Blood transfusion reactions and risk of acute kidney injury and major adverse kidney events.

BACKGROUND: Blood transfusion reactions may have a negative impact on organ function. It is unknown whether this association holds true for acute kidney injury (AKI). Therefore, we conducted a cohort study to assess the association between transfusion reactions and the incidence of AKI and major adverse kidney events. METHODS: In this retrospective cohort study, we included patients who received transfusion of blood products during hospitalization at the Hospital Civil of Guadalajara. We analyzed them according to the development of transfusion reactions, and the aim was to assess the association between transfusion reactions and AKI during long-term follow-up. RESULTS: From 2017 to 2021, 81,635 patients received a blood product transfusion, and 516 were included in our study. The most common transfusion was red blood cell packaging (50.4%), fresh frozen plasma (28.7%) and platelets (20.9%); of the 516 patients, 129 (25%) had transfusion reactions. Patients who had transfusion reactions were older and had more comorbidities. The most common type of transfusion reaction was allergic reaction (70.5%), followed by febrile nonhemolytic reaction (11.6%) and anaphylactoid reaction (8.5%). Most cases were considered mild. Acute kidney injury was more prevalent among those who had transfusion reactions (14.7%) than among those who did not (7.8%), p = < 0.01; those with AKI had a higher frequency of diabetes, vasopressors, and insulin use. Transfusion reactions were independently associated with the development of AKI (RR 2.1, p = < 0.02). Major adverse kidney events were more common in those with transfusion reactions. The mortality rate was similar between subgroups. CONCLUSION: In our retrospective cohort of patients who received blood product transfusions, 25% experienced transfusion reactions, and this event was associated with a twofold increase in the probability of developing AKI and some of the major adverse kidney events during long follow-up.

Educación ambiental en tiempos de crisis socio-ambiental: posibilidades de su inclusión en la formación de terapia ocupacional, desde la perspectiva de las/os docentes / Educação ambiental em tempos de crise socioambiental: possibilidades de sua inclusão na formação em terapia ocupacional, desde a perspectiva de docentes / Environmental education in times of social-environmental crisis: possibilities of its inclusion in occupational therapy training, from the academics' perspective

Resumen Introducción La crisis socio-ambiental es un tema relevante y existe una urgencia en su reflexión y búsqueda de soluciones en todas las áreas del conocimiento. Este estudio, usando como base la educación ambiental, se hace parte de dicha necesidad desde la formación profesional en terapia ocupacional. Objetivo Analizar las posibles relaciones entre la educación ambiental y la formación disciplinar, a partir de la perspectiva de los y las terapeutas ocupacionales que se dedican a la docencia universitaria en la provincia de Concepción, Chile. Método Metodología cualitativa con la realización de 7 entrevistas individuales a terapeutas ocupacionales que se desempeñan como docentes universitarios. La información se somete a un análisis de contenido temático y triangulación teórica. Resultados Existen fundamentos teóricos y éticos en la disciplina vinculados a la naturaleza, que pueden ser incluidos en la formación profesional. Se plantea que esta temática debe ser abordada de manera transversal en la formación. Las metodologías de enseñanza más acordes para su implementación serían de carácter teórico práctico como el aprendizaje basado en proyectos o el aprendizaje de servicio. Las acciones basadas en la naturaleza pueden ser enseñadas como una estrategia de intervención al servicio del cuidado de la naturaleza, y al mismo tiempo para el cuidado de las personas y comunidades. Conclusiones Se invita a incluir la educación ambiental en la formación de terapeutas ocupacionales, dado que es una herramienta potente para avanzar en la protección y conservación el medio ambiente.

Resumo Introdução A crise socioambiental é um tema relevante e há urgência em sua reflexão e busca de soluções em todas as áreas do conhecimento. Este estudo, tendo como base a educação ambiental, torna-se parte dessa necessidade de formação profissional em terapia ocupacional. Objetivo Analisar as possíveis relações entre educação ambiental e formação disciplinar, desde a perspectiva de terapeutas ocupacionais que se dedicam ao ensino universitário na província de Concepción, Chile. Método Metodologia qualitativa, com a realização de sete entrevistas individuais com terapeutas ocupacionais que atuam como professores universitários. A informação é submetida a uma análise de conteúdo temática e triangulação teórica. Resultados Existem fundamentos teóricos e éticos nas disciplinas ligadas à natureza, que podem ser incluídos na formação profissional. Propõe-se que esta temática seja abordada de forma transversal na formação. As metodologias de ensino mais adequadas para a sua implementação seriam de natureza teórico-prática, como a aprendizagem baseada em projetos ou a aprendizagem em serviço. As ações baseadas na natureza podem ser ensinadas como uma estratégia de intervenção ao serviço do cuidado da natureza e, ao mesmo tempo, do cuidado das pessoas e das comunidades. Conclusão Convida-se a incluir a educação ambiental na formação de terapeutas ocupacionais, pois é uma ferramenta poderosa para avançar na proteção e conservação do meio ambiente.

Abstract Introduction The socio-environmental crisis is a relevant issue and there is an urgency in its reflection and search for solutions in all areas of knowledge. This study, using environmental education as a base, becomes part of this need from professional training in occupational therapy. Objective To analyze the possible relationships between environmental education and disciplinary training, from the perspective of occupational therapists who are dedicated to university teaching in the province of Concepción, Chile. Method Qualitative methodology through 7 individual interviews with occupational therapists who work as university academics. The information is subjected to a thematic content analysis and theoretical triangulation. Results There are theoretical and ethical foundations in the discipline linked to nature, which can be included in professional training. It is proposed that this issue should be addressed transversally in training. The most appropriate teaching methodologies for its implementation would be of a theoretical-practical nature, such as project-based learning or service learning. Nature-based actions can be taught as an intervention strategy at the service of caring for nature, and at the same time for caring for people and communities. Conclusions It is invited to include environmental education in the training of occupational therapists, since it is a powerful tool to advance in the protection and conservation of the environment.

