Availability and barriers to access post-stroke rehabilitation in Latin America.

OBJECTIVES: To describe the availability and barriers to access post-stroke rehabilitation services in Latin America. MATERIALS AND METHODS: We conducted a multi-national survey in Latin American countries. The survey consisted of three sections: (1) the national state of post-stroke rehabilitation; (2) the local state of post-stroke rehabilitation; and (3) the coverage and financing of post-stroke services. Stroke leaders from the surveyed countries were involved in developing and disseminating the survey. RESULTS: 261 responses were collected from 17 countries. The mean age of respondents was 42.4 ± 10.1 years, and 139 (54.5 %) of the respondents were male. National clinical guidelines for post-stroke rehabilitation were reported by 67 (25.7 %) of the respondents. However, there were discrepancies between respondents within the same country. Stroke units, physiotherapy, occupational therapy, speech therapy, and neuropsychological therapy services were less common in public than private settings. The main barriers for inpatient and outpatient services included limited rehabilitation facilities, coverage, and rehabilitation personnel. The main source of financing for the inpatient and outpatient services was the national health insurance, followed by out-of-pocket payments. Private and out-of-pocket costs were more frequently reported in outpatient services. CONCLUSIONS: Post-stroke rehabilitation services in Latin American countries are restricted due to a lack of coverage by the public health system and private insurers, human resources, and financial aid. Public settings offer fewer post-stroke rehabilitation services compared to private settings. Developing consensus guidelines, increasing coverage, and using innovative approaches to deliver post-stroke rehabilitation is paramount to increase access without posing a financial burden.

Furoxans and tocopherol analogs-furoxan hybrids as anticancer agents.

We determined the antiproliferative and nitric oxide (NO)-releasing activity of furoxans and tocopherol analogs-furoxan hybrids by tandem Griess/resazurin/sulforhodamin B assays in HeLa, 253J, T24, and HepG2 cancer cells. In addition, to investigate the NO implications in the inhibition of cell growth, cells were pretreated with the NO scavenger hemoglobin and the genotoxic damage was determined. The compounds 1 and 3 emerged as good anticancer agents for bladder cancer treatment. The NO-releasing activity of these compounds appears to be necessary to obtain the antiproliferative effect. Although compound 1 exerted a DNA damage mechanism of action, compound 3 seemed to act in a different way. The low toxicity levels against normal cell line HaCaT point them out as a very promising scaffold for the further design of new anticancer agents.

Supporting sexuality for people living with epidermolysis bullosa: clinical practice guidelines.

This article presents evidence-based Clinical Practice Guidelines (CPG) for the provision of healthcare services to address sexuality for people living with epidermolysis bullosa (EB). Currently, a lack of EB-specific research limits these services to sexual health assessment and intervention strategies designed for the general population. Due to the unique challenges of EB, a rare skin-fragility condition causing blistering responses to minor skin trauma and other systemic and secondary complications, condition-specific strategies are needed to support people with EB in achieving valued sexual lifestyles. This CPG represents the work of an international panel comprised of thirteen members including a medical doctor, nurses, psychologists, a social worker, an occupational therapist, and patient population involvement members living with EB. It describes the development of EB-specific recommendations for two primary domains of assessment and intervention related to sexuality: psychosocial and mechanical. Following a rigorous evidence-based guideline development process, this CPG establishes the first internationally actionable clinical practice recommendations for sexuality-related assessment and intervention for this population. Future research priorities are identified. Supplemental materials included provide additional support to clinicians in developing the necessary understanding and skills to promote equity and efficacy in this care domain.

Occurrence, Distribution, and Ecological Risk of Fluoroquinolones in Rivers and Wastewaters.

