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El objeto del presente artículo es el análisis de la actuación de la Inspección de Trabajo y de Seguridad Social en relación con las personas con discapacidad y, específicamente, el impacto de la misma tanto para el cumplimiento de la cuota de reserva de trabajadores con discapacidad en empresas de 50 o más trabajadores como, en general, para el incremento de la inclusión laboral del colectivo. La Inspección está realizando desde hace tres lustros una campaña específica de control de esta obligación legal. Se analizan los datos que publicita esta institución en sus memorias anuales y se proponen algunas mejoras. Los resultados demuestran que esta intervención administrativa ha sido muy interesante para aumentar la inclusión laboral del colectivo, aunque parece que hemos llegado a un tope, por lo que se propone la necesidad de un cambio de paradigma y la introducción de nuevas medidas de políticas activas de empleo.

The lack of safe and cost-effective treatments against leishmaniasis highlights the urgent need to develop improved leishmanicidal agents. Antimicrobial peptides (AMPs) are an emerging category of therapeutics exerting a wide range of biological activities such as anti-bacterial, anti-fungal, anti-parasitic and anti-tumoral. In the present study, the approach of repurposing AMPs as antileishmanial drugs was applied. The leishmanicidal activity of two synthetic anti-lipopolysaccharide peptides (SALPs), so-called 19-2.5 and 19-4LF was characterized in Leishmania major. In vitro, both peptides were highly active against intracellular Leishmania major in mouse macrophages without exerting toxicity in host cells. Then, q-PCR-based gene profiling, revealed that this activity was related to the downregulation of several genes involved in drug resistance (yip1), virulence (gp63) and parasite proliferation (Cyclin 1 and Cyclin 6). Importantly, the treatment of BALB/c mice with any of the two AMPs caused a significant reduction in L. major infective burden. This effect was associated with an increase in Th1 cytokine levels (IL-12p35, TNF-α, and iNOS) in the skin lesion and spleen of the L. major infected mice while the Th2-associated genes were downregulated (IL-4 and IL-6). Lastly, we investigated the effect of both peptides in the gene expression profile of the P2X7 purinergic receptor, which has been reported as a therapeutic target in several diseases. The results showed significant repression of P2X7R by both peptides in the skin lesion of L. major infected mice to an extent comparable to that of a common anti-leishmanial drug, Paromomycin. Our in vitro and in vivo studies suggest that the synthetic AMPs 19-2.5 and 19-4LF are promising candidates for leishmaniasis treatment and present P2X7R as a potential therapeutic target in cutaneous leishmaniasis (CL).

Preeclampsia is a major cause of maternal and fetal morbidity and mortality. Early recognition of the disease may be challenging. Complications may precede the onset of clinical symptoms and medical intervention is often delayed. Moreover, in the absence of specific clinical signs, many patients will present symptoms mimicking the disease without ever being diagnosed with preeclampsia. This situation may, however, lead to medical interventions and cause unnecessary stress for the patient. For many years, research tried to evaluate the significance of serum biomarkers as early indicators of preeclampsia. Among many, the sFlt-1/PlGF ratio, given its performance, aroused the greatest interest. This article reviews current knowledge on the subject, focusing on a Swiss perspective.

Introducción El estudio del paisaje en general, y de las infraestructuras verdes en particular, es especialmente complejo, principalmente para atender a los aspectos perceptivos que exige toda caracterización. El uso de un análisis cualitativo para el estudio de la percepción en los casos de estudio permite profundizar en los detalles y matices que surgen al analizar lo que la literatura ha denominado la visión «no experta» del paisaje Objetivos; Métodos Para este análisis de la percepción de la infraestructura verde urbana se utiliza una metodología cualitativa, apoyada en el software NVIVO. El software se usa para codificar las respuestas de una serie de entrevistas semiestructuradas que se realizan en los casos de estudio; parques metropolitanos del contorno de la ciudad de Madrid, que permita estudiar su percepción. Para la codificación, se hace un proceso de “decantación”: se empieza por una codificación abierta, se pasa a una codificación axial, para terminar con una codificación selectiva, creando así una jerarquía entre los principales conceptos (denominados “nodos”) que surgen a lo largo de las entrevistas Resultados Conclusiones El análisis metodológico propuesto tiene como objetivo entender la percepción de los elementos que forman parte de la red de infraestructura verde del contorno de Madrid. Los resultados obtenidos demuestran que estas técnicas de entrevista aportan resultados significativos con una muestra relativamente pequeña de entrevistas. Tras el desarrollo de esta investigación, se ha optado por el uso de esta nomenclatura: «técnica» y «cotidiana» para referirnos a las miradas al paisaje. Así, se ahonda en el sentido del lugar, la conectividad, multifuncionalidad y accesibilidad de la infraestructura verde urbana o en la imagen de la ciudad.

