In vivo selection in non-human primates identifies AAV capsids for on-target CSF delivery to spinal cord.

Systemic administration of adeno-associated virus (AAV) vectors for spinal cord gene therapy has challenges including toxicity at high doses and pre-existing immunity that reduces efficacy. Intrathecal delivery of AAV vectors into cerebral spinal fluid (CSF) can avoid many issues, although distribution of the vector throughout the spinal cord is limited, and vector entry to the periphery sometimes initiates hepatotoxicity. Here we performed biopanning in non-human primates (NHPs) with an intrathecally-injected AAV9 peptide display library. We identified top candidates by sequencing inserts of AAV DNA isolated from whole tissue, nuclei, or nuclei from transgene-expressing cells. These barcoded candidates were pooled with AAV9 and compared for biodistribution and transgene expression in spinal cord and liver of intrathecally injected NHPs. Most candidates displayed increased retention in spinal cord compared to AAV9. Greater spread from lumbar to thoracic and cervical regions was observed for several capsids. Furthermore, several capsids displayed decreased biodistribution to the liver compared to AAV9, providing a high on-target/low off-target biodistribution. Finally, we tested top candidates in human spinal cord organoids and found them to outperform AAV9 in efficiency of transgene expression in neurons and astrocytes. These capsids have potential to serve as leading-edge delivery vehicles for spinal cord-directed gene therapies.

An AAV capsid increases transduction of striatum and a ChAT promoter allows selective cholinergic neuron transduction.

Adeno-associated virus (AAV) vectors are currently the most efficient option for intracranial gene therapies to treat neurodegenerative disease. Increased efficacy and safety will depend upon robust and specific expression of therapeutic genes into target cell-types within the human brain. In this study, we set out with two objectives: (1) to identify capsids with broader transduction of the striatum upon intracranial injection in mice and (2) to test a truncated human choline acetyltransferase (ChAT) promoter that would allow efficient and selective transduction of cholinergic neurons. We compared AAV9 and an engineered capsid, AAV-S, to mediate widespread reporter gene expression throughout the striatum. We observed that AAV-S transduced a significantly greater area of the injected hemisphere primarily in the rostral direction compared with AAV9 (CAG promoter). We tested AAV9 vectors packaging a reporter gene expression cassette driven by either the ChAT or CAG promoter. Specificity of transgene expression of ChAT neurons over other cells was 7-fold higher, and efficiency was 3-fold higher for the ChAT promoter compared with the CAG promoter. The AAV-ChAT transgene expression cassette should be a useful tool for the study of cholinergic neurons in mice, and the broader transduction area of AAV-S warrants further evaluation of this capsid.

Effectiveness of a Gamification Strategy to Prevent Childhood Obesity in Schools: A Cluster Controlled Trial.

OBJECTIVE: The aim of this study was to examine the effectiveness of a school-based gamification strategy to prevent childhood obesity. METHODS: Schools were randomized in Santiago, Chile, between March and May 2018 to control or to receive a nutrition and physical activity intervention using a gamification strategy (i.e., the use of points, levels, and rewards) to achieve healthy challenges. The intervention was delivered for 7 months and participants were assessed at 4 and 7 months. Primary outcomes were mean difference in BMI z score and waist circumference (WC) between trial arms at 7 months. Secondary outcomes were mean difference in BMI and systolic and diastolic blood pressure between trial arms at 7 months.  RESULTS: A total of 24 schools (5 controls) and 2,197 students (653 controls) were analyzed. Mean BMI z score was lower in the intervention arm compared with control (adjusted mean difference -0.133, 95% CI: -0.25 to -0.01), whereas no evidence of reduction in WC was found. Mean BMI and systolic blood pressure were lower in the intervention arm compared with control. No evidence of reduction in diastolic blood pressure was found. CONCLUSIONS: The multicomponent intervention was effective in preventing obesity but not in reducing WC. Gamification is a potentially powerful tool to increase the effectiveness of school-based interventions to prevent obesity.

