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Las experiencias didácticas surgidas en los últimos años en el sector educativo suponen un cambio de paradigma respecto de la enseñanza tradicional. La COVID-19 impulsó de manera definitiva esta praxis, abogando por el empleo de las tecnologías de la información y la comunicación. Entre estas prácticas educativas realizadas entre profesores y estudiantes destaca la creación de vídeos con contenidos didácticos por parte del alumnado, lo cual no sólo fomenta la creatividad de los estudiantes sino también la eficacia y eficiencia para el estudio de conceptos relacionados con sus campos de investigación. El objetivo final de este trabajo es evaluar la implementación de vídeos cortos entre el estudiantado de educación secundaria y superior, así como valorar de manera comparativa en qué etapa educativa son más proclives a su elaboración. Para conseguir el citado objetivo se implementó una actividad de carácter voluntario, basada en la grabación de vídeos didácticos por parte del propio alumnado y que se desarrolló de forma paralela en ambos niveles educativos. Los resultados obtenidos de esta evaluación arrojaron un bajo nivel de participación del estudiantado, siendo todavía menor en educación superior. Por el contrario, como aspecto positivo destaca la fluidez y claridad expositiva de los participantes. Además, se observa como un enfoque basado en videos permite lograr una mayor motivación entre los estudiantes. En definitiva, la elaboración de vídeos por parte del alumnado constituye una metodología eficaz para captar la atención de aquellos que los visionan, ampliando sus conocimientos y mejorando sus destrezas comunicativas.

Introdução: A empatia é uma técnica essencial na relação clínica, podendo ser treinada e aferida. Pensa-se que a exposição dos profissionais de saúde a programas de arte possa melhorar a empatia clínica percecionada pelos utentes; porém, desconhece-se qual a sua influência na comunicação com os utentes. Objetivos: Avaliar a influência dum programa de arte na empatia percecionada pelos utentes relativamente aos profissionais de saúde duma unidade de saúde familiar e verificar a relação entre a empatia percecionada pelos utentes e as características sociodemográficas dos mesmos. Métodos: Estudo quase-experimental, com avaliação pré e pós-intervenção, conduzido numa unidade de saúde familiar entre janeiro e julho de 2018. Utilizaram-se amostras de conveniência calculadas a partir da população inscrita na unidade de saúde familiar com idade igual ou superior a 18 anos. A intervenção, aplicada aos médicos e enfermeiros, consistiu num programa de arte constituído por três sessões referentes a cinema, literatura e fotografia. Para determinar a influência da intervenção, avaliou-se a empatia pré e pós-intervenção através do questionário “The Consultation and Relational Empathy” e dum questionário sociodemográfico. As associações entre variáveis foram testadas com testes não paramétricos (Mann-Whitney e Kruskal-Wallis) e correlação de Spearman, com um nível de significância de 0,05.Resultados: Obtiveram-se 390 e 371 questionários antes e após a intervenção. Verificou-se um aumento estatisticamente significativo da empatia percecionada pelos utentes após a intervenção (p=0,001). As únicas associações estatisticamente significativas verificadas foram com a escolaridade (p=0,000) e situação profissional (p=0,0001) no período pré-intervenção.Discussão: Demonstra-se que um programa de arte aplicado a uma equipa de saúde pode apresentar impacto na empatia percecionada pelos utentes, alertando para a possibilidade de criação futura de espaços de integração artística orientados para o ensino da empatia clínica nos cuidados de saúde primários.

Traballo fin de grao (UDC.DER). Dereito. Curso 2020/2021

Resumo Em 1999, o relatório “Errar é humano: construir um sistema de saúde mais seguro” do Instituto de Medicina dos Estados Unidos concluiu que a atividade de atendimento especializado não era uma prática infalível e que havia maior probabilidade de causar eventos adversos. Para reduzir os danos dos sistemas de cuidados de saúde, os países desenvolvidos concentraram seu interesse nos cidadãos a partir dos primeiros anos do século XXI. Todas as estratégias de modernização terão como objetivo melhorar a qualidade do atendimento. Nesse contexto, a segurança do paciente é um componente-chave da qualidade assistencial. Em 2003, o Hastings Center publicou o relatório “Promover a segurança do paciente: uma base ética para a deliberação de políticas”, que faz uma reflexão ética das obrigações morais subjacentes à cultura de segurança desenvolvida na sequência da publicação do relatório “Errar é humano”. Abstract The “To err is human: building a safer health system” report from the United States Institute of Medicine in 1999 concluded that skilled care activity was not infallible and was likely to cause adverse events. From the early years of the twenty-first century developed countries have focused their interest on citizens in order to reduce the damage of health care systems. All modernization strategies will aim to improve the quality of care. In this context, patient safety is a key component of quality of care. In 2003 the Hastings Center published the report “Promoting patient safety: an ethical basis for policy deliberation”, which provides an ethical reflection on the moral obligations underlying the safety culture developed following the publication of the report To err is human. Resumen En 1999, el informe “Errar es humano: construir un sistema de salud más seguro” del Instituto de Medicina de los Estados Unidos llegaba a la conclusión de que la especializada actividad asistencial no era una práctica infalible y había supuesto una mayor probabilidad de ocasionar eventos adversos. Para aminorar los daños derivados de la atención sanitaria, los sistemas sanitarios de los países desarrollados centrarán su interés en el ciudadano a partir de los primeros años del siglo XXI. Todas las estrategias de modernización tendrán como objetivo la mejora de la calidad asistencial. En ese contexto, un componente fundamental de la calidad lo constituye la seguridad del paciente. En 2003, el Hastings Center publicó el informe Promoviendo la “Seguridad del paciente: una base ética para la deliberación de políticas”, que realiza una reflexión ética de las obligaciones morales que subyacen en la cultura de seguridad desarrollada tras la publicación del informe “Errar es humano”.