Factores de Riesgo de Hospitalización en Camas Básicas y Críticas asociados a Síndrome Inflamatorio Multisistémico Pediátrico (SIM) relacionado a COVID-19 de Niños, Niñas y Adolescentes: Revisión Sistemática Exploratoria / Risk Factors of Hospitalization in Basic and Critical Cases associated with Pediatric Multisystemic Inflammatory Syndrome (SIM) related to COVID-19 in Boys, Girls and Adolescents: Exploratory Systematic Review

Introducción. Introducción. La pandemia por SARS-CoV-2 en pediatría ha tenido un bajo impacto en niños y niñas adolescentes (NNA) debido a que un gran porcentaje son asintomáticos o desarrollan síntomas leves. No obstante, se han reportado casos de síndrome inflamatorio multisistémico pediátrico (SIM) por este virus, el cual afecta a múltiples órganos y sus manifestaciones se asemejan a la enfermedad de Kawasaki. La mayoría ha requerido hospitalización en unidades críticas (UCI). A pesar de la vigilancia epidemiológica de esta enfermedad, no se han reportado factores de riesgo (FR) para hospitalización. Objetivo. Explorar en la literatura los FR asociados a hospitalización en camas básicas y críticas de NNA con SIM relacionado a COVID-19. Métodos. Revisión sistemática exploratoria de bases de datos Pubmed, Epistemonikos, Lilacs y Scielo desde el año 2020, con un rango etario de 0 a 19 años, con estrategia de búsqueda sensible para FR de hospitalización en camas básicas y críticas por SIM. Resultados. De 84 artículos se seleccionaron 7. Las manifestaciones clínicas incluyeron fiebre persistente, síntomas gastrointestinales y parámetros inflamatorios severos. También se reporta asociación a comorbilidades y estrato socioeconómico bajo. El ingreso mediano a UCI fue de un 60%, y la mortalidad por SIM fue menor a un 2%, pero de mayor magnitud comparado con los ingresos por COVID-19 en este grupo etario. Los FR de ingreso a UCI fueron asociados a dolor abdominal [OR 1,7 (IC95% 1,2; 2,7)] y a mayor edad, con OR ajustado de 1,9 [IC95%1,4; 6] para edad de 6 a 12 años, OR ajustado de 2,6 [IC95% 1,8; 3,8] para edad de 13 a 20 años. La elevación de proteína C reactiva, troponina, ferritina, dímero D, péptido natriurético cerebral (BNP), BNP N-terminal pro tipo B o interleucina-6, y/o recuentos reducidos de plaquetas, linfocitos o albúmina se asociaron a ingreso a UCI. La etnia afroamericana se asoció a mayor ingreso a UCI con OR de 1,6 [IC95% 1,0; 2,4]. Conclusión. Los FR para hospitalización de NNA con SIM, reportados y seleccionados en la literatura, son edad sobre los 6 años, etnia afroamericana, presencia de comorbilidades y nivel socioeconómico bajo. Para el ingreso a UCI, se suma a esto, compromiso clínico respiratorio y/o gastrointestinal, y presencia de parámetros inflamatorios elevados. La mortalidad fue inferior al 2%, pero significativamente mayor que la mortalidad por infección COVID-19 exclusiva.

Background. SARS-CoV-2 pandemic in pediatrics population (children and adolescents) has low impact in due to large percent of asymptomatic or mild symptoms. However, since March 2020, cases of pediatric multisystemic inflammatory syndrome (PMIS) have been reported, which affects multiple organs and its main manifestations resemble Kawasaki disease. This group frequently required hospitalization in critical care units (ICU), and despite epidemiological surveillance of this disease, no risk factors (RF) for hospitalization of these children has been reported. Objetive. To explore RF in literature associated with pediatric hospitalization in basic and critical care beds from children and adolescents with PMIS related to COVID-19. Methodology. exploratory systematic review of Pubmed, Epistemonikos, Lilacs and Scielo databases, with limits: publication date from 2020 until now, and age range from 0 to 19 years. We made a sensitive search strategy for RF of pediatric hospitalization in basic and critical beds by PMIS. Results. clinical manifestations of hospitalized patients included persistent fever (3 to 5 days), gastrointestinal symptoms (vomiting, nausea, diarrhea and abdominal pain), and inflammatory laboratory parameters in highly ranges. It is also reported an association with presence of comorbidities and low socioeconomic status. The median admission to ICU was 60%, and mortality less than 2%, but greater magnitude compared to COVID-19 mortality. RF for ICU admission were associated with older age, with adjusted OR of 1.9 [CI95% 1.4; 6] for age 6 to 12 years, adjusted OR of 2.6 [CI95% 1.8; 3.8] for age 13 to 20 years, and abdominal pain [OR 1.7 (CI95% 1.2; 2.7)]. Among laboratory tests, elevated C-reactive protein, troponin, ferritin, D-dimer, brain natriuretic peptide (BNP), N-terminal pro-B-type BNP or interleukin-6, and/or reduced platelet, lymphocyte or albumin counts were associated with ICU admission. African-American ethnicity was also associated with higher ICU admission with OR of 1.6 [CI95% 1.0; 2.4]. Conclusion. RFs for hospitalization of children with PMIS reported and selected in the literature were: age over 6 years, Afro-American ethnicity, presence of comorbidities and low socioeconomic level. In addition to this, for ICU admission, it is reported respiratory and/or gastrointestinal clinical involvement, and elevated inflammatory parameters presence. Mortality was less than 2%, but significantly higher than mortality due to exclusive COVID-19 infection.

