Yale School of Medicine researchers have found that the likelihood of becoming disabled with age increases with the following factors: having a chronic condition or cognitive impairment; low physical activity; slower gross motor coordination; having poor lower-extremity function; and being hospitalized. Women are also more likely than men to become disabled in their later years. Based on 12 years of data, the findings are published in the Jan.17 issue of Annals of Internal Medicine by a research team led by Dr. Thomas Gill, the Humana Foundation Professor of Geriatric Medicine and professor of medicine, epidemiology, and public health at Yale School of Medicine.
With age, many people can no longer walk short distances or drive a car, and those with long-term loss of mobility have difficulty regaining independence.
"Losing the ability to walk independently not only leads to a poorer overall quality of life, but prolonged disability leads to higher rates of illness, death, depression and social isolation," said Gill, who followed a group of 641 people aged 70 or older who could walk a quarter mile unassisted or who were active drivers at the start of the study. All participants could perform essential activities of daily living, such as bathing and dressing.
Gill and his team assessed the participants for changes in potential disability risk factors every 18 months between 1998 and 2008. They also assessed the participants' mobility each month. Those who said they needed help from another person to walk a quarter mile were considered to be walking disabled. Those who said that they had not driven a car during the past month were considered driving disabled.
On a monthly basis, the research team also assessed the participants' exposure to potential causes of disability, including illnesses or injuries leading to hospitalization and restricted activity, which increased the likelihood of long-term disability by 6-fold.
The team found that multiple risk factors, together with subsequent illness and injury leading to hospitalization and restricted activity, are associated with an increased likelihood of developing long-term walking and driving disability. The team considered a disability to be long term if it persisted for at least six months.
"We've learned that targeted strategies are needed to prevent disability among older people living independently in the community," said Gill.
Other authors on the study include Eveleyne A. Gahbauer, M.D.; Terrence E. Murphy; Ling Han, M.D.; and Heather G. Allore.
The National Institute on Aging funded the study, which was conducted at the Yale Pepper Center/Program on Aging.
*Source: Yale University
Diario digital con noticias de actualidad relacionadas con el mundo de la salud. Novedades, encuestas, estudios, informes, entrevistas. Con un sencillo lenguaje dirigido a todo el mundo. Y algunos consejos turísticos para pasarlo bien
Traductor
17 January 2012
La incapacidad para caminar o conducir aumenta el riesgo de muerte según un estudio
Poder caminar sin ayuda del portal de casa a la parada del autobús es una 'sencilla' actividad, pero cuando se trata de personas mayores, el gesto, además de algo más costoso, puede ser la diferencia entre tener una vida social y rica o una de aislamiento y soledad. Una investigación apunta ahora cuáles son las causas más frecuentes de la pérdida o la dificultad de movilidad en la última etapa de la vida.
"La discapacidad a largo plazo para la movilidad comunitaria es el resultado de una combinación de factores predisponentes, que hacen al individuo más vulnerable, y enfermedades o lesiones, que actúan como desencadenantes". Ésta es la principal conclusión del estudio, publicado en 'Annals of Internal Medicine', que ha realizado un seguimiento de 12 años a 641 mayores de 70 años.
A lo largo de ese periodo, el 50% de los participantes pasó de no tener problemas para desplazarse a ser incapaz de caminar 400 metros o de conducir -las dos variables analizadas-. Esto "no sólo lleva a una menor calidad de vida sino que la invalidez prolongada provoca más tasas de enfermedad, muerte, depresión y aislamiento social", como apunta el principal autor, Thomas Gill, Catedrático de Geriatría de la Universidad de Yale (EEUU).
La buena noticia es que muchos de los factores predisponentes y desencadenantes identificados por Gill y sus colegas se pueden prevenir o modificar. La baja actividad física, las alteraciones cognitivas y el funcionamiento deficiente de las extremidades inferiores (los tres factores de riesgo más importantes) se pueden cambiar teniendo, como recomiendan las autoridades sanitarias,un envejecimiento activo.
También se pueden prevenir "muchos de los eventos mediadores, incluidas las caídas, los infartos, la insuficiencia cardiaca, el ictus y la artritis", recuerda el trabajo. Aumentar la actividad física, mejorar la dieta, evitar hábitos como fumar o beber alcohol ayuda a que lo mayores de 70 años se mantengan sanos y con una movilidad adecuada, que les permita llevar una vida activa.
Las intervenciones para alcanzar estas metas se deben realizar 'a priori' ya que la capacidad de recuperación de los mayores es muy pequeña, con tasas del 2,2% en la conducción y del 3,1% en los desplazamientos a pie, según este estudio. "Hemos aprendido -resume Gill- que necesitamos estrategias para prevenir la discapacidad entre las personas mayores que viven de forma independiente en la comunidad".
Lograr que un porcentaje elevado de esta población tenga una vida activa e independiente durante el mayor tiempo posible es además una forma de ahorrar dinero, en estos tiempos de crisis en los que la Sanidad se encuentra en el punto de mira.