Caracterización de pacientes con antecedente de colposuspensión de Burch que consultan en uroginecología / Characterization of patients with a background of Burch colposuspension consulting in urogynecology

INTRODUCCIÓN Y OBJETIVOS: La incontinencia de orina de esfuerzo (IOE) es una patología muy frecuente. El tratamiento estándar corresponde al uso de cintas medio uretrales. Dentro de las técnicas quirúrgicas clásicas se encuentra la colposuspensión de Burch (CSB), poco frecuente en la actualidad. El objetivo de este estudio es describir las características de las pacientes con antecedentes de una CSB que consultan en la unidad de Uroginecología. MÉTODOS: Revisión tipo transversal de los datos ingresados a la unidad de Uroginecología del Hospital Dr. Sótero Del Río desde 2007 al 2019. Análisis descriptivo de los antecedentes de las pacientes con antecedente de CSB. RESULTADOS: Durante el periodo analizado, 63 pacientes presentaban antecedentes de CSB. La edad promedio fue 68 años, 88% eran post menopáusicas, 60% fueron sometidas a histerectomía y 24% a cirugías por prolapso (POP). La paridad promedio fue 3 hijos, 15% tuvieron al menos un parto por fórceps. Un 51% consultó por IOE, 54% por vejiga hiperactiva (VH) y 56% por sensación de bulto o peso. El 38% consultó por incontinencia de orina mixta, 37% por IOE + POP y 41% por VH + POP. 22% fueron reoperadas, 16% por medio de TVT y 6% por TOT. CONCLUSIONES: El antecedente de CSB es infrecuente en nuestra población. Similar a lo descrito en la literatura, más de un 50% de las pacientes consultó por síntomas de recurrencia y por complicaciones como POP y VH. Próximos estudios deberían evaluar si el antecedente de CSB es un factor de riesgo de complicaciones quirúrgicas o recurrencia.

INTRODUCTION AND OBJECTIVES: Stress urinary incontinence (SUI) is a common pathology. The standard treatment corresponds to the mid urethral slings. Among the classic surgical techniques is Burch colposuspension (CSB), currently rare. The objective of this study is to describe the characteristics of the patients with a previous history of CSB who consult in the Urogynecology unit. METHODS: Cross sectional review of the data of all the patients admitted to the Urogynecology unit of the Dr. Sótero Del Río Hospital from 2007 to 2019. Descriptive analysis of the antecedents of the patients with a history of CSB. RESULTS: During the analyzed period, 63 patients had a history of CSB. The average age was 68 years. 88% were postmenopausal, 60% underwent hysterectomy, and 24% underwent prolapse (POP) surgery. The average parity was 3, 15% had at least one forceps delivery. 51% consulted for SUI, 54% for overactive bladder (OAB) and 56% for sensation of lump or weight. 38% consulted for mixed urine incontinence, 37% for SUI + POP and 41% for OAB + POP. 22% were reoperated, 16% through TVT and 6% through TOT. CONCLUSION: The history of CSB is infrequent in our population. Similar to that described in the literature, more than 50% of the patients consulted for recurrence symptoms and complications such as POP and OAB. Future studies should assess whether a history of CSB is a risk factor for surgical complications or recurrence.

Actualización del enfrentamiento y manejo del embarazo ectópico tubario / Update of the confrontation and management of tubal ectopic pregnancy

INTRODUCCÍÓN Y OBJETIVOS: El embarazo ectópico es una condición potencialmente mortal, con una incidencia del 1 al 2%. El 97% se produce en las tubas uterinas, y el 80% de éstos se encuentran en la región ampular. El objetivo de esta revisión es exponer una actualización del enfrentamiento y manejo del embarazo ectópico tubario. MÉTODOS: Mediante el uso de la base de datos Epistemonikos, Scielo, Cochrane y Pubmed, se revisó la literatura existente sobre embarazo ectópico tubario. RESULTADOS: El diagnóstico de embarazo ectópico tubario implica una combinación de síntomas clínicos, serología y ultrasonido. El manejo médico es una opción segura y efectiva en la mayoría de las pacientes hemodinámicamente estables. En caso de fracaso de tratamiento médico, paciente incapaz de mantener seguimiento, embarazo ectópico roto o embarazo heterotópico, debe ser manejado con tratamiento quirúrgico idealmente por laparoscopía. Independiente del tratamiento utilizado, existe gran probabilidad de éxito y escasas complicaciones. CONCLUSIONES: Esta actualización describe la incidencia, factores de riesgo, diagnóstico, y manejo del embarazo ectópico tubario. Es importante un diagnóstico y tratamiento temprano, para reducir complicaciones asociadas a esta patología.

