Traductor

19 December 2011

Midwives use rituals to send message that women's bodies know best

In reaction to what midwives view as the overly medicalized way hospitals deliver babies, they have created birthing rituals to send the message that women's bodies know best. The midwife experience uses these rituals to send the message that home birth is about female empowerment, strengthening relationships between family and friends, and facilitating participatory experiences that put mothers in control, with the ultimate goal of safe and healthy deliveries less focused on technological intervention.
These are some of the findings from an Oregon State University researcher and licensed midwife who witnessed more than 400 home births in order to document an extensive list of practices utilized by midwives to express the symbolic difference between home and hospital births.
In a study now online in the journal Medical Anthropology Quarterly, Melissa Cheyney, an assistant professor of medical anthropology at OSU, charted specific rituals used by midwives. In addition to witnessing and documenting home deliveries, she also conducted more than 50 in-depth interviews with midwives and their clients.
"This is about invoking the mind-body connection," Cheyney said. "We know, for instance, that midwives have better health outcomes in some areas, such as reduced rates of surgical delivery and labor induction, than hospitals. But I wanted to examine how ritual might play a part in producing these positive health outcomes."
Cheyney said evidence shows that hospital births result in about triple the rate of cesarean section for low-risk women compared to midwife-attended home births. Because of her unique role as both a researcher and midwife, Cheyney was able to gain access to hundreds of home births in various parts of the United States, and also witnessed more than 60 hospital births.
What she found was a network of common practices, messages and beliefs that resulted in midwives constructing woman-centered rituals around pregnancy and birth that were set up in opposition to what they believe are the overly medicalized practices of hospitals.
For instance, Cheyney found that midwives conducted many of the same diagnostic procedures as a physician would prenatally, from blood pressure and weight checks to blood testing and fetal heart tone evaluation. But midwives chose to get the entire family involved, often asking the partner to palpitate along with the midwife or allowing older children to hold the equipment used to listen to fetal heart tones.
"The participatory nature was a key component to creating a ritual that empowers the woman and her family to feel in control," Cheyney said. "Many midwives also downplayed the centrality of monitoring and resuscitation equipment setting them off to the side, or placing them under baby blankets during labor so women would not be reminded of the technology in the room. Mothers and babies were still monitored closely, but the monitoring was not made the central focus."
The differences aren't so much in practice, she argues, but in performance.
Cheyney also documented the use of common phrases to create birthing mantras. She lists phrases such as "don't fight it," "let your body do it," "open," and "let it be strong," as key components to the home birth ritual. Many mothers that Cheyney interviewed reported feeling strong and capable during their labors, and women who compared their hospital birth to their home birth reported feeling like they were "doing something, rather than just lying there passively waiting." Midwives also commonly expressed the statement that they were simply "guardians," and that women have all the tools inside of them to birth their own babies.