**Publicado en "EL MUNDO"
"La discapacidad a largo plazo para la movilidad comunitaria es el resultado de una combinación de factores predisponentes, que hacen al individuo más vulnerable, y enfermedades o lesiones, que actúan como desencadenantes". Ésta es la principal conclusión del estudio, publicado en 'Annals of Internal Medicine', que ha realizado un seguimiento de 12 años a 641 mayores de 70 años.
A lo largo de ese periodo, el 50% de los participantes pasó de no tener problemas para desplazarse a ser incapaz de caminar 400 metros o de conducir -las dos variables analizadas-. Esto "no sólo lleva a una menor calidad de vida sino que la invalidez prolongada provoca más tasas de enfermedad, muerte, depresión y aislamiento social", como apunta el principal autor, Thomas Gill, Catedrático de Geriatría de la Universidad de Yale (EEUU).
La buena noticia es que muchos de los factores predisponentes y desencadenantes identificados por Gill y sus colegas se pueden prevenir o modificar. La baja actividad física, las alteraciones cognitivas y el funcionamiento deficiente de las extremidades inferiores (los tres factores de riesgo más importantes) se pueden cambiar teniendo, como recomiendan las autoridades sanitarias,un envejecimiento activo.
También se pueden prevenir "muchos de los eventos mediadores, incluidas las caídas, los infartos, la insuficiencia cardiaca, el ictus y la artritis", recuerda el trabajo. Aumentar la actividad física, mejorar la dieta, evitar hábitos como fumar o beber alcohol ayuda a que lo mayores de 70 años se mantengan sanos y con una movilidad adecuada, que les permita llevar una vida activa.
Las intervenciones para alcanzar estas metas se deben realizar 'a priori' ya que la capacidad de recuperación de los mayores es muy pequeña, con tasas del 2,2% en la conducción y del 3,1% en los desplazamientos a pie, según este estudio. "Hemos aprendido -resume Gill- que necesitamos estrategias para prevenir la discapacidad entre las personas mayores que viven de forma independiente en la comunidad".
Lograr que un porcentaje elevado de esta población tenga una vida activa e independiente durante el mayor tiempo posible es además una forma de ahorrar dinero, en estos tiempos de crisis en los que la Sanidad se encuentra en el punto de mira.
**Publicado en "EL MUNDO"
Traditional physical autopsies -- not high-tech 'virtopsies' -- still 'gold standard'
TV crime shows like Bones and CSI are quick to explain each death by showing highly detailed scans and video images of victims' insides. Traditional autopsies, if shown at all, are at best in supporting roles to the high-tech equipment, and usually gloss over the sometimes physically grueling tasks of sawing through skin and bone. But according to two autopsy and body imaging experts at The Johns Hopkins Hospital, the notion that "virtopsy" could replace traditional autopsy -- made popular by such TV dramas -- is simply not ready for scientifically vigorous prime time. The latest virtual imaging technologies -- including full-body computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, X-ray and angiography are helpful, they say, but cannot yet replace a direct physical inspection of the body's main organs.
"The traditional autopsy, though less and less frequently performed, is still the gold standard for determining why and how people really died," says pathologist Elizabeth Burton, M.D., deputy director of the autopsy service at Johns Hopkins.
Burton and Johns Hopkins clinical fellow Mahmud Mossa-Basha, M.D., in an editorial set to appear in the Annals of Internal Medicine online Jan. 17, offer their own assessment of why the numbers of conventional autopsies have steadily declined over the past decade and why, despite this drop, the virtopsy is unlikely to properly replace it anytime soon.
Burton, who has performed well over a thousand autopsies, says current imaging technologies can help tremendously when used in combination with autopsies. "It's not a question of either traditional autopsy or virtopsy," she says, "it's a question of what methods work best in determining cause of death."
The Johns Hopkins experts base their claims on evidence, some of which will also be published in the same edition of Annals, that some common diagnoses are routinely missed when imaging results are compared to autopsy findings, and there is no proof that virtopsy is a more reliable alternative to conventional autopsy, at least, for now.
According to Burton, a visiting associate professor at the Johns Hopkins University School of Medicine, hospital autopsy rates in the United States -- for patients who die of natural causes in hospitals -- whose bodies do not have to be examined by the local medical examiner or coroner -- have fallen from a high of about 50 percent in the 1960s to about 10 percent today. At The Johns Hopkins Hospital, she says, the rate remains close to a once-required standard for hospital accreditation of 25 percent, set as an appropriate goal for teaching medical residents and fellows, and auditing clinical practice.
Burton says many reasons are behind the drop in conventional autopsy rates. Medical overconfidence in diagnostic imaging results partly explains the decline, but is also to blame for the high number of diagnostic errors.
"If we chose the right test at the right time in the right people, and followed clinical guidelines to the letter, then modern diagnostic tests would produce optimal results. But we don't," says Burton.
