Community pharmacy is the key to improving vitamin D levels.

Introduction: Vitamin D is an essential micronutrient that participates in the body's fundamental physiological processes. The pharmacist should involve the patient in his medication adherence, leading to a change in the patient's attitude towards his medication and towards his health problem, in order to achieve the pharmacological objective set. Methods: Quasi-experimental multicenter study design with non-probabilistic convenience sampling. A pharmacist-led intervention in health education was carried out, divided in two groups, face-to-face interview and on-line survey, and the results were evaluated 3 months later to observe if there was any change in the patient's health status or in their vitamin D levels. Results: The study was conducted in four pharmacies through face-to-face interviews (n = 49 patients) and online surveys (n = 23). Pharmaceutical intervention improved habits of exercise (0.81 ± 1.44 days/week face-to-face interviews vs -0.09 ± 2.35 days/week online surveys (p = 0.048)). In face-to-face interviews, consumption of vitamin D-rich foods was increased (0.55 unit of tuna/week; p = 0.035 and 0.56 unit of avocado/week; p = 0.001) and was improved correct intake of vitamin D supplements (32.5% baseline to 69.8% at 3 months). The increase in 25-hydroxyvitamin D levels (11.5 ng/mL after 3 months (p = 0.021)) was correlated to salmon consumption (0.951; p = 0.013) and the improvement of quality of life was correlated to avocado consumption (1; p < 0.001). Conclusion: There are habits that improve vitamin D production such as increased physical activity, the correct use of vitamin D supplements and the consumption of foods with high vitamin D levels. The role of the pharmacist is crucial, involving the patient in the treatment making aware of the benefits for his/her health status of increasing vitamin D levels.

Factores asociados a la satisfacción del residente con su formación como especialista / Factors associated with residents’ satisfaction with their training as specialists

Antecedentes y objetivos: No se conoce qué factores influyen en la percepción de la satisfacción de los residentes durante su formación. El objetivo del estudio fue analizar la satisfacción del especialista en formación y sus factores asociados. Material y métodos: Estudio transversal mediante encuestas autocumplimentadas a los residentes en formación del Hospital Clínico San Carlos en los cortes realizados en los años 2006, 2009, 2010 y 2012. La variable dependiente del estudio fue la satisfacción global con la formación, y como factores independientes se estudiaron características sociodemográficas y laborales, variables relacionadas con la actividad asistencial, docente e investigadora. Resultados: Porcentaje de participación total de un 83,7% (1.424/1.701). La edad media fue 28,4 (DE 3,2) años. El porcentaje de satisfacción global fue de un 75,2%. En el análisis multivariado, los factores asociados de manera estadísticamente significativa a la satisfacción global fueron: la implicación del personal docente (tutores y adjuntos) en la formación, mayor satisfacción en especialidades médicas frente a las quirúrgicas, el año de residencia, las facilidades para realizar la tesis, trabajar menos de 40h a la semana, el tiempo adecuado para la realización de las tareas diarias, la adecuación en el número de sesiones en el servicio y el no disponer de otra especialidad previa. Conclusiones: Las actividades relacionadas con la investigación y docencia están asociadas con la satisfacción global del residente. Los factores de la actividad rutinaria que más se asocian con la satisfacción fueron el tiempo disponible y las horas de trabajo. Son necesarios más estudios para conocer el impacto de la satisfacción del residente en la calidad asistencial y en su actividad como futuro especialista (AU)

Background and objectives: We do not know what factors influence residents’ perceived satisfaction during their training. The aim of this study was to analyze the satisfaction of specialists with their training and its associated factors. Material and methods: This was a cross-sectional study using self-completion surveys of residents in training at the Clinic Hospital San Carlos for the courses conducted in 2006, 2009, 2010 and 2012. The study's dependent variable was overall satisfaction with the training; the independent factors were demographic and occupational characteristics, variables related to healthcare, teaching and research activity. Results: The total participation percentage was 83.7% (1,424/1,701), and the mean age was 28.4 years (SD, 3.2 years). The overall satisfaction percentage was 75.2%. The factors statistically associated with overall satisfaction in the multivariate analysis were the involvement of the teaching staff (tutors and assistants) in the training, greater satisfaction in medical versus surgical specialties, the year of residence, the facilities for completing the thesis, working less than 40h a week, adequate time to perform daily tasks, appropriate number of department meetings and not having a previous specialty. Conclusions: the activities related to research and teaching are associated with the overall satisfaction of residents. The routine activity factors most closely associated with satisfaction were the time available and the work hours. More studies are necessary to understand the impact of resident satisfaction on care quality and in their activity as future specialists (AU)

PPARß activation restores the high glucose-induced impairment of insulin signalling in endothelial cells.