**Source: Oregon State University

UCSF-led team discovers cause of rare disease



A large, international team of researchers led by scientists at the University of California, San Francisco (UCSF) has identified the gene that causes a rare childhood neurological disorder called PKD/IC, or "paroxysmal kinesigenic dyskinesia with infantile convulsions," a cause of epilepsy in babies and movement disorders in older children. The study involved clinics in cities as far flung as Tokyo, New York, London and Istanbul and may improve the ability of doctors to diagnose PKD/IC, and it may shed light on other movement disorders, like Parkinson's disease.
The culprit behind the disease turns out to be a mysterious gene found in the brain called PRRT2. Nobody knows what this gene does, and it bears little resemblance to anything else in the human genome.
"This is both exciting and a little bit scary," said Louis Ptacek, MD, who led the research. The John C. Coleman Distinguished Professor of Neurology at UCSF and a Howard Hughes Medical Institute Investigator, Ptacek is a professor in the Department of Neurology, which seeks to discover the causes of human nervous system disorders and improve treatment options for patients by applying state-of-the-art translational research methods and engaging in collaborations with colleagues around the globe.
Discovering the gene that causes PKD/IC will help researchers understand how the disease works. It gives doctors a potential new way of definitively diagnosing the disease by looking for genetic mutations in the gene. The work may also shed light on other conditions that are characterized by movement disorders, including possibly Parkinson's disease.
"Understanding the underlying biology of this disease is absolutely going to help us understand movement disorders in general," said Ptacek.
Disease Strikes Infants with Epileptic Seizures
PKD/IC strikes infants with epileptic seizures that generally disappear within a year or two. However, the disease often reemerges later in childhood as a movement disorder in which children suffer sudden, startling, involuntary jerks when they start to move. Even thinking about moving is enough to cause some of these children to jerk involuntarily.
The disease is rare, and Ptacek estimates strikes about one out of every 100,000 people in the United States. At the same time, the disease is classified as "idiopathic" -- which is just another way of saying we don't really understand it, Ptacek said.
If you take an image of the brain by MRI, patients with the disease all look completely normal. There are no injuries, tumors or other obvious signs that account for the movements -- as is often the case with movement disorders. Work with patients in the clinic had suggested a genetic cause, however.
"Sometimes we trace the family tree, and lo and behold, there is a history of it," said Ptacek. In the last several years, he and his colleagues have developed a large cohort of patients whose families have a history of the disease.
The new research was based on a cohort of 103 such families that included one or more members with the disease. Genetic testing of these families led to the researchers to mutations in the PRRT2 gene, which cause the proteins the gene encodes to shorten or disappear entirely in the brain and spinal cord, where they normally reside.
One possible explanation for the resulting neurological symptoms, the researchers found, relates to a loss of neuronal regulation. When the genetic mutations cause the gene products to go missing, the nerve cells where they normally appear may become overly excited, firing too frequently or strongly and leading to the involuntary movements.


