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Autism spectrum disorder is characterized by a qualitative alteration in social interaction and communication associated with restricted interests and stereotyped behaviors. This condition will accompany people throughout their lives, with variations in their evolution. Our objectives were to know the evolutionary characteristics of people with autistic spectrum disorder, analyzing cognitive, behavioral, health, mortality and their needs in the aging stage, which will guide the planning of specific support resources. We analyze studies related to the evolution in adult life in people with this disorder, with or without identified entities, and socio-health conditions that should be considered in the aging process. The knowledge about aging in people with autism is still scarce and it is difficult to define a specific pattern because this will depend, among other factors, on the etiology, the degree, the presence of intellectual disability and/or epilepsy, and the scope in where live, which can even condition the life expectancy. Aging has been associated with mood disorders, depression, deterioration in executive functions and episodic memory, although it is difficult to differentiate it from natural aging in people with typical development. The identification of a specific entity will allow to know the possible evolution and prevent complications in syndromes that may be associated with autism: fragile X, Down, Angelman, Rett and Williams, for that reason we rank the genetic and neurological consultation.

Stroke is the most important medical condition leading to permanent disability in adults. The aim of this study is to evaluate the efficacy of dynamic orthoses in the rehabilitation of the upper limbs in patients who have had a stroke.We conducted a longitudinal case-control study. The sample used in the study consisted of patients from rehabilitation centres who presented hemiparesis secondary to an ischaemic or haemorrhagic stroke. The patients were randomly distributed into a study group, whose members received a dynamic orthosis on an upper limb for a six-month period, and a control group. Appraisals were performed pre- and post-treatment with the orthosis with Fugl-Meyer Assessment Scale and with Wolf Motor Function to measure their command over body functions and activities. Differences between pre- and post-test were compared using ANCOVA and Student's t.The sample included 40 patients (65% males) who presented chronic hemiparesis secondary to ischaemic (n = 28) or haemorrhagic stroke (n = 12), with a mean age of 58.43 ± 8.67 years. After the six-month follow-up, improved motor function was observed in both groups, according to both scales. The use of a dynamic orthosis was associated with a tendency towards improved strength in the upper limb.Rehabilitation following a stroke improves strength and body activities in the upper limb. The use of a dynamic orthosis can further improve the strength in this limb, but additional research is needed to confirm our results.Eficacia de la ortesis dinamica del miembro superior en la fase cronica del ictus. Estudio longitudinal.Objetivo. El ictus es la condicion medica mas importante que origina discapacidad permanente en el adulto. El objetivo es valorar la eficacia de ortesis dinamicas en la rehabilitacion del miembro superior en pacientes que han presentado un ictus. Pacientes y metodos. Estudio longitudinal de casos y controles. Se incluyo una muestra de pacientes procedentes de centros de rehabilitacion que presentaban hemiparesia secundaria a ictus isquemico o hemorragico. De forma aleatoria, los pacientes fueron distribuidos en un grupo de estudio, cuyos miembros recibieron una ortesis dinamica en el miembro superior durante seis meses, y un grupo control. Se realizaron valoraciones pre y postratamiento con la ortesis con la Fugl-Meyer Assessment Scale y con la Wolf Motor Function para medir los dominios de las funciones y actividades corporales. Se compararon las diferencias entre pre y postest usando ANCOVA y t de Student. Resultados. Se incluyo a 40 pacientes (65% hombres) que presentaban una hemiparesia cronica secundaria a ictus isquemico (n = 28) o hemorragico (n = 12), con una edad media de 58,43 ± 8,67 años. Tras el seguimiento de seis meses, se observo una mejoria en ambos grupos en la funcion motora segun ambas escalas. El uso de la ortesis dinamica se asocio a una tendencia hacia la mejoria en la fuerza de la extremidad superior. Conclusiones. La rehabilitacion tras el ictus mejora la fuerza y las actividades corporales en el miembro superior. El uso de una ortesis dinamica puede adicionalmente mejorar la fuerza en este miembro, pero se necesitan mas estudios para confirmar nuestros resultados.