INTRODUCTION AND OBJECTIVES: Ectopic pregnancy is a potencially lethal condition, it has an incidence of 1-2%. 97% occurs in uterine tubes, and 80% in the ampulla. The objetive of this review is to update management of this pathology. METHODS: Existent literature was reviewed in different data base: Epistemonikos, Scielo, Cochrane and Pubmed. RESULTS: Tubal Ectopic Pregnancy Diagnostic implies a combination of clinical features, serology and ultrasound. Medical management is a safe and effective alternative in most of hemodinamically stable patients. When medical treatment fails, or patient is not able to stay in observation, or ectopic/heterotopic pregnancy is diagnosed, surgical management is needed specially by laparoscopy. Regardless of the treatment, there is a high chance of success and low rate of complications. CONCLUSIONS: This update describes incidence, risk factors, diagnostic and management of tubal ectopic pregnancy. An early diagnostic and treatment are crucial to reduce complications due to this pathology.

Actualización del enfrentamiento y manejo de localizaciones poco frecuentes del embarazo ectópico / Update of the confrontation and management of unusual locations of ectopic pregnancy

INTRODUCCIÓN Y OBJETIVOS: El embarazo ectópico no tubario es una condición poco frecuente, asociado a una alta morbimortalidad materna. Existe escasa información que abarque de forma completa los distintos tipos de EE no tubarios. El objetivo de esta publicación es describir una actualización del enfrentamiento y manejo de los distintos tipos de embarazo ectópico. MÉTODOS: Mediante el uso de la base de datos Epistemonikos, Scielo, Cochrane y Pubmed, se revisó la literatura existente sobre embarazo ectópico tubario, cornual/intersticial, abdominal, ovárico, cervical y cicatriz de cesárea. RESULTADOS: Para realizar el diagnóstico, hay que considerar la clínica y antecedentes de las pacientes. Se deben medir los niveles de β-hCG y complementar esto con ultrasonido transvaginal. Sin embargo, muchas veces el diagnóstico se realiza con laparoscopía. En el embarazo ectópico en cicatriz de cesárea, ovárico, abdominal e intersticial, el manejo quirúrgico laparoscópico es de elección. No se recomienda el metotrexato como primera línea. En el embarazo ectópico cervical, el metotrexato es de elección. En inestabilidad hemodinámica o sospecha de embarazo ectópico roto, es necesaria una laparotomía exploratoria. En el embarazo heterotópico, el metotrexato tiene contraindicación absoluta, siendo la salpingectomía vía laparoscópica el abordaje de primera línea recomendado. CONCLUSIONES: Esta actualización describe la incidencia, factores de riesgo, diagnóstico, y manejo de los distintos tipos de embarazo ectópico no tubario. Es importante recalcar la baja tasa de sospecha clínica de esta patología. Un diagnóstico y tratamiento temprano son fundamentales para reducir complicaciones asociadas a esta patología.

INTRODUCTION AND OBJECTIVES: Non tubal Ectopic Pregnancy is a rare condition, associated with high maternal morbidity and mortality. There is little information that completely covers the different types of non-tubal ectopic pregnancy. The objective of this publication is to describe an update on the assessment and management of the different types of ectopic pregnancy. METHODS: By using the database Epistemonikos, Scielo, Cochrane and Pubmed, we reviewed the existing literature on tubal, cornual/interstitial, abdominal, ovarian, cervical and caesarean section scar EE. RESULTS: To make the diagnosis, it is necessary to consider the clinical feature and history. β-hCG levels should be measured and supplemented by transvaginal ultrasound. However, the diagnosis is often made with laparoscopy. In caesarean section scar, ovarian, abdominal and interstitial ectopic pregnancy, laparoscopic surgical management is of choice. Methotrexate is not recommended as first line treatment. In cervical ectopic pregnancy, methotrexate is the first choice. In hemodynamic instability or suspected broken ectopic pregnancy, an exploratory laparotomy is necessary. In heterotopic pregnancy, methotrexate has an absolute contraindication, with laparoscopic salpingectomy being the recommended first line approach. CONCLUSIONS: This update describes the incidence, risk factors, diagnosis, and management of the different types of non-tubal ectopic pregnancy. It is important to emphasize the low rate of clinical suspicion of this pathology. Early diagnosis and treatment are essential to reduce complications associated with this pathology.