Introducao: A hipertensao arterial (HTA) secundaria corresponde a cerca de 5-10% dos casos de hipertensao. Perante uma hipertensao em adultos jovens deve-se suspeitar de causas secundarias e proceder a uma investigacao clinica, laboratorial e imagiologica adequada. Em adultos jovens (19-39 anos) as causas mais frequentes de HTA secundaria sao as disfuncoes tiroideias, a displasia fibromuscular da arteria renal e as doencas do parenquima renal. Relata-se um caso clinico de uma jovem, na qual o estudo de hipertensao secundaria revelou hipertiroidismo auto-imune. Descricao do Caso: Utente do sexo feminino, 19 anos de idade, que recorreu a consulta de saude de adultos por palpitacoes, taquicardia (FC media: 117 bpm), e tensao arterial elevada (TA media: 154/86 mmHg), objetivadas em ambulatorio desde ha um mes. Constatou-se ainda ansiedade, insonia inicial, irritabilidade e polifagia. Ao exame objetivo confirmou-se HTA grau 1 e taquicardia, bem como palpacao de bocio difuso, indolor e simetrico, sem nodulos aparentes, tendo sido medicada com propranolol. Do estudo efetuado confirmou-se hipertiroidismo de etiologia auto-imune, anemia microcitica e hipocromica, aspetos sugestivos de tiroidite na ecografia, bem como bocio difuso com captacao aumentada na cintingrafia tiroideia, sugestivo de Doenca de Graves . A utente foi medicada com metibasol 5 mg 12/12h e referenciada para consulta de Endocrinologia. Verificou-se melhoria da sintomatologia, estabilizacao tensional e normalizacao da funcao tiroideia. Comentario: Este caso clinico pretende ilustrar a abordagem diagnostica e terapeutica da HTA no adulto jovem, nos cuidados de saude primarios. Visa ainda fomentar o espirito critico na interpretacao dos exames auxiliares de diagnostico perante uma dissociacao clinico-imagiologica. O hipertiroidismo e uma causa comum de hipertensao sistolica isolada e o seu diagnostico e tratamento atempados podem prevenir a emergencia de complicacoes e influenciar o prognostico. Para tal, e fundamental uma boa articulacao entre os cuidados de saude primarios e secundarios. Palavras-Chave: Hipertensao arterial, Hipertensao secundaria, Hipertiroidismo, Doenca de Graves, Jovem

Traballo Fin de Mestrado (UDC.DER). Mestrado Universitario en Avogacía. Curso 2019/2020 Traballo fin de mestrado (UDC.DER). Mestrado Universitario en Avogacía. Curso 2019/2020