Purpose: to study the possible association between long-term treatment with aromatase inhibitors and deteriorated bone quantity and quality in postmenopausal women with breast cancer, leading to a higher prevalence of osteoporosis and fragility fractures. Methods: case and control study. One hundred and four women with breast cancer who had been taking AIs for a median of 3 years were the cases and 104 women of similar age, height and weight made up the control group. We measured biochemical parameters of bone remodeling, vitamin D (25HCC) and PTH. Bone mineral density was determined by bone densitometry in the lumbar spine and in the proximal femur, and TBS in the lumbar spine. Finally, QUS parameters of the dominant foot were estimated. Results: 46.3 % of patients had osteoporosis compared to 16.1 % of controls 38.4 % of these women had suffered at least one fragility fracture, compared to 20.1 % of controls. Women with AI had lower values of bone mass as well as QUS and TBS. Only 9.6 % of women receiving AI had optimal 25HCC levels (greater than 30 ng/mL) compared to 20.2 % of controls. In the logistic regression analysis, the variables associated with the presence of fragility fractures were the time taking AI, vitamin D levels, TBS and beta-crosslaps (CTX). TBS correlated with QUI (r = 0.754. p < 0.01). Conclusions: AIs cause a decrease of bone mass and an alteration in bone quality which increase the risk of fractures. After having had AI for at least 3 years, 46.3 % had densitometric osteoporosis and 38.4 % had suffered at least one fragility fracture. Less than half of the patients had prescribed calcium and vitamin D and less than 20 % some drug for osteoporosis. [ABSTRACT FROM AUTHOR]

Introduction: in recent years, there has been considerable interest in vitamin D, both regarding its physiological aspects and its deficiency, the need for supplementation, recommended doses, and even the type of metabolite that should be used. Material and Methods: given the lack of universally accepted criteria among all scientific societies and the significant heterogeneity observed in clinical practice regarding these issues, we conducted a survey of a sample of 698 doctors in Spain from the specialties of Primary Care, Internal Medicine, Rheumatology, Traumatology, Endocrinology, Gynecology, and Geriatrics to understand their opinions on various aspects of vitamin D management. Results: there is a notable disparity in the responses to the 8 questions related to their usual clinical practice, both in the likelihood of requesting a vitamin D determination and in how it is prescribed. Conclusion: finally, the recommendations of the expert panel that developed the survey and analyzed its results are presented. [ABSTRACT FROM AUTHOR]

While there is general consensus on the importance of landscape perception in urban studies, there is still a need to broaden the toolkit for researchers and practitioners to document, analyse and interpret these inputs, in line with the postulates of the European Landscape Convention and overcoming conventional formats based on descriptions and static photography. This becomes particularly pertinent in the peri-urban landscapes of large cities, bearers of the relations and contradictions between urban growth, resource consumption and landscape protection, and especially vulnerable to tabula rasa approaches. We case study the surrounding landscapes of Madrid at a metropolitan scale, addressing the gap between scopes and scales of recent landscape reports and focusing on two elements connecting (visually, or physically) the city with its commuting zone: lookouts and roads. An expert-based methodology presents the criteria for their selection and a description of desk and field work. A sample for each local approach is further developed to exemplify the application, combining cartography, 3D modelling, visual basins, on-site photography and interpretive drawings. This results in a multifaceted vision of how the city and its hinterland is perceived, illustrating both outstanding and everyday landscapes and how they interweave in a continuous experience.

Abstract Background Migrant mothers in high-income countries often encounter more complications during pregnancy, delivery, and the postpartum period. To enlighten health care providers concerning potential barriers, the objective of this study was to explore positive and negative experiences with maternal health services in the University Hospitals of Geneva and Zurich and to describe barriers to maternity services from a qualitative perspective. Methods In this qualitative study, six focus groups (FGs) were conducted involving 33 women aged 21 to 40 years. All FG discussions were audio-recorded and later transcribed. Data were analysed using a thematic analysis approach assisted by the Atlas.ti qualitative data management software. Results Positive experiences included not only the availability of maternity services, especially during emergency situations and the postpartum period, but also the availability of specific maternity services for undocumented migrants in Geneva. Negative experiences were classified into either personal or structural barriers. On the personal level, the main barriers were a lack of social support and a lack of health literacy, whereas the main themes on the structural level were language barriers and a lack of information. Conclusion Structural adaptation is necessary to meet the needs of the extremely diverse population. The needs include (1) the provision of specific information for migrant women in multiple languages, (2) the availability of trained interpreters who are easily accessible to health care providers, (3) specifically trained nurses or social assistance providers to guide migrants through the health system, and (4) a cultural competence-training programme for health care providers.

