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Este proyecto trata de leer la historia social a través de historias de vida, poniendo el foco en el fenómeno de la soledad en personas mayores con discapacidad visual y el contexto en el que viven. El objetivo es acercar a los lectores la cotidianeidad de estas situaciones y mostrarlas tal y como ellos las perciben y las describen. Para ello se utiliza la metodología biográfico-narrativa, un método de investigación científica cualitativo, válido para conocer una realidad social determinada que se centra en el individuo, sus experiencias y percepciones. Nadie mejor que ellos para transmitir lo que sienten. De esta manera, se consigue un acercamiento dinámico, participativo e integral al tema de la soledad, empoderando a las personas mayores y convirtiéndolas en coautores de este proyecto. Sus voces nos dan claves para la comprensión de la pluralidad de los sistemas en los que viven y nos permiten explorar los vacíos y silencios de los mismos. El estudio se aplica en la Comunidad Autónoma de Galicia, con informantes que viven en diferentes localidades. Las conclusiones resaltan aspectos sobre variables que afectan a la soledad de estas personas: el funcionamiento social, las vulnerabilidades y el vacío en el entramado estructural de apoyo a sus necesidades.

Background: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. Objectives: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). Methods: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants 0 or >346 weeks of gestational age (GA) were excluded. Results: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of “outborn” patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (230 to 266 weeks' GA) from 26.6 to 31.6% (p < 0.001). Conclusions: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.

El presente estudio tiene como objetivo evaluar la regeneración periodontal de defectos infraóseos que, por sus características anatómicas, son no contenidos. Este tipo de defectos, anchos y con un número de paredes remanentes menor, tienen un potencial de regeneración inferior que aquéllos considerados más contenidos. Por un lado, las propiedades estructurales del defecto para albergar el coágulo son menores y, por otro lado, presentan una menor vascularización debido a la reducción del número de superficies óseas por donde recibiría el aporte vascular. La hipótesis de trabajo de esta investigación propone una terapia combinada mediante el uso de dos materiales de regeneración, el Emdogain® y el Bone Ceramic®. Ambos materiales han sido estudiados demostrando diferentes características en la regeneración en defectos infraóseos contenidos. El objetivo de realizar una terapia combinada mediante la mezcla de ambos, es el de aportar un andamiaje al defecto que dé soporte y favorezca la regeneración. Por lo tanto, la hipótesis de este estudio pretende demostrar que la terapia combinada mediante Emdogain® y Bone Ceramic® es superior tanto clínica como radiográficamente a la aplicación única de Emdogain® en el tratamiento quirúrgico de defectos infraóseos no contenidos. Se incluyen un total de 52 pacientes diagnosticados de periodontitis crónica moderada o avanzada, con presencia de 1 defecto vertical formado predominantemente por 1y/o 2 paredes. Los defectos se asignan de manera aleatoria al grupo de tratamiento control (Emdogain®) o al grupo de tratamiento test (Emdogain® y Bone Ceramic®). Se realizan mediciones al inicio, a los 6 meses y a los 12 meses incluyendo profundidad de sondaje, nivel de inserción y relleno óseo radiográfico. En conclusión, ambos grupos de tratamiento obtienen resultados estadísticamente significativos en cuanto a reducción de la profundidad de sondaje, ganancia de inserción y reducción del componente infraóseo radiográfico. Estas diferencia significativas se mantienen tanto a los 6meses como a los 12 meses respecto a la situación inicial, concluyendo que, tanto Emdogain® sólo o la combinación de Emdogain® con Bone Ceramic® son efectivos en la mejoría de los parámetros clínicos y radiográficos de defectos infraóseos no contenidos. Sin embargo, no se demuestra que una terapia sea superior a la otra, al no encontrar diferencias estadísticamente significativas entre grupos, en ninguna variable ni en ningún momento en el tiempo de evaluación. Además se observa que aunque existe una asociación entre el ángulo del defecto y el numero de paredes residuales en relación a la ganancia de inserción, esta asociación no es estadísticamente significativa.

