RESUMEN

Research has highlighted the wide impact of maternal mental health problems during and beyond the postpartum period and the public health role of community health professionals in early detection of women who may be at risk. This paper aims to describe, explore and test an a priori hypothesised conceptual model of postnatal experience, identifying the relationships between postnatal mental vulnerability and postnatal adjustment to maternal roles and attitudes, marital/partner-relationship and sense of coherence. Three validated self-report questionnaires (WAST, MAMA, SOC) measuring the variables of the encompassing framework and EPDS were administered in random order. The conceptual models were tested using the software IBM SPSS Statistics and LISREL and the tests performed were: Student's ttest, chi-square tests, Explanatory factor analysis using a Varimax rotation Principal Components Method, Confirmatory analysis -known as structural equation modelling- of principal components. Psychometric scores indicate high correlation between WAST, MAMA, SOC and EPDS. An exploratory factor analysis confirmed the role of SOC, specific MAMA subscales (maternal roles and attitudes, body image, sex, breasts, nausea) and WAST (relationship tension and emotional and physical abuse) subscales (KMO measure of sampling adequacy=0.735 and Bartlett's test of sphericity=184,786, df=36, p<0.0005). The latent variables confirmed with SEM were marital relationship, maternity experience and self-efficacy (Chi-square=28.45, df=24, P-value=0.24, RMSEA=0.046 p<0.05). Marital Relationship (Factor I: Eigenvalue=3.066) concerning lack of or disappointment with partner support, poor marital relationship and emotional/physical abuse has been associated with high levels of postpartum anxiety and depression. Maternity Experience (Factor II: Eigenvalue=1.280) representing postnatal roles and attitudes towards their infant can be as useful as mood changes for evaluation of mothers. Self-Efficacy (Factor III: Eigen- value=3.144) and especially attitudes regarding body image, sex and coping resources and options of dealing with the stressor, has been demonstrated that serve as a mediator or buffer for psychological distress. The results of this study have implications for the prevention and intervention of postnatal adjustment difficulties both of which need to be intensified in order to minimise perinatal mental vulnerability.

Asunto(s)

RESUMEN

The relationship between epilepsy and behavioral disturbances has been a subject of controversy since the 19th century. Affective changes may occur prior, during, or after the ictal discharge. Depression is the most prevalent comorbidity. Anxiety, panic attacks, and pseudoseizures may resemble complex partial seizures, and their diagnosis and treatment may be confusing, even to experienced clinicians. Epilepsy-related psychosis is less common, manifesting occasionally with symptoms that are indistinguishable from schizophrenia. There is no clear evidence of a distinct "epileptoid" personality, and interictal violence is extremely rare. Pharmacologic treatment with anticonvulsants remains the cornerstone of treatment. In case of psychiatric comorbidities or refractory seizures, the diagnosis should be re-examined.

Asunto(s)

Asunto(s)

RESUMEN

Cataract surgery may exacerbate preexisting diabetic retinopathy. Especially diabetics with active retinal neovascularisation are at high risk of rubeosis iridis after intracapsular cataract extraction. Thirty-five eyes previously treated with panretinal photocoagulation underwent extracapsular cataract extraction with posterior chamber lens implantation. Twenty-eight eyes with retinal neovascularisation required further Argon laser PRP after surgery. Fourteen eyes required YAG-laser capsulotomy. From the group of eyes without YAG-laser capsulotomy none developed neovascular glaucoma. From the YAG laser capsulotomy group six eyes developed rubeosis iridis and neovascular glaucoma. Our results indicate that eyes in which PRP has been performed, have an excellent prognosis after ECCE with posterior chamber lens implantation only if YAG Laser posterior capsulotomy is not performed.

Asunto(s)

RESUMEN

The aim of this study is to present preliminary experience with 137Cs medium dose rate (MDR) afterloading transurethral radiotherapy for small-sized (< 2.5 cm) prostatic carcinomas. The phase II protocol comprises 46 Gy of external beam radiotherapy, followed by two insertions (1 week apart) of 137Cs MDR transurethral brachytherapy, each one delivering 8 Gy to a point 0.5 cm from the urethral walls. The treatment is completed with a 14-Gy boost to the prostatic area through lateral external beam fields. Up to now, 9 patients have been treated. The transurethral insertion is a simple procedure, requires no anesthesia and the ultrasonographic observation precisely and easily guided the positioning of the applicator. All 9 patients are alive and disease-free 12-36 months after the end of radiotherapy. One of them presented a mild degree of urethral stricture and none developed chronic proctitis or cystitis. Seven patients were sexually potent before radiotherapy and all of them maintained their potency. Transurethral radiotherapy for prostatic carcinoma requires further investigation. The radiation dose that the procedure delivers to the prostate is higher than the one prescribed for external beam irradiation regimens. Rectal and bladder dose is substantially reduced. Although the prostatic urethra receives a higher dose, the incidence of urethral stricture is low probably because of the small tissue volume (8 cm3) in the high radiation dose area.

Asunto(s)

RESUMEN

A series of 52 patients, aged 60-85 and suffering from chronic obstruction of the nasolacrimal duct with no other complication of the lacrimal mechanism or of the eyelids (e.g. ectropium), were treated by means of silicon tube intubation instead of dacryocystorhinotomy. The tubes remained in place for 10-12 months and the patients were observed a 3-year postoperative period. In 37 cases (71%) the nasolacrimal duct remained patient after 3 years. In 7 cases, although the drainage was not opened, the patients ceased to show evidence of secretion of mucus or pus. We consider that intubation of the nasolacrimal duct is an alternative to dacryocystorhinotomy, but only if the patient knows that the tubes are to remain in place for a lengthy period of time. This does not disturb a cooperative patient since the tubes are essential and do not create any irritation. Furthermore, tears are partially eliminated around them and, thus, improvement of the symptoms is apparent from the first day onward.

Asunto(s)

Asunto(s)

Asunto(s)