Obesity risk in 10-year-old children, based on attributes observed at 4 years of age, provides evidence on how to target interventions to lower obesity rates in mid-childhood / El riesgo de obesidad en escolares de 10 años, considerando atributos observados a los 4 años, proporciona evidencia para focalizar intervenciones y así reducir la obesidad infantil

Introduction: although in Chile 75 % of obese preschool children participate in a primary health intervention, obesity rates have increased. Objective: to determine the risk of children being obese in 5th grade (10 yrs), according to biological and social attributes observed when they attended prekindergarten (PK) at 4 yrs, to determine which preschoolers should be prioritized for targeting Method: a retrospective cohort study including 55,623 participants. The variables collected when children attended PK were age, sex, weight, height, maternal educational level and employment status, the child´s relationship with persons living at home, person in charge of the child after school, and number of household members, plus weight, height, and age in 5th grade. To determine the risk of being obese in 5th grade we did two logistic regression models—the first one included all PK children and the above variables, while the second model considered additionally the presence of obesity in PK. The rest of the variables were the same. Results: the risk of children being obese in 5th grade (10 yrs) was 1.43 times higher if their mothers had ≤ 8 yrs of schooling, 1.13 times higher if they lived with a grandparent, and slightly higher if their mothers had an occupation (1.04 times). Boys had a significantly higher risk (1.74 times). Obesity at 4 yrs constituted the highest obesity risk later on (5.3 times). Conclusions: targeting obese 4-year-old boys who participate in a primary health intervention, whose mothers have low education and who live with a grandparent, may lower obesity rates in mid-childhood (AU)

Introducción: aunque, en Chile, el 75 % de los preescolares obesos participan en un programa de salud primaria, la obesidad infantil ha aumentado. Objetivo: determinar el riesgo de obesidad en escolares de 5º básico (10 años), según las características biológicas y sociales observadas en prekínder (PK) a los 4 años, para determinar qué preescolares debieran ser priorizados para intervenir. Método: cohorte retrospectiva de 55.623 participantes. Las variables recolectadas en PK fueron: edad, sexo, peso, estatura, nivel educacional y situación laboral de la madre, relación del preescolar con miembros del hogar, persona que cuida al escolar y número de miembros del hogar, además de peso, estatura y edad en 5º básico. El riesgo de obesidad en 5º básico se determinó a través de 2 modelos de regresión logística: el primero incluyó a todos los preescolares en PK y las variables mencionadas anteriormente, y el segundo consideró adicionalmente la presencia de obesidad en PK. El resto de las variables fueron las mismas. Resultados: el riesgo de que los escolares presenten obesidad en 5º básico (10 años) fue 1,43 veces mayor si sus madres tenían ≤ 8 años de escolaridad, 1,13 veces mayor si vivían con un abuelo y ligeramente mayor si sus madres estaban ocupadas (1,04 veces). Los hombres tenían un riesgo significativamente mayor (1,74 veces). La obesidad a los 4 años constituyó el mayor riesgo de obesidad posteriormente (5,3 veces). Conclusión: centrar la atención en los niños obesos de 4 años que participen en una intervención de atención primaria, cuyas madres tengan menor educación y que vivan con un abuelo podría reducir la prevalencia de la obesidad (AU)

Obesity risk in 10-year-old children, based on attributes observed at 4 years of age, provides evidence on how to target interventions to lower obesity rates in mid-childhood.

Introduction: Introduction: although in Chile 75 % of obese preschool children participate in a primary health intervention, obesity rates have increased. Objective: to determine the risk of children being obese in 5th grade (10 yrs), according to biological and social attributes observed when they attended prekindergarten (PK) at 4 yrs, to determine which preschoolers should be prioritized for targeting. Method: a retrospective cohort study including 55,623 participants. The variables collected when children attended PK were age, sex, weight, height, maternal educational level and employment status, the child´s relationship with persons living at home, person in charge of the child after school, and number of household members, plus weight, height, and age in 5th grade. To determine the risk of being obese in 5th grade we did two logistic regression models-the first one included all PK children and the above variables, while the second model considered additionally the presence of obesity in PK. The rest of the variables were the same. Results: the risk of children being obese in 5th grade (10 yrs) was 1.43 times higher if their mothers had ≤ 8 yrs of schooling, 1.13 times higher if they lived with a grandparent, and slightly higher if their mothers had an occupation (1.04 times). Boys had a significantly higher risk (1.74 times). Obesity at 4 yrs constituted the highest obesity risk later on (5.3 times). Conclusions: targeting obese 4-year-old boys who participate in a primary health intervention, whose mothers have low education and who live with a grandparent, may lower obesity rates in mid-childhood.

Introducción: Introducción: aunque, en Chile, el 75 % de los preescolares obesos participan en un programa de salud primaria, la obesidad infantil ha aumentado. Objetivo: determinar el riesgo de obesidad en escolares de 5º básico (10 años), según las características biológicas y sociales observadas en prekínder (PK) a los 4 años, para determinar qué preescolares debieran ser priorizados para intervenir. Método: cohorte retrospectiva de 55.623 participantes. Las variables recolectadas en PK fueron: edad, sexo, peso, estatura, nivel educacional y situación laboral de la madre, relación del preescolar con miembros del hogar, persona que cuida al escolar y número de miembros del hogar, además de peso, estatura y edad en 5º básico. El riesgo de obesidad en 5º básico se determinó a través de 2 modelos de regresión logística: el primero incluyó a todos los preescolares en PK y las variables mencionadas anteriormente, y el segundo consideró adicionalmente la presencia de obesidad en PK. El resto de las variables fueron las mismas. Resultados: el riesgo de que los escolares presenten obesidad en 5º básico (10 años) fue 1,43 veces mayor si sus madres tenían ≤ 8 años de escolaridad, 1,13 veces mayor si vivían con un abuelo y ligeramente mayor si sus madres estaban ocupadas (1,04 veces). Los hombres tenían un riesgo significativamente mayor (1,74 veces). La obesidad a los 4 años constituyó el mayor riesgo de obesidad posteriormente (5,3 veces). Conclusión: centrar la atención en los niños obesos de 4 años que participen en una intervención de atención primaria, cuyas madres tengan menor educación y que vivan con un abuelo podría reducir la prevalencia de la obesidad.

