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Granular cell tumors are predominantly benign soft tissue tumors originating from Schwann cells, whereas melanocytic nevi are benign proliferations of melanocytes. We present the case of a patient with the presence of both entities located in the cecum and anal canal, respectively, constituting an extremely rare coincidental finding. A 43-year-old woman was evaluated by colonoscopy for iron-deficiency microcytic anemia that had lasted for 1 year. Colonoscopy demonstrated a macular lesion of 0.3 cm with a melanocytic appearance in the anal canal; at the cecum level, a subepithelial, yellowish, and partially mobile firm nodular lesion measuring 1.3 cm was observed. A histopathological study showed a melanocytic nevus in the anal canal and a granular cell tumor in the cecum. This is the first reported case of a patient with the extremely rare coincidental-incidental finding of these 2 entities at the same time.

Work-related musculoskeletal disorders are some of the most prevalent diseases in the world. They have a multifactorial aetiology encompassing ergonomic and psychosocial risk factors. The aim of this study is to analyse the way job insecurity and physical workload are linked to musculoskeletal disorders, as well as the mediating role other psychosocial work risks can have on this potential relationship. A parallel mediation path regression analysis was designed using a sample of 457 nursing aides. The influence job insecurity and physical workload has on the onset of musculoskeletal symptoms together with the variables which mediate this relationship were examined. The results prove that both independent variables explain the onset of musculoskeletal symptoms in these professionals. The influence exerted by job insecurity is mediated by the social support received at work and the demands of the job. However, when analysing the physical workload, the social support received at work is not relevant as a mediator in this relationship. Job insecurity and physical workload are significant variables on the occurrence of musculoskeletal symptoms. The data obtained supports the need to focus on physical and psychosocial factors in order to prevent these disorders.

Rotavirus (RV) is the most common cause of severe gastroenteritis (GE) in infants and young children worldwide and is associated with a significant clinical and economic burden. The objective of this study was to analyze the characteristics, healthcare resource utilization and the direct medical costs related to RVGE hospitalizations in Spain. An observational, multicenter, cross-sectional study was conducted from June 2013 to May 2018 at the pediatric departments of 12 hospitals from different Spanish regions. Children under 5 years of age admitted to the hospital with a confirmed diagnosis of RVGE were selected. Data on clinical characteristics, healthcare resource use and costs were collected from patient records and hospital databases. Most children hospitalized for RVGE did not have any previous medical condition or chronic disease. Forty-seven percent had previously visited the Emergency Room (ER), 27% had visited a primary care pediatrician, and 15% had received pharmacological treatment prior to hospital admission due to an RVGE episode. The average length of a hospital stay for RVGE was 5.6 days, and the mean medical costs of RVGE hospitalizations per episode ranged from 3,940€ to 4,100€. The highest direct medical cost was due to the hospital stay. This study showed a high burden of health resource utilization and costs related to the management of cases of RVGE requiring hospitalization. RV vaccination with high coverage rates should be considered to minimize the clinical and economic impacts of this disease on the health-care system.

Job insecurity is an indicator of precarious work that refers to the fear of losing one's job. It is a relevant source of stress, with negative consequences on people's mental health. The main objective and contribution of this study is to identify how gender inequality and job insecurity are related, responding to the lack of consensus found in scientific literature in this field of study. To do so, a predictive study of job insecurity, broken down by gender, is developed, considering sociodemographic and labor variables as antecedents. The sample included 1,005 employees (420 men and 585 women) aged between 18 and 65, and a linear regression was conducted for each group. Results show that women perceive greater insecurity under precarious working conditions (temporary work, informal work, salary cuts, tenure), whereas in the case of men variables related to their professional careers (job category, education) and household incomes were relevant predictors. It is concluded that job insecurity affects both gender groups, but the conditions in which this perception grows are significantly impacted by gender inequality. These findings will allow for holistic and effective actions to decrease the effects of precarious work., (Copyright © 2020 Menéndez-Espina, Llosa, Agulló-Tomás, Rodríguez-Suárez, Sáiz-Villar, Lasheras-Díez, De Witte and Boada-Grau.)