The use of algorithms for automatic classification of aerial laser scanner 3D Point Clouds is the main process that improves its thematic quality. The main objectives of using 3D Point Clouds are the description of the surface and the detection of objects. The aim of this proposal for bridge and water detection algorithms is to increase the range and accuracy of the classification parameters of these products obtained with LiDAR technologies. With this methodology, the Digital Elevation Models (DEM) quality is improved and they are obtained by automated models of bridges and hydrography.This paper describes a methodology to detect and classify bridges and continental water bodies in points using the properties of LiDAR technology such as radiometric and geometric variables implementing indexes like NDVI, NDWI or NFC. In addition, the Network of Roads and Hydrographic models in Spain are used to reduce the area of interest and errors. Part of the province of Teruel (Spain) has been used as study area.

Objetivo: La osteonecrosis de maxilares (ONM) es una enfermedad recientemente descrita cuya etiopatogenia es desconocida, aunque se ha atribuido, entre otras causas, al tratamiento prolongado con bifosfonatos. Sin embargo, mientras que la ONM es una patología localizada, la acción de los bifosfonatos es generalizada, es decir, afecta a todos los huesos. No hay estudios que muestren el estado óseo general de los pacientes con ONM. Con este trabajo hemos querido estudiar en pacientes afectos de ONM dicho estado general mediante medidas cuantitativas y estimaciones cualitativas del hueso por medio de la densidad mineral ósea (DMO) y el trabecular bone score (TBS) y los parámetros ultrasonográficos en el calcáneo (QUS), además de la presencia de otras enfermedades y la toma de fármacos (especialmente los bifosfonatos) en los pacientes con ONM que pudieran participar en su etiopatogenia. Material y método: Estudio observacional y transversal de casos y controles, realizado en 304 pacientes de ambos sexos, en los que el grupo de casos (grupo I) estaba formado por 24 pacientes que habían sufrido una ONM, mientras que el grupo control (grupo II) estaba formado por 280 pacientes que no presentaban ONM y que recibían bifosfonatos desde un mínimo de 5 años por causas diversas. A todos ellos se les realizó una densitometría ósea (DXA, Hologic 4500 Discovery®) en la columna lumbar y en la extremidad proximal del fémur. Además, se les realizó mediciones del TBS en la columna lumbar, así como de los parámetros ultrasonográficos en el calcáneo (Hologic, Sahara®) en el pie dominante (QUS). Resultados: Los pacientes afectos de ONM tenían una mayor comorbilidad que los controles, con una mayor prevalencia de las siguientes enfermedades: diabetes mellitus, cáncer, artritis reumatoide, hipertiroidismo, cardiopatía, arritmias, insuficiencia cardíaca e hipercolesterolemia. Por ello, el consumo de corticoides, (orales e inhalados), anticoagulantes, hipnóticos, bifosfonatos i.v. (zoledronato), y quimioterapia antineoplásica fue también mayor entre los pacientes afectos de ONM que los pacientes controles. Sin embargo, entre los pacientes con ONM el porcentaje que tomaba bifosfonatos orales fue menor. Los valores densitométricos (DMO medida en la columna lumbar L2-L4, cuello femoral y total de cadera) fueron más elevados en los pacientes con ONM en comparación con los de los controles. El TBS no mostró diferencias estadísticamente significativas entre ambos grupos, y los ultrasonidos presentaron valores más elevados de QUI y SOS en los pacientes con ONM que en los controles. La prevalencia de fracturas por fragilidad fue similar en ambos grupos. Conclusiones: Nuestros pacientes afectos de ONM mostraron una mayor comorbilidad y un mayor consumo de fármacos que los pacientes del grupo control, a excepción de bifosfonatos orales. Por otro lado, tanto la DMO como los parámetros ultrasonográficos mostraron valores más elevados en los pacientes con ONM que los controles. Si consideramos la DXA como una técnica medidora de la cantidad de masa ósea, y el TBS y la ultrasonografía de calcáneo técnicas estimadoras de aspectos cualitativos del hueso, podemos suponer que ni la cantidad ni la calidad óseas en general parecen estar afectadas en la ONM, siendo probablemente otro su mecanismo etiopatogénico. Los bifosfonatos orales no parecen estar entre los fármacos que participen en la etiología de la ONM, aunque sí los bifosfonatos más potentes que se administran por vía intravenosa, si bien no pueden considerarse independientemente de la patología subyacente para la cual se administran.

