The importance of cell uptake in photothermal treatments mediated by biomimetic magnetic nanoparticles.

Biomimetic magnetic nanoparticles (BMNPs) mediated by MamC have proven to be photothermal agents able to allow an optimized cytotoxicity against tumoral cells when used simultaneously as drug nanotransporters and as hyperthermia agents. However, it remains unclear whether BMNPs need to be internalized by the cells and/or if there is a threshold for internal Fe concentration for the photothermal therapy to be effective. In this study, three different situations for photothermal treatments have been simulated to disentangle the effect of BMNPs cell uptake on cell viability after photothermal treatments. Human hepatoblastoma (HepG2) cell line was treated with suspensions of BMNPs, and protocols were developed to have only intracellular BMNPs, only extracellular BMNPs or both, followed by photothermal exposure of the treated cell cultures. Our data demonstrate that: (1) Although the heating efficiency of the photothermal agent is not altered by its location (intra/extracellular), the intracellular location of BMNPs is crucial to ensure the cytotoxic effect of photothermal treatments, especially at low Fe concentration. In fact, the concentration of BMNPs needed to reach the same cytotoxic effect following upon laser irradiation of 0.2 W/cm2 is three times larger if BMNPs are located extracellularly compared to that needed if BMNPs are located intracellularly; (2) For a given location of the BMNPs, cell death increases with BMNPs (or Fe) concentration. When BMNPs are located intracellularly, there is a threshold for Fe concentration (∼ 0.5 mM at laser power intensities of 0.1 W/cm2) needed to affect cell viability following upon cell exposure to photothermia. (3) Bulk temperature rise is not the only factor accounting for cell death. Actually, temperature increases inside the cells cause more damage to cell structures and trigger cell death more efficiently than an increase in the temperature outside the cell.

[Intervention with community health agents in immunization programs in the gypsy population]. / Intervención con agentes de salud comunitarios en programas de inmunizaciones en la comunidad gitana.

OBJECTIVE: To measure how the vaccination coverage of the Gypsy child population in the Cartuja and Almanjayar quarters evolved throughout a Health Education Intervention using Community Health workers belonging to the Gypsy community. DESIGN: A descriptive study, pre-test/post-test, with no control group. SETTING: Community level. Primary Care. PATIENTS AND OTHER PARTICIPANTS: The whole of the Gypsy child population under 14, consisting of 1,073 children, and four Community Health workers. INTERVENTIONS: Health Education for mothers and carers, by means of home visits carried out by four Health workers, previously trained and contracted for this purpose for a year by the Andalusian School of Public Health. MEASUREMENTS AND MAIN RESULTS: We measured the Vaccination Coverage in September 1988 (42.2%) in order to establish the situation both at the start of the intervention in March 1990 (46.2%) and at its end in March 1991 (68.2%). We measured Vaccination Coverage of the different vaccine doses through frequency allocations. CONCLUSIONS: The Health Centre increased Vaccination Coverage by 4% in 18 months. The intervention increased it by 22.2% in 12 months. This demonstrates the intervention's effectiveness and underlines the importance of carrying out this kind of intervention when working with at-risk population groups.

Preferencias de tratamiento de soporte vital en condiciones críticas de salud / Life support treatment preferences in critical health situations

Objetivo. Explorar las preferencias de los ciudadanos sobre el tratamiento de soporte vital en situaciones sanitarias críticas. Método. Estudio transversal mediante encuesta a 306 participantes, seleccionados aleatoriamente de consultas de enfermería, centros culturales, residencias asistidas y aulas universitarias. Para medir las preferencias en el tratamiento ante situaciones sanitarias críticas se empleó el cuestionario Life Suport Preferences Questionnaire (LSPQ). Se realizó un análisis descriptivo, bivariante y multivariante de los datos. Resultados. La edad media de los participantes fue de 39,28 años y la desviación estándar (DE) de 24,52; el 29,1% de los encuestados eran varones y un 37% no tenía estudios o sólo estudios primarios. La edad se mostró inversamente correlacionada con la preferencia de aceptar tratamientos, de tal manera que los mayores de 55 años optan en menor medida por los tratamientos de soporte vital que los más jóvenes y ocurre lo mismo con los de menor nivel académico respecto a los de nivel superior. Entre varones y mujeres no se han encontrado diferencias. Ante enfermedades graves sin posibilidad de recuperación las preferencias son similares, hay un rechazo del tratamiento en todos los grupos de edad. Cuando hay posibilidad de recuperación o se trata de tratamientos no invasivos, las personas de 21 o más años prefieren recibir tratamiento. Conclusión. Existe una gran variabilidad entre la población a la hora de aceptar o rechazar el tratamiento de soporte vital. Es inadecuado considerar que consiste siempre en la aceptación de tratamientos a toda costa. Convendría divulgar el conocimiento y uso de las instrucciones previas como mejor vía para respetar la voluntad del paciente cuando no tenga la capacidad de expresarla personalmente (AU)

Objective. To explore citizens’ treatment preferences in critical health situations.Method. We performed a cross-sectional study through a questionnaire administered to 306 participants, randomlyselected from nursing consultations, cultural centers, nursing homes and the university. Treatment preferences in critical health situations were measured through the Life Support Preferences Questionnaire (LSPQ). A descriptive bivariate and multivariate analysis was performed.Results. The mean age of participants was 39.28 years (SD: 24.52), 37% had primary school or no education, and29.1% were male. Age was inversely correlated with accepting treatments; thus acceptance of life support measures was lower among participants older than 55 years than among the youngest participants and was also lower among those with a lower educational level than those with a higher educational level. No differences were found between men and women. In serious diseases with no possibility of recovery, all age groups rejected treatment. When there was the potential for recovery or for non-invasive treatments, participants aged 21 years old or older would prefer to be treated.Conclusion. There is wide variability among the population when accepting or rejecting life support treatment. The view that treatment should be accepted at all costs is inappropriate. Disseminating knowledge of advance directives and the use of these documents is recommended as the most effective way to respect patients’ wishes when they are unable to express themselves (AU)