Burton says such misinterpretations of images, lab results, and physical signs and symptoms, help explain the roughly 23 percent of new diagnoses that are detected by autopsy.
She acknowledges that it also is easier for physicians to rely on existing diagnostic techniques to determine the cause of death than to go through the often uncomfortable task of asking grieving family members for permission to perform a conventional autopsy to confirm the cause of death. Making the process more difficult is that many physicians simply don't know what steps to take, including the paperwork and approvals, to get an autopsy performed.
For many families, dissuading factors include the prospect of delaying funeral arrangements, possible disfigurement to a loved one's body as well as the stress in coping with their loss, and the cost of an autopsy, which can run upwards of $3,000, unless the hospital offers to do it at no charge for teaching or its own auditing purposes.
While diagnostic overconfidence, changing cultural norms and cost may depress autopsy rates, Burton says, overreliance on technology underscores an inherent flaw in switching to virtopsy.
In a German study that accompanies the Hopkins editorial, conventional autopsy and imaging results, as would be seen in virtopsy, were compared for accuracy in 162 people who died in hospital. Some had just virtopsy, while the others had both virtopsy and conventional autopsy. In the 47 who underwent both procedures, 102 new diagnoses were found; while in comparison, 47 new diagnoses were found among the 115 who underwent virtopsy alone. Study results also showed that virtual autopsy by CT scan failed to pick up 20.8 percent of the new diagnoses, while conventional autopsy missed only 13.4 percent.
Medical problems most commonly missed or not seen by autopsy included air pockets in collapsed lungs (which could have impeded breathing) and bone fractures, and the most common diagnoses missed by imaging were heart attack, pulmonary emboli and cancer.
Burton says the study findings are not surprising because, for example, a tumor nodule in the lung could appear on any scan or X-ray image as a small, dense, white spot or so-called coin lesion that could easily be interpreted as a fungal infection, tuberculosis-related granuloma or benign tissue mass. But until the tissue is physically examined in a lab, after biopsy or during traditional autopsy, "there's no way to know the diagnosis with 100 percent certainty."
In addition to diagnostic weaknesses, Mossa-Basha says that perhaps the biggest hurdle for proponents of the virtopsy alternative is the high cost of imaging. Modern ultrasounds and MRI scanners cost hundreds of thousands of dollars, with the most advanced CT scanners needed for the most detailed imaging priced well in excess of a million dollars. Full-body CT scans, he says, run about $1,500 each, which, when added to device purchasing and maintenance fees, make vitropsy an expensive option.
Mossa-Basha says major advances in scanning devices make some forensic aspects of autopsy easier when keeping the body closed protects physical evidence from being destroyed, such as tracking bullet trajectories in gun victims.
"Steady progress in imaging technology is refining conventional autopsy, making it better and more accurate," says Mossa-Basha, a clinical fellow in neuroradiology at Johns Hopkins. "Physicians really need to be selective and proactive -- even before a critically injured patient in hospital dies -- in deciding whether an autopsy is likely to be needed and, if so, whether to approach the family in advance. Only in this way do we ensure that we are using the latest scanning devices appropriately during autopsy and when it is most effective in producing the most accurate-as-possible death certificates."
**Source: Johns Hopkins Medicine
"The traditional autopsy, though less and less frequently performed, is still the gold standard for determining why and how people really died," says pathologist Elizabeth Burton, M.D., deputy director of the autopsy service at Johns Hopkins.
Burton and Johns Hopkins clinical fellow Mahmud Mossa-Basha, M.D., in an editorial set to appear in the Annals of Internal Medicine online Jan. 17, offer their own assessment of why the numbers of conventional autopsies have steadily declined over the past decade and why, despite this drop, the virtopsy is unlikely to properly replace it anytime soon.
Burton, who has performed well over a thousand autopsies, says current imaging technologies can help tremendously when used in combination with autopsies. "It's not a question of either traditional autopsy or virtopsy," she says, "it's a question of what methods work best in determining cause of death."
The Johns Hopkins experts base their claims on evidence, some of which will also be published in the same edition of Annals, that some common diagnoses are routinely missed when imaging results are compared to autopsy findings, and there is no proof that virtopsy is a more reliable alternative to conventional autopsy, at least, for now.
According to Burton, a visiting associate professor at the Johns Hopkins University School of Medicine, hospital autopsy rates in the United States -- for patients who die of natural causes in hospitals -- whose bodies do not have to be examined by the local medical examiner or coroner -- have fallen from a high of about 50 percent in the 1960s to about 10 percent today. At The Johns Hopkins Hospital, she says, the rate remains close to a once-required standard for hospital accreditation of 25 percent, set as an appropriate goal for teaching medical residents and fellows, and auditing clinical practice.
Burton says many reasons are behind the drop in conventional autopsy rates. Medical overconfidence in diagnostic imaging results partly explains the decline, but is also to blame for the high number of diagnostic errors.
