Intervenciones breves para promover cambios conductuales en el ámbito de la atención primaria: revisión de su efectividad en consumo de tabaco, alcohol y sedentarismo / Brief interventions to promote behavioral change in primary care settings, a review of their effectiveness for smoking, alcohol and physical inactivity

La intervención breve en salud es una estrategia terapéutica, sugerida para abordar cambios conductuales asociados a factores de riesgo de enfermedades crónicas no transmisibles. Existe amplia evidencia sobre su efectividad. Sin embargo, esta evidencia se sustenta en distintas definiciones de intervención breve, lo que dificulta su aplicación clínica. Este artículo de revisión de literatura, se propuso realizar una búsqueda de revisiones sistemáticas en la base de datos Epistemonikos con el fin de identificar factores comunes en su definición y resumir algunas estrategias de intervención breve usadas con frecuencia en la atención primaria de salud. Asimismo, se busca describir su efectividad en este contexto clínico, para tres factores de riesgo: tabaco, alcohol y actividad física.

The brief intervention is a therapeutic strategy suggested to address behavioral changes associated with risk factors for chronic non-communicable diseases and there is ample evidence of its effectiveness. However, this evidence is sustained by various definitions of "brief intervention", a fact that makes the clinical application of this strategy difficult. This literature review article aimed to conduct a search for systematic reviews in the Epistemonikos database in order to identify common factors in the definition of "brief intervention" and summarize some brief intervention strategies frequently used in primary health care. It also seeks to describe their effectiveness, for three risk factors: tobacco, alcohol and physical activity, within this clinical context

Protecting children and families from tobacco and tobacco-related NCDs in the Western Pacific: good practice examples from Malaysia, Philippines and Singapore.

BACKGROUND: Non-communicable diseases (NCDs) are generally considered diseases of adulthood, but NCD risk factors like tobacco use often are taken up during childhood and adolescence, and second-hand smoke exposure affects child survival and development. METHODS: At a regional meeting of the Asia Pacific Child and Family Health Alliance for Tobacco Control, members reviewed existing good practices of child-focused tobacco control approaches using health promotion strategies. These interventions were implemented nationally in Malaysia, the Philippines and Singapore. RESULTS: Three good practice national examples were identified that focused on creating supportive tobacco-free environments and upgrading cessation skills among paediatricians. These country examples highlight strategic areas to protect children and families from the harms of tobacco, as part of NCD prevention and control. Training paediatricians in brief cessation advice has enabled them to address tobacco-using parents. Fully enforcing smoke-free public areas has led to an increase in smoke-free homes. The Tobacco Free Generation is a tobacco control 'endgame' strategy that taps into a social movement to deglamorize tobacco use and empower youth born in and after year 2000 to reject tobacco and nicotine addiction. CONCLUSION: Tobacco control is pivotal in the fight against NCDs; health promotion strategies to protect children and youth from tobacco have a critical role to play in NCD prevention and control. Frontline health workers, including primary care paediatricians, need to step up and actively advocate for full implementation of the WHO Framework Convention on Tobacco Control, including tobacco tax increases and smoke-free areas, while monitoring patients and their parents for tobacco use and second-hand smoke exposure, preventing adolescent smoking uptake, and offering cessation support. A life-course approach incorporating child-focused efforts to prevent initiation of smoking and second-hand smoke exposure with measures promoting cessation among parents will offer the greatest chance of overcoming future tobacco-related NCD burden.

The intracellular fate of an amphipathic pH-responsive polymer: Key characteristics towards drug delivery.