The use of fluoroquinolones for the treatment of infections in humans and animals has increased in Argentina, and they can be found in large amounts in water bodies. The present study investigated the occurrence and associated ecological risk of 5 fluoroquinolones in rivers and farm wastewaters of San Luis, Santa Fe, Córdoba, Entre Ríos, and Buenos Aires provinces of Argentina by high-performance liquid chromatography coupled to fast-scanning fluorescence detection and ultra-high-performance liquid chromatography coupled to triple quadrupole mass spectrometry detection. The maximum concentrations of ciprofloxacin, enrofloxacin, ofloxacin, enoxacin, and difloxacin found in wastewater were 1.14, 11.9, 1.78, 22.1, and 14.2 µg L-1 , respectively. In the case of river samples, only enrofloxacin was found, at a concentration of 0.97 µg L-1 . The individual risk of aquatic organisms associated with water pollution due to fluoroquinolones was higher in bacteria, cyanobacteria, algae, plants, and anurans than in crustaceae and fish, with, in some cases, risk quotients >1. The proportion of samples classified as high risk was 87.5% for ofloxacin, 63.5% for enrofloxacin, 57.1% for ciprofloxacin, and 25% for enoxacin. Our results suggest that the prevalence of fluoroquinolones in water could be potentially risky for the aquatic ecosystem, and harmful to biodiversity. Environ Toxicol Chem 2019;38:2305-2313. © 2019 SETAC.

El trabajo emocional en la asesoría de negocios a emprendimientos y microempresas chilenas / Emotional labor in business consulting advisors for Chilean entrepreneurs and microenterprises

Resumen El trabajo emocional es un proceso multidimensional que adquiere relevancia debido a su creciente prevalencia y las serias consecuencias que tiene para trabajadores y organizaciones. La presente investigación busca describir las experiencias de trabajo emocional en trabajadores pertenecientes a centros de negocios que asesoran a emprendimientos y microempresas chilenas, cómo estas afectan su trabajo y las estrategias adoptadas para gestionarlo. Para esto, se organizaron cuatro grupos focales en cuatro centros de negocios con financiamiento público. Los análisis revelaron que el trabajo de los asesores/as requiere demandas de apoyo y contención emocional que están por fuera de su rol y competencias profesionales, lo cual tiene consecuencias negativas para su trabajo y su salud mental. Estas exigencias les hicieron desplegar una serie de estrategias individuales y grupales para disminuir los efectos negativos del trabajo emocional. Dentro de las estrategias individuales se observaron: establecer límites con los clientes, regular expectativas sobre las asesorías, desarrollar un endurecimiento emocional, practicar el autocuidado a través de la autoexploración emocional y, en algunos casos, buscar ayuda profesional de psicólogos/as. Como estrategia grupal, se observó el apoyo y la contención de los miembros de los equipos, los cuales, a su vez, facilitaban la derivación de clientes con situaciones complejas a asesores/as con más experiencia. Estos resultados muestran el carácter invisibilizado del trabajo emocional en la asesoría de negocios a emprendimientos y microempresas, como también la importancia de reconocerlo y gestionarlo como parte de los riesgos laborales para prevenir sus efectos en trabajadores y en las organizaciones.

Abstract Emotional labor is a multidimensional concept that includes the interactions between emotional requirements of the jobs, how emotions are expressed and the regulation strategies that it entails. In the last decades it has increased its importance due to its rising prevalence and its severe consequences for employee's health and organizational performance. Within this context, the present study seeks to address the different components of emotional labor and its effects on business consulting advisors for Chilean entrepreneurs and microenterprises, working in public-funded small business development centers. In doing so, four focus groups were carried out in four small business development centers located in Santiago of Chile. Analyses revealed that mentoring entrepreneurs and micro-enterprises is more complex than it appears, showing that advisors must provide support and comfort to their clients to succeed in their job goals. These demands go beyond their work role and exceed their competencies, which negatively impacts job performance and mental health of business advisors. In order to cope with the job demands, business advisors display several individual and collective strategies. As part of the individual strategies, the following was found: establishing boundaries with clients, regulating clients' expectations of the mentoring sessions, developing "emotional hardening", practicing self-care throughout emotional self-exploration, and in some cases, looking for psychological counseling. Interestingly, the term "emotional hardening" matches the definition of the superficial strategy formulated by Alicia Grandey, in which employees simulate or perform the emotion required by a job without changing their inner selves. Vast evidence has demonstrated that the use of this strategy is associated with serious health consequences for employees, therefore, this finding may be considered as a warning sign for the small business development centers. As a collective strategy, business advisors rely on their work teams. Specifically, advisors look for support and comfort from their co-workers and when confronted with complex clients the team referrers them to more experienced advisors. In addition, analyses showed other aspects that hinder the work of business advisors, such as the high amount and diversity of job tasks that are asked from business advisors, combined with several deadlines coming from government institutions and the centers. Furthermore, woman business advisors expressed they face more obstacles at work compared to their male co-workers, most of these obstacles are related to a gender-based discrimination coming from some clients, who doubt their expertise and competences as female advisors, and prefer to deal with male advisors. Overall, results aligned with the literature on emotional labor, showing that emotional labor is characterized by being a secondary and veiled issue in mentoring entrepreneurs and micro-enterprises. Furthermore, using the strategies revealed that emotional labor involves visible processes but also intrapsychic processes that led to a decrease in employees' resources and energy. Considering the effects of emotion labor in the context of business advisory, our results may help to strengthen the main Chilean strategy, and a well-known international program, to promote the development of entrepreneurs and microenterprises. This is even more relevant in the context of the social and employment crisis that Chile and most of the countries undergo, where entrepreneurship (formal and informal) has emerged as the main alternative to cope with unemployment. In conclusion, despite the long tradition of research on emotional labor and its serious consequences, it remains an invisible and secondary process within organizations. This research highlights the importance of identifying and managing emotions as a nuclear part of the job of business consulting advisors for Chilean entrepreneurs and microenterprises.