Resumen: Objetivo: conocer el tipo de unidades de cuidados intensivos neonatales (UCIN) que proporcionan asistencia respiratoria neonatal en España y sus características. Material y método: encuesta multicéntrica estructurada para conocer la actividad asistencial respiratoria prestada por las UCIN en 2005. Resultados: contestaron 96 unidades neonatales con una representatividad estimada en un 63%, con un intervalo entre el 3 y el 92%, según las áreas geográficas; las unidades IIIc se encuentran en el rango superior. Contestaron la encuesta 26 unidades tipo IIb (27%), 16 IIIa (17%), 40 IIIb (42%) y 14 IIIc (14%). Las camas totales de intensivos de nivel III fue de 541 (1,2 camas cada 1.000 recién nacidos vivos; intervalo, 0,7-1,7). La media de camas por unidad fue de 4,1 para las IIIa, 2,8 para las IIIb y 14,6 para las IIIc. En las unidades de nivel III, la relación camas/médicos fue de 2,4 camas/medico y la de camas/enfermeras 2,8 camas/enfermera (2,2 en nivel IIIc). Hubo un total de 13.219 ingresos, de los que el 54% precisó ventilación (el 36% en las IIIa y el 65% en las IIIc). La posibilidad de reanimación en el paritorio con mezcla de gases (aire y oxígeno) sólo la tiene el 42% de las IIIb y IIIc. La relación respirador/cama fue de 1/1; el 63% puede proporcionar ventilación de alta frecuencia (VAF). Todas disponen de sistemas de presión positiva continua nasal (CPAP-n). Sistemas para aplicar ventilación nasal intermitente están disponibles en el 25% de las IIIa, el 58% de las IIIb y el 64% de las IIIc. Todas las IIIc y el 93% de las IIIb pueden proporcionar oxido nítrico inhalado. Cuatro unidades disponían de ECMO. Conclusiones: la media de camas de UCIN de nivel III cada mil nacidos está en el límite bajo de lo recomendable, con notables diferencias regionales. La necesidad de ventilación mecánica fue del 54%. La relación de camas por enfermera fue de 2,8. Existe una buena dotación de respiradores (1 por cama) con alta disponibilidad de VAF (63%). Todas las unidades disponen de CPAP-n. Abstract: Aim: To learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain. Material and method: A structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005. Results: A total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.7–1.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO. Conclusions: The mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems.

Resumen: Introducción: el síndrome HELLP es un trastorno hipertensivo de la gestación que se asocia a un incremento de la morbilidad y mortalidad materna y perinatal. El objetivo de nuestro estudio es conocer las complicaciones neonatales de este síndrome. Pacientes y método: estudio retrospectivo observacional de los recién nacidos de madres con síndrome HELLP asistidas en el Hospital Virgen del Rocío entre 1995 y 2005. Se estudió a 120 recién nacidos de 99 madres con síndrome HELLP. Se analizaron la edad gestacional, el peso, la longitud, el perímetro craneal, el porcentaje de ingreso y la mortalidad. El peso, la longitud y el perímetro craneal se compararon con los de una población sana de la misma edad gestacional utilizando las gráficas de Lubchenco. Se determinó si había asociación estadística entre el número de plaquetas de la madre y el peso y la mortalidad perinatal. Resultados: el 80% de los partos fueron prematuros, con una media de 33±4 (intervalo intercuartílico, 24-41) semanas de gestación. El peso medio de los recién nacidos fue de 1.834±810 g; la longitud media, 41±6cm y el perímetro craneal, 29±3cm. Un tercio de los neonatos presentaban retraso del crecimiento intrauterino. El 61% de los pacientes precisó ingreso hospitalario, y los motivos más frecuentes fueron la prematuridad y el bajo peso al nacer. Hubo 24 muertes perinatales. En nuestra muestra no se evidenció correlación significativa entre el número de plaquetas de la madre y el peso o la mortalidad del recién nacido. Conclusiones: este síndrome es una complicación rara pero potencialmente grave del embarazo que conlleva un riesgo de problemas maternos y fetales aumentado. Abstract: Introduction: HELLP syndrome is a variant of pregnancy-induced hypertension that is associated with significant maternal and perinatal morbidity and mortality. The aim of our study was to investigate the neonatal complications associated to this syndrome. Patients and method: A retrospective observational study was carried out on all newborns of mothers with HELLP syndrome in Virgen del Rocio hospital from 1995 to 2005. There were 120 newborns of 99 mothers with HELLP syndrome. Gestational age, birth weight, length, skull perimeter, number of hospital admissions and mortality were analyzed. The birth weight, length and skull perimeter were compared with a healthy population of the same gestational age using Lubchenco charts. The statistical relationships were determined between the mothers’ platelet counts and the birth weight and perinatal mortality. Results: A total of 80% of pregnancies were preterm delivery with a mean gestational age of 33 weeks. Mean birth weight was 1,834g, length 41cm and skull perimeter 29cm. A third of newborns had fetal growth restriction. 61% of newborns needed admitting to hospital due to prematurity and low birth weight. There were 24 perinatal deaths. We did not find any correlation between the number of platelets of the mother and birth weight or perinatal mortality. Conclusions: HELLP syndrome is an uncommon but potentially serious complication of pregnancy which is associated with an increased risk of adverse maternal and fetal outcome.

