Telesalud mental en una unidad pública de psiquiatría infanto-juvenil en pandemia: estudio cualitativo de implementación / Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study

Antecedentes La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. Métodos Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada Resultados En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. Conclusiones Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.

Background The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. Methods This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. Results In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. Conclusions There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Experiencia de la pandemia por SARS-CoV-2 en un centro hospitalario de alta complejidad en Chile

Background: The knowledge about the epidemiological profile of patients admitted to the hospital for severe COVID infection, allows an adequate health care planning and resource allocation. Aim: To describe the epidemiology of patients with COVID-19 admitted to a public hospital between March 2020 and July 2021. Material and Methods: Demographic variables, comorbidities, ventilatory support requirements, and hospital resources were recorded from clinical records and hospital databases of diagnosis related groups. The primary outcomes were overall mortality and need of ventilatory support. Results: In the study period, 4,474 patients (56% males) were hospitalized with a diagnosis of COVID-19. Overall mortality was 25.8% and in-hospital mortality was 18%. Invasive and non-invasive ventilatory support was required in 1349 (30.2%) and 2060 (46%) patients, respectively. The most common comorbidities in admitted patients were diabetes mellitus (29.2%), chronic kidney disease (11.1%), and chronic liver disease (10.4%). The readmission rate was 3.2%. Conclusions: Mortality associated with COVID-19 in this hospital was similar to the rates reported abroad. Local risk predictors for this infection should be identified.

Perinatal and long-term outcome of endoscopic laser surgery for twin-twin transfusion syndrome with and without selective fetal growth restriction: A retrospective cohort study.

OBJECTIVE: Report survival rates, neonatal mortality and morbidity and long-term outcomes of monochorionic (MC) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) or TTTS plus selective fetal growth restriction (sFGR) treated by endoscopic laser surgery. METHODS: Retrospective cohort study including 149 MC twin pregnancies complicated by TTTS or TTTS plus sFGR.Medical records were reviewed for survival rates, neonatal mortality, neonatal morbidity and long-term outcomes at 2 and 6 years of age. RESULTS: Survival of both babies was higher in the TTTS group than in the TTTS plus sFGR group (72.9%vs.54.8%); survival of at least one baby was similar in the two groups (90.7% and 88.1%). The incidence of severe neurological disability was not significantly different between TTTS and TTTS plus fetal growth restriction group at both stages, 1.9% versus 2.3% (p-value = 1) and 3.4%vs6.1% (p-value = 0.31). Multivariable analysis demonstrated that intact neurological outcome at 2 years of age was related with gestational age (GA) at birth and z score birthweight (Z BW), and at 6 years of age with GA at birth, Z BW and TTTS stage4. sFGR or abnormal brain findings at neonatal ultrasound were not related with impaired neurological outcome at two or 6 years of age. CONCLUSIONS: In pregnancies with TTTS and TTTS plus sFGR survival of at least one baby and long-term neurological outcome are comparable between both groups.

Development in Sustainable Concrete with the Replacement of Fume Dust and Slag from the Steel Industry.

Nowadays, the reuse of waste is a challenge that every country in the world is facing in order to preserve the planet and introduce a circular economy. The chemical composition of some steel waste suggests that there are potentially appropriate substances for reuse, since this type of slag undergoes a process similar to that of cement in its manufacture. The advantages for the environment are obvious, as it valorises waste that is deposited in landfills. This paper studies the field of stainless steel, because its composition is different from that of carbon steel, and the replacement of cement with material or waste produced in the manufacture of stainless steel in a concrete matrix. This paper presents the results of replacing 25% of cement with material or waste produced in the manufacture of stainless steel in a concrete matrix whose values in the substitutions carried out were around 21% and 25% in terms of increased resistance capacity. These results have been obtained by carrying out tests, in terms of both strength and environmental capacity, allowing us to determine viable applications for the use of steel waste to improve the performance of cement or at least match it.