Abstract Background The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is one of the most widely used health-related quality of life questionnaires for patients with heart failure (HF). The objective of the present study was to explore the responsiveness of the MLHFQ by estimating the minimal detectable change (MDC) and the minimal clinically important difference (MCID) in Spain. Methods Patients hospitalized for HF in the participating hospitals completed the MLHFQ at baseline and 6 months, plus anchor questions at 6 months. To study responsiveness, patients were classified as having “improved”, remained “the same” or “worsened”, using anchor questions. We used the standardized effect size (SES), and standardized response mean (SRM) to measure the magnitude of the changes scores and calculate the MDC and MCID. Results Overall, 1211 patients completed the baseline and follow-up questionnaires 6 months after discharge. The mean changes in all MLHFQ domains followed a trend (P

The synthesis of 1,2-divinylcyclopropanes by the reaction of cyclopropenes with 1,3-dienes is reported. The process relies on the ability of ZnCl2 or [Rh2(OAc)4] to generate metal–vinyl carbene intermediates from cyclopropenes, which effect cyclopropanation of 1,3-dienes. Most of the reactions proceeded in reasonable yields while the diastereoselectivity strongly depends on the structure of the diene. An example of an intramolecular process as well as the use of furan and 1,4-cyclohexadiene as dienes are also reported.

Perineal lacerations affect between 35 and 85% of women during childbirth and may be responsible for postpartum pain. Honey has been demonstrated to have interesting properties that can promote wound healing. The aim was to evaluate the effectiveness of the application of honey to the perineum to reduce perineal pain during the early postpartum period. A randomized controlled trial including 68 women was conducted. In the intervention group, honey was applied to perineal lacerations for four days, in addition to standard care. The control group received only standard care. The primary outcome was pain intensity using the Visual Analog Scale and pain perception using the McGill Pain Questionnaire (QDSA). The secondary outcomes were a burning sensation, the use of a pain killer, and the women’s satisfaction with the honey application. The intensity of pain was not significantly different between the groups on Day 1 (VAS 3.38 in the control group versus 3.34 in the intervention group, p = 0.65) or on Day 4 (VAS 2.28 versus 1.41, respectively, p = 0.09). There was no significant difference regarding the perception of pain with the QDSA. Despite this, most of the women in the intervention group (93%) were satisfied or very satisfied with the use of honey on their perineum.

Se presenta el caso de una paciente ingresada por cuadro clínico de infarto agudo de miocardio con elevación del segmento ST. Tras la realización de una coronariografía emergente en la que se evidencia un trombo en la arteria coronaria derecha, sin objetivar lesiones ateroscleróticas, es diagnosticada de infarto de probable origen embólico. Tras realizar un ecocardiograma transtorácico, se detecta la presencia de trombos en las cavidades derechas e izquierdas del corazón. Por ello se realiza angiografía por tomografía computarizada con protocolo de embolia pulmonar, que confirma la presencia de embolia pulmonar bilateral masiva. Tras esto, se repitió el ecocardiograma transtorácico, hallándose un aneurisma del septo interauricular, con aparente protrusión de una masa trombótica a través de él. Se inició terapia anticoagulante con buena evolución por parte de la paciente, habiendo desaparecido los trombos en el ecocardiograma con test de burbujas que se realizó días después, en el que se demostró la presencia de un foramen oval permeable. Con la presentación de este caso se pretende, en primer lugar, ilustrar una afección que en contadas ocasiones se puede objetivar mediante prueba de imagen, y en segundo lugar, hacer una breve revisión del diagnóstico y el manejo del foramen oval permeable como parte del estudio de fuente embólica.