OBJETIVO Adaptar culturalmente al español y validar el SPICTTM, una herramienta breve y sencilla para apoyar una mejor identificación de pacientes crónicos que presentan necesidades de atención paliativa. MÉTODOS Para este estudio se diseñó un proyecto multicéntrico y nacional entre centros de Galicia, Islas Baleares y Andalucía. Para el proceso de traducción y adaptación transcultural del SPICTTM al castellano, se siguieron los pasos propuestos por Beaton et al. con sucesivas traducciones y posterior consenso de expertos mediante la metodología debriefing. Tras finalizar la validación de contenido se procedió a la validación de las propiedades psicométricas. Se diseñó un estudio longitudinal prospectivo en 188 pacientes de Galicia, Baleares y Andalucía. Fue analizada la consistencia interna y la fiabilidad test-retest a los 10 días por el mismo investigador. RESULTADOS A más del 90% de los participantes SPICT-ESTM les parece sencillo cumplimentarlo, y consideran que está escrito en un lenguaje comprensible. El tiempo medio para aplicar el cuestionario sin conocimiento previo fue de 4 minutos y 45 segundos. Para la evaluación de la consistencia interna del instrumento, se ha utilizado la fórmula Kuder Richardson 20. La consistencia interna es de 0,71. El índice de concordancia del test Kappa se encuentra entre 0,983 y 0,797 para los distintos ítems. CONCLUSIONES En este estudio se ha demostrado la equivalencia de contenido con el original. Además, la validación de las propiedades psicométricas establece que SPICT-ESTM mantiene una adecuada fiabilidad y estabilidad. Si añadimos la satisfacción mostrada por los profesionales y la facilidad de uso, SPICT-ESTM es una herramienta adecuada para la identificación de pacientes paliativos con enfermedades crónicas y necesidad de cuidados paliativos. OBJECTIVE To culturally adapt and validate the SPICTTM to Spanish, which is a brief and simple tool to support a better identification of chronic patients who have palliative care needs. METHODS For this study, we designed a multicenter and national project between the centers of Galicia, Balearic Islands, and Andalusia. For the process of translation and cross-cultural adaptation of the SPICTTM to Spanish, we followed the steps proposed by Beaton et al. with successive translations and subsequent consensus of experts using the debriefing methodology. After the content validation was completed, the psychometric properties were validated. A prospective longitudinal study was designed with 188 patients from Galicia, the Balearic Islands, and Andalusia. The internal consistency and reliability of the test and retest was analyzed for 10 days by the same researcher. RESULTS For more than 90% of the participants of the SPICT-ESTM, it seems simple to be filled out, and they consider it written in an understandable language. The average time to apply the questionnaire without prior knowledge was 4 minutes and 45 seconds. To evaluate the internal consistency of the instrument, we used the Kuder-Richardson formula 20. Internal consistency is 0.71. The agreement index of the Kappa test is between 0.983 and 0.797 for the different items. CONCLUSIONS In this study, we demonstrate the equivalence of content with the original. In addition, the validation of the psychometric properties establishes that the SPICT-ESTM maintains adequate reliability and stability. If we add the satisfaction shown by the professionals and the ease of use, the SPICT-ESTM is an adequate tool for the identification of palliative patients with chronic diseases and palliative care needs.

The aim of this study was to ascertain the relationship between social network and the appearance of mortality (cardiovascular events (CVEs)) in patients with arterial hypertension (AHT). This is a cohort study of 236 patients with a 9-year follow-up. Measurements included age, sex, blood pressure (BP), diabetes, hypercholesterolemia, marital status, social network, social support, stage of family life cycle (FLC), mortality and CVEs. Patients with a low social network registered higher global mortality (hazards ratio (HR) 2.6 (95% confidence interval (CI) 1.3; 5.5)) as did the oldest patients (HR 5.6 (1.9; 16.8)), men (HR 3.5 (95% CI 1.3; 9.3)) and subjects in the last FLC stages (HR 4.3 (95% CI 1.3;14.1)). Patients with low social support registered higher cardiovascular mortality (HR 2.6 (95% CI 1.1; 6.1)) as did the oldest patients (HR 12.4 (95% CI 2.8; 55.2)) and those with diabetes (HR 3.00 (95% CI 1.2; 7.6)). Patients with a low social network registered more CVEs (HR 2.1 (95% CI 1.1; 4.1)) than patients with an adequate network, as did the oldest patients (HR 3.1 (95% CI 1.4; 6.9)), subjects who presented with a higher grade of severity of AHT (HR 2.7 (1.3; 5.5)) and those in the last FLC stages (HR 2.5 (95% CI 1.0; 6.2)). A low social network is associated with mortality and the appearance of CVEs in patients with AHT. Low functional social support is associated with the appearance of cardiovascular mortality.

Dio3 is the most distal gene of the imprinted Dlk1-Dio3 gene locus and is expressed according to parental origin. Dio3 encodes the type 3 deiodinase (D3), a thioredoxin-fold like containing selenoenzyme that inactivates thyroid hormone and dampens thyroid hormone signaling. Here we used heterozygous animals with disruption of the Dio3 gene to study the allelic expression pattern of Dio3 in pancreatic β-cells and the metabolic phenotype resulting from its inactivation. Adult heterozygous mice with disruption of the Dio3 gene with maternal inheritance of the inactive Dio3 allele exhibited a total loss of D3 activity in isolated pancreatic islets, approximately 30% reduction in total pancreatic islet area, a marked decrease in insulin2 mRNA and in vivo glucose intolerance. In contrast, inheritance of the inactive Dio3 allele from the father did not affect D3 activity in isolated pancreatic islets and did not result in a pancreatic phenotype. Furthermore, exposure of pancreatic explants, D3-expressing MIN6-C3 cells or isolated pancreatic islets to 100 nM T3 for 24 hours reduced insulin2 mRNA by approximately 50% and the peak of glucose-induced insulin secretion. An unbiased analysis of T3-treated pancreatic islets revealed the down-regulation of 21 gene sets (false discovery rate q value < 25%) involved in nucleolar function and transcription of rRNA, ribonucleotide binding, mRNA translation, and membrane organization. We conclude that the Dio3 gene is preferentially expressed from the maternal allele in pancreatic islets and that the inactivation of this allele is sufficient to disrupt glucose homeostasis by reducing the pancreatic islet area, insulin2 gene expression, and glucose-stimulated insulin secretion.