Penicillin doses for children should be reviewed, say UK experts

A team of scientists and clinicians, led by researchers at King's College London and St George's, University of London, are calling for a review of penicillin dosing guidelines for children, that have remained unchanged for nearly 50 years. The call comes as a study published in the British Medical Journal indicates some children may not be receiving effective doses, which could potentially lead to failed treatment and contribute to antibiotic resistance.
Oral penicillins (such as amoxicillin) account for nearly 4.5 million of the total 6 million annual prescriptions for antibiotics given to treat childhood bacterial infections each year in the UK.
Current dosing guidelines for penicillin are provided by the British National Formulary for Children (BNFC) and are mainly based on age bands. The doses given have not changed in almost 50 years. But the dose of penicillin needed is determined by a child's weight, and the guidelines have not taken into account the increase in the average weight of children over time. The experts say reviewing these guidelines is essential, to ensure all children who require penicillin are receiving effective doses.
The review was led by Dr Paul Long from the Institute of Pharmaceutical Science at King's College London and Professor Mike Sharland at St George's, University of London on behalf of the improving Children's Antibiotic Prescribing Research Network (iCAP).
The team carried out a literature review of evidence, including all the historic archives of the Royal Pharmaceutical Society and the British Medical Association, to understand the origins of the current dosing guidelines. They found that prescribing based on age bands had first been suggested in the early 1950s, based on the results of oral dosing studies. Following these findings, a general recommendation to use age banding for all antibiotics in children was published in the BMJ in 1963, and these same recommendations remain in use today.
The researchers found that the age band guidelines set in 1963 were accompanied by average weights, and doses are based on fractions of the widely used adult doses. The BNFC structured dosing bands are: birth to 1 year (10kg); 2 years (13kg); 5 years (18kg); and 10 years (30kg). However, according to the Health Survey for England 2009, the average weight today of a 5 year old is 21kg and a 10 year old is 37kg, indicating that average weights today are up to twenty percent higher than in 1963.
Under-dosing is potentially a problem for children, as this could lead to sub-therapeutic concentrations.
The researchers also noted that adult penicillin recommendations have been re-evaluated taking modern weights into consideration, and penicillin doses have consequently increased. But UK recommendations for children have not been reassessed in the same way.
Dr Paul Long, Senior Lecturer in Pharmacognosy at King's College London, said: 'We were surprised at the lack of evidence to support the current oral penicillins dosing recommendations for children, as it is such a commonly used drug. Children's average size and weight are slowly but significantly changing, so what may have been adequate doses of penicillin 50 years ago are potentially not enough today.
'It is important to point out that this study does not provide any clinical evidence that children are receiving sub-optimal penicillin doses that lead to harm, and we want to reassure parents of that. But what we are saying is that we should ensure that children with severe infections who need these antibiotics the most are still receiving an effective dose.
'In the long-term we are concerned that under-dosing could lead to penicillin-resistance in both individuals and wider communities, which is a very serious issue, given the number of prescriptions of this medicine given every year for common childhood infections.
'If we want to be sure that we are treating childhood bacterial infections effectively, the evidence base behind these prescribing guidelines needs to be improved, and the recommended doses reviewed accordingly.'
Professor Mike Sharland from St George's, University of London, and co-author of the study said: 'Although there is now a very formal process of determining the right dose for new drugs being licensed for use in children, we also need to check more carefully that the guidelines are still correct for older drugs that have been used for a long time. We are not saying the current doses are wrong or unsafe and parents should always give the medicine at the doses prescribed by their GP. We are saying that we need to develop a clearer system to check the doses used for older medicines.'
Simon Keady, Royal Pharmaceutical Society spokesperson on children's medicines, said: 'This research and its outcomes clearly demonstrates the importance of continued work in the field of paediatrics as further evidence and experience is gathered. The use of penicillins over many years for a wide variety of conditions should not stop us from continuing to identify the most appropriate dose which gives us the most effective outcomes. The work clearly shows that the focus should not always be about new drugs but also looking at where we have historically centred dosing around age bands.'
NICE (National Institute for Health and Clinical Excellence) guidance on Upper Respiratory Tract Infections (URTIs) suggests that the majority of minor URTI's in children are viral and will resolve on their own without the need for antibiotics. Therefore, the authors also suggest that not only do the effective doses for children of all ages and weights need to be determined, but there is the need to target more clearly which children will really benefit most from antibiotics.

*Source: King's College London

Los científicos de la XXV campaña en la Antártida estudiarán los efectos antitumorales de la naturaleza austral

¿Pueden las estrellas de mar de la Antártida curar el cáncer? ¿Qué lecciones vulcanológicas podemos extraer de Isla Decepción para casos como El Hierro? ¿Qué hay del cambio climático? Estas serán algunas de las preguntas que hasta el próximo mes de abril tratarán de responderse los 150 investigadores y técnicos militares y civiles que integran la Campaña Antártica Española 2011-2012, que cumple su XXV edición.
Entre los proyectos que desarrollarán los investigadores destaca el «Actiquim-II», que establecerá el potencial farmacológico de determinados compuestos antitumorales. Desarrollado por la Facultad de Biología de la Universidad de Barcelona, tiene entre los objetivos «describir nuevos productos naturales y evaluar su actividad antitumoral y antiinflamatoria a partir de muestras tomadas mediante buceo en los alrededores de las dos bases españolas», explica Margarita Yela, del área de investigación polar del Ministerio de Ciencia e Innovación que, con el apoyo de Defensa, destina este año siete millones de euros a la Campaña Antártica, que involucrará en 16 proyectos a 20 instituciones científicas.
«Si los productos naturales de la Antártida tienen ese papel antitumoral habrá que tratar de sintetizarlos para poder utilizarlos», explica Yela.
La apertura de las bases antárticas españolas «Juan Carlos I» y «Gabriel de Castilla» ha supuesto todo un desafío logístico y de coordinación para transportar a la Antártida unas 20 toneladas de material científico y 40 toneladas de material técnico para renovar y mejorar las instalaciones.