Primary Ovarian Failure in Addition to Classical Clinical Features of Coats Plus Syndrome in a Female Carrying 2 Truncating Variants of CTC1.

Coats plus syndrome is an autosomal recessive multisystemic and pleiotropic disorder affecting the eyes, brain, bone, and gastrointestinal tract, usually caused by compound heterozygous variants of the conserved telomere maintenance component 1 gene (CTC1), involved in telomere homeostasis and replication. So far, most reported patients are compound heterozygous for a truncating mutation and a missense variant. The phenotype is believed to result from telomere dysfunction, with accumulation of DNA damage, cellular senescence, and stem cell depletion. Here, we report a 23-year-old female with prenatal and postnatal growth retardation, microcephaly, osteopenia, recurrent fractures, intracranial calcification, leukodystrophy, parenchymal brain cysts, bicuspid aortic valve, and primary ovarian failure. She carries a previously reported maternally inherited pathogenic variant in exon 5 (c.724_727del, p.(Lys242Leufs*41)) and a novel, paternally inherited splice site variant (c.1617+5G>T; p.(Lys480Asnfs*17)) in intron 9. CTC1 transcript analysis showed that the latter resulted in skipping of exon 9. A trace of transcripts was normally spliced resulting in the presence of a low level of wild-type CTC1 transcripts. We speculate that ovarian failure is caused by telomere shortening or chromosome cohesion failure in oocytes and granulosa cells, with early decrease in follicular reserve. This is the first patient carrying 2 truncating CTC1 variants and the first presenting primary ovarian failure.

The degree of engagement of overweight/obese adult women in the recommended activities of the Chilean "Vida Sana" program is directly correlated with its effectiveness / El grado de participación de las mujeres adultas con sobrepeso/obesidad en las actividades recomendadas por el programa chileno "Vida Sana" se correlaciona directamente con su efectividad

Introduction: the Chilean Ministry of Health implements the Vida Sana (VS) program with the objective of reducing risk factors for chronic diseases in overweight/obese (OW/OB) individuals, aged 2-64. Objective: to determine the effectiveness of VS in OW/OB women (20-44 yrs) in terms of their engagement in the recommended activities. These consist of participating in a minimum number each of three core activities (psychologist consultations, lifestyle workshops, and physical activity sessions) during 6 months, to obtain a 5 % weight loss and improved physical fitness (PF). Methods: a retrospective study involving secondary analyses of the 2017 VS database (n = 5,179 OW/OB women). We determined effectiveness by: a) comparing changes in weight and PF in participants who achieved one or both outcomes, using t-tests and tests of proportions, and b) assessing the probability of achieving the program's goal, according to participation in 1, 2, or 3 core activities, individually and jointly, using the OR (95 % CI) and trend analysis. Results: around 32 %, 88 %, and 29 % of women achieved 5 % weight loss, improved PF, and both, respectively. The high percentage of women who improved PF was due to a permissive criterion. Although 20 % of women attained the program's goal with 0 engagement, among participants, the ORs (95 % CI) for achieving the program's goal when engaging in 1, 2, or 3 core activities were 1.55 (CI 1.2-2.03), 2.34 (1.76-3.11), and 3.5 (2.21-5.53), respectively. Conclusion: effectiveness parallels degree of engagement in the recommended activities of VS. A characterization of a program's participation rate is crucial for improving its effectiveness. (AU)

Introducción: el objetivo del programa chileno Vida Sana (VS) es reducir los factores de riesgo de enfermedades crónicas en personas de 2-64 años con sobrepeso/obesidad (SP/OB). Objetivo: determinar la efectividad del programa VS en mujeres SP/OB (20-44 años) a través de su participación en cada una de las actividades recomendadas (consultas con psicólogo, talleres y actividad física) durante 6 meses, para lograr perder un 5 % de peso y mejorar la condición física (CF). Métodos: estudio retrospectivo con análisis secundario de la base de datos VS de 2017 (n = 5179 mujeres SP/OB). Se determinó la efectividad: a) comparando los cambios en el peso y la CF de las participantes que lograron uno o ambos resultados, usando el test de la "t" y el de proporciones; b) evaluando la probabilidad de lograr el objetivo de acuerdo con la participación en 1, 2 o 3 actividades, de manera individual y conjunta, calculando los OR (IC 95 %) y el análisis de tendencias. Resultados: el 32 %, 88 % y 29 % de las mujeres perdieron un 5 % de peso, mejoraron la CF o consiguieron ambas cosas, respectivamente. El alto porcentaje que mejoró la CF se debió a un criterio permisivo. Aunque el 20 % de las mujeres lograron el objetivo del programa con una participación "0", los OR (IC del 95 %) de lograr el objetivo al participar en 1, 2 o 3 de las actividades fueron de 1,55 (IC: 1,2-2,03), 2,34 (IC: 1,76-3,11) y 3,5 (IC: 2,21-5,53), respectivamente. Conclusión: la efectividad del programa VS se asocia directamente con el grado de participación en las actividades. Caracterizar la participación de un programa es clave para mejorar su efectividad. (AU)

The degree of engagement of overweight/obese adult women in the recommended activities of the Chilean "Vida Sana" program is directly correlated with its effectiveness.

