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Aim To explore the perceptions of main caregivers regarding caring for chronic complex patients in two different regions of Spain. BACKGROUND: Spain is a country with an ageing population and a high number of people with chronic diseases. It is well known that the role of the caregiver is important to ensure quality of life and appropriate care. METHODS: Qualitative design using focus groups. Five focus groups, from two different regions, were conducted with 22 caregivers of people with chronic complex diseases to explore their personal experience, examine the quality of care received by the patient and their family and to develop strategies for the improvement of the quality of health care. The focus groups were audio and video recorded. The transcriptions of the focus group sessions were exported to qualitative software analysis MAXQDA 2018.2. The qualitative content analysis was based on different analytical cycles. RESULTS: In general terms, caregivers would refer to accepting the care of their family members, but they highlight many negative aspects such as tiredness, lack of help and overload of care. They indicated general satisfaction with the health system but indicated that help was insufficient and that strategies to better address the situations of the complex chronic patient should be improved. The main categories observed were: Conclusions. Complex chronic illnesses are increasingly common at present, generating important consequences on the lives of patients and that of their caregivers. The design of any health strategy for facing the dilemma of chronic illnesses, must necessarily include the vision of the caregivers.

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Linear and nonlinear characteristics of devices using millimeter-scale spools of highly nonlinear fiber are experimentally investigated within 2000-2400nm spectral range. Coils with radius larger than 3.5 mm indicate that macro-bending induced radiation loss is negligible up to 2400nm. Devices with smaller diameter coiling resulted in macro-bending losses that dominate over micro-bending losses beyond 2200nm. A tunable short-wave infrared source was constructed using a coin-sized fiber module to demonstrate an efficient nonlinear conversion from 1.26 to 2.2 microm.

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Acoustic deprivation, i.e. hearing loss, is responsible for a cascade of processes resulting in reorganisation of the cortex. Tinnitus mechanisms are explained by synchronization of the neural spontaneous activity and might be related to cortical re-mapping. Auditory discrimination training (ADT) has demonstrated in both animals and humans to induce tonotopical changes in the auditory pathways through neural plasticity. We hypothesize that ADT could have some effect on tinnitus perception. The objective of this study is to compare the effect on tinnitus following two paradigms of ADT. Only patients from 20 to 60 years of age were recruited. Inclusion criteria were pure tone tinnitus of mild or moderate handicap according to the Tinnitus Handicap Inventory score (<56). ADT patients were randomized in two groups: SAME (ADT in the same frequency of tinnitus pitch, 20 patients) and NONSAME (ADT in the frequency one-octave below tinnitus pitch, 21 patients). Groups of pair of tones (70% standard tones ST, 30% deviant tones ST + 0.1-0.5 kHz) were randomly mixed for 20 min/day during 1 month. Patient had to mark when the two sounds of the pair were similar or different. Control group included 26 patients from the waiting list (WLG). Patients were also divided according to the trained frequency and the deepest hearing-impaired frequency. Outcome parameters were set up according to the answer to the question "is your tinnitus better, same, or worse with the treatment?" (RESP), the tinnitus handicap inventory (THI) and the visual analogue scale from 1 to 10 on tinnitus intensity (VAS). Tinnitus improved in 42.2% of the patients (RESP). VAS and THI scores were reduced but only THI differences were statistically significant (P = 0.003). ADT patients improved significantly compared with WLG in RESP and THI scores (P < 0.01). Training frequencies one-octave below the tinnitus pitch (NONSAME) decreased significantly THI scores compared with patients trained frequencies similar to tinnitus pitch (SAME, P = 0.035). RESP and VAS scores decreased more in NONSAME group though differences were not significant. We did not find any differences when comparing the group training the deepest hearing-impaired frequency and the group who trained other frequencies. Auditory discrimination training significantly improved tinnitus handicap compared to a waiting list group. Those patients who trained frequencies one octave below the tinnitus pitch had better outcome than those who performed the ADT with frequencies similar to the tinnitus pitch (P = 0.035).

