[Identification of ICF categories representative of functioning problems in adult cancer patients at hospital discharge: National expert consensus]. / Identificación de un conjunto de categorías CIF representativas del funcionamiento al egreso hospitalario de personas adultas tratadas por cáncer: consenso nacional de expertos.

INTRODUCTION: The International Classification of Functioning, Disability and Health (ICF) provides a standardised language and conceptual framework for health and health-related conditions, aiming to unify communication between different disciplines. OBJECTIVE: To describe the process of selecting (through national expert consensus) ICF categories representative of functioning problems in cancer patients at hospital discharge. METHOD: We conducted a descriptive qualitative and quantitative study that used the expert consensus method to design a clinical instrument. The study included 21 experts, consisting of 2 patients and 19 health professionals from different disciplines. A total of 208 ICF categories obtained in a previous stage through a systematic review and linking process were evaluated in 3 rounds. Participants evaluated each code and classified it as: highly relevant, relevant, slightly relevant, and not relevant at all. Only those codes assessed as «highly relevant¼ by more than 50% of the experts were included (cut off). In addition, another 143 ICF categories were evaluated in the second round. RESULTS: In all, 24 ICF categories were obtained: 10 corresponded to the body function component, 11 to activities and participation, and 3 to environmental factors. CONCLUSIONS: Consensus using the common language of the ICF resulted in the selection of 24 representative categories of the main health problems related to functioning at hospital discharge in adults treated for cancer.

Identificación de un conjunto de categorías CIF representativas del funcionamiento al egreso hospitalario de personas adultas tratadas por cáncer: consenso nacional de expertos / Identification of ICF categories representative of functioning problems in adult cancer patients at hospital discharge: national expert consensus

INTRODUCCIÓN: La Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF) proporciona un lenguaje estandarizado y un marco conceptual para la salud y las condiciones relacionadas para una comunicación unificada entre diferentes disciplinas. OBJETIVO: Describir el proceso de selección (consenso de expertos nacionales) de un conjunto de categorías CIF relacionadas con el funcionamiento en el momento del egreso hospitalario que presentan las personas adultas tratadas por cáncer. MÉTODO: Estudio descriptivo cualitativo-cuantitativo con metodología de consenso de expertos como fase de desarrollo de un futuro instrumento de uso clínico. Participaron 21 expertos (2 pacientes y 19 profesionales de la salud de diferentes disciplinas). Mediante 3rondas de trabajo se evaluaron 208 categorías CIF obtenidas en una etapa previa de revisión sistemática y proceso de vinculación. Los participantes evaluaron cada categoría y la clasificaron como: muy relevante, relevante, ligeramente relevante y nada relevante. Solo se incluyeron los códigos que más del 50% de los expertos evaluaron como «muy relevantes». Además, en una segunda ronda se evaluaron otras 143 categorías. RESULTADOS: Se obtuvieron 24 categorías, 10 correspondieron al componente de función corporal, 11 a actividades y participación y 3 a factores ambientales. CONCLUSIONES: El consenso de expertos, usando el lenguaje común de la CIF, concluyó en la selección de 24 categorías representativas de los principales problemas de salud relacionados con el funcionamiento al egreso hospitalario de los adultos tratados por cáncer

INTRODUCTION: The International Classification of Functioning, Disability and Health (ICF) provides a standardised language and conceptual framework for health and health-related conditions, aiming to unify communication between different disciplines. OBJECTIVE: To describe the process of selecting (through national expert consensus) ICF categories representative of functioning problems in cancer patients at hospital discharge. METHOD: We conducted a descriptive qualitative and quantitative study that used the expert consensus method to design a clinical instrument. The study included 21 experts, consisting of 2 patients and 19 health professionals from different disciplines. A total of 208 ICF categories obtained in a previous stage through a systematic review and linking process were evaluated in 3 rounds. Participants evaluated each code and classified it as: highly relevant, relevant, slightly relevant, and not relevant at all. Only those codes assessed as «highly relevant» by more than 50% of the experts were included (cut off). In addition, another 143 ICF categories were evaluated in the second round. RESULTS: In all, 24 ICF categories were obtained: 10 corresponded to the body function component, 11 to activities and participation, and 3 to environmental factors. CONCLUSIONS: Consensus using the common language of the ICF resulted in the selection of 24 representative categories of the main health problems related to functioning at hospital discharge in adults treated for cancer

[Smoking among undergraduate university students]. / Diagnóstico del consumo de tabaco en estudiantes de pregrado de la Pontificia Universidad Católica de Valparaíso.