INTRODUCTION: Introduction: the Chilean Ministry of Health implements the Vida Sana (VS) program with the objective of reducing risk factors for chronic diseases in overweight/obese (OW/OB) individuals, aged 2-64. Objective: to determine the effectiveness of VS in OW/OB women (20-44 yrs) in terms of their engagement in the recommended activities. These consist of participating in a minimum number each of three core activities (psychologist consultations, lifestyle workshops, and physical activity sessions) during 6 months, to obtain a 5 % weight loss and improved physical fitness (PF). Methods: a retrospective study involving secondary analyses of the 2017 VS database (n = 5,179 OW/OB women). We determined effectiveness by: a) comparing changes in weight and PF in participants who achieved one or both outcomes, using t-tests and tests of proportions, and b) assessing the probability of achieving the program´s goal, according to participation in 1, 2, or 3 core activities, individually and jointly, using the OR (95 % CI) and trend analysis. Results: around 32 %, 88 %, and 29 % of women achieved 5 % weight loss, improved PF, and both, respectively. The high percentage of women who improved PF was due to a permissive criterion. Although 20 % of women attained the program´s goal with 0 engagement, among participants, the ORs (95 % CI) for achieving the program´s goal when engaging in 1, 2, or 3 core activities were 1.55 (CI 1.2-2.03), 2.34 (1.76-3.11), and 3.5 (2.21-5.53), respectively. Conclusion: effectiveness parallels degree of engagement in the recommended activities of VS. A characterization of a program´s participation rate is crucial for improving its effectiveness.

INTRODUCCIÓN: Introducción: el objetivo del programa chileno Vida Sana (VS) es reducir los factores de riesgo de enfermedades crónicas en personas de 2-64 años con sobrepeso/obesidad (SP/OB). Objetivo: determinar la efectividad del programa VS en mujeres SP/OB (20-44 años) a través de su participación en cada una de las actividades recomendadas (consultas con psicólogo, talleres y actividad física) durante 6 meses, para lograr perder un 5 % de peso y mejorar la condición física (CF). Métodos: estudio retrospectivo con análisis secundario de la base de datos VS de 2017 (n = 5179 mujeres SP/OB). Se determinó la efectividad: a) comparando los cambios en el peso y la CF de las participantes que lograron uno o ambos resultados, usando el test de la "t" y el de proporciones; b) evaluando la probabilidad de lograr el objetivo de acuerdo con la participación en 1, 2 o 3 actividades, de manera individual y conjunta, calculando los OR (IC 95 %) y el análisis de tendencias. Resultados: el 32 %, 88 % y 29 % de las mujeres perdieron un 5 % de peso, mejoraron la CF o consiguieron ambas cosas, respectivamente. El alto porcentaje que mejoró la CF se debió a un criterio permisivo. Aunque el 20 % de las mujeres lograron el objetivo del programa con una participación "0", los OR (IC del 95 %) de lograr el objetivo al participar en 1, 2 o 3 de las actividades fueron de 1,55 (IC: 1,2-2,03), 2,34 (IC: 1,76-3,11) y 3,5 (IC: 2,21-5,53), respectivamente. Conclusión: la efectividad del programa VS se asocia directamente con el grado de participación en las actividades. Caracterizar la participación de un programa es clave para mejorar su efectividad.

Evaluación del programa chileno Vida Sana 2017 en participantes menores de 20 años después de 6 meses de intervención / Evaluation of the Chilean program "Vida Sana 2017" in participants under 20 years of age after 6 months of intervention

INTRODUCCIÓN: el programa chileno Vida Sana (PVS) busca disminuir los factores de riesgo de enfermedades crónicas en sujetos con sobrepeso/obesidad entre 2 y 64 años de edad. OBJETIVO: evaluar los resultados del PVS 2017 en menores de 20 años luego de 6 meses de intervención. MÉTODOS: estudio observacional analizando datos secundarios. El PVS incluyó consultas médicas, nutricionales y sicológicas (CS), exámenes de laboratorio, sesiones de actividad física (SAF) y círculos vida sana (CVS). Los sujetos se categorizaron por edad en: 2-5, 6-10 y 11-19 años. Se analizó la participación en actividades; la mejora del estado nutricional (EN) [z-IMC] y la condición física (CF) [test de marcha 6 minutos, test de salto con pies juntos y test de sentadillas en 30 segundos] según EN inicial, utilizando la "t" de Student para muestras pareadas, y la contribución de las actividades al EN y la CF (regresión logística, test de Hosmer-Lemeshow). Se utilizó el programa STATA 14.2, considerando como significativo el valor p < 0,05, con IC del 95 %. RESULTADOS: se estudiaron 13.611 sujetos (53 % de niñas). A los 6 meses, cerca de un 50 % de los participantes logró mejorar el EN y la CF. De 2 a 5 años, la asistencia a ≥ 48 SAF, 2 CS y ≥ 3 CVS aumentó significativamente la probabilidad de mejorar el EN y la CF. De 6 a 10 solo contribuyeron los CVS, y de 11 a 19 años las SAF en los sujetos inicialmente obesos. CONCLUSIONES: las actividades del PVS-2017 contribuyeron a la mejoría del EN y la CF solo en el grupo de 2-5 años, ya que en los de 6-10 y 11-19 años su aporte fue bajo. Solo la mitad de los sujetos que ingresan al programa logra mejorar el EN y la CF en los 6 meses de intervención