Netrin 1-Mediated Role of the Substantia Nigra Pars Compacta and Ventral Tegmental Area in the Guidance of the Medial Habenular Axons.

The fasciculus retroflexus is an important fascicle that mediates reward-related behaviors and is associated with different psychiatric diseases. It is the main habenular efference and constitutes a link between forebrain regions, the midbrain, and the rostral hindbrain. The proper functional organization of habenular circuitry requires complex molecular programs to control the wiring of the habenula during development. However, the mechanisms guiding the habenular axons toward their targets remain mostly unknown. Here, we demonstrate the role of the mesodiencephalic dopaminergic neurons (substantia nigra pars compacta and ventral tegmental area) as an intermediate target for the correct medial habenular axons navigation along the anteroposterior axis. These neuronal populations are distributed along the anteroposterior trajectory of these axons in the mesodiencephalic basal plate. Using in vitro and in vivo experiments, we determined that this navigation is the result of netrin 1 attraction generated by the mesodiencephalic dopaminergic neurons. This attraction is mediated by the receptor deleted in colorectal cancer (DCC), which is strongly expressed in the medial habenular axons. The increment in our knowledge on the fasciculus retroflexus trajectory guidance mechanisms opens the possibility of analyzing if its alteration in mental health patients could account for some of their symptoms.

Arthrospira (Spirulina) platensis Attenuates Dextran Sulfate Sodium-induced Colitis in Mice by Suppressing Key Pro-inflammatory Cytokines.

Background/Aims: Therapies aimed at modulating cytokines have been used to treat inflammatory illnesses, such as inflammatory bowel disease. On the other hand, patients may become intolerant, refractory, or present with several side effects. Arthrospira (Spirulina) platensis (SPI) is a blue-green microalga with bioactive molecules that have been evaluated to treat inflammatory diseases. On the other hand, few studies have examined their effects on the production of specific cytokines and the intestinal architecture in dextran sulfate sodium (DSS)-induced colitis. Therefore, this study examined the effects of a treatment using SPI in a murine model of intestinal inflammation. Methods: All mice (C57BL/6 male) were evaluated daily for their food and water intake, bodyweight variations, and clinical signs of disease. Colon inflammation was induced by exposure to DSS for 6 consecutive days. SPI was given orally at 50, 100, and 250 mg/kg/day. ELISA was performed to assess the production of cytokines. Myeloperoxidase and nitric oxide were also investigated. The level of microscopic damage was assessed by staining colon sections with hematoxylin and eosin. Results: SPI attenuated the DSS-induced inflammation, with improvements in the clinical signs and a decrease in the production of inflammatory cytokines, such as tumor necrosis factor-α and interferon-γ. In addition, particularly at 250 mg/kg, SPI attenuated the severity of colitis by modulating the level of mucosal and submucosal cell infiltration, which preserved the epithelial barrier. Conclusions: SPI may be an alternative source of bioactive molecules with immunomodulatory properties, and has great potential to be used in the treatment of inflammatory diseases.

Astaxanthin Counteracts Excitotoxicity and Reduces the Ensuing Increases in Calcium Levels and Mitochondrial Reactive Oxygen Species Generation.

Astaxanthin (ASX) is a carotenoid pigment with strong antioxidant properties. We have reported previously that ASX protects neurons from the noxious effects of amyloid-ß peptide oligomers, which promote excessive mitochondrial reactive oxygen species (mROS) production and induce a sustained increase in cytoplasmic Ca2+ concentration. These properties make ASX a promising therapeutic agent against pathological conditions that entail oxidative and Ca2+ dysregulation. Here, we studied whether ASX protects neurons from N-methyl-D-aspartate (NMDA)-induced excitotoxicity, a noxious process which decreases cellular viability, alters gene expression and promotes excessive mROS production. Incubation of the neuronal cell line SH-SY5Y with NMDA decreased cellular viability and increased mitochondrial superoxide production; pre-incubation with ASX prevented these effects. Additionally, incubation of SH-SY5Y cells with ASX effectively reduced the basal mROS production and prevented hydrogen peroxide-induced cell death. In primary hippocampal neurons, transfected with a genetically encoded cytoplasmic Ca2+ sensor, ASX also prevented the increase in intracellular Ca2+ concentration induced by NMDA. We suggest that, by preventing the noxious mROS and Ca2+ increases that occur under excitotoxic conditions, ASX could be useful as a therapeutic agent in neurodegenerative pathologies that involve alterations in Ca2+ homeostasis and ROS generation.