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Some alleles are inherited more frequently than expected from Mendel's rule. This phenomenon, known as transmission ratio distortion (TRD), is found in a broad variety of taxa, but it is thought to be unusual and occurs at a low frequency in any particular population. Here, we used seven microsatellite markers to search for possible TRD in a wild lesser kestrel (Falco naumanni) population. Among the nine alleles analysed with at least 200 known meioses for each sex, we found that two of them (156-AG5 in males and 362-FN1.11 in females) presented subtle (k=0.6) but significant departures from Mendelian segregation. Moreover, in a sample of 53 alleles with at least 15 known meioses, we found a positive correlation between their transmission rates and their frequencies in the population. To estimate the transmission scores for the loci and individuals, we developed a method that allowed us to discover that another locus, FP-46, showed significant TRD, despite the lack of a significant deviation from parity for the alleles considered individually. Finally, we found a consistent transmission bias both within loci and within individuals across loci. Inter-individual differences in TRD support the idea that distorters act over several loci that are evenly distributed across the whole genome, particularly in individuals bearing the distorter alleles. Overall, these findings suggest that TRD might be a more widespread phenomenon than previously revealed by analyses at the allele level.

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Heterozygosity as a target of mate choice has received much attention in recent years and there is growing evidence supporting its role in the evolution of mate preferences. In this study we analyse mating patterns in relation to heterozygosity in a lesser kestrel (Falco naumanni) population intensively monitored over six study years (2002-2007). The magnitude of heterozygosity-based assortative mating varied over time, being particularly patent in the last study years (2006, 2007). We have found evidence that this mating pattern entails both direct and indirect-genetic benefits. Clutch size increased with female heterozygosity and more heterozygous males raised a higher number of fledglings particularly in those years when the strength of the heterozygosity-based assortative mating was markedly higher. In the last study year, parent-offspring correlation of heterozygosity was stronger and higher than the expected if individuals would have randomly mated with respect to heterozygosity. Overall, our results offer empirical support to the heterozygous mate hypothesis of sexual selection but suggest that genetic diversity may act as a temporally variable target for mate choice.

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OBJECTIVE: To perform a structured review of the literature from 2000 to 2007 on the needs of the caregivers of stroke survivors in the postacute phase of the illness process at home. METHODS: Searches were conducted in the CINAHL, MEDLINE, EMBASE, PSYCHINFO, Cochrane Library Plus, CDSR (coch), DARE, CCTR, ACP Journal Club (ACP), IBECS, LILACS and IME databases using the terms "stroke", "caregiver" and "needs (assessment)". RESULTS: We selected 270 abstracts for review. Of these, only 53 met the inclusion criteria and just 12 achieved preestablished quality standards. Despite wide variability among the selected studies, the literature reviewed revealed that the two most prevalent needs for the caregivers of stroke survivors were information and support in the development of caregiving skills. Care for the caregiver herself, as well as the development and provision of support services, were defined as the two main areas where these participants seem to need support while adapting to and performing this newly adopted role. CONCLUSIONS: The studies reviewed show an increasing demand for support and care for stroke survivors' caregivers. Because of the highly diverse contexts of these studies, the lack of an explicit definition on the concept of "need", and the wide heterogeneity in caregivers' situations, summarizing the results of these studies is difficult. New studies are required in our context that take these limitations into account and try to overcome them.

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Scientific evidence has proved reorganisation processes in the auditory cortex after sensorineural hearing loss and overstimulation of certain tonotopic cortical areas, as we see in auditory conditioning techniques. Acoustic rehabilitation reduces the impact of these reorganisation changes. Recent theories explain tinnitus mechanisms as a negative consequence of neural plasticity in the central nervous system after a peripheral aggression. Auditory discrimination training (ADT) could partially reverse the wrong changes in tonotopic representation and improve tinnitus. We discuss different studies and their efficacy on tinnitus perception and annoyance. Indications, method, dose and sound strategy need to be implemented.

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OBJECTIVES: Polyposis handicap evaluation through Spanish validation of the Rhinosinusitis Disability Index. MATERIAL AND METHODS: Spanish validation of the Polyposis Disability Index (PDI). One hundred and fifty one patients referred to our Nose Unit in Fundación Hospital Alcorcón. The Spanish version of the PDI was administered after translation and retrotranslation. Internal consistency and reliability were established. RESULTS: Spanish adaptation of the PDI and ists subscales (functional, emotional and physical) showed a high reliability and internal consistency (Cronbach's alfa: 0,90). CONCLUSIONS: Spanish adaptation of the PDI is valid, reliable and can be used in a clinical setting to quantify the impact of polyposis on patient's quality of life.