The lack of adherence to treatment in hypertension affects approximately 30 % of patients. The elderly, those with several co-morbidities, social isolation, low incomes or depressive symptoms are the most vulnerable to this problem. There is no ideal method to quantify the adherence to the treatment. Indirect methods are recommended in clinical practice. Any intervention strategy should not blame the patient and try a collaborative approach. It is recommended to involve the patient in decision-making. The clinical interview style must be patient-centered including motivational techniques. The improvement strategies that showed greater effectiveness in the compliance of hypertension treatment were: treatment simplification, appointment reminders systems, blood pressure self-monitoring, organizational improvements and nurse and pharmacists care. The combination of different interventions are recommended against isolated interventions.

Deiodinases are selenoproteins that activate or inactivate thyroid hormone. During vertebrate development, these pathways control thyroid hormone action in a cell-specific fashion explaining how systemic thyroid hormone can affect local control of tissue embryogenesis. Here we investigated the role of the thyroid hormone-inactivating deiodinase (D3) in pancreatic islet function and glucose homeostasis. D3 expression was determined by real-time PCR, immunofluorescence, and enzyme activity. Embryonic and adult wild-type mice and Mice with targeted disruption of Dio3 gene (D3KO) as well as human fetal pancreas and adult islets were studied. Insulin secretion was evaluated in adult mouse isolated islets. We found Dio3 gene expression and protein highly expressed in embryonic and adult pancreatic islets, predominantly in β-cells in both humans and mice. However, mRNA levels were barely detectable for both the thyroid hormone-activating deiodinases types 1 and 2. D3KO animals were found to be glucose intolerant due to in vitro and in vivo impaired glucose-stimulated insulin secretion, without changes in peripheral sensitivity to insulin. D3KO neonatal (postnatal day 0) and adult pancreas exhibited reduced total islet area due to reduced β-cell mass, insulin content, and impaired expression of key β-cells genes. D3 expression in perinatal pancreatic β-cells prevents untimely exposure to thyroid hormone, the absence of which leads to impaired β-cell function and subsequently insulin secretion and glucose homeostasis. An analogous role is likely in humans, given the similar D3 expression pattern.

Acetylcholine is a neurotransmitter that plays a major role in the function of the insulin secreting pancreatic beta cell1,2. Parasympathetic innervation of the endocrine pancreas, the islets of Langerhans, has been shown to provide cholinergic input to the beta cell in several species1,3,4, but the role of autonomic innervation in human beta cell function is at present unclear. Here we show that, in contrast to mouse islets, cholinergic innervation of human islets is sparse. Instead, we find that the alpha cells of the human islet provide paracrine cholinergic input to surrounding endocrine cells. Human alpha cells express the vesicular acetylcholine transporter and release acetylcholine when stimulated with kainate or a lowering in glucose concentration. Acetylcholine secretion by alpha cells in turn sensitizes the beta cell response to increases in glucose concentration. Our results demonstrate that in human islets acetylcholine is a paracrine signal that primes the beta cell to respond optimally to subsequent increases in glucose concentration. We anticipate these results to revise models about neural input and cholinergic signaling in the endocrine pancreas. Cholinergic signaling within the islet represents a potential therapeutic target in diabetes5, highlighting the relevance of this advance to future drug development.

Extracellular ATP has been proposed as a paracrine signal in rodent islets, but it is unclear what role ATP plays in human islets. We now show the presence of an ATP signaling pathway that enhances the human β cell's sensitivity and responsiveness to glucose fluctuations. By using in situ hybridization, RT-PCR, immunohistochemistry, and Western blotting as well as recordings of cytoplasmic-free Ca 2+ concentration, [Ca 2+ ] i , and hormone release in vitro, we show that human β cells express ionotropic ATP receptors of the P2X 3 type and that activation of these receptors by ATP coreleased with insulin amplifies glucose-induced insulin secretion. Released ATP activates P2X 3 receptors in the β-cell plasma membrane, resulting in increased [Ca 2+ ] i and enhanced insulin secretion. Therefore, in human islets, released ATP forms a positive autocrine feedback loop that sensitizes the β cell's secretory machinery. This may explain how the human pancreatic β cell can respond so effectively to relatively modest changes in glucose concentration under physiological conditions in vivo.