INTRODUCTION: the Chilean "Programa Vida Sana" (Healthy Life Program) (PVS) seeks to reduce risk factors for chronic diseases in overweight/obese subjects between 2 and 64 years of age. OBJECTIVE: to evaluate in 2-20-year-old participants the results of the PVS applied in 2017 in relation to nutritional status and fitness after a 6-month intervention. METHODS: an observational study analyzing secondary data. During 6 months the PVS included: medical, nutritional and psychological consultations (PC), laboratory exams, physical activity sessions (PAS), and healthy life workshops (HLW). Subjects were categorized into: 2-5, 6-10, and 11-19 years. We analyzed participation in activities; improvement of nutritional status [BMI-Z] and fitness [standing long-jump test (SLJ), 6-minute walk test (6MWT), 30-second chair stand (30-SCS)] according to initial NS using Student's t-test for paired samples, and the contribution of the program's activities to NS and fitness (logistic regression, Hosmer-Lemeshow test). The STATA 14.2 program was used, with p < 0.05, 95 % CI, being considered significant. RESULTS: the sample included 13,611 (53 % girls). At 6 months about 50 % of participants improved their EN and CF. From 2 to 5 years, participation in ≥ 48 PAS, 2 PC and ≥ 3 HLW significantly increased the likelihood of improvement in NS and fitness. From 6 to 10 only HLW played a role, and from 11 to 19 only PAS in initially obese subjects. CONCLUSIONS: the activities of PVS-2017 contributed significantly to improved NS and fitness in subjects of 2-5 years of age; however, in 6-10- and 11-19-year-old participants its contribution was low. Only half of participants improved their NS and fitness during the 6 months of intervention

Free Fatty Acid Receptor 1 Signaling Contributes to Migration, MMP-9 Activity, and Expression of IL-8 Induced by Linoleic Acid in HaCaT Cells.

Keratinocytes and neutrophils are the main cellular components in wound healing during re-epithelization and inflammation. Free fatty acids such as linoleic acid (LA) present beneficial properties for wound healing by modulating the inflammatory response. LA is a natural ligand of free fatty acids receptor 1 (FFA1), a G protein-coupled receptor (GPCR), able to modulate inflammatory process; however, the role of FFA1 in keratinocytes and wound healing remains poorly understood. In this study, we investigated the role of FFA1 signaling in migration, matrix metalloproteinase-9 (MMP-9) activity, and IL-8 expression induced by LA in keratinocytes. We confirmed that HaCaT cells, a human keratinocyte cell line, expresses the FFA1 receptor and GW1100, a selective antagonist of FFA1, decreased LA-induced migration of HaCaT cells. Also, GW9508, a synthetic agonist of FFA1, increased migration of these cells. Furthermore, ERK1/2 and p38 MAPK inhibitors abolished the LA-induced increase in cell migration. Besides, HaCaT cells stimulated with LA or GW9508 increased the activity of MMP-9 and the expression of IL-8. GW1100 partially inhibited both responses. We further evaluated the effects of HaCaT cells conditioned media stimulated with LA or GW9508 on neutrophil chemotaxis. Conditioned media induced neutrophil chemotaxis. Furthermore, IL-8 secreted by HaCaT cells stimulated with LA or GW9508, contributed to neutrophil chemotaxis. In conclusion, LA increased migration, MMP-9 activity, and expression of IL-8 from HaCaT cells via FFA1. Hence, these results showed that the effects induced by LA in keratinocytes can be mediated through FFA1, thus explaining a possible mechanism by which this fatty acid could accelerate wound healing.

[Evaluation of the Chilean program "Vida Sana 2017" in participants under 20 years of age after 6 months of intervention]. / Evaluación del programa chileno Vida Sana 2017 en participantes menores de 20 años después de 6 meses de intervención.

INTRODUCTION: Introduction: the Chilean "Programa Vida Sana" (Healthy Life Program) (PVS) seeks to reduce risk factors for chronic diseases in overweight/obese subjects between 2 and 64 years of age. Objective: to evaluate in 2-20-year-old participants the results of the PVS applied in 2017 in relation to nutritional status and fitness after a 6-month intervention. Methods: an observational study analyzing secondary data. During 6 months the PVS included: medical, nutritional and psychological consultations (PC), laboratory exams, physical activity sessions (PAS), and healthy life workshops (HLW). Subjects were categorized into: 2-5, 6-10, and 11-19 years. We analyzed participation in activities; improvement of nutritional status [BMI-Z] and fitness [standing long-jump test (SLJ), 6-minute walk test (6MWT), 30-second chair stand (30-SCS)] according to initial NS using Student's t-test for paired samples, and the contribution of the program´s activities to NS and fitness (logistic regression, Hosmer-Lemeshow test). The STATA 14.2 program was used, with p < 0.05, 95 % CI, being considered significant. Results: the sample included 13,611 (53 % girls). At 6 months about 50 % of participants improved their EN and CF. From 2 to 5 years, participation in ≥ 48 PAS, 2 PC and ≥ 3 HLW significantly increased the likelihood of improvement in NS and fitness. From 6 to 10 only HLW played a role, and from 11 to 19 only PAS in initially obese subjects. Conclusions: the activities of PVS-2017 contributed significantly to improved NS and fitness in subjects of 2-5 years of age; however, in 6-10- and 11-19-year-old participants its contribution was low. Only half of participants improved their NS and fitness during the 6 months of intervention.

