Andalucía pone en marcha un plan de actuación global para crónicos

Mejorar la calidad de vida de los enfermos crónicos es el objetivo primordial del Plan de Atención Integrada a Pacientes Crónicos puesto en marcha por la Consejería de Salud de Andalucía. La consejera, María Jesús Montero, ha explicado que se trata de una nueva estrategia que pretende abordar la situación sanitaria y social de las personas con múltiples patologías desde una perspectiva global e integral.

El Plan aglutina todas las estrategias existentes enfocadas en las enfermedades crónicas -cardiopatías, diabetes, VIH…- y unifica la atención a este colectivo implicando a todos los niveles profesionales y disciplinas. En su elaboración han participado profesionales de atención primaria y hospitalaria, entre ellos enfermeras, farmacéuticos, médicos de familia e internistas, quienes han trabajado con el "desafío" de considerar la "cronicidad como concepto más amplio", como "un concepto global que requiere de un tratamiento masivo global". En Andalucía, prácticamente una de cada dos personas de la población adulta tiene una enfermedad crónica, una cifra que, en mayores de 75 años, asciende a nueve de cada diez.

Montero calificó este documento de "herramienta" que contribuye a "alinear los esfuerzos realizados en planes integrales" como los de diabetes, cardiopatías, ictus, oncología, cuidados paliativos, salud mental, dolor, y otros programas como tabaquismo, obesidad infantil, promoción de la actividad física y la alimentación equilibrada, y el de cuidados y atención a cuidadoras.

-Sujetos activos
En este sentido, entre los pilares básicos del Plan está el de favorecer la implantación de los mecanismos adecuados para que pacientes, cuidadores y familia sean sujetos activos en la toma de decisiones sobre su enfermedad, siempre compartidas con los profesionales sanitarios.

Manuel Ollero, director del Plan, ha explicado que el objetivo de la estrategia "no es tratar una enfermedad, sino a un paciente en su entorno social y familiar", para lo que es necesario dar una visión global en la que interviene la Atención Primaria y la hospitalaria, tanto desde una perspectiva médica como enfermera. Así, Ollero ha insistido en que "no se puede dar una visión atomizada de la atención sanitaria sino dar una visión global para tomar decisiones sobre personas".

Paloma Porras, médica de familia participante en el grupo que elaboró el documento, ha destacado por su parte, que la referencia del paciente ha de estar en el equipo de atención primaria (médico-enfermera), cuyas competencias, dijo, hay que ampliar, y a la vez mejorar la colaboración entre niveles (atención primaria-hospitalaria) con la perspectiva de aportar esta visión global e integradora que aporta el Plan.

España lidera los casos de fecundación artificial en Europa

Los ginecólogos denuncian que las mujeres acuden muy tarde a la maternidad, lo que provoca problemas a la hora del embarazo y aumenta la necesidad de acudir a las técnicas de reproducción asistida. Especialistas reunidos en Málaga en un Seminario organizado por Merck Serono y el Hospital Quirón han hecho un llamamiento a la población femenina en cuanto a este tema. "Hay que concienciar a la gente que la maternidad es una prioridad en cuanto a la edad, por lo que conforme superan los 35 años se va reduciendo drásticamente elm posible embarazo", según afirmó la doctora Olga Ramón( Unidad de Reproducción Humana del Hospital de Cruces de Bilbao). La frontera que los especialistas traza está en los 35 años de media. Aunque en Madrid el promedio de edad de las mujeres que acuden a la FIV es de 38 años, 37 en Bilbao y casi 34 en Málaga.
"Una pareja que mantiene relaciones plenas sin protección durante seis meses y ella tiene 35 años y no se ha quedado embarazada debe acudir al médico para analizar el problema. Conforme vaya pasando el tiempo pierde casi un 40% de opciones de ser padres" indicó el doctor Enrique Pérez de la Blanca( Unidad de Reproducción Asistida del Hospital Quirón de Málaga). El dato es duro pero las estadísticas hablan que la mitad de las parejas con infertilidad no acuden al médico y que el 60% de las que van no pasan de la primera visita.
En el Seminario celebrado en Málaga se indicó que España es el país líder en Europa en cuanto a inseminaciones artificiales. Tanto que se produce la llegada de muchas extranjeras para ser sometidas a estas técnicas que en Europa tienen una mayor restricción por el temor a los embarazos múltiples y a la obligatoriedad de aceptar la transferencia de los óvulos.
Por término medio una FIV puede cpsta sobre los 5.000 euros, una cifra no excesivamente alta si se consigue el sueño de ser padre. Los expertos estiman que "es una opción altamente exitosa en parejas con fertilidad disminuida pero no estériles".