New Metrics to Assess Type 2 Diabetes After Bariatric Surgery: The "Time-Within-Remission Range".

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the "time-within-remission range" as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, "time-within-remission range" and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m2) underwent primary bariatric procedures. "Time-within-remission range" were 83.3% (33.3-91.6) after gastric bypass, 68.7% (7.1-87.5) after sleeve gastrectomy and 90% (83.3-92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the "time-within-remission range". The association of bariatric techniques with "time-within-remission range", using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34-5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40-0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The "time-within-remission range" unveils a superiority of gastric bypass compared to sleeve gastrectomy.

Impact of clinical features, cytogenetics, genetic mutations, and methylation dynamics of CDKN2B and DLC-1 promoters on treatment response to azacitidine.

Azacitidine (AZA) is a DNA hypomethylation agent administered in myeloid neoplasms; however, there is still a lack of established predictors of response. We studied 113 patients with myelodysplastic syndromes (n = 85) or acute myeloid leukemia (n = 28) who received AZA to assess the predictive value on response of clinical features, cytogenetics, and molecular markers. Overall, 46 patients (41%) responded to AZA. Platelet doubling after the first AZA cycle was associated with a better response (68% vs. 32% responders, P = 0.041). Co-occurrence of chromosome 7 abnormalities and 17p deletion was associated with a worse response (P = 0.039). Pre-treatment genetic mutations were detected in 98 patients (87%) and methylation of CDKN2B and DLC-1 promoters were detected in 50 (44%) and 37 patients (33%), respectively. Patients with SF3B1 mutations showed a better response to AZA (68% vs. 35% responders, P = 0.008). In contrast, subjects with mutations in transcription factors (RUNX1, SETBP1, NPM1) showed a worse response (20% vs. 47% responders, P = 0.014). DLC-1 methylation pre-treatment was associated with poor clinical features and its reduction post-treatment resulted in a better response to AZA in MDS patients (P = 0.037). In conclusion, we have identified several predictors of response to AZA that could help select the best candidates for this treatment.

Synergistic Antioncogenic Activity of Azacitidine and Curcumin in Myeloid Leukemia Cell Lines and Patient Samples.

BACKGROUND/AIM: Azacitidine (AZA) is a hypomethylating agent used in myeloid neoplasms, however, approximately half of patients show treatment failure or relapse. This in vitro study investigated the effect of the combination of AZA with the natural compound curcumin (CUR) in increasing its efficacy. MATERIALS AND METHODS: We analyzed the effects of AZA plus CUR on proliferation, apoptosis, cell cycle and differentiation in myeloid leukemic cell lines (U-937, HL-60, K-562, and OCI-AML3) and bone marrow samples of patients. RESULTS: The results showed a synergy between AZA and CUR in all leukemic lines and in most leukemic samples, with a decrease in proliferation and an increase in apoptosis compared to the activity of each drug separately. In addition, AZA plus CUR showed low cytotoxicity in healthy samples. CONCLUSION: A remarkable antioncogenic effect of the combination of AZA plus CUR was shown, providing a basis for future studies analyzing the clinical efficacy of these drugs.