Deficits in the perception of time and processing of changes across time are commonly observed in individuals with autism. This pilot study evaluated the efficacy of the use of the software tool Tic-Tac, designed to make time visual, in three adults with autism and learning difficulties. This research focused on applying the tool in waiting situations where the participants exhibited anxiety-related behaviour. The intervention followed a baseline and intervention (AB) design, and a partial interval recording procedure was used to code the presence of stereotypes, nervous utterances, wandering or other examples of nervousness during the selected waiting situations. The results showed that the use of Tic-Tac resulted in lower levels of anxiety-related behaviour in all three participants, compared to the baseline, suggesting that this software may be an effective technology for helping people with autism with organisation and predictability during waiting periods. The results are discussed in terms of limitations and implications for further study.

The concept of quality of life is of great importance for interventions directed at people living with disabilities. It is undeniable that the achievement of a satisfactory quality of life should be the objective of clinical interventions that are directed at the group of people with autism spectrum disorder (ASD) and should be a key element in the design of the treatments that are needed to improve the prognosis of future development. Nevertheless, knowledge of both the objective and the subjective conditions that predict greater quality of life satisfaction in people with ASD is still very limited.To explore the perception of the quality of life experienced by a group of children and adolescents with ASD without intellectual disability.A sample of 12 children and 11 adolescents with ASD without intellectual disability. In accordance with their age, they were administered the corresponding quality of life questionnaires.Both groups reported positively on their quality of life, without any differences in the basic dimensions. Nevertheless, in the case of adolescents, very low scores were obtained in the area of self-determination in comparison with their scores in other areas.The discussion centers on the identification of the most relevant dimensions for quality of life, the implications for intervention, and the need to adapt the methodologies in use for the subjective evaluation of those factors, due to the characteristics of ASD that can affect the capabilities necessary for the evaluation of personal experience, and may require the adaptation of the procedures that are employed.Calidad de vida en niños y adolescentes con trastorno del espectro autista sin discapacidad intelectual.Introduccion. El concepto de calidad de vida tiene gran importancia en la intervencion dirigida a las personas con discapacidad. Resulta indiscutible que el alcance de una calidad de vida satisfactoria debe ser el objetivo de las intervenciones clinicas dirigidas al colectivo de personas con trastorno del espectro autista (TEA), y un elemento clave para diseñar los tratamientos necesarios que mejoren el pronostico de desarrollo futuro. A pesar de ello, el conocimiento sobre las condiciones objetivas y subjetivas que predicen una mayor satisfaccion en las personas con TEA es aun muy limitado. Objetivo. Explorar la percepcion de la calidad de vida que experimenta un grupo de niños y adolescentes con TEA sin discapacidad intelectual asociada. Pacientes y metodos. Muestra de 12 niños y 11 adolescentes con TEA sin discapacidad intelectual asociada. Dependiendo de la edad, se les aplico el cuestionario de calidad de vida especifico. Resultados. Ambos grupos informan positivamente sobre su calidad, sin que existan diferencias en las dimensiones basicas. No obstante, en el caso de los adolescentes se obtienen puntuaciones mas bajas en el area de autodeterminacion en comparacion con las demas. Conclusiones. La discusion se centra en la identificacion de las dimensiones mas relevantes para la calidad de vida, las implicaciones para la intervencion y la necesidad de adecuar las metodologias empleadas para la evaluacion subjetiva de estos factores, debido a que las caracteristicas de los TEA pueden alterar las habilidades necesarias para la valoracion de la experiencia personal y requerir la adaptacion de los procedimientos empleados.