Although, recently, the biopsychosocial approach has been emphasized in the practice of family medicine, how psychologists and physicians interact in collaborative family health care practice is still emerging in Portugal. This article describes a qualitative study that focused on the understanding of psychologists and family physicians' perceptions of their role and the collaborative approach in health care.A questionnaire gathered information regarding collaboration, referral, training and the practice of biopsychosocial medicine. A content analysis on respondents' discourse was performed. Results show that both physicians and psychologists agree on the importance of the biopsychosocial model and interdisciplinary collaboration. However, they also mentioned several difficulties that have to do with the lack of psychologists working full time in health care centers, lack of communication and different expectancies regarding each other roles in health care delivery.Both physicians and psychologists acknowledge the lack of academic training and consider the need for multidisciplinary teams in their training and practice to improve collaboration and integrative care. Implications for future research and for the practice of biopsychosocial medicine are addressed.

An important feature of glucose homeostasis is the effective release of glucagon from the pancreatic alpha cell. The molecular mechanisms regulating glucagon secretion are still poorly understood. We now demonstrate that human alpha cells express ionotropic glutamate receptors (iGluRs) that are essential for glucagon release. A lowering in glucose concentration results in the release of glutamate from the alpha cell. Glutamate then acts on iGluRs of the AMPA/kainate type, resulting in membrane depolarization, opening of voltage-gated Ca(2+) channels, increase in cytoplasmic free Ca(2+) concentration, and enhanced glucagon release. In vivo blockade of iGluRs reduces glucagon secretion and exacerbates insulin-induced hypoglycemia in mice. Hence, the glutamate autocrine feedback loop endows the alpha cell with the ability to effectively potentiate its own secretory activity. This is a prerequisite to guarantee adequate glucagon release despite relatively modest changes in blood glucose concentration under physiological conditions.

The lack of adherence to treatment in hypertension affects approximately 30 % of patients. The elderly, those with several co-morbidities, social isolation, low incomes or depressive symptoms are the most vulnerable to this problem. There is no ideal method to quantify the adherence to the treatment. Indirect methods are recommended in clinical practice. Any intervention strategy should not blame the patient and try a collaborative approach. It is recommended to involve the patient in decision-making. The clinical interview style must be patient-centered including motivational techniques. The improvement strategies that showed greater effectiveness in the compliance of hypertension treatment were: treatment simplification, appointment reminders systems, blood pressure self-monitoring, organizational improvements and nurse and pharmacists care. The combination of different interventions are recommended against isolated interventions.

In this work, particulate matter was collected using an active sampling system consisting of a PM10 (

Nephrin belongs to a family of highly conserved proteins with a well characterized function as modulators of cell adhesion and guidance, and nephrin may have a role in metabolic pathways linked to podocyte and pancreatic β–cell survival. However, this role is incompletely characterized. In this study, we developed floxed nephrin mice for pancreatic β-cell–specific deletion of nephrin, which had no effect on islet size and glycemia. Nephrin deficiency, however, resulted in glucose intolerance in vivo and impaired glucose–stimulated insulin release ex vivo. Glucose intolerance was also observed in eight patients with nephrin mutations compared with three patients with other genetic forms of nephrotic syndrome or nine healthy controls. In vitro experiments were conducted to investigate if nephrin affects autocrine signaling through insulin receptor A (IRA) and B (IRB), which are both expressed in human podocytes and pancreatic islets. Coimmunoprecipitation of nephrin and IRB but not IRA was observed and required IR phosphorylation. Nephrin per se was sufficient to induce phosphorylation of p70S6K in an phosphatidylinositol 3-kinase–dependent but IR/Src-independent manner, which was not augmented by exogenous insulin. These results suggest a role for nephrin as an independent modulator of podocyte and pancreatic β–cell nutrient sensing in the fasting state and the potential of nephrin as a drug target in diabetes.

BALB/c mice were intramuscularly immunized with low doses (25-50microg) of DNA cocktail containing plasmids encoding the full-length SAG1/P30 and the 196-561 terminal sequence of ROP2 genes. This immunization resulted in a Th1-type response with predominance of IgG2a and a specific T-cell proliferation with high levels of interferon-gamma (IFN-gamma) secretion, whereas no IL-4 was detected. Moreover, DNA cocktail immunization induced a long-lasting protection against a lethal challenge with the highly virulent Toxoplasma gondii RH strain, whereas low doses of single genes were not protective. These results support further investigations to achieve a multigene anti-T. gondii DNA vaccine.