La Enfermería pinareña en el internacionalismo cubano 1970-1997 / Nursing Care in Pinar del Río: participation in International missions from 1970 to 1997

RESUMEN Introducción: una característica que distingue a la Revolución Cubana es la solidaridad internacional que se ha materializado en diversos sectores de la sociedad, la salud entre estos. Objetivo: testimoniar la evolución histórica del internacionalismo en Enfermería y sus particularidades en Pinar del Río de 1972 a 1997. Métodos: se seleccionó una muestra intencional de 42 enfermeras y enfermeros que cumplieron misión internacionalista en el período de elección utilizando para la investigación el método dialéctico y el histórico mediante testimonios. Se elaboró un cuestionario para la recolección de información de los participantes seleccionados sobre tipo de misión, tiempo, país y vivencias más relevantes durante su desarrollo. Resultados: se constató que, en Pinar del Río, se destacaron mujeres que, sin ser enfermeras, curaban heridos y atendieron enfermos con la delicadeza propia de la mujer. En la etapa analizada muchos enfermeros pinareños, brindaron su ayuda solidaria en países de África, Asia y América en difíciles condiciones por conflictos bélicos y desastres naturales. Conclusiones: el internacionalismo en la Enfermería pinareña estuvo presente en todos los momentos históricos desde las guerras de independencia hasta la actualidad con una memorable y destacada participación, que debiera incorporarse a las modalidades docentes y sociales como promoción de los valores humanísticos de la Revolución.

ABSTRACT Introduction: a characteristic that distinguishes the Cuban Revolution is the international solidarity that has been materialized in various sectors of society, including health system. Objective: to witness the historical evolution of the nursing care international work and its distinctiveness in Pinar del Río from 1972 to 1997. Methods: an intentional sample of 42 nurses was chosen, those who completed international missions during the chosen period, dialectical and historical methods were applied to carry out the research through testimonies. A questionnaire was completed to collect information from the selected participants on the type of mission, time, country and most relevant experiences during their work abroad. Results: it was found that in Pinar del Río, women prevailed, who without even being graduate nurses, cured the wounded and cared for the sick with the delicacy proper to women. In the period analyzed, many nurses from Pinar del Río offered their assistance in countries of Africa, Asia and America in difficult conditions due to war conflicts and natural disasters. Conclusions: international nursing care missions in Pinar del Río were present in all historical moments from the wars of independence to the present with a memorable and outstanding participation, which should be incorporated into the teaching and social modalities as a promotion of the humanistic values of the Revolution.

Therapy-related acute myeloid leukemia developing 14 years after allogeneic hematopoietic stem cell transplantation, from a persistent R882H-DNMT3A mutated clone of patient origin.

BACKGROUND: Therapy-related acute myeloid leukemia (t-AML) develops in patients with prior exposure to cytotoxic therapies. Selection of a pre-existing TP53 mutated clone prone to acquire additional mutational events has been suggested as the main pathogenic mechanism of t-AML. Here, we report a unique case of t-AML which developed from a pre-existing DNMT3A mutated clone that persisted in the patient for more than 10 years despite treatment with intensive chemotherapy and allogeneic hematopoietic stem cell transplantation (alloHSCT). CASE PRESENTATION: A 42-year-old male was diagnosed with AML harboring a normal karyotype and mutations in the NPM1 (c.863_864ins, p.W288 fs*12), DNMT3A (c.2645G > A, p.R882H), and IDH1 (c.395G > A, p.R132H) genes. He achieved complete remission with intensive chemotherapy and was subsequently submitted to alloHSCT. Eleven years later, he was given chemotherapy and radiotherapy to treat a lung carcinoma. Three years later, t-AML was diagnosed; the disease had arisen from a pre-existing DNMT3A mutated patient-origin clone that had subsequently acquired a TP53 mutation and a complex karyotype. Although a second transplantation was intended, the disease was refractory to induction chemotherapy, and the patient eventually died from disease complications. We retrospectively demonstrated the persistence and post-transplantation latency of the R882H-DNMT3A mutation using a real-time PCR allele-specific analysis at different time-points during the observation period. DISCUSSION AND CONCLUSION: The present case highlights the potential clinical implications of a R882H-DNMT3A mutated clone that persisted after conventional AML treatment, including alloHSCT. It also reinforces the notion of the importance of cell non-intrinsic factors, such as the hematopoietic-stress induced by chemotherapy and radiotherapy, as drivers of clonal expansion.