"If we chose the right test at the right time in the right people, and followed clinical guidelines to the letter, then modern diagnostic tests would produce optimal results. But we don't," says Burton.
Burton says such misinterpretations of images, lab results, and physical signs and symptoms, help explain the roughly 23 percent of new diagnoses that are detected by autopsy.
She acknowledges that it also is easier for physicians to rely on existing diagnostic techniques to determine the cause of death than to go through the often uncomfortable task of asking grieving family members for permission to perform a conventional autopsy to confirm the cause of death. Making the process more difficult is that many physicians simply don't know what steps to take, including the paperwork and approvals, to get an autopsy performed.
For many families, dissuading factors include the prospect of delaying funeral arrangements, possible disfigurement to a loved one's body as well as the stress in coping with their loss, and the cost of an autopsy, which can run upwards of $3,000, unless the hospital offers to do it at no charge for teaching or its own auditing purposes.
While diagnostic overconfidence, changing cultural norms and cost may depress autopsy rates, Burton says, overreliance on technology underscores an inherent flaw in switching to virtopsy.
In a German study that accompanies the Hopkins editorial, conventional autopsy and imaging results, as would be seen in virtopsy, were compared for accuracy in 162 people who died in hospital. Some had just virtopsy, while the others had both virtopsy and conventional autopsy. In the 47 who underwent both procedures, 102 new diagnoses were found; while in comparison, 47 new diagnoses were found among the 115 who underwent virtopsy alone. Study results also showed that virtual autopsy by CT scan failed to pick up 20.8 percent of the new diagnoses, while conventional autopsy missed only 13.4 percent.
Medical problems most commonly missed or not seen by autopsy included air pockets in collapsed lungs (which could have impeded breathing) and bone fractures, and the most common diagnoses missed by imaging were heart attack, pulmonary emboli and cancer.
Burton says the study findings are not surprising because, for example, a tumor nodule in the lung could appear on any scan or X-ray image as a small, dense, white spot or so-called coin lesion that could easily be interpreted as a fungal infection, tuberculosis-related granuloma or benign tissue mass. But until the tissue is physically examined in a lab, after biopsy or during traditional autopsy, "there's no way to know the diagnosis with 100 percent certainty."
In addition to diagnostic weaknesses, Mossa-Basha says that perhaps the biggest hurdle for proponents of the virtopsy alternative is the high cost of imaging. Modern ultrasounds and MRI scanners cost hundreds of thousands of dollars, with the most advanced CT scanners needed for the most detailed imaging priced well in excess of a million dollars. Full-body CT scans, he says, run about $1,500 each, which, when added to device purchasing and maintenance fees, make vitropsy an expensive option.
Mossa-Basha says major advances in scanning devices make some forensic aspects of autopsy easier when keeping the body closed protects physical evidence from being destroyed, such as tracking bullet trajectories in gun victims.
"Steady progress in imaging technology is refining conventional autopsy, making it better and more accurate," says Mossa-Basha, a clinical fellow in neuroradiology at Johns Hopkins. "Physicians really need to be selective and proactive -- even before a critically injured patient in hospital dies -- in deciding whether an autopsy is likely to be needed and, if so, whether to approach the family in advance. Only in this way do we ensure that we are using the latest scanning devices appropriately during autopsy and when it is most effective in producing the most accurate-as-possible death certificates."
**Source: Johns Hopkins Medicine
Mal uso de las cremas solares en la población infantil
No basta con aplicarse crema de protección solar. Además, hay que prestar atención a la cantidad que usted extiende por su cuerpo, concretamente por el de sus hijos. Según un estudio publicado en 'Archives of Dermatology' , se echan menos de la mitad de lo que deben y, por lo tanto, al contrario de lo que piensan sus padres, no están lo suficientemente protegidos de la radiación ultravioleta.
Como explica Yolanda Gilaberte, dermatóloga del Hospital de San Jorge de Huesca, la eficacia de un filtro de 50 puede reducirse a la de uno de ocho si la frecuencia de la aplicación o la cantidad no es la adecuada. Es decir, para que el fotoprotector cumpla su función (en la prevención del cáncer de piel), "se debe extender una capa de dos miligramos por centímetro cuadrado en la piel media hora antes de la exposición solar". Y añade: "No es que sea la cantidad recomendada, es que es con la que se hacen las mediciones de los filtros solares".
Todos los estudios realizados al respecto indican que los adultos no cumplen con esta premisa y ahora, por primera vez, un grupo de expertos del Queensland Institute of Medical Research (Australia) comprueba que los más pequeños tampoco. "De media, se echaban una capa de 0,48 miligramos por centímetro cuadrado", afirman los responsables del estudio en el artículo. Así lo demuestran los 87 niños australianos (entre 5 y 12 años) que participaban en la investigación.