Job insecurity is a growing phenomenon, typical of an employment context characterised by high rates of temporary work and unemployment. Previous research has shown a direct relationship between job insecurity and mental health impairment. The present analysis goes into this relationship in depth, studying the moderating role of coping strategies and predicting that men and women implement different types of strategies. A sample of 1.008 workers is analysed, 588 women and 420 men. The Tobin CSI scale was used to analyse the coping strategies, in addition to JIS-8 to assess job insecurity, the MOS Perceived Social Support Survey and the GHQ-28 test to evaluate mental health. Then, a hierarchical linear regression was designed to study the moderating role of 8 coping strategies of job insecurity and 4 mental health subscales in men and women, separately. Results illustrate that coping strategies play a moderating role in the relationship between job insecurity and mental health. However, the aggravating role of disengagement coping strategies is more relevant than the buffering role of engagement strategies. On the other hand, women implement a greater number of coping strategies, with more positive results for mental health. Also, in the relationship between job insecurity and mental health the most important strategies are the ones related to social interaction inside and outside an organisation, and these are the main ones used by women. It therefore follows that strengthening rich social relationships inside and outside the working environment is a guarantee of well-being.

This corrects the article DOI: 10.1038/pr.2017.95.

Background: This instrumental study is the Spanish adaptation and validation of the Job Insecurity Scale in its 8-item version (JIS-8). This is one of the reference tests in this field and it also allows the distinction between affect and cognition in quantitative job insecurity to be tested., Method: The JIS-8 was carried out on a Spanish sample with 592 participants (186 men, 406 women; Mean age = 36.68), together with mental health and job satisfaction tests. An exploratory factor analysis and confirmatory factor analysis were carried out, and the relationship between the scale and other variables was examined., Results: The Spanish validation shows good construct validity, internal consistency and a Cronbach a = .88, higher than the value obtained in the validation of the original instrument. The analysis shows the consequences of job insecurity on workers’ mental health, as well as on their job satisfaction. The exploratory factor analysis as well as the confirmatory analysis, in which a one-dimensional and a two-dimensional model were tested, maintain the presence of two factors: the cognitive and the affective dimensions., Conclusions: The results underpin the fact that the test is appropriate for application to people in active employment in the Spanish population.

Growth retardation is a major manifestation of chronic kidney disease (CKD) in pediatric patients. The involvement of the various pathogenic factors is difficult to evaluate in clinical studies. Here, we present an experimental model of adenine-induced CKD for the study of growth failure. Three groups (n = 10) of weaning female rats were studied: normal diet (control), 0.5% adenine diet (AD), and normal diet pair fed with AD (PF). After 21 days, serum urea nitrogen, creatinine, parathyroid hormone (PTH), weight and length gains, femur osseous front advance as an index of longitudinal growth rate, growth plate histomorphometry, chondrocyte proliferative activity, bone structure, aorta calcifications, and kidney histology were analyzed. Results are means ± SE. AD rats developed renal failure (serum urea nitrogen: 70 ± 6 mg/dl and creatinine: 0.6 ± 0.1 mg/dl) and secondary hyperparathyroidism (PTH: 480 ± 31 pg/ml). Growth retardation of AD rats was demonstrated by lower weight (AD rats: 63.3 ± 4.8 g, control rats: 112.6 ± 4.7 g, and PF rats: 60.0 ± 3.8 g) and length (AD rats: 7.2 ± 0.2 cm, control rats: 11.1 ± 0.3 cm, and PF rats: 8.1 ± 0.3 cm) gains as well as lower osseous front advances (AD rats: 141 ± 13 μm/day, control rats: 293 ± 16 μm/day, and PF rats: 251 ± 10 μm/day). The processes of chondrocyte maturation and proliferation were impaired in AD rats, as shown by lower growth plate terminal chondrocyte height (21.7 ± 2.3 vs. 26.2 ± 1.9 and 23.9 ± 1.3 μm in control and PF rats) and proliferative activity index (AD rats: 30 ± 2%, control rats: 38 ± 2%, and PF rats: 42 ± 3%). The bone primary spongiosa structure of AD rats was markedly disorganized. In conclusion, adenine-induced CKD in young rats is associated with growth retardation and disturbed endochondral ossification. This animal protocol may be a useful new experimental model to study growth in CKD., (Copyright © 2015 the American Physiological Society.)