-Experiencias en El Hierro
«Para nosotros es un orgullo colaborar con los científicos para que España sea más reconocida en el mundo de la investigación», comenta el jefe de división de Operaciones del Ejército de Tierra, general de brigada Fernando Alejandre. La Armada participa también en la campaña con los buques de investigación oceanográfica «Hespérides» y Las Palmas».
Serán cuatro meses aislados, a 13.000 kilómetros de España, en un entorno con sensaciones térmicas por debajo de -30ºC, un escenario ideal para lo que en el argot militar se conoce como «lecciones aprendidas» trasladables también al ámbito civil. De este modo se avanzará en campos, como el de la vulcanología y sismología, un ámbito que ya exploraron los investigadores españoles que se encuentran actualmente en la isla de El Hierro, siguiendo la evolución de los acontecimientos que allí se están produciendo.
El cambio climático y su impacto sobre los ecosistemas, la oceanografía o el impacto de la actividad humana en el continente antártico serán otros campos de actuación de la presente campaña.

**Publicado en "ABC"

18 December 2011

El INGESA presenta en Ceuta una guía práctica de bioestadística aplicada a las ciencias sociales

El Área Sanitaria de Ceuta ha presentado en el H. Universitario, la "Guía Práctica del Curso de Bioestadística Aplicada a las Ciencias de la Salud", publicada por los Servicios Centrales del Instituto Nacional de Gestión Sanitaria, INGESA. Se trata de una herramienta de apoyo formativo y de investigación de los profesionales sanitarios.
El doctor Jacobo Díaz Portillo, especialista en análisis clínicos del citado centro ceutí y autor de la publicación, explica que la razón de ser de esta guía es la de aunar las herramientas estadísticas que debe contemplar toda investigación del ámbito de las ciencias de la salud. "La medicina es una ciencia estadística, pues siempre trabaja con la probabilidad de enfermar y con la oportunidad incierta del diagnóstico y del tratamiento. El médico debe adecuar sus conocimientos científicos y tecnológicos a la situación clínica del paciente del que se ocupa en ese momento, ya que no existen enfermedades sino enfermos", señala.

En su opinión, "el buen juicio médico se basa en el mejor equilibrio posible entre el riesgo que comporta toda intervención diagnóstica y terapéutica y el beneficio esperable de dicho acto médico en el paciente concreto, lo que obliga a combinar ciencia y arte, pues no es fácil trabajar con la incertidumbre; sólo la bioestadística nos proporciona el instrumento adecuado que nos permite convivir con el azar y con las limitaciones del conocimiento médico".

En la presentación de la guía, el doctor Díaz Portillo, estuvo acompañado por el gerente del Área Sanitaria de Ceuta, Juan Carlos Querol, y por el director médico de Atención Especializada, Carlos Ramírez, además, de compañeros y autoridades sanitarias como el consejero de Sanidad y Consumo, Abdelhakim Abdeselam, y gran parte de la directiva del INGESA de Ceuta.

Viajes: Despide el año en un escenario como el “Gran Hotel” de la tele

La serie de televisión “Gran Hotel” hace revivir los buenos tiempos en los grandes hoteles de principios del siglo XX. En este caso, se ha rodado en los exteriores del magnífico Palacio de la Magdalena de Santander. Los mismos arquitectos que hicieron ese palacio son también los autores del Balneario-Hotel Palacio de las Salinas, en Medina del Campo (Valladolid), un singular edificio que cuenta con todas las comodidades y que, por cierto, también ha sido escenario de varias películas.
Totalmente restaurado y equipado, el Balneario-Hotel Palacio de las Salinas está abierto todo el año, y dispone de 64 habitaciones. Todo él ha sido decorado para crear un ambiente cálido, confortable y luminoso. Con más de 5.000 m2 de instalaciones y 80.000 m2 de jardines, ofrece una opción única y completa para el descanso. Las aguas de este espléndido balneario han sido consideradas como las de más fuerte mineralización de Europa.
Se puede disfrutar ahora de sus propiedades en el balneario equipado con las más modernas instalaciones y bajo un estricto control médico especializado.