BACKGROUND AND PURPOSE: PPARß enhances insulin sensitivity in adipocytes and skeletal muscle cells, but its effects on insulin signalling in endothelial cells are not known. We analysed the effects of the PPARß/δ (PPARß) agonists, GW0742 and L165041, on impaired insulin signalling induced by high glucose in HUVECs and aortic and mesenteric arteries from diabetic rats. EXPERIMENTAL APPROACH: Insulin-stimulated NO production, Akt-Ser(473) and eNOS-Ser(1177) phosphorylation, and reactive oxygen species (ROS) production were studied in HUVECs incubated in low- or high-glucose medium. Insulin-stimulated relaxations and protein phosphorylation in vessels from streptozotocin (STZ)-induced diabetic rats were also analysed. KEY RESULTS: HUVECs incubated in high-glucose medium showed a significant reduction in insulin-stimulated production of NO. High glucose also reduced insulin-induced Akt-Ser(473) and eNOS-Ser(1177) phosphorylation, increased IRS-1-Ser(636) and ERK1/2-Thr(183) -Tyr(185) phosphorylation and increased ROS production. The co-incubation with the PPARß agonists GW0742 or L165041 prevented all these effects induced by high glucose. In turn, the effects induced by the agonists were suppressed when HUVEC were also incubated with the PPARß antagonist GSK0660, the pyruvate dehydrogenase kinase (PDK)4 inhibitor dichloroacetate or after knockdown of both PPARß and PDK4 with siRNA. The ERK1/2 inhibitor PD98059, ROS scavenger catalase, inhibitor of complex II thenoyltrifluoroacetone or uncoupler of oxidative phosphorylation, carbonyl cyanide m-chlorophenylhydrazone, also prevented glucose-induced insulin resistance. In STZ diabetic rats, oral GW0742 also improved insulin signalling and the impaired NO-mediated vascular relaxation. CONCLUSION AND IMPLICATIONS: PPARß activation in vitro and in vivo restores the endothelial function, preserving the insulin-Akt-eNOS pathway impaired by high glucose, at least in part, through PDK4 activation.

Factors associated with residents' satisfaction with their training as specialists.

BACKGROUND AND OBJECTIVES: We do not know what factors influence residents' perceived satisfaction during their training. The aim of this study was to analyze the satisfaction of specialists with their training and its associated factors. MATERIAL AND METHODS: This was a cross-sectional study using self-completion surveys of residents in training at the Clinic Hospital San Carlos for the courses conducted in 2006, 2009, 2010 and 2012. The study's dependent variable was overall satisfaction with the training; the independent factors were demographic and occupational characteristics, variables related to healthcare, teaching and research activity. RESULTS: The total participation percentage was 83.7% (1,424/1,701), and the mean age was 28.4 years (SD, 3.2 years). The overall satisfaction percentage was 75.2%. The factors statistically associated with overall satisfaction in the multivariate analysis were the involvement of the teaching staff (tutors and assistants) in the training, greater satisfaction in medical versus surgical specialties, the year of residence, the facilities for completing the thesis, working less than 40 h a week, adequate time to perform daily tasks, appropriate number of department meetings and not having a previous specialty. CONCLUSIONS: the activities related to research and teaching are associated with the overall satisfaction of residents. The routine activity factors most closely associated with satisfaction were the time available and the work hours. More studies are necessary to understand the impact of resident satisfaction on care quality and in their activity as future specialists.

Reducción del riesgo de complicaciones relacionadas con los catéteres venosos centrales: una propuesta para mejorar la seguridad del paciente / Reduction of the risk of complications related to central venous catheters: a proposal for improving patient safety

Objetivo: Implementar medidas eficaces para disminuir la bacteriemia relacionada con catéter venoso central. Material y método: Se revisó la técnica de inserción y el material necesario, elaborando instrucciones y material gráfico de ayuda. Calculamos la prevalencia de inserción de los catéteres venosos centrales (CVC). Se han analizado todas las listas de verificación realizadas entre 2010 y 2012 en un año y los datos de una encuesta autocumplimentada y anónima para valorar los conocimientos del mantenimiento de la vía central, evaluando el resultado conforme a las nuevas instrucciones. Se elaboró la «Instrucción de seguridad para la prevención de la bacteriemia relacionada con el catéter en pacientes hospitalizados», se organizó un kit de inserción y se formó a 58 médicos y 168 enfermeras. Se revisó a 687 pacientes, encontrando un 6,7% de portadores de un CVC. Resultados: El 21,7% de los pacientes tenían cumplimentada la lista de verificación y un 39,4% necesitó más de un intento. En cuanto a los cuidados, falló el registro de fechas de cambios de apósito y de sistemas de infusión. Conclusiones: Se ha conseguido una máxima difusión del material elaborado. Se deben reforzar aquellos procedimientos donde se han producido un mayor porcentaje de errores (AU)