Experiencia y manejo del embarazo ectópico cervical: revisión del tema / Experience and management of cervical ectopic pregnancy: topic review

Introducción y Objetivos: El Embarazo Cervical (EC) corresponde a una patología de muy baja frecuencia y tasa de sospecha. En la literatura actual se han propuestos diferentes tratamientos, pero se recomienda el manejo médico con Metotrexato como primera línea. Los objetivos de este estudio son describir las características relevantes de los casos de EC en el servicio de Ginecología del Hospital Dr. Sótero del Río y realizar una revisión actualizada del tema. Métodos: Estudio Retrospectivo de todas las pacientes hospitalizadas en la unidad de Ginecología entre 2004 y 2020. Análisis descriptivo de las pacientes con diagnóstico de Embarazo Cervical. Resultados: Se revisaron 33740 pacientes. 1910 presentaron diagnóstico de Embarazo ectópico, de las cuales 6 corresponden a embarazo cervical, 5 casos se sospecharon desde el ingreso y sólo 1 caso ingresó con el diagnóstico de aborto en evolución. La mayoría fue manejada con Metrotrexato, con buenos resultados y sin complicaciones. Conclusiones: El Embarazo cervical es una patología poco frecuente. El manejo médico con Metrotrexato es la opción de primera línea en pacientes hemodinámicamente estable posibilitando la fertilidad posterior.

Introduction and Objectives: Cervical Pregnancy is known as a pathology of very low frequency and suspicion rate. Different treatments have been proposed in the current literature, but medical management with Methotrexate is recommended as the first line. The objectives of this study are to describe the relevant characteristics of cervical pregnancy cases in the Gynecology Department of the Dr. Sotero del Rio Hospital and to carry out an updated review of the subject. Methods: Retrospective study of all hospitalized patients in the Gynecology unit between 2004 and 2020. Descriptive analysis of patients diagnosed with Cervical Pregnancy. Results: 33740 patients were reviewed. 1910 presented a diagnosis of ectopic pregnancy, of which 6 correspond to cervical pregnancy, 5 cases were suspected from admission and only 1 case entered with the diagnosis of abortion in progress. Most were managed with Methotrexate, with good results and without complications. Conclusion: Cervical pregnancy is a rare disease. Medical management with Methotrexate is the first line option in hemodynamically stable patients enabling subsequent fertility.

[Risk of falls among patients admitted to a medical-surgical ward. Analysis of 376 medical records]. / Prevalencia de pacientes con alto riesgo de caídas en un servicio médico-quirúrgico de un hospital universitario.

BACKGROUND: Detecting patients at risk of falls during hospital stay is of utmost importance to implement preventive measures. AIM: To determine the frequency of patients with a high risk of falls admitted to a medical-surgical ward. To assess the preventive measures implemented. MATERIALS AND METHODS: Review of medical records of 376 patients aged 20 to 97 years (28% older than 70 years) admitted to a clinical hospital in a period of four months. RESULTS: Eleven percent of patients had a history of falls, 50% had a sensory deficit, 68% had unstable gait, 8% had a neurological risk condition, 8% had drowsiness or disorientation, 4% had psychomotor agitation or delirium, 86 % used high risk medications, 73% used 2 or more high risk drugs and 72% were using devices that decrease mobility. One hundred forty-one patients (38%) had a high risk of falling. The mean age of the latter was 77 years, 89% had a sensory deficit, 96% had unstable gait, 4% had psychomotor agitation or delirium and 98% used high risk drugs. Less than 1% had a medical prescription of a caregiver, physical restraints or antipsychotics, however, 21% of patients had a caregiver. CONCLUSIONS: The percentage of patients with a high risk of falling is important. The main risk factors were sensory deficit, unstable gait and the use of high risk medications. The low frequency of preventive measures prescriptions is striking.