INTRODUCCIÓN: Introducción: el programa chileno Vida Sana (PVS) busca disminuir los factores de riesgo de enfermedades crónicas en sujetos con sobrepeso/obesidad entre 2 y 64 años de edad. Objetivo: evaluar los resultados del PVS 2017 en menores de 20 años luego de 6 meses de intervención. Métodos: estudio observacional analizando datos secundarios. El PVS incluyó consultas médicas, nutricionales y sicológicas (CS), exámenes de laboratorio, sesiones de actividad física (SAF) y círculos vida sana (CVS). Los sujetos se categorizaron por edad en: 2-5, 6-10 y 11-19 años. Se analizaron la participación en actividades; la mejora del estado nutricional (EN) [z-IMC] y la condición física (CF) [test de marcha 6 minutos, test de salto con pies juntos y test de sentadillas en 30 segundos] según EN inicial, utilizando la "t" de Student para muestras pareadas, y la contribución de las actividades al EN y la CF (regresión logística, test de Hosmer-Lemeshow). Se utilizó el programa STATA 14.2, considerando como significativo el valor p < 0,05, con IC del 95 %. Resultados: se estudiaron 13.611 sujetos (53 % de niñas). A los 6 meses, cerca de un 50 % de los participantes logró mejorar el EN y la CF. De 2 a 5 años, la asistencia a ≥ 48 SAF, 2 CS y ≥ 3 CVS aumentó significativamente la probabilidad de mejorar el EN y la CF. De 6 a 10 solo contribuyeron los CVS, y de 11 a 19 años solo sirvieron las SAF en los sujetos inicialmente obesos. Conclusiones: las actividades del PVS-2017 contribuyeron a la mejoría del EN y la CF solo en el grupo de 2-5 años, ya que en los de 6-10 y 11-19 años su aporte fue bajo. Solo la mitad de los sujetos que ingresan al programa logra mejorar el EN y la CF en los 6 meses de intervención.

Quality-of-life outcomes of a weight management program for adolescents based on motivational interviewing.

OBJECTIVE: To compare motivational interviewing (MI) with conventional care regarding the health-related quality-of-life (HRQoL) of adolescents with overweight/obesity. METHODS: RCT with parallel design, involving two groups: intervention group (MI group [MIG]) and control group (conventional intervention group [CIG]). The intervention included three 30-minute interviews 3 months apart. OUTCOME: Change in Pediatric Quality of Life Inventory (PedsQL) scores. A mixed repeated-measures analysis of variance was used to assess group versus time interactions. RESULTS: Eighty-three participants finished the protocol (82% girls). MIG participants showed a significant average increase (+4.7) on the Psychosocial (t[41] = -2.388, p = .022, d = .37) and Emotional Subscales (+5.1) (t[41] = 5.733, p < .001, d = .88). CIG participants showed a significant average decrease on the Psychosocial (-6.1) (t[40] = 5.733, p < .001, d = .90), Emotional (-14.1) (t[40] = 7.249, p < .001, d = 1.13) and Social Subscales (-3.8) (t[40] = 3.782, p = .001, d = .59) and on the Total Score (-4.4) (t[40] = 3.535, p = .001, d = .55) CONCLUSION: MI improved HRQoL among overweight adolescents participating in a weight management program. PRACTICE IMPLICATIONS: MI increases HRQoL and has the potential to benefit weight management programs for adolescents.

Anthropometric outcomes of a motivational interviewing school-based randomized trial involving adolescents with overweight.

Motivational interviewing (MI) is an effective method to promote weight loss that can be delivered by non-mental health providers. The aim of this study was to evaluate whether MI was superior to conventional counseling to improve the anthropometric outcomes of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design in a school setting. The study included two groups: Motivational Interviewing Group (MIG) and control group (Conventional Intervention Group, CIG). Students participated in three face-to-face 30-min interviews, 3 months apart. Outcomes were BMI z-score, abdominal circumference, percentages of fat mass and muscle mass, and blood pressure. Sessions were coded with the Motivational Interviewing Treatment Integrity (MITI) manual. Mixed repeated-measures ANOVAs were used to assess the group versus time interaction. Effect sizes were calculated for each ANOVA with eta-squared measures (η2). Eighty-three adolescents finished the protocol. While MIG participants showed a significant improvement in all anthropometric scores at 6 months, CIG participants showed an unfavorable change in those variables.Conclusion: Our results provide additional evidence of the short-term usefulness of a school-based MI intervention on anthropometric outcomes of adolescents with obesity/overweight, demonstrating that pediatricians can play an important role in the prevention and management of pediatric obesity.Trial registration: The study is called IMAGINE and is registered in Clinicaltrials.gov with the number NCT02745795. What is Known: • Although MI has been recognized as an effective counseling style for behavioral change in weight loss, there are few reports about the anthropometric outcomes of interventions with adolescents being treated for obesity/overweight. • Our study showed significant positive changes in anthropometric variables (BMI z-score, abdominal circumference, percentage of fat mass, percentage of muscular mass, systolic and diastolic blood pressure) after only three face-to-face sessions over 6 months. What is New: • MI delivered by non-mental health providers in a school setting seems to have short-term usefulness in a program aiming the treatment of obese/overweight adolescents.

Effect of Motivational Interviewing on depression scale scores of adolescents with obesity and overweight.

The aim of this study was to compare the effect of motivational interview (MI) with conventional care on the depression scale scores of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design, including two groups: intervention group [Motivational Interview Group (MIG)], control group [Conventional Intervention Group (CIG)]. INTERVENTION: three face-to-face 30min' interviews three months apart (only MIG interviews were based on MI principles). OUTCOMES: change in Children Depression Inventory (CDI) scores. We used a mixed repeated-measures ANOVAs analysis to assess the group vs time interaction. Effect size was calculated for ANOVA with difference of means of the total score (DOMTS). CDI scores were compared by a paired t-test. Eighty-three (84%) adolescents finished the intervention. There was a significant time vs group interaction both groups. While in the CIG scores significantly increased, in the MIG the scores significantly decreased. The DOMTS was significantly different between the two groups. We concluded that MI showed a positive effect on depression scale scores over time relatively to conventional intervention.

[Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012]. / Vigilancia de la resistencia a los antibióticos en Staphylococcus aureus en Galicia: 2007-2012.