The aim of this study was to test the hypothesis of an association between the -30GA polymorphism of the promoter of the glucokinase gene and the prevalence and incidence of obesity. We studied the -30GA polymorphism of the glucokinase gene promoter in 981 persons, of whom 866 were seen again 6 years later. All the persons underwent an oral glucose-tolerance test and the BMI (weight/height(2)) was recorded. The -30GA polymorphism of the glucokinase gene promoter was studied using RFLP-PCR. At the initial study, the probability of having a BMIor =25 in carriers of the A allele was significantly lower than expected by chance (odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.456-0.885). In those persons with a BMIor =30 at the first study, the probability at 6 years of losing weight (reaching a BMI30) was greater in carriers of the A allele (OR = 0.22; 95% CI = 0.087-0.576). The increase in weight over these 6 years, taken as a continuous variable, was significantly less only in those persons who were originally obese (P = 0.018). In conclusion, in a population from southern Spain, carriers of the A allele of the -30GA polymorphism in the promoter of the glucokinase gene had a lower risk for obesity and the likelihood of losing weight was greater in those obese persons who had the A allele (GA or AA).

To study the prevalence and correlates of body size phenotypes in an adult Spanish population.We undertook a cross-sectional analysis in a random sample of 2,270 individuals. We defined six body size phenotypes based on body mass index category (normal-weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; obese, ≥30.0 kg/m2) and the presence of ≤1 (metabolically healthy) or ≥2 (metabolically abnormal) cardiometabolic abnormalities: metabolically healthy normal-weight (MHNW), metabolically abnormal normal-weight (MANW), metabolically healthy overweight (MHOW), metabolically abnormal overweight (MAOW), metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). We considered four cardiometabolic abnormalities: systolic and/or diastolic blood pressure ≥130/85 mm Hg, triglycerides ≥150 mg/dL, high-density-lipoprotein cholesterol levels40/50 mg/dL in men/women, and elevated glucose (fasting plasma glucose ≥100 mg/dL or previous diabetes).The prevalence of the MHO, MHOW, and MANW phenotypes was 2.2, 13.9, and 7.9%, respectively. Whereas 9.6% of obese and 32.6% of overweight individuals were metabolically healthy, 21.3% of the normal-weight subjects were metabolically abnormal. A multivariate regression model (adjusted for age, sex, and waist circumference) showed that age40 years, male sex, and higher waist circumference were independently associated with the metabolically abnormal phenotype MANW, whereas younger age, female sex, and lower waist circumference were independently associated with the metabolically healthy phenotypes.The prevalence of MHO in our population is low and is more common in women and younger people. In contrast, a high proportion of normal-weight individuals (mainly over 40 years of age) in our population show cardiometabolic abnormalities.

To analyse the differences in the prevalence of diabetes and dysglycaemia using fasting plasma glucose and HbA(1c) criteria.Analytical cross-sectional study undertaken in a random sample of 2144 individuals (age 18-80 years) without known diabetes from the primary care setting in Malaga (Spain). Dysglycaemia was defined as fasting plasma glucose 5.6-6.9 mmol/l or HbA(1c) 39-46 mmol/mol (5.7-6.4%) and diabetes as fasting plasma glucose ≥ 7.0 mmol/l or HbA(1c)≥ 48 mmol/mol (≥ 6.5%).The proportion of subjects who were normoglycaemic was significantly higher using fasting plasma glucose than HbA(1c) (83.5 vs. 65%) (P0.0001). Compared with fasting plasma glucose, HbA(1c) detects more cases of dysglycaemia (32 vs. 14.8%) (P0.0001) and diabetes (3 vs. 1.7%) (P0.0001).In our environment, using HbA(1c) for the diagnosis of pre-diabetes and diabetes could increase the target population for preventive and therapeutic measures. Further cost-effectiveness studies are needed before the widespread diagnostic use of HbA(1c) can be recommended.