Rapamycin, an immunosuppressant agent used in renal transplantation with antitumoral properties, has been reported to impair longitudinal growth in young individuals. As growth hormone (GH) can be used to treat growth retardation in transplanted children, we aimed this study to find out the effect of GH therapy in a model of young rat with growth retardation induced by rapamycin administration. Three groups of 4-week-old rats treated with vehicle (C), daily injections of rapamycin alone (RAPA) or in combination with GH (RGH) at pharmacological doses for 1 week were compared. GH treatment caused a 20% increase in both growth velocity and body length in RGH animals when compared with RAPA group. GH treatment did not increase circulating levels of insulin-like growth factor I, a systemic mediator of GH actions. Instead, GH promoted the maturation and hypertrophy of growth plate chondrocytes, an effect likely related to AKT and ERK1/2 mediated inactivation of GSK3β, increase of glycogen deposits and stabilization of β-catenin. Interestingly, GH did not interfere with the antiproliferative and antiangiogenic activities of rapamycin in the growth plate and did not cause changes in chondrocyte autophagy markers. In summary, these findings indicate that GH administration improves longitudinal growth in rapamycin-treated rats by specifically acting on the process of growth plate chondrocyte hypertrophy but not by counteracting the effects of rapamycin on proliferation and angiogenesis.

Background: Leiomyoma is the most common benign esophageal tumor that originates in the muscular layer, with the most common site located in the distal third of the esophagus. Its growth causes symptoms due to partial obstruction of the esophageal lumen, leading to the diagnosis and subsequent treatment. Today, due to modern minimally invasive surgical techniques, complete removal of these tumors can be accomplished with minimal morbidity and excellent results., Case Report: We report the case of a 49-year-old female with a history of dysphagia, epigastric pain, and halitosis. She was diagnosed with a benign tumor originating from the muscular layer of the distal esophagus. Multiple biopsies had previously been taken, without histological confirmation. The patient underwent surgery where complete tumor enucleation was done laparoscopically., Conclusions: Preoperative diagnosis of these tumors should be based on clinical history and studies such as esophagoscopy and endoscopic ultrasound. Laparoscopic enucleation is the treatment of choice for leiomyomas of the esophagogastric junction. Biopsy specimens should be avoided because histology is not always possible. Furthermore, they are related to rupture of the esophageal mucosa during surgical treatment. After enucleation in selected patients, anti-reflux procedure should be carried out in order to protect the area of surgical resection and prevent complications from weakening the lower esophageal sphincter, as well as to resolve reflux symptoms.

Background: Identifying the level of culture and awareness on patient safety is essential in order to improve the quality of care. The objective of our research was to assess patient safety culture in healthcare professionals., Methods: Derived from the implementation of a survey on patient safety to 174 health professionals, data related to demographic characteristics were analyzed. Scores were determined on the 12 dimensions of the scale including additional items on perception and degree of overall patient safety, frequency and number of events reported, as well as Cronbach's alpha for the different dimensions. Descriptive statistics were used., Results: Overall perception on safety was 51%. The lowest dimension was communication openness (38%), whereas organizational learning had the highest scores (68%). Analysis showed low Cronbach's alpha for dimensions of overall perception on safety (0.35), non-punitive response to error (0.55) and staff allocation (0.12)., Conclusions: A low overall perception on patient safety indicates the need for increased institutional actions for improvement. Low Cronbach's alpha in some measurements may suggest the need for adjustments to the instrument. Results on the overall perception on patient safety, nonpunitive response to error and staff allocation (staffing) should be interpreted with caution, given the low reliability of such dimensions.