Objective: To adopt effective measures for reducing bacteremia related to central venous catheters (CVCs). Material and methods: A review was made of the insertion technique and required material, developing instructions and graphic support. The prevalence of CVC insertion was calculated. An analysis was made of all the yearly checklists between 2010 and 2012, along with the data drawn from an anonymous self-administered questionnaire, to assess knowledge of maintenance of central catheterization, and evaluating performance on the basis of the new instructions provided. «Safety instructions for the prevention of catheter-related bacteremia in hospitalized patients» were developed, an insertion kit was produced, and 58 physicians and 168 nurses were trained. A total of 687 patients were reviewed, of which 6.7% were seen to carry a CVC. Results: The checklist was found to be completed in 21.7% of the patients, and 39.4% required more than one catheterization attempt. Regarding care-related aspects, there were deficiencies in the registry of the dates on which the dressings and infusion systems were replaced. Conclusions: Maximum diffusion of the developed material was achieved. Reinforcement is required of those procedures in which a greater percentage of errors were detected (AU)

Different cardiovascular protective effects of quercetin administered orally or intraperitoneally in spontaneously hypertensive rats.

We tested whether the administration procedure of quercetin affects its metabolite profile and antihypertensive activity. Spontaneously hypertensive rats (SHR) were randomly assigned to four experimental treatments: (1) 1 mL of 1% methylcellulose by oral gavage and 2% DMSO i.p. (control group); (2) 10 mg kg⁻¹ quercetin by oral gavage once daily and 2% DMSO i.p.; (3) 10 mg kg⁻¹ quercetin by oral gavage divided in two daily doses (5 + 5 at 12 h intervals) and 2% DMSO i.p.; (4) 1 mL of 1% methylcellulose by oral gavage and 10 mg kg⁻¹ quercetin i.p. injection. Rats were treated daily for 5 weeks. Single dose and two daily doses, in a long-term oral treatment were equally efficient, both restoring the impaired aortic endothelium-dependent vasodilatation and reducing mesenteric contractile response to phenylephrine, systolic blood pressure, heart rate, and heart and kidney hypertrophy. Attenuation of vascular NADPH oxidase-driven O2⁻ production was also found in orally treated rats. Intraperitoneal administration reduced, to lesser extent than oral administration, the increased systolic blood pressure, being without effect to the endothelial dysfunction and vascular oxidative stress. In contrast, greater levels of metabolites were quantified following intraperitoneal compared to oral administration at any time point, except for higher plasma methylated quercetin aglycone in oral as compared to intraperitoneal administration at 2 but not at 8 h. In conclusion, oral quercetin was superior to intraperitoneal administration for the protection from cardiovascular complications in SHR. No differences were found between the oral administration as a single daily dose or divided into two daily doses.

Quemaduras solares: fotoprotección y tratamiento / Sun burn: photoprotection and treatment

La radiación ultravioleta es la principal responsable de los efectos nocivos de la radiación solar sobre el organismo. Las quemaduras solares, reacción aguda y visible de la exposición de la piel a dicha radiación, pueden cursar con lesiones cutáneas graves, destrucción celular y afectación de tejidos anexos, pudiéndose acompañar de edemas y pérdida de líquidos. La revisión tiene por objeto describir y valorar los efectos de la reactividad cutánea frente a la exposición a la radiación ultravioleta y clarifi car las distintas estrategias de prevención y/ o tratamiento de las quemaduras solares. Parece recomendable incidir en la necesidad de adoptar hábitos saludables frente a la exposición a la radiación ultravioleta, especialmente en los primeros 18 años de vida, así como realizar campañas educativas con el objetivo de prevenir la aparición y/ o agravamiento de enfermedades derivadas de dicha exposición

The harmful effects of solar radiation on the organism originate mainly from Ultraviolet rays. Sun burn, an acute and visible reaction arising from skin exposure to such radiation, can cause serious coetaneous lesions, cellular destruction and harmful effects on connective tissue, and may even be accompanied by oedema and loss of liquids. The aims of this work have been to describe and assess the effects of skin reactions to exposure to ultraviolet radiation, to elucidate on different prevention strategies and/or treatment of the sunburn. In general, it seems to be necessary to stress the importance of adopting healthy habits with regard to ultraviolet radiation exposure, especially important in fi rst eighteen y cars of live, and to carry out educational campaigns to prevent the appearance and/or worsening of conditions arising from such

Synthesis of ecteinascidin ET-743 and phthalascidin Pt-650 from cyanosafracin B.

An efficient new process is described for the synthesis of ecteinascidin ET-743 (1) and phthalascidin (2), starting from readily available cyanosafracin B (3).