Se revisan los estándares para el diseño de una unidad de neonatología. El proceso debe iniciarse con un equipo de planificación que debe indicar los objetivos que se desean conseguir, para que posteriormente intervenga el equipo de arquitectos.Se deben tener en cuenta las aportaciones médicas, los estándares y recomendaciones, y las aportaciones arquitectónicas (adecuada privacidad e intimidad, necesidad de apoyo social y comunicación, flexibilidad y accesibilidad).Desde el punto de vista arquitectónico, el mayor problema es el del espacio disponible, y debemos tener en cuenta que si queremos personalizar el entorno del cuidado para el recién nacido y su familia e introducir los cuidados centrados en la familia, las necesidades de espacio serán aún mayores.Se analizan los estándares y recomendaciones relativos al espacio, ubicación de la unidad, área de atención directa al neonato, instalación eléctrica, iluminación y nivel de ruido, equipamiento, personal de enfermería, sistemas de comunicaciones, mantenimiento y renovación. : Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects.Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account.From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater.The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment.

Late preterm infants, born at 34-36(+6) weeks gestation, are physiologically more immature than term infants. As a consequence, they have an increased risk of morbidity and mortality. Since health outcomes in prematurity may change depending on local factors we have proposed determine the short-term medical problems of these infants in our hospital.A retrospective observational study was carried out on all newborn ≥ 34 weeks gestation admitted to Virgen del Rocio hospital from May 2005 to December 2008. We divided this cohort into late preterm (34-36(+6) weeks, n=769) and term (37-41(+6) weeks, n=1460) groups. We compared mortality and morbidity data between the 2 groups.Late preterm group was associated with assisted reproduction, twin pregnancy, caesarean delivery and preeclampsia during pregnancy. The risk of hospitalization was six times greater in these infants and neonatal intensive care admissions were twice as common. The hospital stay was double in this group. Neonatal respiratory morbidity and jaundice were greater in the preterm group. The use of surfactant, oxygen and respiratory support (CPAP and CMV) was also higher. There were no significant differences in hypoglycaemia and neonatal mortality between both groups.Late preterm infants represent a well-defined risk group for developing complications and should be available the necessary resources should be made available for their special care.

We present the fulminant case of a neonate whose symptoms, lesions, imaging, and laboratory tests perfectly simulated a neonatal neuroblastoma and the definitive diagnosis was finally given by necropsy as follows: Infantile hepatic hemangioendothelioma type 2 with extrahepatic extension affecting skin, lung, intestine, suprarenal, and soft tissue.

Resumen tomado de la publicación Se analiza la preparación que reciben los docentes en formación, los universitarios de especialidades afines (Psicología, Pedagogía) y los profesionales en ejercicio sobre las características y necesidades de los alumnos con capacidad superior en veintiséis países europeos. La importancia viene acentuada por la cada vez mayor movilidad de profesionales y estudiantes dentro del marco de convergencia europea, la necesidad de este conocimiento básico a la hora de tratar el tema en distintos países y la ausencia en nuestro contexto de este tipo de estudios actualizados. Los resultados muestran que es menor el número de países en los que los futuros docentes reciben formación sobre esta temática frente a lo que ocurre en estudios superiores, del mismo modo que la formación de los profesores en ejercicio y otros profesionales es mucho más amplia, en buena medida debido a sus propias demandas. La existencia de grupos y asociaciones sin fines de lucro es otro de los cauces de formación. Asturias Universidad de Oviedo. Facultad de Ciencias de la Educación; Calle Aniceto Sela s. n.; 33005 Oviedo; Tel. +34985103215; Fax +34985103214; ESP