Rapamycin, a potent immunosuppressant used in renal transplantation, has been reported to impair longitudinal growth in experimental studies. Rapamycin is both antiproliferative and antiangiogenic; therefore, it has the potential to disrupt vascular endothelial growth factor (VEGF) action in the growth plate and to interfere with insulin-like growth factor I (IGF-I) signaling. To further investigate the mechanisms of rapamycin action on longitudinal growth, we gave the 4-week-old rats rapamycin daily for two weeks. Compared with a vehicle-treated group, rapamycin-treated animals were severely growth retarded and had marked alterations in the growth plate. Vascular invasion was disturbed in the rapamycin group, there was a significant reduction in osteoclast cells near the chondro-osseus junction, and there was lower VEGF protein and mRNA expression in the terminal chondrocytes of the growth cartilage. Compared with the control group, the rapamycin group had higher levels of circulating IGF-I as well as the mRNAs for IGF-I and of the receptors of IGF-I and growth hormone in the liver but not in the growth cartilage. Thus our findings explain the adverse effect of rapamycin on growth plate dynamics. This should be taken into account when the drug is administered to children.

Introduction and Objectives: Advanced simulation (AS) is a teaching methodology that has shown to be useful for training health staff at hospital level; however, its application in primary care paediatrics is very limited. Our objective was the development of an AS project focused on the learning needs of the primary care paediatricians, as well as to know the participants' opinions as one of the elements to assess its appropriateness., Material and Methods: Phase 1: A multidisciplinary working group was organized and sponsored by the SEPEAP to design and put the course into practice. Phase 2: Itinerant courses were carried out in several cities in Spain. At the end of each course, a survey was carried out that was focused on motivation aspects, pertinence of contents and methodology. Each item was scored on a numerical scale from 0 (very bad) to 10 (very good)., Study Period: May 2008 to May 2009., Results: After analysing the potential learning needs of target population, available time, teaching material available and methodology of simulation and debriefing, a course model was designed and the cases were programmed. Twelve courses were carried out in 12 cities. The total number of participants was 186; of them, 177 (95.2%) answered the survey. Mean+/-SD scores for main items were: organization (9.23+/-0.50), objectives related to prior expectation (9.29+/-0.43), usefulness of course program to work activity (9.42+/-0.43), cases that resemble reality (9.18+/-0.42) and good instructors-participants relationship (9.68+/-0.20)., Conclusions: The AS course for primary care paediatrics, with the proposed format, is feasible and well adapted to the needs of the target population. Primary care paediatricians consider this type of teaching and learning activity as a useful tool for their continuing education and for improving their professional abilities., (Copyright (c) 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Objective: To carry out the epidemiological analysis of 122 influenza A (H1N1) deaths confirmed by laboratory and help to improve the diagnosis and timely managing of cases., Material and Methods: A total of 122 clinical records were analyzed of patients with confirmed influenza A (H1N1) virus infection who died., Results: Fifty-one percent of patients were female and 49% were male. A total of 45.l% who died were between 20 and 39 years old. Overall fatality was 2.2% and ranged between 0.3% for the l0 to l9 year-old group to 6.3% for the 50 to 59 year-old group. Forty-three percent of deaths were concentrated in only two of the thirty-two states and 5l% received medical attention in social security institutions. Only l7% received hospital attention within 72 hours and 42% died within 72 hours of hospital attention., Discussion: Novel Influenza A (H1N1) virus produces higher mortality in young people whereas seasonal influenza has a greater impact on young children and older people. Delay in medical care and the associated morbidity were relevant factors for death.

Social relations in the workplace are one of the main sources of risk for the onset of mobbing. In this work, we analyzed, through the perceived social climate, the influence of interpersonal relations on the characterization of the processes of mobbing, in a sample of local police (N = 235). In particular, the policemen and women's opinions of the quality of the personal relations among the group members and the treatment they receive from the command posts were assessed. The results of the study show that the development of guidelines of social interaction based on discrimination and abuse of authority are predicting variables of mobbing in this group.

Objectives: Treatment with growth hormone (GH) improves growth retardation of chronic renal failure. cDNA microarrays were used to investigate GH-induced modifications in gene expression in the tibial growth plate of young rats., Design: RNA was extracted from the tibial growth plate from two groups, untreated and treated with GH, of young rats made uremic by subtotal nephrectomy (n=10). To validate changes shown by the Agilent oligo microarrays, some modulated genes known to play a physiological role in growth plate metabolism were analyzed by real-time quantitative polymerase chain reaction (qPCR)., Results: The microarrays showed that GH modified the expression of 224 genes, 195 being upregulated and 29 downregulated. qPCR results confirmed the sense of expression change found in the arrays for insulin-like growth factor I, insulin-like growth factor II, collagen V alpha 1, bone morphogenetic protein 3 and proteoglycan type II., Conclusions: This study shows for the first time the profile of growth plate gene expression modifications caused by GH treatment in experimental uremia and provides a basis to further investigate selected individual genes with potential implication in the stimulating effect on the growth of GH treatment in chronic renal failure.