Hand eczema is not uncommon in children but it is rarely studied using skin-prick tests. Few reports have addressed their usefulness in children and none has specifically analyzed their use in children with hand eczema.We performed a retrospective study of all children up to 16years of age with hand eczema who were assessed in the Department of Dermatology at Hospital General Universitario in Alicante, Spain with the standard GEIDAC panel over a 5-year period. We compared the epidemiologic data and results of skin-prick tests in this group with those obtained in children with eczema at any site and in adults with hand eczema.The study included a total of 1695 patients: 141 (8.3%) children and 1533 (91.7%) adults. Hand eczema was diagnosed in 496 (31.9%) adults and 32 (22.7%) children. Positive results were obtained in skin-prick tests in 50% of children with hand eczema compared with 37.6% of children with eczema at any site and 50.6% of adults with hand eczema. The current relevance of the positive allergens found in children with hand eczema (76.2%) was greater than that observed in children with eczema at any site (61%) or in adults with hand eczema (43%). The most common allergens in children with hand eczema were kathon CG and fragrance mix I, whereas in the other 2 groups metals were the most common. The most common final diagnosis in children with hand eczema was allergic contact dermatitis (34.3%), which proved to be more common than atopic dermatitis.We recommend the use of skin-prick tests in all children with chronic hand eczema.

gastrointestinal stromal tumors (GISTs) are rare (10 to 20/million). They exist in the whole digestive system and its surroundings, and are most common in the stomach (70%), followed by the small intestine (20-25%), colon and rectum (5%), and esophagus (5%). Their clinical presentation varies from small, incidentally found nodules to large and aggressive tumors. Nowadays GISTs are classified according to Fletcher s classification.to review the features of our GIST population.a retrospective study of GIST patients identified by immunohistochemical criteria, from 1997 to December 2007, and classified according to Fletcher s criteria.43 patients were included (24 men, 19 women) with a mean age of 62.7 years. Gastric GISTs (20 cases, 46.5%), small intestine GISTs (18 cases, 41.9%); in 5 cases metastases of occult tumors were found. Eighteen cases had no symptoms. Tumors were classified according to Fletcher s criteria as high-risk (n = 19), intermediate-risk (n = 7), low-risk (n = 12), and indeterminate-risk (n = 5). Death occurred in 10 patients, and 13 patients had metastatic disease.our results are in accordance with the world literature, in which a majority of cases are men with gastric tumors. The 5-year survival rate was 42%. Fletcher s criteria were easily applicable criteria and could predict tumor behavior.

The aim of this study was to evaluate patterns of insulin resistance in the general population. The study was cross sectional. Clinical, anthropometric, and lipid measurements were made in 1226 persons aged 18–65 years. An oral glucose tolerance test (OGTT) was performed in 1020 subjects, with insulin levels determined at baseline and after 2 h. The homeostasis model assessment insulin resistance index (HOMA IR) and HOMA β-cell function were calculated. Compared with subjects with normal glucose tolerance, the groups with abnormal OGTT had different baseline insulinemia, 2 h post OGTT insulinemia, HOMA IR and HOMA β-cell indices. Serum insulin levels at baseline and 2 h after OGTT showed a characteristic pattern for each category of glucose tolerance, resulting from the different insulin responses. In the subjects with normal glucose tolerance, the pattern of the relationships between both types of serum insulin levels was exactly the same, so that it was possible to determine risk groups according to the ratio of baseline serum insulin/2 h insulin. HOMA IR and HOMA β-cell were significantly associated with the risk of impaired fasting glucose, previously unknown diabetes mellitus, and known diabetes mellitus. These results support the rationale for introducing preventive measures against insulin resistance in the general population.

Our purpose was to evaluate in a cross-section, populational study the association between daily physical activity and various metabolic and cardiovascular disease risk factors.A total of 1226 randomly selected persons (aged 18-65 years) from a town in southeast Spain were evaluated for studying the association between the level of daily physical activity, both in and out of working hours, and the following variables: body mass index, plasma lipids, hypertension, obesity, altered baseline glycemia, and abnormal glucose tolerance.The intensity of the physical activity at work was related negatively with insulin resistance and levels of LDL cholesterol, and positively with HDL cholesterol. The probability of hypertension, altered baseline glycemia, and abnormal glucose tolerance was greater in those undertaking less daily physical activity.Daily physical activity, considered as part of the lifestyle, is related with the presence of components of the metabolic syndrome. An increase in daily physical activity should contribute to improve preventible cardiovascular risk factors.

Benign bladder tumors of mesenchymal origin have a very low appearance incidence, being the most frequent the leiomyoma. We report new case, making a discussion about the complementary tests needed for the diagnose.