OBJECTIVE To culturally adapt and validate the SPICTTM to Spanish, which is a brief and simple tool to support a better identification of chronic patients who have palliative care needs. METHODS For this study, we designed a multicenter and national project between the centers of Galicia, Balearic Islands, and Andalusia. For the process of translation and cross-cultural adaptation of the SPICTTM to Spanish, we followed the steps proposed by Beaton et al. with successive translations and subsequent consensus of experts using the debriefing methodology. After the content validation was completed, the psychometric properties were validated. A prospective longitudinal study was designed with 188 patients from Galicia, the Balearic Islands, and Andalusia. The internal consistency and reliability of the test and retest was analyzed for 10 days by the same researcher. RESULTS For more than 90% of the participants of the SPICT-ESTM, it seems simple to be filled out, and they consider it written in an understandable language. The average time to apply the questionnaire without prior knowledge was 4 minutes and 45 seconds. To evaluate the internal consistency of the instrument, we used the Kuder-Richardson formula 20. Internal consistency is 0.71. The agreement index of the Kappa test is between 0.983 and 0.797 for the different items. CONCLUSIONS In this study, we demonstrate the equivalence of content with the original. In addition, the validation of the psychometric properties establishes that the SPICT-ESTM maintains adequate reliability and stability. If we add the satisfaction shown by the professionals and the ease of use, the SPICT-ESTM is an adequate tool for the identification of palliative patients with chronic diseases and palliative care needs. RESUMEN OBJETIVO Adaptar culturalmente al español y validar el SPICTTM, una herramienta breve y sencilla para apoyar una mejor identificación de pacientes crónicos que presentan necesidades de atención paliativa. MÉTODOS Para este estudio se diseñó un proyecto multicéntrico y nacional entre centros de Galicia, Islas Baleares y Andalucía. Para el proceso de traducción y adaptación transcultural del SPICTTM al castellano, se siguieron los pasos propuestos por Beaton et al. con sucesivas traducciones y posterior consenso de expertos mediante la metodología debriefing. Tras finalizar la validación de contenido se procedió a la validación de las propiedades psicométricas. Se diseñó un estudio longitudinal prospectivo en 188 pacientes de Galicia, Baleares y Andalucía. Fue analizada la consistencia interna y la fiabilidad test-retest a los 10 días por el mismo investigador. RESULTADOS A más del 90% de los participantes SPICT-ESTM les parece sencillo cumplimentarlo, y consideran que está escrito en un lenguaje comprensible. El tiempo medio para aplicar el cuestionario sin conocimiento previo fue de 4 minutos y 45 segundos. Para la evaluación de la consistencia interna del instrumento, se ha utilizado la fórmula Kuder Richardson 20. La consistencia interna es de 0,71. El índice de concordancia del test Kappa se encuentra entre 0,983 y 0,797 para los distintos ítems. CONCLUSIONES En este estudio se ha demostrado la equivalencia de contenido con el original. Además, la validación de las propiedades psicométricas establece que SPICT-ESTM mantiene una adecuada fiabilidad y estabilidad. Si añadimos la satisfacción mostrada por los profesionales y la facilidad de uso, SPICT-ESTM es una herramienta adecuada para la identificación de pacientes paliativos con enfermedades crónicas y necesidad de cuidados paliativos.

Early Online, Background: Performance indicators assessing the quality of medical care and linked to pay for performance may cause disagreement. Portuguese indicators included in recent health care reform are controversial. Objectives: To obtain consensus from opinion leaders in family medicine regarding the performance indicators for practice management used in the evaluation of Family Health Units in Portugal. Methods: Eighty-nine specialists in primary care were invited to answer the following question in an online Delphi study: 'Which performance indicators should be assessed regarding the organization and management of clinical practice in primary care in Portugal?' A Likert scale was used to evaluate validity, reliability, feasibility and sensitivity to change. Twenty-seven experts participated in the second round and achieved a high degree of consensus. Eight categories were created for analysis. Results: The experts suggested the use of existing indicators as well as new indicators. Thirty-nine indicators suggested by the experts are currently in use in Portugal. The assessment of the number of clinical acts performed, the number of administrative acts, and evaluation of the clinical demographic profile achieved a high degree of consensus. The expert panel suggested fifty new indicators. Five categories of these new indicators had a high degree of consensus, and three categories had a low degree of consensus. Conclusion: The expert panel recommended that performance indicators of practice management should first assess the quantity of clinical and administrative activities undertaken. These indicators must take into account the human and financial resources available to the clinic and its demographic context.