Furoxans and tocopherol analogs-furoxan hybrids as anticancer agents

We determined the antiproliferative and nitric oxide (NO)-releasing activity of furoxans and tocopherol analogs-furoxan hybrids by tandem Griess/resazurin/sulforhodamin B assays in HeLa, 253J, T24, and HepG2 cancer cells. In addition, to investigate the NO implications in the inhibition of cell growth, cells were pretreated with the NO scavenger hemoglobin and the genotoxic damage was determined. The compounds 1 and 3 emerged as good anticancer agents for bladder cancer treatment. The NO-releasing activity of these compounds appears to be necessary to obtain the antiproliferative effect. Although compound 1 exerted a DNA damage mechanism of action, compound 3 seemed to act in a different way. The low toxicity levels against normal cell line HaCaT point them out as a very promising scaffold for the further design of new anticancer agents(AU)

Las confabulaciones: más allá de un déficit mnésico / The confabulations: more than a memory déficit

Las confabulaciones o “mentiras honestas” como las define Marcovich, constituyen un fenómeno complejo cuyo estudio y conceptualización ha ido evolucionando en el último siglo. Inicialmente se consideró a las confabulaciones como un fenómeno eminentemente amnésico con alteraciones principales en la recuperación de la información. Sin embargo la investigación de distintos cuadros clínico-patológicos, ha demostrado que en las confabulaciones interviene una amplia red de procesos cognoscitivos, involucrándose procesos tales como el funcionamiento ejecutivo, emociones, motivación y temporalidad; adicionándose a los subsistemas de memoria ampliamente descritos en la literatura. El presente trabajo constituye una revisión sobre los principales tipos y modelos explicativos de las confabulaciones así como de los avances en la neuropatología de las mismas. Asimismo, se realiza una breve descripción de las confabulaciones en algunos de los principales cuadros nosológicos como son el Síndrome de Korsakoff, la Enfermedad de Alzheimer y la esquizofrenia; resaltando las características compartidas y distintivas entre los distintos cuadros. En forma anexa se describe la relevancia de las emociones en la naturaleza y contenido de las confabulaciones como una posible forma adicional para su caracterización, conceptualización y comprensión. Por último se hace énfasis en la participación del neuropsicólogo durante el proceso de valoración y análisis clínico como parte fundamental en la exploración de rutina e investigación clínica.

The confabulations or "honest lies" as defined by Marcovich, are complex phenomena whose study and conceptualization has been changed in the last century. Initially it was thought confabulation as an eminently amnestic phenomenon with major alterations on the information retrieval; nevertheless, from the research in different clinical and pathological studies, today it is known that the confabulation involved an extensive network of cognitive processes such as executive functioning, emotions, motivation and temporality in addition to the memory subsystems widely described in the literature. The present work constitutes a review of the principal types and confabulation’s explanatory models, including also advances in the neuropathology of them. Likewise, there is a brief description of the confabulations in some of the main nosological tables such as Korsakoff's syndrome, Alzheimer’s disease and schizophrenia, highlighting the shared and distinctive features between them. It also describes the relevancy of emotions in the nature and content of the confabulations as a possible additional form for its characterization, conceptualization and understanding. Finally, it emphasizes the participation of neuropsychologist during clinical assessment as a fundamental part in the routine examination and clinical research.