Prevalencia de pacientes con alto riesgo de caídas en un servicio médico-quirúrgico de un hospital universitario / Risk of falls among patients admitted to a medical-surgical ward: analysis of 376 medical records

Background: Detecting patients at risk of falls during hospital stay is of utmost importance to implement preventive measures. Aim: To determine the frequency of patients with a high risk of falls admitted to a medical-surgical ward. To assess the preventive measures implemented. Materials and Methods: Review of medical records of 376 patients aged 20 to 97 years (28% older than 70 years) admitted to a clinical hospital in a period of four months. Results: Eleven percent of patients had a history of falls, 50% had a sensory deficit, 68% had unstable gait, 8% had a neurological risk condition, 8% had drowsiness or disorientation, 4% had psychomotor agitation or delirium, 86 % used high risk medications, 73% used 2 or more high risk drugs and 72% were using devices that decrease mobility. One hundred forty-one patients (38%) had a high risk of falling. The mean age of the latter was 77 years, 89% had a sensory deficit, 96% had unstable gait, 4% had psychomotor agitation or delirium and 98% used high risk drugs. Less than 1% had a medical prescription of a caregiver, physical restraints or antipsychotics, however, 21% of patients had a caregiver. Conclusions: The percentage of patients with a high risk of falling is important. The main risk factors were sensory deficit, unstable gait and the use of high risk medications. The low frequency of preventive measures prescriptions is striking.

The National Cancer Institute's Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned.

BACKGROUND: We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities. METHODS: Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme. RESULTS: Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services. IMPLICATIONS: Findings demonstrate the value of government-supported, community-academic, CBPR partnerships in cancer prevention and control research.

Critical periods in the variation in body composition in school children.

OBJECTIVE: To identify critical periods in the variation in body composition during a school year and determine possible causes. METHODS: A total of 363 boys and girls aged between 10 and 14 years participated in the study. Before and after the Winter Holidays (WIH) and National Holidays (NAH) (July and September, respectively), measurements were taken of body weight, body fat percentage, waist perimeter, time spent on physical activity and hours of sleep in order to determine the variations. The normality of the data was confirmed and the means were compared with an alpha significance level of p<0.05. RESULTS: The school children increased in weight by 600 g and 510 g in the NAH and WIH, respectively (p<0.0001), and their body fat percentage was significantly increased during both periods (0.51%); however, the waist perimeter measurement saw no significant changes. It can also be seen that in NAH physical activity dropped by an important amount (-41 min, p<0.0001), though this did not occur in WIH. A significant increase in hours of sleep was also seen during the two holiday periods (~1 to 2 hours/day). CONCLUSION: It is concluded that both NAH and WIH can be considered critical periods due to the sharp increase in body weight and body fat percentage in the school children, where a possible cause is the reduction in time spent on physical activity.

Objetivo: Identificar periodos críticos en la variación de la composición corporal durante un año escolar y determinar causas posibles. Métodos: Un total de 363 niños y niñas entre 10 y 14 años participaron en el estudio. Antes y después de las Vacaciones de invierno (VI) y Vacaciones nacionales (VN) (julio y septiembre, respectivamente), se tomaron mediciones de peso corporal, porcentaje de grasa corporal, perímetro en la cintura, tiempo dedicado a actividad física y horas de sueño para determinar las variaciones. La normalidad de los datos fue confirmada y las medias fueron comparadas con un nivel de significancia alfa de p.

Relationships hold the key to trustworthy and productive translational science: recommendations for expanding community engagement in biomedical research.