Introduction: The advent of computed tomography (CT) has allowed the early detection of pathological changes in patients with cystic fibrosis (CF). Description of the early pathological changes and distribution of bronchiectasis in children with CF is limited, because most studies have been performed in older children and adults with well-established lung disease. The aim of this study was to describe the distribution pattern of this disease in Asturius., Material and Method: We performed a retrospective study of the medical records and CT scans of patients followed up in our Cystic Fibrosis Unit. CT scans were scored by two radiologists according to Bhalla and Nathanson scores. Pathological changes were analyzed and correlated with clinical data and pulmonary function tests., Results: The 41 CT reviewed contained between 10 and 47 slices, with a median of 16. The total number of slices was 758, of which 606 (79.95%) were considered acceptable and 152 were considered unacceptable by the radiologists. The most frequent lesions found were bronchiectasis (78.38%), followed by mucous plugs (37.84%). The most frequently affected bronchopulmonary segments were S1 and S2 in the right lung. Statistically significant correlations were found between Bhalla and Nathanson scores and disease duration. No statistically significant correlations were found between Bhalla and Nathanson scores and pulmonary function tests., Conclusions: The most frequent lesions in our environment were bronchiectasis followed by mucous plugs. The upper right lobe was the first to be affected, which correlates with findings in most published studies.

Objective: To analyze chronic obstructive lung disease (COPD) subjects in acute hypercapnic failure who were treated with non-invasive mechanical ventilation in a general respiratory ward., Methods: This was a two-year prospective study of 35 patients with acute exacerbation of COPD and mean FEV1/FVC relation in stable condition of 55.3 +/- 14.8% of predicted that were treated with positive pressure respiration using a facemask in a general respiratory ward. 17 (48.5%) receive long-term oxygen therapy. Analysis was made of blood gases, before and after treatment of non-invasive ventilation, complications, and failure during treatment., Results: A significant improvement in blood gases was observed 24 hours after non-invasive ventilation treatment. The mean hospital stay was of 15.0 +/- 9.1 days and failures were registered in 3 cases (8.5%). Facial scares were the most common complication (13 patients) but it was possible to continue treatment., Conclusions: Non-invasive ventilation is a viable treatment for patients with chronic obstructive lung disease and acute hypercapnic failure being treated in a general respiratory ward.

Objective: The purpose of this study was to determine the epidemiological characteristics of tuberculosis (TB) in the Public Health System District of Santiago de Compostela (population : 386125) from 1999 to 2002., Methods: Inclusion criteria were: 1). microbiological and/or pathological diagnosis of TB in any specimen, and 2). patient younger 35 years old with recent medical history of TB. Mantoux test positive, and pleural effusion with linfocitosis and adenosine deaminase >47 IU/ml., Results: 946 patients were included (568 men and 378 women), with ages ranging from 2 months to 96 years. The incidence of TB was 60.9/100000 in 1999, 67.6/100000 in 2000, 61.9/100000 in 2001 and 54.6/100000 in 2002. The incidence rate of tuberculous meningitis was 1.03/100000 in 1999 and 2000, 0.77/100000 in 2001 and 0.51/100000 in 2002. The percentage of cases associated with HIV was 3.4% in 1999, 1.9% in 2000, 2.4% in 2001 and 2002. We found an increase in the rate of males over 55 years of age; with incidence per 100000 inhabitants of 122.4 in 1999, 142.8 in 2000, 115 in 2001 and 119 in 2002, whereas in females the incidence was 40.6 in 1999, 60.9 in 2000, 54.1 in 2001 and 39.1 in 2002., Conclusions: In last four years the incidence of tuberculosis has decreased but remains high in males over 55 years old.