INTRODUCTION: Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported. METHODS: A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients. RESULTS: The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007- 2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional. CONCLUSIONS: The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nursing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated.

Vigilancia de la resistencia a los antibióticos en Staphylococcus aureus en Galicia: 2007-2012 / Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012

Introducción. Desde 2007 el Programa Gallego de Vigilancia de Resistencias Antimicrobianas recogió datos de los patrones de sensibilidad de Staphylococcus aureus. Se analizaron e informaron los datos entre 2007 y 2012. Métodos. Se incluyeron 4.577 aislamientos de S. aureus procedentes de líquido cefalorraquídeo o de sangre. Los distintos centros enviaron información sobre los patrones de sensibilidad, los métodos de ensayo, los criterios de interpretación seguidos y datos demográficos de los pacientes. Resultados. El porcentaje de aislamientos S. aureus resistentes a meticillina (SARM) fue del 22% (2007-2010) y del 26% (2011-2012), aunque en determinada área el porcentaje alcanzó el 57% (2007-2010) o 66% (2011-2012). Las tasas más altas de resistencias se encontraron en los mayores de 75 años. La resistencia a gentamicina fue menor del 9% y la de quinolonas sobre el 25%. Existe fuerte asociación entre resistencias a meticilina y quinolonas (91%). La resistencia frente a linezolid y glicopéptidos fue excepcional. Conclusiones. El porcentaje de SARM a lo largo del periodo de estudio ha presentado ciertas fluctuaciones alcanzándose en 2012 una situación similar en Galicia a la del conjunto de España. No obstante, hay importantes diferencias entre las áreas geográficas estudiadas. La mayoría de los SARM fueron aislados en pacientes hospitalizados, pero se observó un incremento entre ambulatorios. Dado que los pacientes mayores institucionalizados fueron incluidos en el grupo de los ambulatorios es posible que las tasas de SARM en este grupo hayan sido sobreestimadas (AU)

Introduction. Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported. Methods. A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients. Results. The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007-2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional. Conclusions. The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nursing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated (AU)

Lack of correlation between phenotypic techniques and PCR-based genotypic methods for identification of Enterococcus spp.

A total of 123 genetically-unrelated strains of Enterococcus spp. strains (51 Enterococcus faecalis, 57 Enterococcus faecium, 10 Enterococcus gallinarum, and 5 Enterococcus casseliflavus) were phenotypically identified by biochemical profiles and by using an automated method. The strains were also analyzed by a PCR assay to assess the accuracy of the phenotypically-based methods for identification of Enterococcus spp. With this aim, a PCR assay using different cell targets, which allows simultaneous detection of glycopeptide-resistant genotypes as well as identification to the species level by means of different gene targets, was used as the gold standard method. All 51 strains of E. faecalis were correctly identified, whereas 48 of 57 strains (84.2%) of E. faecium, were correctly identified. All of the strains of E. gallinarum and 3 out of 5 strains of E. casseliflavus were also correctly identified. The overall results showed that it is possible to identify Enterococcus spp. at the molecular level in less than 30 hours, compared with the 48-96 hours required for the phenotypically-based methods. The excellent accuracy of the PCR assay in identifying these species, particularly E. faecium, must also be emphasized. These findings may have implications for the routine clinical identification of enterococci species.

Ocorrência de larva migrans na areia de áreas de lazer das escolas municipais de ensino infantil, Araçatuba, SP, Brasil / Presence of larva migrans in sand boxes of public elementary schools, Brazil

A areia das áreas de lazer de escolas podem constituir vias de transmissäo para várias zoonoses parasitárias, representando risco potencial para as crianças que brincam nesses locais. Foi avaliada a ocorrência de agentes de larva migrans em 28 escolas municipais de ensino infantil de Araçatuba, SP. Foram colhidas 535 amostras de areia das áreas de lazer dessas escolas nos meses de janeiro (veräo) e julho (inverno) de 1997 para estabelecimento da freqüência de isolamento de larvas e/ou ovos de Ancylostoma spp. e de ovos de Toxocara spp., pelos métodos de centrífugo-flutuaçäo e de Baermann, respectivamente. A presença de larvas de Ancylostoma spp. foi observada em, pelo menos, uma das amostras, em 35,7 por cento (10/28) das amostras da primeira colheita (veräo) e em 46,4 por cento (13/28) quando da segunda colheita (inverno). Ovos de Toxocara spp. näo foram encontrados e a presença de ovos de Ancylostoma spp. foi observada em 0,56 por cento (3/535) das amostras

Saúde bucal do idoso: alterações fisiopatológicas, psicossociais e possibilidades de intervenção na atenção primária

A transição demográfica no Brasil e no mundo é fato real. O Brasil está envelhecendo, e, segundo projeção para 2025, é esperado um crescimento de 15 da população idosa. O número de idosos brasileiros aumentou a partir da segunda metade dos anos setentas, quando ocorreu redução significativa das taxas de natalidade e mortalidade. Junto à transição demográfica, observa-se a transição epidemiológica caracterizada pelo aumento das doenças crônico-degenerativas alterando os padrões de morbimortalidade. A partir de vários aspectos da saúde, a saúde bucal merece atenção especial, uma vez que a abordagem de pacientes idosos difere daquela direcionada à população em geral. O envelhecimento leva a alterações fisiológicas que predispõem o idoso a apresentar condições patológicas típicas que requerem cuidados por parte dos profissionais. A atenção primária das equipes de saúde da família é destacada como estratégia fundamental para a saúde bucal dos idosos. Assim, o objetivo deste trabalho é realizar uma revisão da literatura que permita identificar as alterações fisiopatológicas e psicossociais relacionadas com a saúde bucal em idosos e as possibilidades de intervenção no âmbito da atenção primária à saúde.