An expression genomic library of Trypanosoma cruzi (T. cruzi) constructed using pcDNA3 plasmid was used for the immunisation (25 ug) of Balblc mice. Expression of T. cruzi antigens in the muscle of inoculated mice was detected by indirect immunofluorescence 7 days after immunisation. Specific IgG antibodies were significatively increased (P ~0.05) in animals that were reimmunised with 50 ,ug of the genomic library. An antigen specific lymphoproliferative response was detected in one animal of 0 1998 Elsevier Science Ltd. All the group inoculated with one dose of the library rights reserved

The aim of this study was the assesment of psychometric properties of the Portuguese version of the instrument "Medical Outcomes Study - Social Support Survey (MOSSSS)". This questionnaire has been translated and adapted in a Portuguese sample of 101 patients with chronic illness of a rural health centre in Portugal. The average age of patients was 63.4 years, 56.4% female. 29% were illiterate and 2% had completed high school. 78% had arterial hypertension and the 56.4% had diabetes mellitus type 2. The internal consistency was evaluated using Cronbach's alpha. Exploratory and Confirmatory factor analysis were performed in order to confirm reliability and validity of the scale and its multidimensional characteristics. The 2-week test-retest reliability was estimated using weighted kappa for the ordinals variables and intraclass coefficient correlation for the quantitative variables. Cronbach's alphas for the subscales ranged from 0.873 to 0.967 at test, and 0.862 to 0.972 at retest. Exploratory factor analysis revealed the existence of four factors (emotional, tangible, positive interaction and affection support) that explain the 72.71% of the variance. Confirmatory factor analysis supported the existence of four factors that allowed the application of the scale with original items. The goodness-of-fit measures corroborate the initial structure, with chi2/ df=2.01, GFI=0.998, CFI=0.999, AGFI=0.998, TLI=0.999, NFI=0.998, SRMR=0.332, RMSEA=0.76. The 2-weeks test-retest reliability of the Portuguese MOS-SSS as measured by the intraclass correlation coefficient was ranged from 0.941 to 0.966 for the four dimensions and the overall support index. The weighted kappa was ranged from 0.67 to 0.87 for all the items. The MOS-SSS Portuguese version demonstrates good psychometric properties and seems to be useful to measure multidimensional aspects of social support in the Portuguese population.

A genomic expression library of Trypanosoma cruzi (T. cruzi) was made using plasmid pcDNA3 as a vector, with which male mice from the Balb/c isogenic line were intramuscullary inoculated. It was used a positive control group that was administered soluble antigens of T. cruzi. Other 2 groups received genomic and plasmid DNA, respectively. One group was not immunized. Weekly blood samples were obtained from all the animals until the fourth week and 2 weeks after reimmunization to study the response of specific antibodies against the microorganism antigens by an indirect immunoenzymatic assay (ELISA). It was observed a significant increase of specific antibodies in the animals reimmunized with 50 micrograms of the library, as well as in the group immunized with soluble antigens of T. cruzi.

An immunoenzymatic system on solid phase for the detection of IgG antibodies in serum from chronic Chagasic patients was standardized. A protease from Trypanosoma cruzi (GP57/51KDa) was used as an antigen. The sensitivity, specificity and predictive values of the procedure were calculated taking into account the results obtained from conventional serology (CS), indirect immunofluorescence (IIF), indirect hemagglutination (IHA) and complement-mediated lysis test (CML) for the detection of anti-Trypanosoma cruzi antibodies in serum. Except one, the positive samples obtained by those techniques were also positive by our method. These results show that GP 57/51 is useful in the serodiagnosis of Chagas disease.

The utilization of a coagglutination technique for the identification of a human source for feeding mosquitoes is described. The dilution of ingested blood samples in filter paper was performed in 2 mL of a sodium chloride solution at 0.85%. It was used a suspension of sensibilized Staphylococcus aureus with rabbit's serum, human plasmatic anti-proteins, and human anti-IgG rabbit's serum discriminated well between human and non human blood. No agglutination was observed with the negative control. This technique proved to be sensitive to identify 100% of the human blood samples taken to the paper 24 hours after the mosquitoes completed their feeding at a temperature of 26 to 28 degrees C. Among mosquitoes fed and collected in the fields the test had a satisfactory result. Therefore, it may be used in routine work in the fields. The results showed the sensitivity and specificity of this method for identifying human blood ingested by mosquitoes.

A specific monoclonal antibody was characterized to Toxoplasma gondii. The hybridoma produced IgG immunoglobulins. The western blot analysis showed that the monoclonal antibody was specific for the antigen of an apparent molecular mass of 30 kd, which was present on the antigen surface. The monoclonal antibody was purified starting from mouse's ascitic fluid and it was matched with sepharose 4B. This immunoabsorbent was used to purify the specific parasitic antigen. The monoclonal antibody studied may be useful for those techniques contributing to the toxoplasmosis diagnosis.

