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Resumen En la continuidad asistencial del paciente que ha sufrido un sindrome coronario agudo es fundamental la rehabilitacion cardiaca. Es mas, centrar los cuidados en el paciente obliga a coordinar la atencion cardiologica con atencion primaria para mejorar la adherencia a los programas y una atencion continua adecuada. Los programas de rehabilitacion cardiaca comunitaria son indispensables para cumplir con los objetivos preventivos, pero somos conscientes de las dificultades de implementacion y la necesidad de apoyo de gestores y especialistas. Debemos ayudar a concienciar sobre esta necesidad y apoyar a los especialistas que tengan iniciativas en la creacion de este tipo de programas. Este documento trata de sintetizar los puntos basicos de la atencion y la coordinacion entre cardiologia y atencion primaria para la creacion y el desarrollo de estos programas comunitarios.

Resumen La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clinicos implicados que las tratan y las diferentes estrategias terapeuticas que precisan la participacion indispensable de diversas disciplinas. La presencia en los servicios de cardiologia de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afeccion y unidades de rehabilitacion cardiaca que, entre sus indicaciones para la reduccion de la morbimortalidad, tambien estan implicadas en la atencion de esos mismos pacientes puede causar dificultades de coordinacion y perdida de una atencion integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinacion entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiologia y la continuidad asistencial con atencion primaria, tanto tras haber conseguido la estabilidad como la interrelacion para una coordinacion posterior mas efectiva.

Objectives: To determine the level of knowledge of paediatricians and parents from Andalucía (southern Spain) about early-onset tooth decay, and to assess if paediatricians provide information to parents about paediatric oral care and visits to the paediatric dentist. Materials and methods: A random sample of 113 paediatricians and 112 parents with children under 3 years of age received an anonymous questionnaire comprising 14 items for paediatricians and 16 items for parents, grouped into five blocks: visits to the dentist, oral hygiene, caries, nutritional habits, and treatment of caries. The chi-squared test was used to assess differences between groups. Results: Paediatricians showed deficiencies in their knowledge about visits to the dentist and treatment of caries, however their level of knowledge on oral hygiene, tooth decay and nutritional habits were adequate. Parents showed a low level of knowledge in all aspects of the study, mainly about the treatment of tooth decay. There were no significant differences between paediatricians and parents in the knowledge about visits to the dentist, however paediatricians had more knowledge than the parents about hygiene, tooth decay, nutritional habits and treatment (P

The aim of this study was to evaluate masticatory muscle activity and kinematics of mandible changes in children with unilateral posterior cross-bite (UPXB) after orthodontic treatment, and one year after retention. Twenty-five children with UPXB and functional mandibular shift were evaluated before treatment (mean age 12.5years), after treatment (mean age 14.9years), and one year after retention (mean age 16.8years). The same data were collected in a control group of thirty age-matched normocclusive children. Simultaneous bilateral surface electromyographic (sEMG) activity from anterior temporalis (AT), posterior temporalis (PT), masseter (MA), and supra-hyoid (SH) muscle areas were evaluated at rest, during swallowing, mastication and clenching. Kinematic records of rest position, mandibular lateral shift, swallowing and mastication were analyzed. Results showed a lateral shift of the mandible present at rest. During swallowing, sEMG activity of SH predominated before and post-treatment and retention. High frequency of immature swallowing was maintained post-treatment and retention. During mastication, MA activity increased significantly and its asymmetry was corrected post-treatment. During clenching, cross-bite side AT and MA activity increased significantly posttreatment and remained stable after retention, and MA/AT ratio reversed. These findings reinforce the advantages of treating children with UPXB and functional shift as early as possible.

To test the hypothesis that midline basicranial orientation and posterior cranial base length are discriminating factors between adults of different populations and its potential maxillo/mandibular disharmonies.Twenty-nine 2D landmarks of the midline cranial base, the face and the mandible of dry skull X-rays from three major populations (45 Asians, 34 Africans, 64 Europeans) were digitized and analysed by geometric morphometrics. We used, first, MANOVA to test for mean shape differences between populations; then, principal components analysis (PCA) to assess the overall variation in the sample and finally, canonical variate analysis (CVA) with jack-knife validations (N=1000) to analyse the anatomical features that best distinguished among populations.Significant mean shapes differences were shown between populations (P0.001). CVA revealed two significant axes of discrimination (P0.001). Jack-knife validation correctly identified 92% of 15,000 unknowns. In Africans the whole cranial base is rotated into a forward-downward position, while in Asians it is rotated in the opposite way. The Europeans occupied an intermediate position. African and Asian samples showed a maxillo/mandibular prognathism. African prognathism was produced by an anterior positioned maxilla, Asian prognathism by retruded anterior cranial base and increase of the posterior cranial base length. Europeans showed a trend towards retracted mandibles with relatively shorter posterior cranial bases.The results supported the hypothesis that basicranial orientation and posterior cranial base length are valid factors to distinguish between geographic groups. The whole craniofacial configuration underlying a particular maxillo-facial disharmony must be considered in diagnosis, growth predictions and resulting treatment planning.