BACKGROUND: Smoking is one of the major Public Health problems worldwide. AIM: To study the frequency of tobacco smoking among undergraduate students of a Chilean university. MATERIAL AND METHODS: An opinion survey was sent by e-mail to all undergraduate students of a university, registering gender, age, study years, study area, smoking behavior, motivation (reason for smoking), intention to quit and tobacco law perception. RESULTS: 1,008 (57% females) out of 11,679 surveys were answered back. Prevalence of active smoking among respondents was 36%, without association with gender, age or years of study. However, students from scientific areas had a lower prevalence. Seventy seven percent of smokers manifested the intention to quit the habit or have started quitting already. Ninety six percent were acquainted with the tobacco law and by 73% agreed with it. CONCLUSIONS: Smoking is highly prevalent among university students. It is necessary to develop strategies for smoking cessation within universities that may prevent or reduce tobacco smoking among students.

Diagnóstico del consumo de tabaco en estudiantes de pregrado de la Pontificia Universidad Católica de Valparaíso / Smoking among undergraduate university students

Background: Smoking is one of the major Public Health problems worldwide. Aim: To study the frequency of tobacco smoking among undergraduate students of a Chilean university. Material and Methods: An opinion survey was sent by e-mail to all undergraduate students of a university, registering gender, age, study years, study area, smoking behavior, motivation (reason for smoking), intention to quit and tobacco law perception. Results: 1,008 (57% females) out of 11,679 surveys were answered back. Prevalence of active smoking among respondents was 36%, without association with gender, age or years of study. However, students from scientific areas had a lower prevalence. Seventy seven percent of smokers manifested the intention to quit the habit or have started quitting already. Ninety six percent were acquainted with the tobacco law and by 73% agreed with it. Conclusions: Smoking is highly prevalent among university students. It is necessary to develop strategies for smoking cessation within universities that may prevent or reduce tobacco smoking among students.

Assessment of the water self-purification capacity on a river affected by organic pollution: application of chemometrics in spatial and temporal variations.

Water pollution caused by organic matter is a major global problem which requires continuous evaluation. Multivariate statistical analysis was applied to assess spatial and temporal changes caused by natural and anthropogenic phenomena along Potrero de los Funes River. Cluster analysis (CA), principal component analysis (PCA) and analysis of variance (ANOVA) were applied to a data set collected throughout a period of 3 years (2010-2012), which monitored 22 physical, chemical and biological parameters. Content of dissolved oxygen in water and biochemical oxygen demand in a watercourse are indicators of pollution caused by organic matter. For this reason, the Streeter-Phelps model was used to evaluate the water self-purification capacity. Hierarchical cluster analysis grouped the sampling sites based on the similarity of water quality characteristics. PCA resulted in two latent factors explaining 75.2 and 17.6 % of the total variance in water quality data sets. Multidimensional ANOVA suggested that organic pollution is mainly due to domestic wastewater run-offs and anthropogenic influence as a consequence of increasing urbanization and tourist influx over the last years. Besides, Streeter-Phelps parameters showed a low reaeration capacity before dam with low concentration of dissolved oxygen. Furthermore, self-purification capacity loss was correlated with the decrease of the Benthic Index. This measurement suggested that biological samplings complement the physical-chemical analysis of water quality.

A multiple-antibiotic resistance-independent active chloramphenicol efflux in an Escherichia coli clinical isolate.

The clinical isolate, Escherichia coli 1941, exhibits high resistance to chloramphenicol and tetracycline (minimum inhibitory concentrations of 512 micrograms/ml). Neither resistance is linked to the large conjugative plasmid present in the strain. The intracellular accumulation of radiolabeled chloramphenicol increased about 9-fold after the addition of the energy uncoupler carbonyl cyanide m-chlorophenol-hydrazone to an E. coli 1941 culture, indicating the presence of an active efflux mechanism. Sequence analysis and expression study suggested that the multiple-antibiotic resistance marRAB locus and the AcrAB drug-efflux pump were not involved in this active efflux of chloramphenicol.