Y aún más, después de analizar los formatos de los fotoprotectores, también se dieron cuenta de que "los niños se aplicaban más cantidad cuando utilizaban el producto en forma de spray (0,75 miligramos por centímetro cuadrado), en comparación con el bote normal (0,57 miligramos por centímetro cuadrado) y el de roll-on (0,22 miligramos por centímetro cuadrado)".
En España, el formato roll-on no se comercializa, pero sí hay cremas protectoras en espuma, en geles y en barra (para los labios). "El fotoprotector en spray es más agradable, más cómodo y fácil de aplicar. Su textura facilita la aplicación, sobre todo para aquellos que suelen rechazar ponerse cremas, como los niños, adolescentes y hombres", puntualiza Gilaberte. "Existe la percepción de que, como es líquido, protege menos, pero si se compensa aplicando más, puede ser un producto muy ventajoso", recalca.
En el estudio, ninguno de los niños se puso los dos miligramos por centímetro cuadrado, lo que avala la preocupación que tienen los dermatólogos por el uso correcto de los fotoprotectores. "Estamos infrautilizando este producto y, en vista de las conclusiones, debemos seguir recomendando otros métodos de protección como la ropa y evitar las horas de máxima insolación (entre las 12 y las 16)", recomienda Raúl de Lucas, dermatólogo del Hospital Universitario La Paz, quien recuerda que no sólo debemos protegernos en verano, también en invierno. "Más del 60% de las radiaciones solares a lo largo de la vida se reciben en la edad escolar, sobre todo en el recreo y haciendo ejercicio al aire libre. Por eso, durante el curso los niños tienen que utilizar los fotoprotectores".
Si se pregunta qué factor es el adecuado para su hijo, Gilaberte explica que, "como ya sabemos que no usamos la cantidad recomendada, para un fototipo de piel normal (2 o 3), en lugar de un 15, aconsejamos un 30".
Dado que ni los adultos ni los niños se echan suficiente crema, los autores de este estudio proponen "diseñar intervenciones educativas para ayudar a mejorar la aplicación de los filtros solares. Además, conviene insitir en otras recomendaciones complementarias, como el uso del gorro o la sombra".
**Publicado en "EL MUNDO"
Como explica Yolanda Gilaberte, dermatóloga del Hospital de San Jorge de Huesca, la eficacia de un filtro de 50 puede reducirse a la de uno de ocho si la frecuencia de la aplicación o la cantidad no es la adecuada. Es decir, para que el fotoprotector cumpla su función (en la prevención del cáncer de piel), "se debe extender una capa de dos miligramos por centímetro cuadrado en la piel media hora antes de la exposición solar". Y añade: "No es que sea la cantidad recomendada, es que es con la que se hacen las mediciones de los filtros solares".
Todos los estudios realizados al respecto indican que los adultos no cumplen con esta premisa y ahora, por primera vez, un grupo de expertos del Queensland Institute of Medical Research (Australia) comprueba que los más pequeños tampoco. "De media, se echaban una capa de 0,48 miligramos por centímetro cuadrado", afirman los responsables del estudio en el artículo. Así lo demuestran los 87 niños australianos (entre 5 y 12 años) que participaban en la investigación.
Y aún más, después de analizar los formatos de los fotoprotectores, también se dieron cuenta de que "los niños se aplicaban más cantidad cuando utilizaban el producto en forma de spray (0,75 miligramos por centímetro cuadrado), en comparación con el bote normal (0,57 miligramos por centímetro cuadrado) y el de roll-on (0,22 miligramos por centímetro cuadrado)".
En España, el formato roll-on no se comercializa, pero sí hay cremas protectoras en espuma, en geles y en barra (para los labios). "El fotoprotector en spray es más agradable, más cómodo y fácil de aplicar. Su textura facilita la aplicación, sobre todo para aquellos que suelen rechazar ponerse cremas, como los niños, adolescentes y hombres", puntualiza Gilaberte. "Existe la percepción de que, como es líquido, protege menos, pero si se compensa aplicando más, puede ser un producto muy ventajoso", recalca.
En el estudio, ninguno de los niños se puso los dos miligramos por centímetro cuadrado, lo que avala la preocupación que tienen los dermatólogos por el uso correcto de los fotoprotectores. "Estamos infrautilizando este producto y, en vista de las conclusiones, debemos seguir recomendando otros métodos de protección como la ropa y evitar las horas de máxima insolación (entre las 12 y las 16)", recomienda Raúl de Lucas, dermatólogo del Hospital Universitario La Paz, quien recuerda que no sólo debemos protegernos en verano, también en invierno. "Más del 60% de las radiaciones solares a lo largo de la vida se reciben en la edad escolar, sobre todo en el recreo y haciendo ejercicio al aire libre. Por eso, durante el curso los niños tienen que utilizar los fotoprotectores".
Si se pregunta qué factor es el adecuado para su hijo, Gilaberte explica que, "como ya sabemos que no usamos la cantidad recomendada, para un fototipo de piel normal (2 o 3), en lugar de un 15, aconsejamos un 30".