Microorganisms causing urinary tract infections in a teaching hospital in northeastern Brazil / Microorganismos causantes de infecciones del tracto urinario en un hospital universitario en el noreste Brasil / Microorganismos causadores de infecções do trato urinário em um hospital universitário do nordeste do Brasil

Objective: to study the UTI-causing bacteria frequency and sensitivity profiles in a teaching hospital in northeastern Brazil. Method: A retrospective cross-sectional study was conducted based on the review of 279 patients for whom uroculture and urinary catheter cultures were routinely processed in the Microbiology Laboratory of São Vicente de Paulo Hospital. Results: For the catheter culture group, the most frequent microorganism was Staphylococcus epidermidis (47%), while in urine culture group Escherichia coli was the microorganism most frequently isolated (52%). E. coli showed 76.46%, 70%, and 86.36% resistance to ampicillin, amoxicillin and Sulfamethoxazole/trimethoprim respectively. S. epidermidis showed high resistance to most drugs used, demonstrating that these drugs should not be used to treat UTIs in this institution. Conclusion: This study represents the first study evaluating bacterial resistance in this institution and since data involving epidemiological surveillance and microbiological are limited in this region and due to its importance in the national context, the results may reflect important information to the body of research/data on bacterial resistance in the world.

Objetivo: estudiar los perfiles de frecuencia y sensibilidad de las bacterias causantes de ITUs en un hospital universitario del nordeste brasileño. Método: Se realizó un estudio retrospectivo de corte transversal, con base en la revisión de 279 pacientes, para los cuales las culturas de urocultura y catéter urinario fueron analizadas en el Laboratorio de Microbiología del Hospital São Vicente de Paulo. Resultados: En el grupo de cultivo de catéteres, el microorganismo más frecuente fue el Staphylococcus epidermidis (47%), mientras que en el grupo de la urocultura la Escherichia coli fue el microorganismo más aislado (52%). La E. coli mostró 76,46%, 70% y 86,36% de resistencia a la ampicilina, amoxicilina y sulfametoxazol/trimetoprima, respectivamente. S. epidermidis mostró una alta resistencia a la mayoría de los fármacos utilizados indicando que los medicamentos en cuestión no deben ser usados en el tratamiento de ITUs en esa institución. Conclusión: Este estudio representa el primer estudio que evalúa la resistencia bacteriana en esa institución y una vez que los datos que involucran vigilancia epidemiológica y microbiológica son limitados en esta región y debido a su importancia en el contexto nacional, estos resultados pueden reflejar informaciones importantes para el cuerpo de búsqueda/datos sobre resistencia en el mundo.

Objetivo: estudar os perfis de frequência e sensibilidade das bactérias causadoras de ITUs em um hospital universitário do nordeste brasileiro. Método: Foi realizado um estudo retrospectivo de corte transversal, com base na revisão de 279 pacientes, para os quais as culturas de urocultura e cateter urinário foram analisadas no Laboratório de Microbiologia do Hospital São Vicente de Paulo. Resultados: no grupo de cultura de cateteres, o microrganismo mais frequente foi o Staphylococcus epidermidis (47%), enquanto no grupo da urocultura a Escherichia coli foi o microrganismo mais isolado (52%). A E. coli mostrou 76,46%, 70% e 86,36% de resistência à ampicilina, amoxicilina e sulfametoxazol/trimetoprima, respectivamente. S. epidermidis mostrou uma alta resistência à maioria dos fármacos utilizados indicando que os medicamentos em questão não devem ser usados no tratamento de ITUs nessa instituição. Conclusão: Este estudo representa o primeiro estudo que avalia a resistência bacteriana nessa instituição e uma vez que os dados que envolvem vigilância epidemiológica e microbiológica são limitados nesta região e devido a sua importância no contexto nacional, estes resultados podem refletir informações importantes para o corpo de pesquisa/dados sobre resistência no mundo.