A new mechanism of antibiotic resistance in Enterobacteriaceae induced by a structural modification of the major porin.

In Enterobacter aerogenes, multidrug resistance involves a decrease in outer membrane permeability associated with changes in an as yet uncharacterized porin. We purified the major porin from the wild-type strain and a resistant strain. We characterized this porin, which was found to be an OmpC/OmpF-like protein and analysed its pore-forming properties in lipid bilayers. The porin from the resistant strain was compared with the wild-type protein and we observed (i) that its single-channel conductance was 70% lower than that of the wild type; (ii) that it was three times more selective for cations; (iii) a lack of voltage sensitivity. These results indicate that the clinical strain is able to synthesize a modified porin that decreases the permeability of the outer membrane. Mass spectrometry experiments identified a G to D mutation in the putative loop 3 of the porin. Given the known importance of this loop in determining the pore properties of porins, we suggest that this mutation is responsible for the novel resistance mechanism developed by this clinical strain, with changes in porin channel function acting as a new bacterial strategy for controlling beta-lactam diffusion via porins.

Membrane permeability modifications are involved in antibiotic resistance in Klebsiella pneumoniae.

Two Klebsiella pneumoniae strains selected according to their high cross-resistance pattern to cephalosporins were characterized by (i) outer membrane protein content such as OmpA or nonspecific porins, (ii) MICs of various cephalosporins and unrelated antibiotics, (iii) beta-lactamase production, and (iv) active efflux of fluoroquinolones. An association of porin deficiency and beta-lactamase production induced a noticeable cephalosporin resistance. In addition to these mechanisms, the presence of an active efflux participating in high-level fluoroquinolone resistance was identified in one strain. The decrease of antibiotic uptake associated with efflux explains the Klebsiella adaptation against the drugs present in the environment.

Comparative aspects of the diffusion of norfloxacin, cefepime and spermine through the F porin channel of Enterobacter cloacae.

In Enterobacteriaceae, the permeability of the outer membrane to hydrophilic antibiotics is associated with the presence of pore-forming proteins. We tested the diffusion of the fluoroquinolone norfloxacin in four Enterobacter cloacae strains: a clinical isolate and three derivatives variously producing or lacking the D and F porins. We analysed the entry of norfloxacin into E. cloacae cells in the presence of either the polyamine spermine or the recently developed cefepime, which are known to penetrate through the Escherichia coli OmpF porin. Uptake of the fluoroquinolone was decreased in both cases; the initial rate of penetration decreased as more spermine blocked the channel. Our results indicate that, like beta-lactam molecules, fluoroquinolones translocate through the outer membrane via the F porin and that cefepime and norfloxacin entries are polyamine-sensitive. This suggests that the closure of the F porin channel by polyamines might modulate the susceptibility of E. cloacae to both fluoroquinolone and cephalosporin antibiotics.

Standardized surveillance of hemodialysis vascular access infections: 18-month experience at an outpatient, multifacility hemodialysis center.

OBJECTIVE: To develop a standardized surveillance system for monitoring hemodialysis vascular-access infections in order to compare infection rates between outpatient sites and to assess the effectiveness of infection control interventions. DESIGN: Prospective descriptive analysis of incidence infection rates. SETTING: An outpatient hemodialysis center with facilities in Idaho and Oregon. PATIENTS: All outpatients receiving chronic outpatient hemodialysis. RESULTS: There were 38,096 hemodialysis sessions (31,603 via permanent fistulae or grafts, 5,060 via permanent tunneled central catheters, and 1,433 via temporary catheters) during an 18-month study period in 1997 to 1998. We identified 176 total infections, for a rate of 4.62/1,000 dialysis sessions (ds). Of the 176, 80 involved permanent fistulae or grafts (2.53/1,000 ds), 69 involved permanent tunneled central catheter infections (13.64/1,000 ds), and 27 involved temporary catheter infections (18.84/1,000 ds). There were 35 blood-stream infections (0.92/1,000 ds) and 10 episodes of clinical sepsis (0.26 /1,000 ds). One hundred thirty-one vascular-site infections without bacteremia were identified (3.44/1,000 ds), including 65 permanent fistulae or graft infections (2.06/1,000 ds), 42 permanent tunneled central catheter infections (8.3/1,000 ds), and 24 temporary catheter infections (16.75/1,000 ds). CONCLUSIONS: Infection rates were highest among temporary catheters and lowest among permanent native arteriovenous fistulae or synthetic grafts. This represents the first report of extensive incidence data on hemodialysis vascular access infections and represents a standardized surveillance and data-collection system that could be implemented in hemodialysis facilities to allow for reliable data comparison and benchmarking.