Good relationships between research institutions and communities are an essential, but often neglected, part of the infrastructure of translational science. In an effort to create greater interest among translational science researchers in cultivating relationships with community members, we report the results of a workshop we convened to learn how relationships vital to research are best created and sustained. We highlight common barriers and challenges that hinder relationships. We also provide recommendations that individual research institutions and teams can use to expand and strengthen their relationships with community members. The improved relationships between universities and communities that could result from their implementation should build greater public trust in biomedical research, lead to a stronger commitment to see it succeed, and engender shared values and commitments that will give rise to new rewards, recognition and admonishment to sustain those values and commitments over time, all of which would facilitate translational science.

Prevalencia de dolor orofacial en la consulta máxilofacial del centro médico San Joaquín de la Pontificia Universidad Católica de Chile / Prevalence of orofacial pain in the maxillofacial consultation of the centro médico San Joaquin, Pontificia Universidad Catílica de Chile

Introducción: Los variados cuadros clínicos que cursan con dolor orofacial, así como las repercusiones en la calidad de vida y la economía, tanto de los pacientes como de los organismos de atención de salud, hace que éstos requieran de un manejo multidisciplinario. Objetivo: Determinar la prevalencia de dolor orofacial como motivo de consulta maxilofacial en el Centro Médico San Joaquín de la Pontificia Universidad Católica de Chile. Material y método: Estudio descriptivo-retrospectivo del total de primeras consultas de Cirugía Maxilofacial entre los años 2007 y 2010. Se obtuvieron características demográficas y clínicas, generales y específicas para dolor orofacial. Resultados: De un total de 818 pacientes, 245 consultas (30 por ciento) fueron por dolor orofacial, de las cuales 174 (71 por ciento) correspondieron a dolor orofacial músculoesquelético. Conclusiones: La prevalencia de dolor orofacial en nuestro estudio fue de un 30 por ciento, cifra que se encuentra dentro de lo estimado en la literatura (1 por ciento a 55 por ciento), destacando el dolor músculoesquelético como el más prevalente. Un enfoque multidisciplinario se hace necesario dada la complejidad de estos pacientes.

Introduction: The varied clinical conditions that present with orofacial pain, and the impact on quality of life and economy of both the patients and health care agencies, make these require a multidisciplinary management. Objective: To determine the prevalence of orofacial pain as the reason for maxillofacial consultation to Centro Médico San Joaquín, Pontificia Universidad Católica de Chile. Material and Method: Retrospective descriptive study of all first consultations of Maxillofacial Surgery between 2007 and 2010. Clinic and demographic characteristics were obtained.Results: Of a total of 818 patients, 245 (30 per cent) consultations were for orofacial pain, of which 174 (71 per cent) were for musculoskeletal orofacial pain. Conclusions: The prevalence of orofacial pain found is similar to that reported in the literature. We found a high prevalence of neuropathic pain in this study. Specialized multidisciplinary approach is necessary for the management of this type of pathology, given the complexity in both the diagnosis and treatment.

The Latina Breast Cancer Screening Sacle: beliefs about breast cancer and breast cancer screening.

The Latina Breast Cancer Screening (LBCS) was developed to measure Latinas' culturally-shared health beliefs about breast cancer and breast cancer screening. A 60-item LBCS scale was tested with 288 participants and reduced to 35 items using principal components analyses. The 35-item LBCS scale and other measures were administered to a second sample of 147 participants to establish the scale's validity and reliability. A six-factor solution suggested six LBCS sub-scales. The LBCS in its entirety displayed strong internal consistency (alpha =.93) with adequate estimates of convergent, discriminant, and predictive validity. The LBCS scale appears to be a valid and reliable measure.