Principales resultados del Proyecto Cubano para formación de Licenciados en Enfermería en Cuando Cubango, Angola / Main results of the Cuban Project for training of Nursing Graduates in Cuando Cubango, Angola

Se realizó una investigación descriptiva, prospectiva y longitudinal con el objetivo de valorar los principales resultados de la implementación del proyecto cubano para las carreras de la salud en la provincia de Cuando Cubango, República de Angola. El universo coincide con la muestra y lo constituyen 330 estudiantes matriculados desde el 2010-2015. Los datos se obtuvieron a través de la revisión bibliográfica, entrevistas a fundadores de la escuela, documentos de la secretaría docente. Los resultados obtenidos permitieron constatar la efectividad del proyecto, fundamentado en la enseñanza científica y sobre la base de los valores que distinguen la profesión, el fruto de la cooperación entre ambos países se refleja en los más de cien egresados que serán los encargados de elevar los niveles de salud de la población angoleña y abre nuevas perspectivas en el desarrollo de la enfermería en la provincia(AU)

A descriptive, prospective and longitudinal research was carried out with the objective of evaluating the main results of the implementation of the Cuban project for health care in the province of Cuando Cubango, Republic of Angola. The universe and the sample were 330 students since 2010 to 2015. The data were obtained through the bibliographic review, interviews with school founders, and documents of the teaching secretary. The results allowed the verification of the effectiveness of the project, based on scientific education and based on the values that distinguish the profession, the cooperation between both countries is reflected in the more than one hundred professional in charge of raising the Levels of health of the Angolan population and opens new perspectives in the development of the nursing in the province(AU)

Educación participativa comunitaria para prevenir el deterioro cognitivo en el adulto mayor / Participative community education to prevent cognitive impairment in older adults

Este artículo presenta una intervención educativa realizada por alumnas de enfermería de la Pontificia Universidad Católica de Chile, a un grupo de adultos mayores pertenecientes a la comuna de Puente Alto, Santiago de Chile. OBJETIVO: Prevenir el deterioro cognitivo enfocado en la memoria, empoderando a la comunidad en su autocuidado. METODOLOGÍA: La comunidad se conformó por personas de un rango etario entre 60 y 85 años. En la valoración y análisis se utilizó el modelo "Comunidad como Socio" de Anderson y McFarlane, junto a encuestas elaboradas para este trabajo. Se realizó un diagnóstico participativo con el objetivo de definir la necesidad educativa de la comunidad, donde se decidió trabajar el tema "La memoria y la prevención de su deterioro en adultos mayores" en seis sesiones de una duración de 60 minutos cada una. Las intervenciones y actividades realizadas tomaron como base el modelo Educación Participativa para Adultos de Jane Vella. RESULTADOS: Los participantes adquirieron conocimientos sobre la temática tratada en las sesiones y lograron incrementar su autoeficacia. El programa educativo los impulsó a un autocuidado consciente y la prevención del deterioro cognitivo. CONCLUSIÓN: Las metodologías participativas facilitaron a los integrantes a tomar un rol protagónico en la construcción de su propio conocimiento, posibilitando su integración en la vida diaria.