1) To identify the profile of the cases requested for autopsy; 2) to analyze the clinocopathological discordance; 3) to investigate predictive factors for unsuspected clinically relevant diagnoses.All autopsies performed between January 1999 and December 2005 in a tertiary neonatal intensive care unit, were retrospectively reviewed. Clinicopathological concordance was assessed independently by two neonatologists and two pathologists, according to a modification of the Goldman classification. A comparison was made between newborns who had an autopsy performed and those who did not and predictive factors for unsuspected findings were investigated.During the study period, there were 309 deaths, and autopsies were performed in 128 (41.4 %) of these cases. Autopsies were more common in newborns who had gestational age36 weeks (p0.001), birthweight1500 g (p0.001) and congenital defects (p0.007). However, the probability that the autopsy was granted decreased with increasing death age (p0.016). Unsuspected diagnoses were observed in 49.2 % of the autopsies, being a major finding in 21.1 % of the cases. A clinicopathological discordance involving the prognosis was found in four cases (3.1 %). Relevant unsuspected findings could not be predicted from the ante-mortem clinical diagnosis, gestational age, birthweight, sex, and death age.The autopsy remains the "gold standard" method to reveal major and unsuspected diagnoses and there is no substitute for it. Postmortem examination should be requested systematically in every neonatal death. However, several factors such as gestational age, birthweight, presence of congenital defects and death age, influence the likelihood of autopsy being granted.

To learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain.A structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005.A total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.7-1.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO.The mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems.

Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects. Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account. From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater. The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment.

HELLP syndrome is a variant of pregnancy-induced hypertension that is associated with significant maternal and perinatal morbidity and mortality. The aim of our study was to investigate the neonatal complications associated to this syndrome.A retrospective observational study was carried out on all newborns of mothers with HELLP syndrome in Virgen del Rocio hospital from 1995 to 2005. There were 120 newborns of 99 mothers with HELLP syndrome. Gestational age, birth weight, length, skull perimeter, number of hospital admissions and mortality were analyzed. The birth weight, length and skull perimeter were compared with a healthy population of the same gestational age using Lubchenco charts. The statistical relationships were determined between the mothers' platelet counts and the birth weight and perinatal mortality.A total of 80% of pregnancies were preterm delivery with a mean gestational age of 33 weeks. Mean birth weight was 1,834g, length 41cm and skull perimeter 29cm. A third of newborns had fetal growth restriction. 61% of newborns needed admitting to hospital due to prematurity and low birth weight. There were 24 perinatal deaths. We did not find any correlation between the number of platelets of the mother and birth weight or perinatal mortality.HELLP syndrome is an uncommon but potentially serious complication of pregnancy which is associated with an increased risk of adverse maternal and fetal outcome.

En el presente artículo intentamos reflexionar brevemente sobre la enseñanza de las Lenguas de Signos como segunda lengua para personas oyentes. Después de una introducción general sobre sus características, hacemos unas consideraciones psicolingüísticas sobre la modalidad viso-espacial: implicación de procesos de percepción, memoria y ejecución; sobre los problemas de aprendizaje que ello plantea: dificultades de los aprendices oyentes para percibir, memorizar y ejecutar los parámetros manuales y los componentes faciales; y sobre las estrategias más adecuadas en la enseñanza de ésta lengua. También se hacen algunas consideraciones sobre el estado actual de la enseñanza de la Lengua de Signos Española. The aim of this article is to reflect shortly on the teaching of Sign Languages as second languages for hearing people. After a general introduction on their characteristics, we make some psicolinguistic considerations about their visual-spatial modality: implication of perception, memory and execution processes; about their learning problems: hearing student´s difficulties to perceive, to memorize and to execute the manual parameters and the facial components; and on the most appropriate strategies for teaching this language. Some considerations are also made on the current state of the teaching of the Spanish Sign Language.