Burnout y apoyo social en personal del servicio de psiquiatría de un hospital público / Burnout and social support staff of a public hospital psychiatry

Este artículo presenta resultados de un estudio descriptivo-correlacional que tuvo como objetivos identificar la presencia de burnout y establecer su relación con el apoyo social en el trabajo en personal de un servicio de psiquiatría de un hospital público. Los participantes constituyen el 71 por ciento del personal profesional y de apoyo del servicio. Los resultados muestran que la mayoría de los participantes presenta estrés laboral crónico o burnout, siendo particularmente alta la presencia de agotamiento emocional. Destaca una mayor despersonalización entre quienes realizan turnos y atienden pacientes judicializados, y en los subgrupos de enfermeras, técnicos para-médicos y auxiliares de servicio. Estos resultados señalan la presencia de un grupo ocupacional en situación de vulnerabilidad expresada en un riesgo importante de deterioro de su salud física y mental y con consecuencias laborales negativas sobre la calidad del servicio, la propensión al abandono de la institución, la satisfacción laboral y la tendencia al ausentismo. Por último, la influencia del apoyo social es notable en la disminución de los niveles de agotamiento emocional, despersonalización y baja realización personal, sobre todo cuando proviene de los superiores. El reforzamiento de la capacidad de entregar apoyo de supervisores y jefes mediante un programa de entrenamiento de bajo costo podría tener un efecto altamente positivo en este tipo de servicio.

Results of a descriptive-correlational study that it had as objectives to identify the presence of burnout and to establish its relation with the social support in work in personnel of a service of psychiatry of a public hospital, are presented in this article. Participants constitute 71 percent of the professional personnel and support of the service. Results show that the majority of the participants displays chronic labor stress or burnout, being particularly high the presence of emotional exhaustion. It emphasizes a greater depersonalization between those who work with patients derived by the judicial system or work on shift, and in the sub-groups of nurses, paramedical and auxiliary technicians on watch. These results indicate the presence of an occupational group in situation of vulnerability expressed in an important risk of deterioration of their physical and mental health and with negative labor consequences on the quality of the service, the propensity to the abandonment of the institution, the labor satisfaction and the tendency to the absenteeism. Finally, the influence of the social support is remarkable in the diminution of the levels of emotional exhaustion, depersonalization and low personal accomplishment, mainly when it comes from the superiors. The reinforcing of the capacity to give support of supervisors and heads by means of a program of training of low cost, could have a highly positive effect in this type of ward.

The greater Denver Latino Cancer Prevention/Control Network. Prevention and research through a community-based approach.

The Latino/a Research & Policy Center (LRPC), at the University of Colorado (UC) at Denver and Health Sciences Center built the Greater Denver Latino Cancer Prevention Network, a successful cancer prevention network, in 6 Denver metro area counties. The Network consisted of 23 Latino community-based organizations, health clinics, social service agencies, faith-based groups, and employee-based organizations; 2 migrant health clinics; and 14 scientific partners including the UC Comprehensive Cancer Center, the Colorado Department of Public Health and Environment, and the American Cancer Society. The Network focused on 5 significant cancers: breast, cervical, lung, colorectal, and prostate cancer. The Steering Committee initiated a review process for junior researchers that resulted in 5 NCI-funded pilot projects. Pilot projects were conducted with various Latino populations. The Network developed community education and health promotion projects including the bilingual outreach play The Cancer Monologues. The Network's partnership also started and held 2 annual health fairs, Dia de la Mujer Latina/Day of the Latina Woman, and annual health prevention summits. The Special Population Network (SPN) adapted and revised a clinical trials education outreach module that reached Network community partners. SPN partners recruited Latino/a students to cancer research through a6-week NCI training program held yearly at the UCHSC campus. The Network methodology of bringing together the Latino community with the scientific community increased the level of awareness of cancer in the Latino community and increased cancer research and the level of engagement of the scientific partners with the Latino community. Cancer 2006. (c) 2006 American Cancer Society.

An exploration of Latino smokers and the use of pharmaceutical aids.

BACKGROUND: Latino smokers are less likely than white non-Latino smokers to use nicotine replacement therapy (NRT) or bupropion when trying to quit smoking. The current study explored sociocultural and psychosocial factors related to nonuse of smoking-cessation medications among Latino smokers. METHODS: Structured discussions were held with six separate focus groups of current smokers (n =49) who self-identified as Latino, had attempted to quit in the past 12 months, and were aged 35 to 64 years. Participants were recruited from Latino-serving health clinics, community events, and community organizations. Session recordings were transcribed, and content analysis was used to organize themes into categories. RESULTS: Six thematic categories emerged across most or all discussion groups: (1) smoking is a weakness rather than an illness, (2) pharmaceuticals are generally avoided, (3) NRT is mistrusted, (4) bupropion is widely rejected, (5) views are mixed regarding ethnic dimensions of smoking and quitting, and (6) misconceptions are common regarding smoking and cessation. CONCLUSIONS: Cognitive reframing strategies should be developed and tested for Latino smokers who decline pharmacologic smoking-cessation assistance for reasons other than well-informed autonomous choice.