Dado que ni los adultos ni los niños se echan suficiente crema, los autores de este estudio proponen "diseñar intervenciones educativas para ayudar a mejorar la aplicación de los filtros solares. Además, conviene insitir en otras recomendaciones complementarias, como el uso del gorro o la sombra".
**Publicado en "EL MUNDO"
Revolutionary surgical technique for perforations of the eardrum
A revolutionary surgical technique for treating perforations of the tympanic membrane (eardrum) in children and adults has been developed at the Sainte-Justine University Hospital Centre, an affiliate of the Université de Montreal, by Dr. Issam Saliba. The new technique, which is as effective as traditional surgery and far less expensive, can be performed in 20 minutes at an outpatient clinic during a routine visit to an ENT specialist. The result is a therapeutic treatment that will be much easier for patients and parents, making surgery more readily available and substantially reducing clogged waiting lists. "In the past five years, I've operated on 132 young patients in the outpatient clinic at the Sainte-Justine UHC using this technique, as well as on 286 adults at the University of Montreal Hospital Centre (CHUM) outpatient clinic," says Dr. Saliba. "Regardless of the size of the perforation, the results are as good as those obtained using traditional techniques, with the incomparable advantage that parents don't have to lose an entire working day, or 10 days or more off school in the case of children."
The technique, which Dr. Saliba has designated "HAFGM" (Hyaluronic Acid Fat Graft Myringoplasty), requires only basic materials: a scalpel, forceps, a probe, a small container of hyaluronic acid, a small amount of fat taken from behind the ear and a local anesthetic. The operation, which is performed through the ear canal, allows the body by itself to rebuild the entire tympanic membrane after about two months on average, allowing patients to recover their hearing completely and preventing recurring cases of ear infection (otitis). Because it requires no general anesthetic, operating theatre or hospitalization, the technique makes surgery much more readily available, particularly outside large hospital centres, and at considerably lower cost.
"With the traditional techniques, you have to be on the waiting list for up to a year and a half in order to be operated on. Myringoplasty (reconstruction of the eardrum) using the HAFGM technique reduces waiting times, cost of the procedure and time lost by parents and children. What's more, it will help clear the backlogs on waiting lists," Dr. Saliba says.
-Perforations of the eardrum
Myringoplasty is surgical procedures to repair the tympanic membrane or eardrum when it has been perforated or punctured as the result of infection, trauma or dislodgement of a myringotomy tube (also known as a pressure equalization tube). Surgical repair of the perforation will allow the patient to recover his or her hearing and prevent repeated ear infections, particularly after swimming or shower. Traditionally, these procedures are performed using what are known as overlay and underlay techniques, which require hospitalization for at least one day, and 10 to 15 days off work. Every year in Quebec, some 750 myringoplasties are performed on adult or child patients.
-Details of the study
This world premiere of a new form of eardrum surgery is based on results of a four-year prospective cohort study of 208 children and adolescents, 73 of whom were treated using the new HAFGM technique. This study was published on December 16, 2011 in the scientific journal Archives of Otolaryngology -- Head and Neck Surgery by Dr. Issam Saliba, otolaryngologist (ear, nose and throat or ENT specialist), surgeon and researcher at the Sainte-Justine University Hospital Centre affiliated with the Université de Montréal, where he is also professor of otology and neuro-otology. Dr. Saliba is also a surgeon and researcher at the CHUM, where he conducted a similar study, applying the same HAFGM technique to cohorts of adult patients between 2007 and 2010, with publication in the August 20, 2008 issue of the scientific journal Clinical Otolaryngology and subsequently in the February 12, 2011 issue of The Laryngoscope. The University of Montreal and Sainte-Justine University Hospital Centre are known officially as Université de Montréal and Centre hospitalier universitaire Sainte-Justine, respectively.
**Source: Université de Montréal
The technique, which Dr. Saliba has designated "HAFGM" (Hyaluronic Acid Fat Graft Myringoplasty), requires only basic materials: a scalpel, forceps, a probe, a small container of hyaluronic acid, a small amount of fat taken from behind the ear and a local anesthetic. The operation, which is performed through the ear canal, allows the body by itself to rebuild the entire tympanic membrane after about two months on average, allowing patients to recover their hearing completely and preventing recurring cases of ear infection (otitis). Because it requires no general anesthetic, operating theatre or hospitalization, the technique makes surgery much more readily available, particularly outside large hospital centres, and at considerably lower cost.
"With the traditional techniques, you have to be on the waiting list for up to a year and a half in order to be operated on. Myringoplasty (reconstruction of the eardrum) using the HAFGM technique reduces waiting times, cost of the procedure and time lost by parents and children. What's more, it will help clear the backlogs on waiting lists," Dr. Saliba says.