Substitutions in the eyelet region disrupt cefepime diffusion through the Escherichia coli OmpF channel.

The Escherichia coli OmpF porin is a nonspecific channel involved in the membrane translocation of small hydrophilic molecules and especially in the passage of beta-lactam antibiotics. In order to understand the dynamic of charged-compound uptake through bacterial porins, specific charges located in the E. coli OmpF channel were mutated. Substitutions G119D and G119E, inserting a protruding acidic side chain into the pore, decreased cephalosporin and colicin susceptibilities. Cefepime diffusion was drastically altered by these mutations. Conversely, substitutions R132A and R132D, changing a residue located in the positively charged cluster, increased the rate of cephalosporin uptake without modifying colicin sensitivity. Modelling approaches suggest that G119E generates a transverse hydrogen bond dividing the pore, while the two R132 substitutions stretch the channel size. These charge alterations located in the constriction area have differential effects on cephalosporin diffusion and substantially modify the profile of antibiotic susceptibility.

In vivo modification of porin activity conferring antibiotic resistance to Enterobacter aerogenes.

Cephalosporins are widely used in chemotherapy of bacterial infections and resistance mechanisms seriously impair their antibacterial activity. Several resistant strains of Enterobacter aerogenes, a frequently isolated nosocomial pathogen, were analyzed. One isolate exhibited a strong modification of the porin antigenic pattern, especially with an immunological probe directed against an epitope located inside the pore lumen. A strong decrease of cefepime uptake was evidenced for this isolate, similarly to ones observed for porin-deficient strains: these kinetics show a serious alteration of the channel properties which may support cephalosporin resistance. This is the first E. aerogenes isolate using such adaptive response which defines an original enterobacterial answer to cephalosporin.

Most Enterobacter aerogenes strains in France belong to a prevalent clone.

The aim of this study was to determine the distribution in France of the Enterobacter aerogenes prevalent clone isolated in the hospitals of the Marseille area (A. Davin-Regli, D. Monnet, P. Saux, C. Bosi, R. Charrel, A. Barthelemy, and C. Bollet, J. Clin. Microbiol. 34:1474-1480, 1996). A total of 123 E. aerogenes isolates were collected from 23 hospital laboratories and analyzed by random amplification of polymorphic DNA and enterobacterial repetitive intergenic consensus-PCR to determine their epidemiological relatedness. Molecular typing revealed that 21 of the 23 laboratories had isolated this prevalent clone harboring the plasmid encoding for extended-spectrum beta-lactamase of the TEM-24 type. Most isolates were susceptible only to imipenem and gentamicin. Their dissemination seems to be clonal and was probably the result of the general use of broad-spectrum cephalosporins and quinolones. Four isolates showed an alteration of their outer membrane proteins, causing decrease of susceptibility to third-generation cephalosporins and imipenem and leading to the critical situation of having no alternative therapeutic. The large dissemination of the E. aerogenes prevalent clone probably results from its good adaptation to the antibiotics administered in France and the hospital environment, particularly in intensive care units.

Prevalence of outer membrane porin alteration in beta-lactam-antibiotic-resistant Enterobacter aerogenes.

We evaluated the prevalence of impermeability as a mechanism associated with resistance against beta-lactam antibiotics in members of the family Enterobacteriaceae. During a 1-year period, 80 strains were selected from 3,110 routinely isolated strains according to their noticeable cross-resistance pattern to cephalosporins. They were tested for (i) outer membrane nonspecific porins involved in the entry of small hydrophilic molecules; (ii) the MICs of cefepime, cefotaxime, imipenem, and moxalactam; and (iii) beta-lactamase production. Immunological investigations using specific probes showed that 23 of 80 strains presented an alteration of the porin content, most of them expressing an additional resistance mechanism. The prevalence of this porin-deficient phenotype is especially high in Enterobacter aerogenes and concerns 6.4% of the clinical isolates.