Challenges in operationalizing the DSM-IV clinical significance criterion.

BACKGROUND: An explicit clinical significance (CS) criterion was added to many DSM-IV diagnoses in an attempt to more closely approximate the clinical diagnostic process and reduce the proportion of false positives in epidemiological studies. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) offered a unique opportunity to examine the success of this effort. OBJECTIVE: To determine the impact of distress, impairment, and help-seeking reported in a lay structured interview on concordance with a clinical reappraisal. Further, to test the efficacy of 5 operationalizations of CS on the concordance and prevalence of DSM-IV lifetime disorders. DESIGN: Completed between 1997 and 2000, a cross-sectional probability sample survey with clinical reappraisal of approximately 10% of participants. SETTING: General community. PARTICIPANTS: A population-based sample of 3084 members of 2 American Indian tribal groups, who were between the ages of 15 and 54 years and resided on or near their home reservations, were randomly sampled from the tribal rolls and participated in structured psychiatric interviews. Clinical reappraisals were conducted with approximately 10% of the lay-interview participants. The response rate for the lay interview was 75%, and for the clinical reappraisal it was 72%. MAIN OUTCOMES MEASURES: The AI-SUPERPFP Composite International Diagnostic Interview (CIDI), a culturally adapted version of the CIDI, University of Michigan version. Adapted to assess DSM-IV diagnoses, questions assessing the CS criterion were inserted in all diagnostic modules. The Structured Clinical Interview for DSM-III-R (SCID) was used in the clinical reappraisal. RESULTS: Most participants who qualified as having AI-SUPERPFP CIDI lifetime disorders reported at least moderate levels of distress or impairment. Evidence of increased concordance between the CIDI and the SCID was lacking when more restrictive operationalizations of CS were used; indeed, the CIDI was very likely to underdiagnose disorders compared with the SCID (false negatives). Concomitantly, the CS operationalizations affected prevalence rates dramatically. CONCLUSION: The CS criterion, at least as operationalized to date, demonstrates little effectiveness in increasing the validity of diagnoses using lay-administered structured interviews.

Latinos report less use of pharmaceutical aids when trying to quit smoking.

BACKGROUND: Latino smokers are more likely than white non-Latino smokers to attempt cessation, but less likely to receive cessation advice from physicians or to use nicotine replacement therapy (NRT). Proposed underlying causes have included lighter smoking, lower financial status, and less healthcare access. This study assessed these factors as possible explanations for disparate rates of smoking-cessation support. METHODS: Data were analyzed from a random, population-level telephone survey of Colorado adults that interviewed 10,945 white non-Latino respondents and 1004 Latino respondents. For the current analysis, main outcome measures were receipt of physician advice to quit smoking, use of NRT, and use of bupropion or other anti-depressant for smoking cessation. RESULTS: Latino smokers reported higher prevalence of quit attempts (71.5% v 61.6%, p <0.01) but less physician advice to quit smoking (46.4% v 56.2%, p <0.05) and less use of NRT or an anti-depressant for cessation (10.6% v 24.8%, p <0.0001). Adjusted for potentially confounding factors, the odds ratio (OR) for less Latino use of cessation medications was substantial and significant (full model OR=0.31; 95% confidence interval, 0.17 to 0.57). The adjusted OR for physician cessation advice was not significant. CONCLUSIONS: Population-level differences in health status, smoking level, financial status, or healthcare access do not explain why Latino smokers less often use proven pharmaceutical aids to increase cessation. Further research is needed to understand these disparities, and greater effort is needed to deliver cessation support to Latino smokers seeking to quit.