It is know that 30% of AIDS patients may develop toxoplasmic encephalitis in an advanced stage of the disease. This study was conducted to investigate the presence of antigens to Toxoplasma gondii in the urine of patients infected by human immunodeficiency virus, group IV, who presenting with acute toxoplasmosis. These proteins were identified by electrophoresis in polyacrylamide gels, in the presence of sodium dodecyl sulfate in reduction conditions with the subsequent transfer to nitrocellulose sheets. Finally, they were isolated by affinity chromatography. Proteins with molecular weights nearly 66 and 61 KD were identified in the samples studied. Results obtained from this study highlights the presence of Toxoplasma gondii circulating antigens in patient presenting with AIDS and toxoplasmic encephalitis. The detection of these antigens in the urine of patients would be a very useful tool for the diagnosis of the acute infection by this protozoon.

Toxoplasmic encephalitis (TE) is a mayor cause of central nervous system infection in patients with acquired immunodeficiency syndrome (AIDS). Toxoplasma antibodies were detected in 56 of 79 patients with AIDS (71%), in the present study. Fourteen out of 57 seropositive patients developed TF (25%) and had Toxoplasma gondii antigen detected in their urine. For this, most of them received an effective therapy, with the subsequent disappearance of the symptoms and discontinuity of excretion of the T. gondii antigens. Our results suggest that the monitoring of T. gondii antigen in the urine of AIDS patients may be useful to decide on the proper time for therapy, as well as to avoid the beginning of neurologic signs in these patients.

A national seroepidemiological survey was carried out to assess the prevalence of anti-Toxoplasma gondii antibodies. 8863 samples taken in filter paper through the ELISA test were analyzed and 29.70% positivity was obtained. No significant differences were found regarding sex. Seropositivity increased with age, up to the 20-29 age group, with a stable behavior in over-29-year age groups. The highest percentage of annual change was registered in the 5-9 age group (1.62%). This parameter reached 0.93% in the women's 25-29 age group.

The presence of Dirofilaria immitis excretory-secretory (ES) products was detected in the urine of infected dogs using a coagglutination assay. Urine samples from 30 naturally infected dogs were positive. Seventeen of them were microfilaremic, whereas 13 had become amicrofilaremic after receiving 2 courses of diethylcarbamazine. Urine samples from 20 dogs infected with other parasites, Dipetalonema reconditum (7), Toxocara canis (5), and Ancylostoma caninum (8), and urine samples from 20 healthy dogs were negative. The assay detected 200 ng/ml or more of ES products. This assay is simple, easy to perform with minimum training, and requires no equipment. Therefore it should be useful to detect canine filariasis under field conditions.

A pilot Toxoplasma survey was conduct in Ciego de Avila province during the month of September, 1985, to assess, in practice, the methodologic structure proposed for the National Toxoplasma Survey. Of the 292 listed individuals, 284 were surveyed during the field work phase (97.2%) and the remaining 2.8% of no response was due mainly to the fact that dwellers were not at home during the visit. The best day for this type of survey resulted to be Sunday, in the morning. No difficulty was noted with the used modelling, and results obtained in the application of used techniques and procedures are appropriate for use in the National Toxoplasma Survey. The prevalence rate of anti- Toxoplasma antibodies was 55.9%. There was a significant association between some risk factors such as: living with cats, ingestion of non potable water and ingestion of raw meat.

The presence ofDirofilaria immitis excre- tory-secretory (ES) products was detected in the urine of infected dogs using a coagglutination assay. Urine samples from 30 naturally infected dogs were positive. Seventeen of them were microfilaremic, whereas 13 had become amicrofilaremic after receiving 2 courses of diethylcarbamazine. Urine samples from 20 dogs infected with other parasites, Dipetalonema recondi- tum (7), Toxocara canis (5), and Ancylostoma caninum (8), and urine samples from 20 healthy dogs were neg- ative. The assay detected 200 ng/ml or more of ES products. This assay is simple, easy to perform with minimum training, and requires no equipment. There- fore it should be useful to detect canine filariasis under field conditions. ABSTRACT: The presence ofDirofilaria immitis excre- tory-secretory (ES) products was detected in the urine of infected dogs using a coagglutination assay. Urine samples from 30 naturally infected dogs were positive. Seventeen of them were microfilaremic, whereas 13 had become amicrofilaremic after receiving 2 courses of diethylcarbamazine. Urine samples from 20 dogs infected with other parasites, Dipetalonema recondi- tum (7), Toxocara canis (5), and Ancylostoma caninum (8), and urine samples from 20 healthy dogs were neg- ative. The assay detected 200 ng/ml or more of ES products. This assay is simple, easy to perform with minimum training, and requires no equipment. There- fore it should be useful to detect canine filariasis under field conditions.

A seroepidemiologic study of toxoplasmosis was made in Ciego de Avila province. By means of an ELISA for toxoplasma, blood samples from 284 people from the Ciego de Avila and Majagua districts were examined, for a 55.9% prevalence. An association with various factors, such as eating raw meat, contract with the earth, having cats at home, and rural origin with the occurrence of infection. 89.3% of positive sera ranged from 1:400 to 1:800 which are low titers.