Biopolymers have become important drug delivery systems for therapeutic molecules by enhancing their accessibility and efficacy intracellularly. However, the transport of these drugs across the cell membrane and their release into the cytosol remain a challenge. The trafficking of poly (l-lysine iso-phthalamide) grafted with phenylalanine (PP-50) was investigated using an osteosarcoma cell line (SAOS-2). Colocalisation of this amphipathic biopolymer with endocytosis tracers, such as transferrin and lactosylceramide, suggested that PP-50 is partially internalised by both clathrin and caveolin-mediated endocytosis. Macropinocytosis was also investigated, but a smaller correlation was found between this mechanism and PP-50 transport. A significant decrease in polymer-mediated calcein uptake was found when cells were pre-incubated with endocytosis inhibitors, suggesting also the use of a combination of mechanisms for cell internalisation. In addition, PP-50 colocalisation with endosome and lysosome pathway markers showed that the polymer was able to escape the endolysosomal compartment before maturation. This is a critical characteristic of a biopolymer towards use as drug delivery systems and biomedical applications.

Increased cryosurvival of osteosarcoma cells using an amphipathic pH-responsive polymer for trehalose uptake.

Amphipathic pH-responsive polymers have shown to increase the permeability of cell membranes to trehalose hence improving the cryopreservation of mammalian cells. However, the trafficking of both the polymer and trehalose across the cell membrane has not yet been thoroughly analysed. The objective of this study was to investigate the effect on cryopreservation of the trafficking of the disaccharide trehalose along PP-50, an amphipathic polymer, through an osteosarcoma cell line (SAOS-2). Confocal microscopy analysis confirmed the presence of intracellular labelled trehalose only when incubated in the presence of PP-50. Further analysis confirmed that both trehalose and PP-50 localised in the cytoplasm, accumulated mainly in the perinuclear area. Quantitative analysis of the colocalisation between trehalose and PP-50 showed Pearson and Manders coefficients of 0.862 ± 0.008 and 0.766 ± 0.033, respectively, suggesting a high degree of intracellular colocalisation between these molecules. Cryopreserved cells pre-incubated with trehalose and PP-50 showed increased cryosurvival when compared with cells pre-incubated in the absence of the polymer. PP-50 showed to be directly involved in the uptake of trehalose, a critical characteristic towards use in cryopreservation and biomedical applications.

Inhalación masiva de amoniaco: reporte de dos casos / Massive ammonia inhalation: report of two cases

Ammonia (NH3) is an irritant and corrosive gas whose inhalation at high concentrations mainly occurs during agricultural and industrial activities, as occupational accidents. The extent and severity of the damage depends on the concentration and time of exposure to the toxic, which can cause skin, eye, respiratory and life-threatening injuries. We present two cases of patients acutely exposed to high concentrations of NH3. Both patients survived to the acute phase of the respiratory injury, but developed chronic lung derangements.

El amoniaco (NH3) es un gas irritante y corrosivo cuya inhalación aguda en altas concentraciones se produce principalmente durante accidentes laborales en el sector agrícola e industrial. La extensión y severidad del daño depende de la concentración y tiempo de exposición al tóxico, el cual puede causar lesiones a nivel cutáneo, ocular, respiratorio y riesgo vital. Presentamos dos casos de pacientes expuestos en forma aguda a NH3 en altas concentraciones. Ambos pacientes sobrevivieron a la fase aguda y evolucionaron con lesiones respiratorias crónicas.

The catalytic cracking of hydrocarbons: paraffins in the HZSM-5 zeolite.

An elementary reaction during cracking of a hydrocarbon in a nanoporous silicalite catalyst includes ejection of a hydrid ion as shown in the picture. The reaction was simulated by means of quantum molecular dynamics.

Stability of isoflavones during extrusion processing of corn/soy mixture.

