos.The study was financial support by the Andalusian Government’s Health Department

Cell death in the developing vertebrate limb: A locally regulated mechanism contributing to musculoskeletal tissue morphogenesis and differentiation

Our aim is to critically review current knowledge of the function and regulation of cell death in the developing limb. We provide a detailed, but short, overview of the areas of cell death observed in the developing limb, establishing their function in morphogenesis and structural development of limb tissues. We will examine the functions of this process in the formation and growth of the limb primordia, formation of cartilaginous skeleton, formation of synovial joints, and establishment of muscle bellies, tendons, and entheses. We will analyze the plasticity of the cell death program by focusing on the developmental potential of progenitors prior to death. Considering the prolonged plasticity of progenitors to escape from the death process, we will discuss a new biological perspective that explains cell death: this process, rather than secondary to a specific genetic program, is a consequence of the tissue building strategy employed by the embryo based on the formation of scaffolds that disintegrate once their associated neighboring structures differentiate.Spanish Science and Innovation Ministry, Grant/Award Numbers: BFU2017-84046-P, BES-2015-07426