La regla general en derecho español es que los herederos forzosos, descendientes o ascendientes reciban bienes de la herencia en pago de su derecho; y en lo que se refiere al cónyuge viudo, el derecho hereditario forzoso viene concretado en un usufructo sobre una parte de la herencia. Se analizan aquí, en primer lugar, los casos excepcionales en que el testador puede lograr que los herederos forzosos perciban dinero no hereditario; y, en segundo lugar, los modos de conmutar el usufructo del cónyuge viudo por otro modo diferente de percepción. Finalmente, se dedican también unas páginas a la posibilidad reconocida al testador por el artículo 831 del Código Civil de encomendar al cónyuge viudo la facultad de distribuir la herencia como estime conveniente entre los descendientes comunes y la medida en que esta facultad puede afectar a la legítima de estos últimos.

Resumen: El síndrome de la costilla deslizante causa dolor intenso en los pacientes por otra parte sanos. Se presenta el caso de una mujer de 24 años con dolor abdominal y vómitos diagnosticada de este síndrome. Esta enfermedad consiste en hipermovilidad de las costillas falsas anteriores por fijación ligamentosa inadecuada. Se produce subluxación repetitiva de los cartílagos costales y una costilla se desliza por detrás de la superior. El diagnóstico es de exclusión, según la clínica y la maniobra «del gancho». Frecuentemente el diagnóstico es tardío por desconocimiento de las afecciones de la pared toracoabdominal, centrando los esfuerzos en el origen visceral. Puede llevar a pruebas diagnósticas innecesarias, por lo que conocer este síndrome es determinante para su diagnóstico y su manejo apropiado. Abstract: Slipped rib syndrome causes intense pain in otherwise healthy patients. The case is presented of a 24 year-old woman with abdominal pain and vomiting, who was diagnosed with this syndrome. This pathology consists of the hypermobility of the false anterior ribs due to inadequate ligament fixation. Subluxation of the costal cartilages occurs and a rib slides behind the upper one. The diagnosis is one of exclusion, according to the clinical picture and the “hooking” manoeuvre. The diagnosis is often delayed due to lack of knowledge of thoracoabdominal wall disorders, focusing efforts on the visceral origin. This may lead to unnecessary diagnostic tests, which is why being aware of this syndrome is a determining factors for its successful diagnosis and proper management.

La narrativa neopolicial del cubano Leonardo Padura Fuentes diluye los límites genéricos a través de la focalización de lo social por encima del proceso detectivesco. Los crímenes investigados por el teniente de policía Mario Conde en la tetralogía Las cuatro estaciones recrean la Cuba de 1989. A través del enfoque de la migración transnacional y la metodología propia del ámbito de la memoria en su trabajo con fotografías, este artículo analiza el álbum familiar del protagonista como dispositivo literario ligado a la nostalgia. Mediante este recurso, Padura refuerza la representación del peculiar transnacionalismo de Cuba, rasgo fundamental de su realidad, principalmente, a partir del Periodo Especial iniciado en los primeros años de los 90.

Apunto de cumplirse los 10 años de vida de nuestra Revista, queremos presentar el trayecto recorrido hasta ahora y la situación actual para conocimiento de nuestros lectores.

Abstract Background Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study aims to describe rates and temporal trends of non-spontaneous LPT neonates delivered according to evidence-based or non-evidence-based criteria and to evaluate the number of avoidable LPT deliveries, including severe neonatal morbidity rates and associated risk factors. Methods Retrospective cohort study including all LPT neonates born at a Swiss university maternity unit between January 1, 2002 and December 31, 2012. Trends of LPT neonates and neonatal complications were assessed across time using Poisson regression and risk factors for neonatal complications by logistic regression. Results Among 40,609 singleton live births, 4223 (10.5%) were preterm and 2017 (4.9%) LPT. In the latter group, 26.2% were non-spontaneous (evidence-based: 12.0%; non-evidence-based: 14.2%). The most frequent indications for evidence-based non-spontaneous LPT delivery were severe preeclampsia (51.8%) and abnormal fetal tracing (24.7%). Indications for non-evidence-based non-spontaneous LPT deliveries were hemorrhage (36.2%) and mild preeclampsia (15.7%). LPT birth rates remained stable over time. The rate of neonatal complications after non-evidence-based LPT birth remained high over time (43.8% vs. 43.5% in 2002 and 2012, respectively; P = 0.645), whereas the annual proportion of neonatal complications overall showed a decreasing trend (from 38.0% in 2002 to 33.5% in 2012; P = 0.051). Conclusions LPT birth rates were stable over time, but neonatal complications remained high, particularly after non-evidence-indicated LPT birth. A total of 287 LPT births could have been potentially avoided if an evidence-based protocol for delivery indications had been used. Efforts should be made to avoid non-spontaneous LPT births in order to reduce neonatal complications.