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The interest to study the effects of inbreeding in natural populations has increased in the last years. Several microsatellite-derived metrics have recently been developed to infer inbreeding from multilocus heterozygosity data without requiring detailed pedigrees that are difficult to obtain in open populations. Internal relatedness (IR) is currently the most widespread used index and its main attribute is that allele frequency is incorporated into the measure. However, IR underestimates heterozygosity of individuals carrying rare alleles. For example, descendants of immigrants paired with natives (normally more outbred) bearing novel or rare alleles would be considered more homozygous than descendants of native parents. Thus, the analogy between homozygosity and inbreeding that generally is carried out would have no logic in those cases. We propose an alternative index, homozygosity by loci (HL) that avoids such problems by weighing the contribution of each locus to the homozygosity index depending on their allelic variability. Under a wide range of simulated scenarios, we found that our index (HL) correlated better than both IR and uncorrected homozygosity (H(O)), measured as proportion of homozygous loci) with genome-wide homozygosity and inbreeding coefficients in open populations. In these populations, which are likely to prevail in nature, the use of HL instead of IR reduced considerably the sample sizes required to achieve a given statistical power. This is likely to have important consequences on the ability to detect heterozygosity fitness correlations assuming the relationship between genome-wide heterozygosity and fitness traits.

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Hyperacusis is a decreased sound tolerance. Prevalence of the disease is described in 9-15% of the population, but this percentage increases among the tinnitus patients. Pathophysiological mechanisms involve some disruptions in the amplification and regulation processes of the external hair cells or affect the central sound processing at the subcortical level. The role of the serotonin, also involved in other diseases related with hyperacusis (migraine, depression), can be crucial in this disorder. Other theories confirm the effect of the endorphins that activate the excitatory function of the glutamate, the auditory neurotransmitter, increasing its toxicity. The activation of the limbic and autonomic nervous systems produces the emotional reaction of the hyperacusis (anxiety, fear and depression). Proposed treatments are based on acoustic stimulation by a progressive introduction of sound (tinnitus retraining therapy TRT). Noise generators and hearing aids can be fitted in severe cases. The role of some drugs involved in the metabolism of the serotonin open new approaches for the management of hyperacusis.

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CONCLUSION: This clinical assay has demonstrated the efficacy of auditory discrimination therapy (ADT) in tinnitus management compared with a waiting-list group. In all, 43% of the ADT patients improved their tinnitus, and its intensity together with its handicap were statistically decreased (EMB rating: B-2). OBJECTIVE: To describe the effect of sound discrimination training on tinnitus. ADT designs a procedure to increase the cortical representation of trained frequencies (damaged cochlear areas with a secondary reduction of cortical stimulation) and to shrink the neighbouring over-represented ones (corresponding to tinnitus pitch). STUDY DESIGN: This prospective descriptive study included 14 patients with high frequency matched tinnitus. Tinnitus severity was measured according to a visual analogue scale (VAS) and the Tinnitus Handicap Inventory (THI). Patients performed a 10-min auditory discrimination task twice a day for 1 month. Discontinuous 8 kHz pure tones were randomly mixed with 500 ms 'white noise' sounds through a MP3 system. ADT group results were compared with a waiting-list group (n=21). RESULTS: In all, 43% of our patients had improvement in their tinnitus. A significant improvement in VAS (p=0.004) and THI mean scores was achieved (p=0.038). Statistical differences between ADT and the waiting-list group have been proved, considering patients' self-evaluations (p=0.043) and VAS scores (p=0.004). A non-significant reduction of THI was achieved (p=0.113).

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BACKGROUND: Hyperacusis is a decreased sound tolerance. The audiological examination includes the loudness discomfort level measurement and the handicap evaluation, so we introduce the Spanish validation of the german sound intolerance questionnaire. OBJECTIVES: To update the concept of hyperacusis and to evaluate its handicap through a Spanish validation of the Geräuschüberempfindlichkeit (GUF). PATIENTS: Forty patients referred to our Tinnitus and Hyperacusis Clinic in the University Hospital, between October 2004 and February 2005. OUTCOME MEASURES: The Spanish version of the GUF was performed after transla-tion and retro-translation. Internal consistency and reliability were established. RESULTS: Spanish adaptation of the GUF and its subscales (cognitive, somatic behaviour and emotional reaction) showed a high reliability and internal consistency (Cronbach's alfa: 0.9007). Higher GUF scores were statistically demonstrated in hyperacusis patients with hearing loss (p < 0.05) or tinnitus (p < 0.05). CONCLUSIONS: Spanish adaptation of the GUF is valid, reliable and can be used in a clinical setting to quantify the impact of hyperacusis on patient's quality of life.