This article presents an educational intervention carried out by nursing students of Pontificia Universidad Católica de Chile, to a group of older adults belonging to Puente Alto, Santiago, Chile. OBJECTIVE: To prevent cognitive impairment focused on memory, empowering the community in its self-care. METHODOLOGY: The community was formed by people of an age range between 60 and 85 years. In the assessment and analysis the Community as Partner model by Anderson and McFarlane was used, along with surveys developed for this work. A participatory diagnosis was made in order to define the educational needs of the community, six sessions were held for 60 minutes each, where the theme was "Memory and prevention of its deterioration in older adults". The interventions and activities were based on Jane Vella's Participative Adult Education model. RESULTS: Participants acquired knowledge about the topics dealt within the sessions and were able to increase their self-effectiveness. The educational program promoted conscious self-care and prevention of cognitive impairment. CONCLUSION: Participatory methodologies facilitate members to take a leading role in building their own knowledge, enabling their integration into everyday life.

Application of FISH 7q in MDS patients without monosomy 7 or 7q deletion by conventional G-banding cytogenetics: does -7/7q- detection by FISH have prognostic value?

Chromosomal abnormalities are detected in 40-60% of patients with de novo myelodysplastic syndromes (MDS). This study used the FISH technique in 773 patients with de novo MDS without evidence of monosomy 7 (-7) or 7q deletion (7q-) by conventional G-banding cytogenetics (CC) to analyze their prognostic impact by FISH alone. FISH detected -7/7q- in 5.2% of patients. Presence of -7/7q- was associated with shorter overall survival than absence of such aberrations. Our results suggest that FISH 7q could be beneficial in patients with intermediate WHO morphologic risk stratification and no evidence of -7/7q- by CC.

Association analysis between breast cancer genetic variants and mammographic density in a large population-based study (Determinants of Density in Mammographies in Spain) identifies susceptibility loci in TOX3 gene.

BACKGROUND: Mammographic density (MD) is regarded as an intermediate phenotype in breast cancer development. This association study investigated the influence of 14 breast cancer susceptibility loci identified through previous genome-wide association studies on MD among the participants in the "Determinants of Density in Mammographies in Spain" (DDM-Spain) study. METHODS: Our study covered a total of 3348 Caucasian women aged 45-68years, recruited from seven Spanish breast cancer screening centres having DNA available. Mammographic density was blindly assessed by a single reader using a semiquantitative scale. Ordinal logistic models, adjusted for age, body mass index and menopausal status, were used to estimate the association between each genotype and MD. RESULTS: Evidence of association with MD was found for variant rs3803662 (TOX3) (Odds Ratio (OR)=1.13, 95% Confidence Interval (CI)=1.03-1.25), and marginal evidence of association for susceptibility loci rs3817198 (LSP1) (OR=1.09, 95% CI=1.00-1.20) and rs2981582 (FGFR2) (OR=0.92, 95% CI=0.84-1.01). Two other loci were associated with MD solely among pre-menopausal women, namely, rs4973768 (SLC4A7) (OR=0.83, 95% CI=0.70-1.00) and rs4415084 (MEPS30) (OR=1.22, 95% CI=1.00-1.49). CONCLUSIONS: Our findings lend some support to the hypothesis which links these susceptibility loci to MD.

Diet quality and related factors among Spanish female participants in breast cancer screening programs.