-Perforations of the eardrum
Myringoplasty is surgical procedures to repair the tympanic membrane or eardrum when it has been perforated or punctured as the result of infection, trauma or dislodgement of a myringotomy tube (also known as a pressure equalization tube). Surgical repair of the perforation will allow the patient to recover his or her hearing and prevent repeated ear infections, particularly after swimming or shower. Traditionally, these procedures are performed using what are known as overlay and underlay techniques, which require hospitalization for at least one day, and 10 to 15 days off work. Every year in Quebec, some 750 myringoplasties are performed on adult or child patients.
-Details of the study
This world premiere of a new form of eardrum surgery is based on results of a four-year prospective cohort study of 208 children and adolescents, 73 of whom were treated using the new HAFGM technique. This study was published on December 16, 2011 in the scientific journal Archives of Otolaryngology -- Head and Neck Surgery by Dr. Issam Saliba, otolaryngologist (ear, nose and throat or ENT specialist), surgeon and researcher at the Sainte-Justine University Hospital Centre affiliated with the Université de Montréal, where he is also professor of otology and neuro-otology. Dr. Saliba is also a surgeon and researcher at the CHUM, where he conducted a similar study, applying the same HAFGM technique to cohorts of adult patients between 2007 and 2010, with publication in the August 20, 2008 issue of the scientific journal Clinical Otolaryngology and subsequently in the February 12, 2011 issue of The Laryngoscope. The University of Montreal and Sainte-Justine University Hospital Centre are known officially as Université de Montréal and Centre hospitalier universitaire Sainte-Justine, respectively.
**Source: Université de Montréal
El chupete podría ayudar a evitar la muerte súbita del lactante
El uso del chupete para dormir ejerce como factor protector frente a la muerte súbita del lactante (SMSL), que afecta a uno de cada mil bebés en nuestro país, con una media de cien muertes al año, y supone la primera causa de muerte del periodo postnatal, comprendido entre el primer mes y el año de vida.
Es la principal conclusión del trabajo la "Asociación del uso del chupete en la prevención de la muerte súbita del lactante" que, realizado por el residente de matrona en el Hospital General La Mancha Centro de Alcázar (Ciudad Real) Sergio J. Amores, junto a las enfermeras María Victoria y María Ángeles Martínez, ha sido premiado en el último Congreso de Investigación del Sindicato de Enfermería SATSE, celebrado en Albacete, explica una nota de prensa.
El objetivo del grupo investigador era realizar una revisión sistemática para determinar si el uso del chupete durante el sueño se considera un factor protector en la muerte súbita del lactante. Para ello rastrearon numerosas bases de datos (Cochrane, Pubmed, Cuiden, Cuidatge y Enfispo), en las que obtuvieron resultados en dieciocho artículos, de los que finalmente siete fueron seleccionados y analizados.
-Microdespertares
Recientemente, se ha recomendado el uso del chupete como factor protector frente al SMSL por quedar demostrado que aumenta los microdespertares, favorece que la lengua se mantenga en posición anterior, aumenta levemente los niveles de dióxido de carbono y el tono muscular de la vía aérea.Asimismo, incrementa la producción de IgA, por la succión no nutritiva, y su presencia en la boca impide la obstrucción total de la boca y nariz sobre el colchón.
Pese a que el uso del chupete se puede relacionar con la disminución de duración de la lactancia materna, maloclusión dentaria e incidencia de algunas infecciones, podría ser razonable no desaconsejarlo o incluso alentar su uso en determinados momentos (como al ir a dormir durante los primeros meses de vida) una vez esté instaurada la lactancia materna.
Según los autores del trabajo, en la mayor parte de la bibliografía revisada se concluye que el uso del chupete para dormir ejerce un factor protector frente a la muerte súbita del lactante, no conociéndose muy bien su mecanismo de acción.
El síndrome del SMSL se define como la muerte súbita de un niño menor de un año de edad sin que exista una explicación después de una investigación minuciosa del caso, incluyendo la realización de una autopsia completa, el examen de la escena del fallecimiento y la revisión de la historia clínica. Además del uso del chupete, se recomienda que los niños duerman en posición supina (boca arriba) o lateral durante el sueño, ya que la probabilidad de padecer una muerte súbita durmiendo en decúbito prono (boca abajo) es de 3,5 y 9,3 veces superior que durmiendo en cualquier otra postura.
Asimismo, se deben quitar las almohadas y cojines gordos o colchas gruesas de la cuna donde se acuesta, porque podrían ahogar al lactante, como quedar descubierta la cabeza del bebe, pues los estudios demuestran que entre un 16 y 22 por ciento de los niños víctimas de la muerte súbita tienen su cabeza cubierta. Además de incrementarse el riesgo de SMSL en 4,09 veces si la madre fuma durante el embarazo o el primer año de vida del bebé, se recomienda ofrecer el chupete al niño antes de dormirse y no forzarlo si no lo quiere, como también no mojarlo en ninguna sustancia dulce.
nota
*Agencia "EFE"
Es la principal conclusión del trabajo la "Asociación del uso del chupete en la prevención de la muerte súbita del lactante" que, realizado por el residente de matrona en el Hospital General La Mancha Centro de Alcázar (Ciudad Real) Sergio J. Amores, junto a las enfermeras María Victoria y María Ángeles Martínez, ha sido premiado en el último Congreso de Investigación del Sindicato de Enfermería SATSE, celebrado en Albacete, explica una nota de prensa.