New procedure repairs severed nerves in minutes, restoring limb use in days or weeks

American scientists believe a new procedure to repair severed nerves could result in patients recovering in days or weeks, rather than months or years. The team used a cellular mechanism similar to that used by many invertebrates to repair damage to nerve axons. Their results were recently published in the Journal of Neuroscience Research.
"We have developed a procedure which can repair severed nerves within minutes so that the behavior they control can be partially restored within days and often largely restored within two to four weeks," said Professor George Bittner from the University of Texas. "If further developed in clinical trials this approach would be a great advance on current procedures that usually imperfectly restore lost function within months at best."
The team studied the mechanisms all animal cells use to repair damage to their membranes and focused on invertebrates, which have a superior ability to regenerate nerve axons compared to mammals. An axon is a long extension arising from a nerve cell body that communicates with other nerve cells or with muscles.
This research success arises from Bittner's discovery that nerve axons of invertebrates which have been severed from their cell body do not degenerate within days, as happens with mammals, but can survive for months, or even years.
The severed proximal nerve axon in invertebrates can also reconnect with its surviving distal nerve axon to produce much quicker and much better restoration of behaviour than occurs in mammals.
"Severed invertebrate nerve axons can reconnect proximal and distal ends of severed nerve axons within seven days, allowing a rate of behavioural recovery that is far superior to mammals," said Bittner. "In mammals the severed distal axonal stump degenerates within three days and it can take nerve growths from proximal axonal stumps months or years to regenerate and restore use of muscles or sensory areas, often with less accuracy and with much less function being restored."
The team described their success in applying this process to rats in two new research papers. The team were able to repair severed sciatic nerves in the upper thigh, with results showing the rats were able to use their limb within a week and had much function restored within 2 to 4 weeks, in some cases to almost full function.
"We used rats as an experimental model to demonstrate how severed nerve axons can be repaired. Without our procedure, the return of nearly full function rarely comes close to happening," said Bittner. "The sciatic nerve controls all muscle movement of the leg of all mammals and this new approach to repairing nerve axons could almost-certainly be just as successful in humans."
To explore the long term implications and medical uses of this procedure, MD's and other scientist- collaborators at Harvard Medical School and Vanderbilt Medical School and Hospitals are conducting studies to obtain approval to begin clinical trials.
"We believe this procedure could produce a transformational change in the way nerve injuries are repaired," concluded Bittner.

*Source: Wiley-Blackwell

¿Qué es la Inseminación Artificial?

La Inseminación Artificial( IA) es una de las técnicas que existen actualmente en Reproducción Humana Asistida. Es el procedimiento más sencillo y consiste en depositar de forma artificial espermatozoides previamente seleccionados en el tracto reproductor femenino. De esta manera, se intenta acortar la distancia que separa óvulo y espermatozoide y facilitar el encuentro entre ambos.


Se habla de inseminación artificial conyugal( IAC) cuando se realiza con espermatozoides de la pareja y de Inseminación artificial donante( IAD) cuando el semen es de donante.


La IA consta de tres fases: estimulación hormonal del ovario para aumentar el número de ovocitos maduros, preparación del semen( seleccionando y concentrando los espermatozoides móviles) y, finalmente, la inseminación de la mujer.

Coughing and other respiratory symptoms improve within weeks of smoking cessation

If the proven long-term benefits of smoking cessation are not enough to motivate young adults to stop smoking, a new study shows that 18- to 24-year olds who stop smoking for at least two weeks report substantially fewer respiratory symptoms, especially coughing. The study findings are detailed in Pediatric Allergy, Immunology, and Pulmonology, a peer-reviewed journal published by Mary Ann Liebert, Inc. Karen Calabro, DrPH and Alexander Prokhorov, MD, PhD, The University of Texas MD Anderson Cancer Center, Houston, compared self-reported respiratory symptoms among two groups of college students who participated in programs designed to motivate them to stop smoking. One group achieved smoking cessation for two weeks or longer and the other group failed to stop smoking. More than half of the students smoked 5-10 cigarettes a day and had smoked for 1-5 years.
"That the benefit of stopping smoking starts in days to weeks-not years or decades-is important. Now health care providers can counsel young smokers that their breathing can feel better soon after they stop. This can help to motivate young adults to stop smoking before the severe damage is done," says Harold Farber, MD, MSPH, Editor of Pediatric Allergy, Immunology, and Pulmonology and Associate Professor of Pediatrics, Section of Pulmonology, Baylor College of Medicine, Houston, TX.