Crucial domains are conserved in Enterobacteriaceae porins.

With the recent resolution of the crystal structures of several bacterial porins, it is worthwhile to define the generality of their organization throughout the Enterobacteriaceae. The distribution of specific epitopes was analysed among various Gram-negative bacterial porins using anti-peptide antibodies specific to exposed, transmembrane spanning, or pore-forming regions of Escherichia coli porins. Anti-peptide antibodies which recognized the exposed epitopes indicated a great variability among the bacterial porins analysed. Interestingly, an antigenic site located in the internal loop L3 constricting the pore diameter was present in the majority of the bacterial porins tested. Two epitopes located in domains involved in subunit interaction were also highly conserved. The presence of these common peptides suggested a conservation of specific regions involved in the functional organization of the enterobacterial porins.

Biological and immunological comparisons of Enterobacter cloacae and Escherichia coli porins.

Bacteriocin susceptibilities indicate that during cloacin DF13 uptake the F porin of Enterobacter cloacae plays a similar role to that reported for the OmpF porin of Escherichia coli during colicin A entry. The translocatory activities of these two porins during the bacteriocin uptake can be substituted by the porins D and OmpC, respectively, under conditions not requiring the receptor binding step. Using anti-peptide antibodies, a peptide located in the internal loop L3 of the Escherichia coli OmpF porin was identified in the D and F porins of Enterobacter cloacae. The results demonstrated the existence of a close relationship between porins in terms of both antigenic determinants and bacteriocin susceptibilities.

Isolation, structural identification and biological activity of two metabolites produced by Penicillium olsonii Bainier and Sartory.

From the culture broth of a fungus, two metabolites have been isolated: bis(2-ethylhexyl)phthalate (DEHP) precedently isolated from Streptomyces sp. and 2-(4-hydroxyphenyl)-2-oxoacetaldehyde oxime (PHBA) here reported as a natural compound in the (E)-s-cis configuration. The producing organism was identified as a strain of Penicillium olsonii. Culture growth and chemical identification are discussed in the present work.

Bioactive Diterpenoids Isolated from Dilophus ligulatus.

Nine diterpenoids, acetyldictyolal ( 1), epoxyoxodolabelladiene ( 2), dictyotalide B ( 3), neodictyolactono ( 4), pachylactone ( 5), the acetals 6A and 6B, isoacetoxycrenulatin ( 7), and dictyolactone ( 8) were isolated from the brown alga DILOPHUS LIGULATUS (Kütz.) Feldm. Their structures have been elucidated by comparison of mass, IR, (1)H- and (13)C-NMR spectra with reported literature data. Compounds 1, 2, 4, 7, and 8 exhibited antifungal activity. Cytotoxic activity against several types of mammalian cells (KB, P-388, P-388/DOX, and NSCLCN6-L16) in culture was examined for the 8 diterpenoids. Some of them showed stronger cyto-toxicity than mercaptopurine which was used as a positive control in this study.

Seasonal allergic symptoms and their relation to pollen exposure in south-east France.

In order to evaluate the relationship between pollen exposure and prevalence of allergic respiratory symptoms, we performed a cross-sectional epidemiological study in 2 areas with contrasted exposure to cypress and grass pollens. The study population consisted of 5427 subjects 18 to 65-years-old representative of the general population. All answered an abridged version of the 1978 ATS questionnaire and a sample had a skin test evaluation including grass and cypress pollens. Prevalence of hay fever symptoms was equal to 31.5% and 14.1%, respectively, in exposed and less exposed community (P < 0.001). Prevalence of hay fever symptoms together with a positive skin test to pollen was also significantly higher in the exposed (13.6%) vs less exposed community (5.5%, P < 0.001). In contrast, overall prevalence of asthma was equal to 4.5% and 3.4%, respectively. Prevalence of asthma with positive skin tests was also not statistically significant, equal to 2.5% and 1.9%, respectively. Thus, high exposure to pollen is a risk factor for developing hay fever but not asthma.