-Diversas propuestas.
Para los días navideños Palacio de la Salinas tiene varias propuestas para estancias largas o cortas. Por ejemplo del 25 de diciembre al 1 de enero: 8 noches, media pensión (incluida cena de Nochevieja con botella de cava por habitación + comida de Año Nuevo)+Circuito termo-lúdico diario o Tratamiento terapeútico + cosmética de vino en habitación desde 770 euros. Del 30 de diciembre al 1 de enero: 2 noches, media pensión (incluida cena de gala de Nochevieja con botella de cava por habitación + cotillón con pinchadiscos)+Circuito termo- lúdico diario + cosmética de vino en habitación: desde 279 euros por persona.

* Info: tel.: 983 804 450
www.palaciodelassalinas.es

Granada en enero será sede del Congreso de la Sociedad Andaluza de Oftalmología



Bajo del lema “Granada, embrujo a la vista” el 44 Congreso de la Sociedad Andaluza de Oftalmología (SAO) se presenta con un “programa denso, muy preparado y profesional”. Tendrá lugar del 19 al 21 de enero y así lo califica el presidente de la SAO, Dr. Ignacio Vinuesa, quien calcula que la ciudad granadina aglutinará a casi 500 profesionales de la vista (300 médicos y casi 200 enfermeros) ya que a la misma vez se celebra el 15 Congreso Nacional de Enfermería Oftalmológica.
El programa destaca dos de las grandes subespecialidades de la oftalmología: el estrabismo (desviación de un ojo con respecto del otro) y el glaucoma (hipertensión ocular que afecta al nervio óptico). También se abordarán las últimas técnicas de intervenciones con láser: “En este campo es donde hay más novedades”, afirma el Dr. Vinuesa.






-Fuga de cerebros
Uno de los puntos fuertes del programa es la mesa titulada ‘Fuga de cerebros’ coordinada por el Dr. Vinuesa en la que participarán cinco ponentes, todos ellos oftalmólogos andaluces que ejercen en otras comunidades autónomas. Los hay de Madrid, Vigo, Salamanca… “No es que estén mejor considerados fuera, es una cuestión de oportunidades y en Andalucía la oftalmología tiene un gran nivel”, aclara Vinuesa.
Otra novedad del Congreso es la conferencia de clausura ‘La oftalmología desde el punto de vista del paciente’ que impartirá Rafael Martínez Sierra, paciente de Degeneración Macular Asociada a la Edad (DMAE). Se trata de una enfermedad que, aunque no produce dolor, provoca alteraciones en la vista como visión borrosa, aparición de un punto negro en el campo visual o percepción de líneas rectas, por citar los síntomas más frecuentes. “Será muy interesante ya que hablará de la enfermedad desde el punto de vista del enfermo, no del médico”.






-El oftalmólogo de S.M. el Rey Don Juan Carlos
El atractivo del programa radica no sólo en los temas que aborda sino en la calidad y prestigio de los ponentes. Un ejemplo de ello es que uno de los ponentes de la mesa sobre el Glaucoma es el oftalmólogo de Su Majestad el Rey Don Juan Carlos, el profesor Dr. Julián García Sánchez.
Este año está siendo un éxito la presentación de póster por parte de los MIR de oftalmología. A fecha de hoy, hay más de 100 registrados por médicos residentes procedentes no sólo de todas las provincias andaluzas sino que también hay algunos de Castilla La Mancha. Esta cifra supera a la del año pasado, donde no se llegó a presentar ni medio centenar de póster.




*Para más información: http://www.congresosao2012.com/

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