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OBJECTIVE: To present the usefulness of the new classification of neck nodes based in commuted tomography (CT). MATERIAL AND METHODS: We present several illustrative images showing neck nodes in each of the new levels (Ia, Ib, IIa, IIb, III, IV, Va, Vb, and VI) as an adjunct to nodal classifications. RESULTS AND CONCLUSION: An imaging-based classification for the cervical nodes allows to know much better their distribution along the neck, helping to find correlation between clinical, radiological and surgical findings.

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We present a case of a patient with vertigo, disequilibrium and facial palsy. Nistagmus features pointed to a diagnosis of central vertigo. MRI showed a basilar aneurysm that compressed the brain stem and caused a stroke. We review the diagnosis.

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OBJECTIVE: To know the values of the olfactory test (CCCRC) performed in healthy people. To analyse how the age and sex affect the test. MATERIAL AND METHODS: Descriptive study in 100 volunteers with no olfactory disorders. We used CCCRC olfactory test, which it has an odor threshold component, an odor identification component and a composite score. We analysed how age and sex variables affect olfactory test data, listing a t-Student test. The size sample is calculated to 0.05 alfa error. RESULTS: Threshold test data mean was 5.8. Identification test data mean was 7.5. Composite score mean was 6.7. CONCLUSION: Age is a significant factor in our study but not sex. Sample size is sufficient to analyze normal values. Our results are similar to other authors.

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AIM: To quantify the cost of minor surgery in our health district during a year, by examining the amounts charged. To find the degree of clinical/pathological correlation and the number of complications, as indirect indicators of quality. DESIGN: Descriptive, cross-sectional, retrospective study. SETTING: Primary care, Río Nacimiento Health District, Abla (Almería). PARTICIPANTS: The study included all those patients attended within the minor surgery programme in the year 2000, and all the procedures used (84 patients and 95 procedures). MAIN MEASUREMENTS: The variables analysed were: type of procedure and surgery, clinical/pathological correlation, early surgical complications, and cost per procedure. We calculated the cost of our activity on the basis of: a) cost occasioned at the health centre; b) what a medical insurance company would bill; c) what a primary care district would bill, and d) what a health service hospital would bill. RESULTS: 95 procedures in 84 patients were examined. 31 samples were sent to pathology with a clinical-pathological correlation of 77.42%. No complications were recorded. At our centre the cost was 817.18 euros. An insurance company would have charged 8803.63 euros; a PC district, 4852.03 euros; and a health service hospital, 14 015.39 euros. CONCLUSION: The minor surgery performed at our health centre by our team was more cost-effective than if it was performed in other public or private centres with high standards of quality.

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Certain characters are more susceptible to increased fluctuating asymmetry (FA) than others. This trait-specific susceptibility has normally been attributed to different degrees of developmental stability, which could be caused by different modes of selection, functionality, or the stress experienced during the development process. Recently, it has also been suggested that the expression of FA not only depends on developmental stability, but also on the cost of growth of the trait, defined as the amount of structural components necessary to form a unit of length of a given character. In accordance with this argument, a trait with more structural components per unit of length should show lower asymmetry than a simpler one. To test this hypothesis, we examine the structure (number of barbs, barb length, and rachis width) and asymmetry of the longest tail feathers in 26 bird species. Regression analyses using phylogenetically independent contrasts show that FA is negatively correlated with the number of barbs and feather rachis width in males (including species with elongated tails subjected to sexual selection), and with rachis width in females, whose tails supposedly evolve by natural selection. Moreover, the negative correlation between FA and rachis width persisted when taking only the males of non-dimorphic species. These results confirm the hypothesis, suggesting that a trait's susceptibility to express developmental instability by fluctuating asymmetry depends on its structural composition.

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