*Source: Mary Ann Liebert, Inc., Publishers

Gene related to fat preferences in humans found

A preference for fatty foods has a genetic basis, according to researchers, who discovered that people with certain forms of the CD36 gene may like high-fat foods more than those who have other forms of this gene. The results help explain why some people struggle when placed on a low-fat diet and may one day assist people in selecting diets that are easier for them to follow. The results also may help food developers create new low-fat foods that taste better.
"Fat is universally palatable to humans," said Kathleen Keller, assistant professor of nutritional sciences, Penn State. "Yet we have demonstrated for the first time that people who have particular forms of the CD36 gene tend to like higher fat foods more and may be at greater risk for obesity compared to those who do not have this form of the gene. In animals, CD36 is a necessary gene for the ability to both detect and develop preferences for fat. Our study is one of the first to show this relationship in humans."
Keller and a team of scientists from Penn State, Columbia University, Cornell University and Rutgers University examined 317 African-American males and females because individuals in this ethnic group are highly vulnerable to obesity and thus are at greatest risk for obesity-related diseases.
The team gave the participants Italian salad dressings prepared with varying amounts of canola oil, which is rich in long-chain fatty acids. The participants were then asked to rate their perceptions of the dressings' oiliness, fat content and creaminess on a scale anchored on the ends with "extremely low" and "extremely high."
The team also gave participants questionnaires aimed at understanding their food preferences. Participants rated how much they liked each food on a scale anchored with "dislike extremely" and "like extremely." Foods included on the questionnaire were associated with poor dietary intake and health outcomes, such as half-and-half, sour cream, mayonnaise, bacon, fried chicken, hot dogs, French fries, cheese, chips, cake, cookies and doughnuts.
The researchers collected saliva samples from the participants to determine which forms of CD36 they had. From the saliva samples, they extracted DNA fragments and examined differences in the CD36 gene contained within the fragments.
They found that participants who had the "AA" form of the gene -- present in 21 percent of the population -- rated the salad dressings as creamier than individuals who had other forms of the gene. These individuals reported that the salad dressings were creamier regardless of how much fat was actually in them. The researchers also found that "AA" individuals liked salad dressings, half-and-half, olive oil and other cooking oils more than those who had other forms of the gene. The results are published in a recent issue of the journal Obesity.
"It is possible that the CD36 gene is associated with fat intake and therefore obesity through a mechanism of oral fat perception and preference," said Keller. "In other words, our results suggest that people with certain forms of the CD36 gene may find fat creamier and more enjoyable than others. This may increase their risk for obesity and other health problems."
According to Keller, having certain forms of a gene that help in the perception and enjoyment of fats in foods might once have been an advantage.
"Fats are essential in our diets," she said. "In our evolutionary history, people who were better able to recognize fats in foods were more likely to survive. Such forms of the gene, however, are less useful to us today as most of us no longer have to worry about getting enough fats in our diets."
In fact, she added, having such forms of a gene can be detrimental in today's world of fat-laden convenience foods.
"Our results may help explain why some people have more difficulty adhering to a low-fat diet than other people and why these same people often do better when they adopt high-fat, low-carbohydrate diets such as the Atkins diet," said Keller. "We hope these results will one day help people select diets that are easier for them to follow. We also think the results could help food developers create better tasting low-fat foods that appeal to a broader range of the population."
In the future, the team plans to expand the population they examine to include children.
"By the time we are adults it is very hard for us to change our eating behaviors," said Keller. "So if we can determine which children have forms of the CD36 gene, as well as other genes that are associated with greater liking of fats, we can help them develop healthier eating behaviors at a young age."
Keller also plans to incorporate novel techniques, such as functional magnetic resonance imaging (fMRI), to better understand why certain forms of the CD36 gene are linked to higher fat preferences.
"We plan to scan children while they are tasting high-fat foods and beverages so that we can see how their brains react to fats," she said. "By doing this, we may be able to develop foods that are perceived by the brain as palatable high-fat treats, even though in reality, they are low-fat and healthy."


**Source: Penn State

Se celebró en Málaga la Reunión Nacional de Consultas de Esterilidad

Unos 150 especialistas en Ginecología de toda España han participado en Málaga en la Reunión Nacional de Consultas de Esterilidad, organizada por Merck Serono con el apoyo del Hospital Quirón de Málaga. El tema principal fde debate fue la situación actual de la Inseminación Artificial en España, considerada una de las técnicas más exitosas para un perfil determinado de parejas que tienen problemas para ser padres.
En Málaga cada año se producen unas 2.500 por esterilidad, cifra que a la hora de la verdad es mayor "por razones de miedo o vergüenza a la hora de exponer su problema", según afirmó el doctor Enrique Pérez de la Blanca( de la Unidad de Reproducción Asistida del Hospital Quirón de Málaga. En la provincia hay 18 Centros de Reproducción Humana Asistida acreeditados, que realizan unas 2.000 inseminaciones artificialesd por año. En 2010 nacieron 250 bebés en ña provincia gracias a esta técnica.
Para la doctora Olga Ramón( de la Unidad de Reproducción Humana del Hospital Cruces de Bilbao) "esta técnica es menos costosa y, en un elevado porcentaje, se trata a las pacientes utilizando medicamentos con una innovadora biotecnología recombinante, como ocurre en la FIV. Mujeres con una adecuada reserva ovárica y al menos una trompa permeable, cuyo compañero cuente con una recuperación de espermatozoidez móviles igual o superior a 5.000.000, son perfectas candidatas para logar el embarazo mediante inseminación artificial".
Los problemas de fertilidad afectan en España a una de cada seis parejas. El retraso en la maternidad aparece como uno de los principales factores que influyen en esto. El doctor Eleuterio Hernández( del Centro de Reproducción FIV-Madrid) indicó "que en el Registro de la SEF( Sociedad Española de Fertilidad) se observa que el 40% de los tratamientos de Reproducción Asistidad en España son inseminaciones artificiales conyugales. La tasa de embarazo por paciente tras 4 o 6 ciclos consecutivos puede llegar casi al 50%".