OBJECTIVE: A healthy diet is particularly important during menopause, a period in which the risk of a number of health problems increases. This study analyzed diet quality as measured by two indices, namely, the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet (aMED) index, which measures adherence to a Mediterranean diet, and examined the factors associated with lower diet quality. METHODS: This was a cross-sectional study covering 3,564 women aged 45 to 68 years who underwent breast cancer screening at 7 centers (Corunna, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia, and Zaragoza). Data on diet were collected using a food frequency questionnaire validated for the Spanish population. We calculated the AHEI out of a total of 80 points and the aMED out of a total of 9 points. Ordinal logistic regression models were fitted, taking diet quality (tertiles of the AHEI and the aMED) as dependent variables. The following were included in the final multivariate models as explanatory variables: sociodemographic characteristics, chronic diseases, and lifestyles that were associated with diet quality, with a P value <0.100 in an initial simple model (adjusted solely for calorie intake and screening center). Interaction between menopause status and the other explanatory variables was checked. RESULTS: The median score for AHEI was 40 of a maximum of 80 points. Lower diet quality was registered by the youngest women (P for trend < 0.001), premenopausal and perimenopausal women (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; and OR, 1.48; CI, 1.20-1.83, respectively), obese women (OR, 1.18; CI, 0.99-1.41), those with a diagnosis of diabetes (OR, 1.35; CI, 1.01-1.79), smokers (OR, 1.41; CI, 1.21-1.66), and women reporting lower daily physical activity (OR, 1.31; CI, 1.12-1.53). Better diet quality was shown by women with higher education (OR, 0.74; CI, 0.62-0.88) and ex-smokers (OR, 0.82; CI, 0.69-0.98). Nulliparity was associated with higher AHEI scores, but only among premenopausal women (OR, 0.50; CI, 0.32-0.78). aMED index varied between 0 and 9 (median 5). Lower scores were associated with younger age (P for trend < 0.001), low socioeconomic level (OR, 1.13; CI, 0.96-1.33), lower educational level (P for trend = 0.008), and low level of daily physical activity (OR, 1.27, CI, 1.08-1.50). CONCLUSIONS: The youngest women, the most sedentary women, and those who had a lower educational level and socioeconomic status registered worse diet quality. Ex-smokers and postmenopausal women obtained better scores, probably reflecting a keener concern about leading a healthy life.

Radiobiology and reproduction-what can we learn from Mammalian females?

Ionizing radiation damages DNA and induces mutations as well as chromosomal reorganizations. Although radiotherapy increases survival among cancer patients, this treatment does not come without secondary effects, among which the most problematic is gonadal dysfunction, especially in women. Even more, if radio-induced DNA damage occurs in germ cells during spermatogenesis and/or oogenesis, they can produce chromosomal reorganizations associated with meiosis malfunction, abortions, as well as hereditary effects. However, most of our current knowledge of ionizing radiation genotoxic effects is derived from in vitro studies performed in somatic cells and there are only some experimental data that shed light on how germ cells work when affected by DNA alterations produced by ionizing radiation. In addition, these few data are often related to mammalian males, making it difficult to extrapolate the results to females. Here, we review the current knowledge of radiobiology and reproduction, paying attention to mammalian females. In order to do that, we will navigate across the female meiotic/reproductive cycle/life taking into account the radiation-induced genotoxic effects analysis and animal models used, published in recent decades.

Childhood factors associated with mammographic density in adult women.

Growth and development factors could contribute to the development of breast cancer associated with an increase in mammographic density. This study examines the influence of certain childhood-related, socio-demographic and anthropometric variables on mammographic density in adult woman. The study covered 3574 women aged 45-68 years, participating in breast cancer-screening programmes in seven Spanish cities. Based on a craniocaudal mammogram, blind, anonymous measurement of mammographic density was made by a single radiologist, using Boyd's semiquantitative scale. Data associated with the early stages of life were obtained from a direct survey. Ordinal logistic regression and generalised linear models were employed to estimate the association between mammographic density and the variables covered by the questionnaire. Screening programme was introduced as a random effects term. Age, number of children, body mass index (BMI) and other childhood-related variables were used as adjustment variables, and stratified by menopausal status. A total of 811 women (23%) presented mammographic density of over 50%, and 5% of densities exceeded 75%. Our results show a greater prevalence of high mammographic density in women with low prepubertal weight (OR: 1.18; 95% CI: 1.02-1.36); marked prepubertal height (OR: 1.25; 95% CI: 0.97-1.60) and advanced age of their mothers at their birth (>39 years: OR: 1.28; 95% CI: 1.03-1.60); and a lower prevalence of high mammographic density in women with higher prepubertal weight, low birth weight and earlier menarche. The influence of these early-life factors may be explained by greater exposure to hormones and growth factors during the development of the breast gland, when breast tissue would be particularly susceptible to proliferative and carcinogenic stimulus.