El objetivo del grupo investigador era realizar una revisión sistemática para determinar si el uso del chupete durante el sueño se considera un factor protector en la muerte súbita del lactante. Para ello rastrearon numerosas bases de datos (Cochrane, Pubmed, Cuiden, Cuidatge y Enfispo), en las que obtuvieron resultados en dieciocho artículos, de los que finalmente siete fueron seleccionados y analizados.
-Microdespertares
Recientemente, se ha recomendado el uso del chupete como factor protector frente al SMSL por quedar demostrado que aumenta los microdespertares, favorece que la lengua se mantenga en posición anterior, aumenta levemente los niveles de dióxido de carbono y el tono muscular de la vía aérea.Asimismo, incrementa la producción de IgA, por la succión no nutritiva, y su presencia en la boca impide la obstrucción total de la boca y nariz sobre el colchón.
Pese a que el uso del chupete se puede relacionar con la disminución de duración de la lactancia materna, maloclusión dentaria e incidencia de algunas infecciones, podría ser razonable no desaconsejarlo o incluso alentar su uso en determinados momentos (como al ir a dormir durante los primeros meses de vida) una vez esté instaurada la lactancia materna.
Según los autores del trabajo, en la mayor parte de la bibliografía revisada se concluye que el uso del chupete para dormir ejerce un factor protector frente a la muerte súbita del lactante, no conociéndose muy bien su mecanismo de acción.
El síndrome del SMSL se define como la muerte súbita de un niño menor de un año de edad sin que exista una explicación después de una investigación minuciosa del caso, incluyendo la realización de una autopsia completa, el examen de la escena del fallecimiento y la revisión de la historia clínica. Además del uso del chupete, se recomienda que los niños duerman en posición supina (boca arriba) o lateral durante el sueño, ya que la probabilidad de padecer una muerte súbita durmiendo en decúbito prono (boca abajo) es de 3,5 y 9,3 veces superior que durmiendo en cualquier otra postura.
Asimismo, se deben quitar las almohadas y cojines gordos o colchas gruesas de la cuna donde se acuesta, porque podrían ahogar al lactante, como quedar descubierta la cabeza del bebe, pues los estudios demuestran que entre un 16 y 22 por ciento de los niños víctimas de la muerte súbita tienen su cabeza cubierta. Además de incrementarse el riesgo de SMSL en 4,09 veces si la madre fuma durante el embarazo o el primer año de vida del bebé, se recomienda ofrecer el chupete al niño antes de dormirse y no forzarlo si no lo quiere, como también no mojarlo en ninguna sustancia dulce.
nota
*Agencia "EFE"
Broken arm? Brain shifts quickly when using a sling or cast
Using a sling or cast after injuring an arm may cause your brain to shift quickly to adjust, according to a study published in the January 17, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology. The study found increases in the size of brain areas that were compensating for the injured side, and decreases in areas that were not being used due to the cast or sling. "These results are especially interesting for rehabilitation therapy for people who've had strokes or other issues," said study author Nicolas Langer, MSc, with the University of Zurich in Switzerland. "One type of therapy restrains the unaffected, or "good," arm to strengthen the affected arm and help the brain learn new pathways. This study shows that there are both positive and negative effects of this type of treatment."
For the study, researchers examined 10 right-handed people with an injury of the upper right arm that required a sling for at least 14 days. The entire right arm and hand were restricted to little or no movement during the study period. As a result, participants used their non-dominant left hand for daily activities such as washing, using a toothbrush, eating or writing. None of the people in the study had a brain injury, psychiatric disease or nerve injury.
The group underwent two MRI brain scans, the first within two days of the injury and the second within 16 days of wearing the cast or sling. The scans measured the amount of gray and white matter in the brain. Participants' motor skills, including arm-hand movements and wrist-finger speed, were also tested.
The study found that amount of gray and white matter in the left side of the brain decreased up to ten percent, while the amount of gray and white matter in the right side of the brain increased in size.
"We also saw improved motor skills in the left, non-injured hand, which directly related to an increase in thickness in the right side of the brain," said Langer. "These structural changes in the brain are associated with skill transfer from the right hand to the left hand."
Langer noted that the study did not look at whether the decreases would be permanent.
"Further studies should examine whether using a restraint for stroke patients is really a necessity for improving arm and hand movement," he said. "Our results also support the current trauma surgery guidelines stating that an injured arm or leg should be immobilized 'as short as possible, as long as necessary.'"
The study was supported by the National Center of Competence in Research and the Swiss National Science Foundation.
**Source: American Academy of Neurology (AAN)
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