The influence of extrusion processing in the presence of corn on the quantity and quality of genistein, daidzein, and their respective beta-glucoside, acetyl glucoside, and malonyl glucoside derivatives was evaluated. Products of 100% soy (textured) and a blend of 20% soy protein concentrate (SPC) and 80% corn meal (direct-expanded) were extruded, with evaluations before and after extrusion. In addition, a 3 x (3 x 3) split-plot factorial experiment investigated the influence of barrel temperature (110, 130, 150 degrees C), moisture content (22, 24, 26%), and relative residence time (1, 0.8, 0.6) on extruder response and isoflavone profile. The extrusion barrel temperature had the most influence on isoflavone profile, especially decarboxylation of the malonyl beta-glucoside, followed by the moisture content. The amount of extractable isoflavones decreased after extrusion for both the SPC and SPC/corn meal blend when extracted with 80% aqueous methanol but remained approximately the same when first hydrated with water before extraction. However, initially hydrating with water produced enzymatic glycolysis in the unextruded samples, increasing the aglycons dramatically.

Fluorescent antinuclear antibody and anti-double-stranded DNA antibody testing: a four years experience.

Fluorescent antinuclear antibody test (FANA) and anti-double stranded deoxytribonucleic acid (dsDNA) antibody testing is an integral part of the evaluation of the patients who are suspected of having connective tissue disease. We tested 2,140 serum samples for FANA and 1,460 serum samples for anti-dsDNA antibodies. Of 2,140 serum samples tested for FANA, 492 (23%) yielded a positive result (titre of 1:80 or greater) and of 1,460 serum samples tested for anti-dsDNA, 69 (4.7%) yielded positive results. Highest number (n = 27) of serum samples positive for anti-dsDNA antibodies were found in serum samples that were positive for FANA test at a titre of 1:1280 or greater. In conclusion, FANA test can be used as an initial screening test for connective tissue/autoimmune disorders.

Smoking cessation in Texas-Mexico border communities: a quasi-experimental panel study.

UNLABELLED: BACKGROUDd. Smoking-related disease and injury is prominent among the numerous health problems on the U.S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region. METHOD: Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U.S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates. RESULTS: Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling. DISCUSSION: Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point.

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi.

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.

Electrolysis for recanalization of urinary collecting system obstructions: a percutaneous approach.

Nine recent endourologic cases are presented that evidence percutaneous electrolysis and electrocautery as new and safe techniques for incising the urothelium. Electrolysis with balloon dilation was employed to remove stones sequestered behind infundibular and/or diverticular neck stenoses, to correct uretero-pelvic junction (UPJ) stenoses and strictures, and to recanalize a totally obstructed fibrotic UPJ.

Percutaneous extraction of urinary calculi: use of the intercostal approach.

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.

Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy.

Seven episodes of acute thrombosis occurring in five patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in six out of seven patients, although in one of these six, the graft reopened. The seventh patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only one patient. The authors contend that in these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creation of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.

The CO2 flush: a new technique for percutaneous extraction of ureteral calculi.

A new technique for the percutaneous extraction of ureteral calculi is described. A jet of CO2 is injected through a retrograde ureteral catheter to dislodge ureteral stones. This safe and simple technique has been successfully used in ten patients.

Failing arteriovenous dialysis fistulas: evaluation and treatment.

A total of 31 patients with 45 episodes of failing arteriovenous dialysis fistulas was studied. Fistula failure was usually due to venous and/or anastomotic stenosis, often in conjunction with thrombosis. Abnormalities were treated by percutaneous dilation and occasionally streptokinase infusion. Most complications and failures occurred either in patients with recently created fistulas or in those with multiple or long segment stenosis associated with thrombosis. Patients with a single nonobstructing stenosis were very successfully treated with percutaneous techniques, which are the treatment of choice for this condition.

Carbon dioxide as a lighter-than-urine contrast medium for percutaneous nephrostomy.

Carbon dioxide was used either alone or in combination with standard triiodinated contrast media in 32 patients who underwent percutaneous nephrostomy. Carbon dioxide was used to opacify the posterior calyces, which are the uppermost structures in the kidney of the prone or prone-oblique patient. Carbon dioxide is usually injected in small amounts (20-40 cm3), although clinical and laboratory data indicate that it can be used as the only medium in large amounts with complete safety. There were no complications.